DOH Compound, Sta. Cruz, Manila Telephone No.: (+63) 942-982-7911 l Email Address:
[email protected] l FB Page: www.facebook.com/PHICNA Philippine Hospital Infection Control Nurses Association (PHICNA), Inc. PRC CPD Provider Accreditation No. 2017-142 Monthly Patient and Device Utilization Census per Area (Form 1A) Month and year ___________ Area _____________ Type of Patient: Burn Coronary Care Medical Medical/Surgical Neurosurgical Pediatric Respiratory Surgical Trauma Others ________ First day patient census of the Month ___________ First day patient census of the next Month __________ Total No. of Mortality ____________ Date # New Arrival # Patients # Discharges # Patients w/ Ventilator # Patients w/ Urinary Catheter # Patients w/ Central Lines 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 TOTAL Adapted from CDC NHSN Data Collection Forms 2018
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