EHR for Visit Data (quarterly) (2024)

National Ambulatory Medical Care Survey (NAMCS)

Documents and Forms

Document Name Document Type
Form 0920-0234 EHR for Visit Data (quarterly) (2024) Form and Instruction
0920-0234 NAMCS Electronic Health Record (EHR): Pulling and Sendin Attachment O_NAMCS EHR Record Pulling Burden.docx Form and Instruction
0920-0234 National Health Care Surveys Release 1 Attachment I_EHR Implementation guide templates.pdf Form and Instruction
0920-0234 HL7 CDA® R2 Implementation Guide: National Health Care S Attachment H_EHR Implementation guide.pdf Form and Instruction
Attachment G_Electronic Health Record (EHR) Variable List.xlsx Electronic Health Record Variable List IC Document

Information Collection (IC) Details

IC Title:	EHR for Visit Data (quarterly) (2024)	Agency IC Tracking Number:	0920-0234

Is this a Common Form? Yes		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	0920-0234	NAMCS Electronic Health Record (EHR): Pulling and Sending Records	Attachment O_NAMCS EHR Record Pulling Burden.docx	Yes	Yes	Fillable Fileable
Form and Instruction	0920-0234	National Health Care Surveys Release 1	Attachment I_EHR Implementation guide templates.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	0920-0234	HL7 CDA® R2 Implementation Guide: National Health Care Surveys Release 1,	Attachment H_EHR Implementation guide.pdf	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 50	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 0 %

	Requested	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	200	68	132
Annual IC Time Burden (Hours)	200	68	132
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
Electronic Health Record Variable List	Attachment G_Electronic Health Record (EHR) Variable List.xlsx	12/20/2024

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.