NAMCS and NHAMCS Survey Instruments
Visit the National Ambulatory Medical Care Survey website at https://www.cdc.gov/nchs/namcs/ and the National Hospital Ambulatory Medical Care Survey at https://www.cdc.gov/nchs/nhamcs/ for more information about these surveys.
On This Page
Note: In addition to NAMCS and NHAMCS data released on public use micro-data files, results from the survey supplements listed below may also be available in the NCHS Research Data Center (RDC). For example, data from the NAMCS Electronic Medical Record Supplement (2008-2011), the National Electronic Health Records Survey (2012-2015), and the 2008 NHAMCS Pandemic and Emergency Response Preparedness Supplement, are now available for use in the RDC. Please refer to NAMCS and NHAMCS Restricted Data Available at the NCHS Research Data Center [PDF – 53 KB] for more information, visit the RDC website or contact the Ambulatory and Hospital Care Statistics Branch at 301-458-4600.
NAMCS Survey Instruments
- Patient Record Sample Card [PDF – 95 KB]
- Physician Induction Interview Sample Card [PDF - 285 KB]
- Lookback Module [PDF - 75 KB]
- National Electronic Health Records Survey [PDF - 172 KB]
- Physician Workflow Supplement for EHR Adopters [PDF - 105 KB]
- Physician Workflow Supplement for EHR Non-Adopters [PDF - 106 KB]
- Patient Record Sample Card [PDF – 95 KB]
- Physician Induction Interview Sample Card [PDF - 288 KB]
- Lookback Module [PDF - 75 KB]
- National Electronic Health Records Survey [PDF - 189]
- Physician Workflow Supplement for EHR Adopters [PDF - 389 KB]
- Physician Workflow Supplement for EHR Non-Adopters [PDF - 386 KB]
- Asthma Supplement [PDF – 137 KB]
- Patient Record Form [PDF - 129 KB]
- Physician Induction Interview Form [PDF - 303 KB]
- Community Health Center Induction Interview Form [PDF -222 KB]
- Electronic Medical Records Supplement [PDF - 74 KB]
- Physician Workflow Supplement for EHR Non-Adopters [PDF - 116 KB]
- Physician Workflow Supplement for EHR Adopters [ PDF 199 KB]
- Patient Record Form A [PDF - 140 KB]
- Patient Record Form B [PDF - 125 KB] (contains additional questions on lab values on the reverse side, completed only by certain physician specialties)
- Cervical Cancer Screening Supplement [PDF - 132 KB]
- Physician Induction Interview Form [PDF - 354 KB]
- Community Health Center Induction Interview Form [PDF - 194 KB]
- Electronic Medical Records Supplement [PDF - 91 KB]
- Emergency Department Patient Record Form [PDF - 118 KB]
- Outpatient Department Patient Record Form [PDF - 140 KB]
- Ambulatory Surgery Center Patient Record Form [PDF - 125 KB]
- Hospital Induction Interview Form [PDF – 4.8 MB]
- Freestanding Ambulatory Surgery Center Induction Interview Form [PDF – 299 KB]
- Ambulatory Unit Induction Interview Form [PDF - 104 KB]
- Emergency Department Patient Record Form [PDF - 103 KB]
- Outpatient Department Patient Record Form [PDF - 123 KB]
- Ambulatory Surgery Center Patient Record [PDF - 110 KB]
- Cervical Cancer Screening Supplement [PDF - 138 KB]
- Hospital Induction Interview Form [PDF - 359 KB]
- Freestanding Ambulatory Surgery Center Induction Interview Form [PDF – 263 KB]
- Ambulatory Unit Induction Interview Form [PDF - 110 KB]
- Emergency Department Patient Record Form [PDF - 114 KB]
- Outpatient Department Patient Record Form [PDF - 168 KB]
- Ambulatory Surgery Center Patient Record [PDF - 132 KB]
- Cervical Cancer Screening Supplement [PDF - 150 KB]
- Hospital Induction Interview Form [PDF - 558 KB]
- Ambulatory Unit Induction Interview Form [PDF - 186 KB]
- Emergency Department Patient Record Form [PDF - 208 KB]
- Outpatient Department Patient Record Form [PDF - 453 KB]
- Cervical Cancer Screening Supplement [PDF - 189 KB]
- Hospital Induction Interview Form [PDF - 1277 KB]
- Ambulatory Unit Induction Interview Form [PDF - 129 KB]
- Pandemic and Emergency Response Preparedness Supplement [PDF - 119 KB]
- Emergency Department Patient Record Form [PDF - 58 KB]
- Outpatient Department Patient Record Form [PDF - 51 KB]
- Emergency Pediatric Services and Equipment Supplement [PDF - 228 KB]
- Cervical Cancer Screening Supplement [PDF - 54 KB]
- Hospital Induction Interview Form [PDF - 126 KB]
- Ambulatory Unit Induction Interview Form [PDF - 54 KB]
Last Reviewed: January 8, 2018