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Scientific Data Documentation
National Hospital Ambulatory Medical Care Survey, 1992
DSN: CC37.NHAMCS92.EMRGENCY (Emergency Department File)
     CC37.NHAMCS92.OPATIENT (Out-Patient Department File)


ABSTRACT

 This report provides documentation for users of the 1992 National Hospital
 Ambulatory Medical Care Survey (NHAMCS) Micro-Data Tape for patient visits
 and drug mentions. Section I, "Description of the National Hospital Ambula-
 tory Medical Care Survey," includes information on the sample design, data
 collection activities, medical coding procedures, population estimates, and
 relative standard errors. Section II provides technical details of the tapes
 (number of tracks, record length, etc.), and a detailed description of the
 contents of each data record by location.  Section III contains marginal data
 for selected data items.  The appendixes contain sampling errors,
 instructions, and definitions for completing the Patient Record Forms, and
 lists of codes used in the survey.

INTRODUCTION

                          DESCRIPTION OF NHAMCS


 The National Hospital Ambulatory Medical Care Survey (NHAMCS) was inaugurated
 to learn more about the ambulatory care rendered in hospital emergency and
 outpatient departments in the United States.  Ambulatory medical care is the
 predominant method of providing health care services in the United States.
 Since 1973 data on ambulatory patient visits to physicians' offices have been
 collected through the National Ambulatory Medical Care Survey (NAMCS).

 However, visits to hospital emergency and outpatient departments, which
 represent a significant segment of total ambulatory medical care, are not
 included in the NAMCS.1/

 Furthermore, hospital ambulatory patients are known to differ from office
 patients in their demographic characteristics and are also thought to differ
 in medical aspects.2/  Therefore, the omission of hospital ambulatory care
 from the ambulatory medical care database leaves a significant gap in coverage
 and limits the utility of the current NAMCS data.  The NHAMCS fills this data
 gap. This survey was endorsed by the American Hospital Association, the Emer-
 gency Nurses Association, and the American College of Emergency Physicians.
 A complete description of the NHAMCS is contained in the publication entitled:
 "Plan and Operation of the National Hospital Ambulatory Medical Care Survey,
 United States, 1994."3/

 This micro-data tape comprises the data collected by the NHAMCS in 1992,
 conducted by the Ambulatory Care Statistics Branch of the National Center for
 Health Statistics, Centers for Disease Control and Prevention.  The NHAMCS
 provides data from samples of patient records selected from the emergency
 departments (ED's) and outpatient departments (OPD's) of a national sample of
 hospitals.  The national estimates produced from these studies describe the
 utilization of hospital ambulatory medical care services in the United States.
 In 1992 there were 36,271 Patient Record Forms provided by 437 ED's and
 35,114 Patient Record Forms provided by 314 OPD's that participated in the
 survey.  This micro-data tape contains both data files.

 There are two important points relative to analyzing data from this micro-
 data tape that should be noted:

            1.  Micro-data tape users should be fully aware of the importance of
  "patient visit weight" and how it must be used.  Information about the
  patient visit weight is presented on page 17.  If more information is
  needed the staff of the Ambulatory Care Statistics Branch can be consulted
  by calling 301/436-7132 during regular working hours.

            2.  Users should also be aware of the reliability or unreliability o
  certain estimates, particularly the smaller estimates.  The National
  Center for Health Statistics, which conducts many health surveys of the
  American people, considers an estimate to be reliable if it has a relative
  standard error of 30% or less.  Therefore, it is important to know the
  value of the lowest possible estimate in this survey that is considered
  reliable, so as not to present data in a journal article or paper that may
  be unreliable.  Most data tape users can obtain an adequate working
  knowledge of the relative standard error from the information presented in
  Appendix I.  If you would like more information, do not hesitate to
  consult the staff of the Ambulatory Care Statistics Branch.
1SAMPLE DESIGN

 The 1992 NHAMCS included a national probability sample of visits to the
 emergency and outpatient departments of noninstitutional general and short-
 stay hospitals, exclusive of Federal, military, and Veterans Administration
 hospitals, located in the 50 states and the District of Columbia.  The NHAMCS
 was designed to provide estimates based on the following priority of survey
 objectives:  U.S.; region; emergency and outpatient departments; and type of
 ownership.  The NHAMCS used a four-stage probability design with samples of
 PSUs, hospitals within PSUs, clinics within hospitals, and patient visits
 within clinics.  Each stage of sampling is described below.

Primary Sampling Units

 The first-stage sample consisted of 112 PSUs which comprised a probability
 subsample of the PSUs used in the 1985-94 NHIS.  The NHAMCS PSU sample
 included with certainty the 26 NHIS PSUs with the largest populations.  In
 addition, the NHAMCS sample included half of the next 26 largest PSUs, and
 one PSU from each of the 73 PSU strata formed from the remaining PSUs for the
 NHIS sample.

 The NHIS PSU sample was selected from approximately 1,900 geographically
 defined PSUs which covered the 50 States and the District of Columbia.  A
 PSU consists of a county, a group of counties, county equivalents (such as
 parishes and independent cities), towns, townships, minor civil divisions
 (for some PSUs in New England), or a metropolitan statistical area (MSA).
 MSAs were defined by the U.S. Office of Management and Budget on the basis of
 the 1980 Census.  The 1,900 PSUs were stratified by socioeconomic and demo-
 graphic variables and then selected with a probability proportional to their
 size.  Stratification was done within four geographical regions by MSA or
 non-MSA status.

 A detailed description of the 1985-94 NHIS PSU sample design is presented in a
 Vital and Health Statistics Series 2 report.4/

Hospitals

 The sampling frame for the 1992 NHAMCS was compiled from the hospitals listed
 on the April 1991 SMG Hospital Market Data Base.  Hospitals with an average
 length of stay for all patients of less than 30 days (short-stay) or hospitals
 whose specialty was general (medical or surgical) or children's general were
 eligible for the NHAMCS.  Excluded were Federal hospitals, hospital units of
 institutions, and hospitals with less than six beds staffed for patient use.
 The SMG Hospital Market Data Base contained 6,249 hospitals which met this
 eligibility criteria.  Of the eligible hospitals, 5,582 (89 percent) had
 emergency departments (ED) and 5,654 (90 percent) had outpatient departments
 (OPD).  Hospitals were defined to have an ED if the hospital file indicated
 the presence of such a unit or if the file indicated a non-zero number of
 visits to such a unit.  A similar rule was used to define the presence of an
 OPD.  Hospitals were classified into four classes:  those with only an ED;
 those with an ED and an OPD; those with only an OPD; and those with neither
 an ED nor an OPD.  Hospitals in the last class were considered as a separate
 stratum and a small sample (50 hospitals) was selected from this stratum to
 allow for estimation to the total universe of eligible hospitals and the
 opening and closing of EDs and OPDs in the sample hospitals.  The hospital
 selections were made so that each hospital would be chosen only once to avoid
 multiple inclusion of very large hospitals.  Table I contains the response
 rates of the 524 hospitals that were selected in the sample.

Outpatient Clinics and Emergency Service Areas

 Within each hospital, either all outpatient clinics and emergency service
 areas or a sample of such units were selected.  Clinics were in scope if
 ambulatory medical care was provided under the supervision of a physician and
 under the auspices of the hospital.  Clinics were required to be "organized"
 in the sense that services were offered at established locations and
 schedules.  Clinics where only ancillary services were provided or other
 settings in which physician services were not typically provided were out of
 scope.  In addition, freestanding clinics were out of scope since they are
 included in the NAMCS, and ambulatory surgery centers, whether in hospitals
 or freestanding, were out of scope since they are to be included in the
 National Survey of Ambulatory Surgery which will be fielded in 1994.  A list
 of in scope and out of scope clinics is provided on pages 57-59.  The OPD
 clinic definition excluded the "hospital as landlord" arrangement in which
 the hospital only rented space to a physician group and was not otherwise in-
 volved in the delivery of services.  These physicians are considered office-
 based and are currently included in the NAMCS.  Emergency services provided
 under the "hospital as landlord" arrangement, however, were eligible for the
 study.  An emergency department was in scope if it was staffed 24 hours a day.
 If an inscope emergency department had an emergency service area that was
 staffed less than 24 hours a day, then it was considered an outpatient clinic.

 Hospitals may define the term "separate clinic" differently, for example, by
 physical location within the hospital, by staff providing the services, by
 specialty or subspecialty, by schedules, or by patients' source of payment.
 Because of these differences, "separate clinics" in the NHAMCS were defined
 as the smallest administrative units for which the hospital kept patient
 volume statistics.

 During the visit by a field representative to induct a hospital into the
 survey, a list of all emergency service areas and outpatient clinics was
 obtained from the sample hospital.  Each outpatient department clinic's
 function, specialty, and expected number of visits during the assigned
 reporting period were also collected.  In approximately 20 percent of the
 hospitals the outpatient department had more than 5 clinics. Generally, these
 outpatient departments had fewer than 20 clinics, but several had more than
 100 clinics.  If there were 5 or fewer clinic sampling units, then all were
 included in the sample. If there were more than 5 clinic sampling units, then
 5 units were randomly selected.  The individual clinics were listed first by
 five clinic categories:  general medicine, surgery, pediatrics,
 obstetrics/gynecology, and other.  During data processing, substance abuse
 clinics were removed from the "other" category and placed in a separate
 stratum.

 Within each category, clinics were listed in order of clinic size, from
 smallest to largest.  Clinic size was defined as the expected number of
 patient visits during the assigned 4-week reporting period.  Within each
 clinic group, if a clinic expected fewer than 30 visits, it was grouped with
 one or more other clinics to form a sampling unit.  Over 90 percent of the
 clinics were large enough to form their own sampling unit. After grouping the
 clinics into sampling units, 5 of these sampling units were selected based on
 probability proportional to the size of the sampling unit. If clinic sampling
 was required, the sampling was completed by Census headquarters staff in
 Washington, DC.  The 1992 NHAMCS included 854 clinics from 314 outpatient
 departments.

 The emergency department was treated as a separate stratum and all emergency
 service areas were selected with certainty.  In the rare instance that a
 sample hospital had more than 5 emergency service areas, a sample of five
 emergency service areas was selected based on probability proportional to
 size.  Only one hospital in the 1992 NHAMCS reported having more than five
 emergency service areas and required sampling.  The 1992 NHAMCS included 462
 emergency service areas from 437 emergency departments.

Visits

 The basic sampling unit for the NHAMCS is the patient visit or encounter.
 Only visits made in the United States by patients to ED's and OPD's of
 nonfederal, short-stay, or general hospitals were included in the 1992 NHAMCS.
 Ambulatory encounters not included in the NHAMCS were those made by telephone.

 Within emergency service areas or outpatient department clinics, patient
 visits were systematically selected over a randomly assigned 4-week reporting
 period.  A visit was defined as a direct, personal exchange between a patient
 and a physician, or a staff member acting under a physician's direction, for
 the purpose of seeking care and rendering health services.  Visits solely for
 administrative purposes, such as payment of a bill, and visits in which no
 medical care was provided, such as visits to deliver a specimen, were out of
 scope.

 The target numbers of Patient Record Forms to be completed for ED's and OPD's
 were 50 and 150, respectively.  In clinics with volumes higher than these
 desired figures, visits were sampled by a systematic procedure which selected
 every nth visit after a random start.  Visit sampling rates were determined
 from the expected number of patients to be seen during the reporting period
 and the desired number of completed Patient Record Forms.  During the 1992
 NHAMCS, Patient Record Forms were completed for 36,271 ED visits and 35,114
 OPD visits.

 Original specifications for visit sampling called for a maximum sampling rate
 of 1 in 20 visits or a maximum of 500 visits, whichever yielded the smaller
 sample size.  Field experience in the early part of the 1992 study indicated
 the potential for heavy respondent burden for clinics with high volume.
 Therefore, the maximum number of sampled visits was reduced to 200 and the
 sampling rates were increased accordingly.


DATA COLLECTION PROCEDURES

                                Field Training

 The Bureau of the Census was the data collection agent for the 1992 NHAMCS.
 Census Headquarters staff were responsible for overseeing the data collection
 process, training the Census Regional Office staff, and writing the field
 manual.  Regional Office staff were responsible for training the field
 representatives and monitoring hospital data collection activities.  Field
 representative training included approximately 4 hours of self-study and 1
 1/2 to 2 days classroom training. Field representatives inducted the hospital
 and trained the hospital staff on visit sampling and completion of the
 Patient Record Forms.

                               Hospital Induction

 Approximately 3 months prior to the hospital's assigned reporting period, NCHS
 sent an personally signed introductory letter from the Director of NCHS to
 hospital administrator or chief executive officer of each sampled hospital.
 The names of the hospital officials were obtained from the American Hospital
 Association (AHA) Guide To Health Care.  In addition to the introductory
 letter, NCHS also enclosed endorsement letters from the AHA, the Emergency
 Nurses Association, and the American College of Emergency Physicians to
 emphasize the importance of the study to the medical community.

 Approximately a week after the mailing of the introductory letter, the Census
 field representative called the hospital administrator to arrange for an
 appointment to further explain the study and to verify hospital eligibility
 for the survey.  Earlier studies indicated that the three-month lead time was
 necessary to obtain a meeting with the administrator, gain hospital approval,
 collect the required information about the hospital's ambulatory care
 services, develop the sampling plan, and train participating hospital
 staff.5/-6/

            Outpatient Clinic and Emergency Service Area Induction

 After the initial visit and the development of the sampling plan, the field
 representative contacted the hospital coordinator to arrange for induction of
 the sample emergency service areas and outpatient clinics and for instruction
 of the hospital staff.  At these visits, the field representative described
 the purpose and use of the survey data, explained the data collection process,
 including the visit sampling procedures, and presented the Patient Record
 Forms.

                             Data Collection

 The actual visit sampling and data collection for the NHAMCS was primarily
 the responsibility of hospital staff.  This procedure was chosen for several
 reasons. First, the lack of a standard form or record coversheet in hospital
 and the individuality of the hospital recordkeeping made field representative
 training difficult.  Second, for confidentiality reasons, numerous hospitals
 did not want the field representatives to review patient logs or see actual
 medical records.  Third, hospital staffs were better qualified to abstract
 data since they were familiar with the medical terms and coding, knew the
 recordkeeping systems, and could complete the Patient Record Forms at or near
 the time of the visit when the information was the most complete and easiest
 to retrieve.

 Hospital staff responsible for completing the Patient Record Forms were
 instructed how to complete each item by the field representatives.  Separate
 instruction booklets for emergency service areas and outpatient department
 clinics were prepared and provided to guide hospital staff in this task.
 These booklets provided an overview of the survey, sampling instructions,
 instructions for completing the Patient Record Forms, and definitions.

 A brief, one page Patient Record Form consisting of two sections was com-
 pleted for each sample visit. To account for the differences in emergency and
 outpatient care, different Patient Record Forms were developed for each of
 these settings.  The top section of each Patient Record Form, which contains
 the patient's name and record number, was separated from the bottom section
 by a perforation running across the page. The top section remained attached
 to the bottom until the entire Patient Record Form was completed.  To ensure
 confidentiality, before collecting the completed Patient Record Forms, the
 top section was detached and given to the hospital staff.  The field
 representatives instructed hospital staff to keep this portion for a period
 of four weeks, in case it was necessary to retrieve missing information or
 clarify information that had been recorded.

 The Patient Record Forms were patterned after the NAMCS and can be completed
 in 2-3 minutes. The OPD Patient Record Form most closely resembles the NAMCS
 Patient Record Form, while the ED Patient Record Form has been designed to
 reflect the type of care provided in that setting. Copies of the 1992 NHAMCS
 Patient Record Forms are shown in Figures I and II.  Terms and definitions
 relating to the Patient Record Forms are shown in Appendix I.


FIELD QUALITY CONTROL

 The field representative visited the sampled emergency service areas and
 clinics each week during the data collection period and maintained telephone
 contact with the hospital staff involved in the data collection effort.  The
 field representative reviewed the log or other records used for visit sampling
 to determine if any cases were missing and also edited completed forms for
 missing data.  Attempts were made to retrieve both missing cases and missing
 data on specific cases, either by consulting with the appropriate hospital
 staff or by reviewing the pertinent medical records.

 On the final visit, the field representative collected the remaining  Patient
 Record forms and obtained or verified the total count of visits occurring
 during the reporting period by reviewing the log used for sample selection or
 by obtaining counts directly from hospital staff.  Because this information
 was critical to the estimation process, extensive effort was made to ensure
 the accuracy of this number.

 At the end of the hospital's reporting period the field representative sent
 the administrator a personalized "Thank You" letter.


CONFIDENTIALITY

 Assurance of confidentiality was provided to all hospitals according to
 Section 308 (d) of the Public Health Service Act (42 USC 242m).  Strict
 procedures were utilized to prevent disclosure of NHAMCS data.  All
 information which could identify the hospital or their facilities was
 confidential and was seen only by persons engaged in the NHAMCS, and was not
 disclosed or released to others for any other purpose.  Names or other
 identifying information for individual patients were not removed from the
 hospitals or individual facilities.


MEDICAL CODING

 The Patient Record Forms for the NHAMCS contain five medical items requiring
 three separate coding systems. The three coding systems are described briefly
 below.  A dependent verification procedure was used to control the medical
 coding operation.  Differences between coders were adjudicated by a third
 coder.  Definitions of the five medical items are on pages 50, 51 and 53 of
 this documentation.

  (A)  Patient's Reason for Visit:  Information contained in
   item 10 of the OPD, and item 11 of the ED Patient Record Forms was coded
   according to an updated version of A Reason for Visit Classification for
   Ambulatory Care (RVC).7/  The updated classification has not been published
   as of this writing but the list of codes is contained in Appendix II.  The
   classification was updated to incorporate several new codes as well as
   changes to existing codes.  The system continues to utilize a modular
   structure composed of seven modules.  The digits 1 through 8 precede the
   3-digit RVC codes to identify the various modules as follows:


         Prefix           Module

         "1" =     symptom module

         "2" = disease module

         "3" =     diagnostic, screening, and preventive module

         "4" =     treatment module

         "5" = injuries and adverse effects module

         "6" =     test results module

         "7" =     administrative module

         "8" =     Uncodable entries

         "9" =     special code = blank

    A maximum of 3 Reasons for Visit were coded in sequence; coding
    instructions are contained in the NAMCS Medical Coding Manual.8/
    Copies are available upon request.
  (B)  Physician's Diagnoses:  Diagnostic information in item 11 of the OPD
   and item 12 of the ED Patient Record Forms was coded according to the
   International Classification of Diseases, 9th Revision, Clinical
   Modification (ICD-9-CM).9/  The 1992 NHAMCS micro-data tape codes for
   diagnoses have the following characteristics:

     1. The prefix "1" preceding the diagnostic codes has
        been added to identify all codes in the range
        001.00-999.90, e.g. '138100' = '381.00' = Acute
        nonsupporative otitis media, unspecified.

     2. The prefix "20" preceding diagnostic codes
        represents V code diagnoses V01.00-V82.90, e.g.
        '201081' = 'V10.81' = personal history of malignant
        neoplasm of bone.

        NOTE: The use of prefixes facilitates the
              calculation of percent distributions, while
              substituting "20" for the letter "V" allows
              that all diagnostic fields on the data tape will
              contain numerical data.

     3. In addition to the diagnostic codes from the
        ICD-9-CM there are 3 unique codes in the diagnostic
        fields that were developed by the NAMCS staff:

          209900 = - noncodable diagnosis
                   - insufficient information for coding
                   - illegible diagnosis

          209970 =   diagnosis of "none"

          900000 =   blank diagnosis

     A maximum of three diagnoses were coded in sequence:
     coding instructions concerning diagnoses are contained
     in the NAMCS Medical Coding Manual.8/

        Cause of Injury:  (ED ONLY) Information contained in Item 10 of the
   Patient Record Form (cause of injury) was coded also according to the
   ICD-9-CM9/, using the Supplemental Classification of External Causes of
   Injury and Poisoning (E codes).  A maximum of three causes of injury were
   coded, in sequence:  coding instructions are contained in the NHAMCS
   Coding Requirements Manual, Volume I.  Copies are available upon request.

        Surgical Procedures:  (OPD ONLY) Surgical information in item 13 of
   the Patient Record Form was also coded according to the (ICD-9-CM),9/ using
   the four digit surgical codes in Volume 3.  A maximum of two surgical
   procedures were coded for each form.     (C)  Medication Therapy This Visit:
   in item 17 on the ED and item 16 on the OPD Patient Record Forms have been
   classified and coded according to a unique classification scheme10/
   developed at NCHS.  The scheme is based on the American Society of
   Hospital Pharmacists' Drug Product Information File which is maintained by
   the American Druggist Blue Book Data Center.  A list of the drug codes are
   in Appendix III.  The Patient Record Forms allow for the recording of up
   to 5 drugs.

 It should be noted that starting in 1992 the Ambulatory Care Statistics
 Branch will no longer produce separate public use tapes for patient visits
 and drug mentions. The data will be combined on one tape and the length of
 the record will be expanded to include the additional information on drugs
 that was previously available only on the public use tape for drug mentions.
 The additional information includes:

   Generic name code:  A unique, 5-digit code assigned to each official
     generic name assigned to every drug entity by the United States
     Pharmacopeia or other responsible authority.

   Prescription status code:  A code designed to identify the legal status
     (prescription or nonprescription) of the drug entry.

   Controlled substance status code:  A code used to denote the degree of
     potential abuse and federal control of a drug entry.

   Composition status code:  A code used to distinguish between single-
     ingredient and combination drugs.
         Note:    If the user is searching for single ingredient (or single
                  entity) drugs, then he or she should utilize the composition
                  status code = '1', in conjunction with the "generic name
                  code" field.  A single ingredient drug will have one generic
                  code in the "generic name code" field, and blanks in the five
                  "ingredient codes" fields.  Ingredient codes should not be
                  used when analyzing single entity drugs.
             On the other hand, if the user is searching for combination
             drugs, then he or she should utilize composition status code
             = '2' in conjunction with the "ingredient codes" fields.  A
             combination drug will have a blank generic code in the
             "generic name code" field, and from one to five generic codes
             in the "ingredient codes" fields.  The "generic name code"
             field should not be used when analyzing combination drugs.

   Ingredient codes:  Codes used to identify the active generic ingredients
     of combination drugs.  A maximum of 5 ingredients can be identified for
     each combination drug.

   Drug class code:  A code used to identify each of the 20 major classes to
     which the drug entry may belong.  (Based on the Standard Drug
     Classifications used in National Drug Code Directory, 1985 edition 11/).

 Most data users are interested primarily in visit data so the combining of
 the tapes will have little or no effect on their particular needs.

 For those users who are interested in analyzing drug data only they will need
 to isolate those records with drugs, or drug mentions, and create a subset
 of drug mentions. Each Patient Record Form can have anywhere from one to five
 drug mentions recorded, so whatever subset is created will need to include
 all of them. This documentation contains marginal data on drug mentions and
 appropriate relative standard errors.  Should the data user need additional
 assistance in analyzing data on drug mentions the staff of the Ambulatory
 Care Statistics Branch is available on 301-436-7132. POPULATION FIGURES

 The base population used in computing annual visit rates is presented in
 Table II.  These figures are based on provisional estimates for the civilian
 noninstitutionalized population as of July 1, 1992, provided by the U.S.
 Bureau of the Census.  The population estimates are presented here solely for
 the purpose of providing denominators for rate computation and should not be
 considered as official population estimates.


DATA PROCESSING

                                     Edits

 In addition to followups for missing and inconsistent data made by the field
 staff, numerous clerical edits were performed on data received for central
 data processing.  Detailed editing instructions were provided to manually
 review the patient records and to reclassify or recode "other" entries.
 Computer edits for code ranges and inconsistencies were also performed.

                                Quality control

 All medical and drug coding and keying operations were subject to quality
 control procedures.  Quality control for the medical and drug coding
 operation, as well as straight-key items, involved a two-way 10-percent
 independent verification procedure.  As an additional quality control, all
 Patient Record Forms with differences between coders or with illegible en-
 tries for the reason for visit, diagnosis, E-code, and medication items were
 reviewed and adjudicated at NCHS.The average keying error rate for nonmedical
 items was 0.5 percent.  For items which required medical coding, discrepancy
 rates averaged less than 5 percent.

                                  Imputations


 Item nonresponse was quite low, three percent or less, for all data items
 with the following exceptions: race (8 percent), ethnicity (15 percent),
 whether the patient had been seen previously for the same condition, item 12
 on the OPD form (7 percent), and whether the visit was alcohol or drug-related
 item 14 on the ED form (8 percent).  Incomplete data items were imputed using
 "hot deck" procedure by assigning a value from a randomly selected Patient
 Record Form with similar characteristics.  For item 13 (urgency) on the ED
 Patient Record Form, the sorting used was ED size by the 3-digit ICD-9-CM
 code for principal diagnosis.  For other ED variables {i.e., item 4 (date of
 birth), item 5 (sex), item 6 (race), item 7 (ethnicity), item 14 (problem
 alcohol- or drug-related), item 18 (disposition), and item 19 (providers)},
 the sort used was ED size by urgency by the 3-digit ICD-9-CM code for
 principal diagnosis.

 For the OPD,imputation procedures were performed for the following variables:
 item 4 (date of birth), item 5 (sex), item 6 (race), item 7 (ethnicity), item
 9 (referral), item 12 (patient seen before), item 17 (disposition), and item
 18 (providers).  The sorting used was OPD size by clinic type by the 3-digit
 ICD-9-CM code for principal diagnosis.  ED and OPD records with imputed
 variables were flagged on the public use data tape.


ESTIMATION PROCEDURES

 The probability sample design of the NHAMCS allowed the sample data to be
 weighted to produce national estimates for the U.S.  Unweighted data are not
 used for analysis as unweighted data ignore the disproportionate sampling
 used in the NHAMCS.  Statistics from the NHAMCS were derived by a multistage
 estimation procedure that produces essentially unbiased national estimates.
 Separate national estimates were produced for visits to hospital emergency
 and outpatient departments.  The weight included three basic components: (1)
 inflation by reciprocals of the probabilities of selection, (2) adjustment
 for nonresponse, and (3) ratio adjustment to fixed totals. Each component is
 briefly described below.

 (1)   Inflation by reciprocals of probabilities of selection

 Because the survey utilized a four-stage sample design, four  probabilities
 of selection existed:  (A) the probability of selecting the PSU; (B) the
 probability of selecting the hospital  within the PSU; (C) the probability of
 selecting the emergency service area or outpatient clinic within the hospital;
 and (D) the probability of selecting the visit within the particular emergency
 service area or clinic.  The overall probability of including a hospital in
 the sample was the product of the probability of the PSU being selected
 multiplied by the probability of the hospital being selected.  The proba-
 bility of selecting the hospital was 1.0 for hospitals in noncertainty PSUs
 with fewer than five hospitals and was the hospital size divided by a sampling
 interval for all other hospitals.  The sampling intervals for PSUs with more
 than five hospitals was the cumulative sum of the hospital sizes (the total of
 ED and OPD visits) in each PSU divided by five.  The sampling interval for the
 certainty PSUs was the cumulative sum of all hospitals in these PSUs divided
 by 240.

 The probability of selecting a clinic within a hospital was 1.0 for clinics
 in hospitals with five or fewer clinics and was the clinic size divided by
 the sampling interval for clinics in hospitals with more than five clinics.
 The sampling interval was defined to be the cumulative sum of sizes for the
 clinics (the expected number of visits during the reporting period) in the
 hospital divided by five.

 The probability of selecting a visit was defined as the actual number of
 visits during the hospital's assigned reporting period divided by the number
 of Patient Record Forms completed.  Estimates were adjusted to account for
 the extended data collection period for the 1992 survey which included 14
 four week reporting periods from December 2, 1991 through December 27, 1992.
 Subsequent survey years will include 13 four-week reporting periods which
 will be inflated to derive annual estimates.

                        (2)Adjustment for nonresponse

 Estimates from NHAMCS data were adjusted to account for sample units that
 were in scope, but did not participate in the study.  These adjustments were
 calculated to minimize the impact of nonresponse on final estimates by
 imputing to nonresponding units the characteristics of similar responding
 units.  As nonresponse may occur at each stage of sampling, several
 adjustments were required.  For these adjustments, hospitals were judged
 similar if they had the same ownership and were in the same PSU or region and
 MSA status.  Clinics were judged similar if they were of the same clinic type
 and were in the same PSU.  Visits were judged similar if they occurred in the
 same clinic.
                         (3)Ratio adjustment

 NHAMCS estimates were adjusted within 12 strata defined by region and
 ownership.  Separate poststratification adjustments were made for emergency
 and outpatient department estimates.  For ED estimates, the ratio adjustment
 for each stratum was a multiplication factor which had as its numerator the
 number of ED visits in the universe in the stratum and as its denominator the
 estimated number of ED visits in that stratum.  For OPD estimates, the ratio
 adjustment for each stratum was a multiplication factor which had as its
 numerator the number of hospitals with an OPD in the universe in the stratum
 and as its denominator the estimated number of hospitals with OPD's in that
 stratum.  The data for the numerator and denominator of both adjustments were
 based on figures from the SMG Hospital Market Data Base.
1PATIENT VISIT WEIGHT

 The "patient visit weight" is a vital component in the process of producing
 national estimates from sample data and its use should be clearly understood
 by all micro-data tape users. The statistics contained on the micro-data tape
 reflect data concerning only a sample of patient visits--and not a complete
 count of all the visits that occurred in the United States.  Each record on
 the ED data tape represents one visit in the sample of 36,271 visits, and
 each record on the OPD data tape represents one visit in the sample of 35,114
 visits.  In order to obtain national estimates from the two samples, each
 record is assigned an inflation factor called the "patient visit weight."

 By aggregating the "patient visit weights" on the 36,271 ED sample records
 for 1992 the user can obtain the total of 89,795,736 estimated visits made by
 all patients to ED's in the United States.  Also, by aggregating the "patient
 visit weights" on the 35,114 OPD sample records for 1992 the user can obtain
 the total of 56,604,704 estimated visits made by all patients to OPD's in the
 United States.

 The marginal tables on pages 42-45 contain data on numbers of records for
 selected variables as well as the corresponding national estimated number of
 visits and drug mentions obtained by aggregating the "patient visit weights"
 on those records.


HOSPITAL CODE

 The purpose of this code is to allow for greater analytical depth by
 permitting the user to link individual Patient Record Forms on the public use
 tape with individual hospitals.  This linking code will enable users to
 conduct more comprehensive analysis without violating the confidentiality of
 patients or hospitals.

CLINIC TYPE CODE (For OPD's only)

 The purpose of this code is the same as that of the hospital code.


REFERENCES


 1.   Current Estimates from the National Health Interview Survey.  1991.
      National Center for Health Statistics.  Vital Health Stat 10(184). 1992.

 2.   Loft JD, Sheatsley PB, Frankel MR.  Comparison Report on the Hospital
      Ambulatory Medical Care Evaluation Study.  Contract No. 282-82-2111.
      Chicago, Illinois:  National Opinion Research Center, 1985.

 3.   McCaig LF, McLemore T.  Plan and Operation of the National Hospital
      Ambulatory Medical Care Survey, 1992.  National Center for Health
      Statistics.  Vital and Health Stat 1(34). 1994.

 4.   Massey JT, Moore TF, Parsons VL, Tadros W. Design and estimation for the
      National Health Interview Survey, 1985-94.  National Center for Health
      Statistics.  Vital Health Stat 2(110).  1989.

 5.   Methodological Report on the Hospital Ambulatory Medical Care Evaluation
      Study.  Contract No. 282-82-2111.  Chicago, Illinois.  National Opinion
      Research Center.  1984.

 6.   Final Report - Survey of Hospital Emergency and Outpatient Departments.
      Contract No. 200-88-7017.  Rockville, Maryland.  Westat.  1990.

 7.   Schneider D, Appleton L, McLemore T.  A Reason for Visit Classification
      for Ambulatory Care.  National Center for Health Statistics.  Vital
      Health Stat 2(78).  1979.

 8.   National Ambulatory Medical Care Survey:  Medical Coding Manual (updated
      annually).

 9.   Public Health Service and Health Care Financing Administration.
      International Classification of Diseases, 9th Revision, Clinical
      Modification.  Washington:  Public Health Service.  1980.

 10.  Koch h, Campbell W.  The Collection and Processing of Drug Information.
      National Ambulatory Medical Care Survey, 1980.  National Center for
      Health Statistics.  Vital and Health Stat 2 (90). 1982.

 11.  Food and Drug Administration.  National Drug Code Directory, 1985
      Edition.  Washington:  Public Health Service. 1985.



1992 Format For Emergency Department Micro Data Tape


 This section consists of a detailed breakdown of the data tape record,
 providing a brief description of each item of data included in the records.
 The data are arranged sequentially according to their physical location on
 the tape record. Unless otherwise stated in the "item description" column,
 the data are derived from the Emergency Department (ED) Patient Record Form
 (page 9). The AMA, the hospital induction questionnaire, and the SMG Hospital
 Market Data Base are alternate sources of data, while the computer generates
 other items by recoding selected data items.

RECORD LAYOUT FOR EMERGENCY FILE

  Item    Field    Tape
   No.   Length  Location   Item Description and Codes - Emergency Departments
  ____   ______  ________   __________________________________________________

   1        6     1-6       Date of visit
                            _____________
   1.1      2     1-2             Month of visit
                                     01-12:  January-December
   1.2      2     3-4             Day of visit
                                     01-31
   1.3      2     5-6             Year of visit
                                     Last 2 digits of year (91 or 92)*


  2        2     7-8       Patient age  (in years; derived from date of birth)
                            ___________
                                  00-99

   3        1     9         Sex
                            ___
                                  1 = Female
                                  2 = Male

   4        1     10        Race
                            ____
                                  1 = White
                                  2 = Black
                                  3 = Asian/Pacific Islander
                                  4 = American Indian/Eskimo/Aleut

   5        1     11        Ethnicity
                            _________
                                  1 = Hispanic origin
                                  2 = Not Hispanic

   6        9     12-20     Expected source(s) of payment
                            _____________________________
   6.1      1     12              Medicare                 (1=Yes, and 0=No)
   6.2      1     13              Medicaid                         "
   6.3      1     14              Other government                 "
   6.4      1     15              Private/commercial               "
   6.5      1     16              HMO/other prepaid                "
   6.6      1     17              Patient paid                     "
   6.7      1     18              No charge                        "
   6.8      1     19              Other                            "
   6.9      1     20              Unspecified                      "

  * The 1992 NHAMCS included data collected from Dec. 2, 1991 to Dec. 27, 1992.

  Item    Field    Tape
   No.   Length  Location   Item Description and Codes - Emergency Departments
  ____   ______  ________   __________________________________________________


   7        1     21        Major reason for this visit
                            ___________________________
                                  1 = Injury, first visit
                                  2 = Injury, follow-up
                                  3 = Illness, first visit
                                  4 = Illness, follow-up
                                  5 = Other reason
                                  9 = Blank or invalid


   8        15    22-36     Cause of injury (see page 12 and reference 9)

   8.1      5     22-26           Injury # 1: 88000-89999 = E8000-E9999
                                              80000       = Blank
                                              80010       = Illegible
   8.2      5     27-31           Injury # 2: 88000-89999 = E8000-E9999
                                              80000       = Blank
                                              80010       = Illegible
   8.3      5     32-36           Injury # 3: 88000-89999 = E8000-E9999
                                              80000       = Blank
                                              80010       = Illegible


   9        15    37-51     Patient reasons for visit (see pages 11 and 61-84)

   9.1      5     37-41           Reason # 1: 10050-89990 = 10050-89990
                                              90000       = Blank
   9.2      5     42-46           Reason # 2: 10050-89990 = 10050-89990
                                              90000       = Blank
   9.3      5     47-51           Reason # 3: 10050-89990 = 10050-89990
                                              90000       = Blank


   10       18    52-69     Physician's diagnoses (see page 12 and reference 9)

   10.1     6     52-57           Diagnosis # 1: 100100-209970 = 00100-V9970
                                                 900000       =  Blank
   10.2     6     58-63           Diagnosis # 2: 100100-209970 = 00100-V9970
                                                 900000       =  Blank
   10.3     6     64-69           Diagnosis # 3: 100100-209970 = 00100-V9970
                                                 900000       =  Blank


   11       1     70        Urgency of this visit
                            _____________________
                                  1 = Urgent/Emergent
                                  2 = Non-urgent


   12       1     71        Is problem alcohol- or drug related?
                            ____________________________________
                                  1 = Neither
                                  2 = Alcohol-related
                                  3 = Drug-related
                                  4 = Both


  Item    Field    Tape
   No.   Length  Location   Item Description and Codes - Emergency Departments
  ____   ______  ________  ___________________________________________________


   13       1     72        Were medications ordered or provided at this visit?
                            ___________________________________________________
                                  0 = Yes
                                  1 = No



   14       1     73        Number of medications coded for this visit
                            __________________________________________
                                  0-5



   15       25    74-98     Medications (see pages 13 and 85-95)

   15.1     5     74-78           Medication Code # 1
                                  ___________________
                                        00005-92190 = 00005-92190
                                        90000       = Blank
                                        99980       = Unknown entry; Other
                                        99999       = Illegible entry

   15.2     5     79-83           Medication code # 2
                                  ___________________
                                        00005-92190 = 00005-92190
                                        90000       = Blank
                                        99980       = Unknown entry; Other
                                        99999       = Illegible entry

   15.3     5     84-88           Medication code # 3
                                  ___________________
                                        00005-92190 = 00005-92190
                                        90000       = Blank
                                        99980       = Unknown entry; Other
                                        99999       = Illegible entry

   15.4     5     89-93           Medication code # 4
                                  ___________________
                                        00005-92190 = 00005-92190
                                        90000       = Blank
                                        99980       = Unknown entry; Other
                                        99999       = Illegible entry

   15.5     5     94-98           Medication code # 5
                                  ___________________
                                        00005-92190 = 00005-92190
                                        90000       = Blank
                                        99980       = Unknown entry; Other
                                        99999       = Illegible entry

  Item    Field    Tape
   No.   Length  Location   Item Description and Codes - Emergency Departments
  ____   ______  ________   ___________________________________________________


   16       12    99-110    Diagnostic/screening services

   16.1     1     99              None                     (1=Yes, and 0=No)
   16.2     1     100             Blood pressure check            "
   16.3     1     101             Urinalysis                      "
   16.4     1     102             HIV serology                    "
   16.5     1     103             Other blood test                "
   16.6     1     104             EKG                             "
   16.7     1     105             Mental status exam              "
   16.8     1     106             Chest x-ray                     "
   16.9     1     107             Extremity x-ray                 "
   16.10    1     108             Ct scan/MRI                     "
   16.11    1     109             Other diagnostic imaging        "
   16.12    1     110             Other (Specify)                 "

   17       11    111-121   Procedures

   17.1     1     111             None                     (1=Yes,and 0=No)
   17.2     1     112             Endotracheal intubation         "
   17.3     1     113             CPR                             "
   17.4     1     114             IV fluids                       "
   17.5     1     115             NG tube/gastric lavage          "
   17.6     1     116             Wound care                      "
   17.7     1     117             Eye/ENT care                    "
   17.8     1     118             Orthopedic care                 "
   17.9     1     119             Bladder catheter                "
   17.10    1     120             Lumbar puncture                 "
   17.11    1     121             Other(s)(specify)               "

   18       10    122-131   Disposition of this visit

   18.1     1     122             Return to ED P.R.N.       (1=Yes, and 0=No)
   18.2     1     123             Return to ED-appointment           "
   18.3     1     124             Return to referring physician      "
   18.4     1     125             Refer to other physician/clinic    "
   18.5     1     126             Admit to hospital                  "
   18.6     1     127             Transfer to other facility         "
   18.7     1     128             DOA/died in ED                     "
   18.8     1     129             Left AMA                           "
   18.9     1     130             No follow-up planned               "
   18.10    1     131             Other (specify)                    "

   19       8     132-139   Providers seen this visit

   19.1     1     132             Resident/Intern           (1=Yes, and 0=No)
   19.2     1     133             Staff physician                    "
   19.3     1     134             Other physician                    "
   19.4     1     135             Physician assistant                "
   19.5     1     136             Nurse practitioner                 "
   19.6     1     137             Registered nurse                   "
   19.7     1     138             Licensed practical nurse           "
   19.8     1     139             Nurse's aid                        "

  Item    Field    Tape
   No.   Length  Location   Item Description and Codes - Emergency Departments
  ____   ______  ________   ___________________________________________________


   20       5     140-144   Patient visit weight (see page 17)
                                  A right justified, alphanumeric integer
                                  developed by the NHAMCS staff for the purpose
                                  of producing national estimates from sample
                                  estimates.

   21       1     146       Geographic region (based on actual location of
                                               physician's practice)
                                  1 = Northeast
                                  2 = Midwest
                                  3 = South
                                  4 = West

   22       1     147       Metropolitan/nonmetropolitan
                                  Based on actual location, in conjunction with
                                  the definition of the Bureau of the Census and
                                  the U.S. Office of Management and Budget.
                                       1 = MSA (Metropolitan Statistical Area)
                                       2 = Non-MSA

   23       1     148       Hospital ownership
                            __________________
                                  1 = Voluntary non-profit
                                  2 = Government
                                  3 = Proprietary

   24       3     149-151   Hospital code
                                  001-605 :  A unique code assigned to all the
                                             records from a particular hospital

   25       8     152-159   Imputations
                            ___________
                                  (1 = data imputed; blank = data not computed)

   25.1     1     152             Birth year                      (Item 4) *
   25.2     1     153             Sex                             (Item 5) *
   25.3     1     154             Race                            (Item 6) *
   25.4     1     155             Ethnicity                       (Item 7) *
   25.5     1     156             Urgency                         (Item 13)*
   25.6     1     157             Alcohol- or drug-related        (Item 14)*
   25.7     1     158             Disposition of visit            (Item 18)*
   25.8     1     159             Providers                       (Item 19)*


    * These refer to items on the Patient Record Form on page 9.

  Item    Field    Tape
   No.   Length  Location   Item Description and Codes - Emergency Departments
  ____   ______  ________   ___________________________________________________


   26-31    35    160-194   Drug related information for medication code # 1

   26       5     160-164   Generic name code (see pages 96-103 for codes and
                            names)

                                50001-92506 : Specific generic code
                                50000       : Generic name undetermined


   27       1     165       Prescription status code
                            ________________________
                                1 = Prescription drug
                                2 = Nonprescription drug
                                3 = Undetermined


   28       1     166       Controlled substance status code
                            ________________________________
                                1 = Schedule I (research only)
                                2 = Schedule II
                                3 = Schedule III
                                4 = Schedule IV
                                5 = Schedule V
                                6 = No control
                                7 = Undetermined


   29       1     167       Composition status code
                            _______________________
                                1 = Single entity drug
                                2 = Combination drug
                                3 = Undetermined


   30       2     168-169   Drug classes
                            ____________
                                01-19 : Major NDC drug class
                                   20 : Other or undetermined
                                blank : blank
                                        (See page 104 for list of major NDC
                                         drug class codes and names)


   31       25    170-194   Ingredient codes (Ingredients of combination
                                drugs; maximum of 5 generic name codes)
                                Ingredient code (50001-92506, or 50000)
                                Ingredient code (50001-92506, or 50000)
                                Ingredient code (50001-92506, or 50000)
                                Ingredient code (50001-92506, or 50000)
                                Ingredient code (50001-92506, or 50000)

  Item    Field    Tape
   No.   Length  Location   Item Description and Codes - Emergency Departments
  ____   ______  ________   ___________________________________________________


   32-37    35    195-229   Drug related information for medication code # 2

   32       5     195-199   Generic name code (see pages 96-103 for codes
                            and names)

                                50001-92506 : Specific generic code
                                50000       : Generic name undetermined


   33       1     200       Prescription status code
                            ________________________
                                1 = Prescription drug
                                2 = Nonprescription drug
                                3 = Undetermined


   34       1     201       Controlled substance status code
                            ________________________________
                                1 = Schedule I (research only)
                                2 = Schedule II
                                3 = Schedule III
                                4 = Schedule IV
                                5 = Schedule V
                                6 = No control
                                7 = Undetermined


   35       1     202       Composition status code
                            _______________________
                                1 = Single entity drug
                                2 = Combination drug
                                3 = Undetermined


   36       2     203-204   Drug classes
                            ____________
                                01-19 : Major NDC drug class
                                   20 : Other or undetermined
                                blank : blank
                                        (See page 104 for list of major NDC
                                         drug class codes and names)


   37       25    205-229   Ingredient codes (Ingredients of combination
                                drugs; maximum of 5 generic name codes)
                                Ingredient code (50001-92506, or 50000)
                                Ingredient code (50001-92506, or 50000)
                                Ingredient code (50001-92506, or 50000)
                                Ingredient code (50001-92506, or 50000)
                                Ingredient code (50001-92506, or 50000)

  Item    Field    Tape
   No.   Length  Location   Item Description and Codes - Emergency Departments
  ____   ______  ________   ___________________________________________________


   38-43    35    230-264   Drug related information for medication code # 3


   38       5     230-234   Generic name code (see pages 96-103 for codes
                            and names)

                                50001-92506 : Specific generic code
                                50000       : Generic name undetermined


   39       1     235       Prescription status code
                            ________________________
                                1 = Prescription drug
                                2 = Nonprescription drug
                                3 = Undetermined


   40       1     236       Controlled substance status code
                            ________________________________
                                1 = Schedule I (research only)
                                2 = Schedule II
                                3 = Schedule III
                                4 = Schedule IV
                                5 = Schedule V
                                6 = No control
                                7 = Undetermined


   41       1     237       Composition status code
                            _______________________
                                1 = Single entity drug
                                2 = Combination drug
                                3 = Undetermined


   42       2     238-239   Drug classes
                            ____________
                                01-19 : Major NDC drug class
                                   20 : Other or undetermined
                                blank : blank
                                        (See page 104 for list of major NDC
                                         drug class codes and names)


   43       25    240-264   Ingredient codes (Ingredients of combination
                                drugs; maximum of 5 generic name codes)
                                Ingredient code (50001-92506, or 50000)
                                Ingredient code (50001-92506, or 50000)
                                Ingredient code (50001-92506, or 50000)
                                Ingredient code (50001-92506, or 50000)
                                Ingredient code (50001-92506, or 50000)

  Item    Field    Tape
   No.   Length  Location   Item Description and Codes - Emergency Departments
  ____   ______  ________   ___________________________________________________


   44-49    35    265-299   Drug related information for medication code # 4

   44       5     265-269   Generic name code (see pages 96-103 for codes
                            and names)

                                50001-92506 : Specific generic code
                                50000       : Generic name undetermined


   45       1     270       Prescription status code
                            ________________________
                                1 = Prescription drug
                                2 = Nonprescription drug
                                3 = Undetermined


   46       1     271       Controlled substance status code
                            ________________________________
                                1 = Schedule I (research only)
                                2 = Schedule II
                                3 = Schedule III
                                4 = Schedule IV
                                5 = Schedule V
                                6 = No control
                                7 = Undetermined


   47       1     272       Composition status code
                            _______________________
                                1 = Single entity drug
                                2 = Combination drug
                                3 = Undetermined


   48       2     273-274   Drug classes
                            ____________
                                01-19 : Major NDC drug class
                                   20 : Other or undetermined
                                blank : blank
                                        (See page 104 for list of major NDC
                                         drug class codes and names)


   49       25    275-299   Ingredient codes (Ingredients of combination
                                drugs; maximum of 5 generic name codes)
                                Ingredient code (50001-92506, or 50000)
                                Ingredient code (50001-92506, or 50000)
                                Ingredient code (50001-92506, or 50000)
                                Ingredient code (50001-92506, or 50000)
                                Ingredient code (50001-92506, or 50000)
  Item    Field    Tape
   No.   Length  Location   Item Description and Codes - Emergency Departments
  ____   ______  ________   ___________________________________________________


   50-55    35    300-334   Drug related information for medication code # 5


   50       5     300-304   Generic name code (see pages 96-103 for codes
                            and names)

                                50001-92506 : Specific generic code
                                50000       : Generic name undetermined


   51       1     305       Prescription status code
                            ________________________
                                1 = Prescription drug
                                2 = Nonprescription drug
                                3 = Undetermined


   52       1     306       Controlled substance status code
                            ________________________________
                                1 = Schedule I (research only)
                                2 = Schedule II
                                3 = Schedule III
                                4 = Schedule IV
                                5 = Schedule V
                                6 = No control
                                7 = Undetermined


   53       1     307       Composition status code
                            _______________________
                                1 = Single entity drug
                                2 = Combination drug
                                3 = Undetermined


   54       2     308-309   Drug classes
                            ____________
                                01-19 : Major NDC drug class
                                   20 : Other or undetermined
                                blank : blank
                                        (See page 104 for list of major NDC
                                         drug class codes and names)


   55       25    310-334   Ingredient codes (Ingredients of combination
                                drugs; maximum of 5 generic name codes)
                                Ingredient code (50001-92506, or 50000)
                                Ingredient code (50001-92506, or 50000)
                                Ingredient code (50001-92506, or 50000)
                                Ingredient code (50001-92506, or 50000)
                                Ingredient code (50001-92506, or 50000)
RECORD LAYOUT

 This section consists of a detailed breakdown of the data tape record,
 providing a brief description of each item of data included in the records.
 The data are arranged sequentially according to their physical location on
 the tape record. Unless otherwise stated in the "item description" column,
 the data are derived from the Outpatient Department (OPD) Patient Record Form
 (page 10).  The AMA, the hospital induction questionnaire, and the SMG
 Hospital Market Data Base are alternate sources of data, while the computer
 generates other items by recoding selected data items.

  Item    Field    Tape
   No.   Length  Location   Item Description and Codes - Outpatient Departments
  ____   ______  ________   ___________________________________________________


   1        6     1-6       Date of visit
                            _____________
   1.1      2     1-2             Month of visit
                                     01-12:  January-December
   1.2      2     3-4             Day of visit
                                     01-31
   1.3      2     5-6             Year of visit
                                     Last 2 digits of year (91 or 92)*

   2        2     7-8       Patient age  (in years; derived from date of birth)
                            ___________
                                  00-99

   3        1     9         Sex
                            ___
                                  1 = Female
                                  2 = Male

   4        1     10        Race
                            ____
                                  1 = White
                                  2 = Black
                                  3 = Asian/Pacific Islander
                                  4 = American Indian/Eskimo/Aleut

   5        1     11        Ethnicity
                            _________
                                  1 = Hispanic origin
                                  2 = Not Hispanic

   6        9     12-20     Expected source(s) of payment
                            _____________________________
   6.1      1     12              Medicare                 (1=Yes, and 0=No)
   6.2      1     13              Medicaid                         "
   6.3      1     14              Other government                 "
   6.4      1     15              Private/commercial               "
   6.5      1     16              HMO/other prepaid                "
   6.6      1     17              Patient paid                     "
   6.7      1     18              No charge                        "
   6.8      1     19              Other                            "
   6.9      1     20              Unspecified                      "

  * The 1992 NHAMCS included data collected from Dec. 2, 1991 to Dec. 27, 1992.

  Item    Field    Tape
   No.   Length  Location   Item Description and Codes - Outpatient Departments
  ____   ______  ________   ___________________________________________________


   7        1     21        Was patient referred by another physician?
                            __________________________________________
                                  1 = Yes
                                  2 = No

   8        15    22-36     Patient reasons for visit (see pages 11 and 61-84)

   8.1      5     22-26           Reason # 1: 10050-89990 = 10050-89990
                                                90000     = Blank
   8.2      5     27-31           Reason # 2: 10050-89990 = 10050-89990
                                                90000     = Blank
   8.3      5     32-36           Reason # 3: 10050-89990 = 10050-89990
                                                90000     = Blank

   9        18    37-54     Physician's diagnoses (see page 12 and reference 9)

   9.1      6     37-42           Diagnosis # 1: 100100-209970 = 00100-V9970
                                                    900000     = Blank
   9.2      6     43-48           Diagnosis # 2: 100100-209970 = 00100-V9970
                                                    900000     = Blank
   9.3      6     49-54           Diagnosis # 3: 100100-209970 = 00100-V9970
                                                    900000     = Blank


   10       10    55-64     Ambulatory surgical procedures (see page 12 and ref.

   10.1     4     55-58           Surgical procedure code # 1
                                  ___________________________
                                              0101-9998 = 0101-9998
                                              0000      = Blank
                                              9999      = Other and uncodable

   10.2     1     59                    Scheduled/performed
                                        ___________________
                                              0 = Not applicable (if no code
                                                    entered) or  Unspecified
                                                    (if a code is entered)
                                              1 = Scheduled
                                              2 = Performed

   10.3     1     60                    Type of anesthesia
                                        __________________
                                              0 = Not applicable (if no code
                                                    entered) or Unspecified
                                                    (if a code is entered)
                                              1 = Local
                                              2 = Regional
                                              3 = General
   10.4     4     61-64           Surgical procedure code # 2
                                  ___________________________

                                              0101-9998 = 0101-9998
                                              0000      = Blank
                                              9999      = Other and uncodable

  Item    Field    Tape
   No.   Length  Location   Item Description and Codes - Outpatient Departments
  ____   ______  ________   ___________________________________________________


   11.1     1     65        Have you seen patient before?
                            _____________________________
                                  1 = Yes....
                                  2 = No

   11.1     1     66                  If yes, for the condition in item 11a?
                                      ______________________________________
                                                0 = Not applicable
                                                1 = Yes
                                                2 = No

   12       19    67-85     Diagnostic/screening services
                            _____________________________
   12.1     1     67              None                     (1=Yes, and 0=No)
   12.2     1     68              Blood pressure                   "
   12.3     1     69              Urinalysis                       "
   12.4     1     70              EKG - resting                    "
   12.5     1     71              EKG - exercise                   "
   12.6     1     72              Mammogram                        "
   12.7     1     73              Chest x-ray                      "
   12.8     1     74              Other radiology                  "
   12.9     1     75              Allergy testing                  "
   12.10    1     76              Spirometry                       "
   12.11    1     77              Pap test                         "
   12.12    1     78              Strep throat test                "
   12.13    1     79              HIV serology                     "
   12.14    1     80              Cholesterol measure              "
   12.15    1     81              Other lab test                   "
   12.16    1     82              Hearing test                     "
   12.17    1     83              Visual acuity                    "
   12.18    1     84              Mental status exam               "
   12.19    1     85              Other                            "

   13       17    86-102    Therapeutic services
                            ____________________
   13.1     1     86              None                (1=Yes, and 0=No)
   13.2     1     87              Diet                       "
   13.3     1     88              Exercise                   "
   13.4     1     89              Cholesterol reduction      "
   13.5     1     90              Weight reduction           "
   13.6     1     91              Drug abuse                 "
   13.7     1     92              Alcohol abuse              "
   13.8     1     93              Smoking cessation          "
   13.9     1     94              Family/social              "
   13.10    1     95              Growth/development         "
   13.11    1     96              Family planning            "
   13.12    1     97              Other counseling           "
   13.13    1     98              Psychotherapy              "
   13.14    1     99              Corrective lenses          "
   13.15    1     100             Hearing aid                "
   13.16    1     101             Physiotherapy              "
   13.17    1     102             Other therapy              "

  Item    Field    Tape
   No.   Length  Location   Item Description and Codes - Outpatient Departments
  ____   ______  ________   ___________________________________________________


   14       30    103-132   Medications (see pages 13 and 85-95)
                            ___________

   14.1     5     103-107         Medication Code # 1
                                  ___________________
                                        00005-92190 = 00005-92190
                                        90000       = Blank
                                        99980       = Unknown entry; Other
                                        99999       = Illegible entry

   14.2     1     108                      New medication?:
                                           ________________
                                                  0 = Unspecified
                                                  1 = Yes
                                                  2 = No

   14.3     5     109-113         Medication code # 2
                                  ___________________
                                        00005-92190 = 00005-92190
                                        90000       = Blank
                                        99980       = Unknown entry; Other
                                        99999       = Illegible entry

   14.4     1     114                      New medication?:
                                           ________________
                                                  0 = Unspecified
                                                  1 = Yes
                                                  2 = No

   14.5     5     115-119         Medication code # 3
                                  ___________________
                                        00005-92190 = 00005-92190
                                        90000       = Blank
                                        99980       = Unknown entry; Other
                                        99999       = Illegible entry

   14.6     1     120                      New medication?:
                                           ________________
                                                  0 = Unspecified
                                                  1 = Yes
                                                  2 = No

   14.7     5     121-125         Medication code # 4
                                  ___________________
                                        00005-92190 = 00005-92190
                                        90000       = Blank
                                        99980       = Unknown entry; Other
                                        99999       = Illegible entry

   14.8     1     126                      New medication?:
                                           ________________
                                                  0 = Unspecified
                                                  1 = Yes
                                                  2 = No

   14.9     5     127-131         Medication code # 5
                                  ___________________
                                        00005-92190 = 00005-92190
                                        90000       = Blank
                                        99980       = Unknown entry; Other
                                        99999       = Illegible entry

   14.10    1     132                      New medication?:
                                           ________________
                                                  0 = Unspecified
                                                  1 = Yes
                                                  2 = No

  Item    Field    Tape
   No.   Length  Location   Item Description and Codes - Outpatient Departments
  ____   ______  ________   ___________________________________________________

   15       1     133       Were medications ordered or provided at this visit?
                            ___________________________________________________
                                  0 = Yes
                                  1 = No

   16       1     134       Number of medications coded
                            ___________________________
                                  0-5

   17       8     135-142   Disposition of this visit
                            _________________________

   17.1     1     135             Return to Clinic P.R.N.   (1=Yes, and 0=No)
   17.2     1     136             Return to Clinic-appointment       "
   17.3     1     137             Telephone follow-up planned        "
   17.4     1     138             Return to referring physician      "
   17.5     1     139             Refer to other physician/clinic    "
   17.6     1     140             Admit to hospitalned               "
   17.7     1     141             No follow-up planned               "
   17.8     1     142             Other (specify)                    "


   18       8     143-150   Providers seen this visit
                            _________________________

   18.1     1     143             Resident/Intern           (1=Yes, and 0=No)
   18.2     1     144             Staff physician                    "
   18.3     1     145             Other physician                    "
   18.4     1     146             Physician assistant                "
   18.5     1     147             Nurse practitioner                 "
   18.6     1     148             Registered nurse                   "
   18.7     1     149             Licensed practical nurse           "
   18.8     1     150             Nurse's aid                        "

   19       5     151-155   Patient visit weight (see page 17)
                            ____________________
                                  A right justified, alphanumeric integer
                                  developed by the NAMCS staff for the purpose
                                  of producing national estimates from sample
                                  estimates.

  Item    Field    Tape
   No.   Length  Location   Item Description and Codes - Outpatient Departments
  ____   ______  ________   ___________________________________________________

   20       1     156       Geographic region (based on actual location of
                            physician's practice)
                                  1 = Northeast
                                  2 = Midwest
                                  3 = South
                                  4 = West

   21       1     157       Metropolitan/nonmetropolitan
                            ____________________________
                            Based on actual location, in conjunction with
                            the definition of the Bureau of the Census and
                            the U.S. Office of Management and Budget.
                                 1 = MSA (Metropolitan Statistical Area)
                                 2 = Non-MSA

   22       1     158       Hospital ownership
                            __________________
                                  1 = Voluntary non-profit
                                  2 = Government
                                  3 = Proprietary

   23       3     159-161   Hospital code
                            _____________
                                  001-605 :  A unique code assigned to all the
                                             records from a particular hospital

   24       1     162       Clinic type
                            ___________
                                  1 = General medicine
                                  2 = Surgery
                                  3 = Pediatrics
                                  4 = Obstetrics/Gynecology
                                  5 = Other
                                  6 = Substance abuse

   25       8     163-171   Imputations
                            ___________
                               (1 = data imputed;  blank = data not imputed)

   25.1     1     163            Birth year                      (Item 4) *
   25.2     1     164            Sex                             (Item 5) *
   25.3     1     165            Referral                        (Item 9) *
   25.4     1     166            Seen patient before             (Item 12)*
   25.5     1     167            If yes, for diagnosis in 11a    (Item 12)*
   25.6     1     168            Disposition                     (Item 17)*
   25.7     1     169            Providers                       (Item 18)*
   25.8     1     170            Race                            (Item 6) *
   25.9     1     171            Ethnicity                       (Item 7) *

    * These refer to items on the Patient Record Form on page 10.

  Item    Field    Tape
   No.   Length  Location   Item Description and Codes - Outpatient Departments
  ____   ______  ________   ___________________________________________________


   26-31    35    172-206   Drug related information for medication code # 1
                            ________________________________________________



   26       5     172-176   Generic name code (see pages 96-103 for codes and na
                            _________________
                                50005-92506 : Specific generic code
                                50000       : Generic name undetermined

   27       1     177       Prescription status code
                            ________________________
                                1 = Prescription drug
                                2 = Nonprescription drug
                                3 = Undetermined

   28       1     178       Controlled substance status code
                            ________________________________
                                1 = Schedule I (research only)
                                2 = Schedule II
                                3 = Schedule III
                                4 = Schedule IV
                                5 = Schedule V
                                6 = No control
                                7 = Undetermined

   29       1     179       Composition status code
                            _______________________
                                1 = Single entity drug
                                2 = Combination drug
                                3 = Undetermined
                                5 = Multivitamin

   30       2     180-181   Drug classes
                            ____________
                                01-19 : Major NDC drug class
                                   20 : Other or undetermined
                                blank : blank
                                        (See page 104 for list of major NDC
                                         drug class codes and names)

   31       25    182-206   Ingredient codes (Ingredients of combination
                                drugs; maximum of 5 generic name codes)
                                Ingredient code (50005-92506, or 50000)
                                Ingredient code (50005-92506, or 50000)
                                Ingredient code (50005-92506, or 50000)
                                Ingredient code (50005-92506, or 50000)
                                Ingredient code (50005-92506, or 50000)

  Item    Field    Tape
   No.   Length  Location   Item Description and Codes - Outpatient Departments
  ____   ______  ________   ___________________________________________________


   32-37    35    207-241   Drug related information for medication code # 2
                            ________________________________________________

   32       5     207-211   Generic name code (see pages 96-103 for codes and na
                            _________________
                                50005-92506 : Specific generic code
                                50000       : Generic name undetermined

   33       1     212       Prescription status code
                            ________________________
                                1 = Prescription drug
                                2 = Nonprescription drug
                                3 = Undetermined

   34       1     213       Controlled substance status code
                            ________________________________
                                1 = Schedule I (research only)
                                2 = Schedule II
                                3 = Schedule III
                                4 = Schedule IV
                                5 = Schedule V
                                6 = No control
                                7 = Undetermined

   35       1     214       Composition status code
                            _______________________
                                1 = Single entity drug
                                2 = Combination drug
                                3 = Undetermined
                                5 = Multivitamin

   36       2     215-216   Drug classes
                            ____________
                                01-19 : Major NDC drug class
                                   20 : Other or undetermined
                                blank : blank
                                        (See page 104 for list of major NDC
                                         drug class codes and names)

   37       25    217-241   Ingredient codes (Ingredients of combination
                                drugs; maximum of 5 generic name codes)
                                Ingredient code (50005-92506, or 50000)
                                Ingredient code (50005-92506, or 50000)
                                Ingredient code (50005-92506, or 50000)
                                Ingredient code (50005-92506, or 50000)
                                Ingredient code (50005-92506, or 50000)

  Item    Field    Tape
   No.   Length  Location   Item Description and Codes - Outpatient Departments
  ____   ______  ________   ___________________________________________________


   38-43    35    242-276   Drug related information for medication code # 3
                            ________________________________________________

   38       5     242-246   Generic name code (see pages 96-103 for codes and na
                            _________________
                                50005-92506 : Specific generic code
                                50000       : Generic name undetermined

   39       1     247       Prescription status code
                            ________________________
                                1 = Prescription drug
                                2 = Nonprescription drug
                                3 = Undetermined

   40       1     248       Controlled substance status code
                            ________________________________
                                1 = Schedule I (research only)
                                2 = Schedule II
                                3 = Schedule III
                                4 = Schedule IV
                                5 = Schedule V
                                6 = No control
                                7 = Undetermined

   41       1     249       Composition status code
                            _______________________
                                1 = Single entity drug
                                2 = Combination drug
                                3 = Undetermined
                                5 = Multivitamin

   42       2     250-251   Drug classes
                            ____________
                                01-19 : Major NDC drug class
                                   20 : Other or undetermined
                                blank : blank
                                        (See page 104 for list of major NDC
                                         drug class codes and names)

   43       25    252-276   Ingredient codes (Ingredients of combination
                            ________________
                                drugs; maximum of 5 generic name codes)
                                Ingredient code (50005-92506, or 50000)
                                Ingredient code (50005-92506, or 50000)
                                Ingredient code (50005-92506, or 50000)
                                Ingredient code (50005-92506, or 50000)
                                Ingredient code (50005-92506, or 50000)

  Item    Field    Tape
   No.   Length  Location   Item Description and Codes - Outpatient Departments
  ____   ______  ________   ___________________________________________________

   44-49    35    277-311   Drug related information for medication code # 4
                            ________________________________________________

   44       5     277-281   Generic name code (see pages 96-103 for codes and na
                            _________________
                                50005-92506 : Specific generic code
                                50000       : Generic name undetermined

   45       1     282       Prescription status code
                            ________________________
                                1 = Prescription drug
                                2 = Nonprescription drug
                                3 = Undetermined

   46       1     283       Controlled substance status code
                            ________________________________
                                1 = Schedule I (research only)
                                2 = Schedule II
                                3 = Schedule III
                                4 = Schedule IV
                                5 = Schedule V
                                6 = No control
                                7 = Undetermined

   47       1     284       Composition status code
                            _______________________
                                1 = Single entity drug
                                2 = Combination drug
                                3 = Undetermined
                                5 = Multivitamin

   48       2     285-286   Drug classes
                            ____________
                                01-19 : Major NDC drug class
                                   20 : Other or undetermined
                                blank : blank
                                        (See page 104 for list of major NDC
                                         drug class codes and names)

   49       25    287-311   Ingredient codes (Ingredients of combination
                            ________________
                                drugs; maximum of 5 generic name codes)
                                Ingredient code (50005-92506, or 50000)
                                Ingredient code (50005-92506, or 50000)
                                Ingredient code (50005-92506, or 50000)
                                Ingredient code (50005-92506, or 50000)
                                Ingredient code (50005-92506, or 50000)

  Item    Field    Tape
   No.   Length  Location   Item Description and Codes - Outpatient Departments
  ____   ______  ________   ___________________________________________________

   50-55    35    312-346   Drug related information for medication code # 5
                            ________________________________________________

   50       5     312-316   Generic name code (see pages 96-103 for codes and na
                            _________________
                                50005-92506 : Specific generic code
                                50000       : Generic name undetermined

   51       1     317       Prescription status code
                            ________________________
                                1 = Prescription drug
                                2 = Nonprescription drug
                                3 = Undetermined

   52       1     318       Controlled substance status code
                            ________________________________
                                1 = Schedule I (research only)
                                2 = Schedule II
                                3 = Schedule III
                                4 = Schedule IV
                                5 = Schedule V
                                6 = No control
                                7 = Undetermined

   53       1     319       Composition status code
                            _______________________
                                1 = Single entity drug
                                2 = Combination drug
                                3 = Undetermined
                                5 = Multivitamin

   54       2     320-321   Drug classes
                            ____________
                                01-19 : Major NDC drug class
                                   20 : Other or undetermined
                                blank : blank
                                        (See page 104 for list of major NDC
                                         drug class codes and names)

   55       25    322-346   Ingredient codes (Ingredients of combination
                                drugs; maximum of 5 generic name codes)
                                Ingredient code (50005-92506, or 50000)
                                Ingredient code (50005-92506, or 50000)
                                Ingredient code (50005-92506, or 50000)
                                Ingredient code (50005-92506, or 50000)
                                Ingredient code (50005-92506, or 50000)

MARGINAL DATA
Marginal Data for Emergency Department Patient Visits

 PATIENT AGE   TOTAL     < 15      15-24     25-44     45-64    65-74      75+
             _________ _________ _________ _________ _________ _________ _______

         ALL     36271      9212      5873     11231    4917      2288      2750
              89795736  22522543  14847861  27239895 12509277   5805530  6870630
               100.000    25.082    16.535    30.335   13.931     6.465    7.651

 PATIENT SEX          TOTAL     FEMALE    MALE
                    _________ _________ _________

                ALL     36271     18778     17493  RECORDS
                     89795736  46611996  43183740  VISITS
                      100.000    51.909    48.091  PERCENT

 PATIENT RACE                   WHITE     BLACK    ASIAN/PA  AMERIN/
                      TOTAL                        ISLANDER ESK/ALEU
                    _________ _________ _________ _________ _________

                ALL     36271     27471      7730       791      279  RECORDS
                     89795736  70477789  17149703   1399595   768649  VISITS
                      100.000    78.487    19.099     1.559   0.856  PERCENT

 ETHNICITY                    HISPANIC     NOT
                      TOTAL              HISPANIC
                    _________ _________ _________

                ALL     36271      4664     31607  RECORDS
                     89795736   9503457  80292279  VISITS
                      100.000    10.583    89.417  PERCENT

 SOURCE OF               MEDICARE  MEDICAID   OTHER   PRIVATE/ HMO/OTHER PATIENT
 PAYMENT        TOTAL                          GOVT    COMMER   PREPAID    PAID
              _________ _________ _________ _________ _________ _________ ______

          ALL     36271      5271      8425      1622     11931    3321     5298
               89795736  13582252  20339368   4032150  32331413 6566039 12402458
                100.000    15.126    22.651     4.490    36.006   7.312   13.812

                                 NO       OTHER      NO
                               CHARGE              ANSWER
                              _________ _________ _________

                                    200      2640       656  RECORDS
                                 778070   6116894   1505422  VISITS
                                  0.866     6.812     1.676  PERCENT

 MAJOR REASON          INJURY    INJURY    ILLNESS  ILLNESS    OTHER   BLANK OR
 FOR THIS     TOTAL   1ST VISIT FOLLOW-UP 1ST VISIT FOLLOW-UP  REASON   INVALID
 VISIT      _________ _________ _________ _________ _________ _______ _________

        ALL     36271     11143      1248     20184     1181    1979       536
             89795736  28388457   3178320  49690585  2836619 4430440   1271315
              100.000    31.614     3.539    55.337    3.159   4.934     1.416

 URGENCY OF                    URGENT/    NON-
 THIS VISIT           TOTAL    EMERGENT   URGENT
                    _________ _________ _________

                ALL     36271     16675     19596  RECORDS
                     89795736  40078495  49717241  VISITS
                      100.000    44.633    55.367  PERCENT

 IS PROBLEM                    NEITHER   ALCOHOL    DRUG      BOTH
 ALCOHOL OR          TOTAL               RELATED   RELATED
 DRUG RELATED?      _________ _________ _________ _________ _________

                ALL     36271     34739       970       408      154  RECORDS
                     89795736  86014107   2458996    995529   327104  VISITS
                      100.000    95.789     2.738     1.109    0.364  PERCENT


Marginal Data for Emergency Department Drug Mentions

 PATIENT AGE     TOTAL     < 15     15-24     25-44      45-64   65-74     75+
               _________ _________ ________ _________ _________ ________ _______

           ALL     45844     10226     6432     14322     7449     3521     3894
               117418882  25441186 16889626  36196345 19772429  9253241  9866055
                 100.000    21.667   14.384    30.827   16.839    7.881    8.402

 PATIENT SEX          TOTAL     FEMALE    MALE
                    _________ _________ _________

                ALL     45844     24471     21373  RECORDS
                    117418882  63296149  54122733  MENTIONS
                      100.000    53.906    46.094  PERCENT

 PATIENT RACE                   WHITE     BLACK    ASIAN/PA  AMER IN/
                      TOTAL                        ISLANDER ESK/ALEU
                    _________ _________ _________ _________ _________

                ALL     45844     35152      9312       994      386  RECORDS
                    117418882  92796663  21975123   1626858  1020238  MENTIONS
                      100.000    79.030    18.715     1.386    0.869  PERCENT

 ETHNICITY                                 NOT
                      TOTAL   HISPANIC   HISPANIC
                    _________ _________ _________

                ALL     45844      5722     40122  RECORDS
                    117418882  12164555 105254327  MENTIONS
                      100.000    10.360    89.640  PERCENT

 SOURCE OF            MEDICARE  MEDICAID  OTHER   PRIVATE/ HMO/OTHER  PATIENT
 PAYMENT     TOTAL                         GOVT   COMMER   PREPAID    PAID
           _________ _________ _________ ________ _________ _________ _________

       ALL     45844      7823     10780     1995    15377     4448      6399
           117418882  20953208  27291795  5124712 42710885  8211439  15757616
             100.000    17.845    23.243    4.364   36.375    6.993    13.420


                                 NO                  NO
                               CHARGE     OTHER    ANSWER
                              _________ _________ _________

                                    169      2914       623 RECORDS
                                1079721   6830633   1424909 MENTIONS
                                  0.920     5.817     1.214 PERCENT

 MAJOR REASON           INJURY    INJURY    ILLNESS   ILLNESS    OTHER  BLANK OR
 FOR THIS      TOTAL   1ST VISIT FOLLOW-UP 1ST VISIT FOLLOW-UP  REASON  INVALID
 VISIT       _________ _________ _________ _________ _________ ________ ________

         ALL     45844     11494       832     29362     1674      1881      601
             117418882  29939678   2109516  75178547  4088368   4568684  1534089
               100.000    25.498     1.797    64.026    3.482     3.891    1.307

 PRESCRIPTION                              NON
   STATUS                     PRESCRIP- PRESCRIP-  UNDETER-
                       TOTAL  TION DRUG TION DRUG   MINED
                    _________ _________ _________ _________

                ALL     45844     35746      7757      2341 RECORDS
                    117418882  92251104  19115184   6052594 MENTIONS
                      100.000    78.566    16.279     5.155 PERCENT

 IS PROBLEM                              ALCOHOL    DRUG
 ALCOHOL OR          TOTAL     NEITHER   RELATED   RELATED    BOTH
 DRUG RELATED?     _________ _________ _________ _________ _________

                ALL     45844     43879      1247       531      187  RECORDS
                    117418882 112445807   3154265   1383596   435214  MENTIONS
                      100.000    95.765     2.686     1.178    0.371  PERCENT

Marginal Data for Outpatient Department Patient Visits

 PATIENT AGE     TOTAL     < 15      15-24     25-44     45-64    65-74      75+
               _________ _________ _________ _________ ________ ________ _______

           ALL     35114      7605      4979     10440     6814     3099    2177
                56604704  12712696   7241933  16484282 11295379  5030767 3839647
                 100.000    22.459    12.794    29.122   19.955    8.888   6.783

 PATIENT SEX          TOTAL     FEMALE    MALE
                    _________ _________ _________

                ALL     35114     21689     13425  RECORDS
                     56604704  34741328  21863376  VISITS
                      100.000    61.375    38.625  PERCENT

 PATIENT RACE                                      ASIAN/PA  AMER IN/
                      TOTAL     WHITE     BLACK    ISLANDER ESK/ALEU
                    _________ _________ _________ _________ _________

                ALL     35114     26185      7827       986      116  RECORDS
                     56604704  42033459  12549117   1608598   413530  VISITS
                      100.000    74.258    22.170     2.842    0.731  PERCENT

 ETHNICITY                                 NOT
                      TOTAL   HISPANIC   HISPANIC
                    _________ _________ _________

                ALL     35114      4730     30384  RECORDS
                     56604704   9635178  46969526  VISITS
                      100.000    17.022    82.978  PERCENT

 SOURCE OF               MEDICARE  MEDICAID   OTHER   PRIVATE/ HMO/OTHER PATIENT
 PAYMENT        TOTAL                          GOVT    COMMER   PREPAID   PAID
              _________ _________ _________ _________ _________ ________ _______

          ALL     35114      5471     11162      2122     8747      2856    4434
               56604704   9239617  17647144   3683830 13477922   4364114 7747591
                100.000    16.323    31.176     6.508   23.811     7.710  13.687


                                 NO                  NO
                               CHARGE     OTHER    ANSWER
                              _________ _________ _________

                                    803      2156      1059 RECORDS
                                1640364   3115824   1711791 VISITS
                                  2.898     5.505     3.024 PERCENT

 PATIENT              TOTAL      YES       NO
 REFERRAL           _________ _________ _________
 STATUS
               ALL     35114      4482     30632  RECORDS
                     56604704   6421516  50183188  VISITS
                      100.000    11.344    88.656  PERCENT

 VISIT                                   OLD PAT   OLD PAT
 STATUS               TOTAL    NEW PAT   NEW PROB  OLD PROB
                    _________ _________ _________ _________

                ALL     35114      8945      4845     21324 RECORDS
                     56604704  12425178   8545076  35634450 VISITS
                      100.000    21.951    15.096    62.953 PERCENT

 WERE MEDICATIONS     TOTAL       YES      NO
 ORDERED OR         _________ _________ _________
 PROVIDED
 AT THIS        ALL     35114     18363     16751  RECORDS
 VISIT?              56604704  30155994  26448710  VISITS
                      100.000    53.275    46.725  PERCENT

Marginal Data for Outpatient Department Drug Mentions

 PATIENT AGE    TOTAL     < 15      15-24     25-44     45-64    65-74      75+
              _________ _________ _________ _________ _______  ________ _______

          ALL     38507      7429      3938      9859     9266     4513    3502
               63298431  11822475   5345628  16845304 15695042  7452868 6137114
                100.000    18.677     8.445    26.613   24.795   11.774   9.696

 PATIENT SEX          TOTAL     FEMALE    MALE
                    _________ _________ _________

                ALL     38507     23823     14684  RECORDS
                     63298431  38861084  24437347  MENTIONS
                      100.000    61.393    38.607  PERCENT

 PATIENT RACE                                      ASIAN/PA  AMER IN/
                      TOTAL     WHITE     BLACK    ISLANDER ESK/ALEU
                    _________ _________ _________ _________ _________

                ALL     38507     28008      9298      1026      175  RECORDS
                     63298431  46046215  15077604   1697594   477018  MENTIONS
                      100.000    72.745    23.820     2.682    0.754  PERCENT

 ETHNICITY                                 NOT
                      TOTAL   HISPANIC   HISPANIC
                    _________ _________ _________

                ALL     38507      4579     33928  RECORDS
                     63298431   9652943  53645488  MENTIONS
                      100.000    15.250    84.750  PERCENT

 SOURCE OF               MEDICARE  MEDICAID   OTHER   PRIVATE/ HMO/OTHER PATIENT
 PAYMENT        TOTAL                          GOVT    COMMER   PREPAID   PAID
              _________ _________ _________ _________ _________ ________ _______

          ALL     38507      8661     12739      2337     9843     2654     4438
               63298431  14495065  20326663   3899882 15361950  4841802  7617630
                100.000    22.900    32.112     6.161   24.269    7.649   12.034


                                 NO                  NO
                               CHARGE     OTHER    ANSWER
                              _________ _________ _________

                                    640      2138       994 RECORDS
                                1454114   3376809   1591678 MENTIONS
                                  2.297     5.335     2.515 PERCENT

 PATIENT              TOTAL      YES       NO
 REFERRAL           _________ _________ _________
 STATUS
                ALL     38507      3762     34745  RECORDS
                     63298431   5054125  58244306  MENTIONS
                      100.000     7.985    92.015  PERCENT

 VISIT                                   OLD PAT   OLD PAT
 STATUS                 TOTAL  NEW PAT   NEW PROB  OLD PROB
                    _________ _________ _________ _________

                ALL     38507      9155      5377     23975 RECORDS
                     63298431  11075770   9277633  42945028 MENTIONS
                      100.000    17.498    14.657    67.845 PERCENT

 IS THIS              TOTAL      YES       NO     UNSPECIFD
 A NEW              _________ _________ _________ _________
 MEDICATION?
                ALL     38507     14400     20684      3423 RECORDS
                     63298431  21128622  36884549   5285260 MENTIONS
                      100.000    33.379    58.271     8.350 PERCENT

 PRESCRIPTION                              NON
   STATUS                     PRESCRIP- PRESCRIP-  UNDETER-
                       TOTAL  TION DRUG TION DRUG   MINED
                    _________ _________ _________ _________

                ALL     38507     30423      5197      2887 RECORDS
                     63298431  50403224   8480457   4414750 MENTIONS
                      100.000    79.628    13.398     6.975 PERCENT

APPENDIX 1

                      Relative Standard Errors

     The standard error is primarily a measure of the sampling variability that
 occurs by chance because only a sample is surveyed, rather than the entire
 universe.  The relative standard error (R.S.E.) of an estimate is obtained by
 dividing the standard error of the estimate by the estimate itself and is
 expressed as a percentage of the estimate.

 TABLE III.  Relative standard errors for estimated numbers of PATIENT VISITS
             and DRUG MENTIONS: National Hospital Ambulatory Medical Care
             Survey, 1992.

 ______________________________________________________________________________
                                        }
             PATIENT VISITS             }             DRUG MENTIONS
 _______________________________________}______________________________________
                                        }
  Estimate      Relative Standard Error }    Estimate   Relative Standard Error
  ________     ________________________      ________ _________________________
  (x 1000)         ED'S       OPD'S     }    (x 1000)        ED'S      OPD'S
 _______________________________________}______________________________________
                                        }
      10  .......  71.1       87.2      }       10  .......  71.9      75.2
      20  .......  50.4       62.0      }       20  .......  50.9      53.9
      30  .......  41.2       51.0      }       30  .......  41.6      44.5
      40  .......  35.7       44.4      }       40  .......  36.1      39.0
      57  .......  30.0*      37.5      }       58.5.......  30.0*     32.9
      80  .......  25.4       32.1      }       72.5.......  27.0      30.0*
      93  .......  23.6       30.0*     }       90  .......  24.3      27.4
     100  .......  22.8       29.0      }      100  .......  23.1      26.3
     200  .......  16.4       21.6      }      200  .......  16.6      20.4
     400  .......  11.9       16.7      }      400  .......  12.2      16.7
   1,000  .......   8.1       12.9      }    1,000  .......   8.5      14.0
   5,000  .......   5.1       10.3      }    5,000  .......   5.5      12.3
  10,100  .......   4.6        9.9      }   10,000  .......   5.0      12.1
  50,000  .......   4.1        9.6      }   50,000  .......   4.6      11.9
 100,000  .......   4.0        9.6      }  100,000  .......   4.5      11.9

 ______________________________________________________________________________
       * The lowest reliable estimate.

 Example of use of table:  An aggregate estimate of 1 million patient visits to
         OPD's has a relative standard error of 12.9%, or a standard error of
         129,000 patient visits (12.9 percent of 1 million).

 For aggregate estimates, relative standard errors may be calculated using
 the following general formula, where "x" is the aggregate of patient visits
 or drug mentions in thousands, and coefficients "A" and "B" are obtained
 from Table IV.

 For estimates of percentages, relative standard errors may be calculated
 using the following general formula, where "p" is the percent of visits
 or mentions, "X" is the denominator of the percent in thousands, and
 coefficient "B" is obtained from Table IV.

 Table IV.  Coefficients appropriate for determining relative standard errors
            of patient visit or drug mention estimates (in 1,000'S) for ED's or
            OPD's:  National Hospital Ambulatory Medical Care Survey, 1992.

 ______________________________________________________________________________

                                                             Coefficient
                                                    ___________________________

                                                         A              B
 ______________________________________________________________________________

 Patient visits

         Emergency Departments......................  0.00158         5.0405
         Outpatient Departments.....................  0.00912         7.5165

 Drug mentions

         Emergency Departments......................  0.002           5.142932
         Outpatient Departments.....................  0.014           5.519726


 ______________________________________________________________________________

 ______________________________________________________________________________

 For estimates of visit rates, in which the numerator is the number of visits
 for a particular characteristic, and the denominator is the total United States
 population, the relative standard error is equivalent to the relative standard
 error of the numerator, as shown in the previous paragraph on aggregate estimat


PATIENT RECORD FORM DATA ITEMS

                      DEFINITIONS AND INSTRUCTIONS

  Item 3 - DATE OF VISIT

            Self-explanatory


  ITEM 4 - DATE OF BIRTH

            Record exact date.  Estimate year if date is unknown.


  ITEM 5 - SEX

            Self-explanatory


  ITEM 6 - COLOR OR RACE

            Record according to observation or knowledge of patient.  If the
            patient's race is not obvious, the hospital staff are instructed
            to mark the appropriate category based on the hospital's usual
            practice or knowledge.

                 1.  White:  A person having origins in any of the original
                 peoples of Europe, North Africa, or the Middle East.

                 2.  Black:  A person having origins in any of the black
                 racial groups of Africa.

                 3.  Asian/Pacific Islander:  A person having origins in any
                 of the original peoples of Far East, Southeast Asia, the
                 Indian subcontinent, or the Pacific Islands.  This area
                 includes for example, China, India, Japan, Korea, the
                 Philippine Islands and Samoa.

                 4.  American Indian/Eskimo/Aleut:  A person having origins
                 in any of the original peoples of North America, and who
                 maintains cultural identification through tribal affiliation
                 or community recognition.

  ITEM 7 - ETHNICITY

            Record according to observation or knowledge of the patient.  If
            the patient's ethnicity is not obvious, the hospital staff are
            instructed to mark the appropriate category based on the
            hospital's usual practice or knowledge.

                 1 - Hispanic Origin:  A person of Mexican, Puerto Rican,
                 Cuban, Central or South American or other Spanish culture or
                 origin.  regardless of race.

                 2 - Not Hispanic:  Check "Not Hispanic" for all persons who
                 are not of Hispanic origin.

  ITEM 8 - EXPECTED SOURCE(S) OF PAYMENT

       Hospital staff are instructed to check the source(s) that would pay for
       the visit.

                        Source                      Definition

            1.  Medicare:             Changes paid in part or in full by
                                      a Medicare plan.  Includes
                                      payments made directly to the
                                      hospital as well as payments
                                      reimbursed to the patient.

            2.  Medicaid:             Changes paid in part or in full by
                                      a medicaid plan.  Includes
                                      payments made directly to the
                                      hospital as well as payments
                                      reimbursed to the patient.

            3.  Other government:     Includes payments made under any
                                      other local, state, or Federal
                                      health care programs, such as
                                      workman's compensation programs
                                      and Civilian Health and Medical
                                      Programs of Uniformed Services
                                      (CHAMPUS).

          4.  Private/Commercial:   Charges paid in part or in full by
                                    a private insurance company.
                                    Includes payments made directly to
                                    the hospital as well as payments
                                    reimbursed to the patients.

          5.  HMO/Other prepaid:    Charges included under a
                                    prepayment plan.  Includes Health
                                    Maintenance Organizations (HMO'S),
                                    Independent Practice Associations
                                    (IPA'S), Preferred Provider
                                    Organizations (PPO's), etc.

          6.  Patient paid:         Charges paid in part or in full by
                                    the patient or the patient's
                                    family, which will not be
                                    reimbursed by a third party.
                                    Includes "co-payments" and
                                    "insurance deductibles".  Excludes
                                    prepaid plan visits for which no
                                    co-payment is charged.

          7.  No charge:            Visits for which no fee is
                                    charged.

          8.  Other:                Any other source of payment not
                                    covered in the categories above.
  ITEM 9-(OPD) - WAS PATIENT REFERRED FOR THIS VISIT BY ANOTHER PHYSICIAN?

        Referrals are any visits that are made at the advice or direction of a
        physician other than the one being visited.  The interest is in
        referrals for the current visit and not in referrals for any prior
        visit.


  ITEM 9-(ED) - MAJOR REASON FOR THIS VISIT

       Hospital staff are instructed to indicate whether this visit is the
       first visit or follow-up visit for an injury or illness.

            1.  Injury, first visit:   Self-explanatory

            2.  Injury, follow-up:     Self-explanatory

            3.  Illness, first visit:  Self-explanatory

            4.  Illness, follow-up:    Self-explanatory

            5.  Other reason:     Includes general health maintenance
                                  examinations, routine periodic
                                  examinations of presumably health
                                  persons, both children and adults, and
                                  malingering.


  ITEM 10-(ED) - CAUSE OF INJURY

       Hospital staff are instructed to describe in detail the events and
       circumstances surrounding the injury, for example, the place and cause
       of injury.

  ITEM 10 OR 11 - PATIENT'S COMPLAINT(S), SYMPTOM(S), OR OTHER REASON(S) FOR
              THIS VISIT (in patient's own words)

       The patient's problem, complaint, symptom, or other reason for this
       visit as expressed by the patient.  Hospital staff are instructed to
       record key words or phrases verbatim from the patient, to the extent
       possible.  The physician may recognize right away, or may find out after
       examination, that the real problem is something entirely different, but
       the physician's diagnosis is recorded in the following item and should
       not be reported here.  Example:  "pain in chest"  "Cramps after eating".

       There will, of course, be visits by patients for reasons other than some
       complaint or symptom.  Examples might be:  annual checkup, routine
       prenatal or postnatal care.  In such cases, simply record the reason for
       the visit.  If the reason for the patient visit was only to pay a bill
       or ask the physician to fill out an insurance form or to drop off a
       specimen, no Patient Record Form should be completed.

       Space has been allotted for up to three patient problems and they should
       be recorded in the order of importance.

   ITEM 11 OR 12 - PHYSICIAN'S DIAGNOSES

       (1)  This item should never be blank.  The principal, or first listed
       diagnosis, is the physician's best assessment of diagnosis of the
       patient's most important problem, complaint or symptom--at the time of
       the visit.

       (2)  The diagnosis may be tentative, provisional, or definitive.

       (3)  If no diagnosis exists for the patient's visit (e.g., a visit for a
       well-person exam), enter "well person" or other appropriate description
       of the situation.

       (4)  Space has been allotted to record up to two other diagnoses which
       exist at the time of visit, whether or not they are of direct concern to
       this visit.


  ITEM 13-(ED) - URGENCY OF THIS VISIT

       Hospital staff are instructed to check the category which best indicates
       the visit.

            (1)  Urgent/Emergent  patient requires immediate attention
                                  for acute illness or injury that
                                  threatens life or function.  Delay
                                  would be harmful to the patient.

            (2)  Non-Urgent       patient does not require attention
                                  immediately or within a few hours.

  ITEM 14-(ED) - IS PROBLEM ALCOHOL OR DRUG RELATED?

       This item refers to the patient's most important presenting problem.
       Simply check the correct box.


  ITEM 12-(OPD) - HAS PATIENT BEEN SEEN IN THIS CLINIC BEFORE?

       "Seen" means "provided care for" at any time in the past.  If "yes",
       also answer whether it was for the condition diagnosed in ITEM 11.


  ITEM 13-OPD - AMBULATORY SURGICAL PROCEDURE(S)

       Hospital staff are instructed to record up to two outpatient surgical
       procedures that were performed in the clinic or scheduled to be
       performed elsewhere on an outpatient basis, including suturing of
       wounds, reduction of fractures, application or removal of casts,
       incision and drainage of abscesses, application of supportive materials
       for fractures and sprains, irrigations, aspirations, dilations, and
       excisions.  Procedures that were performed should be recorded before
       those that were scheduled.  When there is more than one procedure to be
       recorded, record the more complex procedure first.  Also, check the
       appropriate boxes for the first procedure.

  ITEM 14 OR 15 - DIAGNOSTIC/SCREENING SERVICES

       Check ALL appropriate boxes for services ordered or provided.  In OPD's,
       if serum cholesterol level was included in a panel of blood tests, check
       "cholesterol measure", and "other lab test".  For "Other" services
       describe the service on the line provided.

             1.  None             13.  CT scan/MRi (ED)
             2.  Blood Pressure   14.  Other diagnostic Imaging (ED)
             3.  Urinalysis       15.  Pap test (OPD)
             4.  EKG-resting      16.  Strep throat test (OPD)
             5.  EKG-exercise     17.  HIV serology
             6.  Mammogram (OPD)  18.  Other blood test (ED)
             7.  Mental Status Exam    19.  Cholesterol measure (OPD)
             8.  Chest X-ray      20.  Other lab test (OPD)
             9.  Extremity X-ray (ED)  21.  Hearing test (OPD)
            10.  Other radiology (OPD) 22.  Visual acuity (OPD)
            11.  Allergy testing (OPD) 23.  Other (specify)
            12.  Spirometry (OPD)


  ITEM 15 (OPD) - THERAPEUTIC SERVICES

       Check ALL appropriate boxes for counseling/education AND other
       therapeutic services ORDERED OR PROVIDED.

       Check "OTHER COUNSELING" for counseling regarding a current or potential
       health problem not included in the preceding categories, e.g.,
       instruction on proper use of drugs and devices.

       Check "OTHER THERAPY" for any treatment or therapeutic services,
       EXCLUDING MEDICATION, ordered or provided and not included in the
       specific categories listed.

        1.  None

                             Counseling/education:

        2.  Diet                   8.  Smoking cessation

        3.  Exercise               9.  Family/social

        4.  Cholesterol reduction 10.  Growth/development

        5.  Weight reduction      11.  Family planning

        6.  Drug abuse            12.  Other counseling

        7.  Alcohol abuse

                                Other therapy:

       13.  Psychotherapy         16.  Physiotherapy

       14.  Corrective lenses     17.  Other therapy (specify)

       15.  Hearing aid

  ITEM 16 OR 17 - MEDICATION

       List ALL prescription and non-prescription drugs ORDERED OR PROVIDED--by
       any route of administration--at THIS VISIT.  Include immunization
       agents, desensitization agents, and other biologicals.

       Include drugs prescribed at previous visit if patient was instructed at
       THIS VISIT to continue the medication.

       Use SPECIFIC BRAND OR GENERIC DRUG NAMES as entered on prescription or
       medical records.  Do NOT enter broad drug classes, such as "pain
       medication."

       Limit entries to DRUG NAME ONLY.  Additional information, such as route
       of administration, dosage, form, strength, or regimen is not required.

       In OPD'S, check the appropriate box for any new medications.


  ITEM 16-(ED) - PROCEDURES

       Hospital staff ar instructed to mark all procedures provided this visit.
       For "Other" procedure(s) describe up to two other procedures on the
       lines provided.

            1.  None               6.  Wound Care
            2.  Endotracheal Intubation      7.  Eye/ENT Care
            3.  CPR                8.  Orthopedic Care
            4.  IV fluids          9.  Bladder catheter
            5.  NG tube/gastric lavage 10.  Lumbar puncture
                                  11.  Other(s) (Specify)


  ITEM 17 OR 18 - DISPOSITION THIS VISIT

       Hospital staff were instructed to mark all categories that apply.

                      DISPOSITION                         DEFINITION

        1.  Return to ED or OPD Clinic R.R.N.   The patient is instructed
                                                to return to the ED or OPD
                                                clinic if the patient
                                                considers it necessary.
                                                (P.R.N. pro re nata, as
                                                necessary, as the occasion
                                                rises.)

        2.  Return to ED/OPD Clinic-Appointment The patient is told to
                                                schedule an appointment or
                                                is given an appointment to
                                                return to the ED or OPD
                                                clinic at a particular
                                                time.

         3.  Telephone follow-up planned (OPD)  The patient is instructed
                                                to telephone the physician
                                                or other clinic staff on a
                                                particular day to report on
                                                his or her progress, or to
                                                call at any time if he or
                                                she has a problem or wishes
                                                further consultation.

         4.  Return to referring physician      The patient was referred to
                                                the ED or OPD clinic by his
                                                or her personal physician
                                                or some other physician and
                                                is now instructed to return
                                                to that physician for
                                                further consultation.

         5.  Refer to other physician/clinic    The patient is instructed
                                                to consult or seek care
                                                from another physician or
                                                clinic.

         6.  Admit to hospital                  The patient is instructed
                                                that further care or
                                                treatment will be provided
                                                as an inpatient in the
                                                hospital.

         7.  Transfer to other facility (ED)    The patient is transferred
                                                to a facility other than a
                                                facility operated under the
                                                auspices of this hospital.

         8.  DOA/Died in ED                    If the patient is dead on
                                               arrival (DOA) or died in
                                               the ED, the patient is
                                               still included in the
                                               sample.

         9.  Left AMA                          If the patient was
                                               registered to be seen but
                                               left prior to being seen by
                                               a health care provider or
                                               left "against medical
                                               advice" (AMA), this patient
                                               is still included in the
                                               sample.

        10.  No-follow-up planned              No return visit or
                                               telephone contact is
                                               scheduled or planned for
                                               the patient's problem on
                                               this visit.

        11.  Other (specify)                   For any other disposition,
                                               describe the disposition on
                                               the line provided.

  Item 18 or 19 - PROVIDERS SEEN THIS VISIT

       Hospital staff were instructed to mark all providers seen by the patient
       during this visit.

                 Provider                                   Definition

       1.  Resident/Intern          Persons graduated from medical
                                    school and in training.

       2.  Staff physician          Physician who is employed by the
                                    hospital or the university
                                    affiliated with the hospital and is
                                    a member of the hospital staff.

       3.  Other physician          Consulting physician and other
                                    part-time physicians who are not
                                    considered to be members of the
                                    hospital staff.

       4.  Physician assistant      Certified health care professional
                                    who delivers health care services.

       5.  Nurse practitioner       Registered nurse with advanced
                                    training who provides primary health
                                    care services.  Supervision by a
                                    physician is required in some
                                    states.

       6.  Registered nurse         Self-explanatory

       7.  Licensed practical nurse Self-explanatory

       8.  Nurse's aid              Self-explanatory

DEFINITIONS


 Patient-An individual seeking personal health services not currently admitted
 to any health care institution on the premises. A person under a physician's
 care for health reasons. Patients are defined as in scope or out of scope as
 follows:

          In scope-A patient seen by hospital staff in an in scope emergency
          service area or clinic except as excluded below.

          Out of scope-Patients seen by a physician in their private office,
          nursing home, or other extended care institution or in the
          patient's home.  Patients who contact and receive advice from
          hospital staff via telephone.  Patients who come to the hospital
          only to leave a specimen, to pick up insurance forms, to pick up
          medication, or to pay a bill.

 Visit-A visit is a direct, personal exchange between an ambulatory patient
 and a physician or other health care provider working under the physician's
 supervision, for the purpose of seeking care and receiving personal health
 services.

 Drug mention-The entry of a pharmaceutical agent ordered or provided-by any
 route of administration-for prevention, diagnosis, or treatment.  Generic as
 well as brand name drugs are included, as are nonprescription as well as
 prescription drugs.  Along with all new drugs, the hospital staff also records
 continued medication if the patient was specifically instructed during the
 visit to continue the medication.

 Hospital-All hospitals with an average length of stay for all patients of
 less than 30 days(short-stay) or hospital whose specialty is general(medical
 or surgical) or children's general are eligible for the National Hospital
 Ambulatory Medical Care Survey except Federal hospitals and hospital units of
 institutions, and hospitals with less than six beds staffed for patient use.

 Ownership-Hospitals are designated according to the primary owner of the
 hospital based on the SMG Hospital Market Data Base.

          Voluntary nonprofit-hospitals operated by a church or another
          nonprofit organization

          Government, non-Federal-hospitals operated by state or local
          governments

          Proprietary-hospitals operated by individuals, partnerships, or
          corporations for profit.

 Urbanicity-Hospitals are classified by their location in a metropolitan or
 non-metropolitan statistical area.

 MSA-Metropolitan Statistical Area as defined by the U.S. Office of Management
 and Budget.  The definition of an individual MSA involves two considerations:
 first, a city or cities of specified population that constitute the central
 city and identify the county in which it is located as the central county;
 second, economic and social relationships with "contiguous" counties that are
 metropolitan in character so that the periphery of the specific metropolitan
 area may be determined.  MSAs may cross state lines.  In New England, MSAs
 consist of cities and towns rather than counties.

 Non-MSA-Non-metropolitan Statistical Area (other than metropolitan).

 Emergency department-Hospital facility for the provision of unscheduled
 outpatient services to patients whose conditions require immediate care and
 which is staffed 24 hours a day.  Emergency departments that are open less
 than 24 hours a day are included as part of the hospital's outpatient
 department.

 Emergency service area-Area within the emergency department where emergency
 services are provided.  This includes services provided under the "hospital as
 landlord" arrangement in which the hospital rents space to a physician group.

 Outpatient department-Hospital facility where non-urgent ambulatory medical
 care is provided under the supervision of a physician.

 Clinic-Administrative unit within an organized outpatient department that
 provides ambulatory medical care under the supervision of a physician. This
 excludes the "hospital as landlord" arrangement in which the hospital only
 rents space to a physician group and is not otherwise involved in the delivery
 of services.  Clinics are grouped into the following six specialty groups for
 purposes of systematic sampling and non-response adjustment:  general
 medicine, surgery, pediatrics, obstetrics/gynecology, substance abuse, and
 other.  Clinics are defined as in scope or out of scope as follows:


                         In scope-General Medicine

  AIDS                      Geriatric                Nephrology
  Allergy                   Head (Non-Surgical)      Neurocutaneous
  Ambulatory Care           Head and Neck (Non-      Oncology
  Anti-coagulation            Surgical)              Outreach Program
  Anesthesia/Pain           Hematology                 (General Medicine)
  Apnea                     Hemophilia (Adult)       Pacemaker
  Arthritis                 Homeless                 Pentamidine
  Asthma                    Huntington's             Peripheral Vascular
  Brain Tumor (& Other        Disease/Chorea           Disease
    Tumor)                  Hyperlipidemia           Pheresis/Plasma
  Cardiology                Hypertension               Pheresis
  Cerebral Palsy (Adult)    Immunology               Pigmented Lesion
  Chest                     Infectious Diseases      Primary Care
  Coagulant                 Internal Medicine        Pulmonary
  Cystic Fibrosis           Lead Poisoning (Adult)   Renal
    (Adult)                 Leukemia/Bone Marrow     Rheumatology
  Cytomegalovirus             Aspiration             Seizure
  Dermatology               Lipid                    Senior Care
  Diabetes                  Liver                    Sexually Transmitted
  Diabetic Counseling       Lupus (Systemic Lupus      Diseases (STD)
  Digestive Diseases          Erythematosus)         Sickle Cell (Adult)
  Down's Syndrome           Medical Screening        Spina Bifida (Adult)
    (Adult)                 Melanoma                 Thyroid
  Endocrinology             Metabolic                Tuberculosis
  Epilepsy                  Movement and Memory      Urgent Care
  Family Practice             Disorders              Walk-in and/or
  Gastroenterology          Multiple Sclerosis         Screening
  General Medicine          Muscular Dystrophy       Weight Management
  Genetics (Adult)          Myelomeningocele         24 Hour Observation

                             In scope-Surgery

  Amputee (Surgery and      General Surgery          Pediatric Urology
    Rehabilitation)         Genitourinary            Plastic Surgery
  Ano-Rectal                Genitourinary Surgery    Post-Operative
  Arthroscopy               Hand Surgery             Proctology
  Back Care                 Head and Neck Surgery    Pulmonary/Thoracic
  Breast                    Knee                       Surgery
  Breast Care               Lithotripsy              Scoliosis (Adult)
  Bronchoscopy              Myelo- (and other        Sigmoidoscopy
  Burn                        myelo)                 Spine
  Cardiothoracic            Neurologic Surgery       Sports Medicine
  Cast/Brace                Oncologic Surgery        Suture
  Chief Resident Follow-    Ophthalmologic Surgery   Transplant Surgery
    up (Surgery)            Ophthalmology            Trauma
  Chronic Wound             Orthopedic               Urodynamics
  Cleft Palate              Orthopedic Surgery       Uroloc Surgery
  Club Foot                 Ostomy                   Urology
  Colon and Rectal          Otolaryngology           Vascular Surgery
    Surgery                 Otolaryngologic          Visual Fields
  Cryosurgery                 Surgery
  Cystoscopy                Otology
  Elective Surgery          Otorhinolaryngology
  Endoscopy                 Pediatric Ear, Nose,
  ENT (Ear, Nose, and         and Throat
    Throat)                 Pediatric Orthopedic
  Eye                         Surgery
  Fine Needle               Pediatric
    Aspiration                Otolaryngology
  Fracture                  Pediatric Surgery

                            In scope-Pediatrics

  Adolescent/Yong Adult     Developmental             Newborn
  Adolescent Medicine         Evaluation              Oncology (Pediatric)
  Airway (Pediatric)        Diagnostic (Pediatric)    Ophthalmology
  Allergy (Pediatric)       Down's Syndrome             (Pediatric)
  Behavior and                (Child)                 Pediatrics
    Development (Child)     Endocrinology             Perinatal
  Birth Defect                (Pediatric)             Phenylketonuria
  Cardiology (Pediatric)    Gastroenterology          Pulmonary (Pediatric)
  Cerebral Palsy (Child)      (Pediatric)             Regional Development
  Child Sexual Assualt      Genetics                  Rheumatic Heart
  Clotting (Pediatric)      Hematology (Pediatric)    Rheumatology/Arthritis
  Congenital Heart          Hemoglobinopathy           (Pediatric)
  Continuity (Pediatric)      (Pediatric)             Scoliosis (Child)
  Craniofacial              Hemophilia (Child)        Seizure (Pediatric)
  Craniomalformation        High Risk (Pediatric)     Sickle Cell (Child)
  Critical Care             Infant Apnea              Spina Bifida
    (Pediatric)             Infectious Diseases       Teenage
  Cystic Fibrosis             (Pediatric)             Teen-Tot
  Dermatology               Lead Poisoning (Child)    Well Child Care
    (Pediatric)             Learning Disorder
  Developmental             Neonatology
    Disability              Nephrology (Pediatric)


                      In scope-Obstetrics/Gynecology

  Adolescent Gynecology     Maternity                  Prenatal
  Birth Control             Maternal Health            Preteen Gynecology
  Colposcopy                Obstetrics                 Reproductive
  Dysplasia                 Obstetrics - High Risk     Reproductive
  Family Planning           Obstetrics - Post-         Endocrinology
  Gynecology                  Partum                   Well Woman
  Gynecologic Oncology      Obstetrics - Prenatal      Women's Care
  In Vitro Fertilization    Pregnancy - Counseling
  Infertility               Pregnancy Verification


                         In scope-Substance Abuse

  Alcohol Abuse                           Drug Abuse (excluding Methadone
  Alcohol Detoxification                    Maintenance)
 Alcohol Walk-in                          Drug Detoxification
 Chemical Dependency (excluding           Substance Abuse
   Methadone Maintenance)                 Women's Alcohol Program


                              In scope-Other

  Adolescent Psychiatry     Myasthenia Gravis       Psychopharmacology
  Adult Psychiatry          Neurology               Sleep Disorder
  Anxiety                   Neurophysiology         Social Evaluation
  Biofeedback               Pain Management         Toxicology
  Child Psychiatry          Partial
  Eating Disorder             Hospitalization
  General Preventive          Program
    Medicine                  (Psychiatric)
  Mental Health             Pediatric Neurology
  Mental Hygiene            Preventive Medicine


                               Out of scope

  Abortion/Pregnancy        Employee Health          Physical
    Termination               Service                Medicine/Therapy
  Ambulatory Surgery        Hemodialysis             Podiatry
    Centers                 Kidney (Renal)           Radiation
  Blood Bank                  Dialysis               Therapy/Radiation
  Cardiac                   Methadone Maintenance    Diagnosis/Radiation
    Catheterization         Occupational Safety      Oncology
  Chemotherapy                and Health             Radiology/Diagnostic
  Dental/Dental             Occupational Therapy       x-ray (Imaging)
    Oncology/Dental         Oral Surgery             Reading and Language
    Surgery                 Pharmacy                 Rehabilitation


 Region-Hospitals are classified by location in one of the four geographic
 regions of the United States that correspond to those used by the U.S. Bureau
 of the Census.

   Region                          States included

  Northeast.... Connecticut, Maine, Massachusetts, New Hampshire, New Jersey,
              New York, Pennsylvania, Rhode Island, and Vermont

  Midwest...... Illinois, Indiana, Iowa, Kansas, Michigan, Minnesota, Missouri,
              Nebraska, North Dakota, Ohio, South Dakota, and Wisconsin

  South........ Alabama, Arkansas, Delaware, District of Columbia, Florida,
              Georgia, Kentucky, Louisiana, Maryland, Mississippi, North
              Carolina, Oklahoma, South Carolina, Tennessee, Texas, Virginia,
              and West Virginia

  West......... Alaska, Arizona, California, Colorado, Hawaii, Idaho, Montana,
              Nevada, New Mexico, Oregon, Utah, Washington, and Wyoming




This page last reviewed: Thursday, January 28, 2016
This information is provided as technical reference material. Please contact us at cwus@cdc.gov to request a simple text version of this document.
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