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E railroad insurance number): Resident Name, Last: First: *Gender: M F Other *Ethnicity (specify): Hispanic or Latino Not Hispanic or Latino Declined to respond Unknown *Date of First Admission to Facility: / / *Event Type: UTI *Resident Care Location: *Primary Resident Service Type: (check one) Middle: *Date of Birth: / / *Race (specify): American Indian/Alaska Native Black or African American Native Hawaiian/Other Pacific.

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Related content

57.140 UTI LTCF
Secondary Bloodstream Infection: Yes No. Died within 7 days of date of event: Yes No...
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2020 NHSN LTCF Component Manual
Numerator: The Urinary Tract Infection (UTI) for LTCF form (CDC 57.140) is used to collect...
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