The goal of this information collection is to 1) capture the daily, aggregate impact of COVID-19 on healthcare facilities, and 2) monitor medical capacity to respond at local, state, and national levels. This information will be used to inform the overall real-time COVID-19 response efforts and possible resource allocation, and enable state and local health departments to gain immediate access to the COVID-19 data for hospitals within their jurisdiction. Information collection for long term care facilities are being added to this request. This Change Request is requested by the White House Coronavirus Task Force, and is submitted to add data elements to the Patient Impact and Hospital Capacity form in order to strengthen the COVID-19 response efforts.
The latest form for National Healthcare Safety Network (NHSN) Patient Impact Module for Coronavirus (COVID-19) Surveillance in Healthcare Facilities expires 2020-09-30 and can be found here.
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Federal Enterprise Architecture: Health - Public Health Monitoring
Form NA | COVID-19 Patient Impact Module Form | NA | Form |
Form 00920-1290 | COVID-19 Patient Impact Module Form 29MAY2020 | NA | Form |
Form 0920-1290 | COVID-19 Patient Impact Module Form - 14MAY2020 | NA | Form |
Review document collections for all forms, instructions, and supporting documents - including paper/printable forms.