12. Which medical treatment facilities are required to use the Inpatient Treatment
Record Cover Sheet?
________________________________________________________________
13. Which copy of the Inpatient Treatment Record Cover Sheet is usually used and
distributed as the worksheet?
________________________________________________________________
14. Nonautomated sites obtain data for items 1 through 30 (except Items 25 and 26) of
the Inpatient Treatment Record Cover Sheet from what source?
________________________________________________________________
15. Name the three categories of patients for whom the Inpatient Treatment Record
Cover Sheet is prepared.
a.
______________________________.
b.
______________________________.
c.
______________________________.
16. Define the following abbreviations.
a.
PR: ___________________________.
b.
NB: ___________________________.
c.
ACH: __________________________.
d.
Abs Sk: ________________________.
e.
MEB: __________________________.
f.
SI: ____________________________.
g.
AMA: _____________________________.
h.
TDRL: ____________________________.
MD0753
3-19