Public access to statistical information of a public hospital

MAINE STATE LEGISLATURE The following document is provided by the LAW AND LEGISLATIVE DIGITAL LIBRARY at the Maine State Law and Legislative Reference Library http://legislature.maine.gov/lawlib Reproduced from scanned originals with text recognition applied (searchable text may contain some errors and/or omissions) This document is from the files of the Office of the Maine Attorney General as transferred to the Maine State Law and Legislative Reference Library on January 19, 2022 J. ., • •riich~rd S, Cohen st~~:;t) 1 ~1;.; :•! l~>~X}f.\.\."• :m£-m;~ xr.r. x :im ~:-.-:< A"I HHiNfa 'V c,raNI-: n f.,L, J Ol-1/11 1\1. It I'/\ Tl•. Hi.tl N l:IM.1:K.l0XXlll-r.~.XMt>lC< STA'J'E ()lo' M AlNJ1: D1~;(•/\lt't',\W'r-l'1' 01" 'l'IJI-: Ar·rc>1tNl!:\' G1~Nl!:ltAL A lJ(HJl:-,TA, .1\1 Al Ng 0-1:J!-!3 li'ebruar.y .5, 1979 Honoi:ablc Walter tv. ·uichens Maine State s~nate State House Augu~ta; Ma:i.ne 04333 01;.PU f V /IT I <JIIN!iVS Gt.Nl.lll\l •. . .RE: Public Access ·to Statistical Information of a Public Hospital Dear Senator Hichens: Th.is ·r~~s·ponds · to your rcqucist for an opini.01-i' a·s to· whether a pub,1 i.c hospi tnl j_s r0qu.i.red hy law to provide its statisti'cal in- fonn~t icn td a priv~tc viti~cn upon rcgucst. There are no statutc.~s which speci.f ~c.:i.lly give a priv~te e~ti- zen the right to access to statistical information directly from a · hospital. However, much of thi8 information is avi:1.ilabl~ to the 'pubiic inc.lir:ectly through sourcef5 other than .the hospital. The .Heal th Facilities Inforniatio~ Disciosure Act, 22 M. R. S·.A. S35]. .E:!t seq., requires hospit.alB to compile, and di.s~lose a consid~;r:-able amount--o"f-da tn rclat,i.ng to.administration of the f'1c.llities. Section 353 of the Act establishes the Health Facilities Cost Review Board~ Section 3~8 (4) rctiuires the hospitals to submit the fol;Lowing informa- tion to the Doard. A. Financic1l information. including costs of operation, rcvnnu~s, ~ssets,. liabilities, fund balances, other. income,. rate, . charges, ~nit8 of R~rvj.cas und such other financial infoim~tiod.bs· th0 board dciems ~ccessary for the pciformanco of ils duties; and · B. Gl.'.:opr~ of i:erv.icc• inf:pnntit.i.011, jnclucHng bi~ci n1pacit}', by ·f:erv.ico p,rovided, ·special ·. iervices, ancillary services, physician pro~ filc·s in tht! a9q:rcgato bj, clinti::al spccic1lities, and such other scope o:f service information as the l>oarc:'l c1,~ern:, necessary for tli(~ pcrforrttnnc~ of itR duti.L:!S. .. l ionorable Walter W. Hichens ;.~Laine S1:ate Senate -2- Feb.ruary s, 19i9 Section 358 (5) requires further that the hospital provide 'to an 1! ~ •• independent data organization a completed Uniform -Hospital Discharge Data Set, ·or comparable information, for each patient dis- charged ·from the facility. 11 With the exception of information rela- tive to identification of individual patient.s or healt,h care ·prac- ·. titioners, _-this discharge data is available to the Board. The information in the possession of the· Board is available· ·to the public; pursuant to 22 M.R.S.A. §365 which reads as follows: ' ' •Any information, exc.ept privileged medical in- form·ation, which is filed with the board under this chapter shall be made available to .any public or· private agencies or other persons upon request, pro- vided that individual patients or health care prac- titioners are not directly identified. The board shall adopt its own policies pursuant . to · section _366 and ··after a public hearing· for· information mao.e ava-il- able which may indirectly identify a particular patient or heal th care p·ractitioner. . · ' . . . The . Bureau of Heal th Planning and Development of th_e Department of Human Services obtains the foregoing list of information from the Board, using.· the attached· forms. The data is . there tore available to the public directly from the Board, as well as from the Department of Human Services [See l ·M.~.s.~. S401 et seq.,. Freedom of Access]. · Another source of information for individual hosp.ital stat.is-- tics ·is the Bureau of Health, Division -of Hospital Services, an agency within the Department ot Human Services. This Bureau ,ts in.charge of licensing all hospitals ·in the State. The application .for license form annexed hereto indicates the type of data contained in the Bureau •·s records. This in:formation·, again, is available to the _public pur~uant to 1 M.R.S.A. s ·401 et seq·.,. t _he so-called Freedom of Accei'ss Laws. . · · · . Finally, the Depart.men·t . of · Human Services maintains records re_: · fleeting the tota·l numbers of births_,_ deaths,· abortions, etc_. occurring within the St~te tor a given year. _This information, however, is not necessarily broken down on the basis of individual hospitals. These statistics are also ope·n to the public. pu:i;suant to l M. R. S • "-. S 401 et seq . . . V;.;l truly yours, 'r:tr'rt~ s :.~\. Thomas E. GeyerJ .Assist.ant Attorney General TEG:mrn t TO SVJ!JECT: FROM : - 1 - STATE OF MAINE DEPARTMENT O'F UUMAN SERVICES Division of Hospital Licensing Department of Ru~n Servic~s State House, Augusta, Maine 04333 LicenRe No; Checked By: Approved: Application for Renewal of .Hospital License fOJ: the Per~od of:·, . . . . . to: --------- (Name of Hospital} (Street Address) (City) . (Zir Code) (Telephone Number) .Under.the provisions of M.R.S.A. 1964, Title 22, S .. 1811-1R21, an act relatin~ to licensin~· hospitala and related. institut-ions in the .·state of Maine~ 8'PPlication is hereby made -to t-.,e De-partment of HU'l'llan Services- for a: license or renewal.-of. license to mainta!n end operate f _ -~eneral- Hosi,ital, as h_erein specified. 1 --A~~licant hnApital is owned by: ______ ____ __...._..r ______________ _ • Operated by: _____ _______ ______ _________ _____ _ 2. Chief Executive Officer: .· . --------==--:-------------- -=..,.....,=-=------- ( Name) (Title) 3. Number of Beds by Level of Care:, Acute Hospital Be~s Bassinets Skilled Nursin~ Intermediate Bo_ardinR Home Loca~ion(If other than above) - --------- ----,- .. -.--.... - .. . · •· . .:ck those h<?nl th-care oervices you pr.opoae to render. · Lieenac w:Ul ·be lhnit~~ to .~al th-care services ,md beds und bnRsinets applied· for and approved~ 'I'h~ first ~1·ot.ip of ocrviccs relates· to Dai l\' Ho~rdtal !np;i.tient Servic~s. cave number of bcrla by catcv,orv. This total number of beds nhould agree with the totals on the first page, The second group of services rela tea to Ancillnn• Services which can be provided to either inpatients and/or outpatiento. DAILY HOSPITAL IN1'ATIF.NT SF.RVICES Acute Care- l. Surgical 2·, OB/r.YN · 3. Pediatric 4, Psychiatric 5. Medical · 6. Isolation . 7, Detoxification .8. Alcoholic Rehabilitation llX Private No. of Beds - --- - 9. Other Acute Hospital Beds Acute Bed.Totals· - ---- 12X Semi-private· No. of Beds 15X Ward· No. of Beds 16X Other ~o. of Beds (These totals combined with int.ensive care and Coronar1r care beds should equal acute beds under 3, page 1,) · Skilled Nursin~ · ·\termediate Care .. ____ , ___ _ ~ - " · -:oardin!' Ho!!'le Care \ 20X INTENSIVE CARE o. General 1. Surgical 2. Medical l. Pediatric. 4. Psychiatric ~- Neo Natal (Level It)- 6. Ne~ Natal (Level III) 7. Burn Care 8. Traurn·a. 9. Other(Specify) 21X 'CORONARY .GARE BEDS 1, Myocardial Infarction 2. Pulrnonaey Care 3~-Heart Transplant ---,lt.-Other-(Spec-:i:fy)-:--- - . ' - • ·- ··- ---- ~~ .• ·---·➔~- -----.. ·--· .. _ .~----· ... -- ... . • - J ~TAT; AN<:IU,ARY .srmvrr.r.~ , t ( isx l'HAR'fA<:V . ... -nc 1.A'RORATORV 1. Clinic.al 2. Anatomical Pathol~P,y '\. llematolqsw 4. Chemistry . s. ImrnunoloP,y 6. Bae te•riology 1 .• tTrine a. CvtoloP.V 9. Other(i::pecifv) 32X, RAO!m.nr.v-ntAt";NOSTIC 1. An~iocarrlio9.ra,:,hy Check 45X EHF.Rr.F.NCY ROOM Level III Level II. Level I 47X AUnT()JJ)cy· · SPX ORr.ANI7.F.D OUTl> ATIF.NT SF.RVICES 51X ORGANI7.ED CLINICS l. Psychiatric 2. Surp,ery 3. Admittin_g 4. Diabetic 5. ENT . ·6. Eye . 7 • . Ob/Gyn Check -- 2'. ·ComTiuted Tomographv Scan-Head· ,. Com,ut~d Tomo~raphv Scan-Tota~l_B_o_d~v---- 8. Orthopedic 9. Pediatric 10. Cardiolo~y ~ f 4. "fammop,raphy 5. Anptiography 6. Other(Specify) "4'3X R.AnIOLOr.Y-TltE'RAl>ElJT1C (Radi~tion Oncolo~y) . 1. Radiation Therapy · ·Cobalt Therapy Radium -Therapy l =1tx -r-ruci~AR ?-mnrr,r~rF: ' ( 1. Dia1.nost'ic . 2 • Therapeutic · · 16X. SURGICAL. SF.RVICES l. t.eneral Sur~ery 2. pr~an Transplants 3. Open. Heart Surp;ery 4. Neurosur,a;erv , 5. nrthpoaedic Sur~erv 6. D~y. SurP,ery . . l•. £.~hfrrJS:g__ecify) '- ,_'\ ··11x ANF.S'fllF.~ A "~~~e~~i°'tv l. Anesthesia M.D. 2. Anesthesia C.R~N.A. 4~ Acupuncture "V4X BT.Onn BM~ '\9X n~coLnr.y ~ERVIr.r:· A l.X 'RF.~'l'IRATORY SF.R~HCF.S l. Inhalation ~ervices ... . . -~ --- 2. _Hynerbaric Oxygen Ther:1pv 1. -·Pulnonarv Function. · · --- .. 2X 'PHYSICAT, TimRA'PY 1X nr..r.m1 f.TI ON At. T!IER.A.''PV ·~4X h P f.E.C!I PA Tll O J.nr,v -- 11, Physical Medicin~ 12. Urology 13, Cancer. 14. Ophthalmologv . 15. Other(Specify) 54X AMBUL.4.NCE SERVICE 56X MF.nICAL SOCIAL SERVICES 59X HOME HEALTH £ERV!CE 7J."X R'P.r.OVF.RV ROOM 72X l:ABOR A.~D DELIVP:B!, 1. Labor Room .2. Delivery Room 71X RKG 74X F.F,~ 76X NURSV.RY No. of Bassinets L N~born1Z:-eveI""""I)___ -· - ----· 2. Premature ---~ -_-_3_.-I~Q!Jtion_·=--,..- ··-- - -- --,,.,. _. ___ . Total Bassinets · (Should a~ree w~th total, Pap.e ·1) AMIHTT,ATOR'Y CAR.f. CEN'l'ER . . -.--·-----------· .... ·---·- • • .tf:~AI, DIALYSIS T.-tnpaticnt1femocti.al:tsis 2. _Inpatient Peritoncnl Dialysis 3, Outpatient Hemodialysis C:heck 4, 01Jtoi:1tfont Per:f.t-n.,cal Dialysis .J• J.l"B.J.11 ... u~ uUlilUU.1.cS.L,YoJ.~ ' · --_.,.:: .. . _ ,_- .. --·: .•:••·.;-·;-:.-=,-,_-_______ ____ ___ _ 6. Training Peritoneal Dialysis JX OTHER SF.~VlCES 1. Dental Services 2. Electromvography 4 ~ Recreational Therapy 6 .• Ul~rasound · · . 7. Other Therapy(Specify) 8. Patient Education/Training . q, Pod.\~\,;.\cJ. Se.~..,,c..e.s 91X PSYCHIATRIC/PSYCHOLOGICAL SERVICES 1. Rehabilitation · 2. Day Care- :3. Individual ·_Therapy 4. Group Therapy 5. Family Thera~y 6. Bio Fe~dback 7. Testing 8. Electric Shock Treatment 9. Other (S~ecify) List. anv other hosoital facilities at locations other than the above addresses which are ••'l'\der the same ownership and ·governin~ authority . . { - l. s. · Accreditations and Cer.tifications J CAH: Date of Last JCAH Survey: ________ .Accredit~tion for: 2 yrs_.__J.yr.~None__;_ A.o.·A.: Date of. Last A.o·.A~ Survey:_· ___ ....... Accredited for ___ years. Laboratory.Accredited by C.A.P. Date: Number of Years. ----- ----- ---- 111 u e Cross _Part'icipatin~: _ _ _ _ _ ___ ______ o·ther: _ ______ ~--- -- Medicare/Medicaid Certified - - --------- - --- PS RO DelcP,nted Non-Delegated - ------- ---- --- ~ - ------ - ----- l'SRO No~-'Participa.tin~,_ ___ ________ _ Partiallv Dcle~ate.d by ?SRO !or: Admiesions and Extended Stays ----- - --- --- i ~cnl Care Evaluation Physician Adv-isor -------- ------ - ------- ( f I \ . . --: !> - l-1ao liogpital Chartet', Constitution,. or nyl.awa been amended since last liccnRe appli.c~tion? ___ ··- --,-- -:--- (If "yes", file an amended copy with this application.) Date on which current hospital c:hirrtcr, cq11stitution, or bylaws adoi,t~d by Covernin~ Authority . • ------------- . ' .,;.;.:. ••.·· ,...·--· .... --~--- Have Medical Staff Dylavs been amended.-since last license application? .. . . ...... . ------- (! f 11yes", file an amended copy with this applicntion.) . Dat_e on which curr~nt medical staff bylaws were approved by hospital ~overning· authori~y - --- - - ---- - - . . Use the s·pace· below to elaborate on any of the answers giveri above or to make any pertinent remarks. Refer to each item number to which co~_ents pertain·. I,_-,----,-----=---:,--,--...--,--,-- --,---,----,,-bein~ duly authorizJd to assume responsibility for the conduct of the· institution herein descri~ed, hereby file this application for a license and agree to assume responsibility .for the institution, complying with all the current regulations o·f . the Department of Ruman Services, as authorized by M.R~S.A., 1964, Title 22t s. 1811-1821 and amendments and additions thereto. · · DATE: ----- - - Chief Executive Officer {Address of Chief Executive Officer, if different from above) f'EES: $ 50. 00 FEE FOR·_ A HOSPITAL OF LES.S THAN -SO BEDS IN-._ SIZE, $100. 00 FEE . FOR A HOSPITAL 01 S1 TO 100 BEDS· IN SIZE, AND $200.00 FF.R FOR A HOSVITAL LARGER THAN 100 BEDS IN SIZE. MAKE CHECKS mr MONEY ORDERS PAY.ABLE TO TREASURER OF STATE, AND MAIL TO DEPARTMENT OF HUMAN SERVICES, STATE HOUSEi AUGUSTA-, ·MAINE 04'.333. ·-· ··•- •· · ·- · -· - - 1 f I t I l1 J I I -1. l i' I I • ~ . i ~ I ! --- l ( I ' ( l I i • l'OIIM HDS.\ "ORM&RL~ .......... t 11•14-.UI CONFIDENTIAL• All i11lotma.1ioa "kkh c,ould p1:it1111 idcn1Uic■1ion of an individval or of ■n r11abli1kmen1 .,;JI b• h'cld confidendal, .,;fl•• ucd oaly l,y pcH0<11 caa,,i•d i• ud for the pu1poou ol ,he ,urvcy ud will not ~ di1d0Jcd or ,rlc■scd 10 01hcr pc11on • or u~d for an)' 01hu ~•rpon. DEPI.RTMENT Of HEALTH, EDUC/.TIOM, .lNO WELFARE ·p.,l,Hc Huhh Service H .. lth Ruo.,rc.u Ad111lnl~trollon ND!IOl\ol Center far Health ·Stotlst1e1 MEDICJ.L ,USTRJ.CT - HOSPITAL DISCHARGE SURVEY I. Patient Identification 1, Hospital number ............ . 4. Data of admission Month 2. HOS llumber ._ ........... ~ ... .. S. Date of discharge 3. · Medical record number ... .. Month . . II. Patient Charecteristics 1, • Date of birth: _________ _ 2. Age (complete ONLY· Day Year oav Yter Month Day Year if date of birth not given): { 1 Or.oar& __ U_n_lt_s__ 2. 0 ma'lthll 3 D c1ava 3. Sex: 1 O Male 2 QFwnale 4. Race or color: 1 O White 2 0 Negro 3 0 Other nonYWhite ·4 0 "Nonwhite'' 5 0 Not stated 6. Marital status: \ ·o Married 2 0 Single ~ 0 Widowed CO Divorced 6 0 Separated 6 0 Not stated 6. Discharge status: \ O AHve Ill, Diagnoses and Operations 1 •. Final diagnos_es a, Principal _di_a;no 1i a: • b. Other diognosn: □- IBY91'&e irlde 2. Operations:------- ----------------- ------- --- Completed by - - ---------------- Date FOR NCHS USE ONLY Diagno·ses ____ _ Operations ____ _ . Flgure I. MediClll Abstizct form · 67 I l ANNUAL SUHVEY OF HEALTH FACILITIES· t·IOSPITALS 1979 . . PL EASE REl-'ER T~ THE INSTRUCJ"/ONSAND DEFINITJONSSHcET ... . . A PERS.ON COMPLETING REPORT 11 th!'rit are questions il!J<,lllf your respcm,e~· 10 this surny, who 1houfci lu, con1acred? · NGm•'---------- ~~-- --,------ --- (p/1:,11 print} -· 7,1. No. _ _ ,--____ _ ___ ____ _ _ En. __ _ B. REPORTrNG PERIOD (12 month period January 1, 1978 through Dece.mber 31, 1978 preferred) Indicate ptrlod u~d: Beginning Oats - ----,.:-::~:-on-t.-.'h- ·--=0a=--y--.Y...-,-,.-,.- ---- ,·. Endino D11te _ _ __ --;Mc.o-n-=m-;,-.-,b'-.1-:-y- .-~,.. 11 _ 11 ,. ____ _ -[c._-fACILITIES AND SERViCES -·· ........ ---. ·-·- ·c---- •,•'I • . . ... , . . L Checlc th• bolt 1CS.ntifyin9 a facility or NA'ic• whic:h i1 avallebl• within your hospital 13• 1M acci,mpa,,ying lnsuudiON and d■fini1iDffll sllwt). 0 1 •. Panopentlve RecoYery AOOffl. - . □ "Z7. Cllnigf Psych.ol~IIY ~il:n. . 0 2~ 0,,-H•wt Surgary F.ciHtlw O 28. Ori,atJind Outpetien\ C•partnient □ 3. Phi,m,aby w/Full•tim~ Raglst.-.d Pha,macist 29. Emerg-v D•partm•nt 0 4; Pharmacy w/P.,>rt-tim• Ragist•ed Pharmacin □ a. uvel I 11 :. Twenty-four Hout E"'41tget<Cy Care·. □ S. X-Ray Th-py O b. Lml ·II: Standby l!mw~ Can 0 6. Cobalt Th..,.py · □. c.- Lnal I: I nhlal Tr lag• 111d R~■rral Cal'lt 0 7. R.ldiuffl Tlm:ipy D 30. Scc.lal 0 Wo'1c D1partment 0 B: Ct111mothi.npy .□ 31. Family Pl.,ni~g S1nile11 -Numbw of Vllltt ---- 0 9. DiagnOA:ic R.aclioitotop9 FacilitY □ 32, Ganftlc Counseling S1ivlcs □ 10. Th-pwtia Ra~oi1otop• Facility □ 33. Abar1ionS.rviCA1 {outpaciand-Nun1berof Visits ___ _ 0 11. Histopa(hology l.lbonitMY □ 34. Alcoholilfll S■rvic" (outpatiawtl -No. of Vwla ---- □ 12. Otg,1t1 B.ank □ 35, cti.mlcal Dep.nd,n~y S.,v!Cllt lout,:,11t1ant1v· . • . -Number ot· i,111 0 13. Blood Banlt D 36. Harne Cani 01partm1nt · ---- □ 14. EJ■CIU'Otlf'l~ph;ilography . 0 37_. Dental kwicff □ 15. Respiratory !Inhalation I Therapy' C■partrnitnt □ ali. Podiatric S1trvle•s 0 _16. Prem•~,. Nurs■ry O 39. SpNch Pathology _ S■rvice■ 0_ 17. R•n•I Dialy1is (inpati11nd D 40. l\u::lioiogy Servicu 0 19~ Physical Therapy Oapartm1nt C:l 41. Hospital Auidllary 0 20. Oecup;ailonel Th•ra~y Ospartmfflt O 42. ~o!i.tllt•ar.Srrvlces O~i •. ~'"':;,, ( f t , . t.:h,·r:t,.. ctu• b:,')l irh•11t:!·ti:1'1 " 1'",{ ... J."1(.1;11 1up.llc .. n\ Uhil r, ..... ,,:rl v:;111; •• 1J,r: li-,~pir,d. Uur·,u1J,1hr: Uhit lrni.h ,~1 UJ• i•htl s·1.:aH•~ct .,t lh0 f 1111t (JI~., ..... • •"pr,1111,q permtl. Aitn,1;•.11,11~ ilnd lllt,1;,t11•11r d,,y:. .,,._. 10 b~ 11M:urth•,: fu1 11,r. 1:nti,11 rdJJUrl111!.I p1:rinrJ, · b. f.p•tci~I c..,,., U11i1-. 0 ,. Catdiac lnr1t~i11rt C:ir,1 Ur1il D 2. lntensiY• Ciln Unit IMi11ud D 3. Burn C;ira UniT (] 4. SaU•C.1,11 Unit □ 5. P,.,h,1Jiliu11ion Unit 0 G,: Tu!;1ur.11l,,,-i, Uf'lil 0 7. P$.Y'-hi:ilric Unit 0 ·a. Padi,atric Unit □ 9. Obstetric Unit □ 10. Alc:ol\olism Unit 0 11. Ch,im,c.:,I O"penr!•ncy Unit. 0 12. Abortion Unit /ldmim'um Buds Set U,? (/nr:. In tvr-11nil 11nd St;,ffecl. 1,..,mfttrs) /r,parierrr t:•,,ys - -- -- - -· - □ 13. 0th'"' (sp1teily') _ _ ___ ___ _ _ _ 014. Ott,~rl~~c:ifyl____ _ ______ _ _ . ·- :--- 0 15, Och•r lspacifyl,___________ __ I ,..Oar-111~-• _r,lofb ~rkMbiifogiutnio ... i~er.aii• 8olh-rJi.,r&l••~~~iim~ Rapon tho number of beds Sll'I up !"-u, staffad on th• lat day 'Of yoi,r reponlo9 period, Admi,aions, disc;h;,rga,, inp;ti1nt d,ws and ditcharo• days ar, to ba recorded for u,,· entir11 · ritpo~ing period, · · ~ Bffl S11t Up •· · ar,d Smff,d Admlulon1 Dlicll■rgu lnpat/Mi·t Day, Oif:hwg._ Dl'/f □ 18. Skmcd Nur,ing Facility □ 17, lntam11dl11te ·ea,, Facility Fl. 18. EN,dmg Cat• B,ld, -- -.- c, Was tti.r, a paima~iini r;hang1 or. ~gnific11nt tamporary ch1111ga in tha number of staffed beds fot UN during tho rep~nln9 p,:riod7 YES □ NO □- ,. Bad Chenga I-+- or-): Date . ....,._,,__,,,,_...,,...._ 2. Bad Change· ,...:·0,-1:· Data . · · . · --- · Montlt Day Yur · · - ·-. -,.,.,.,...o-n""rh--:D:-11-y-~"",,-.,- 5. PATU!NT CENSUS on iha lat day of yCM1r _raporting period (ax.c:lud1 newborn,! ___ ,,__ __ _ 6. TOTAL ·INFATIENT CEATHS {itxc:lu·dirtg DOA's) for your nporting p,riod. ___ ____ _ FINANCI_AL DATA (for the reporting period only) · 1. PAYROLL EXPENSES ___________ _ _ 2. NONPAVAOI.L EXPENSES {lnclud111 Fringe Benefial· - - - ---------- .. ·-·-·-·--.. -·-··-·-·- - .. ' 3. TOTAL EXPENSES (1 + 2),=====-====== F. EMPLOYEE STATISTICS · · l I -.. Using your last payroll· WN"k, ph,ase indic:at,, far each cati,gory. th■ number of full•tim1 and part-lime 11~ploy11es, For ·part-time: •mpioye~ only. I also givir th" total number of hours worke:d durir11tth1 w•ek for &ach category. Do not includ• c:ourtll'Jy or attending staff, fep for service 1meloylHl'I, ··-· .... ,,.,.~- ,.. .. ---•-..... -.. _..,. __ ------· . .. ·-·-. .. . . ... . - - -· ..... . . .. . - . --- ' ----- ·---- { lr1J:i f'i H !(;T IOi\l!:; J),I\: L} U u: 11',JJ"i IUi\l:.; Fl)H .ANNUAL SUHVEY OF HEALTII FACILITIES: I-IOSPITALS 1~79 .A. PERSON COMPLETING REPORT· fl th• p1:,~on Ct)<T11,1h:tm\l llus r'!port ho, ;,iny qu,nrion,. hfl or .sho mnv call: N,rncy M11l,11ky or Brunt.la WP.bb!lr - 289·3001. C. ; .. ·: ·:: REPORTING PEntOD . . R,i~ord the·b;i<Jinnin'J ;ind r.nr,1in!l dat':!\ ol lh,: r!,PMtinn p~riod in u silC-di!)it rrutnbPr; for 111.>mplt, Jan. 1,·1978 shol41d b11 shown ,n 01/01/78. U1ili• zotion ;,hd liria,,c:,,s should b~ pnn.,_nti<d for d~ys rarionod only, .. , ·. ·. .. • FACILITIES ANO SERVICES 1. POSTOPERAT_IVE RECOVERY ROO.M. A s1::,ia,11t• rac:ili1y. usad ~>tdusivaly to mnn,tiw- patients r~overinn from :1n11uh11,ia or to ob~ervt p111i11n1~ for po~t-sur9ic.il rP.turn to phyiiological, st~bility. U th•Ht? s•1rvi.:,i•~n,11 pro..,irl~d in .in intensivtt c.:irij unit, r~porr only intan1i,r9 e;vr: un,t c,,,,. rr,,mb•rf r.HH(.:il bttl'uwl. · · 2. OPF.N-HcAAr SUt'\G!:H'( FACILITlES. The cquipmvnt ilnd m11f Mc11un,y co pnrform cp1m•htor1 s11r9uy. . 3 .· PHARMACY W/FT Rt:GJ!iT!:R!:.O PHARl\1ACIST.'Sup~rvisecl by ;i full,riml! regiW!r•!d pharmaciu who i1 employ!!d by th! hospital. 4, PHARMACY W/?T fll:GISTEREO PHARMACIST, Sup~rvi1fd li•t ,1 p:,rt-time r<>gi.r~rod pharmaciu who is employed by 1h11 hospital (N01'l'.: If you ha"'t Loth a full-timH .:ind~ par Mimit regirn1red ph.irm11ciu, check faciliry 3 only). 5, X-RAY THERAPY. Th11 t~11atm•m1 of dlsuic bv ro~nrgan r.ivs or Oth!r radiunt en~rg-,.; wirh exce?1ion of radium, c:o!>alt, or r3dioiso1opes. · 6; COBALT THERAPY. The use or th~ metal cobalr and th!t sp111:i111iurd 1:quipm;rn1 r!!quir!d for deorp thr:r~PV. threarment of c.inr.er and otfu:r dis11Mes. . . 7. RADl\.!M THERAPY. Th~ use of th,nnerill roclium lor th11 trl!n1m<!•~·1 of .:in abnorm;il c:oudiriori or dise;ue. 8. CHi:MOTHi:RAPV, Tre.J!rTl'!nt of d•s~as,i by 1.13" of drugs .ind c."'l.iinicals. 9.' DIAGNOSTIC RADIOISOTO?!: FACILITY. Th!! use ol radioactivo lso1op11s as. 1rm:ers ori"dica1ors to detect an abnl)J'rnal cnndition or dist.11111, 10. THERAPEUTIC RAOJOl:SOTO?E FACILITY. The u~e of radio11c1ive isotopes tor 1he rri:atm~I\I of an obnorrn1I condition or c.!iseue. 11. HIS!OPATHOI.OGY LABORATORY. A libor.i10ry in which tim,10 s::iecimenJ are exarrrln,id by a qualified pathologist. · . . . . 1 l. ORGAN 8ANK. A septrate reposito,y of the hospital, e,tablisl\ed for tho preservation ol such org.:JI\S as ey ■s, splao!n, liver, ve'1~h. ban~, and so forth.: . . . . . . 13. BL.000 8~.NK. A.mffdical facilitY with responsibility for each of the following: blood procurement, dra.wing, procH$ing, and distril>ullon. 14. ELECTROENCEPHALOGRAPHY. A recording of electric currents generated i_n the braill', by meant of el~1rodes 11pplieu to the scalp or b~in itself. . · fs: R,ESPIRATOAY THERAPY DePARTMENT. A saparaully orgar,izod deparrmanr providin;grttpirarory therapy service, to patients, 16. PREMATURE flll,JASERY. A s11p.a,a1e facilicv used u1clusivelv for th• care al lnfanu· whOSltblrth weight is 2500 grams 15.512 lbs.) or 1es-. 17. HEMODIAL YSIS (INPATIENT!. Provision or. equipmenJ and p11rson•I for tho tre-11tm1M1t of renal insufficiency, on an lnp11tient bi1ls.. 18. HEMODIALYSIS (OIJTPATIENT): Provision of equipment and p1~onnal tor tho tr■airnent of renal in1uHicieney, on un· outp1ti1nt baslJ. 19, PHYSICAL THERAPY OEP'AA,TMl:NT. F11ciliti111 for the provision of physical therapy .services preu:ribad by phyrici,ns ilnd administered by, or ur1der th• dlrocdon of, o qualifi!!d physical therapist. · . 20. OCCUPATIONAL THERAPY DEPARTMENT. Facilitin for th• provision of occupationaiJ therapy servic11 prBKribed by phylicieM 1nd edmin• isterlld by, or under tha dir~tlon of, a qualified occupatiO!'lill th1m1pist. . 21, REHAEill.lTATION OUTPATIENT SERVICES, The provision of caordinattd mul~idi51ciplinary physical rtstOt9tive ser,,ices to ambulatory ·patients und9t the dlrec:ion of a physician knowledgeable and experl1nc:ed In rehabilitation mtdicln1. 22, PSYCHIA'.rRIC OUTP:O.TIENT SERVICES. Organizlld hospital facilities arid services frN ui·, medical care (including diagnosi1 1nd trHtm•nt) or psychiatric outP,atiants. . . . · . '23. PSYCHIATRIC PARTIAL HOSPITALIZATION PROGRAM. Org.ini:i:11d hospftal facilitlaand sarvices ror da'f care and/or night care of psycbiatric p,nient!I wlio do not rtquir, 24-hqur-a<lay lnpacient c.ire. 24. PSYCHIATJ:\IC EMERGENCY SE~VICES. Orsanizcd ho,pltal facilltias and s1trvfcas fM em_argency outpatient c1t1 of psychierrle patisnts whc;is, condi rioos ara ::onsidered to raquir11 lmrt1,diau1 care. Staff _mu,t _b11 available 24 h~rs a day. . . 2S •. PSYCHIATRIC FOSTER ANO/OR HOME CARE. Planned pon-<Jl,charg9 psyd.)iatric obsefvetlon and eare. In tlla p1ti11nt'1 'plac:e of rffidenca or in ·,1n apprnved f01t1r home. . · ·. · · ,· · ·. · . ·· · 26. PSYCHIATRIC CONSULTATION ANO EDUCATION SERVICES. Provision of intel'J)i'etMt psychiatric consultation and ec!uc:arlon servic:e1 co· community ag1nclas and workers such .is rc:hools, police, courts, public health nurset, welfar1. agencies, ·clergy., and so forth. The pur;,os. Is to expand.th• mental health knowledge and comp1111mce of persomiol not working in the m,nt■I tiealth fi1ld and to promote goodmenral healcn .. through improvad u.nd11ntandic,g, atthude1 and behavioral patterns. . . . . . . . . . . 27. CLINICAL PSYCHOLOGY SERVICES,' Q,ia or mora 'clinical psychologi.stl1) wfio prowde diagnostic or therap1utic Jtrvic,, to inpetitn-u or outpatisrnt'I'. This mav be on a full-time regularly schoduled or on an lnt11rmitten1 basis. . . . · 28.' ORGANIZEO OUTPATIENT DEPARTMENT. Regularly scheduled organiied servicn or specialty cllnics to provide non-amt(!Jency servic11 on an outpatiecit basis, · 29. EMERGENCY DEPARTMENT, . • . . a. LEVEL Ill: r.-nry•FQur Ht,r,f Em11rg,nt:y Care Fac.lliry: Hospital facilitiH jr, this eat,tgory •r1111bl1 to handle vinually :ill em~rgency i;:ondl• tions detinitiv11ly except. for thos.e requiring very special procedure, or facilitifs such as cardiopulmonary ~ypass or renal d ialysis. Such facili, this will vary likely recai11e a significant number' of patients on raferral from other facilities In th1ir area 111d will only rarely find it necu ;ary to refer pati1ntt from their faclliry to an'Other. · · ·-----,---------- .L. ' ,.,,~. , .,. ..... •• - - - ~-f' •• ,..;· !J~41"1" 1.:-11·;.r,r,!J 1r1PJ\ll ':1•Jr~,-ri\'l'l!i"llt::i. _ · • >': •a /\II 11,.w,,-,1, ~h1;,,1,r cn,r,;.il-,11! thi~ \~.::liun, H;,,·,11ir.1I; th,11 .in· u11it~ of nn11-ho•,j,i1JI in~rilutioni huch ;,, uni•,..:r~iti••~ ;,11cf cormc1io•1:,1 in;:i E. F. t1111'1) •,f,,JUlcl t.,por, fur ll••• t10•,.,111,1I u1111 011lv, . _ , _ L1.:r:11:,•t ll•·th -il,•pon thi: 101.,I 111unl1~r of .:irl1Jh ,1/\Ci p,?cli:urir. b!•cl~ rc,r whir.l'I y(wr Fi1cili1y w111· lir.11rmul nn lll"•J l;,,1 rl,W of yc,u, ri•;,o,ti11~ p,:rincl, f;><cl,11J11 SNI-', ICi-. ilntl l}C b•tl\, E~c-lud11 hiJs,inet~. IJ~rJ1 Sµr LJ:> ,wd Sr,1!1,·rl-l"l ,,pl)rr t::t-t n,111111-.-r •)I ,11-ltllt :inrl P"dr,Hri,:. t,ud1 r~:1°, 1.or:•1 :i~,ril,,hl~ Ill tl,r tllld of 1la,, rr:1mttin<11,uri:.,!1, rl1•pc,r1 ,.1,l•1 o:>':lr.ttin'} t,~-rl,, ,.,,1 c • .:in-,1ru.:t11rl hud c.,u,1- ny. ln~lutlo: a:I l.11:d l;,,:ili<io:, th:,1 ;.,,. s,:t •~fl 1111d ~l;iff,,tf for u•,11 hy ir,p;,:i•rn!\ v,lil) h,w'! ,,.:. ,.: 11,_., l>~ci f;,,:,1,ti,i -:w;i~111~•.I to r,r r,,v,rv•,11 for u, .. ,,;, n•rh ;,s iH>l;,ci.-,11 u,,ir~. quiol rmu:H ;uuJ n:topti,:,n nncl oh1crvdtion uni\~. E>:clud, n•wb<,rn t,.i,,,:,,,,c, ;1~d b,nJ l_.l.:ilr1iM for pJti,w•~ r•!c1°;..-ing s0..:ci,1I pro<:•:r.hu11t for n pc,rtinn ol 1h-,ir stay who h~v._, orher h•,rl r,,~ilir,~, ,111;,;n,,rJ t', nr. re,11rvi,,J ro, th11m. f,rclud.-, tor c-c,,tnf'III!, labor room, p.:i~l•.JnPsthe,i:i or po-.1 cw..:r.iilvd fl!CUY~ry room b~rJ,, p,ychii11ric huld1n11 bi:d~ ur:iJ berJs th•t ~•~ u~ud o nly"~ holdinl} 1;1::ili"lies I:,: :,v:icr.a· p6or tu :h,:ir \rar,;l,:r tu anc,1h~r hm1,111 .. I. . • : · Admlr.;io11.,-1"':lud~ the nurT~h,,, ol ;)J<tl: on<.I p .. tJiatrk. n;lmi,~iom 0,11•1 l~xclurht ult1t,~) rt,is liyuro should i:iclucl'I .,r, P,Hi,.,,h a'1rr,i:t~d cJ.,rin!I Ill• rdpOl"ti'11J pc,forl ... ' . . . . _. . . . -· . . • . . .. : . . -o·,.1ch.Jl");oJr-.R<!port th~ mirr.b.r · ol nrhtl ct t<1trtl tn:di;,1ric di~clwr:N~ L'nly (inc1ud~ d~.irh~. exc!L•lf~ 111:wborr,1). · ·rhis -ri,1urt- ~hould Inc Ilic::.: all .,u·p,.tl:u,1~ dijch:lf',l,td dur,n,:r· 1h11 ,cp~r,in!J p,,riod. , ln1>Jtict>t D,1yr-A-1~0, t 1hi, nutnblfr ol tidul t ;ind p~diatric Jay~ of ciirt:l renJ:,rC•~ during the on tire re;>ortin!) p~riod. l)o nor u-:clud~ ~,.,~ cf earn tL•ndeorrd for inl.:1nts l>orn in thi! hospir:-il, btu do ir1clud1: tho~r. for rh11ir rno:hcrs. An innuil?nt d;,iy ol carri lll,o kno-.-.n :11 ·c~MuS dJy· r,: 'cu:cr,pittf b11d dc1y') i:, o period·or s11,vic• btlM<:en 11'1• ct'rlsu1 r;:king hours on two iL!Cctssi·,e cah,rul,ir days, th!! d.J'( of dis::hlr!J~ b~ing coun,~d onl)' Y11hen th• parient wits admitwd the ,am11 d;iy, • · b. 1-15. Special Care Uniu. Check th~ bo" ideri1ifyin9 ::i spacial core unit lnc~tcd ~-,i:llin th!! hospit.-,1 (~(.-e darir,itio11s bo:lc,w) and \1mr,ly l~r r,;,i;:h th«.nurn!:,11r ol ti~d, s11t u;i :md st~ll!.'d at tt>n ertd of.1tii, r,iporti,19 period, an;:J 11c!mh~loll~ nnd ln;>,,ti~nt d~ys for rh1 tn:ir~ r•1r1c,r1i;io ·p,..riod,· R~port <> unit only wh,m· :i ,,,t rturnl),:u ol h•:tls ti~.,;, t:i'l'tn p'!!rm~mirtlv a.i:9n::L.1 3nd m=,infoin~d tor a 1pecihc ~itr1,:c-1. Do r.ot coo,t•t -1 b.:d, discnatg<!, ar in~,uitn, a11y in more th:,n cin,i ca1e9ory. NOTE.: lncluc.f!l c·,.-ns/~,s b,!'tw•t:n H'l~cial c;o1re unlu·in 11-ie .idrninio,11 count l(,r each unit and r.epor, 1hc inpatiotnt days only for the tirn& spent in each ,pecijt c;;,re unit. • , ••• , , • •• • , •• •.•• , , ....... .. . , , • Special C11re Llnit Delinition, · . · 1. CA~DIAC INTENSIVE CAAE UNl1'. A special unit stntfcd s,nd equippl!d solely far tho in1i:n1ive cor,: of c:1rdi11c; pa1f'ents, 2. INT'ENSIVl: CARE UNIT (MIXED). A special unit in which p~1l1•riu lll'e c0r,r.l!nlr,m1d, by reuon:; or serious iltn~~s. witi'lout rvg.vd to dia;:in03is. SpP.(;iat lifa-nving te1chniqufl and ·•ciuipm11n1 otl! immcdia1ely av~llable, and patienls 1_r ■ undrr con1inuous observllion t,y nu:-slng staff spi.cially tr:iined and selected for rhft r:are of thi1 rype ol pa!il!M, . · · 3. BlJRN CARE UNIT. A sp,ci.-il unit Stalled and equipped solely for th■ trtatmt?nt of sev~rely burMd p.1tien1s, . 4. SaLF·CARe UNIT, A unit dasign,d for ambulatory patients who !'lllltl minim~! nursing.c11r1: but who m,m ,-main ~ospit11liud. - . 5. r-<EH~Sl LITATION UNt-T. A u·n'it that providl!f c00rdinat11d mulcidisciplioery physical rutoratlve 11rvic11 under tho direction of a phy2icien knowledgeable and ••i>erlet1cad ill rel'l.ibiliration m~icin•. · · · 6. TUBERCULOSIS UNIT. A unit th11t provides medical and/or rRhabi_litatlve tl'eatment sel"tlf.:e, to Inpatients for w~om the i?rlr11.:ry diagnosii Is tubetculotis or orher rtspiratory diseaH. . · · 7. PSYCHIATRIC UNIT. A spm:ifie s~tion, ward, wing, floor ot bulldlno devo1ed primarily to tha c:11ro or p,vchlatrie inpatlenr,. 8. PEOIATAlr. UNlT. A unit with ori,an~•d faciliiies ~d servicfl ror th11 tlevelopmcn\' end r.,1re of inianu end chitdrer,, wilh thit tre111• ment of th.:r diseH111. . , -..•. 9. ODSTETRIC UNIT. A unit with 0r9tnited fa11:ifitlet and ,vrvfcas perteiniJ\g to pragnancy •"d delivuy. · · ·· · . 10. ALCOl◄OLlSM UNIT. A unit that l!)roviclei medical car11 IJf'ld/or rllh11bilitative rraatment servic,:s to i11p1tle,m for whom the primary· rJ!aqnosil I~ al ,;oh r,llsm, : · · - · • _ · _ - , . . . 11. CHt;MICAL 0°EF-ENOENCY UN!T.. /\ unit 1h,r provid\11 m1dlc11I care and/or rol\abincariva treatmtnt 1m,icin to lnpalitnts for whom th'!r primary 1Ji11gnosis is ehemicai d.tpe<lc!cncy othor than alcoholism, . · • .-. 12. P,£,OATION WNCT. A unit that pr0vid11s pregnancy termination services to inpatients. lJ,is. CTHE~. U vour r.11cili\y has $peclflc bed units which ere not lis\■d above, please provid1 data on these "oth1r"_u1\it1, Oo not in-:hidi, SNF, ICF, or BC unit. . . . TG-18.- SHF ICF ANO EC BEDS. Report bads sat up and staffed, ndmls~ions, discharges and inpatient days accordins to the above ddini- tlon,. I~ addition, repo~ th• total nurnb1r of patient days oi care r11nde.red to patient, di~chuged during the reponfngpa;10c1(cfi!k:l-,1r;e , days>. Count all ·days of c;ir11 ;,nd■rl!d to patients who war11 discharged during the- reporting p1irfod, regardl ■si of wl\en they ent~.-,,d !ho ho~pitAI. Do not re-pon di!ch;irg11 days _fo_r p,ulents tr~nsferred bttwNn _short•rerm and rong•1erm units e~c1pt for th0$1! pe1ienu dis- chor~ fro.--n the long-term care unit fo110win11 tran,for. ln this cast, report discharge divs according to th, days of c.are renuercd in t t>e ·10ng.t1rm unit. _ · c. A slgnificr.nt te,·nporary change occurt when bed1 are temporarily_ Qut of use and not included In th• bed' cotiot. Ir '1-'es, gl11B b!ds llCld,;c! o_r withdrawn (show increau, by+ and d11c:rease by-) and datet or change, Jt more th.-,n two chenges occured durini 1h11 rop~,:ti"lg p~rlod, plt:i:-~e rapo,"t a~I cmnges an a res:,ar11e pieca of pap■r. · FINANCIAL·OATA 2. Non-payroll F.xpenus, Fringe benefits ara employer paid btn1fits-l.o., social u:eurlty, g~ou~ insurance and retir11m1nt benaliu.· EMPLOYEE STATfSTICS ··- . Complete this section according to the instructions given on the survey form. Report all full-time end part•tlm! p-~rsormel in columru A and e wl,o wire on the hospit;,1 payroll lit ol the lalt payroll wee!< in your repor:lnq ~~!_IE~: .. !.n ~o!u_mn. ~•!!£>!?4'..~-'~! . .toJ!(P..lfJ:i.l.ro.1 .b,01u.s .. wac.kil.d l1v .. al.L1.bc. .. -·-· _ ! __ ·--·-·· •• - .. • . ... •' • .. ... .. • --·· . . • • .