OMB control number

Ambulatory Care Pretest: National Hospital Care Survey

OMB 0920-0944 · HHS/CDC.

OMB 0920-0944

Latest Forms, Documents, and Supporting Material

Document Name
Form 5 Pulling and Refiling Medical Records Form
Form 4 Prepare and Transmit UB-04 Files Form
Form 3 Ambulatory Induction Form
Form 2 Free-Standing Ambulatory Surgery Center Induction Form
Form 1 Hospital Induction Interview Form
Sup Sta Part B FINAL 050312.docx Supporting Statement B
Att L AS PRF.docx Supplementary Document
Att K OPD PRF.docx Supplementary Document
Att J - NHCS Ambulatory Pretest ED PRF.xlsx Supplementary Document
Att F Flowchart.docx Supplementary Document
Att E FSASC Intro Letter.docx Supplementary Document
Att D Hospital Intro Letter.docx Supplementary Document
Att C - NHCS Ambulatory Pretest IRB Approval Letter.pdf Supplementary Document
Att A Applicable Laws and Regulations.docx Supplementary Document
NHCS Amb Pretest Sup Sta Part A FINAL Rev. 073012.docx Supporting Statement A
Pulling and Refiling Medical Records Form
Prepare and Transmit UB-04 Files Form
Ambulatory Induction Form
Free-Standing Ambulatory Surgery Center Induction Form
Hospital Induction Interview Form

All Historical Document Collections

201205-0920-009

2012-05-23