The code block below illustrates how one might use # and // as comments in your logic and calculations.

This value you provided is not a number. Please try again.

This value you provided is not an integer. Please try again.

The value entered is not a valid Vanderbilt Medical Record Number (i.e. 4- to 9-digit number, excluding leading zeros). Please try again.

The value you provided must be within the suggested range

The value you provided is outside the suggested range

This value is admissible, but you may wish to double check it.

The value entered must be a time value in the following format HH:MM within the range 00:00-23:59 (e.g., 04:32 or 23:19).

This field must be a 5 or 9 digit U.S. ZIP Code (like 94043). Please re-enter it now.

This field must be a 10 digit U.S. phone number (like 415 555 1212). Please re-enter it now.

This field must be a valid email address (like joe@user.com). Please re-enter it now.

The value you provided could not be validated because it does not follow the expected format. Please try again.

Required format:

JyQYtNCnyKvjpPxxYWdBTm3aowDSrZ8VsG2MKnuyMG5AswXirLUFUbeV

Facility Contact Inventory

Hello,

We are updating our contact lists of all the infection preventionists and/or facility points of contact. Please complete the survey below so we have the most updated information.

Thank you!

Facility Name

* must provide value

Facility Type

* must provide value

Acute care hospital

Long-term acute care hospital

Critical access hospital

Inpatient rehabilitation facility

Nursing home/skilled nursing facility

Intermediate care facility*

Assisted Living/residential care home

Dialysis facility

CMS-certified ASC

Other

reset

If Other, please specify

* must provide value

Total Licensed Beds

* must provide value

NHSN # (if applicable)

CLIA # (if applicable)

Medicare/Medicaid Number (if applicable)

Medical Director Name

Medical Director Phone

Medical Director Fax

Medical Director Email

Name

* must provide value

Phone

* must provide value

Fax

* must provide value

IP Name

* must provide value

IP Phone

* must provide value

IP Fax

* must provide value

IP Email

* must provide value

Number of Full Time IP

* must provide value

No IP Present

1 FTE

More than 1 FTE

Less than 1 FTE

reset

If more than 1 FTE, specify how many?

* must provide value

If Less Than one, % of time the IP is devoted to the Infection Prevention?

* must provide value

Trained in Infection Prevention and Control

* must provide value

Yes

reset

Certified in Infection Control

* must provide value

Yes

reset

Health System Affiliation (if applicable)

Accreditation

Street

* must provide value

City

* must provide value

County

* must provide value

Local Health Department

* must provide value

If not listed, please specify

* must provide value

State

* must provide value

Zipcode

* must provide value

Phone

* must provide value

Fax

* must provide value

Please specify your website address if you have one.

Is mailing address same as above?

* must provide value

Yes

reset

If different, please enter details below.

Street

* must provide value

City

* must provide value

State

* must provide value

Zipcode

* must provide value

Phone

* must provide value

You have selected an option that triggers this survey to end right now.

To save your responses and end the survey, click the 'End Survey' button below. If you have selected the wrong option by accident and/or wish to return to the survey, click the 'Return and Edit Response' button.