Survey Instruments
On This Page
Note: In addition to NAMCS and NHAMCS data released on public use micro-data files, results from the survey supplements listed below may also be available in the NCHS Research Data Center (RDC). For example, data from the NAMCS Electronic Medical Record Supplement (2008-2011), the National Electronic Health Records Survey (2012-2015), and the 2008 NHAMCS Pandemic and Emergency Response Preparedness Supplement, are now available for use in the RDC. Please refer to NAMCS and NHAMCS Restricted Data Available at the NCHS Research Data Center Cdc-pdf[PDF – 53 KB] for more information, visit the RDC website or contact the Ambulatory and Hospital Care Statistics Branch at 301-458-4600.
NAMCS Survey Instruments
- Patient Record Sample Card Cdc-pdf[PDF – 95 KB]
- Physician Induction Interview Sample Card Cdc-pdf[PDF - 285 KB]
- Lookback Module Cdc-pdf[PDF - 75 KB]
- National Electronic Health Records Survey Cdc-pdf[PDF - 172 KB]
- Physician Workflow Supplement for EHR Adopters Cdc-pdf[PDF - 105 KB]
- Physician Workflow Supplement for EHR Non-Adopters Cdc-pdf[PDF - 106 KB]
- Patient Record Sample Card Cdc-pdf[PDF – 95 KB]
- Physician Induction Interview Sample Card Cdc-pdf[PDF - 288 KB]
- Lookback Module Cdc-pdf[PDF - 75 KB]
- National Electronic Health Records Survey Cdc-pdf[PDF - 189]
- Physician Workflow Supplement for EHR Adopters Cdc-pdf[PDF - 389 KB]
- Physician Workflow Supplement for EHR Non-Adopters Cdc-pdf[PDF - 386 KB]
- Asthma Supplement Cdc-pdf[PDF – 137 KB]
- Patient Record Form Cdc-pdf[PDF - 129 KB]
- Physician Induction Interview Form Cdc-pdf[PDF - 303 KB]
- Community Health Center Induction Interview Form Cdc-pdf[PDF -222 KB]
- Electronic Medical Records Supplement Cdc-pdf[PDF - 74 KB]
- Physician Workflow Supplement for EHR Non-Adopters Cdc-pdf[PDF - 116 KB]
- Physician Workflow Supplement for EHR Adopters Cdc-pdf[ PDF 199 KB]
- Patient Record Form A Cdc-pdf[PDF - 140 KB]
- Patient Record Form B Cdc-pdf[PDF - 125 KB] (contains additional questions on lab values on the reverse side, completed only by certain physician specialties)
- Cervical Cancer Screening Supplement Cdc-pdf[PDF - 132 KB]
- Physician Induction Interview Form Cdc-pdf[PDF - 354 KB]
- Community Health Center Induction Interview Form Cdc-pdf[PDF - 194 KB]
- Electronic Medical Records Supplement Cdc-pdf[PDF - 91 KB]
- Emergency Department Patient Record Sample Card Cdc-pdf[PDF - 101 KB]
- Outpatient Department Patient Record Sample Card Cdc-pdf[PDF - 98 KB]
- Ambulatory Surgery Patient Record Sample Card Cdc-pdf[PDF - 65 KB]
- Lookback Module Sample Card Cdc-pdf[PDF – 73 KB]
- Hospital Induction Interview Form Cdc-pdf[PDF – 477 KB]
- Emergency Department Patient Record Form Cdc-pdf[PDF - 118 KB]
- Outpatient Department Patient Record Form Cdc-pdf[PDF - 140 KB]
- Ambulatory Surgery Center Patient Record Form Cdc-pdf[PDF - 125 KB]
- Hospital Induction Interview Form Cdc-pdf[PDF – 4.8 MB]
- Freestanding Ambulatory Surgery Center Induction Interview Form Cdc-pdf[PDF – 299 KB]
- Ambulatory Unit Induction Interview Form Cdc-pdf[PDF - 104 KB]
- Emergency Department Patient Record Form Cdc-pdf[PDF - 103 KB]
- Outpatient Department Patient Record Form Cdc-pdf[PDF - 123 KB]
- Ambulatory Surgery Center Patient Record Cdc-pdf[PDF - 110 KB]
- Cervical Cancer Screening Supplement Cdc-pdf[PDF - 138 KB]
- Hospital Induction Interview Form Cdc-pdf[PDF - 359 KB]
- Freestanding Ambulatory Surgery Center Induction Interview Form Cdc-pdf[PDF – 263 KB]
- Ambulatory Unit Induction Interview Form Cdc-pdf[PDF - 110 KB]
- Emergency Department Patient Record Form Cdc-pdf[PDF - 114 KB]
- Outpatient Department Patient Record Form Cdc-pdf[PDF - 168 KB]
- Ambulatory Surgery Center Patient Record Cdc-pdf[PDF - 132 KB]
- Cervical Cancer Screening Supplement Cdc-pdf[PDF - 150 KB]
- Hospital Induction Interview Form Cdc-pdf[PDF - 558 KB]
- Ambulatory Unit Induction Interview Form Cdc-pdf[PDF - 186 KB]
- Emergency Department Patient Record Form Cdc-pdf[PDF - 208 KB]
- Outpatient Department Patient Record Form Cdc-pdf[PDF - 453 KB]
- Cervical Cancer Screening Supplement Cdc-pdf[PDF - 189 KB]
- Hospital Induction Interview Form Cdc-pdf[PDF - 1277 KB]
- Ambulatory Unit Induction Interview Form Cdc-pdf[PDF - 129 KB]
- Pandemic and Emergency Response Preparedness Supplement Cdc-pdf[PDF - 119 KB]
- Emergency Department Patient Record Form Cdc-pdf[PDF - 439 KB]
- Outpatient Department Patient Record Form Cdc-pdf[PDF - 146 KB]
- Cervical Cancer Screening Supplement Cdc-pdf[PDF - 107 KB]
- Hospital Induction Interview Form Cdc-pdf[PDF - 331 KB]
- Ambulatory Unit Induction Interview Form Cdc-pdf[PDF - 122 KB]
- Emergency Department Patient Record Form Cdc-pdf[PDF - 58 KB]
- Outpatient Department Patient Record Form Cdc-pdf[PDF - 51 KB]
- Emergency Pediatric Services and Equipment Supplement Cdc-pdf[PDF - 228 KB]
- Cervical Cancer Screening Supplement Cdc-pdf[PDF - 54 KB]
- Hospital Induction Interview Form Cdc-pdf[PDF - 126 KB]
- Ambulatory Unit Induction Interview Form Cdc-pdf[PDF - 54 KB]
Page last reviewed: January 8, 2018
Content source: National Center for Health Statistics