Survey Instruments
On This Page
Note: In addition to NAMCS and NHAMCS data released on public use micro-data files, results from the survey supplements listed below may also be available in the NCHS Research Data Center (RDC). For example, data from the NAMCS Electronic Medical Record Supplement (2008-2011), the National Electronic Health Records Survey (2012-2017), and the 2008 NHAMCS Pandemic and Emergency Response Preparedness Supplement, are now available for use in the RDC. Please refer to NAMCS and NHAMCS Restricted Data Available at the NCHS Research Data Center pdf icon[PDF – 53 KB] for more information, visit the RDC website or contact the Ambulatory and Hospital Care Statistics Branch at 301-458-4600.
NAMCS Survey Instruments
2019
- Patient Record Sample Card pdf icon[PDF – 832 KB]
- Traditional Physician Induction Interview Sample Card pdf icon[PDF – 819 KB]
- CHC Administrator/Provider Induction Interview Sample Card pdf icon[PDF – 300 KB]
2018
- Patient Record Sample Card pdf icon[PDF – 143 KB]
- Traditional Physician Induction Interview Sample Card pdf icon[PDF – 107 KB]
- CHC Administrator/Provider Induction Interview Sample Card pdf icon[PDF – 105 KB]
2017
- Patient Record Sample Card pdf icon[PDF – 373 KB]
- Traditional Physician Induction Interview Sample Card pdf icon[PDF – 88 KB]
- CHC Provider Induction Interview Sample Card pdf icon[PDF – 85 KB]
- National Electronic Health Records Survey pdf icon[PDF – 451 KB]
2016
- Patient Record Sample Card pdf icon[PDF – 138 KB]
- Traditional Physician Induction Interview Sample Card pdf icon[PDF – 82 KB]
- CHC Provider Induction Interview Sample Card pdf icon[PDF – 81 KB]
- NAMCS Supplement on Culturally and Linguistically Appropriate Services pdf icon[PDF – 827 KB]
2015
- Patient Record Sample Card pdf icon[PDF – 181 KB]
- Physician Induction Interview Sample Card pdf icon[PDF – 402 KB]
- National Electronic Health Records Survey pdf icon[PDF – 213 KB]
2014
- Patient Record Sample Card pdf icon[PDF – 105 KB]
- Physician Induction Interview Sample Card pdf icon[PDF – 178 KB]
- National Electronic Health Records Survey – Long Form pdf icon[PDF – 295 KB]
- National Electronic Health Records Survey – Short Form pdf icon[PDF – 134 KB]
2013
- Patient Record Sample Card pdf icon[PDF – 95 KB]
- Physician Induction Interview Sample Card pdf icon[PDF – 285 KB]
- Lookback Module pdf icon[PDF – 75 KB]
- National Electronic Health Records Survey pdf icon[PDF – 172 KB]
- Physician Workflow Supplement for EHR Adopters pdf icon[PDF – 105 KB]
- Physician Workflow Supplement for EHR Non-Adopters pdf icon[PDF – 106 KB]
2012
- Patient Record Sample Card pdf icon[PDF – 95 KB]
- Physician Induction Interview Sample Card pdf icon[PDF – 288 KB]
- Lookback Module pdf icon[PDF – 75 KB]
- National Electronic Health Records Survey pdf icon[PDF – 189]
- Physician Workflow Supplement for EHR Adopters pdf icon[PDF – 389 KB]
- Physician Workflow Supplement for EHR Non-Adopters pdf icon[PDF – 386 KB]
- Asthma Supplement pdf icon[PDF – 137 KB]
2011
- Patient Record Form pdf icon[PDF – 129 KB]
- Physician Induction Interview Form pdf icon[PDF – 303 KB]
- Community Health Center Induction Interview Form pdf icon[PDF -222 KB]
- Electronic Medical Records Supplement pdf icon[PDF – 74 KB]
- Physician Workflow Supplement for EHR Non-Adopters pdf icon[PDF – 116 KB]
- Physician Workflow Supplement for EHR Adopters pdf icon[ PDF 199 KB]
2010
- Patient Record Form A pdf icon[PDF – 140 KB]
- Patient Record Form B pdf icon[PDF – 125 KB] (contains additional questions on lab values on the reverse side, completed only by certain physician specialties)
- Cervical Cancer Screening Supplement pdf icon[PDF – 132 KB]
- Physician Induction Interview Form pdf icon[PDF – 354 KB]
- Community Health Center Induction Interview Form pdf icon[PDF – 194 KB]
- Electronic Medical Records Supplement pdf icon[PDF – 91 KB]
2009
- Patient Record Form pdf icon[PDF – 129 KB]
- Cervical Cancer Screening Supplement pdf icon[PDF – 147 KB]
- Physician Induction Interview Form pdf icon[PDF – 518 KB]
- Community Health Center Induction Interview Form pdf icon[PDF – 235 KB]
- Electronic Medical Records Supplement pdf icon[PDF – 72 KB]
2008
- Patient Record Form pdf icon[PDF – 246 KB]
- Cervical Cancer Screening Supplement pdf icon[PDF – 406 KB]
- Physician Induction Interview Form pdf icon[PDF – 2 MB]
- Community Health Center Induction Interview Form pdf icon[PDF – 703 KB]
- Electronic Medical Records Supplement pdf icon[PDF – 346 KB]
2007
- Patient Record Form pdf icon[PDF – 94 KB]
- Cervical Cancer Screening Supplement pdf icon[PDF – 123 KB]
- Physician Induction Interview Form pdf icon[PDF – 400 KB]
- Community Health Center Induction Interview Form pdf icon[PDF – 402 KB]
2006
- Patient Record Form pdf icon[PDF – 104 KB]
- Cervical Cancer Screening Supplementpdf icon[PDF – 259 KB]
- Physician Induction Interview Form pdf icon[PDF – 1 MB]
- Community Health Center Induction Interview Form pdf icon[PDF – 435 KB]
2005
2004
2003
2002
2001
1999-2000
1997-1998
- Patient Record Form pdf icon[PDF – 237 KB]
- Instructions for completing Patient Record Form pdf icon[PDF – 38 KB]
1995-1996
NHAMCS Survey Instruments
2020
- Emergency Department Patient Record Sample Card pdf icon[PDF – 807 KB]
- Hospital Induction Interview Form pdf icon[PDF – 851 KB]
2019
- Emergency Department Patient Record Sample Card pdf icon[PDF – 240 KB]
- Hospital Induction Interview Form pdf icon[PDF – 302 KB]
2018
- Emergency Department Patient Record Sample Card pdf icon[PDF – 679 KB]
- Hospital Induction Interview Form pdf icon[PDF – 624 KB]
2017
- Emergency Department Patient Record Sample Card pdf icon[PDF – 108 KB]
- Outpatient Department Patient Record Sample Card pdf icon[PDF – 165 KB]
- Ambulatory Surgery Patient Record Sample Card pdf icon[PDF – 110 KB]
- Hospital Induction Interview Form pdf icon[PDF – 251 KB]
2016
- Emergency Department Patient Record Sample Card pdf icon[PDF – 76 KB]
- Outpatient Department Patient Record Sample Card pdf icon[PDF – 130 KB]
- Ambulatory Surgery Patient Record Sample Card pdf icon[PDF – 64 KB]
- Hospital Induction Interview Form pdf icon[PDF – 424 KB]
2015
- Emergency Department Patient Record Sample Card pdf icon[PDF – 77 KB]
- Outpatient Department Patient Record Sample Card pdf icon[PDF – 195 KB]
- Ambulatory Surgery Patient Record Sample Card pdf icon[PDF – 100 KB]
- Hospital Induction Interview Form pdf icon[PDF – 420 KB]
2014
- Emergency Department Patient Record Sample Card pdf icon[PDF – 109 KB]
- Outpatient Department Patient Record Sample Card pdf icon[PDF – 104 KB]
- Ambulatory Surgery Patient Record Sample Card pdf icon[PDF – 65 KB]
- Hospital Induction Interview Form pdf icon[PDF – 146 KB]
2013
- Emergency Department Patient Record Sample Card pdf icon[PDF – 101 KB]
- Outpatient Department Patient Record Sample Card pdf icon[PDF – 98 KB]
- Ambulatory Surgery Patient Record Sample Card pdf icon[PDF – 65 KB]
- Lookback Module Sample Card pdf icon[PDF – 73 KB]
- Hospital Induction Interview Form pdf icon[PDF – 477 KB]
2012
- Emergency Department Patient Record Sample Card pdf icon[PDF – 112 KB]
- Outpatient Department Patient Record Sample Card pdf icon[PDF – 60 KB]
- Ambulatory Surgery Patient Record Sample Card pdf icon[PDF – 103 KB]
- Hospital Induction Interview Form pdf icon[PDF – 560 KB]
2011
- Emergency Department Patient Record Form pdf icon[PDF – 118 KB]
- Outpatient Department Patient Record Form pdf icon[PDF – 140 KB]
- Ambulatory Surgery Center Patient Record Form pdf icon[PDF – 125 KB]
- Hospital Induction Interview Form pdf icon[PDF – 4.8 MB]
- Freestanding Ambulatory Surgery Center Induction Interview Form pdf icon[PDF – 299 KB]
- Ambulatory Unit Induction Interview Form pdf icon[PDF – 104 KB]
2010
- Emergency Department Patient Record Form pdf icon[PDF – 103 KB]
- Outpatient Department Patient Record Form pdf icon[PDF – 123 KB]
- Ambulatory Surgery Center Patient Record pdf icon[PDF – 110 KB]
- Cervical Cancer Screening Supplement pdf icon[PDF – 138 KB]
- Hospital Induction Interview Form pdf icon[PDF – 359 KB]
- Freestanding Ambulatory Surgery Center Induction Interview Form pdf icon[PDF – 263 KB]
- Ambulatory Unit Induction Interview Form pdf icon[PDF – 110 KB]
2009
- Emergency Department Patient Record Form pdf icon[PDF – 114 KB]
- Outpatient Department Patient Record Form pdf icon[PDF – 168 KB]
- Ambulatory Surgery Center Patient Record pdf icon[PDF – 132 KB]
- Cervical Cancer Screening Supplement pdf icon[PDF – 150 KB]
- Hospital Induction Interview Form pdf icon[PDF – 558 KB]
- Ambulatory Unit Induction Interview Form pdf icon[PDF – 186 KB]
2008
- Emergency Department Patient Record Form pdf icon[PDF – 208 KB]
- Outpatient Department Patient Record Form pdf icon[PDF – 453 KB]
- Cervical Cancer Screening Supplement pdf icon[PDF – 189 KB]
- Hospital Induction Interview Form pdf icon[PDF – 1277 KB]
- Ambulatory Unit Induction Interview Form pdf icon[PDF – 129 KB]
- Pandemic and Emergency Response Preparedness Supplement pdf icon[PDF – 119 KB]
2007
- Emergency Department Patient Record Form pdf icon[PDF – 439 KB]
- Outpatient Department Patient Record Form pdf icon[PDF – 146 KB]
- Cervical Cancer Screening Supplement pdf icon[PDF – 107 KB]
- Hospital Induction Interview Form pdf icon[PDF – 331 KB]
- Ambulatory Unit Induction Interview Form pdf icon[PDF – 122 KB]
2006
- Emergency Department Patient Record Form pdf icon[PDF – 58 KB]
- Outpatient Department Patient Record Form pdf icon[PDF – 51 KB]
- Emergency Pediatric Services and Equipment Supplement pdf icon[PDF – 228 KB]
- Cervical Cancer Screening Supplement pdf icon[PDF – 54 KB]
- Hospital Induction Interview Form pdf icon[PDF – 126 KB]
- Ambulatory Unit Induction Interview Form pdf icon[PDF – 54 KB]
2005
- Emergency Department Patient Record Form pdf icon[PDF – 66 KB]
- Outpatient Department Patient Record Form pdf icon[PDF – 58 KB]
- Hospital Induction Interview Form pdf icon[PDF – 126 KB]
- Ambulatory Unit Induction Interview Form pdf icon[PDF – 54 KB]
2004
- Emergency Department Patient Record Form pdf icon[PDF – 158 KB]
- Outpatient Department Patient Record Form pdf icon[PDF – 361 KB]
2003
- Emergency Department Patient Record Form pdf icon[PDF – 383 KB]
- Outpatient Department Patient Record Form pdf icon[PDF – 312 KB]
2002
- Emergency Department Patient Record Form pdf icon[PDF – 1.5 MB]
- Outpatient Department Patient Record Form pdf icon[PDF – 1 MB]
2001
- Emergency Department Patient Record Form pdf icon[PDF – 259 KB]
- Outpatient Department Patient Record Form pdf icon[PDF – 319 KB]
1999-2000
- Emergency Department Patient Record Form pdf icon[PDF – 2 KB]
- Outpatient Department Patient Record Form pdf icon[PDF – 2 KB]
1997-1998
- Emergency Department Patient Record Form pdf icon[PDF – 205 KB]
- Outpatient Department Patient Record Form pdf icon[PDF – 208 KB]
- Instructions for completing Patient Record Form pdf icon[PDF – 51 KB]
1995-1996
Page last reviewed: July 29, 2020
Content source: National Center for Health Statistics