| Document Date: 2013-12-06 13:09:49
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Facility Form Completion The NHSN-assigned facility ID / Data Field Facility / / MedicalCondition infection / documented/known allergy / central line-associated infection / / MedicalTreatment catheter / dialysis / / Organization PICC / fluid/medication administration / ID Medicare / Medicare / Required / / Position Physician assistant / Registered Nurse / Advanced Practice Nurse / Attending physician / / Product Chlorhexidine gluconate / Povidone iodine / / Technology dialysis / /
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CLIP Instructions for Completion of the Central Line Insertion Practices Adherence Monitoring Form (CDC[removed]Data Field Facility ID