Form Cdc 57 117 PDF Details

In the realm of healthcare, accurate data collection and reporting are pivotal for enhancing patient care and oversight. The CDC 57 117 form serves as a critical tool in this endeavor, particularly for Specialty Care Areas (SCA) and Oncology units. This document, officially recognized and mandated under OMB No. 0920-0666 with an expiration date of October 31, 2016, is structured to meticulously gather monthly data on various patient care metrics. Essential elements captured include the number of patients with central lines, those with urinary catheters, and those requiring ventilator support, distinguishing between temporary and permanent situations. Facilities are required to report not just patient numbers but also the days each device was used, offering a comprehensive view of the care environment. Beyond mere numbers, the form ensures confidentiality, abiding by Sections 304, 306, and 308(d) of the Public Health Service Act, thus promising the safeguarding of personal and institutional data. It underscores the public reporting burden estimated at 5 hours per response, acknowledging the effort necessary for compliance but emphasizing the value of the information collected. By completing this form, healthcare providers contribute to a larger database, managed by the CDC's National Healthcare Safety Network (NHSN), aimed at monitoring and improving quality care standards across the nation.

QuestionAnswer
Form NameForm Cdc 57 117
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other names242b, Exp, D-74, 242k

Form Preview Example

Form Approved

OMB No. 0920-0666

Exp. Date: 10/31/2016

www.cdc.gov/nhsn

Denominators for Specialty Care Area (SCA)/Oncology (ONC)

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*required for saving

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Facility ID:

 

 

 

*Location Code:

 

 

 

 

*Month:

 

 

*Year:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

**Number of patients with 1 or more

 

 

 

 

 

 

 

 

 

 

 

 

 

Date

 

 

*Number

 

 

 

**Number of patients

 

 

**Number of patients on

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

central lines

 

 

 

 

 

 

 

of Patients

 

 

 

 

 

 

with a urinary catheter

 

 

 

a ventilator

 

 

 

 

 

 

 

 

 

(if patient has both, count as Temporary)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Temporary

 

Permanent

 

 

 

 

 

 

 

Total

Number on

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Patients

APRV

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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Temporary CL-

 

Permanent CL-

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Patient-days

 

 

 

 

Urinary catheter-days

 

 

 

Ventilator-days

 

 

 

 

 

 

 

 

 

days

 

 

days

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

**Conditionally required according to the events indicated in Plan.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Label

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Data

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Assurance of Confidentiality: The voluntarily provided information obtained in this surveillance system that would permit identification of any individual or institution is collected with a guarantee that it will be held in strict confidence, will be used only for the purposes stated, and will not otherwise be disclosed or released without the consent of the individual, or the institution in accordance with Sections 304, 306 and 308(d) of the Public Health Service Act (42 USC 242b, 242k, and 242m(d)).

Public reporting burden of this collection of information is estimated to average 5 hours per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to CDC, Reports Clearance Officer, 1600 Clifton Rd., MS D-74, Atlanta, GA 30333, ATTN: PRA (0920-0666).

CDC 57.117, Rev 1, v7.1