PROGRAMS AND COLLECTION PROCEDURES	 Series 1 

Number 13 

Backgroundand Development 

of the National Reporting System 

for Family PlanningServices 

The development and operation of the National Reporting System 

for Family Planning Services are presented from its origin in 1968 

through its status in 197.5. This presentation includes a description 

of the predecessor of the National Reporting System—the Provisional Reporting System for Family Planning Services. A brief discussion of the legislative and historical background concerning the 

involvement of the Federal Goverment in the provision of family 

planning services is also given. The last section of the report includes a discussion of the growth of the reporting system during the 

first 6 full years of its operation as well as a brief description of the 

conversion of the 100-percent system to a sample survey during 

1977. 

DHEW Publication No. (PHS) 78-1313 

U.S. DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE 

Public Health Service 

National Center for Health Statistics 

Hyattsville, Md. April 1978 
Library of Congress Cataloging in Publication Data 

United States. National Center for Health Statistics. 

Background and development of the National Reporting System for Family Planning 

Services. 

(Vital and hetilth statistics: Series 1, Programs and collection procedures; no. 13) 

(DHEW publication; (PHS) 78-13 13) 

“Data from the data evaluation and methods research” 

1. Birth control clinics– L~nited States—Statistical services–History. I. Title II. Series: 

Llnited ,’jtates. ~ation~] center for Health statistics. vital ~n~ health statistics: series 1, 

Programs and collection procedures; no. 13. III. Series: United States. Dept. of Health,


Education, and Welfare. DHEW publication; (PHS) 78-1313.


RA409.U44 No. 13 [HQ766.5.U] 312’.07’23s [362.8’2]


ISBN 0-8406 -0117-4 77-17379


I 

—. — 

For SIIC by the Superintendent of Documents, U.S. Government Printing Office 

Washington, D .C. 20402 

Stock No. 017-022-0C+312-O 
NATIONAL CENTER FOR HEALTH STATISTICS 

DOROTHY P. RICE, Director 

ROBERT A. lSIbiEL, Deputy Director


JACOB J. FELDMAN, Ph.D., Associate Director for Analysis


GAIL F. FISHER, Associate Director for the Cooperative Health S tatistics System 

ELIJAH L. WHITE, Associate Director for Data Systems 

JAMES T. BAIRD, JR., Ph.D., Assoctite Director for International Statistics 

ROBERT C. HUBER, Associate Director for Management 

MONROE G. SIRKEN, Ph.D., Associate Director for Mathernaticrd S tatistics 

PETER L, HURLEY, Associate Director for Operations 

JAMES M. ROBEY, Ph.D., Associate Director for Program Development 

PAUL E, LEAVERTON, Ph.D., Associate Directorfor Research 

ALICE HAYWOOD, Information Officer 

DIVISION OF HEALTH RESOURCES UTILIZATION STATISTICS 

SIEGFRIED A. HOERMANN, Director


STEWART C. RICE, JR. Acting Chiej Family Phzmzing Statistics Branch


W. EDWARD BACON, Ph.D., Chiej Hospital Care Statistics Branch


JAMES E. DeLOZIER, chief Ambulatory Care Statistics Branch


JOAN F, VAN NOSTRAND, ChieJ Long-Term Care Statistics Branch


MANOOCHEHR K. NOZARY, Chief Technical Services Branch


Vital and Health Statistics-Series 1-No, 13 

DHEW Publication No. (PHS) 78-1313 

Library of Congress Catalog Card Number 77-17379 
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CONTENTS 

htroduction .............................................................................................................................................. 

Back~omd ......................................................................................................................$................o....c... 

Legislative Background ......................................................................................................................... 

Historical Background .......................................................................................................................... 

‘Ihe Provisional Reporting System ............................................................................................................. 

The Report Form ................................................................................................................................. 

Operational Procedures ......................................................................................................................... 

Output Tabdations .............................................................................................................................. 

The National Reporting System ................................................................................................................. 

The Report Fores ................................................................................................................................ 

Operational Procedwes ......................................................................................................................... 

Output Tabtiations .............................................................................................................................. 

Growth and Future of the Reporting System ............................................................................................. 

Appendixes . . 

I. Abbreviations Used in This Report ............................................................................................... 

H.	 Agencies and Persons From W’kom Comments and Input Were Received Regarding the Family 

Planning Reporting Systems ....................................................................................................... 

III. Sample Report Fores ................................................................................................................... 

Iv. Sample Enrollment Fores ............................................................................................................ 

v. Sample Processing Reports ........................................................................................................... 

VI. Standard Table Shells................................................................................................................... 

. 

LIST OF TEXT TABLES 

A. Comparison of items on the Provisional Report Form for Family Planning Services (PRF) and the 

Clinic Vkit Record for Family Planning Services (CVR) by type of information obtained, according to whether item remained the same, was modified, deleted, or added ....................................... 

B. Summary of major differences in operating procedures between the PRSFPS and the NRSFPS, by 

type of procedure ............................................................................................................................ 

C. Summary of major differences in the output tabulations between the PRSFPS and the NRSFPS ...... 

D. Number of participating service sites, family planning patients seen, and clinic visits made for family planning services as reported to the NCHS family planning reporting systems: United States, 

1970.75 ........................................................................................................................................... 

E. Percent increase in the number of participating service sites, family planning patients seen, and 

visits made for family planning services as reported to the NCHS family planning reporting systems: United States, 1970-75 .......................................................................................................... 

F. Percent of records submitted to the NRSFPS by automated and nonautomated submitters: United 

States, 1973-75 ............................................................................................................................... 

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BACKGROUND AND DEVELOPMENT OF 

I THE NA~O~AL REPORTING SYSTEM 

FOR FAMILY PLANNING SERVICES 

I 

Barbara J. Haupt, Division of Health Resources Utilization Statistics ~ 

INTRODUCTION 

1 

The National Center for Health Statistics 

(NCHS) has been operating a reporting system 

for family planning clinic services since May 

\ 1969. Through this system, data are collected about persons who receive family planning services from participating family planning 

service sites throughout the United States and 

,, some of its territories. The information obtained 

is useful for research purposes as well as for 

program planning and evaluation, primarily at 

the national level. 

The data are reported to NCHS by the 

participating family planning clinics and service 

sites. Although all of the sites that provide 

family planning services in the United States do 

not report to NCHS, most of the facilities that 

receive Federal funds for family planning services from the Bureau of Community Health 

I Services (BCHS) in the Department of Health, 

Education, and Welfare (DHEW) do report.a In 

addition, many nonfederally funded famfiy pkm­

!1 ning programs also report data to NCHS. Included ., in the latter category are some clinics and service 

sites that are affiliated with Planned Parenthood/World Population (PP/WP), are operated 

I 

aRefers mainly to sites receiving project grants for 

family planning services. Also included are some sites 

that receive other health services grants, such as maternal 

;‘1	 and child health services or comprehensive health services. Many sites also receive matching funds under the 

Medicaid program and the Aid to Families With Dependent Children program, both also operated by DHEW. 

by State health departments, or are privately 

owned and operated. 

The information obtained through the National Reporting System may be divided into 

four general types: data about the participating 

facilities, data about the sociodemographic 

characteristics of the individuals being served, 

data about the types of services being provided, 

and data about the visits made. 

Because the National Reporting System is 

mainly concerned with the individuals being 

served, the data collected about the participating 

facilities are very limited. The only facility 

information collected is that which is necessary 

for the participation of the clinics and service 

sites. This includes the name and address of each 

facility, each clinic director’s name, a minimum 

amount of funding information, and the expected patient load. 

Information collected about the individuals 

being served consists of identification information and the sociodemographic characteristics of 

each person. Since the name and address of an 

individual are never obtained ~ the National -

Reporting System, ‘tie identification information is limited to a unique nine-digit number 

assigned by the service site personnel. As long as 

the individual continues to receive services from 

the same family planning project, the information about that person should be reported to 

NCHS under the same number. The sociodemographic characteristics collected about the individual served include each person’s date of 

birth, sex, ethnic designation, pregnancy history , 

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(for women only), and Medicaid and welfare 

status. 

Data about the family planning services 

provided refer to the medical, counseling, and 

referral services that each person receives at a 

particular visit. Information about the type of 

contraceptive method adopted by each person, 

as well as any previous contraceptive use, is also 

obtained. 

The visit data collected are limited to the 

date and type of visit made. Because each person 

is uniquely identified within a given family 

planning project, the number of visits made by 

an individual over time can also be determined. 

The data gathered through the National 

Reporting System are used to provide baseline 

statistics on the status of family planning services in the United States. In addition, these data 

are used for program planning, evaluation, and 

monitoring, as well as for research purposes. 

However, NCHS never meant this system to be 

the sole source of family planning data; it was 

intended to provide only a part of the total 

picture. In order to obtain a comprehensive view 

of family planning activities and the effects of 

such activities in the United States, the data 

available from the National Reporting System 

must be used in conjunction with data from 

other sources. 

BACKGROUND 

Legislative Background 

The involvement of the Federal Government 

in the provision of family planning services has 

grown rapidly since the 1960’s. The first Federal 

grants designated specifically for family planning 

services were made available through the Economic Opportunity Act of 1964 (Public Law 

88-452) and administered by the Office of 

Economic Opportunity (OEO). By the mid1960’s, DHEW also made a limited amount of 

money available for family planning services 

through the reimbursement programs under 

titles IV-A (Aid to Families With Dependent 

Children) and”” XIX (Medicaid) of” the SocialSecurity Act.b Later, the 1967 amendments to 

b Under these titles, family planning service providers were able to obtain reimbursement for some of 

the Social Security Act (Public Law 90-248) 

made more family planning service money available through DHEW. These amendments not 

only established categorical project grants for 

family planning services under title V (Maternal 

and Child Health Services) but also required that 

at least 6 percent of the total money appropriated under sections 503, 508, and 512 of title V 

be available for family planning services.c Three 

years later Public Law 91-572, the Family 

Planning Services and Population Research Act 

of 1970 (title X of the Public Health Service 

Act), was passed.d The purpose of this act was 

to assist in making comprehensive voluntary 

family planning services available to all persons 

desiring such services. Lastly, the passage of the 

1972 amendments to the Social Security Act 

(Public Law 92-603) strengthened the family 

planning service aspects of titles IV-A and XIX. 

These amendments made it mandatory that all 

recipients of Aid to Families With Dependent 

Children (AFDC) be informed of the availability 

of family planning services and that such services 

be provided to all eligible persons desiring them. 

States failing to meet these requirements would 

be penalized by a reduction of 1 percent per 

year of the Federal share of AFDC funds. In 

addition, the amendments increased the Federal 

share of matching funds for family planning 

services to 90 percent under both titles IV-A and 

~xoe 

the medical services received by their eligible clients. The 

available funds, however, were not used extensively for 

family planning services until the mid-1970’s. 

cTitle V provided for both formula grants to States 

for Maternal and Child Health Services (section 503) and 

special project grants for Maternity and Infant Care 

(section 508). Title V specifically included family 

planning as part of the maternal health services to be 

provided and allowed the establishment of projects 

specifically for family planning services. Section 512 

authorized research projects relating to maternal and 

child health services. 

‘This act expired in 1975 but was extended for an 

additional 2 years under Public Law 94-63, the Family 

Planning Services and Population Research Act of 1975 

(title II of the Public Health Service Act). 

‘The previous Federal share was 75 percent under 

title IV-A and a variable formula with a range from 50 to 

83 percent under title XIX. 

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Historical Background 

The .DHE W family planning services 

systcm. —Although DHEW has had categorical 

family planning service grant money available 

for some time through titles V, X, and later, II 

of the Public Health Service Act, these grants 

have been administered by different agencies 

within the Department over the years. A brief 

history of the succession of these administering 

agencies is presented in this section. 

Originally the Children’s Bureau (CB) in 

DHEW was responsible for the programs funded 

through title V of the Public Health Service Act. 

However, during 1969 two new agencies were 

created in DHEW’S Health Services and Mental 

Health Administration; (HSMHA): the National 

Center for Family Planning Services (NCFPS) 

and the Maternal and Child Health Service 

(MCHS). These two agencies subsequently were 

made responsible for administering the title V 

programs: MCHS operated the service programs 

that concerned maternal and child health such as 

the children and youth projects, the crippled 

children programs, the maternal and child health 

programs, and the maternity and infant care 

projects. On the other hand, NCFPS was responsible for the development and operation of 

the categorical family planning service programs 

as well as the coordination of family planning 

smvice efforts in the United States. Therefore, 

NCFPS was responsible for administering the 

family planning service aspects of title X of the 

Public Health Service Act after it was passed in 

1970. 

During 1973, the OEO family planning 

service grants were transferred to NCFPS. This 

process was completed by September of that 

year. 

In addition, 1973 also saw the reorganization of the Public Health Service, that segment 

of DHEW dealing with health. One result of this 

reorganization, still in effect, was the abolishment of HShIHA and the creation of the Health 

Resources Administration (HRA) and the Health 

Services Administration (HSA). The reorganization also abolished both NCFPS and MCHS; the 

programs operated by these agencies were incorporated into the newly created Bureau of 

Community Health Services in HSA, along with 

a number of other health service programs in 

DHEW. Within BCHS the title V programs are 

coordinated by the Associate Bureau Director 

for Matermd and Child Health, and the title X 

(now title II) programs are coordinated by the 

Associate Director for Family Planning. 

The family planning information system. – 

The rapid expansion of family planning service 

programs since the mid-1960’s, especially in the 

public sector, made apparent the lack of current 

and accurate information on the extent to which 

family planning services were being provided. 

This information was urgently needed to provide 

a rational basis for the expansion of family 

planning service programs throughout the 

United States and would continue to be needed 

on a timely basis to provide data for the 

evaluation of the effectiveness of such programs. 

Because these data needs were recognized by 

both Federal and private agencies involved in the 

delivery of family planning services, the Interagency Committee for the Development of a 

Uniform Data Collection System for Family 

Planning Services was established in February 

1968. This Committee, which was chaired by 

the DHEW Deputy Assistant Secretary for 

Health and Scientific Affairs, was made up of 

representatives of DHEW, OEO, PP/WP, and 

other interested parties. The Committee met 

throughout 1968 with the purpose of defining 

the requirements of a uniform national family 

planning services reporting system. After much 

hard work and frequently acrimonious debate, a 

set of basic data elements was agreed upon late 

in 1968. The Committee feIt that these were the 

crucial data items for good program planning, 

evaluation, and monitoring, as well as for 

research purposes. 

Meanwhile, in May 1968, the Bureau of the 

Budget in the Executive Office delegated focal 

responsibility for Federal Government family 

planning activities to the Office of the Assistant 

Secretary for Health and Scientific Affairs, 

DHEW. This delegation gave the Assistant Secretary the following responsibilities: 

To take the leadership in the development of 

a coordinated program of statistics on family 

planning. 

To develop standard classifications and terminology. 
To keep the Bureau of the Budget informed 

of relevant data collection plans of Federal 

agencies. 

To obtain, as much as possible, the cooperation of both State and local governmental 

and private agencies. 

To assure the assembly, analysis, and publication of statistical information on all 

aspects of family planning programs in the 

United States, covering all activities of the 

Federal Government and including, to the 

extent possible, those of other public and 

private organizations. 

In the letter of acceptance from DHEW, it 

was specifically pointed out that the Interagency 

Committee, meeting since February 1968, had 

“actively participated” in the “first job undertaken in this direction . . . the development of a 

uniform reporting system for family planning 

services in the United States . . . we anticipate 

continuing the use of this satisfactory instrument and . . . later [including in the reporting 

system] other agencies who have responsibility 

for family planning services.”f 

In November 1968 the Office of the Assistant Secretary, DHEW, gave NCHS the responsibility for developing and operating a national 

statistical system for family planning services. 

This statistical system, when completed, was to 

provide data “on all aspects of family planning 

programs in the U.S., covering all activities of 

the federal government, and including to the 

extent possible those of other public and of 

private organizations.” The Center was also told 

to “work. . . [on] the development of standard 

classification and terminology” in the field of 

family planning. This entire assignment, however, was to be done “under the policy direction” and “together with” the Office of the 

Deputy Assistant Secretary for Health and 

Scientific Affairs.g 

‘Correspondence between the Secretary of DHEW 

and the AssistantDirector for StatisticalStandards, 

Bureau of the Budget, Executive Office of the President, 

dated May 29, 1968, andJune 13, 1968. 

gMemorandum from the Secretsry of DHEW to the 

Assistant Secretary for Health and Scientific Affairs, 

Because the need for family planning data 

had become extremely urgent, both NCHS and 

the Interagency Committee felt that some sort 

of interim data collection activity should be 

undertaken immediately, based on the data 

elements that had already been developed. It 

was, therefore, decided that a computer system, 

originally designed for the DHEW Children’s 

Bureau programs, would be used as an interim 

system until the “final” system was developed. 

The operation of this interim system, therefore, 

met two needs: (1) It provided data for the 

immediate administrative and research needs of 

the major family planning programs, and (2) it 

developed a body of data and experience that 

were used in planning the national statistical 

system. This interim system became known as 

the Provisional Reporting System for Family 

Planning Services (PRSFPS). 

In July 1970, NCHS sent a description of 

the proposed National Family Planning Services 

Statistical System to a number of family planning experts for comments. This description 

pointed out that the total statistical program 

would be made up of three different data 

collection mechanisms: an inventory of family 

planning clinics, a patient contact reporting 

program, and special ad hoc surveys. 

The comments that were received were 

analyzed and used for revising the proposal. 

Besides the reviews received from experts in the 

field, NCHS solicited and obtained comments 

from the major Federal family planning funding 

agencies (OEO and DHEW) as well as from 

PP/wP. 

In 1971 the National Reporting System for 

Family Planning Services (NRSFPS), the second 

of the three data collection mechanisms proposed, was completed and approved for use. 

Subsequently, on January 1, 1972, the NRSFPS 

began operation, replacing the PRSFPS. 

During 1976, work was begun on developing 

a sample system to replace the 100-percent 

reporting system. The conversion to a sample 

DHEW, dated October 18, 1968; and memorandum 

from the Assistant Secretq for Health and Scientific 

Affairs, DHEW, to the Acting Administrator, Health 

Services and Mental Health Administration, DHEW, 

dated November 5, 1968. 

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survey became unavoidable because of the tremendous growth in the number of visits reported to the NRSFPS (from less than 1 million 

in 1970 to almost 6 million in 1975). Although 

the original target date for implementing the 

sample was January 1977, it soon became 

evident that this date did not allow enough lead 

time for the sample survey. As a result, it was 

decided that the NRSFPS would continue on a 

100-percent basis through June 1977 and that 

the sample would be implemented in July. 

THE PROVISIONAL REPORTING SYSTEM 

The Provisional Reporting System for Fam­

,	 fly Planning Services operated from May 1969 

through December 1971. The PRSFPS functioned as an interim data collection mechanism 

while NCHS worked on developing the “final” 

family planning reporting system, the NRSFPS. 

The PRSFPS also functioned as a learning 

mechanism for NCHS, since many of the modifications made for the National Reporting System 

I	 were based on the experience and knowledge 

gained from operating the Provisional Reporting 

System. 

The Report Form 

The data collection form used by the 

PRSFPS, the Provisional Report Form for Family Planning Services (PRF), was designed by the 

Interagency Committee and was the basis for the 

system (see appendix III-A). This form consisted 

t	 of 24 data items (some of which were optional) 

and was to be completed each time a person 

visited a participating service site for family 

planning services. All of the items were completed the first time a form was filled out for an 

d	 individual; however, the questions asked during 

revisits were limited to those that changed over 

time. 1 Three different kinds of information were 

collected on this report form: identification 

information, demographic information, and service information. 

Although there was a place on the form to 

collect the name and address of each patient, 

that portion of the form was for the service 

\ site’s use only and remained at each site. For the 

purposes of the Provisional Reporting System, 

the patients were identified only by a combination of the facility and patient numbers. The 

facility numbers were assigned by NCHS and 

were unique within the PRSFPS. The patient 

numbers, on the other hand, were assigned by 

the service site personnel, usually on a case basis, 

and were meaningful only to the facility providing the services. _—— 

Items o~a demographic nature included each 

patient’s date of birth, ethnic designation, education, pregnancy history, income and family 

size,h and welfare status. It was assumed that all 

of the patients were women. 

Service and administrative data included the 

patient type; types of medical, counseling, and 

referral services given; the contraceptive method 

adopted; the date and session of the visit; and 

the date and type of the next appointment. 

Information about the individual’s contraceptive 

history within the previous 2 years was also 

collected. 

The PRF also included two items that were 

used at the discretion of the local agencies. One 

item pertained to the patient’s current residence; the other item was open and allowed the 

participating facilities to obtain information that 

was relevant to their specific operations but was 

not required for the larger data system. 

Operational Procedures 

Enrollment and training of participants. – 

Lists of the organizations that were to participate in the PRSFPS were supplied to NCHS by 

OEO and DHEW, the two major Federal funding 

agencies. These organizations were called “projects” and received grants that were designated 

either specifically for family planning services or 

for other health services, but with the stipulation that a certain percent of the grant funds be 

spent on family planning services. Planned 

Parenthood-affiliated service sites were also 

invited to participate in the PRSFPS; however, 

PP/WP decided that its affiliates not receiving 

Federal funds for family planning services could 

‘This item was not completed at all service sites: It 

was mandatory ordy for the sites funded by OEO and 

optional for the rest of the sites. 

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postpone their participation until ‘the “final” 

system was implemented. As a result, only one 

of these nonfederally funded affiliates decided 

to enroll and participate in the PRSFPS. 

The projects that were to participate in the 

PRSFPS were contacted by both NCHS and 

their funding agencies, told of the need to 

report, and asked to complete the Project 

Enrollment Form (reproduced in appendix 

IV-A). This form provided NCHS with a list of 

each project’s service sites, expected patient 

load, family planning funding data, and other 

necessary administrative information. Upon receipt of the completed enrollment forms and the 

assignment of the project and service site identification numbers, each site was sent a supply of 

report forms, instruction manuals, and all materials necessary for their participation in the 

Provisional Reporting System. 

Training the site personnel began in May 

1969; most of the classes were held during May, 

June, and July of that year. The training was 

conducted at each project site; a full day was 

allowed for each session. The report form and 

the instruction manual, as well as the administrative details about joining the system and obtaining the reporting materials, were discussed at 

each training session. Ideally, everyone who was 

to handle the report form was to be trained with 

respect to that person’s specific function, but 

unfortunately, this objective was not always 

met. An additional problem encountered was 

the rapid turnover of personnel at the sites; 

because of this turnover, the person who 

attended a training session was not always the 

one who carried out the necessary reporting 

procedures. A very detailed, self-explanatory 

instruction manual was, therefore, developed in 

an attempt to solve this problem. 

Because the PRSFPS operated for 2Y2 years, 

the enrollment process was an ongoing function. 

New enrollments consisted of service sites that 

were newly opened during this time period and 

those that had been previously operating but 

were not included in the first enrollment phase 

because they were not family planning service 

grantees at that time. Ongoing training of new 

site personnel was found to be totally impractical; the constant need for training due to the 

rapid turnover of clinic personnel would have 

resulted in excessive costs for both the travel 

involved and the maintenance of a staff of 

trainers by NCHS. The training manual was, 

therefore, relied on to fill this gap. Clinic 

personnel were also encouraged to call or write 

to NCHS about any reporting problems they 

encountered. In addition, a second major training program of representatives of all the enrolled 

sites was carried out during 1970. 

Data collection and processing. –The PRF, 

the contents of which were discussed in the 

section, “The Report Form,” was the data 

collection instrument for the PRSFPS. This 

form was completed for each patient visit at 

which family planning services were provided, 

except for those visits for which the sole 

purpose was to pick up contraceptive supplies. 

The PRF was a two-part form consisting of 

an original and one carbon copy. The original 

was sent to NCHS for processing; the carbon 

remained at the reporting service site. In 

this way, the service site would keep a record of 

the information that was sent to the PRSFPS; 

many service sites also used the carbon copy as a 

part of each patient’s medical record. 

The completed PRF’s were sent to NCHS 

from each service site either weekly or biweekly, 

depending on the volume of patient visits to the 

site. In addition, personnel at the sites were 

asked to collect and send to NCHS, on the last 

working day of each month, all of the report 

forms for that month that had not yet been 

submitted. This procedure was adopted in order 

to ensure both timely data and an evenly 

distributed workload for data processing. 

Upon receipt, the PRF’s were logged in, 

counted, and sent on for data processing. After 

the data had been put onto computer tape they 

were edited for both the consistency and the 

validity of the information. 

Two types of consistency checks were made: 

The data were edited for internal consistency 

(for example, the same patient should not have 

received both contraceptive services and infertility services) and for consistency with any 

previous data that had been submitted (for 

example, the highest grade of school completed 

by a person could not decrease over time). The 

second type of consistency check was possible 

because the PRSFPS was developed under the 

I

.

“patient string” concept. According to this 

concept, all of the data reported for a patient 

were kept together on the computer file. This 

was possible as long as the patient continued to 

receive services from the same family planning 

project, since the service sites assigned each 

patient an identification number that was 

unique to their project. The maintenance of the 

patient string made it possible to collect certain 

sociodemographic information about each patient only once rather than at each visit, thus 

reducing the reporting burden of personnel at 

the service sites. In addition, it greatly enhanced 

the research potential of the data in the Provisional Reporting System by making longitudinal 

studies possible. _.. ——.- . ...= . Upon completion of the edltmg process, a 

processing report was produced for each service 

site (see appendix V-A). This report consisted of 

three parts: (1) the error report that provided a 

list of all of the “errors” (that is, invalid codes 

or inconsistent data) found during the editing 

procedures; (2) the summary report that presented a tabular summary of the records submitted, accepted, and rejected, the error conditions found, and the acceptance rates; and (3) the 

list of visit forms processed that was simply a list 

of the patient numbers for which forms were 

processed. 

Each processing report, along with the ap~ 

cable source documents, was reviewed by the 

data processing personnel; transcription, coding, 

and other errors were sent back to the computer 

for reprocessing. Each annotated processing report was then sent to the proper service site 

along with the forms that had been rejected and 

that NCHS had been unable to correct. Personnel at the service sites were instructed to 

examine their reports and the forms, make the 

necessary corrections, and resubmit the corrected forms to NCHS for reprocessing. 

Files and maintenance. –There were two 

basic files in the PRSFPS:i (1) the Address File, 

which contained the name, address, and some 

funding information of each enrolled facility; 

and (2) the Patient Record File, which con­

‘Other files were created and used in the operation 

of the PRSFPS,but the Address File and the Patient 

Record File were the basic two. 

tained the current sociodemographic information, a pregnancy history, and all of the service 

and visit information reported for each patient. 

Both files were updated periodically, either by 

adding new facility or patient records or by 

correcting information that had been incorrectly 

entered or had changed over time. 

The Patient Record File was also kept 

current by periodically deleting all of the records of patients who had become inactive by 

not making a visit for family planning services 

for 15 months. The inactive patient records were 

not destroyed; rather, they were maintained on 

an Inactive Patient Record File so they would be 

available for longitudinal research studies. 

Output Tabulations 

The PRSFPS regularly produced monthly, 

quarterly, and annual tables, all at the service 

site, project, State, region, funding agency, and 

national levels. The tables showed summaries of 

the activities that had been reported to NCHS 

and that had occurred during the time period 

specified on each table. These tables were 

distributed to various levels of administration 

throughout the national family planning service 

progra.d 

The eight table formats that were used are 

shown in appendix VI-A. Tables 1 and 2 gave 

basic patient and visit data by type of patient 

and medical services provided. These two tables 

were produced monthly, quarterly, and annually. They were distributed monthly to the service 

sites, projects, State agencies, Federal regional 

offices, and agency headquarters and quarterly 

and annually to the projects, State agencies, 

Federal regional offices, agency headquarters, 

and the Deputy Assistant Secretary for Population Affairs, DHEW. 

Tables 3-6 were produced and distributed 

both quarterly and annually; they were sent to 

the projects, State agencies, Federal regional 

offices, agency headquarters, and the Deputy 

Assistant Secretary for Population Affairs. These 

tables included detailed cross-tabulations of sejEach table recipie~t received only the tables that 

applied to the particular area or agency in question. 

However, NCHS retained copies of all tqbles. 
lected sociodemographic characteristics of the 

patients served as well as the source of referral 

of the new patients. Information about the 

contraceptive method used at the last visit was 

also given. 

Tables 7 and 8 were produced and distributed annually, and the distribution was the 

same as that used for tables 3-6. These tables 

showed additional cross-tabulations of selected 

sociodemographic characteristics of the patients 

served. 

THE NATIONAL REPORTING SYSTEM 

During the time in which the PRSFPS was 

operating, NCHS had begun to work on developing the “final” reporting system. This system, 

the National Reporting System for Family Pkmning Services, was implemented in January 

1972. Since the NRSFPS is primarily a revised 

form of its predecessor, there are more similarities between the two systems than there are 

differences. The changes that were made were 

based on what was learned from operating the 

PRSFPS and were made in order to improve the 

collection, processing, and use of the data. 

The Report Forms 

The major data collection form used in the 

NRSFPS through 1976 was the Clinic Visit 

Record for Family Planning Services (CVR), 

shown in appendix III-B. This form contained 

18 data items (2 of which were optional) and, 

like the Provisional Report Form, was to be 

completed each time a person made a visit to a 

participating service site for family planning 

services. 

The information collected on the CVR was 

similar to that collected on the PRF; in fact, 

Table A. Comparison of items on the Provisional Report Form for Family Planning Services (PRF) and the Clinic Visit Record for 

Familv Planning Services (CVR) by type of information obtained, accorcfirw to whetheri@rnremainedthesame,WasModified 

deleted, or adde~ 

Type of information and item 

Same Modified Deletedl Addedz 

Identification information:


Clinic/service site number .............................................................................................


Patient number ....................................................................... ......................................


Demographic information:


Birth date ............. .........!...... ....................................................... ..................................


Ethnic designation/race ..................................................................................................


Education ........................................................ ...............................................................


Pregnancy history .............. .............................................................................................


Income, and family size ...................................................................................................


Welfare status .................................................................................................................


Current residence ............................................................................................................


Sex .................................................................................................................................


Place of birth ..................................................................................................................


service and administrative information:


Visit date ........................................................................................................................


Visit session .o...........................$..m.......................o.o. ......m.................................................


Patient type ............ ........................................................................................................


Visit type ...............,, ........................................................................................ ...............


Medical services ..............................................................................................................


Counseling services .........................................................................................................


Referral sewices ..............................................................................................................


Date and type of next appointment ................................................. ...............................


Source of referral .................o..om
 ..........................................m........................................... 

Contraceptive method adoptad .......................................................................................


Contraceptive history .....................................................................................................


lItem was on the PRF but was not on the CVR. 

21tem was on the CVR but was not on the PRF. 

r 

x 

x 

x 

x 

x 

x 

x 

x 

x 

x 

x 

x 

x 

x 

x & 

x 

x 

x 

x 

x 

x [ 

x 
most of the items on the CVR were taken from 

the PRF either unchanged or slightly modified 

(see table A). Again, the entire CVR was 

completed the first time the form was filled out 

for a patient, and the items completed during 

revisits were limited to those that changed over 

time. 

The CVR also contained a section for 

agency use only. This section greatly increased 

the flexibility of the NRSFPS because it allowed 

the participating agencies and service sites to 

record information relevant to their specific 

operations but not required for the national data 

system. 

Summary information about the provision 

of nonmedical family planning services and 

medical services provided to nonfamily planning 

patients was collected on the Monthly Counts of 

Ancillary Services Sheet (MCAS), reproduced in 

appendix III-B. By using this mechanism, the 

participating family planning service sites were 

able to report and “get credit” for services they 

provided that could not be reported on the 

CVR. 

Operational Procedures 

The operating procedures of the NRSFPS 

were very similar to those of the PRSFPS; 

refinements and revisions were made where 

necessary in order to improve the efficiency and 

utility of the system. Table B summarizes the 

major differences between the operating procedures of the PRSFPS and the NRSFPS. 

Enrollment and training of participants. – 

Any site providing family planning services was 

eligible to enroll and participate in the NRSFPS. 

A major effort in 1972, however, was made to 

enroll those programs that received family planning service funds from NCFPS, MCHS, or OEO 

or were affiliated with PP/WP because it was felt 

that these four agencies provided the bulk of the 

family planning clinic services in the United 

States. Later, when time and resources permitted, the other few remaining sites would be 

encouraged to enroll and participate in the 

NRSFPS.k 

‘Other sites were identified through the National 

Inventory of Family Planning Service Sites, another 

survey conducted by NCHS. For more information on 

The primary list of participants in the 

NRSFPS was obtained from the PRSFPS; all of 

the service sites enrolled in the Provisional 

Reporting System were contacted and asked to 

“reenroll” in the National Reporting System. In 

addition, the names and addresses of new 

grantees were supplied to NCHS by MCHS, 

NCFPS, and OEO. Planned Parenthood also gave 

NCHS the names and addresses of its affiliates. 

All of these organizations were contacted by 

NCHS, and either their funding agency or 

PP/WP; informed of the necessity to participate 

in the National Reporting System: and asked to 

enroll their service sites that were not already in 

the system: 

Upon receipt of the completed enrollment 

forms and the assignment of the project and 

service site identification numbers, NCHS sent 

each site a supply of the new report forms, 

instruction manuals, and the other administrative materials needed for reporting to the 

NRSFPS. In most cases, the sites that were 

“reenrolled” were reassigned the same numbers 

they had used in the PRSFPS. 

Training for the NRSFPS was conducted late 

in 1971 and was carried out a little differently 

from what had been done in the past. For the 

Provisional Reporting System, an attempt had 

been made to persomdly train every individual 

who was to come into contact with the form. 

Because this procedure was found to be impractical, it was decided, for the National Reporting 

System, to train “trainers.” That is, the intent 

was to train a few seIected people, probably 

from the larger projects, in each area. These 

people, in turn, would be available to help 

others in the same region, State, or locaI area 

with their participation in the National Reporting System. Therefore, NCHS contacted each 

this survey see Development of the National InventoW 

of Family Planning Services, by Gloria H. Kapantais and 

Donna Morrow, Vital and Health Statistics, Series 1, No. 

12, DHEW Pub. No. (HRA) 76-1312, Jan. 1976. 

10nly those service sites receiving funds through 

title X were required to participate in the NRSFPS. All 

other sites were urged to participate in order that the 

National Reporting System would reflect the actual state 

of family planning clinic services in the United States. In 

addition, participating service sites did receive feedback 

from the NRSFPS that could be used for their own 

administrative and evaluative purposes. 

9 
Table	 B. Summary of major differences in operating procedures between the PRSFPS and the NRSFPS, by type of procedure 

Operating procedure PRSFPS NRSFPS 

Enrollment and training ........................... ... Only certain family planning service programs eligible to participate–those 

funded by DHEW title V or X, those 

funded by OEO, or those affiliated with 

PP/WP. Emphasis on training each individual who was to handle the report 

form. 

Data collection and processing .................... Reporting done primarily on hard copy 

(Provisional Report Form). 

Very little imputation done resulting in 

many forms being rejected for incomplete or inconsistent reporting. 

Files and maintenance.., .............................. Two basic data files. Inactive patient records removed from file on an irregular 

All family planning service programs in the 

United States and territories eligible to 

participate regardless of funding or affiliation status. Emphasis on training a few 

select individuals who would then be 

able to help others learn how to participate in the system. .. 

Reporting done on both hard copy (Clinic 

Visit Record) and machine-readable form 

(computer cards or tape), with increasing 

emphasis on machine-readable form. 

Many imputations done resulting in an 

increase in the acceptance rate. Forms no 

longer rejected for incomplete responses . 

to noncritical items. s 

Five basic data files. Inactive patient 

records removed from file on a regular 

basis. basis.

regional office (MCHS, NCFPS, OEO, and 

PP/WP), informed them of the type of training 

that was to be provided, and asked them to get 

in touch with their grantees or affiliates to help 

in assuring that the appropriate people were sent 

to the training sessions. 

The training procedure used for the National 

Reporting System was similar to that used for 

the Provisional Reporting System–the definitions, report forms, and instruction manual were 

reviewed, as well as other adm~istrative details 

about joining and participating in the NRSFPS. 

The most valuable sessions were those which 

were attended by clinic personnel who had 

previously participated in the Provisional Reporting System. These people had experience in 

reporting to NCHS and were able to share this 

experience with the group. 

Data collection and processing. –The patient 

visit data were submitted to the NRSFPS in one 

of two ways: on the CVR itself (hard copy) or 

on computer cards or tape (machine-readable 

form). The data collection and processing procedures used in the NRSFPS for the submitters of 

hard copy were very similar to those used in the 

PRSFPS; for example, the CVR’S were submitted weekly or biweekly, and all of the 

remaining forms for a given month were sent in 

on the last working day of the month. As with 

the PRF, the CVR was a two-part form consisting of an original, which was sent to NCHS, and 

a carbon copy, which was retained at the service 

site. The receipt and control procedures, as well . as the conversion of the data into machinereadable form, were also very similar in the two 

systems. 

The family planning programs that reported r 

their data in machine-readable form through 

local computerized systems were instructed to 

report monthly. As the cards and tapes were ..


received by NCHS, they were logged in and sent


directly for computer processing. Such data,


however, were accepted for the NRSFPS only


after NCHS had determined that the definitions,


data collection and processing procedures, and


record formats of the local systems accorded


with the standards and requirements of the


NRSFPS. This clearance procedure was neces­


sary because most of the local computerized


systems used their own forms rather than the A


CVR. In these cases, the data items required by


NCHS were incorporated into the local report (

! 

form; only the required data items were sub; 

mitted to NCHS. 

The MCAS, the other data collection instrument used by the NRSFPS, was completed and 

submitted to NCHS monthly along with the last 

shipment of CVR’S for the applicable month. 

Initially, card and tape submitters also had to 

report their ancillary services on the MCAS; this 

10 

i 
i was later changed, however, to allow these sites 

to’ report the ancillary services data, as well as 

the patient visit data, in machine-readable form. 

AU data, regardless of the form in which 

they were submitted, were subject to the same 

editing procedures once they were received by 

NCHS. As with the Provisional Reporting System, one result of the editing procedure was a 

processing report, similar to the one obtained 

from the Provisional Reporting System, for each 

site (a sample of this report is shown in 

appendix V-B). Each report that was produced 

for the submitters of hard copy was reviewed, 

annotated if necessary, and returned to the 

applicable site with any rejected records that 

could not be reprocessed by NCHS. Again, 

personnel at the sites were instructed to examine 

the reports for accuracy, make the necessary 

corrections, and resubmit any corrected forms 

to NCHS for reprocessing. 

The processing reports for those sites reporting on cards or tape were sent back to the 

submitters without review by NCHS. This was 

necessary because NCHS did not have the 

original source documents with which to verify 

the data. 

Although the general kinds of edits for the 

NRSFPS were the same as those used for the 

PRSFPS, specific edits had been modified where 

necessary. One major modification, for example, 

was the change that allowed the NRSFPS to 

make imputations and accept records that had 

failed selected edits. This is in contrast with the 

procedure that was used in the PRSFPS where 

every edit failure resulted in the total Visit 

Record being rejected; the valid information in 

the record, therefore, was not added to the data 

file until the record had been manually corrected and resubmitted by the service site or, 

more rarely, by NCHS. For example, in the 

Provisional Reporting System the pregnancy 

history information, such as the number of live 

births, could not decrease over time. If a 

decrease was reported, the record with that 

information on it would be rejected and returned to the reporting service site for correction and resubmission. In the National Reporting System, on the other hand, it would be 

assumed that the larger of the two numbers was 

correct; an “error” message would be printed on 

the processing report giving the patient number, 

the edit, and the imputation made; the record 

would be accepted, and all of the information 

on it wouId be added to the data file. The 

service site would then be sent the processing 

report and, if the imputation made by NCHS 

was incorrect, could submit a “correction form” 

to the NRSFPS so the data file could be 

corrected. If the imputation was valid, no 

further action on the part of the service site was 

necessary. 

Fales and maintenance. –The following were 

the basic files used by the NRSFPS:m 

The Facility Master File 

The Skeleton Master File 

The Patient ,Master File 

The Purged Patients Master File 

The Activity Master File 

The Facility Master File was similar to the 

Address File in the PRSFPS; this was the file 

that contained the name, address, funding and 

Planned Parenthood affiliation data, the ancillary services data, and some other administrative 

data for each facility enrolIed in the NRSFPS. 

This File was updated monthly by adding 

records for new facilities, deleting records of 

inactive facilities, or correcting information that 

had been incorrectly entered or had changed 

over time. 

The Skeleton Master File consisted of one 

record for each active patient in the NRSFPS. 

Each record contained the most current information about each patient in terms of the 

individual’s sociodemographic characteristics, 

most recent contraceptive method used, contraceptive usage before enrollment in the reporting family planning project, and the most recent 

visit date. This File was used primarily in the 

editing process and was updated constantly as 

new or corrected patient visit records were 

received and processed by the NRSFPS. In 

addition, the inactive patient records were deleted from this File every 3 months. 

The Patient Master File contained all of the 

information on each CVR submitted to and ‘ ­

mAgain, as with the PRSFPS, other files were 

created and used in the operation of the NRSFPS, but 

these five were the basic files. 

11

accepted by the NRSFPS for the active patients. 

These records were kept in a consecutive “visit 

string” for each patient; therefore, as long as a 

patient remained active, all visit records for each 

patient were stored together in this File. This 

Fde was updated quarterly by adding new 

records, changing incorrect data, and deleting 

the records of the patients who had become 

inactive. The deleted records were stored on the 

Purged Patients Master File. 

The Activity Master File contained a historical record of facility participation in terms of its 

submission of patient visit data to the NRSFPS 

for each enrolled service site. This File was used 

for administrative and monitoring purposes and 

was updated monthly, based on each site’s 

submission of patient visit data to the NRSFPS. 

Output Tabulations 

As table C indicates, the regular output 

tabulations from the NRSFPS were much more 

extensive than those of the PRSFPS (see appendix VI-B for the NRSFPS table formats). The 

output was again produced on a monthly, 

quarterly, and annual basis; however, unlike the 

Provisional Reporting System, different sets of 

tables were developed for the different time 

periods. In addition, different types of tabulations were produced for each level of 

participant-service site, project, State, region, 

and funding agency or Planned Parenthood-and 

they were intended to be useful for program 

planning and evaluation at each level. Tables 

Table C. Summary of major differences in the output tabulations 

between the PRSFPS and the NRSFPS 

PRSFPS I NRSFPS 

Eight different table formats Twenty-seven different table 

formats 

Some of the same table for- Different table formats were 

mats ware used in producing used in producing the 

the monthly, the quarterly, monthly, the quarterly, and 

and the annual tabulations the annual tabulations 

Service sites received only Service sites received monthly, 

monthly tabulations quarterly, and annual tabulations 

No tables were regularly avail- Some of the tables were proable for the general public duced quarterly and annually for the general public 

were not sent to service sites and projects that 

reported through automated systems, however, 

because it was felt that such systems had been 

developed originally to meet the data needs of 

their family planning programs and, therefore, 

already provided them with the necessary tables. 

By eliminating feedback to these projects and 

service sites, unnecessary duplication of both 

effort and expense was avoided. 

Both the monthly and the quarterly tabulations were designed for administrative and 

management purposes rather than research purposes. The monthly tables contained only basic 

patient counts and service information and were 

distributed to the participating service sites and 

projects, States, and regionzd offices. Distribution was usually completed within 4 weeks after 

the end of the given month. 

The quarterly tables contained, in addition 

to basic patient and service counts, some demographic information about the patients served 

during the particular quarter. These tables were 

sent to the participating service sites, projects, 

States, regional offices, and national offices. 

Because an addkionzd month was aUowed for 

data collection for the quarterly tables, these 

tables were mailed within 2 months after the 

end of the particular quarter. 

More detailed information about the demographic characteristics of the persons served and 

the services they had received was available from 

the annual tabulations. Because both research 

and management needs were considered in designing these tabIes, a much Iarger set of 

tabulations was distributed to the service sites, 

projects, States, regional offices, and national 

offices. Distribution of these tables was completed within 3 months after the end of the 

year. 

Some of the tabulations from the NRSFPS 

were also regularly available for public distribution to persons requesting information about 

family planning clinic services and patients. 

Although no monthly data were distributed to 

the general public, basic patient counts by 

quarter were sent. In addition, since the annual 

tabulations were heavily oriented toward research needs, a much larger set of tables, 

containing both national and State data, was 

available to the general public. 

I


,. 

. 

\

,} 

12 
19712

{ Besides the re~lar tabulations. s~ecial tabu- Table D. Number of participating service sites, family planning 

lations from the fiRSFPS have bee; produced 

and used for both research and management 

patienta seen, and clinic visits made for family planning 

services as reported to the NCHS family planning reporting 

systems: United States,l 1970-75 

needs. Such tabulations have been requested by I 4 t 

i’ 

Federal, State, and local agencies for their own 

research, administrative, or management use. 

Year I Service 

Patients Visits sites I I 

Costs for these tabulations, unless minimal, have Number 

generally been borne by the requester. All such I 

19702 ...... ........................ 290 415,000 640,000 requests are reviewed by NCHS to assure that 19712 .............................. 1,800 798,000 1,268,000


the confidentiality of the data is protected 19723 .............................. 3,270 1,633,000 2,480,000


before the tabulations are released. 19733 .............................. 4,090 2,138,000 3,469,000


19743 .............................. 4,830 2,608,000 4,414,000


19753 .............................. 4,940 3,248,000 5,853,000


GROWTH AND FUTURE OF	 lIncludes Puerto Rico, Virgin Islands, and Guam. 

2PRSFPS. * THE REPORTING SYSTEM 3NRSFPS. 

The 100-percent family planning reporting 

systemn has grown rapidly during the 7 full 

Table E. Percent increase in the number of participating service 

years of its operation. As can be seen in table D, sites, family planning patients seen, and visits made for 

during 1970 some 890 service sites reported family planning services as reported to the NCHS family 

serving 415,000 patients who made 640,000 planning reporting systems: United States, 1 1970-75 

visits for family planning services; these figures 

have increased to 4,940 service sites reporting 

3,248,000 patients who made 5,853,000 visits 

Service 

during 1975. I sites I Patients I Visits 

Table E shows the percent change from one 19702 ........................................ (% (3) (3) 

year to the next of the number of participating ,9724 ........................................ 102.2 92.3 98.1 

service sites, patients served, and visits made as ,9734 ........................................ 81.7 104.6 95.6


reported to NCHS. Although the increase in the ,9744 ........................................ 25.1 30.9 39.9


,9754 ........................................ 18.1 22.0 27.2


number of participating sites seems to have ........................................ 2.3 24.5 32.6


leveled off, the number of patients served has 

lInc]udes puerto Rico, Virgin Islands, and Guam. consistently grown 20 to 30 percent each year 2PRSFPS. 

since 1973. In addition, the number of family 3Base year. 

4NRSFPS. planning visits made by these persons has concurrently increased 30 to 40 percent each year 

over the same period of time. 

The percent of records submitted to the Table F. Percent of records submitted to the NRSFPS by autoNRSFPS through local automated data systems mated and nonautomated submitters: United States,l 

1973-75 

has also continued to increase over the 4 years 

for which this information is available. As can be 

seen in table F, approximately 65 percent of the 

Year records were received through these partici­


percent 

pating systems 

submitted 

during 

during 

1975, 

1973.


up from the 47 m


During 1976, work was undertaken to revise Percent of records 

submitted 

both the basic data collection document used by 

NRSFPS (the CVR) and the National Reporting	 1973 

1974 

1975 .

“’’’’’’’’’’’’’’’’’’’ .......... ................................... IEllii!il E

‘Includes both the PRSFPS and the NRSFPS. lIncludes puerto Rico, Virgin Islands, and Guam. 

13 

i 
System itself. This revision was necessitated by 

the decision to convert the 100-percent National 

Reporting System to a sample survey in 1977. A 

sample survey would allow DHEW to take 

advantage of the benefits of sampling in terms of 

the efficiency, economy, and better quality 

control of the data and the data collection. In 

addition, sampling would allow resources previously directed toward 100-percent reporting to 

be redirected toward obtaining data from sample 

family planning service sites not previously in 

the NRSFPS. Since these sites are mostly those 

which are neither federally funded nor affiliated 

with PP/WP, the data from the National Reporting System would thus become representative of 

the total picture of family planning services in 

the clinic setting in the United States and its 

territories. 

Although the data collected through the 

sample survey will be submitted to NCHS 

mainly in machine-readable form (punched cards 

or magnetic tape), sample sites may use the 

NCHS report form to collect the information 

required. As with the 100-percent NRSFPS, data 

will be accepted from local automated systems 

that are not using the NCHS report form only if 

their definitions, data collection and processing 

systems, and record formats are in accordance 

with the standards and requirements of the 

national survey. 

Sampling will be done in two stages. First, a 

representative sample of about 1,500 service 

sites will be drawn from the total universe of all 

family planning service sites that could be 

identified in the United States and its territories. 

Second, a subsample of family planning visits 

made to these sites will be drawn, and the size of 

each subsample will depend on the size and 

location of each service site. Automated systems 

could submit all of the visit data for their sample 

service sites to NCHS; NCHS would then draw 

00 

these subsamples. Alternatively, each subsample 

could be drawn at the site by use of a log 

attached to the CVR’S. The log will not be 

submitted to NCHS but will remain at the 

service site. 

Since the new CVR is based on the old form, 

many of the items on the two forms are the 

same or similar (see appendix III-C for a sample 

of the new report form). The items on the new 

form can be categorized into three types: 

identification information, social and demographic information, and family planning service 

or clinical information. 

The identification information consists only 

of two numbers—the service site number 

assigned to the site by the NCHS and the patient 

number assigned to the patient by the service 

site. Both of these numbers will be used only for 

purposes of quality control, Moreover, the only 

link between the patient number and the name 

of the patient will exist at the service site, as was 

previously the case. 

Social and demographic information includes data on each person’s birth date, race, 

sex, education, pregnancy history, income, and 

family size. 

Family planning service information refers 

to patient status, date of the visit, and the 

medical services provided at the service sites. 

Information pertaining to the contraceptive’ 

usage of the patient, both prior to and as a result 

of the particular visit, is also collected. 

Estimates at the national, regional, and State 

-levels will be produced from the sample 

NRSFPS. Although the tabulation plans have 

not yet been finalized, it is anticipated that the 

estimates produced from the sample data will be 

used for the overall planning and evaluation of 

the family planning pro~am at the national 

level. In addition, the data collected also will be 

useful for research purposes. 

o


m 

! 

. 
I. 

IL 

III. 

N. 

v.


VI.


.—— —- .—. ..— -

APPENDIXES 

CONTENTS 

Abbreviations Used in TMs Report .................................................................................................... 

Agencies and Persons From Whom Comments and Input Were Received Regarding the Family 

Planning Reporting Systems ............................................................................................................ 

Sample Report Fores ........................................................................................................................ 

A. Provisional Reporting System for Family Planning Services: provisional Report Form for 

Family Planning Setices ......................................................................................................... 

B. National Reporting System for Family Planning Services (100-Percent Survey) 

Clinic Vkit Record for Family Planning Services (HRA-6i3) Rev. 1-76 ................................. 

Monthly Counts of Ancillary Services Sheet......................................................................... 

c.	 National Reporting System for Family Planning Services (Sample Survey): clinic Visit Record 

for Family Planning Services, HRA-192-2, 6/77 ...................................................................... 

Sample Enrollment Fores ................................................................................................................. 

A. Provisional Reporting System for Family Planning Serwices: Project Enrollment Form ............. 

B. National Reporting System for Family Planning Services (100-Percent Survey) 

Project Data Sheet................................................................................................................ 

Service Site Data Weet ......................................................................................................... 

Sample Processing Reports ................................................................................................................. 

A. Provisional Reporting System for Family Planning Services 

Sample: Error Conditions or Possible Oversi@ts .................................................................. 

Sample: Summary of Records Submitted ............................................................................. 

Sample: Lkt of Forms Processed .......................................................................................... 

B. National Reporting System for Family Planning Services (100-Percent Survey) 

Sample: Error Conditions or Inconsistencies ........................................................................ 

sample: Summary of Records Submitted ............................................................................. 

Sample: List of Forms Processed .......................................................................................... 

Standard Table Shells


A. Provisional Reporting System for Faroily Planning Services: Tables 1-8


1 and 2. Number and percent of patients receiving family planning services, by type of


patient and type of service provided and number and percent of visits for family


planning sertices, by type of service provided during visit.......................................... 

3.	 Number and percent of patients receiving family planning services, by ethnic designation and age............................................................................................................ 

4.	 Number and percent of patients receiving family planning services, by highest grade 

of school completed and age...................................................................................... 

5.	 Number and percent of contraceptive patients receiving family planning services, by 

live births and contraceptive method adopted ............................................................ 

6.	 Number and percent of new patients receiving family planning services, by age and 

source of referral........................................................................................................ 

7.	 Number and percent of patients receiving family planning services, by age and by 

public welfare statm .................................................................................................. 

8.	 Number and percent of patients receiving family planning services, by live births 

and highest grade of school completed ....................................................................... 

17


18


20


20


22


23


24


26


26


29


31


33


::


34


35


36


37


38


39


40


41


42


43


44


15

.

B. National Reporting System for Family Planning Services (100-Percent Survey) 

Monthly Tables: M-1 –M-3 

M-1. Family planning services and contraceptive method by type of tilt and summary reports ... ...........................................................................................""""""""..""""""""..".".".""."

M-2. Number of family planning patient visits by type of vbit: each service site and project 

within State..................................................................................................................


M-3. Number of family planning patient visits by type of tilt, by funding agency: each 

project and State witfin region .....................................................................................


Quarterly Tables: Q-1 –Q-9 

Q-1. Activity status of patients by selected patient chmtiefistim .......................................


Q-2. New female contraceptive patients by selected characteristics ......................................


Q-3. Patient visits by type of visit and type of services provided ..........................................


Q4. Number and percent distribution of all patients by selected characteristics: each 

State, project, and service site.......................................................................................


Q-5. Number and percent distribution of new patients by selected characteristics: each 

State, project, and service site.......................................................................................


Q-6. Number of sterilization patients by selected characteristics: each State, project, and 

service site....................................................................................................................


Q-7. Number of infertility patients by selected characteristics: each State, project, and 

service site ....................................................................................................................


Q-8. Number and percent distribution of female patients by type of patient and live btihs:


each State, project, and service site ...............................................................................


Q-9. Number of patients and visits for each project, State, and region, United States ..........


Annuaf Tables: A-1 –A-7 and A-20–A-90 series 

A-1. Number of patients and visits for the United States, each region and State .................. 

A-2. Number of patients and visits by State and funding source for each participating 

project ........................................................................................................................ 

A-3. Number of patients and visits for each project and its service sites...............................


A-3P. Number of patients and visits for each Pfanned Parenthood affiliate ............................


A-4. Number of service sites, patients, and visits by project funding source for the United 

States............................................................................................................................


A-5. Number of service sites, patients, and visits by project funding source for each 

region ...........................................................................................................................


A-6. Number of service sites, patients, and patient visits by funding agency, each region, 

and the United States...................................................................................................


A-7. Number of service sites, patients, and patient visits by region, State, and project for


each funding agency .....................................................................................................


A-20. Number of female patient visits by type of service provided for the United States.......


A-30(N). Number of (new) female patients by age according to selected characteristics for


the United States..........................................................................................................


A40 (N). Number of (new) patients by patient characteristics according to sex and age for 

the United S~tes ..........................................................................................................


A-50. Characteristics of patients receiving public assistance by age and pmit y for the United


States............................................................................................................................


A-60. Number of method changes by type of method after change according to type of


method before change and type of patient: female patients for the United States ........


A-70-1. Number of new female patients by method prior to clinic enrollment and method 

at last visit, and source of method prior to clhic enrollment for the United States......


A-70-2. Number of female patients by method prior to cfinic enrollment, method at end of


initiaf visit, and method at end of last visit according to type of patient and type of


method for the Unrted Stites .......................................................................................


A-SO.	 Female contraceptive patients by contraceptive use prior to cfinic enrollment accord­


ing to age and number of live buths for the United States............................................


A-90.	 Ntunber of new female patients who are under 19 years by selected characteristics for


the United States..........................................................................................................


4!i 

46 

46 

47 

49 

50 

51 

51 

52 

52 

i 53 

53 

54 ,. 

54 7


54


55


55 

55 

56 

56 I 

57 

58 

59 

60 

61 

62 

62 

63 

64 

16 
APPENDIX I 

ABBREVIATIONS USED IN THIS REPORT 

AFDC Aid to Families With Dependent Children


BCHS Bureau of Community Health Services


CB Children’s Bureau


CVR Clinic Visit Record for Family Planning Services


DHEW Department of Health, Education, and Welfare


Health Resources Administration 

HSA Health Services Administration 

HSMHA Health Services and Mental Health Administration 

MCAS Monthly Counts of Ancillary Services Sheet 

MCHS Maternal and Child Health Service 

NCFPS National Center for Family Planning Services


NCHS iNationalCenter for Health Statistics


NRSFPS National Reporting System for Family Planning Services


OEO Office of Economic Opportunity


PP/wP Planned Parenthood/World Population


PRF Provisional Report Form for Family Planning Services


PRSFPS Provisional Reporting System for Family Planning Services

r 

APPENDIX II 

AGENCIES AND PERSONS FROM WHOM COMMENTS AND INPUT 

WERE RECEIVED REGARDING THE FAMILY 

PLANNING REPORTING SYSTEMS 

Although this list may not be complete, it is representative 

persons contacted who had input into the development of 

Reporting System for Family Planning Services and the 

System for Family Planning Services. 

Agencies 

Office of Economic Opportunity 

Planned Parenthood/World Population 

Department of Health, Education, and Welfare 

Office of the Secretary 

Children’s Bureau 

Center for Disease Control 

Food and Drug Administration 

Indian Health Service 

Maternal and Child Health Service 

National Center for Family Planning Services 

National Center for Health Statistics 

Persons 

of the agencies and 

both the Provisional 

National Reporting 

David T. Allen, M.D., Tennessee State Department of Health . 

Samuel Baum, Bureau of the Census 

Joseph Beasley, M.D., Louisiana Family Planning Program 

Donald Bogue, Ph.D., University of Chicago 

Arthur Campbell, Public Health Service, Department of Health, Education, 

and Welfare 

Leslie Corsa, M.D., University of Michigan 

Edwin Daily, M. D., New York City Health Department 

Ralph Frankowski, Ph.D., Tulane University School of Medicine 

Roberto Fuentes, Distn-ct of Columbia Health Department 

Louis M. Hellman, M. D., Downstate Medical Center, New York 

Frederick S. Jaffe, Planned Parenthood/World Population 

Schuyler Kohl, M.D., Do wnstate Medical Center, New York 

f 

r’ 

. 

18

Stephen Polgar, Ph.D., Planned Parenthood/World Population 

v 

Margaret Pratt, George Washington University 

Jack Reynolds, Ph.D., Columbia University 

Jeannie Rosoff, Planned Parenthood/World Population 

Carl S. Shultz, M. D., Department of Health, Education, and Welfare, Office of 

the Secretary 

Eleanor Snyder, Ph.D., Planned Parenthood/World Population 

Sheri Tepper, Rocky Mountain Planned Parenthood 

Christopher Tietze, M.D., Population Council 

George Varkey, Planned Parenthood/World Population 

H. Bradley Wells, Ph.D., University of North Carolina 

1 

Charles Westoff, Ph.D., fi”nceton University 

Gooloo .S. Wunderlich, Ph.D., Department of Health, Education, and Welfare, 

\ Office of the Secretary 
APPENDIX Ill 

SAM PLE REPORT FORMS 

A. PROVISIONAL REPORTING SYSTEIVI FOR FAMILY PLANNING SERVICES 

NATIONAL CENTER FOR HEALTH STATISTICS. PHSe DEPARTMENT OF ffEALTH, EoucATfoN AND wEf-FARE 

PROVISIONAL REPORT FORM FOR FAMILY PLANNING SERVICES ,repared~h,,k,d 

NAME PHONE 

ADDRESS m 

PATlENT NO AGE 

*~For Condnuadon Pat;ents: Shaded Items Should be All information which would permit identification of an individual or 

Completed Every Wsif. Other Items (except Nos. 6, 7.8, 9) Should of a clinic will be held in strict confidence, will be used only by p+rsons engaged in and for tha purpose of the survey and will not be be Completed Only at “AnnuaY Medical Examination. disclosedor releasedto others except for statisticalpurposes. [DETACH runs PART AND RETAIN AT THE cLINlc) 

1. CLINIC NUMBER — 

(NUMBERI 

I I I 

2. PATIENT NUMBER , (NUMBER) 

I 1 1 I I I 

3. PATl ENT TYPE 

~ 

1 

4. DATE AND SESSION OF VISIT 

I MO. [ OAY I YR. -

I II I I s.	 BIRTH DATE 

r MO. I YR. 

I s. ETHNIC DESIGNATION 

( 

7. WHO REFERREO YOU TO US? 

s.	 HAVE YOU RECEIVED FAMILY 

PLANNING SERVICES FROM A (YES OR NO) 00CTOR OR CLINIC WITHIN 

THE LAST TWO YEARS? 

9.	 CONTRACEPTIVE METHOD USEO 

IN THE LAST TWO YEARS 

~ 

1 

10.	 WHAT IS THE HIGHEST GRAOE 

OF SCHOOL COMPLETED? 

Y 

11.INcOME ANO FAMILY SIZE 

a.	 How Much is Your Family’s (wHOLE DOLLARS) 

Weekly Income? 

b.	 How Many People In Your Family (NUMSERI 

Are Supported BY This Income? 

12.	 IS YOUR FAMILY RECEIVING 

ASSISTANCE FROM A PUBLIC (COOESI WELFARE AGENCY ? 

13.	 ARE YOU REGISTERED FOR MEOICAID ? 

(YES OR NO) 

14.	 HAVE YOU EVER BEEN PREGNANT? (YES OR NO) 

If Yes, Provide: 

a.	 Number of Children Born Dead ,(NUf46ERl 

(Anytime After Conception) 

[NUMBER) b. Number of Live Births 

c. Number of Children Who Ware Born (NUMBER) 

~VO SW Oied Sefore One M.mth 

[NUMBER) d.	 Number of Children NOW Living 

I 

15	 ON WHAT OATE 010 

YOUR LAST PREGNANCY 

TERMINATE 7 m
I I I 

16, WHAT WAS THE OUTCOME OF i 

YOUR LAST PREGNANCY ? 

r“ 

F===!=
 INFERTILITY SERVICES 

w 

I 

COUNSELING & REFERRALS 

(Except Infertility Services] 

a.	 Counseling r 

b.	 Referrals 

r 

I 

OATE OF NEXT 

APPOINTMENT 

~ 

1 1 

TYPE OF NEXT 

APPOINTMENT 

I (COOE} 

I CURRENT RESIDENCE 

a. County Code l---== 

[ I 

(WOES) 

b.	 Location Code I I 1 1 1 

LOCAL USE 

a. I 

1 I i 1 

b. 

c. 

d. 

flARKS: 

Bursau of the Bud-wt Approval 66-R-113 

i 

t 

20 
1

2

3

4

5

6

7

CODES FOR COMPLETING PROVISIONAL REPORT FORM 

FAMILY PLANNING SERVICE 

f 

‘“1 

I 

i 

: 

Patient Type: (Cod,) 

flew,,, ................ O Cootlnuatlon ..........

‘m’) 

. 6 @

New-TtwSy.stem . . . . . . . . . 3 Readmission . . . . . . . . . . . 8 

Session of Visit: 

(cd,) (Cod8) 

U!omltrg . . . . . . . . . . . . . . . 5 Affomoon., . . . . . . . . . . . . 7 

Everrhrg. . . . . . . . . . . . . . . . 9 

@ 

Ethnic Designatio~;Od,) (Code) 

Whfto . . . . . . . . . . . . . . . . . . O OtharSparrish Surname.. 5 

Black..., . . . . . . . . . . . . . . 2 American Indian. . . . . . . . 7 

PuertoRica n..., . . . . . . 4 Other . . . . . . . . . . . . . . . . . . 9 

Who Referred You to Us? @ 

(Select Only One Code) 

(cod,) 

PrOgram Personnal . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

OthBr Social Wolfara Agancy . . . . . . . . . . . . . . . . . . . . . . . . . 

Hospital, Madical, or Othm Haalth Source......, . . . . . 

Othar Clinic Patiant, Friand w Ralativa . . . . . . . . . . . . . . . 

Puhfic Walfara Agancy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

Othar Source orSalf . . . . . . . . . . . . . . . ... . . . . . . . . . . . . . . . 

Unknown . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

@ 

Contraceptive Method Used in the 

Last Two Years:


(Select Code for Most Frequently Used Method)


(Cod.) (Cod,) 

Nona . . . . . . . . . . . . . . . . . . 1 Diaphragm,,...,.,,,.., 5 

Oral . . . . . . . . . . . . . . . . . . . 2 Foam . . . . . . . . . . . . . . . . . . 6 @ 

DUO. . . . . . . . . . . . . . . . . . . . 3 Rhythm . . . . . . . . . . . . . . . . 7 

Condom. . . . . . . . . . . . . . . . 4 Other . . . . . . . . . . . . . . . . . . 3 

~	 What is the Highest Grade of School 

Completed? 

Nona Elemmrtary Schoof High School 

(Code) O 1,2,3,4,5,5,7, or8 9,10,11, or12 

Collaga More Than 4Years Collega 

(Code) 13,14,15, or 16 17 

@ 

Is Your Family Receiving Assistance from 

a Public Welfare Agency? 

(code) (“ad.) 

No..., . . . . . . . . . . . . . . . . . O Othar Public Walfara,,.. 9 

AFOC..., . . . . . . . . . . . . . . 5 

~~~~~~~c’$tc”me of YCW 

BORN LIVE: BORN DEAD: 

(coda) (Csdo) 

Twrn (5X lbs. or mom).. 1 Term (5% lbs. or �oro],. 6 

LowWolght . . . . . . . . . . . . 4 Other . . . . . . . . . . . . . . . . . 9 

(Iesatfran6X NM.) 

Types of Medical Service: (There maybe up to 3fx 

Codes entared,) 

(Cad.) (Ccih) 

Breaat Exam.,,..,., . . . . 1 PAP Smear....,.,,,,,,, 6 

Pahric Exam . . . . . . . . . . . . 2 Serology . . . . . . . . . . . . . . 7 

OthsrMadical Esams . . . . 3 Other Lab Testa...,..,., S 

No Exams or Tasts Given . . . . . . . . . . . . . . . . . . . . . . . . . . . . O 

Contraceptive Method Adopted at this Visit: 

(Select Only Ona Code) 

(Code) 

No Charrrm From Previous Mathod . . . . . . . . . . . . . . . . . . . . O 

(Code) [Code) 

Nona . . . . . . . . . . . . . . . ...1 Diaphragm...,,,,,,,.,, 5 

Oral . . . . . . . . . . . . . . . . . . . Z Foam . . . . . . . . . . . . . . . . . . 6 

Nfo.................... 3 Rhythm ..,......,..,,.. 7 

Condom. . . . . . . . . . . . . . . . 4 Other . . . . . . . . . . . . . . . . . 8 

Infertility Services: 

(Cod.+ <Code) 

Treatment . . . . . . . . . . . . . 1 Refsrraf . . . . . . . . . . . . . . . . 3 

Counseling . . . . . . . . . . . . . 2 

No infertility Sarvices Prnvirfed . . . . . . . . . . . . . . . . . . . . . . O 

Counseling and Referrals: (Except Infertility) 

(Code) 

COntrsceptive COunsnling . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 

Other Counseling . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...2 

No Counsafing Providad . . . . . . . . . . . . . . . . . . . . . . . . . . ...3 

tfafarral From Tfds Clinic for: 

Medical Servicas . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 

SOciaIServices . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 

No Referrals . . . . . . . . . . . . . m. . . . . . . . . . . . . . . . . . . . . . . . , 7 

Type of Next Appointment: 

(Cod,) (cod,) 

Anmralhledical . . . . . . . . . 1 .$upplyfh:k . . . . . . . . . . . . 5 

Othzr Medical . . . . . . . . . . 3 Cmmsefi!lg . . . . . . . . . . . . . 7 

No Appointment Mada . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 

21 
(CITY) 

� 

B. NATIONAL REPORTING SYSTEM FOR FAMILY PLANNING 

(100-PERCENT SURVEY) 

CLINIC VISIT RECORD FOR FAMILY PLANNING SERVICES 

#.s.OEP#mUEWWWEALTH,fBMMTBB NAME PRE;;RED CH~J(ED 

AADWELPAAE (FIRST) (MIDDLE) (EAST) (MAIDEN) 

PVILE sEALTN4ERVICE 

HEALTHRE$OBR4MADMIAlkTMllON ADDRESS 

I14TIMALCEIIIIB FOR (STREET) PATIENT NO. 

MEALIIIAliltAllC$ I I E 1 \_..., [STATE) (ZIP COOE) (PHONE NO. ) I

t I

I 

CONFIOENTIALITY ASSURANCE. AU LIIEormaUon whkbwouldpe?mlt ldenflfkxtl.n of an Indlvldual wlllbeheld In strfd confidence, will 

b+ used onfy by persons engagd tn and for the purpo8e of tbe autvey, and will not be dkclood or rekmed by NCHS to others exmpl for 

stdkfkal putp.mts. The provklon of servkts t8 h no way contingent upon the pstknt’s provldtng �ny tnformallo” on thk form. 

(DETACH THIS PARi’AND R) IN AT SERVICE SITE) — 

. SERVICE SITE NUMBER 

NUMBER Ilpll :. PATIENT NUMBER NUMBER 

II II 1.DATE OF VISIT DAY YR. 

1.TYPE OF VISIT 

� Inltbl Wilt 

CODE 

MO. DAY YR. 

~ � hp. Smear 

� ErEvk Exmnl � Urfndysfs (n.e.s.) \% 

� Bremt Exam � Blood Test(n.e.s.) 

� Bbod &llUR w Sterllkatlen ~ s 

� Prewarmy Testkw � Inkrtiflty Treatment 

� V.D. Tdfng � Other 

b. COUNSELING 

� SkrOLzmti.n g $;eyw CODES 

� Contrmeptlon I 7. Referred Elsewhere 

� None Kl lnferWOy Servhs


(iJ AbcmUo”


E WmtUzatlon


R ‘:RL&Fw’$ ~ 

S. Contraceptive Mefbod .t fbe End of Thk Visit 

�. Method 

KI Oral (Pill) � I.]ectlon 

� IUD � Sterlllaat[.an 

~ D#.gm � other 

� N.”e 

� Sbyfbm 

� Condom � I.terlm ðod r 

b. I/ No”.. zive realm! 

� R’tAllmnt � *king &EIuncy COOE 

E other Medkal rkssonn Olher ~ 

L N.sd Ameln!mmt MO. I DAY I YR. 

b.	 FurpoIc (OnIONAL) I 

� .%IPP& O.b � other PURPOSE CODE
 � AmM,l Medk.1 ~ NO Next ApPoIntmeM


El Ofb*r Medical


LGENCY USE 

NCFPS OEO MCHS PP-WP NCHS LOCAL 

b. 

c. 

d. 

> e.	 I I I I I I 

L 

H M-m 

-Mtv. 1.76 

la. m CLtnlc Vidt Record been submitted 10 the NCHS Nstlond 

Reporffr.g System 10. FmmOy PlmmlnS Servkes for thk 

mtk”t durfns the fast 16 monfhm? 

No Compkte Items 10 through 18 below 

[s thk the nrst Record compkted ~or thk palknl this year? 

Ye. Campkte only Itcrm 10, 11, 12 below 

-

a. Nmnber of Live B1t’fhs I 

NUMBER b. Number of Fetel Deaths 

(.?JiUbirfh$ Aborfion. & Mkarri.#es) NuMBER 

c. Number of Children New Living E 

welfarestatus 

YES NO 

b.	 Are YOU or A“yc.nc 1“ Your Family YES NO 

Registered for Medicaid? E 12. Highest Grade Of School 

Compkted 

None Elementary school High School 

Code O 1,2,3.4.5,6,7.8, 9, 10, 11, 12, 

Cdkg’e Mere Than 4 Year, Colk;e cODE 

Code 13, 14, 1S or 16 17 I 13.	 PI*C? of city & stAte (Country if not U.! 

Birth [OPTIONAL) 

16. Rut CODE � White � Am. Ind. 

@ Bkck ~ 04ber 

16. sex CODE 

�	 Female � ml. 

I 

L1. source of Referral 

� outreach Worker 

� other FP CUnlc � An.tber CIMC PaOent 

� Hosplml, or H Famlfy or Frknd 

Ofher He.Rb Ase.cY � TV, Radio, Paper Ad. 

� private Doctor or Nurse � Ofher 

� Welfare Asmcy � Unkmaw” CODE t 

I 

18. Contmceptive Hktimy 

� Have You Ever Used Any Method to Revent Pregnamy? ~ 

b. Are You Currently Using Centraceplloa? 

E c What k the Last Method Used? (Check One) 

� Oral � Rhyfhm 

� IUD � Condom 

~ D#&Em � Injcctlon CODE 

� Other 

d.	 Who RescrIbed that Mdhod: 

� CM* � Omg Store (non-prcscripti.n) CODE 

� FrlvmeDOdor m Oiber 

FORMAPPROVED OMB NO. - 6&R-1137 

‘1 

I’r 

1’

I 

22 
MOtiTHLY COUNTS OF 

ANCILLARY SERVICES SHEET 

NATIONAL REPORTING SYSTEM FOR FAMILY PLANNING SERVICE$ 

Date 

Service Site Number 

Project Number 

I \ & City Y!“? , 

The month in which ancillary services were provided 

The total monthly counts of ancillary services provided at this service site: 

Medical Services 

Supply Visits 

Outreach Contacts” 

Attendees at Lecture Sessions 

Telephone Contacts 

Other Services 

NOTE: Please refer to the Administrative Manual, Section V1. Reporting 

-lary Services to NCHS, for detailed instructions. 

Send all shipments to:


INFORMATICS INC.


6425 Landover Road


Cheverly, Maryland 20785


ATTENTION: FAMILY PIJINNING DIVISION


23 
.

.

.

C. NATIONAL REPORTING SYSTEM FOR FAMILY PLANNING SERVICES 

(SAMPLE SURVEY) 

B 002131 

FAMILY PLANNING VISIT LOG 

Ask ths pstimm “Am you hwo to sw � family planningprovider (phvsiciwr,nu~, �llied 

htdth personnel) �bout obtaining hwlth swvicas ralsted to contrsmption, infertility 

tmstment, or sterilization?” If the Pstlwrt$sw “’ya;’enter tis/hermmaon thelinm 

Mow. timpleta tho olinic Vi$it ROCOKIfor the last name enterad on the Iua. 

FOR SERVICE SITE USE ONLY 

PATI ENT’S NAME DATE OF VISIT . . . . . . . . . .. . . . .. . . .. . .. . . . .. . . . .. . . .. . . . .. . . ..................................................................................................... .:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.. ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ t 

: 

Rtcord Itams 1-14 for thit @tient. 

; 

v 

CONTINUE LISTING PATIENTS ON NEXT PAGE. 

24 
, 

B ()(3213~ O.hn. 68-RI,,, 

U.S. DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE EXPIRATIONDATE 12/31/77 

PUBLIC HEALTH SERVICE 

HEALTH RESOURCES ADMINISTRATION ASSURANCE OF CO NFIDENTIALIT Y-W Information Which would bwmlt Idmtl. 

flca,l.an of �“ Ind,vldu,l, � Ilracilc,. 0, a. .S, at.!,,llme”t w,,, be Imd <.n,, de”t, a,, NATIONAL CENTER FOR HEALTH STATISTICS w,ll be “fed only by 9,,s0”, t“g?gai m and for ,lw w,00,,, of the survey and w,,, 

t 

Clinic Visit Record for Family Planning Services 

1.	 SERVICE NUMBER ~ 

2’ ‘AT’ENTNUMBER ~ 

3.	 DATE OF THIS VISIT non 

4. PATIENT’S SEX 

.	 � FCmate b D ‘*l. 

5, ARE YOU OF HISPANIC ORIGIN OR DESCENT7 

HAND CARD A a � v., bDNo 

6. PATIENT’S RACE (Check one box) 

� � whl~* c � AsI.. Or p* CIfIC l~l..~=~ 

b � ~l~ck d � ‘me’jc~” lndl~n Of Al=kJn N,ll,e 

7.	 WHAT IS YOUR BIRTH OATE? 

a o~t, —0 Q U 

~ � If unknown •~ “HOW old ,,* y..’”’	 — 

[No. of Vez,s) 

R PATIENT STATUS 

Havc you .xr been a patient of thts or my other CImtc (or family 

plmnhw mn servms? 

� IJ Y*, ~aNo 

lr ,8Yes,,. whe,n w,,, you &t, p,,,,., ,, my 00 clink for fmuly pi.. nin~ rnedicd serwms? + ~onth 

9 EOUCATION 

A. What i, the hl’he,t ct,de (,,, Y,,,) of ,wu!w school you h,,, comp!,te, 

(Circle one number) 

0123456789 101112131415,6 17. 

(If %ro, ,, go to 10) 

to. FAMILY INCOME AND FAMILY SIZE 

HAND CARD B �nd HAND CARD C 

A.	 W!tkh of the fol!owing mops represents war Iotd combined gross 

(before deductions) family income for Ihe past 12 nm”ths? 

�O 0. S1,249 d � $6.250.$8,749 9 •l 51 E.750’ 

b � S1,250 .$3,749 e � $8,750.513,749 h � unknown 

C � $3,750.$6,249 f � $13,750 .$1 B,749 

B.	 How many P,OPI, ,,, in y.., family. Ih.t i,, the numb,, 

supprted hy this Income? 

C, Does lhk Income include �ny public ,ssktar,ce? 

� l-j Y,, ~DNo 

D. Whsl is your rel.lionship to the thief e.m.w? 

� � chl@*~rn*f c H rMu,ll,ar/sO” 

b � WiN/HU$L.,”d d � other r.latlve 

AGENCY USE ONLY 

A B c o E F 

1. 

2. 

3. 

4. 

s. 

“o, t., d,scIos,.5o, ,,lea,,d !0 other 9.s,,. ”,or used for any c,tl,e, c.umc.se PK.”,,,.. 

of SW.!.,, is 1“ “o V/y .On,, ”g.n, on ,., .a,,e., % prov,,j,.g . . . ,nfo,mat, on ,., 

Ihls form. 

11. PREGNANCY HISTORY [F,rnde, only] 

A. Ha”. you ,,,, been pregnant” 

� � Ye, b EINO-’3of0l2 

B. How many live births have you had? 

C’. Of the,,, how ninny ,,, now l,ving? 

O.	 How many of your pregmncics were mdtd by stillbirth, 

induced ahortt.n, or rnisc.rriage? (if %ro,,,go to F ) 

E.	 H“* many of th,,e Pre@,ncies w,,, ended by ,nduced 

abort,”. sin,, Jmm,ry 1973? 

F’.	In wh., month ,nd Y,,, d,d your 1,,, PW”,.,Y end 

(rewdles. of how it ended)? ~ 

12.	 CONTRACEPTIVE HISTORY 

A. H,., you we, used , method “f b,rth .“”1,.1 ,qu!,,ly? 

a � v., b UNO-GOt013 

HAND CARD D 

B. What nwth.ad did you Imt “se ,w1.,ly? (Check,// methods that ?PPI”) 

. H 51.,111.,,10” f � condom 

b � Or.1 [w g � Fc.am/JdlY/c,e,m


c � IUD . U N.t. r.t (1.cl.ding rhythm)


d � Dlzc.hr, yn J � other


e n 1“,.,,1.”


C-. no YOU currently “,, that method (P,,rnw method ehe,ktd {“ 12B)? 

� � VeS-GO to E bnNO 

D. 1. what month and year did you stop using that method? Q 

E. How long did you use that method; 

13.	 MEDICAL SERVICES PROVIDED AT THIS VISIT 

a Q PaDwnear g IJ urinalysis I....*.I 

b � *1,1, exam h � aro.ad !.2,1 (“...s.1 

. � O-$1 .-m , � Sterlll.zatt.a” 

~ •1 ~loo~ p~e~su~e K � $nf*#tjlity t,-tm.nt 

e � W,,”,”.. ,,,,1”, m � 0,.., Illeo,cal s.,.,,., 

f � V.D. I.sting 

14, CONTRACEPTIVE METHDD AT THE END OF THIS VISIT 

A. Method (Check,// that ,PPI”) 

a � S,*,,,,,.,,.” f � cona~m


~ •1 o~~l I=!ll $ ~ Fo,mlJ,llY/Cre,m


c IJ IUD n � Natur# Oncl.amg rhythm]


d � Dl, Phr>gm J � Othar


. � ,nj.ctl.an k � None


a. U ,<Non,,<, u., ream. (C3ak one only) 

*	 � %.$”,”1 d � other m.dlut r..s.ans 

b •l 8nf*ft11,:y P.tl.nt . � Rm!ylng m part..r.s mama 

c � E-kln9 pr*gn~ncy f � Other 

HRA-192.2


6/77

APPENDIX” IV 

‘1 

1.


2.


3.


4.


5.


. SAMPLE ENROLLMENT FORMS 

A. PROVISIONAL REPORTING SYSTEM FOR FAMILY PLANNING SERVICES 

PROJECT ENROLLMENT FORM


Name of Project:


(“Project” refers to the program receiving a grant. A number of family


plarming clinits may be funded by one project grant.)


;


Name of Project Director:


Address of Project:


Street Address


Ci


L


Telephone Number:


‘Area Code


How many clinic sites are pa our project? Include project headquarters


if a clinic is operated at t


Number


(“Clinic site” is used to refer to the smallest unit directly providing


family planning services to patients.)


How many family planning staff members are in each of the following cate- i 

gories in your project? 

a) Laboratory Assistants:


b) Social Workers:


c) Administrative Personnel:


d) Clerical Personnel:


e) M.D.:


f) PN/LPN:


g) Nursing Assistants:


h) Laboratory Technici


GO TO QUESTION 6 

26 
Page 2


6.	 Does your family planning project receive funds from the following organi­


zations?


Nat’1 Center for Family Planning Services . . ( ) Yes _% ( ) No


Maternal Child Health Services . . . . . . . ( ) Yes %ONO


Office of Economic Opportunity . . . . . . . ( ) Yes ‘% ( ) No


Other Federal Agency (Specify)


Planned Parenthood-bJorldPopulation . . . . . () Yes i m%


State. . . . . . . . . . . . . . . . . . . . ( ) Yes ‘%ONO


Local Area . . . . . . . . . . . . . . . . . OYes~ %ONO


Other ”(Specify) Y %


3 %


7.	 Does your program have an automated reporting system supporting Family


Planning? ( ) Yes ( ) No


(If yes, please send copies of the forms d and any reports together 

with the completed enrollment form.) 

8.	 Does each family planning clinic “ * ect have a method for number­


ing patients? ( ) Yes ( ) No


* (If no, skip to Question 13)q!$b S 

9* Do any atient number contain a phabetic characters? 

(~Yes ONO 

10.	 Can two patients within a project have the same patient number?


OYeso No”


11. If a patient transfers from one clinic to another in your project, does 

she retain her old patient number? ( ) Yes ( ) No


12. Are any patient numbers more than 6 digits long? ( ) Yes ( ) No


13.	 Your project will receive computer processing reports from us each week.


Please list the names of project staff members who can be contacted regard­


ing these reports:


14.	 Should clarification or correction of the weekly computer processing report


be necessary, we would prefer to notify only the project which in turn


would contact the person marking the form. Should you prefer that we com­


municate directly with the clinic concerned, please mark this box. ( )


GO TO QUESTION 15


27 
Page 3


15.	 Fill in the following information for each clinic in your project offer­


ing family planning services (if more space is needed, please give the


specified information on separate pages):


1.	 Name of Clinic:


Name of Administrator:


Street Address:


City and State:


Zip:


No. of Clinic Sessions per month:


No. of patient visits per month:


2.	 Name of Clinic:


Name of Administrator:


Street Address:


City and State:


Zip:


No. of Clinic Sessions per month:


No. of patient visits per month:


3.	 Name of Clinic:


Name of Administrator:


Street Address:


City and State:


Zip:


No. of Clinic Sessions per month:


No. of patient visits per month:


4.	 Name of Clinic:


Name of Administrator:


Street Address:


City and State:


Zip:


No. of Clinic Sessions per month:


No. of patient visits per month:


5.	 Name of Clinic:


Name of Administrator:


Street Address:


City and State:


Zip:


No. of Clinic Sessions per month:


No. of patient visits per month:


3 

(Signature) Name


.%


\


Q$#$


s 

Title Date 

28 
?

\ 

1.


) 

2.


3.


4.


5.


6.I


7.


B. NATIONAL REPORTING SYSTEM FOR FAMILY PLANNING SERVICES 

(1OO-PERCENT SURVEY) 

Department of Health, Education and Welfare


Public Health Service


Health Resources Administration


National Center for Health Statistics


National Reporting System for Family Planning Services


PROJECT DATA SHEET


a. Name of Project:


b.	 Project Mailing Address:


Number Street


City or Town State Zip Code


Enter the name of the Project Director:


A ti~$


Telephone (Area Code) Extension


‘tibs )Q’:8


How many family planning service site ,- d by or received any part of their


funds from this project? ser \& .> A’service site data sheet must be


completed for each service site in fn eve.)


~%


a. Does this project have a method f numbering patients? No; Yes


b. If there is more than one service site in this project, would a patient use the


same identification number in all of the service sites within this project?


No; Yes


a.	 In what format will this project’s patient visit data be sent to NCHS? (Check


one)


NCHS Clinic Visit Record and Monthly Counts of Ancillary Services


NCHS Monthly Counts of Ancillary Services only


Punched cards in NCHS format and Monthly Counts of Ancillary Services


Magnetic tapes in NCHS format


b.	 If punched cards or magnetic tapes are checked above , Please enter the name of


the data system:


Is this project affiliated with Planned Parenthood/World Population? No; Yes


If YES, enter the name of the Planned Parenthood Affiliate to which the project


bel~s:


NAME


Indicate the number of “Guidelines from the NRSFPS” this project should receive:


Number


29

8. Please indicate,within the appropriate categoriesbelow, the


for this project’s total budget for family planning services,


pending grant numbers where applicable:


Federal Funds Percent


DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE


National Center for Family Planning Services


(TitleX).. . . . . . . . . . . . . . . . . .


Maternal and Child Health Services (Title V) _


Other DHEW Funds (specifysource, Title IV-A,


Title XIX, Title XX, etc.):


Other Federal Agencies (specifysource): Q@


Government Funds Other Than Federal:


~’


State Government . . . . . . . . . >?. . .


Local”Government . . . . . . . . . . . . . .


Private (specifysource):


Source


Total . . . . . 100% 

Person supplying this information:


Name


Telephone (Area Code) Number 

Date Completed: 

Month Day Year 

RETURN TO: INFORMATICSINC. 

6425LANDOVER ROAD


CHEVERLY,MARYLAND 20785


(301)772-3222


30 

percentage of funding


and list all cozres-


Grant No.(s)


i 

( 

Job Title


Extension

Department of Health, Education and Welfare


Public Health Service


Health Resources Administration


National Center for Health Statistics


National Reporting System for Family Planning Services


SERVICE SITE DATA SHEET


1. a. Name of Service Site: 

b.	 Service Site Address:


No. Street P.O. Box, Route, etc.


City or Town State Zip Code


c. Enter mailing address for this service site if different from the above address:


d. Is this service site part of a progr led in the National Reporting
 %


System For Family Planning Servi .


No; Yes 0> %
 @@


%b.,,.I 

p> NCHS Project Number


e. Is this service site a mobile unit? No; —yes


2.	 Enter the name of the service site person to contact concerning the National Reporting


System:


Telephone Number (Area Code) Extension


3. Is this service site affiliated with Planned Parenthood/World Population?


No; Yes


If YES, enter the name of the Planned Parenthood affiliate to which this service


bel~s:


4.	 If this service site will be using the NCHS Clinic Visit Record and the Monthly Counts


of Ancillary Services Sheet, please enter the estimated patient visit load expected


per month: .


Number


5.	 a. In what format will this service site’s patient visit data be sent to NCHS?


(Check one)


NCHS Clinic Visit Record and Monthly Counts of Ancillary Services


NCHS Monthly Counts of Ancillary Services Only


Punched Cards in NCHS Format and Monthly Counts of Ancillary Services


Magnetic Tapes in NCHS Format


31

5.


6.


b.	 If punched cards or magnetic tape are checked above, please enter the name of the


data system:


Please indicate, within the appropriate categories below, the percentage of funding for 

this service site’s total budget for family planning services, and list all corresponding grant numbers where applicable:


FEDERAL FUNDS


DEPARTMENT OF HEALTH, EDUCATION AND WELFARE


National Center for Family Planning Services


(Title X) . . . . . . . . . . . . . . . . . .


Maternal and Child Health Service (Title V)


Other DHEW Funds (specify source, Title IV-A,


Title XIX, Title XX, etc.)


Other Federal Agencies (specify source)­


Government Funds Other Than Fede


& 

State Government . . . . . . . *L-J . . . . . 

Local Government . . . . . . . . . . . . .


Private (specify source):


Source


Total . .


Person supplying this information:


Name


Telephone (Area Code) Numb er


Date:


Month Day Year


RETURN TO: INFORMATICS INC.


6425LANDOVERROAD


CHEVERLY, MARYLAND


(301) 772-3222


PERCENT GRANT NO.(S) 

. 

.!..


x


100% 

Job Title


Extension


r 

\. 
. 

APPENDIX V 

SAMPLE PROCESSING REPORTS 

A. PROVISIONAL REPORTING SYSTEM FOR FAMILY PLANNING SERVICES 

CLINIC YYYY (REGION 01, STATE 00, PROGRAM XXXX)


THE FOLLOWING ERROR CONDITIONS OR POSSIBLE OVERSIGHTS WERE FOUNO IN THE RECORDS SUBMITTED: 

PATIENT INPUT FIELD IS RECORD CONTENTS 

NUMBER OROER NUMBER CONOITION ENCOUNTERED ANO ACTION TAKEN ACCEPTED OF FIELD 

52 3 A FIELO REQUIREO FOR THIS TYPE OF PATIENT IS OMITTED OR INCOMPLETE. NO


;: THE FIELD (OR A PORTION OF THE FIELD) IS OMITTED OR MISCOOED. 000000


18 AOOPTEO METHOO GIVES THE SAME METHOO AS ITEM 9, YET “CHANGE” IS INOICATEO.


22 “NONE” CODED FOR NEXT APPOINTMENT TYPE, YET ITEM 21 HAS AN APPOINTMENT DATE. 0169


53 31 14 “YES” GIVEN TO EVER 

22 “NONE” CODED FOR NEX 

54 12 14 “YES” GIVEN TO EVER 

23 THE FIELD (OR A PORT 

55 13 22 THE FIELD IS MISCODE 

3 THE FIELD (OR A PORT 

249 41 2 THIS BIRTH OATE 00ES 

PREVIOUS RECORD: PAT 

CHILOR 

%,,..,. 1003 44 4 LIVE BIRTHS MUST BE EQUAL TO OR GREATER THAN THAT PREVIOUSLY RECOROED. NO 0 

PREVIOUS RECORO: PATIENT NO.=OOO1OO3 , BIRTH DATE=7/2/38, BIRTHS=7 , LIVING 

CHILDREN=7, OEATHS; FETAL=O, NEONATAL=O, LAST VISIT IN 05/69. 

2229 64 2 THIS BIRTH OATE DOES NOT MATCH THAT PREVIOUSLY RECORDED FOR THIS PATIENT. NO 042547 

PREVIOUS RECORD: PATIENT NO .=0002229, BIRTH DATE=4/25/41 , BIRTHS=4, LIVING 

CHILDREN=3, DEATHS; FETAL=O, NEONATAL=l, LAST VISIT IN 06/68. 

ISCOOED OR INCOMPLETE. NO 111 

1 HAS AN APPOINTMENT DATE. 0169 

ISCODEO OR INCOMPLETE. NO 11 1 

R MISCODEO. ODOOOX 

NO


R MISCODEO.


ORDEO FOR THIS PATIENT. RP 122549


2/25/49, BIRTHS=l , LIVING


L=O> LAST VISIT IN.08/68.


33


. 

9 
Clinic YYYY Agency 1, Region 01, State 00, program xxxx


Summary of Records Submitted for the Period Ending


February 4, 1969


Records Records Records Number of Acceptance


TyP e of Record Submitted Accepted — ~ejected —Error Conditions Rate 

New Patient Visits 100 48 52 70 48% 

New-to-System Visits 100 72 28 40 72% 

Cont. Pat. Visits 50 41 9. 32 80% 

$\ % 

Readmis, Pat. Visits o o 0 0% 

Correction Forms


Total Records


PatientNumber


on Form


0000007


0000010


0000011


0000016


0000029


0000035


0000036


0000048


0000051


0000052*


0000053*


0000054*


ooooo55~~


0000056


0000058


0000059


0000069


0000070


0000072


0000078


0000090


0000092


0000099


0000101


0000112


0000117


0000119


0000125


$j$!9 \ 

o 0 0 o% 

250 161 89 142 68%


Forms reprocessedQ


Forms returned	 —
89


clinicYYYY (Agency1, Region 01, State 00, ProgramXXXX)


List of Forms Processedfor the Period Ending


February4, 1969


PatientNumber Patient Number Patient Number PatientNumber


on Form on Form on Form on Form


0000129


0000145


0000146


0000151


0000249*


0000256


0000876


OOO1OO3*


0001334


0001556


0002229*


0002557


0002559


0003446*


0003449


0003567


etc.


34

--------------------------------

B. NATIONAL REPORTING SYSTEM FOR FAMILY PLANNING SERVICES 

(100-PERCENT SURVEY) 

cLINIC YYYY IV PROJECT XXXX


THE FOLLO?IINGERROR CONDITIONS OR INCONSISTENCIESWERE FOUNO IN THE RECOROS SUSMITTEO.


IF ANY ASSUMPTIONS ARE IN ERROR SUBMIT A CORRECTION FORM---SEE SECTION I OF HANOBOOK.


DATE , IS ITEM ITEM CHECK 

PATIENT ITEM RECORO cONTENTS CONTENTS NUMBER 

NI.NRER V!~lT NL!4BER CONOITION ENCOUNTERED ACCEPTEO BEFORE EOIT AFTER EDIT (1) 

000020346 051376 5 YEAR ANO NONTH OF BIRTH OATE CQES NOT M4TCH PRIOR RECORO YES 090956 010956 000 

PRIOR RECORO: BIRTH OATE=5601, BIRTHS= O, LIVING CHILOREN=O, FETAL 

OEATHS=O, VISIT OATE=7603. CONTRACEPTIVE METHOO IS ORAL 

000021439 050376 5 RP 020552 120552 000 

000026305 052676 6 YES 071547 051647 000


052076 5 YES 080359 0B035B 000


000026348 052776 5 YES 070557 070556 000


000030480 050476 5	 YEAR ANO!!J3NTHOF BIRTH OATE 00ES NOT MATCW PRIOR RECORO YES 022460 052460 000


PRIOR RECORO: BIRTH OATE=6005, BIRTHS= O, LIVING CHILOREN=O, FETAL


OEATHS=O, VISIT 0ATE=7604. CONTRACEPTIVE METHOO IS ORAL


000033136 050476 5 AGE OF PATIENT INVALIO NO 042576 000 

12 HIGH GRAOE TOO HIGH FOR PATIENTS AGE 12 03 

COO033159 051176 6 AGE OF PATIENT INVALIO RP 031756 000 

12 HIGH GRAOE TOO HIGH FOR PATIENTS AGE 14 03 

1 THE CHECK NUIKIERCOLUNN tS FOR COYPUTER CENTER USE ONLY.


RP=REPROCESSED


35 
CLINIC YYYY IN PROJECT XXXX


SOW!ARY OF RECOROS SUBMITTEO FOR TtlEPERIOO ENOING 07/07/76


TYPE OF NINEER OF NUIEIEROF NINBER OF 

RECORO RECOROS SW3MITTE0 RECOROS ACCEPTEO RECOROS REJECTEO 

INITIAL VISITS 251 2s0 1 

REAONISSIONS 0 0 0 

REVISITS-TYPE 2 OR 3-NEHTOSYSTEM 24 24 0 

REVISITS-TYPE 2 OR 3-OTHER 381 330 1 

VISITS UNCLASSIFIED/UNPROCESSED 0 o 

7vPE-1 IL41NTEHANCE 0 0 

fj!iijl% $$ TYPE-2 K41NTEHAHCE 0 0 

VISIT OELETIONS o 

PATIENT OELETIOW $!!% tb 0 0 

TOTAL RECOROS 6S4 2 

FORHS REPROCESSED J_ 

FORM RETURtlEO ~ 

*********************************w**********************ti***********w 

NRSFPS SYSTEM MESSAGES


****** ***** ********


cHECK FORN3 FOR CORRECT CLINIC NL!IGERBEFORE SUBMITTING. � * 

CHECK FORMS FOR CORRECT BIRTHRATES BEFORE SUBMITTING. � * 

hIHENCORRECTING AN ITEM ON A REJECTEO FORM PLEASE IM NOT FILL OUT A NEH


FOPM FOR THAT PATIENT. SIMPLY M4RK THROW THE INCORRECT INFOF#ATION. IIRITE


IN THE CORRECT INFOPJIATIONANO RESUBMIT THE FOPA. THANK YOU-HAVE A NICE OAY
 * *


**m******* ******w** ***** ******* ******..* *****w*************** 

Acceptance


RATES


99.2


.0


100.0


99.7


.0


.0


.0


.0


.0


99.5


* 

{ 
1? CLINIC YYYY IN PROJECT XXXX PAGE 

1.[$1 @F FuRhiS P!-!UC~SSEfi FOR THE PERIOC EhOING 37/07/76 

T3Alt PA flEk T CATF FbTIENl OATE PATIENT OATE PIT IENT cATE PATIENT DATE 

Cf NL#HFR\ rt ,UWBERS OF RUMFSERS CF NLPe FRS OF NUH8ERS OF 

VISIT Ch F13PFS vISIT CN FflRPS vISIT ON FORMS vISIT Oh FCRMS \lSIT ON FORMS vISIT 

GLC.UOCCUA 65(1476 CCLCC3935 C5i 176 CCC C09159 050876 000014819 051876 OOC015866 050676 COO021933 052776 

Gcoocccti3 052C76 coc?939$q 051276 COOOO’92.07 350676 900014836 053376 00 COl~868 051776 000022014 060176 

CC GC7CCC11 l)5?v76 COLC!34037 C52176 CCOO09273 051076 000014895 050676 00 C01S894 05C876 000022146 052976 

00[)000 17A 05177(, CC CCW289 c6c17e CCOC09281 051276 000014951 060176 OOC019897 050676 000022155 050676 

COO)OC?)9 05ti476 cccc3456fi 05J476 ooooo~8z4 050476 000015012 051176 OOCC19907 051876 000022256 052076 

CCUUUC:49 U5?L7(> (C CC0461P C515i6 CC CO09t328 051876 00 C015057 060176 00 C019951 050176 000022282 052076 

ccoo Lc3b5 u515r6 CC C034CZ49 0515?6 0COO09S79 050376 000015131 051576 00 C!J19951 052476 000022285 052276 

CL IJCCC41O U57$T6 CCCCC4760 0=,7<76 CCCO1OOO7 051C76 000015187 051776 00 CC1S971 050876 000022475 051576 

GC!JUOC4A9 05?676 CC CCC14SOI! C57Sit CC CO1OIJO8 052S76 000015311 052576 00 C01S994* 050476 000022507 051876 

0COOOL14V7 .15 )476 CCCC351.:)7 052576 000010077 051576 000015376 050676 00 C020018 050476 000022576 050476 

UCOOGC(.H4 042C70 CC(-C051?3 C52C7SJ CC(3011J515 051576 000015377 050176 00 C020037 050476 000022586 050676 

cLocooltlA 05,)t76 COO’115213 052276 CC3013603 .752776 300015496 051876 00 C020040 051176 000022774 051576 

CCCOOCS27 057276 CCCC053C3 c5147& 000010620. 051776 000015585 052676 00 CC2C043 051076 000022780 051176 

CCOOCCSI.7 U51h76 cotica5.354 ctc17cl OOC011C158” 050476 GOOO15713 051076 00 C020086 052276 COO022857 051576 

cLlo.7Jlc(#l 95>176 cl f3c05453 05277h 000011159 051176 000015781 051876 00 C020092 051S76 000022882 051576 

Cucloulct ? 051476 CC CC054F77 C51i76 ccucl155fl 052C76 000015782 052076 00 C02C097 052576 000022887 042076 

COUIJ1119 o!5d376 COOP35646 ‘35157(! 000011940 J50176 L300015t31R 053176 JO C020099 052276 000022892 060176 

COOIJC1174 U5777b COCL056P? c5117h 0COC119817 052576 000015907 051576 00 C02C123 050176 000022935 052776 

coodLr1521 u 5757,, [C CC U51122 C6C176 CCO0131$$ 051676 000015929 053876 00 C020145 052476 000023003 052976 

000101:30 d5177h CCCC061 7C C51C76 000013301 c352776 JaA30017037 040576 00 C02017? 051076 000023090 051876 

Ocuucl lfJ32 051F76 CC CC C62S1 C52576 052476 00 C020186 052276 COO023050 052676 

0900’11739 05.767A C(7C2 1(..153 ~~,~;~ 051376 00 C020215 052276 000023097 052276 

ccoudl/3c 

noooc 1 75d 

05?476 

051k 7(, 

CCCC36”35? 

CUCCC16443 

C57C7A 

C51376 

C51776 

05’7176 

00 CC2C232 

00 C020235 

052976 

051876 

000023098 

000023149 

052576 

050876 

COCll Ol~/h U4?67(> CCC C905137 C51176 051376 00 C02C24C 050476 000023164 060176 

CTXUC 1$71 05?4718 CUCl!i1671Z C51F 7.5 CCOGI391O 051776 00 C017631 057976 00C020241 052776 000 C23307 050576 

0!313’3J7)II 05)476 CCCC C6U5C J?2S76 ccoil139’+5 05!2676 000317723 051476 00 C020242 051876 000023309 051976 

CWOU?(171 05?57t, COCi706ti5? C51176 CCO014144 060176 000017732 051-476 00 C020301 052776 000023390 060176 

Cuu[ci 1 )(1 0511!70 ccrl. c7cc9 C51Ei6 CC C014166 051176 03’3017970 051776 00 C020346 951376 000024449 052076 

cootJo’J Wo 05?ti76 cccrt77053 C5117C 000014219 041776 000018086 050376 00 CC20400 052576 000024455 C51776 

(.0(,,3!)?5’4/, 051>70 cccrc77c7 C51i76 0COOL43C3 052576 000018086 050676 00 C020486 050476 000024475 C52176 

0JOO02(’11 .)51 176 ccc’1177’i5 051E76 CC30144C7 351.576 000019148 051776 00 C020551 052776 000024476 050876 

Ccrmcm.>u (.60176 COCC G7:171 C57176 0cOC14421 051476 OOOO1935b 052976 oocc2c661 051576 000024478 050376 

ccouc?~91 u 50[, 7A CCCU97H71 C57i74 CC CC14445 052676 !720!319359 053476 ooco2076e s053576 030024495 060176 

C(JOl,030HiJ ti37776 cc)crc79.3c C511 if. GOOO14477 051276 ocoolq379 051376 00 C070768 0525T6 000024496 050876 

Gou Jt)? I 16 U5C. 7(J CCC LCIq5S C4.?i76 CO(3014525 t251176 0CO019414 051476 oOC020775 060176 000024499 050176 

c’30.r137’l/ 151 376 ccc :,),3726 35?17[ oco’J145tl J51f7f 000019445 051874 00 C020S13 050876 000026002 050876 

CO13L’I)3:YI U51,77(3 CCLJ\ltl CJ4 c5257b COO C14606 050476 000019561 051076 00 C02C957 050476 0000260C7 050876 

(1(!OOJ3 1,J9 L15C47h C[)L<~fi08q 05?476 CC C0146?7 05?276 300319590 051876 00 C0713976 050676 000026028 050376 

CC[’UC3303 0511 10 C[; CCJH18/ C511?6 OCG01467EI 05ce76 00001972S 051776 00 C021225 052076 000026038 050676 

ccuoo34j3 U51576 CC C(l,lt1559 C51C76 CCO0146E9 050576 000019739 052776 00 C021231 050876 000026067 050476 

oo>-l~?<!l% .)5/7 /6 coc,>)d 651 ‘J’3117F CC CO147S? 051176 0000197S6 050176 00 C021439 050376 000026070 050676 

c(’uoo37t2 c5067f> C-c, ccosf L5 d6C176 CCOC14743 060176 0CO01980$ 051176 00 CC?1506 051776 000026071 051176 

GOOUG 37t35 050476 coccalJ157 C6C176 oJLlc14e04 J50F76 J30319823 051c776 90 C021747 052576 030026072 05?676 

CCOCC 311.,7 (;52570 CC( COHH14 05C476 oooc14dc5 050E76 COOO1982Ci 050176 00 CC21781 050676 000026C80 050376 

GGr,oL?!r41 (J5117U CCOCJ1 .324 C=2Si6 CCC)C14d15 051576 00 C01S834 050376 00 CO Z1805 0S2576 000026081 050376 

.--.-----

PFCfl L~E Cf [RKCRS CFTECTEn OI; RING PROCFSSIAC. 

A: F(~S IPIE. 

I 

. 

A 

37 
APPENDIX VI 

STANDARD TABLE SHELLS 

A. PROVISIONAL REPORTING SYSTEM FOR FAMILY PLANNING SERVICES 

Tablesl and 2. Number and percent of patients receiving family planning sewices, bytypeof patient and~peof sewica provided and 

number and percent of visits for family planning services, by tvDe . . of service rsrovided durinq visit

Patientsl I Visits 

Percent Type of Number by type of service provided service provided Number Percent 

Total New Continuation Total New Cont. 

Al I patients 

Contraceptive patiants 

Infertility patients 

Medical exam or 

Lab test, tota12 

Breast 

Pelvic 

Other medical exam 

Pap smear 

Serology 

Other lab test 

lUnduplicated count of patients who received one or more services at this clinic during the report period. 

*Total may be 1es5than the Sum of theparts ifmorethan onesewice wasprovided toapatient oratmore than one~sit. Total maY 

be less than total number of patients served or visits if no exam or test was performed for one or more patients, 

38 I 

I 
Table3. Number and Dercent ofpatients receiving family planning sewices, byethnic designation andaw 

Ethnic designation 

Agal 

I (in yaars) 

I 

Al I ages 

Under 15


15-19


20-24


25-29


30-34


36-39


40-44


45 and over


All ages 

Under 15


16-19


20.24


25-29


30-34


35-39


40-44


45 and ovar


All 

Puarto Othar 

groups American

White Black Rican Spanish Indian Othar 

surname 

Numbar 

Percent by ethnic designation 

lAge of the patient at the patient’s last visit of this report period. 
Table 4. 

Agel


(in years)


All ages 

Under 15


15-19


20-24


25-29


30-34


35-39


40 or more


All ages 

Under 15


15-19


20-24


25-29


30-34


35-39


40 or more


mber and percent of patients receiving family planning services, by highest grade of school completed and age 

Highast grade of school complatad 

Total No Grade school High school College 

formal 2 or education Total 1-3 4-6 7-8 Total 1-3 4 Total 1 more 

Parcent by highest grade of school completed 

lAge of the patient at the patient’s last visit of this rePort Period. 
None 

, 

Table 5. Number and percent of contraceptive patients receiving family planning services, by live births and contraceptive method 

adopted 

Type of contraceptive 

method adopted 

Total, contraceptive patientsl 

Oral 

IUD 

Foam 

Diephragm 

Rhythm 

Condom 

Other 

Totel, contraceptive patientsl 

Oral 

IUD


Foam


Diaphragm


Rhythm


Condom


Other


None


I Number of live births 

Total 5 or None 1 2 34 more 

Number 

Parcent by contraceptive mathod adopted 

lExcludes all patients receiving infertility services. 

41 
Table 6. Numbar end percant of ndw patients recaiving family planning services, by age and source of referral 

Source of referral 

All new patients 

Program personnel 

Hospital, medicel, or other 

health sources 

Public welfare egency 

Other social welfara agency 

Other clinic patient, friend, 

or relative 

Other source or self 

Unknown 

All new patients 

Program personnel 

Hospital, medical, or other 

health sources 

Public welfare agancy 

Other social welfare agency 

Other clinic patiant, friand, 

or relative 

Other source or self 

Unknown 

I Aqe (in years)l 

Ail ages Under 40 or 15-19 20-24 25-29 30-34 35-39 

15 more 

Number 

Percent by sourca of rafarral 

lAge of the patient at the patient’s last visit of this report period. 

11

42 
Table 7. Number and percent of patients receiving family planning services, by age and by public welfare status 

Public welfare program 

All patients served 

Total receiving publ. waif. 

AFDC 

Other publ. welf. 

Both AFDC and other 

New patients sewed 

Total receiving publ. welf. 

AFDC 

Other publ. welf. 

Both AFDC and other 

All patients sewed 

Total receiving publ. welf. 

AFDC 

Other publ, welf. 

Both AFDC and other 

New patients sewed 

Total receiving publ. welf. 

AFDC 

Other publ. welf. 

Both AFDC and other 

lA~e of the patient at the patient’s 

I Age (in years) ] 

All eges Under 40 or 15-19 20-24 25-29 30-34 35-39 

15 more 

Number 

Percent by public welfare assistance 

last visit of this rePort Period. 

43 
Table 8. Number and parcant of patients receiving family planning services, by live births and highest grade of school completed 

Numbar of 

live births 

Total 1


None


1


2


3-4


5+


Total 1


None


1


2


3-4


5+


Total 1


None


1


:.4 

5+ 

I Highest grade of school complated 

Total No Grade school High school College 

formal 2 or aducation Total 1-3 4-8 7-8 Total 1-3 4 Total 1 more 

Number 

Percent by highest grada of school completed 

Percent by live births 

l~nduplicated count of patients who re~eiverj one or more services ‘d this ChiC during rePort period. 

44 
B. NATIONAL REPORTING SYSTEM FOR FAMILY PLANNING SERVICES 

Monthly Tables 

Table M-l. Family planning services andcontraceptive method bytypeof visit and summary reports 

Reporting period (Mo/Day/Yr to Mo/Day/Yr) 

Service site (number) Project	 (number) PP affiliate (numbar) (Service site name) (City) (State) 

Patient visits accepted this month by the NRSFPS 

Services 

and 

contraceptive Initial 

method visits 

TV=l 

All visits 

Medical services 

Pap smear 

Pelvic exam 

Breest exam 

Blood pressure 

Pregnancy testing 

V,D, tasting 

Urinalysis (n.e,s.) 

Blood test (n.e.s.) 

Sterilization 

Infertility treatment 

Other 

Counseling services 

Sterilization 

Contraception 

Infertility 

Other 

Referrals 

Abortion 

Sterilization 

Infertility 

Other medical services 

Sociel services 

Contraceptive patients 

Method presently used 

Oral (pill)


IUD


Diaphregm


Foam


Rhythm


Condom


Injection


Sterilization


Other


None


Interim method


Duplicate visits merged 

This moriths visits deleted 

Visits deleted from master 

Summary of visits on file year to date 

First (by type of patient visit) 

revisit Subsequent Readmission Total 

for year ravisits visits visits Type of visit Number 

TV=2 TV=3 TV=4 W=1+2+3+4 

initial visits (TV= I ) 

First revisit for year (TV=2 

Subsequent revisits (TV=3) 

Readmission visits (TV=4) 

Total visits (TV=l +2+3+4) 

Current month processing summary 

Visits received this month 

Reprocess input +_ 

Total visits input . 

Visits rejected 

Net visits processed 

. this month 

45 
Table M-2. Number of family planning patient visits bytypeof visit: e*hservice site andproject within State 

(State name) Region (number) Reporting period (Mo/Day/Yrtc Mo/Dey/Yr) 

Patient visits accepted this month by the NRSFPS 

Projects Responsible First 

and City agency(s) Initial revisit Subsequent Readmission Total * service sites visits for year revisits visits visits 

TV= I TV=2 TV=3 TV=4 TV= I+2+3+4 

State totals 

Project xxxx City 

Service site xxxx City 

Project xxxx City 

Service site xxxx City 

Service site xxxx city 

Service site xxxx City 

Etc. 

Table M-3. Number of family planning patient visits bytypeof visit, by funding agency :eachproject and State within region 

Funding agency Region (num ! Reporting period (Mo/Day/Yrt I Mo/Day/Yr) 

Patient visits accepted this month by the NRSFPS 

States Responsible First 

and City agency(s) Initial revisit Subsequent Readmission Total * projects 

Region totals 

Stata name 

Project xxxx City 

Project xxxx City 

Project xxxx City 

State name 

Project xxxx City 

Project xxxx City 

Project xxxx City 

Project xxxx City 

Etc. 

visits for year revisits visits visits 

TV= I TV=2 TV=3 TV=4 TV= I-?-2-!=3+4 

46 
Quarterly Tables 

Tabla Q-1. Activity status of patients by selected patiant characteristics 

Projact (number) (City) Funding agency Reporting period (Mo/Day/Yr to Mo/Day/Yr) 

Patient chsiracteristics 

Total patients 

Sex 

Female 

Male 

Age groups 

Under 18 

18-19 

20-24 

25-29 

30-34 

35+ 

Live births 

None 

1 

2


3


4


5+


Unknown/male


Latin American descent 

Yes 

No , 

Race 

White 

Negro 

Amarican Indian


Other


Unknown


Education 

None 

1-8 yaws 

9-11 years 

12 

13+ 

Unknown 

Welfere recipient 

Yes 

No 

Unknown 

Registered for Medicaid 

Yas 

No 

Unknown 

Patiants saan this pariod Patients discontinued Active patiants 

Total I New I Continuation 

this period end of pariod 

47 
Table Q-1. Actitity status of patients by selected patient characteristics 

Project (number) Reporting period (Mo/Day/yr to Mo/Day/yr) 

Service site (number) (~ Funding agency PP affiliate (numbel 

I Patiants saen this pariod 

Patient characteristics Ancillary services provided 

Total I New I Continuation 

Total patiants 

Sex 

Female 

Male 

Age groups 

Under 18 

18-19 

20-24 

25-29 

30-34 

35+ 

Live births 

None 

1 

2 

3 

4 

5+ 

Unknown/male 

Latin Amarican dascent 

Yes 

No 

Race 

White 

Nagro 

American Indian 

Other 

Unknown 

Education 

None 

1-8 yaars 

9-11 years 

12 

13+ 

Unknown 

Welfare recipient 

Yes 

No 

Unknown 

Registered for Medicaid 

Yes 

No 

Unknown 

Medical sarvicas


Supply visits


Outreach contacts


Attendees at lecture sassions


Telephone contacts


Other sarvices


48 
Table Q-2. New female contraceptive patients byselwted characteristic 

Project (number) Reporting period (Mo/Day/Yr to Mo/DaylYr) 

Service site	 (number) (City) —— 

A. 

Patient characteristics 

Total new female contraceptive 

patients 

Live births 

None 

1 

2 

3 

4 

5+ 

Unknown 

Source of referral 

Outreach worker 

Other FP clinic 

Hosp,, oth. hlth. agency 

Private phy. or nurse 

Welfare agency 

Cl. Pt., family, friend 

Mass medie 

Other 

Unknown and not reportad 

Ever used any method 

Yes 

No 

Unknown 

Education 

None 

1-8 years 

9-11 years 

12 years 

13+ years 

Unknown 

Latin American descent 

Yes 

No 

Race 

White 

Negro 

American Indian 

Other 

Unknown 

Funding agency - — PPaffiliate (number)

Total all ages Age groups B. 

Contraceptive method prior 

-18 18-19 20-24 I 25-29 30-34 35+ to sarvice site enrollment 

s I 

I Patiants 

Method 

Number Parcent t-­

“otal I 

Oral (pill) 

IUD 

Diaphragm 

Injection 

Condom 

Foam 

Rhythm 

Other 

None 

Unknown 

c. 

Contraceptive	 method at 

end of initial visit 

I Patients 

Method 

Number Parcent 

rOtal


Oral (pill) 

IUD 

Diaphragm 

Injection 

Condom 

Foam 

Rhythm 

Sterilized 

Other 

## intarim 

*# Patient5 prescrib-edmethods 

or an interim period are also 

ncluded in tha figures for each 

nethod listed above. 

49 
Table Q-3, Patient visits byty~of visit andtype ofsewices provided 

Project (number) Reporting period (MolDaylYr to Mo/Day/Yr) 

Service site (number) (~ Funding agency PP affiliate (number) 

1 

Type of services 

Total visits 

Medicel services 

No medical services 

One or more medical services 

Pap smear 

Pelvic exam 

Breest exem 

Blood pressure 

Pregnency testing 

VD testing 

Urinalysis (n.e.s.) 

Blood test (n.e.s.) 

Sterilization 

Infertility treatment 

Other 

Counseling services 

No counseling services 

One or more counseling services 

Sterilization 

Contraception 

Infertility 

Other 

Raferrals 

No referrals 

One or more referrals 

Abortion


Sterilization


Infertility


Other medical services


Sociel services


Method at end of visit 

Oral (pill) 

IUD 

Diaphragm 

Injection 

Condom 

Sterilization 

Foam 

Rhythm 

Other 

None (reasons given below) 

Pregnant 

Other medical reason 

Seeks pregnancy 

Other 

Interim 

Total visits Type of visit 

Number I Percent Initial First revisit Subsequent revisit 

visit I this year this yaar 

so 
Table Q4. Number and pement distribution of all patients by selected characteristiti each State, project, and aam-cesite 

Funding a~ncy Region ~ Reporting period (Mo/Day/Yr I flolDaylYr} 

State 

project number 

serv. site. funding 

sewice site city 

Region _ 

# 

% 

State name 

# 

% 

Project number 

# 

% 

SS. number 

City 

# 

% 

Etc. 

Age groups Rwe Latin 

All American 

latients -18 18-19 20-24 25-29 30-34 35+ descent 

~ 

Tabla Q-5. Number and parcent distribution of new patients by selected characteristics: each State, project, and service site 

Funding agancy Region (number) Reporting period (Mo/DaylYr to MolDay/Yr) 

State Sex Aga groups Race Latin 

project number All American serv. site, funding 

service site city 

patiants ’18 18-19 20-24 25-29 30-34 35+ White Nagro Am. Ind. Other descent F I I 

Region _ 

# 

% 

State name 

# 

% 

Project number 

# 

% 

SS. number 

City 

# 

% 

ol Etc. 
rn Tabla Q-8. Numbarof sterilization patients byselected characteristics: each State, project, andservice sita h) 

Funding agency Region	 (nu Reporting pericd KvlolDaylYr t — 

State 

project number 

serv. site, funding 

service site city 

Region _ 

# 

State name 

# 

Project numbar 

# 

SS. number 

City 

# 

Etc. 

Age groups Race 

All 

patients Mala I Female -18 18-19 20-24 25-29 30-34 35+ White I Negro I Am. Ind. I Other 

Table Q-7. Number of infertility patients by selected characteristics: each State, project, and service site 

Funding agency Region (number) Reporting period {MolDaylYr I 

State Sex Age groups Race 

project number All 

serv. sits, funding patients Male Femala Whita Negro Am. lnd. Other 

service sits city 

Region _ 

# 

State number 

# 

Project number 

# 

SS. number 

# 

SS. number 

# 

Etc. 

rlo/Day/Yr) 

Latin 

American 

dascent 

wlo/Day/Yr) 

Latin 

American 

dascant 
� 

Table Q-8. Number and percent distribution of female patients by type of patient and number of live births: each State, project, and service site 

Funding agency Region (number) Reporting period (Mo/Day/Yr to Mo/Day/Yr) 

A. B. c. 

State All patienta New patients Sterilized patients 

project number Total Total Total

service site, funding Number of live births Number of live

service site city 

Region _ 

# 

% 

State name 

# 

% 

Project number 

# 

% 

SS. number 

City 

Number of live births births 

o 1 2 3 4+ o 1 23 4+ 

# 

% 

Etc. 

Table Q-9. Number of patients and visits for each project, State, and region, United States 

Reporting period (Mo/Day/Yr to Mo/Day/Yr) 

Number of patients reported Number of Project reported 

visits reported ancillary services 

Total New Continuation 

Geographical location 

United States total 

Region _ 

State name 

Proj number 

Proj number 

Proj number 

Etc. ol 

cd 
Annual Tables 

Table A-1. Number of patients and visits for the United States: each region and State 

Reporting period (1 lDaylYr o MolDay/Yr) 

No. of A B c D E F G H I 

Region and service Act. pts. New Cont. Discont. Act. pts. Act. pts. Subsequent Total Total 

states sites at begin. patients patients patients not seen at end of revisits visits ancillary 

of year this year year services 

US total 

Region _ 

State name 

State name 

State name 

State name 

Region _ 

State name 

State name 

State name 

Etc. 

lTable A-2, Number of patients and visits by State and funding source for each participating project I 

(State name) Reporting period (1 ldDaylYr Moli3ayNr) 

A B c D E F G ii I Project 

Project funding Act. pts. New Cont. Discont. Act. pts. Act. pts. Subsequent -rOtal Total 

agencies at begin. patients patients patients not seen at end of revisits visits ancillary 

of year this year year services 

Stete total 

Project _ 

Project _ 

Project _ 

Project _ 

Etc. 

Table A-2. Number of patients and visits for each project and its service sites 

Project (number) Reporting period (MolDay/Yr to Mo/DaY/Yr) 

A B c D E F G H I Project and 

service sites 

Funding 

agencies 

Act. pts. 

at begin. 

of year 

New Cont. Discont. Act. pts. Act. pts. Subsequent 

patients patients patients not seen at end o) revisits this year year 

Total 

visits 

Total 

ancillary 

services 

Project numk 

Service site number 

service site number 

Service site number 

Service site numk 

S+wvice site number 

Etc. 

54 
Table A-3P. Number of patients and visits for each Planned Parenthood affiliate 

Affiliate (number) Reporting period OklolDaylYr to Mo/DayiYr) 

A B c D E F G H I 

Affiliates Funding Act. pts. New Cont. Discont. Act. pts. Act. pts. Subsequent Total Total 

agencies at begin. patients patients patients not seen at end of revisits visits ancillary 

of year this year year sewices 

Affiliate number 

Swvica site numbar 

Etc. 

Table A-4. Number ofservice sites, patients, andvisits byproject funding $ourcefor the United States 

Reporting pariod (MolDaylYr to Mo/DaylYr) 

No. of A B c o E F G H I 

service Act. pts. New Cont. Oiscont. Act. pts. Act. pts. Subsequent Total Total 

sites at begin. patients patients patients not seen at end of revisits visits ancilla~ 

of year this year year services 

US total

MCHS

OEO

NCFPS

PP

MCHS, OEO

MCHS, NCFPS

MCHS, PP

OEO, NCFPS

OEO, PP

NCFPS, PP

MCHS, OEO, NCFPS

MCHS, OEO, PP

MCHS, NCFPS, PP

OEO, NCFPS, PP

MCHS, OEO, NCFPS, PP

Othar I

Unknown

J 

Table A-5. Number ofservice sites, patients, andvisits byproject funding source foreach region 

Region (number) Reporting period (MolOavlYr to Mo/Oav/Yrl ,- -

Project No, of A B c D E F G H 1 

funding service Act, pts. Naw Cont. Oiscont. Act. pts. Act. pts. Subsequent Total Total 

source sites at begin. patiants patients patients not seen at end of revisits visits ancillary 

of year this year year services 

Region total

MCHS

OEO

NCFPS

PP

MCHS, OEO

MCHS, NCFPS

MCHS, PP

OEO, NCFPS

OEO, PP

NCFPS. PP

MCHS, ”OEO, NCFPS

MCHS, OEO, PP

MCHS, NCFPS, PP

OEO, NCFPS, PP

MCHS, OEO, NCFPS. PP

Other

A 

55 
Table A-G. Number ofsewice sites, patients, andpatient visits by fundngagency, each region, andthe United States 

Funding agency Reporting period (Mo/DaylYr to Mo/Day/Yr) 

No. of ! A B c D E F G H I 

service Act . pts. New Cont. Discont. Act, pts. Act . pts. Subsequent Total Total 

sites at begin. patients patients patients not seen at end of revisits visits ancillary 

funded of year this year year services 

US total 

Region 

Region 

Etc. f t 

Table A-7. Number of service sites, patients, and patient visits by region, State, and project for each funding agency 

Agency Region umber) Reporting period (N >ay/Yr t Mo/Day/Yd 

A B c D E F G H 

State No. of 

service Act. pts. New Cont. JiscOnt. !lCt. pts. Act. pts. ub.tequent Total Total 

project number 

agency codes sites at begin. patients patients patients not seen et end of revisits visits ancillary 

of year this year year I services 

Region _ 

State name 

Proj number


Proj number


Proj number


Proj number


Proj number


PrOj numbw


Proj number


Proj number


Proj number


Proj number


Proj number .


Proj number


Proj number


Proj number


State name 

Proj number 

Proj number 

Proj number 

Pro] number 

Etc. 

56 

I 
Table A-20. Number of female patient visits by type of service provided for the United States 

(Level of aggregation)l Reporting pariod & Day/Yr to Mo/Day/Yl 

Initial First revisit Subsequent Total 

revisits Type of service visits this year this year 

visits 

Total number of visits 

Medical services 

No med. serv. 

One or more serv. 

Total med. serv. 

Pap smear ;\ Pelvic exam k’ 

.,’ Breast exam 

Blood pressure 

Preg. testing 

VD testing 

Urinalysis (nes) 

Blood test (nes) 

Sterilization 

Infertility tr. 

Other 

Counseling services 

No counseling 

One or more serv. 

Total coun. serv. 

Sterilization 

Contraception 

Infertility 

Other 

Referrals 

No referrals 

One or more ref. 

Total referrals 

Abortion 

Sterilization 

Infertility 

Other medical 

Social services 

Source of referral 

Outreach 

Other FP clinic 

Hosp. etc.


Private MD or RN


Welfare agency


Other clinic pt.


Family or friend


Radio, TV, paper ad,


Other


Unknown


lf.,eve] ofaggregation Wlbe either United states, agency, region, project (orafffiiate), orser~ce site. 

57 
Table A+ O(N). Number of (naw)female patients byageaccording toselected characteristics forthe United Statas 

(Level of aggregation) 1 Reporting period (Mo/Dav/Yr to Mo/Day/Yr) 

Patient characteristics 

Total patients 

Liva births 

Nona 

1 

2 

3 

4 

5+ 

Unknown 

Living children 

None 

1 

2 

3 

4 

5+ 

Unknown 

Number of pregnancies 

None 

1 

2 

3 

4 

5+ 

Unknown 

Mathod at end of yaar 

Oral


IUD


Diaphragm


Foam


Rhythm


Condom


Injection


Sterilization


Other


None


Interim (not in total)


Ever used any method 

Yes 

No 

Unknown 

Total 36 and 

female Undar 18 18-19 20-24 25-29 30-34 over ,, patients 

,/ 

4 

lJ-,eWI ofaggregation tilbe either United States, agency, region, State, project (oraffiliate), or service site. 

— 

58 
Tabie A40(N). Number of (new) patienG bypatient characteristi= according tosexand aWforthe United Statm 

(Level of aggregation)l Reporting period (Mo/Day/Yr to Mo/Day/Yr) 

Patient Age of women Age of men 

characteristics 

Total -18 18-19 20-24 25-29 30-34 35+ Total -24 25-29 30-34 35-39 40+ 

Total 

Race 

White 

Negro 

Amer. Indian 

Other 

Unknown 

Latin Am origin 

Yes 

No 

Education 

None 

1-8 yrs 

9-11 yrs 

12 yrs 

13+ yrs 

Unknown 

Public assist. 

Yes 

No 

Unknown 

Medicaid regisl 

Yes 

No 

Unknown 

Sterilization 

Medical serv. 

Counseling 

Referral 

Males only: 

Method 

Steril. 

Condom 

None 

Other 

1 Level ~ f aggregation will be either United States, agency, region, State, project (Or affiliate), or service site. 
4 

(Level of aggregation)l 

Patient characteristics 

Total patients 

ContraCaptive method 

Oral 

IUD 

Diaphragm 

Foam 

Condom 

Sterilization 

Other + injection 

Rhythm 

None 

Race 

White 

Negro 

Am. Indian 

Other 

Unknown 

Latin American origin 

Yes 

No 

Unknown 

Education 

None 

1-8 yrs. 

9-11 yrs. 

12 yrs. 

13+ yrs. 

Unknown 

Fetal deaths 

None 

1 

2 

3+ 

Unknown 

Referrals 

None 

Abortion 

Sterilization 

Infertility 

Other medical 

Social servicas 

Table A-50. Characteristics of patients receiving public assistance by age and parity for the Unitad States 

Reporting period UvlolDaylYr to Mo/Day/Yr) 

Total Percent Percent in each age group Percent by number of live births 

— — . — patients Women Men -18 18-19 20-24 25-29 30-34 35+ o 1 2 3 4 5+ Unk 

— — — — — — 

— — — 

l~nl of ~ggmgation will be either United States or agencY. 

— 
Table A.60, Number of method changes by type of method after change according to type of method before change and type of patient: female patients 

for the United States 

(Level of aggregation)l 

Method before change 

New patients 

Number patients with no 

method change 

Total number of method 

changes 

Oral 

IUD 

Diaphragm 

Foem 

Rhythm 

Condom 

Injection 

Sterilization 

Other 

No method 

Continuation pats. 

Number patients with no 

method change 

Total number of method 

changes 

Oral 

IUD 

Diaphragm 

Foam 

Rhythm 

Condom 

Injection 

Sterilization 

Other 

No method 

Total 

changes Oral IUD 3iaphragm Foam 

Raporting period (MolDaylYr to MolDay/Yr) 

Method after change 

Rhythrr :ondom nject. Steril. Other None 

1Level of aggregation will be either United states or WenW. 

L


61

Table A-70-I. Number of new female patients by method prior to clinic enrollment and method at last visit, and source of method prior to clinic 

enrollment for the United States 

(Level of aggregation)l Reporting period (Mo/Day/Yr to MolDay/Yr) 

Total new Method prior to clinic enrollment 

Method at last visit female 

patients Oral IUD )iaphragm Foam Rhythm ;ondom Injection Other None* 

Total patients 

Oral


IUD


Diaphragm


Foam


Rhythm


Condom


Injection


Sterilization


Other


None


Source of prior method 

Clinic 

Private doctor 

Drug store 

Other 

Unknown


No prior method


lLevelof aggregation will beeither United States, agencY, regiOn,Or Project (oraffi~ate). 

*Includes patients with unknown prior methods. 

Table A-70-2. Number of female patientsbv method prior toclinic enrollment, method atendof initial visit, andmethod atendof last visit according totvpeof 

patient and type of method for the United States 

(Level of aggregation) 1 Reporting period f lDaylYr t MolDaylYr) 

Type of contraceptive 

method 

Prior to 

clinic 

enrollment 

End of 

initial 

visit 

End of 

last 

visit 

Type of contraceptive 

method 

Prior to 

clinic 

enrollment 

End of 

initial 

visit” 

End of 

last 

visit 

Total new patients I’otal continuation patients 

Oral Oral 

IUD IUD 

Diaphragm Diaph ragrn 

Foam Foam 

Rhythm Rhythm 

Condom Condom 

Injection Injection 

Sterilization Sterilization 

Dther Other 

None None 

Unknown Unknown 

1 Level ~ f aggregation will be either United States, agency, region, or prOiect (Or affiliate). 

; aD~e~ not i“~lude p~tie”t~ for which initial visits are not On file. 

62 
Table A.80. Female contraceptive patients by contraceptive use prior to clinic enrollment according to age and number of live births for the United States 

(Level of aggregation)l Reporting Period (Mo/DaylYr to Me/Day/Y 

Contraceptive use prior to Total number Percent in each age group Percent by number of live births 

— — — — — clinic enrollment patients -18 18-19 20-24 24-29 30-34 35+ o 1 2 3 4 5+ Unk 

— — — — — 

Total number of patients 

Ever used a method 

Yes 

No 

Unknown 

Currently using a method 

Yes 

No 

Unknown 

Last method used prior to clinic 

enrollment 

Oral 

Iuo 

Diaphragm 

Foam 

Rhythm 

Condom 

Injection 

Other 

Unknown 

No prior method 

Sourca of last method 

Clinic 

Private doctor 

Drug store 

Other 

Unknown 

No prior method — — — — — 

lLevelof aggregation will be either United States, agency, or region. 

63 
Table A-90. Number ofnewfemale patients whoareunder 19yeamby selected characteristics forthe United States 

(Level of aggregation) 1 Reporting period (Mo/Day/Yr to Mo/Day/Yr 

Patient Age groups Patient Age groups 

— — — — characteristics characteristics Total -15 16 17 18 Total -15 18 

— — — — 

Total patients 

Numbar of live births 

N me 

1 

2 

3 

4 

!5+ 

Unknown 

No. of living children 

None 

1 

2 

3 

4 

5+ 

Unknown 

Number of pregnancies 

None 

1 

2 

3 

4 

5+ 

Method at end of visit 

Oral 

IUD 

Diaphragm 

Foam 

Rhythm 

Condom 

Injection 

Sterilization 

Other 

None 

Intarim (not in total) 

Ever used any method 

Yes


No


Unknown


Total patients 

Race 

Whita 

Negro 

American Indian 

Other 

Unknown 

Latin Amar. origin 

Yes 

No 

Education 

None 

1-8 years 

9-11 years 

12 years 

13+ years 

Unknown 

Public assistance 

Yas 

No 

Unknown 

Medicaid registrant 

Yes 

No 

Unknown 

Referrals 

None 

Abortion 

Sterilization 

Infertility 

Other medical ser. 

Social services 

Unknown 

Reason for no method 

Pregnant 

Other med. 

Seeking preg. 

Other 

— 

lLe@ of aggregation will be either United Statea or agencY. 

64 
VITAL AND HEALTH STATISTICS PUBLICATIONS SERIES€

Formerly I%blic Health Service Publication No. 1000 

Series 1.	 Programs and Collection R-ocedures. –Reports which describe the general programs of the National 

Center for Health Statistics and its offices and divisions, data collection methods used, definitions, and 

other material necessary for understanding the data. 

Series 2.	 Data Evaluation and Methods Research. –Studies of new statistical methodology including experimental 

tests of new survey methods, studies of vital statistics collection methods, new analytical techniques, 

objective evaluations of reliability of collected data, contributions to statistical theory. 

Series 3.	 Analytical Studies. –Reports presenting analytical or interpretive studies based on vital and health 

statistics, carrying the analysis further than the expository types of reports in the other series. 

Series 4.	 Documents and Committee Reports. –Final reports of major committees concerned with vital and 

health statistics, and documents such as recommended model vital registration laws and revised birth 

and death certificates. 

Series 10.	 Data fro m the Health Interview Survey .–Statistics on illness; accidental injuries; disability; use of 

hospital, medical, dental, and other services; and other health-related topics, based on data collected in 

a continuing national household interview survey. 

Series 11.	 Data from the Health Examination Survey. –Data from direct examination, testing, and measurement 

of national samples of the civilian, noninstitutionalized population provide the basis for two types of 

reports: (1) estimates of the medically defined prevalence of specific diseases in the United States and 

the distributions of the population with respect to physical, physiological, and psychological characteristics; and (2) analysis of relationships among the various measurements without reference to an 

explicit finite universe of persons. 

Series 12.	 Data from the Institutionalized Population Survey s.–Discontinued effective 1975. Future reports from 

these surveys will be in Series 13. 

Series 13.	 Data on Health Resources Utilization.–Statistics on the utilization of health manpower and facilities 

providing long-term care, ambulatory care, hospital care, and family planning services. 

Series 14.	 Data on Health Resources: Manpower and Facilities. -Statistics on the numbers, geographic distribution, and characteristics of health resources including physicians, dentists, nurses, other health occupations, hospitals, nursing homes, and outpatient facilities. 

Series 20.	 Data on Mortality .–Various statistics on mortality other than as included in regular annual or monthly 

reports. Special analyses by cause of death, age, and other demographic variables; geographic and time 

series analyses; and statistics on characteristics of deaths not available from the vital records, based on 

sample surveys of those records. 

Sert”es 21.	 Data on Natality, Marriage, and Divorce. –Various statistics on nata.lity, marriage, and divorce other 

than as included in regulas annual or monthly reports. Special analyses by demographic variables; 

geographic and time series analyses; studies of fertility; and statistics on characteristics of births not 

available from the vital records, based on sample surveys of those records. 

Series 22.	 Data from the National Mortality and Natality Surveys. –Discontinued effective 1975. Future reports 

from these sample surveys based on vital records will be included in Series 20 and 21, respectively. 

Sm”es 23.	 Data from the National Survey of Fumily Growth. –Statistics on fertility, family formation and dissolution, family planning, and related maternal and infant health topics derived from a biennial survey of 

a nationwide probability sample of ever-married women 15-44 years of age. 

For a list of titles of reports published in these series, write to:	 Scientific and Technical Information Branch 

National Center for Health Statistics 

Public Health Service 

llyattsville, kid. 20782