![NCHS home page graphic and link](https://webarchive.library.unt.edu/eot2008/20081009211734im_/http://www.cdc.gov/nchs/images/nchshd.jpg)
Survey
Instrument
NAMCS
2008
Patient Record
Form
![Click to open pdf. file 246 KB](https://webarchive.library.unt.edu/eot2008/20081009211734im_/http://www.cdc.gov/nchs/images/pdf.jpg)
Cervical
Cancer Screening Supplement
![Click to open pdf. file 406 KB](https://webarchive.library.unt.edu/eot2008/20081009211734im_/http://www.cdc.gov/nchs/images/pdf.jpg)
Physician
Induction Interview
Form
![Click to open pdf. file 1869 KB](https://webarchive.library.unt.edu/eot2008/20081009211734im_/http://www.cdc.gov/nchs/images/pdf.jpg)
Community
Health Center Induction Interview Form
![Click to open pdf. file 703 KB](https://webarchive.library.unt.edu/eot2008/20081009211734im_/http://www.cdc.gov/nchs/images/pdf.jpg)
Electronic
Medical Records Supplement
![Click to open pdf. file 346 KB](https://webarchive.library.unt.edu/eot2008/20081009211734im_/http://www.cdc.gov/nchs/images/pdf.jpg)
2007
Patient Record
Form
![Click to open pdf. file 94 KB](https://webarchive.library.unt.edu/eot2008/20081009211734im_/http://www.cdc.gov/nchs/images/pdf.jpg)
Cervical
Cancer Screening Supplement
![Click to open pdf. file 70 KB](https://webarchive.library.unt.edu/eot2008/20081009211734im_/http://www.cdc.gov/nchs/images/pdf.jpg)
Physician
Induction Interview
Form
![Click to open pdf. file 400 KB](https://webarchive.library.unt.edu/eot2008/20081009211734im_/http://www.cdc.gov/nchs/images/pdf.jpg)
Community
Health Center Induction Interview Form
![Click to open pdf. file 218 KB](https://webarchive.library.unt.edu/eot2008/20081009211734im_/http://www.cdc.gov/nchs/images/pdf.jpg)
2006
Patient Record
Form
![Click to open pdf file 104 KB](https://webarchive.library.unt.edu/eot2008/20081009211734im_/http://www.cdc.gov/nchs/images/pdf.jpg)
Cervical
Cancer Screening Supplement
![Click to open pdf file 259 KB](https://webarchive.library.unt.edu/eot2008/20081009211734im_/http://www.cdc.gov/nchs/images/pdf.jpg)
Physician
Induction Interview
Form
![Click to open pdf file 829 KB](https://webarchive.library.unt.edu/eot2008/20081009211734im_/http://www.cdc.gov/nchs/images/pdf.jpg)
Community
Health Center Induction Interview Form
![Click to open pdf file 435 KB](https://webarchive.library.unt.edu/eot2008/20081009211734im_/http://www.cdc.gov/nchs/images/pdf.jpg)
2005
Patient Record
Form
![Click to open pdf file 58 KB](https://webarchive.library.unt.edu/eot2008/20081009211734im_/http://www.cdc.gov/nchs/images/pdf.jpg)
Physician
Induction Interview
Form
![Click to open pdf file 123 KB](https://webarchive.library.unt.edu/eot2008/20081009211734im_/http://www.cdc.gov/nchs/images/pdf.jpg)
2004
Patient Record
Form
![Click to open pdf file 141 KB](https://webarchive.library.unt.edu/eot2008/20081009211734im_/http://www.cdc.gov/nchs/images/pdf.jpg)
2003
Patient Record
Form
![Click to open pdf file 142 KB](https://webarchive.library.unt.edu/eot2008/20081009211734im_/http://www.cdc.gov/nchs/images/pdf.jpg)
2002
Patient Record
Form
![Click to open pdf file 747 KB](https://webarchive.library.unt.edu/eot2008/20081009211734im_/http://www.cdc.gov/nchs/images/pdf.jpg)
2001
Patient Record
Form (Version A)
![Click to open pdf file 299 KB](https://webarchive.library.unt.edu/eot2008/20081009211734im_/http://www.cdc.gov/nchs/images/pdf.jpg)
1999-2000
Patient Record
Form
![Click to open pdf file 1.7 KB](https://webarchive.library.unt.edu/eot2008/20081009211734im_/http://www.cdc.gov/nchs/images/pdf.jpg)
1997-1998
Patient Record
Form
![Click to open pdf file 237 KB](https://webarchive.library.unt.edu/eot2008/20081009211734im_/http://www.cdc.gov/nchs/images/pdf.jpg)
Instructions for
completing Patient Record Form
![Click to open pdf file 38 KB](https://webarchive.library.unt.edu/eot2008/20081009211734im_/http://www.cdc.gov/nchs/images/pdf.jpg)
1995-1996
Patient Record
Form
![Click to open pdf file 63 KB](https://webarchive.library.unt.edu/eot2008/20081009211734im_/http://www.cdc.gov/nchs/images/pdf.jpg)
Survey Instrument
NHAMCS
2008
Emergency Department
Patient Record Form
![Click to open pdf. file 208 KB](https://webarchive.library.unt.edu/eot2008/20081009211734im_/http://www.cdc.gov/nchs/images/pdf.jpg)
Outpatient Department
Patient Record Form
![Click to open pdf. file 453 KB](https://webarchive.library.unt.edu/eot2008/20081009211734im_/http://www.cdc.gov/nchs/images/pdf.jpg)
Cervical
Cancer Screening Supplement
![Click to open pdf file 189 KB](https://webarchive.library.unt.edu/eot2008/20081009211734im_/http://www.cdc.gov/nchs/images/pdf.jpg)
Hospital
Induction Interview Form
![Click to open pdf. file 1277 KB](https://webarchive.library.unt.edu/eot2008/20081009211734im_/http://www.cdc.gov/nchs/images/pdf.jpg)
Ambulatory
Unit Induction Interview Form
![Click to open pdf. file 129 KB](https://webarchive.library.unt.edu/eot2008/20081009211734im_/http://www.cdc.gov/nchs/images/pdf.jpg)
Pandemic
and Emergency Response Preparedness Supplement
![Click to open pdf. file 114 KB](https://webarchive.library.unt.edu/eot2008/20081009211734im_/http://www.cdc.gov/nchs/images/pdf.jpg)
2007
Emergency Department
Patient Record Form
![Click to open pdf. file 439 KB](https://webarchive.library.unt.edu/eot2008/20081009211734im_/http://www.cdc.gov/nchs/images/pdf.jpg)
Outpatient Department
Patient Record Form
![Click to open pdf. file 146 KB](https://webarchive.library.unt.edu/eot2008/20081009211734im_/http://www.cdc.gov/nchs/images/pdf.jpg)
Cervical
Cancer Screening Supplement
![Click to open pdf file 62 KB](https://webarchive.library.unt.edu/eot2008/20081009211734im_/http://www.cdc.gov/nchs/images/pdf.jpg)
Hospital
Induction Interview Form
![Click to open pdf. file 132 KB](https://webarchive.library.unt.edu/eot2008/20081009211734im_/http://www.cdc.gov/nchs/images/pdf.jpg)
Ambulatory
Unit Induction Interview Form
![Click to open pdf. file 120 KB](https://webarchive.library.unt.edu/eot2008/20081009211734im_/http://www.cdc.gov/nchs/images/pdf.jpg)
2006
Emergency Department
Patient Record Form
![Click to open pdf 66 KB](https://webarchive.library.unt.edu/eot2008/20081009211734im_/http://www.cdc.gov/nchs/images/pdf.jpg)
Outpatient Department
Patient Record Form
![Click to open pdf file 58 KB](https://webarchive.library.unt.edu/eot2008/20081009211734im_/http://www.cdc.gov/nchs/images/pdf.jpg)
Emergency
Pediatric Surveillance and Equipment Supplement
![Click to open pdf file 54 KB](https://webarchive.library.unt.edu/eot2008/20081009211734im_/http://www.cdc.gov/nchs/images/pdf.jpg)
Cervical
Cancer Screening Supplement
![Click to open pdf file 54 KB](https://webarchive.library.unt.edu/eot2008/20081009211734im_/http://www.cdc.gov/nchs/images/pdf.jpg)
Hospital
Induction Interview Form
![Click to open pdf file 126 KB](https://webarchive.library.unt.edu/eot2008/20081009211734im_/http://www.cdc.gov/nchs/images/pdf.jpg)
Ambulatory
Unit Induction Interview Form
![Click to open pdf file 54 KB](https://webarchive.library.unt.edu/eot2008/20081009211734im_/http://www.cdc.gov/nchs/images/pdf.jpg)
2005
Emergency Department
Patient Record Form
![Click to open pdf file 66 KB](https://webarchive.library.unt.edu/eot2008/20081009211734im_/http://www.cdc.gov/nchs/images/pdf.jpg)
Outpatient Department
Patient Record Form
![Click to open pdf file 58 KB](https://webarchive.library.unt.edu/eot2008/20081009211734im_/http://www.cdc.gov/nchs/images/pdf.jpg)
Hospital
Induction Interview Form
![Click to open pdf file 126 KB](https://webarchive.library.unt.edu/eot2008/20081009211734im_/http://www.cdc.gov/nchs/images/pdf.jpg)
Ambulatory
Unit Induction Interview Form
![Click to open pdf file 54 KB](https://webarchive.library.unt.edu/eot2008/20081009211734im_/http://www.cdc.gov/nchs/images/pdf.jpg)
2004
Emergency Department
Patient Record Form
![Click to open pdf file 158 KB](https://webarchive.library.unt.edu/eot2008/20081009211734im_/http://www.cdc.gov/nchs/images/pdf.jpg)
Outpatient Department
Patient Record Form
![Click to open pdf file 361 KB](https://webarchive.library.unt.edu/eot2008/20081009211734im_/http://www.cdc.gov/nchs/images/pdf.jpg)
2003
Emergency Department
Patient Record Form
![Click to open pdf file 383 KB](https://webarchive.library.unt.edu/eot2008/20081009211734im_/http://www.cdc.gov/nchs/images/pdf.jpg)
Outpatient Department
Patient Record Form
![Click to open pdf file 312 KB](https://webarchive.library.unt.edu/eot2008/20081009211734im_/http://www.cdc.gov/nchs/images/pdf.jpg)
2002
Emergency Department
Patient Record Form
![Click to open pdf file 1.5 MB](https://webarchive.library.unt.edu/eot2008/20081009211734im_/http://www.cdc.gov/nchs/images/pdf.jpg)
Outpatient Department
Patient Record Form
![Click to open pdf file 1 MB](https://webarchive.library.unt.edu/eot2008/20081009211734im_/http://www.cdc.gov/nchs/images/pdf.jpg)
2001
Emergency Department
Patient Record Form
![Click to open pdf file 259 KB](https://webarchive.library.unt.edu/eot2008/20081009211734im_/http://www.cdc.gov/nchs/images/pdf.jpg)
Outpatient Department
Patient Record Form (Version A)
![Click to open pdf file 319 KB](https://webarchive.library.unt.edu/eot2008/20081009211734im_/http://www.cdc.gov/nchs/images/pdf.jpg)
1999-2000
Emergency Department
Patient Record Form
![Click to open pdf file 2.1 KB](https://webarchive.library.unt.edu/eot2008/20081009211734im_/http://www.cdc.gov/nchs/images/pdf.jpg)
Outpatient Department
Patient Record Form
![Click to open pdf file 1.7 KB](https://webarchive.library.unt.edu/eot2008/20081009211734im_/http://www.cdc.gov/nchs/images/pdf.jpg)
1997-1998
Emergency Department
Patient Record Form
![Click to open pdf file 205 KB](https://webarchive.library.unt.edu/eot2008/20081009211734im_/http://www.cdc.gov/nchs/images/pdf.jpg)
Outpatient Department
Patient Record Form
![Click to open pdf file 208 KB](https://webarchive.library.unt.edu/eot2008/20081009211734im_/http://www.cdc.gov/nchs/images/pdf.jpg)
Instructions for
completing Patient Record Form
![Click to open pdf file 51 KB](https://webarchive.library.unt.edu/eot2008/20081009211734im_/http://www.cdc.gov/nchs/images/pdf.jpg)
1995-1996
Emergency Department
Patient Record Form
![Click to open pdf file 74 KB](https://webarchive.library.unt.edu/eot2008/20081009211734im_/http://www.cdc.gov/nchs/images/pdf.jpg)
Outpatient Department
Patient Record Form
![Click to open pdf file 73 KB](https://webarchive.library.unt.edu/eot2008/20081009211734im_/http://www.cdc.gov/nchs/images/pdf.jpg)
This page last reviewed
May 16, 2008
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