ICR Documents

Supporting Statement A Document Date Uploaded 0920-0212 SSA 010616.docx 01/07/2016 Supporting Statement B Document Date Uploaded 0920-0212 SSB 010616.docx 01/07/2016 Supplementary Documents Title Document Document Type Date Uploaded Att C - Data Collection Flow Chart Att C - Data Collection Flow Chart.docx Supplementary Document 11/12/2015 Att L - Westat Data Security Plan Att L - Westat Data Security Plan.pdf Supplementary Document 11/12/2015 Att X - Background and Historical Information Att X - Background and Historical Information.docx Supplementary Document 11/12/2015 Att F - Currently Approved UB04 Data Elements Att F - Currently Approved UB04 Data Elements.docx Supplementary Document 11/12/2015 Att M- ERB Approval UPDATED 10 26 15 Att M- ERB Approval UPDATED 10 26 15.pdf Supplementary Document 11/12/2015 Att Y - Proposed changes Annual Hospital Interview Att Y - Proposed changes Annual Hospital Interview.docx Supplementary Document 11/12/2015 Att Z - Proposed changes Initial Hospital Intake Questionnaire Att Z - Proposed changes Initial Hospital Intake Questionnaire.docx Supplementary Document 11/12/2015 Attachment D - Intro Letter to Hosp 010616 Attachment D - Intro Letter to Hosp 010616.docx Supplementary Document 01/07/2016 Attachment E - Amb Intro Letter to Hosp EDs OPDs 010616 Attachment E - Amb Intro Letter to Hosp EDs OPDs 010616.docx Supplementary Document 01/07/2016 Attachment G - List of Var for EHR Ext of IP Disch 010616 Attachment G - List of Var for EHR Ext of IP Disch 010616.docx Supplementary Document 01/07/2016 Attachment H - List of Var for EHR Ext of ED Visits 010616 Attachment H - List of Var for EHR Ext of ED Visits 010616.docx Supplementary Document 01/07/2016 Attachment I - List of Varfor EHR Ext OPD Visits 010616 Attachment I - List of Varfor EHR Ext OPD Visits 010616.docx Supplementary Document 01/07/2016 Attachment J - Annual Hosp Inter 010616 Attachment J - Annual Hosp Inter 010616.docx Supplementary Document 01/07/2016 Attachment Q - Emer Dept Pt Record Form 010616 Attachment Q - Emer Dept Pt Record Form 010616.docx Supplementary Document 01/07/2016 Attachment R - Outpt Dept Pt Record Form 010616 Attachment R - Outpt Dept Pt Record Form 010616.docx Supplementary Document 01/07/2016 Attachment S - NHCS FAQ Brochure 010716 Attachment S - NHCS FAQ Brochure 010716.pdf Supplementary Document 01/07/2016 Attachment T - Hosp Amb Int Changes 010616 Att T - Amb Hosp Induction Inter Changes.docx Supplementary Document 01/07/2016 Attachment U - ED PRF Changes 010616 Att U - ED Patient Record Form Changes.docx Supplementary Document 01/07/2016 Attachment V - OPD PRF Changes 010616 Attachment V - OPD PRF Changes 010616.docx Supplementary Document 01/07/2016 Public Comments Author Name Comment Document Author Affiliation Sponsoring Org. Type Category Date of Comment Date Comment Received