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HRSA Electronic Handbooks

Children's Hospitals Graduate Medical Education

pdf
  • Health Resources and Services Administration
  • Academic Year: 2022-2023
  • Bureau of Health Workforce
  • OMB Number: 0915-0061
  • Annual Performance Report
  • OMB Expiration Date: 01/31/2025

CHD-1: CHGME Hospital Data - Hospital Discharge Data

Please provide the requested general information and answer the lead question below. If your children’s hospital has any residency program where at least one resident spent greater than or equal to 75% time under children’s hospital supervision, please answer ‘Yes’ and complete the table below with hospital-level data. If not, please answer ‘No’, and click ‘Save and Validate’ to proceed to the next required form. If ‘Yes’ was answered, please provide the number of hospital discharges for the most recently completed academic year (July 1 – June 30) for each of the following payment groups. Include all Medicaid payments including Medicaid managed care and any other Medicaid payments under the Medicaid and/or CHIP category. Self-pay refers to patients who have made out-of-pocket payments for services. Uncompensated care means care for which the hospital receives no payment. Do not include lab services under Outpatient visits. Please refer to the instruction manual and/or contact your Government Project Officer if you have any questions about how to complete this form.



General Information
Medicare Provider Number
Year hospital first received funding
How many outside institutions send residents to your hospital?
Did any of your residency programs have at least one resident spending >= 75% under Children’s Hospital Supervision?
(complete table below)(Click Save and Validate to proceed to the next form)
No.Payor
(1)
Enter # of Inpatient Discharges
(2)
Enter # of Outpatient Visits
(3)
Enter # of Emergency Department Visits
(4)
1Private Insurance
2Medicaid and/or CHIP
3Medicare
4Other Public (TRICARE, Indian Health Service)
5Self-Pay
6Uncompensated Care
Total000

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