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OMB No. 0920-0666 Exp. Date 12-31-2015 www. cdc.gov/nhsn Surgical Site Infection SSI Page 1 of 4 required for saving required for completion Facility ID Event Patient ID Social Security Secondary ID Medicare Patient Name Last First Middle Gender F M Other Date of Birth Ethnicity Specify Race Specify Event Type SSI Date of Event NHSN Procedure Code ICD-9-CM Procedure Code Date of Procedure Outpatient Procedure Yes No MDRO Infection Surveillance Yes this infection s pathogen location are...
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Start by downloading the CDC 57120 form from the official website of the Centers for Disease Control and Prevention (CDC).
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Carefully read the instructions provided on the form to understand the required information and any supporting documents that may be needed.
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Begin filling out the form by entering your personal information, including your full name, contact details, and any other requested identification details.
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Submit the form by following the instructions provided on the form or on the CDC's website.
Who needs cdc 57120 form:
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What is cdc 57120 form?
The CDC 57120 form is a document used to report certain information to the Centers for Disease Control and Prevention.
Who is required to file cdc 57120 form?
Healthcare facilities and laboratories are required to file the CDC 57120 form.
How to fill out cdc 57120 form?
To fill out the CDC 57120 form, you need to provide the required information in each section of the form. This includes details about the facility or laboratory, as well as specific data related to the reportable conditions.
What is the purpose of cdc 57120 form?
The purpose of the CDC 57120 form is to collect data on various reportable conditions to help the Centers for Disease Control and Prevention monitor public health trends and respond to outbreaks.
What information must be reported on cdc 57120 form?
The CDC 57120 form requires the reporting of information such as the facility or laboratory name, contact information, specific reportable conditions, and details about the cases or incidents being reported.
When is the deadline to file cdc 57120 form in 2023?
The deadline to file the CDC 57120 form in 2023 has not been specified. It is recommended to check the official guidelines or contact the Centers for Disease Control and Prevention for the most accurate information.
What is the penalty for the late filing of cdc 57120 form?
The penalty for the late filing of the CDC 57120 form can vary depending on the regulations and policies of the Centers for Disease Control and Prevention. It is advisable to consult the official guidelines or contact the relevant authorities for specific details.
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