NBCCEDP Clinic-Level Data Instrument (Screenshots)

ATTACHMENT 6a: NBCCEDP Clinic-Level Data Instrument (Screenshots)

Welcome Screen

Menu Bar and Navigation

Health System Data

Health System Data – Baseline

Health System Data – Annual

Clinic Data - Characteristics

Clinic Data – Baseline Breast

Clinic Data – Baseline Breast (continued)

Clinic Data – Baseline Breast (continued)

Clinic Data – Baseline Breast (continued)

** End date above is auto calculated based on start date.

** If rate status is ‘not available’, collect the following field:

Clinic Data – Baseline Breast (continued)

Clinic Data – Baseline Breast (continued)

Clinic Data – Baseline Breast (continued)

Clinic Data – Baseline Breast (continued)

Clinic Data – Annual Breast

** Collect the following if status is ‘terminated’ or ‘suspended’:

Clinic Data – Annual Breast (continued)

Clinic Data – Annual Breast (continued)

Clinic Data – Annual Breast (continued)

Clinic Data – Annual Breast (continued)

** End date above is auto calculated based on start date.

** If rate status is ‘not available’, collect the following field:

Clinic Data – Annual Breast (continued)

Clinic Data – Annual Breast (continued)

Clinic Data – Annual Breast (continued)

** If not in place at PY end, ask the following question:

** If not in place at PY end, ask the following question:

Clinic Data – Annual Breast (continued)

** If not in place at PY end, ask the following question:

** If not in place at PY end, ask the following question:

Clinic Data – Annual Breast (continued)

** If not in place at PY end, ask the following question:

** If not in place at PY end, ask the following question:

Clinic Data – Annual Breast (continued)

** If not in place at PY end, ask the following question:

Clinic Data – Annual Breast (continued)

** If not in place at PY end, ask the following question:

Clinic Data – Annual Breast (continued)

** If not in place at PY end, ask the following question:

Clinic Data – Annual Breast (continued)

Clinic Data – Baseline Cervical

Clinic Data – Baseline Cervical (continued)

Clinic Data – Baseline Cervical (continued)

Clinic Data – Baseline Cervical (continued)

** End date above is auto calculated based on start date.

** If rate status is ‘not available’, collect the following field:

Clinic Data – Baseline Cervical (continued)

Clinic Data – Baseline Cervical (continued)

Clinic Data – Baseline Cervical (continued)

Clinic Data – Baseline Cervical (continued)

Clinic Data – Annual Cervical

** Collect the following if status is ‘terminated’ or ‘suspended’:

Clinic Data – Annual Cervical (continued)

Clinic Data – Annual Cervical (continued)

Clinic Data – Annual Cervical (continued)

Clinic Data – Annual Cervical (continued)

** End date above is auto calculated based on start date.

** If rate status is ‘not available’, collect the following field:

Clinic Data – Annual Cervical (continued)

Clinic Data – Annual Cervical (continued)

Clinic Data – Annual Cervical (continued)

If not in place at PY end, ask the following question:

If not in place at PY end, ask the following question:

Clinic Data – Annual Cervical (continued)

If not in place at PY end, ask the following question:

If not in place at PY end, ask the following question:

Clinic Data – Annual Cervical (continued)

If not in place at PY end, ask the following question:

If not in place at PY end, ask the following question:

Clinic Data – Annual Cervical (continued)

If not in place at PY end, ask the following question:

Clinic Data – Annual Cervical (continued)

If not in place at PY end, ask the following question:

Clinic Data – Annual Cervical (continued)

If not in place at PY end, ask the following question:

Clinic Data – Annual Cervical (continued)

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