OMB control number

Evaluating the implementation and impact of an opioid medication management program, in a hospital discharge setting, to reduce falls in older adults

OMB 0920-1285 · HHS/CDC.

OMB 0920-1285

The goal of this data collection is to conduct a formative evaluation to inform CDC of best practices for implementation of a fall prevention program into the hospital discharge process targeting opioid prescribing and management.

The latest form for Evaluating the implementation and impact of an opioid medication management program, in a hospital discharge setting, to reduce falls in older adults expires 2023-02-28 and can be found here.

Latest Forms, Documents, and Supporting Material

Document Name
PCP post-discharge survey Form
Clinical staff questionnaire Form
Post-discharge Patient Questionnaire Form
Pre-discharge patient questionnaire Form
POMI-test-article.pdf Supplementary Document
SAMHSA email.pdf Supplementary Document
NCHS email.pdf Supplementary Document
Crosswalk Post Patient Survey Questions.docx Supplementary Document
Crosswalk Pre Patient Survey Questions.docx Supplementary Document
Attachment H Patient Consent Form .docx Supplementary Document
Attachment G3 Correspondence to primary care providers.docx Supplementary Document
Attachment G2 Correspondence to UCSF clinical staff.docx Supplementary Document
Attachment G1 Correspondence to patients.docx Supplementary Document
Attachment F1. Illustrative table shells.xlsx Supplementary Document
Attachment D IRB_Approval letter.pdf Supplementary Document
Attachment C PIA.pdf Supplementary Document
Attachment B 60 day FRN.pdf Supplementary Document
Attachment A Authorizing Legislation.docx Supplementary Document
SSB_Evaluating implementation fall prevention program 10.9.19.docx Supporting Statement B
SSA_Evaluating implementation fall prevention program_10.21.19.docx Supporting Statement A
PCP post-discharge survey Form
Clinical staff questionnaire Form
Post-discharge Patient Questionnaire Form
Pre-discharge patient questionnaire Form