following items show the exact content and of that part of the MFI questionnaire which to the classification of establishments within
of the RPS-I.
L DESCRIPTION OF ESTABLISHMENT. Pl ease read 811 of the clnsses liared below, then place sn “X” in the box opposite the class which best desctibcs this esnblisbment.
a. HOSPITALS
t 0 General hospit& . . . COMPLETE S.nton B on Peg. 2 z f-J Specidcy hospits (I”lnol”d.. In-tllut*on. or horn.. Ior B. ment.lly l.M.llf~d) . . . COMPLETE S.tiion C on PaI. 2
Note: If this is a huspltal systwn composed of a general hospital and a specialry hospita1, complete both Section B md Secrim C. If it is composed of more tbsn one specialty hospital, complere Section C for me of them and furnish the same btfotmstion for each of the orbers on a sepsnte sheer of paper.
b. ESTABLISHMENTS WHICH PROVIDE NURSING, PERSONAL, OR DOMICILIARY CARI
3 0 Nursing Home
COMPLETE S.ctlon D on Parr. 3
COMPLETE S.st1.n E 0” pow 3
34
! Swiion B . GENERAL HOSPITAL
1. TofuI nvmkr of &ads ngulorly malntolnod (set up and staffed for usa) for fnpntlnt~. (In&& beda fn rdxmirs of the hospital such u wards or convalescent units. Exclude beds wed exclushcly for cmer
gency services and b.ssiners for newborn infants.) . . . .
2. Dow this hospltal .drnlt cblldnn only? t O Y C ‘ 2 0N.x
3. On the orwag., how long dld potlm~ I l--J Less than 30 dmys stay In this bspltol during colador
t 0 30 days or PM yam l%l?
a. Number of physiciaw (including residents and interns), nurses md ahcr professional peraotmel, rrd rechaictn~...,...
b. Number of all orher paid employees inclodins adminiscrat.ivc personnel, cl&cd and office rotors, atmd.nr~, sad custodial wakers.. . . . . C. Totdnumbcrofcmployeer . . . .
. .
mp*ncnr*...
7. Number of admissioae to this ward(s) during calendar year l%L . . . . 6. Approrimare sren~c daily CCIISUS in this ward(s) during
c~leod.~ye~r1961...
0 0 Psychiuxic
0 hknrd deficiency or recuduion
2. Dow this hosplkl admit chlldnn o,dy? I I-JYrs z i-JNo
3. Total nmbw of beds nguforly ~rmlntolnad (.n up and sWf.d br US*) for inpe,ia,~. (Erclvd~ beds used exclusively for emegency services and bw&ats &ox newborn infann.).. . . . .
4. What was the number of inpotlwt admissions to lhe hospital during s~lmdor yar l%l? . . . . 5. What was the appmxlmae avemga dally cansus during &los&r ymr l%l? . . . .
6. On the awmge, how long dld patlmts stay In this 1 0 Less Ibaa 30 dsys
hospital during cslndor year 19617 P J-J3O&ysorlnae
1
7. Numbw of pafd l mployws. (Insluda proprietors, muu~ers, and all pold employees rho nsudly roll 15 haus or more . week in this eamblirbmenr.)
a. Number of physicians (including rcsidinrs and interns), rnurses md o&r profeasioed personnel,
~ndttchnickng...
b. Numkr of dl other paid employees including admhircmrive personnel, clericd and office workers, utcndmrs, urd custodid workera. . . . . 5. Tot~lnumberofemployee...
35 I
Section D - ESTABLISHMENT WHICH PROVIDES NURSING, PERSONAL, OR DOMICILIARY kARE NOTE, If the tcpozting establishment is I hospital which has s nursing bomc unit (“Yes” box checked fn Question 9,
Section B a in Ouestion 8. Section CL the items in this section refer to char nursina home unit onlv.
I. Total numb.? of bwds rqulnrly monntalnod for patl*n~ or nsldants. (Inslud~ any beds set up for use whether ot not they ate h use at the present rime. Exclud. beds used by stsff ot my beds used
crclusiveiy for emergency set&es.) . . . . . . . .
!. Tot01 numbwof pwsons (patiwts w nsldontm) rho slopi in thim l stabllshnant last nigh+ (.x&ding
.mployawond pmprlstor~)... t
I. Fx the purpose of this sntvey, the following list of set&es define “Nursing Can”:
Nas.1 feedings Encmn Applic~rion of dtesshS8
Carbererizatioras Hypodermic injections ot bw,dagcs
Itrig*tions Intnrcnoru injections Bowel md bladder
Oxygen therapy Tempcnrutc - pulse - rerpimtion retmining
Full bed b.ths Blood presswe
Du,hp th. pas, s.v.n d,,ys, bow many of tha P E R S O N S In Pwstla 2 ne*lwd “Nursing Can?‘: . . . . III
I. Which of ctn foIlmIng smisw an ROUTINELY provldwl? C ’X” aI1 tial wwly)
I 0 Stlqcrvirion .is provided over medications l 0 Help with tub barb ot shower rbrcb may be selC&&istered
s 0 Help with dtes&S
z 0 Medic+ms td,m accotd.ttcc and tresrm+s mth pbyarcws’ U C -admini* 6 0 Help with cotrespondence ot shopping 7 0 Help ritb w=lkinS or get&g about
I 0 Rub and m.ss.ge * 0 Help rich feediiS
o 0 Nat tespwsible for pmviding any scnicem except mom and board
I. Nunthor of paid l mployoae. (Include pmprietora, managers, and a11 pald employees rho usually work 15 louts ot mote s week h this establishment.)
cm. el”.n dwwtl I” Itern 54 .hO”ld b. tll. .Yln 0, *. Ill”“. .hom in n.m. .t*., 56.. .“d so.,
a. Number of registered professional muses.. . . . . b. Number of licensed pmcricd muses. . . . c. Number of all other pald employees fncluding pbysicisns, proprietors, managers, nuts& aider,
otdedies. clerical md office workers, atccndsztrs, and custodial workers. . . :. . . . d. Total number of employees . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
000
* “. S. GOVERNMENT PRINTIN OFFICE : 1906 0 - 798-850
OUTLINE OF REPORT SERIES FOR VITAL AND HEALTH STATISTICS Public Health Service Publication No. 1000
Series 1. Programs and collection procedures. -Reports which describe the general programs of the National Center for Health Statistics and its offices and divisions, data collection methods used, definitions, and other material necessary for understanding the data.
Reports number 1-4
Series 2. Data evaluation and methods research .-Studies of new statistical methodology including: experimental tests of new survey methods, studies of vital statistics collection methods, new analytical techniques, objective evaluations of reliability of collected data, contributions to statistical theory.
Reports number 1-13
Series 3. Analytical studies. -Reports presenting analytical or interpretive studies based on vital and health sta
tistics, carrying the analysis further than the expository types of reports in the other series.
Reports number 1-4
Series 4. Documents and committee reports .-Final reports of major committees concerned with vital and health statistics, and documents such as recommended model vital registration laws and revised birth and death certificates.
Reports number 1 and 2
Series 10. Data From the Health Interview Survey .-Statistics on illness, accidental injuries, disability, use of hospital, medical, dental, and other services, and other health-related topics, based on data collected in a continuing national household interview survey.
Reports number l-26
Series 11. Data From the Health Examination Survey .-Statistics based on the direct examination, testing, and measurement of national samples of the population, including the medically defined prevalence of spe
cific diseases, and distributions of the population with respect to various physical and physiological measurements.
Reports number l-12
Series 12. Data From the Health Records Survey. -Statistics from records of hospital discharges and statistics relating to the health characteristics of persons in institutions, and on hospital, medical, nursing, and personal care received, based on national samples of establishments providing these services and samples of the residents or patients.
Reports number l-4
Series 20. Data on mortality .-Various statistics on mortality other than as included in annual or monthly reports-special analyses by cause of death, age, and other demographic variables, also geographic and time series analyses.
Reports number 1
Series 21. Data on nutality, marriage, and divorce. -Various statistics on natality, marriage, and divorce other than as included in annual or monthly reports -special analyses by demographic variables, also geo
graphic and time series analyses, studies of fertility.
Reports number l-8
Series 22. Data From the National Natality and Mortality Surveys. - Statistms on characteristics of births and deaths not available from the vital records, based on sample surveys stemming from these records, including such topics as mortality by socioeconomic class, medical experience in the last year of life, characteristics of pregnancy, etc.
Reports number 1
For a list of titles of reports published in these series, write to: National Center for Health Statistics U.S. Public Health Service
Washington, D.C. 20201