Get Appendix E: Sample Form For Quick Review Data ... - Oshpd Ca

Filling out the APPENDIX E Sample Form for Quick Review Data is an essential step in ensuring the accuracy of your CABG data submissions. This guide provides clear, step-by-step instructions to assist you in completing the form accurately and efficiently.

Follow the steps to successfully complete the form online.

1. Click the ‘Get Form’ button to access the form and open it in the designated editor.
2. Begin by entering the hospital name and required details in the specified fields. Ensure all entries are accurate and reflect the latest data.
3. Complete the section for date of surgery, ensuring the format matches the required standard, which is typically MM/DD/YYYY.
4. Fill in insurer information, verifying that each entry corresponds to recognized insurers.
5. Provide the patient's demographics such as date of birth, height, weight, and zip code. Confirm that all values fall within reasonable ranges.
6. Indicate relevant medical history details including diabetes status, hypertension, and any cardiovascular diseases. Check for consistency with other provided figures.
7. Address items that denote logic problems, ensuring conditions such as 'Angina' being marked as 'yes' while 'Unstable Angina' is not reported are corrected.
8. Review all sections for any missing data, as identified problems must be rectified before submission.
9. Once all information is completed and verified, save the changes to the form. You may choose to download or print the completed form for your records.
10. Finally, share the completed form as required or resubmit corrected data if necessary prior to the next reporting period.

Complete your form for accurate data representation and compliance.