This page provides a list of all questions found on the PSRP reporting form for Ambulatory Surgery Centers (ASCs). They are grouped alphabetically by the section of the form in which they appear. This list does not indicate which questions are required for all ASC reports nor which questions only appear for certain event types. A list of required questions can be found here: Required Fields for ASCs.
General Information
| Filter by label (Content by label) |
|---|
| showLabels | false |
|---|
| max | 100 |
|---|
| sort | title |
|---|
| showSpace | false |
|---|
| cql | label = "form_field" and label = "asc" and label = "general_information" and label != "test" and space = currentSpace ( ) |
|---|
|
Summary, Cause and Action Plan Information
| Filter by label (Content by label) |
|---|
| showLabels | false |
|---|
| max | 100 |
|---|
| sort | title |
|---|
| showSpace | false |
|---|
| cql | label = "form_field" and label = "asc" and label = "summary_information" and space = currentSpace ( ) |
|---|
|
...
| Filter by label (Content by label) |
|---|
| showLabels | false |
|---|
| max | 100 |
|---|
| sort | title |
|---|
| showSpace | false |
|---|
| cql | label = "form_field" and label = "asc" and label = "event_information" and space = currentSpace ( ) |
|---|
|
HIT Questions
| Filter by label (Content by label) |
|---|
| showLabels | false |
|---|
| max | 100 |
|---|
| sort | title |
|---|
| showSpace | false |
|---|
| cql | label = "form_field" and label = "asc" and label = "hit" and space = currentSpace ( ) |
|---|
|
Event Type-Specific Questions
Anesthesia Event-Specific Questions
| Filter by label (Content by label) |
|---|
| showLabels | false |
|---|
| max | 100 |
|---|
| sort | title |
|---|
| showSpace | false |
|---|
| cql | label = "form_field" and label = "asc" and label = "anesthesia" and space = currentSpace ( ) |
|---|
|
Blood or Blood Product Event-Specific Questions
| Filter by label (Content by label) |
|---|
| showLabels | false |
|---|
| max | 100 |
|---|
| sort | title |
|---|
| showSpace | false |
|---|
| cql | label = "form_field" and label = "asc" and label = "blood_event" and space = currentSpace ( ) |
|---|
|
Contaminated Drug, Device or Biologic Event-Specific Questions
| Filter by label (Content by label) |
|---|
| showLabels | false |
|---|
| max | 100 |
|---|
| sort | title |
|---|
| showSpace | false |
|---|
| cql | label = "form_field" and label = "asc" and label = "contaminated_event" and space = currentSpace ( ) |
|---|
|
Device, Equipment or Supply Event-Specific Questions
| Filter by label (Content by label) |
|---|
| showLabels | false |
|---|
| max | 100 |
|---|
| sort | title |
|---|
| showSpace | false |
|---|
| cql | label = "form_field" and label = "asc" and label = "device_event" and space = currentSpace ( ) |
|---|
|
Fall Event-Specific Questions
| Filter by label (Content by label) |
|---|
| showLabels | false |
|---|
| max | 100 |
|---|
| sort | title |
|---|
| showSpace | false |
|---|
| cql | label = "form_field" and label = "asc" and label = "fall" and space = currentSpace ( ) |
|---|
|
HAI Event-Specific Questions
| Filter by label (Content by label) |
|---|
| showLabels | false |
|---|
| max | 100 |
|---|
| sort | title |
|---|
| showSpace | false |
|---|
| cql | label = "form_field" and label = "asc" and label = "hai" and space = currentSpace ( ) |
|---|
|
Medication or Other Substance Event-Specific Questions
| Filter by label (Content by label) |
|---|
| showLabels | false |
|---|
| max | 100 |
|---|
| sort | title |
|---|
| showSpace | false |
|---|
| cql | label = "form_field" and label = "asc" and label = "medication_event" and space = currentSpace ( ) |
|---|
|
Surgical or Other Invasive Procedure Event-Specific Questions
| Filter by label (Content by label) |
|---|
| showLabels | false |
|---|
| max | 100 |
|---|
| sort | title |
|---|
| showSpace | false |
|---|
| cql | label = "form_field" and label = "asc" and label = "surgical_event" and space = currentSpace ( ) |
|---|
|
Unintended Retained Foreign Object Event-Specific Questions
| Filter by label (Content by label) |
|---|
| showLabels | false |
|---|
| max | 100 |
|---|
| sort | title |
|---|
| showSpace | false |
|---|
| cql | label = "form_field" and label = "asc" and label = "retained_object_event" and space = currentSpace ( ) |
|---|
|
...
| Filter by label (Content by label) |
|---|
| showLabels | false |
|---|
| max | 100 |
|---|
| sort | title |
|---|
| showSpace | false |
|---|
| cql | label = "form_field" and label = "asc" and label = "review_information" and space = currentSpace ( ) |
|---|
|
Summary, Cause and Action Plan Information
| Filter by label (Content by label) |
|---|
| showLabels | false |
|---|
| max | 100 |
|---|
| sort | title |
|---|
| showSpace | false |
|---|
| cql | label = "form_field" and label = "asc" and label = "summary_information" and space = currentSpace ( ) |
|---|
|