Chart Abstraction of Ryan White HIV/AIDS Program Recipient Data

OMB 0906-0050

Health Resources and Services Administration is required to assess the quality of care provided by Ryan White HIV/AIDS Program recipients. HHS guidelines and U.S. Preventative Services Task Force guidelines serve as the basis for assessing the quality of care within the RWHAP. HRSA will collect patient level clinical information from a representative sample of 50 RWHAP recipients or subrecipients annually for three years. The information collected will be used to assess the quality of care provided through the RWHAP.

The latest form for Chart Abstraction of Ryan White HIV/AIDS Program Recipient Data expires 2023-04-30 and can be found here.

Latest Forms, Documents, and Supporting Material

Document Name
Form 3 Pre-Site Visit Interview Form
Form 2 Site Screening Interview Form
Form 1 Medical Record Data Abstraction Form
Proposed Timeline for Chart Abstraction Client Level Data Collection.docx Supplementary Document
Data dictionary.pdf Supplementary Document
IRB Approval.pdf Supplementary Document
Legislation.pdf Supplementary Document
Privacy Impact Assessment.pdf Supplementary Document
Supporting Statement B Feb 2020.docx Supporting Statement B
Supporting Statement A March 2020.docx Supporting Statement A
Pre-Site Visit Interview Form
Site Screening Interview Form
Medical Record Data Abstraction Form

All Historical Document Collections

201912-0906-001

Approved with change

New collection (Request for a new OMB Control Number)

2019-12-03

OMB Details

Medical Record Data Abstraction

Federal Enterprise Architecture: Health - Health Care Services

Form 1

Medical Record Data Abstraction Screenshots.pdf

Fillable Fileable

Form

Review document collections for all forms, instructions, and supporting documents - including paper/printable forms.