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Survey Instrument
NAMCS

2004

bullet graphicPatient Record Form
View/download PDF 141 KB

2003

bullet graphicPatient Record Form
View/download PDF 363 KB

2002

bullet graphicPatient Record Form
View/download PDF 747 KB

2001

bullet graphicPatient Record Form (Version A)
View/download PDF 299 KB

1999-2000

bullet graphicPatient Record Form
View/download PDF 1.7 MB

1997-1998

bullet graphicPatient Record Form
View/download PDF 237 KB

bullet graphicInstructions for completing Patient Record Form
View/download PDF 38 KB

1995-1996

bullet graphicPatient Record Form
View/download PDF 63 KB

Survey Instrument
NHAMCS

2004

bullet graphicEmergency Department Patient Record Form
View/download PDF 158 KB

bullet graphicOutpatient Department Patient Record Form
View/download PDF 361 KB

2003

bullet graphicEmergency Department Patient Record Form
View/download PDF 383 KB

bullet graphicOutpatient Department Patient Record Form
View/download PDF 312 KB

2002

bullet graphicEmergency Department Patient Record Form
View/download PDF 1.5 MB

bullet graphicOutpatient Department Patient Record Form
View/download PDF 1 MB

2001

bullet graphicEmergency Department Patient Record Form
View/download PDF 259 KB

bullet graphicOutpatient Department Patient Record Form (Version A)
View/download PDF 319 KB

1999-2000

bullet graphicEmergency Department Patient Record Form
View/download PDF 2.1 MB

bullet graphicOutpatient Department Patient Record Form
View/download PDF 1.7 MB

1997-1998

bullet graphicEmergency Department Patient Record Form
View/download PDF 205 KB

bullet graphicOutpatient Department Patient Record Form
View/download PDF 208 KB

bullet graphicInstructions for completing Patient Record Form
View/download PDF 51 KB

1995-1996

bullet graphicEmergency Department Patient Record Form
View/download PDF 74 KB

bullet graphicOutpatient Department Patient Record Form
View/download PDF 73 KB

 

 

 

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This page last reviewed July 08, 2004

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U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Disease Control and Prevention
National Center for Health Statistics
Hyattsville, MD
20782

(301) 458-4000