An official website of the United States government
Archived COVID-19 Module Documents
Archived documents for reference only.
Effective July 15, 2020, NHSN’s Patient Safety Component COVID-19 Module no longer served as an option for hospitals to report their COVID-19 patient impact, capacity, staffing, and supply-related data to the Department of Health and Human Services (HHS). The materials posted on this site are for archival purposes only.
July 2, 2020 – NHSN Application Update
- Patient Impact and Hospital Capacity Pathway (57.130)
- Supplies Pathway (57.132)
June 4, 2020 – NHSN Application Update
- Patient Impact and Hospital Capacity Pathway (57.130)
May 14, 2020 – NHSN Application Update
- Patient Impact and Hospital Capacity Pathway (57.130)
April 13, 2020 – NHSN Application Update
- Patient Impact and Hospital Capacity Pathway (57.130)
- Healthcare Worker Staffing Pathway (57.131)
- Supplies Pathway (57.132)
March 26, 2020 – Patient Safety COVID-19 Module Launch
- Patient Impact and Hospital Capacity Pathway (57.130)
NHSN’s Long-term Care Facility (LTCF) Component COVID-19 Module serves as an option for long-term care facilities (specifically, skilled nursing facilities/nursing homes, long-term care for the developmentally disabled, and assisted living facilities) to report their COVID-19 resident impact, facility capacity, staffing, and supply-related data to the Department of Health and Human Services (HHS). The materials posted on this site are for archival purposes only.
NHSN Application and Table of Instructions Updates
- Resident Impact and Facility Capacity (57.144)
- Form [PDF – 167 KB] (print-only) – V.6 – NHSN Release 9.5.1
- Form [PDF – 170 KB] (print-only) – V.7 – NHSN Release 9.5.2
- Form [PDF – 170 KB] (print-only) – V.8 – NHSN Release 9.5.4
- Form [PDF – 170 KB] (print-only) – V.9 – NHSN Release 9.5.5
- Form [PDF – 100 KB] (print-only) – V.10 – NHSN Release 10.0
- Form [PDF – 242 KB] (print-only) – V.11 – NHSN Release 10.1.3
- Form [PDF – 364 KB] (print-only) – V.12 – NHSN Release 10.1.5
- Form [PDF – 257 KB] (print-only) – V.14 – NHSN Release 11.4
- Table of Instructions [PDF – 606 KB] – V.6 – NHSN Release 9.5.1
- Table of Instructions [PDF – 534 KB] – V.7 – updated 2/18/2021
- Table of Instructions [PDF – 500 KB] – V.8 – NHSN Release 9.5.2
- Table of Instructions [PDF – 500 KB] – V.9 – NHSN Release 9.5.5
- Table of Instructions [PDF – 500 KB] – V.10 – NHSN Release 10.0
- Table of Instructions [PDF – 530 KB] – V.11 – NHSN Release 10.1.0
- Table of Instructions [PDF – 350 KB] – V.12 – NHSN Release 10.1.2
- Table of Instructions [PDF – 431 KB] – V.13 – NHSN Release 10.1.3
- Table of Instructions [PDF – 316 KB] – V.14 – NHSN Release 10.1.4
- Table of Instructions [PDF – 439 KB] – V.15 – NHSN Release 10.1.
- Table of Instructions [PDF – 431 KB] – V.16 – updated 9/14/2022
- Table of Instructions [PDF – 462 KB] – V.17 – updated 1/23/2023
- Table of Instructions [PDF – 452 KB] – V.18 – NHSN Release 11.4.
- Table of Instructions [PDF – 433 KB] – V.19 – NHSN Updated 9/25/23
- Table of Instructions [PDF – 853 KB] – V.20 NHSN Release 11.6.
- Staff and Personnel Impact (57.145)
- Form [PDF – 120 KB] (print-only) – V.2 – NHSN Release 9.5.1
- Form [PDF – 155 KB] (print-only) – V.3 – NHSN Release 10.1.3
- Form [PDF – 267 KB] (print-only) – V.4 – NHSN Release 10.1.5
- Table of Instructions [PDF – 250 KB] – V.4 – NHSN Release 10.1.1
- Table of Instructions [PDF – 343 KB] – V.5 – NHSN Release 10.1.3
- Table of Instructions [PDF – 345 KB] – V.6 – NHSN Release 10.1.4
- Table of Instructions [PDF – 326 KB] – V.7 – Updated 1/23/2023
- Resident Therapeutics Form (57.158)
- Form [PDF – 71 KB] (print-only) – V.1 – NHSN Release 9.5.1
- Form [PDF – 34 KB] (print-only) – V.2 – NHSN Release 9.5.2
- Form [PDF – 80 KB] (print-only) – V.3 – NHSN Release 9.5.3
- Form [PDF – 82 KB] (print-only) – V.4 – NHSN Release 9.5.5
- Form [PDF – 82 KB] (print-only) – V.5 – Updated 01/11/2022
- Form [PDF – 75 KB] (print-only) – V.6 – NHSN Release 10.1.1
- Form [PDF – 74 KB] (print-only) – Form – V.7 – Updated 2/25/2022
- Form [PDF – 104 KB] (print-only) – Form – V.8 – NHSN Release 10.1.4
- Table of Instructions [PDF – 309 KB] – V.1 – NHSN Release 9.5.1
- Table of Instructions [PDF – 272 KB] – V.2 – NHSN Release 9.5.2
- Table of Instructions [PDF – 273 KB] – V.3 – Updated 03/26/2021
- Table of Instructions [PDF – 270 KB] – V.4 – NHSN Release 9.5.3
- Table of Instructions [PDF – 267 KB] – V.5 – NHSN Release 9.5.5
- Table of Instructions [PDF – 311 KB] – V.6 – Updated 01/11/2022
- Table of Instructions [PDF – 289 KB] – V.7 – Updated 2/25/2022
- Table of Instructions [PDF – 375 KB] – V.8 – NHSN Release 10.1.4
- Supplies and Personal Protective Equipment (57.146)
- Form [PDF – 71 KB] (print-only) – V.2 – NHSN Release 9.4.4
- Form [PDF – 165 KB] (print-only) – V.3 – NHSN Release 9.5.2.1
- Form [PDF – 120 KB] (print-only) – V.4 – NHSN Release 10.1.2
- Table of Instructions [PDF – 299 KB] – V.3 – Updated 7/14/2020
- Table of Instructions [PDF – 500 KB] – V.4 – NHSN Release 9.5.2.1
- Table of Instructions [PDF – 430 KB] – V.5 – Update February 10, 2022
- Table of Instructions [PDF – 300 KB] – V.6 – NHSN Release 10.1.2
- Ventilator Capacity and Supplies (57.147)
- Form [PDF – 110 KB] (print-only) – V.2 – NHSN Release 9.4.1
- Table of Instructions [PDF – 200 KB] – V.2 – NHSN Release 9.4.1
November 2020 – NHSN Application Update
- Resident Impact and Facility Capacity (57.144)
- Form [PDF – 150 KB] (print-only)
- Table of Instructions [PDF – 500 KB]
- Staff and Personnel Impact (57.145)
- Form [PDF – 120 KB] (print-only)
- Table of Instructions [PDF – 250 KB]
October 2020 – NHSN Application Update
- Point of Care Testing (57.155)
- Form [PDF – 100 KB] (print-only)
- Table of Instructions [PDF – 350 KB]
August 2020 – NHSN Application Update
- Resident Impact and Facility Capacity (57.144) – Version 4
- Form [PDF – 100 KB] (print-only)
- Table of Instructions [PDF – 350 KB]
- Resident Impact and Facility Capacity (57.144) – Version 3
- Form [PDF – 100 KB] (print-only)
- Table of Instructions [PDF – 350 KB]
July 2020 – NHSN Application Update
- Supplies and Personal Protective Equipment (57.146)
June 2020 – NHSN Application Update
- Resident Impact and Facility Capacity (57.144)
- Form [PDF – 100 KB] (print-only)
- Table of Instructions [PDF – 350 KB]
May 2020 – NHSN Application Update
- Resident Impact and Facility Capacity (57.144)
- Staff and Personnel Impact (57.145)
- Supplies and Personal Protective Equipment (57.146)
- Ventilator Capacity and Supplies (57.147)
- Form [PDF – 110 KB] (print-only)
- Table of Instructions [PDF – 250 KB]
April 2020 – NHSN Application Update
- Resident Impact and Facility Capacity (57.144)
- Form [PDF – 100 KB] (print-only)
- Table of Instructions [PDF – 350 KB]
- Staff and Personnel Impact (57.145)
- Form [PDF – 120 KB] (print-only)
- Table of Instructions [PDF – 250 KB]
- Supplies and Personal Protective Equipment (57.146)
- Form [PDF – 120 KB] (print-only)
- Table of Instructions [PDF – 300 KB]
- Ventilator Capacity and Supplies (57.147)
- Form [PDF – 110 KB] (print-only)
- Table of Instructions [PDF – 250 KB]
