OMB control number

Using Nursing Home Antibiograms to Improve Antibiotic Prescribing and Delivery

OMB 0935-0185 · HHS/AHRQ.

OMB 0935-0185

Latest Forms, Documents, and Supporting Material

Latest forms, documents, and information collections
Document	Type
Form Form #8 NH Leadership Post-Implementation Questionnaire	Form and Instruction
Form Form #7 Nurse Pre/Post Implementation Questionnaire	Form and Instruction
Form Form #6 ED Physician Post-implementation Questionnaire	Form and Instruction
Form Form #5 ED Physician Pre-implementation Questionnaire	Form and Instruction
Form Form #4 NH Provider Post-Implementation Questionnaire	Form and Instruction
Form Form #3 NH Provider Pre-Implementation Questionnaire	Form and Instruction
Form Form #1 Medical Records Extraction	Form and Instruction
Supporting Statement Part B -- Using NH Antibiograms to Improve Antibiotic 1-4-2011.doc	Supporting Statement B
Attachment S--Federal Register Notice.pdf	Supplementary Document
Attachment R -- Fact Sheet.docx	Supplementary Document
Attachment Q -- Nurse Statement of Informed Consent.docx	Supplementary Document
Attachment P -- ED Provider Web-Based Statement of Informed Consent.docx	Supplementary Document
Attachment O -- ED Provider Paper Statement of Informed Consent.docx	Supplementary Document
Attachment N -- NH Provider Web-Based Statement of Informed Consent.docx	Supplementary Document
Attachment M -- NH Provider Paper Statement of Informed Consent.docx	Supplementary Document
Attachment L -- Nurse Recruitment Letter.docx	Supplementary Document
Attachment K -- ED Provider Recruitment Letter.docx	Supplementary Document
Attachment J -- NH Provider Recruitment Letter.docx	Supplementary Document
Attachment A -- Healthcare Research and Quality Act of 1999.pdf	Supplementary Document
Supporting Statement Part A -- Using NH Antibiograms to Improve Antibiotic 9-26-2011-1.doc	Supporting Statement A
NH Leadership Post-Implementation Questionnaire	Form and Instruction
Nurse Pre/Post Implementation Questionnaire	Form and Instruction
ED Physician Post-implementation Questionnaire	Form and Instruction
ED Physician Pre-implementation Questionnaire	Form and Instruction
NH Provider Post-Implementation Questionnaire	Form and Instruction
NH Provider Pre-Implementation Questionnaire	Form and Instruction
Medical Records Extraction	Form and Instruction

All Historical Document Collections

Historical document collections
Reference	Filing	Received	Concluded	Action
201106-0935-005	New collection (Request for a new OMB Control Number)	2011-06-20		Approved with change