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Chart Abstraction Form (pdf file)
www.talkingquality.ahrq.gov/sites/default/files/wysiwyg/policymakers/chipra/factsheets/fullreports/chipra-203-section-2-tech-specs.pdfDecember 14, 2011 - Chart Abstraction Form Basic Elements Patient ID Race Ethnicity Gender Payer Preferred Language Age upon admission (YEARS) [e.g. for 12.5 year old, years = 12) Age upon admission (MONTHS) [ e.g. for 12.5 year old, months = 6] 1 White Non-Hispanic Female Medicaid English …
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