Form #4 Form #4 Example Screen Shots of Web Site Information Collection

AHRQ Medical Office Survey on Patient Safety Culture Comparative Database, Supporting Statement B

Attachment J: Example Screen Shots of Medical Office SOPS Data Submission Web Site Information Collection

Figure 1: Submit questionnaire and link questionnaire to medical office(s)

Questionnaires

Upload a questionnaire

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Status

Date Received

File Name

Number of Sites using this Questionnaire

Note: Acceptable file formats are .doc, .docx, .wpd, .pdf, or .rtf.
Please select a file. File must be a .xls or .xlsx file. Acceptable file formats are .doc, .docx, .wpd, .pdf, or .rtf.

 

Language

English

Spanish

Other

Select the sites that used this questionnaire   Check All   Uncheck All

Select	Site Name	State
	Medical Office A	IL
	Medical Office B	IL

Figure 2: Upload data for each participating medical office

One at a time

Submit Survey Data File(s)

Instructions:

• Once your questionnaire is approved you can begin submitting your data file(s). Select "Submit Data File" next to the medical office you are submitting data for to upload your file(s).

• View data specifications. (PDF, 153 KB, PDF HELP)

• View sample data file (XLSX, 13 KB)

<< Previous | Next >> Records: 1

Submit

Status

Site Name

Denominator

End Month

End Year

Current Data File

Current Data File Status

1.

Submit data file

Pending

Medical Office A

200

11

2010

 

All at once

Instructions:

• Upload survey data file for multiple medical offices. Site IDs must match those in the Site-Level data file.

• Select 'Browse' to locate the data file.

• Select 'Next'.

(Step 1 of 2)

Submit Data: Select file

 

Note: Only Excel files are acceptable (valid file extensions are .xls and.xlsx).

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