Central Line Insertion Practices (CLIP) Adherence

All Data Collection Forms are Print-only

CLIP Event

• Central Line Insertion Practices Adherence Monitoring – January 2021 (57.125) pdf icon[PDF – 80 KB]
  • Customizable form word icon[DOCX – 60 KB]
  • Table of Instructions pdf icon[PDF – 80 KB]

Survey

• Outpatient Dialysis Center Practices Survey Form – January 2022 (57.500) pdf icon[PDF – 250 KB]
  • Table of Instructions pdf icon[PDF – 500 KB]

Monthly Reporting Plan

• Dialysis Component Monthly Reporting Plan form – January 2022 (57.501) pdf icon[PDF – 100 KB]
  • Customizable form word icon[DOCX – 80 KB]
  • Table of Instructions pdf icon[PDF – 300 KB]