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Showing results for "form".

1. Microsoft Word - HOSP EVENT FORM 2006 _legal_.doc (pdf file)
   meps.ahrq.gov/survey_comp/misc_survey/mpc/2006/HSP_06.pdf
   January 01, 2006 - Microsoft Word - HOSP EVENT FORM 2006 _legal_.doc OMB#: 0935-0118 PATIENT … LABEL |__|__|__| OFFICE USE ONLY |__|__|__| OFFICE USE ONLY FORM … MEDICAL EXPENDITURE PANEL SURVEY MEDICAL PROVIDER COMPONENT HOSPITAL EVENT FORM … FOR REFERENCE YEAR 2006 2 HOSPITAL EVENT FORM [COMPLETE ONE FORM FOR EACH EVENT] … [RECORD NAMES ON SEPARATELY BILLING DOCTOR FORM.

2. Pmed (pdf file)
   meps.ahrq.gov/data_stats/nhc/pmed.pdf
   September 30, 1997 - " from PM3; Else if form and strength were added to medicine ("ADD FORM AND STRENGTH" was selected in … "FORM" as displayed on the Redbook list. … " FROM PM3; Else if form and strength were added to a selected medicine ("ADD FORM AND STRENGTH" was … " from PM3; Else if form and strength were added to medicine ("ADD FORM AND STRENGTH" was selected in … " FROM PM3; Else if form and strength were added to a selected medicine ("ADD FORM AND STRENGTH" was

3. MEPS - IC Technical Notes
   meps.ahrq.gov/survey_comp/ic_technical_notes.shtml
   January 01, 2020 - using specialized staff and forms … forms (15 and 15S) for cases … 2002. 2006 Plan Form … 2016 Establishment Form Added … Renumbered questions on the form

4. AHRQ Data Center Application for Access to Restricted MEPS Data (pdf file)
   meps.ahrq.gov/data_stats/data_center_application.pdf
   September 17, 2024 - You can also type the information directly into this form. … You can also type the information directly into this form. 12) List below the MEPS data file(s) and … You can also type the information directly into this form. 14) Are you requesting AHRF data? … You can also type the information directly into this form. 17) Please provide an estimated time … You can also type the information directly into this form. 20) Select below the software to which

5. MEPS
   meps.ahrq.gov/communication/participants/confidentialitypharm.shtml
   Such information may not be published or released in other form if the person who supplied the information … consent is documented through the patient’s signature on the MEPS authorization form … The MEPS authorization form (PDF 202 KB, or HTM 6 KB) was redesigned … in 2002 to meet the HIPAA requirements for authorization forms described in Section 164.508(c) 45 … The revised form was reviewed and deemed HIPAA compliant by the Westat IRB.

6. MEPS
   meps.ahrq.gov/communication/participants/confidentialitymcp.shtml
   Such information may not be published or released in other form if the person who supplied the information … This consent is documented through the patient’s signature on the MEPS authorization form … The MEPS authorization form was redesigned in 2002 to meet the HIPAA requirements for … authorization forms described in Section 164.508(c) 45 CFR 164. … The revised form was reviewed and deemed HIPAA compliant by the Westat IRB.

7. Hlthstat (pdf file)
   meps.ahrq.gov/data_stats/nhc/hlthstat.pdf
   September 30, 1997 - Ranges for determining the validity of the assessment dates for MDS forms are displayed below. … If there are two or more forms completed in the same month and only one has 5 a DAY entry, the form … If no forms dated in the same month have a DAY entry, none are eligible to use as the primary form for … Identify the forms by a “M” or “Q” preceding the section fills. … I am prepared to abstract from the medical record and MDS forms myself.

8. Authorization To Obtain Information OMB #: 0935-0118 PANEL 13
   meps.ahrq.gov/survey_comp/mpc/AuthorizationForms/2008/af_p13_medicalprovider.htm
   January 01, 2008 - This authorization form covers any care I received at your facility during this period, including treatment … This form (or a photocopy of this form) gives you my authorization. … I have signed this form voluntarily, with the understanding that my decision to sign or not to sign the … form will have no effect on my eligibility for treatment, payment, enrollment, or eligibility for any

9. Medical Expenditure Panel Survey - Employer Participant Frequently Asked Questions
   meps.ahrq.gov/communication/employer_participant_faqs.jsp
   I have returned my form. Why have I received another just like it ? … ^top I have returned my form. Why have I received another just like it? … We send follow-up letters and forms when the deadline passes. … Your returned form and our follow-up letter and form may have crossed in the mail. … Some companies receive more than one form so they can report for different lines of business

10. Medical Expenditure Panel Survey Medical Provider Component Data Collection
    meps.ahrq.gov/mepsweb/survey_comp/mpc_data_collection.jsp
    October 01, 2004 - Patients in sampled households were asked to sign authorization forms permitting the data … Institutional Event Form for Non-hospital Facilities. … Office-based Provider Event Form. … Separately Billing Doctors Event Form. … Hospital Event Form.

11. Medical Expenditure Panel Survey - Employer Participant Frequently Asked Questions
    meps.ahrq.gov/mepsweb/communication/employer_participant_faqs.jsp
    I have returned my form. Why have I received another just like it ? … ^top I have returned my form. Why have I received another just like it? … We send follow-up letters and forms when the deadline passes. … Your returned form and our follow-up letter and form may have crossed in the mail. … Some companies receive more than one form so they can report for different lines of business

12. m-hosp4.PDF (pdf file)
    meps.ahrq.gov/survey_comp/misc_survey/mpc/1996/m-hosp4.pdf
    January 01, 1996 - ID: ________________________________________ PATIENT NAME: ____________________________________ FORM … ______ OF ______ MEDICAL EXPENDITURE PANEL SURVEY MEDICAL PROVIDER SURVEY HOSPITAL EVENT FORM PANEL … 1 - YEAR 1 HOSPITAL EVENT FORM [COMPLETE ONE FORM FOR EACH EVENT] QUESTIONS 1 THROUGH 4: TO BE … [RECORD NAMES ON SEPARATELY BILLING DOCTOR FORM. … YES ........................ 1 (GO TO PATIENT ACCOUNTS SECTION (Q5a) OF NEXT EVENT FORM.)

13. Medical Expenditure Panel Survey Survey Questionnaires
    meps.ahrq.gov/mepsweb/survey_comp/survey.jsp
    July 18, 2025 - measures of health status: the Veteran's RAND 12-item (VR-12) (in 2017 this replaces the Short-Form … The most current data years of the authorization forms are available below. … ; they sign the English forms. … Forms All Authorization Forms Medical Provider Authorization Form Medical Provider Authorization … Form - Spanish Pharmacy Authorization Form Pharmacy Authorization Form - Spanish Years

14. Medical Expenditure Panel Survey Survey Questionnaires
    meps.ahrq.gov/survey_comp/survey.jsp
    July 18, 2025 - measures of health status: the Veteran's RAND 12-item (VR-12) (in 2017 this replaces the Short-Form … The most current data years of the authorization forms are available below. … ; they sign the English forms. … Forms All Authorization Forms Medical Provider Authorization Form Medical Provider Authorization … Form - Spanish Pharmacy Authorization Form Pharmacy Authorization Form - Spanish Years

15. Medical Expenditure Panel Survey Medical Provider Component (MPC) Glossary (pdf file)
    meps.ahrq.gov/survey_comp/appendix_d_glossary.pdf
    December 31, 2020 - AF (Authorization Form): Consent form signed by a household respondent during one of the household interviews … Authorization Form: See AF. … Event Forms: Data collection forms used in the MPC to collect information about medical events. … Mental Health Counseling (Psychotherapy): A treatment technique for certain forms of mental disorders … Permission Form: The Authorization Form complies with the requirements of the Health Insurance Portability

16. Methodology Report #29: Outpatient Prescription Drugs: Data Collection and Editing in the 2011 Medical Expenditure Panel Survey
    meps.ahrq.gov/data_files/publications/mr29/mr29.shtml
    March 12, 2014 - Signed authorization forms allow pharmacies to respond to the Pharmacy Component (PC) of MEPS when it … interviews collecting information about medication obtained in 2011, 69.7 percent of pharmacy permission forms … During the second, third, fourth, and fifth HC interviews, sample members are asked to sign permission forms … Conditional on having obtained 69.7 percent of signed permission forms sought in the household interview … the Pharmacy Component is derived from all persons in the Household Component who signed permission forms

17. Context/Flow Specifications for the Overall CAPI Instrument, MEPS-Household Component: Panel 5 (2000-2001) Consolidated Instrument (pdf file)
    meps.ahrq.gov/survey_comp/overall_p5.pdf
    January 01, 2001 - Page does not require timed responses Navigation links Passed Navigation links are not repetitive Forms … Rule Name Status Description Tagged form fields Passed All form fields are tagged Field descriptions … Passed All form fields have description Alternate Text Rule Name Status Description Figures alternate

18. Context/Flow Specifications for the Overall CAPI Instrument, MEPS-Household Component: Panel 4 (1999-2000) Consolidated Instrument (pdf file)
    meps.ahrq.gov/survey_comp/overall_p4.pdf
    January 01, 2000 - Page does not require timed responses Navigation links Passed Navigation links are not repetitive Forms … Rule Name Status Description Tagged form fields Passed All form fields are tagged Field descriptions … Passed All form fields have description Alternate Text Rule Name Status Description Figures alternate

19. Context/Flow Specifications for the Overall CAPI Instrument, MEPS-Household Component: Panel 12 (2007-2008) Consolidated Instrument (pdf file)
    meps.ahrq.gov/survey_comp/overall_p12.pdf
    January 01, 2008 - Page does not require timed responses Navigation links Passed Navigation links are not repetitive Forms … Rule Name Status Description Tagged form fields Passed All form fields are tagged Field descriptions … Passed All form fields have description Alternate Text Rule Name Status Description Figures alternate

20. Context/Flow Specifications for the Overall CAPI Instrument, MEPS-Household Component: Panel 11 (2006-2007) Consolidated Instrument (pdf file)
    meps.ahrq.gov/survey_comp/overall_p11.pdf
    January 01, 2007 - Page does not require timed responses Navigation links Passed Navigation links are not repetitive Forms … Rule Name Status Description Tagged form fields Passed All form fields are tagged Field descriptions … Passed All form fields have description Alternate Text Rule Name Status Description Figures alternate