APPENDIX A. DATA SUBMISSION TIMELINE

Transcription

1 Appendices APPENDIX A. DATA SUBMISSION TIMELINE..... APPENDIX B. LOGS.... APPENDIX C. BACTERIAL PATHOGENS..... APPENDIX D. SURGERY CODES FOR ITEM APPENDIX E. CONGENITAL ANOMALIES FOR ITEM APPENDIX F. CONGENITAL INFECTIONS FOR ITEM 42.. APPENDIX G. OSHPD FACILITY CODES SPECIAL LOCATION CODES.... OSHPD FACILITY CODES Sorted Alphabetically by Facility... APPENDIX H. CALCULATION CHART FOR DATE OF DAY APPENDIX I. CALCULATION CHARTS FOR DATE OF WEEK APPENDIX J. DAY NUMBER CHART.... APPENDIX K. FARENHEIT TO CENTIGRADE CONVERSION TABLE... APPENDIX L. HRIF MEDICAL ELIGIBILITY CRITERIA... APPENDEX M. CPQCC SATELLITE NICU MEMO *Appendices H-K. Adapted from a log developed by Vermont Oxford Network ã 2018 CPQCC, Stanford University

2 Appendix A - Data Submission Timeline (Please see 2018 Finalization Guideline for more details) January 1, 2018 Start using new on-line form for infants born in Centers who submit electronically must submit files using the 2018 EDS specifications. January 8, 2018 Deadline for submitting data to be included in the Fourth Quarter Report for January 2018 Fourth Quarter Report for 2017 available on-line ( CPQCC Data Center releases 2017 Data Finalization Guidelines. Requires confirmation receipt of e-announcement from Data Contact. February 1, 2018 CPQCC Membership payments due (payments NOT received by this date will result in a $300 late fee). April 1, 2018 at 11:59 pm Deadline for submission of CPeTS items C.1 through C.33 and Admission/Discharge items 1 through 60 for all infants born in 2017; Updated data for all Still In-House infants born in Deadline for submission of the CPQCC/VON Contact Report and the 2017 VON Membership Survey (submitted on-line at All deliverables are now submitted on-line. Deadline for on-line submission of the 2017 CCS Supplemental Forms and reviewing the Draft CCS Report Deadline for accuracy. April 8, 2018 Deadline for submitting data to be included in the First Quarter Report for April 8, 2018 CPQCC Data Center Deadline for completing finalization of all data to be included in the VON Database and the Annual NICU Quality Management Report for June 1, 2018 at 11:59 pm Deadline for submission of ALL CPQCC records for 2017 and prior years, which must be complete and 100% error free to be included in the Annual CCS Final Report for 2017, VON NICU Quality Management Report for 2017, the Annual CPeTS Report for 2017, and the Annual CPQCC Web Report for The CCS Final Reports are all rerun and finalized. June 2, 2018 from 12:00 am until 6:59 am The Final CCS Reports are available to be confirmed. June 2nd at 7:00 am until June 7th at 11:59 pm Members are given a six-day window to confirm their Final CCS Report. The Confirmation Button will be enabled ONLY during this time frame. NOTE: The CCS Final Reports will be submitted to CCS on behalf of CPQCC Members. July 8, 2018 Deadline for submitting data to be included in the Second Quarter Report for July 2018 Second Quarter Report for 2018 available on-line ( September 2018 Annual VON NICU Quality Management Report for 2017 available for Centers with finalized 2017 data. October 2018 ã 2018 CPQCC, Stanford University

3 Annual CPQCC Web Report for 2017 available on-line ( for Centers with finalized 2017 data. October 8, 2018 Deadline for submitting data to be included in the Third Quarter Report for October 2018 Third Quarter Report for 2018 available on-line ( January 8, 2019 Deadline for submitting data to be included in the Fourth Quarter Report for Please submit a ticket to with any comments or questions. ã 2018 CPQCC, Stanford University

4 Appendix B - Logs ã 2018 CPQCC, Stanford University

5 PATIENT IDENTIFICATION WORKSHEET FOR INFANTS BORN IN 2018 NETWORK ID: ***** HOSPITAL ID: **** Please use this and the Length of Stay Calculation Worksheet (on the following page) to calculate data elements reported on your 2018 forms. Admission/Discharge Form Transport/Post-Transport Form Please use the Delivery Room Death forms for infants who meet the Delivery Room Death Criteria. Refer to the CPQCC Manual for 2018 when completing worksheets and forms. Do Not Submit This Worksheet to CPQCC Keep on File at Your Center W1. Patient s Name: W2. Mother s Name: W3. Patient s Medical Record Number: W4a. Date of Birth: (MM-DD-YYYY) - - W4b. Time of Birth: : AM/PM W5. Date of Admission: (MM-DD-YYYY) - - W6. Date of Day 28: (MM-DD-YYYY) - - W7. Date of Week 36: (MM-DD-YYYY) - - W8. Date of Initial Discharge, Transfer, or Death: (MM-DD-YYYY) - - W9. Date of Final Discharge or Death: (MM-DD-YYYY) - - This form was developed by Vermont Oxford Network (VON)

6 CPQCC PATIENT LOG 2018 PATIENT LOGS INCLUDE PROTECTED HEALTH CARE INFORMATION FOR YOUR INTERNAL USE ONLY DO NOT SUBMIT TO CPQCC Center Number Center Name CPQCC Network ID Number Patient's Name Medical Record Number Birth Date (MM/DD/YYYY) Birth Time (00:00) AM/PM Eligibility: Admission/Discharge A g OR Form Date Sent B. GA 22/0-31/6 OR (MM/DD/YYYY) C. >1500g and one of the following: Death, Surg, Intubated Assisted Vent >4 continuous hrs, Early Sepsis, Acute Transport in/out, Previously discharged home and readmitted for Total Serum Bilirubin of =>25mg/dL and/or exchange transfusion OR Nasal IMV/SIMV (or any other form of non-intubated assisted vent) for >4 continuous hours. DR Death Form Date Sent (MM/DD/YYY) Transport Form Required? (Y/N) *This form was adapted from a log developed by Vermont Oxford Network

7 OPTIONAL: CPQCC PENDING ELIGIBILITY LOG 2018 ELIGIBILITY LOGS INCLUDE PROTECTED HEALTH CARE INFORMATION FOR YOUR INTERNAL USE ONLY DO NOT SUBMIT TO CPQCC Center Number: Center Name: Patient's Name Birth Date (MM/DD/YYYY) Birth Time (00:00) AM/PM Admit Date (MM/DD/YY) Date of Day 28 SELECTION CRITERIA: To be eligible, infant MUST answer YES to at least one of the following criteria prior to infant reaching Day grams? (Yes/No) Gestational Age between 22/0 and 29/0? (Yes/No) Greater than 1500g/31 wks 6/7 days AND MUST answer YES to at least one criteria: Acute Transport in/out, Surgery, Death, Intubated Assisted Vent >4 continuous hrs., Early Sepsis, Previously discharged home and readmitted for Total Serum Bilirubin of =>25mg/dL and/or exchange transfusion OR Nasal IMV/XIMV (or any other form of nonintubated assisted vent) for >4 continuous hrs. Eligible at discharge? (Yes/No) If infant is eligible, enter date below and enter the infant in the Patient Log (MM/DD/YY ) *This form was adapted from a log developed by Vermont Oxford Network *Submit Items for all transported infants when the Post Transfer Disposition is known. **Submit Items for all readmitted infants when the Disposition After Readmission is known ***Submit Items 66 and 67 for all infants who were transferred more than once when the Ultimate Disposition is known. ****Submit Item 67 for all infants who were transferred when the Date of Final Discharge or Death is known.

8 CPQCC TRANSPORT LOG 2018 ELIGIBILITY LOGS INCLUDE PROTECTED HEALTH CARE INFORMATION FOR YOUR INTERNAL USE ONLY DO NOT SUBMIT TO CPQCC Center Number Center Name CPQCC Network ID Number Patient's Name Birth Date (MM/DD/YY) Birth Time (00:00) AM/PM Transfer Date (MM/DD/YY) Transfer Hospital Name CPQCC Member? (Yes/No) Items Sent* (MM/DD/YY) Required for all Transfers Items Sent** (MM/DD/YY) Items Sent*** (MM/DD/YY) Item 67 Sent**** (MM/DD/Y Y) Required for all Transfers *This form was adapted from a log developed by Vermont Oxford Network *Submit Items for all transported infants when the Post Transfer Disposition is known. **Submit Items for all readmitted infants when the Disposition After Readmission is known ***Submit Items 66 and 67 for all infants who were transferred more than once when the Ultimate Disposition is known. ****Submit Item 67 for all infants who were transferred when the Date of Final Discharge or Death is known.

9 Appendix C - Bacterial Pathogens (For Infants Born in 2018) Code Description 101 Achromobacter species [including A. xylosoxidans (also known as Alcaligenes xylosoxidans) and others] 102 Acinetobacter species including multidrug-resistant Acinetobacter 103 Aeromonas species 104 Alcaligenes species [A. xylosoxidans and others] 201 Bacteroides species 202 Burkholderia species [B. capecia and others] 301 Campylobacter species [C. fetus, C. jejuni and others] including drugresistant Campylobacter 302 Chryseobacterium Species 303 Citrobacter species [C. diversus, C. freundii, C. koseri and others] 304 Clostridium species 501 Enterobacter species [E. aerogenes, E. cloacae, and others] including Carbapenem-resistant Enterobacter 502 Enterococcus species [E. faecalis (also known as Streptococcus faecalis), E. faecium, and others] including Vancomycin-resistant Enterococcus 503 Escherichia coli including Carbapenem-resistant Escherichia coli 601 Flavobacterium species 801 Haemophilus species [H. influenzae and others] 1101 [K. oxytoca, K. pneumoniae and others] including Carbapenem-resistant Klebsiella and Cephalosporin-resistant Klebsiella 1201 Listeria monocytogenes 1301 Moraxella species [M. catarrhalis (also known as Branhamella catarrhalis) and others] 1302 Morganella morganii 1401 Neisseria species [N. meningitides, N. gonorrhoeae and others] including drug-resistant N. gonorrhoeae 1601 Pantoea 1602 Pasteurella species 1603 Prevotella species 1604 Proteus species [P. mirabilis, P. vulgaris and others] 1605 Providencia species [P. rettgeri and others] 1606 Pseudomonas species [P. aeruginosa and others] including multidrug resistant Pseudomonas aeruginosa 1801 Ralstonia species 1901 Salmonella species including drug-resistant Salmonella serotype Typhi 1902 Serratia species [S. liquefaciens, S. marcescens and others] 1903 Staphylococcus coagulase positive [aureus] including Methicillin-resistant Staphylococcus aureus and Vancomycin-resistant Staphylococcus aureus 1904 Stenotrophomonas maltophilia 1905 Group B Streptococcus or GBS [also known as Streptococcus agalactiae] 1906 Streptococcus anginosus [formerly Streptococcus milleri] 1907 Streptococcus pneumoniae ã 2018 CPQCC, Stanford University

10 1908 Streptococcus pyogenes [Group A Streptococcus] Appendix D Surgery Codes for Item 47. (For Infants Born in 2018) Head and Neck Surgery Code S101 S102 S103 S104 S105 S106 S107 S108 S109 S100 Description Tracheostomy/Tracheotomy Cricoid split Ophthalmologic surgery OTHER THAN laser or cryosurgery for ROP NOTE: Record ROP surgery in the ROP Surgery Data Item. Do not record ROP surgery in the Surgery Codes Data Item. Cleft lip or palate repair Branchial cleft sinus excision Thyroglossal duct excision Palliative or definitive repair of choanal atresia Mandibular (jaw) distraction Craniotomy Other head and neck surgery requiring general or spinal Anesthesia (Description required) Thoracic Surgery Code S201 S202 S203 S204 S205 S206 S207 S208 S209 S210 S211 S212 S213 S214 S200 Description Tracheal Resection Aortopexy Tracheoesophageal atresia and/or fistula repair Thoracoscopy (with or without pleuridesis/pleurectomy) Thoracotomy (with or without pleural or lung biopsy) Thoracotomy (or thoracoscopy) with pneumonectomy, lobectomy, or partial lobectomy Resection of pulmonary sequestration (intrathoracic or extrathoracic) Resection of mediastinal mass Resection of chest wall Bronchoscopy (with or without biopsy) Esophagoscopy (with or without biopsy) Surgery for Congenital Cystic Adenomatoid Malformation of the Lung Lung transplant Sternal closure Other thoracic surgery requiring general or spinal anesthesia (Description required) Abdominal and Gastro-Intestinal Surgery Code S301 S302 Description Rectal biopsy with or without anoscopy Laparoscopy (diagnostic, with/without biopsy) Note: If the infant has NEC surgery, record all applicable codes in Item ã 2018 CPQCC, Stanford University

11 47. Other Surgery even if Item 44c. NEC surgery, has already been checked, Yes. S303 S304 S305 S306 S307 S308 S309 S310 S311 S312 S313 S314 S315 S318 S319 S320 S321 S322 S323 S324 S325 S326 S327 S328 S329 S330 S331 S332 S333 S334 S335 S336 S337 S338 S339 S340 S341 S300 Laparotomy (diagnostic or exploratory, with/without biopsy) Fundoplication Pyloromyotomy Pyloroplasty Jejunostomy, ileostomy, enterostomy, colostomy for intestinal diversion (with or without bowel resection, with or without fistula creation) Small bowel resection with or without primary anastomosis Large Bowel Resection Duodenal Atresia/Stenosis/Web Repair Jejunal, ileal, or colonic atresia repair (or repair of multiple intestinal atresias) Excision of Meckel s diverticulum Drainage of intra-abdominal abscess (not as primary treatment for NEC, see code S333). Surgery for meconium ileus Excision of omphalomesenteric duct or duct remnant Lysis of adhesions Repair of imperforate anus (with or without vaginal, urethral, or vesicle fistula) Pull through for Hirschsprung s disease (any technique) Pancreatectomy (partial, near total or total) Splenectomy or splenorrhaphy (partial or complete) Resection of retroperitoneal tumor Resection of sacrococcygeal tumor Repair of diaphragmatic hernia Plication of the diaphragm Gastrostomy tube/jejunostomy tube Upper endoscopy (stomach or duodenum, with or without biopsy) Colonoscopy/sigmoidoscopy (with or without biopsy) Takedown of ostomy and/or reanastomosis of bowel (small or large bowel) Ladd s or other procedure for correction of malrotation Appendectomy Primary peritoneal drainage for NEC, suspected NEC, or intestinal perforation (If infant subsequently has other applicable surgical procedures, code those also.) Anoplasty Kasai procedure Liver biopsy done during laparotomy or laparoscopy (includes wedge or needle techniques) Umbilical hernia repair Primary closure for gastroschisis Staged closure for gastroschisis Primary closure for omphalocele Staged closure for omphalocele Other abdominal surgery requiring general or spinal anesthesia (Description required) ã 2018 CPQCC, Stanford University

12 Genito-Urinary Surgery Code S401 S402 S403 S404 S405 S406 S407 S408 S409 S410 S411 S412 S413 S414 S416 S417 S400 Description Cystoscopy (diagnostic, with or without biopsy) Adrenalectomy Nephrectomy Nephrostomy Ureterostomy Resection of urachal cyst Cystostomy Closure of bladder exstrophy Resection of posterior urethral valves Inguinal hernia repair Orchiopexy Orchiectomy Drainage, excision or removal of ovarian cyst Oopherectomy (partial or complete) Pyeloplasty Renal transplant Other genito-urinary surgery requiring general or spinal anesthesia (description required) Open Heart or Vascular Surgery Code S501 S502 S503 S504 S505 S506 S507 S508 S509 S510 S511 S512 S513 S514 S515 S516 S500 Description Vascular Ring division Repair of coarctation of the aorta Repair of major vascular injury Repair or palliation of congenital heart disease Heart transplant Implated pacemaker (permanent-do not use code for temporary pacemaker) Norwood procedure with Sano modification Norwood procedure with aortopulmonary shunt Hybrid surgery (ductal stenting and bilateral branch pulmonary artery banding) Truncus arteriosus repair Arterial switch Repair of total anomalous pulmonary venous return Aorta pulmonary shunt Pulmonary artery banding Open thoracotomy for patent ductus arteriosus closure Thoracoscopic surgery for patent ductus arteriosus closure Other open heart or vascular surgery requiring general or spinal anesthesia (Description required) Diagnostic or Interventional Cardiac Catheterization ã 2018 CPQCC, Stanford University

13 Code S601 S602 S603 S604 S605 S600 Description Diagnostic cardiac catheterization Interventional catheterization with balloon septostomy Interventional catheterization with aortic valvuloplasty Interventional catheterization with pulmonary valvuloplasty Interventional catheterization for patent ductus arteriosus closure Other interventional catheterization whether or not anesthesia was required (Description required) Skin and Soft Tissue Surgery Code S700 Description Skin or soft tissue surgery requiring general or spinal anesthesia (Description required) Musculo-Skeletal System Surgery Code S800 Description Other musculoskeletal surgery requiring general or spinal anesthesia (Description required) Central Nervous System Surgery Code S901 S902 S903 S904 S905 S900 Description Ventriculoperitoneal or other ventricular shunt External ventricular drain Ventricular drain with reservoir placement or removal Meningocele or myelomeningocele repair Encephalocele repair Other central nervous system surgery requiring general or spinal anesthesia (Description required) Fetal Surgery (record if fetal surgery was done at your hospital or another hospital) Code S1000 S1001 Description Fetal surgery at your hospital (description required) Fetal surgery at another hospital (description required) Conjoined Twins Code S1101 Description Separation of conjoined twins ã 2018 CPQCC, Stanford University

14 Appendix E Congenital Anomalies Item 52. (For Infants Born in 2018) The following Congenital Anomaly Codes require a detailed description in the space provided for Item 52 on the Admission/Discharge Form: Code Description 100 Other Lethal or Life Threatening Defects not listed in Appendix C 150 Other Lethal or Life Threatening Central Nervous System Defects 200 Other Lethal or Life Threatening Congenital Heart Defects 300 Other Lethal or Life Threatening Gastro-Intestinal Defects 400 Other Lethal or Life Threatening Genito-Urinary Defects 504 Other Chromosomal Anomaly 601 Skeletal Dysplasia 605 Inborn Error of Metabolism 800 Other Lethal of Life Threatening Pulmonary Malformation 900 Other Vascular or Lymphatic Defects The following conditions should NOT be coded as Major Congenital Anomalies: Cleft Lip without Cleft Palate Club Feet Congenital Dislocation of the Hips Extreme Prematurity Fetal Alcohol Syndrome Hypospadias Hypothyroidism Intrauterine Growth Retardation Intrauterine Infection Limb Abnormalities Patent Ductus Arteriosus Persistent Pulmonary Hypertension (PPHN) Polydactyly Pulmonary Hypoplasia (use code 401 for bilateral renal agenesis or 604 for oligohydramnios sequence, if applicable) Small Size for Gestational Age Syndactyly Central Nervous System Anomalies Code Description 101 Anencephaly 102 Meningomyelocele 103 Hydranencephaly 104 Congenital Hydrocephalus 105 Holopresencephaly 106 Microcephaly 107 Hypopituitary ã 2018 CPQCC, Stanford University

15 108 Septic Optic Dyplasia 109 Encephalocele 150 Other lethal or life threatening CNS anomaly not listed above (Description required) Congenital Heart Anomalies Codes Description 201 Truncus Arteriosus 202 Transposition of the Great Vessels 203 Tetralogy of Fallot with or without Pulmonary Atresia 204 Single Ventricle 205 Double Outlet Right Ventricle 206 Complete Atrio-Ventricular Canal 207 Pulmonary Atresia with Intact Ventricular Septum 208 Tricuspid Atresia 209 Hypoplastic Left Heart Syndrome 210 Interrupted Aortic Arch 211 Total Anomalous Pulmonary Venous Return 212 Coarctation of the Aorta 213 Atrial septal defect (ASD) 214 Ventricular septal defect (VSD) 215 Arrythmias 216 Ebsteins Anomaly 217 Pericardial Effusion 218 Pulmonary Stenosis 219 Hypertrophic Cardiomyopathy 220 Penatalogy of Cantrell (Thoraco-Abdominal Ectopia Cordis) 200 Other lethal or life threatening Congenital Heart Anomalies not listed above (Description required) Gastro-Intestinal Anomalies Code Description 301 Cleft Palate 302 Tracheo-Esophageal Fistula 303 Esophageal Atresia 304 Duodenal Atresia 305 Jejunal Atresia 306 Ileal Atresia 307 Atresia of Large Bowel or Rectum 308 Imperforate Anus 309 Omphalocele 310 Gastroschisis 311 Pyloric Stenosis 312 Annular Pancreas 313 Biliary Atresia ã 2018 CPQCC, Stanford University

16 314 Meconium Ilius 315 Malrotation Volvuvu 316 Hirschsprung s Disease 300 Other lethal or life-threatening GI Anomalies not listed above (Description required) Genito-Urinary Anomalies Code Description 401 Bilateral Renal Agenesis 402 Bilateral Polycystic, Multicystic, or Dysplastic Kidneys 403 Obstructive Uropathy with Congenital Hydronephrosis 404 Exstrophy of the Urinary Bladder 400 Other lethal or life-threatening Genito-Urinary Anomalies not listed above (Description required) Chromosomal Anomalies Code Description 501 Trisomy Trisomy Trisomy Other Chromosomal Anomaly (Description Required) 505 Triploidy Other Congenital Anomalies Code Description 601 Skeletal Dysplasia (Description Required) 602 Congenital Diaphragmatic Hernia 603 Hydrops Fetalis with anasarca and one or more of the following: ascites, pleural effusion, pericardial effusion 604 Oligohydramnios Sequence including all 3 of the following: (1) Oligohydramnios documented by antenatal ultrasound 5 or more days prior to delivery, (2) evidence of fetal constraint on postnatal physical exam (such as Potter s facies, contractures, or positional physical exam (such as Potter s facies, contractures or positional deformities of limbs), and (3) postnatal respiratory failure requiring endotracheal intubation and assisted ventilation. 605 Inborn Error of Metabolism (Description Required) 606 Myotonic Dystrophy requiring endotracheal intubation and assisted ventilation 607 Conjoined Twins 608 Tracheal Agenesis or Atresia 609 Thanatophoric Dysplasia Types 1 and Hemoglobin Barts ã 2018 CPQCC, Stanford University

17 Pulmonary Anomalies Code Description 701 Congenital Cystic Adenomatoid Malformation of the Lung 801 Congenital Lobar Emphysema 802 Congenital Cystic Adenomatoid Malformation of the Lung 803 Sequestered Lung 804 Aveolar Capillary Dysplasia 800 Other lethal or life-threatening Pulmonary Defects not listed above (Description required) Vascular and Lymphatic Anomalies Code Description 901 Cystic Hygroma 902 Hemangioma 903 Sacrococcygeaal Teratoma 904 Cerebral AV Malformation 900 Other Vascular or Lymphatic not listed above (DESCRIBE) Other Diagnoses Code Description 121 Hematologic 122 Hemolytic Disease of the Newborn (Not ABO) Other Lethal or Life Threatening Anomalies Code Description 100 Other lethal or life threatening anomalies not listed above (description required) ã 2018 CPQCC, Stanford University

18 Appendix F CONGENITAL INFECTIONS Item 42. (For infants born in 2018) Code Description 101 Toxoplasmosis (Toxoplasma gondii) 102 Rubella virus 103 Syphilis (Treponema pallidum) 104 Cytomegalovirus 105 Herpes simplex 106 Parvovirus B Zika virus 108 Varicella zoster virus ã 2018 CPQCC, Stanford University

19 Appendix G - OSHPD FACILITY CODES ã 2018 CPQCC, Stanford University

20 OSHPD FACILITY CODES Sorted by Hospital (JAN 2018) CPQCC Centers Indicated in Bold Italics OSHPD # HOSPITAL NAME CITY COUNTY TH MEDICAL GROUP HOSPITAL TH MEDICAL GROUP HOSPITAL ND MEDICAL GROUP TH MEDICAL GROUP - EDWARDS AIR FORCE BASE ADVENTIST HEALTH MEDICAL CENTER TEHACHAPI VALLEY TEHACHAPI KERN ADVENTIST MEDICAL CENTER HANFORD KINGS ADVENTIST MEDICAL CENTER - REEDLEY REEDLEY FRESNO ADVENTIST MEDICAL CENTER-SELMA SELMA FRESNO ALAMEDA HOSPITAL ALAMEDA ALAMEDA ALAMEDA HOSPITAL AT WATERS EDGE ALAMEDA ALAMEDA ALHAMBRA HOSPITAL MEDICAL CENTER ALHAMBRA LOS ANGELES ALTA BATES SUMMIT MED CTR-HERRICK CAMPUS BERKELEY ALAMEDA ALTA BATES SUMMIT MED CTR-SUMMIT CAMPUS-HAWTHORNE OAKLAND ALAMEDA ALTA BATES SUMMIT MED CTR-SUMMIT CAMPUS-SUMMIT OAKLAND ALAMEDA ALTA BATES SUMMIT MEDICAL CENTER BERKELEY ALAMEDA ALVARADO HOSPITAL MEDICAL CENTER SAN DIEGO SAN DIEGO ANAHEIM GENERAL HOSPITAL ANAHEIM ORANGE ANAHEIM REGIONAL MEDICAL CENTER ANAHEIM ORANGE ANDERSON LUCCHETTI WOMEN'S AND CHILDREN'S CENTER SACRAMENTO SACRAMENTO ANTELOPE VALLEY HOSPITAL LANCASTER LOS ANGELES ARROWHEAD REGIONAL MEDICAL CENTER COLTON SAN BERNARDINO BAKERSFIELD HEART HOSPITAL BAKERSFIELD KERN BAKERSFIELD MEMORIAL HOSPITAL BAKERSFIELD KERN BANNER LASSEN MEDICAL CENTER SUSANVILLE LASSEN BARLOW RESPIRATORY HOSPITAL LOS ANGELES LOS ANGELES BARSTOW COMMUNITY HOSPITAL BARTON MEMORIAL HOSPITAL SOUTH LAKE TAHOEEL DORADO BEACH SIDE BIRTH CENTER BEAR VALLEY COMMUNITY HOSPITAL BIG BEAR LAKE SAN BERNARDINO BELLWOOD HEALTH CENTER BELLFLOWER LOS ANGELES BEVERLY HOSPITAL MONTEBELLO LOS ANGELES CALIFORNIA - CLINIC CALIFORNIA - EMERGENCY ROOM CALIFORNIA - HOME BIRTH CALIFORNIA - MD OFFICE CALIFORNIA - OTHER IN/PATIENT SETTING CALIFORNIA - OTHER OUT/PATIENT SETTING CALIFORNIA HOSPITAL MEDICAL CENTER - LOS ANGELES LOS ANGELES LOS ANGELES CALIFORNIA PACIFIC MED CTR-CALIFORNIA EAST SAN FRANCISCO SAN FRANCISCO CALIFORNIA PACIFIC MED CTR-DAVIES CAMPUS SAN FRANCISCO SAN FRANCISCO CALIFORNIA PACIFIC MED CTR-PACIFIC CAMPUS SAN FRANCISCO SAN FRANCISCO CALIFORNIA PACIFIC MEDICAL CENTER - ST. LUKE'S CAMPUS SAN FRANCISCO SAN FRANCISCO CALIFORNIA PACIFIC MEDICAL CENTER (CPMC) SAN FRANCISCO SAN FRANCISCO

21 OSHPD FACILITY CODES Sorted by Hospital (JAN 2018) CPQCC Centers Indicated in Bold Italics OSHPD # HOSPITAL NAME CITY COUNTY CATALINA ISLAND MEDICAL CENTER AVALON LOS ANGELES CEDARS-SINAI MEDICAL CENTER LOS ANGELES LOS ANGELES CENTINELA HOSPITAL MEDICAL CENTER INGLEWOOD LOS ANGELES CHAPMAN MEDICAL CENTER ORANGE ORANGE CHILDREN S HOSPITAL LOS ANGELES LOS ANGELES LOS ANGELES CHILDREN S HOSPITAL OF ORANGE COUNTY (CHOC ) ORANGE ORANGE CHILDREN S HOSPITAL OF ORANGE COUNTY (CHOC) AT MISSION HOSPITAL MISSION VIEJO ORANGE CHINESE HOSPITAL SAN FRANCISCO SAN FRANCISCO CHINO VALLEY MEDICAL CENTER CHINO SAN BERNARDINO CITRUS VALLEY MEDICAL CENTER WEST COVINA LOS ANGELES CITRUS VALLEY MEDICAL CENTER - IC CAMPUS COVINA LOS ANGELES CLOVIS COMMUNITY MEDICAL CENTER CLOVIS FRESNO COALINGA REGIONAL MEDICAL CENTER COALINGA FRESNO COAST PLAZA HOSPITAL NORWALK LOS ANGELES COASTAL COMMUNITIES HOSPITAL SANTA ANA ORANGE COLLEGE HOSPITAL COSTA MESA COSTA MESA ORANGE COLLEGE MEDICAL CENTER LONG BEACH LOS ANGELES COLORADO RIVER MEDICAL CENTER NEEDLES SAN BERNARDINO COLUSA REGIONAL MEDICAL CENTER COLUSA COLUSA COMMUNITY BEHAVIORAL HEALTH CENTER FRESNO FRESNO COMMUNITY HOSPITAL LONG BEACH LONG BEACH LOS ANGELES COMMUNITY HOSPITAL OF HUNTINGTON PARK HUNTINGTON PARKLOS ANGELES COMMUNITY HOSPITAL OF SAN BERNARDINO SAN BERNARDINO SAN BERNARDINO COMMUNITY HOSPITAL OF THE MONTEREY PENINSULA MONTEREY MONTEREY COMMUNITY MEMORIAL HOSPITAL OF VENTURA VENTURA VENTURA COMMUNITY REGIONAL MEDICAL CENTER (CRMC) FRESNO FRESNO CONTRA COSTA REGIONAL MEDICAL CENTER MARTINEZ CONTRA COSTA CORONA REGIONAL MEDICAL CENTER-MAGNOLIA CORONA RIVERSIDE CORONA REGIONAL MEDICAL CENTER-MAIN CORONA RIVERSIDE COTTAGE HOSPITAL, SANTA BARBARA SANTA BARBARA SANTA BARBARA DELANO REGIONAL MEDICAL CENTER DELANO KERN DESERT REGIONAL MEDICAL CENTER PALM SPRINGS RIVERSIDE DESERT VALLEY HOSPITAL VICTORVILLE SAN BERNARDINO DOCTORS HOSPITAL OF MANTECA MANTECA SAN JOAQUIN DOCTORS MEDICAL CENTER - SAN PABLO SAN PABLO CONTRA COSTA DOCTORS MEDICAL CENTER OF MODESTO MODESTO STANISLAUS DOMINICAN HOSPITAL SANTA CRUZ SANTA CRUZ EAST LOS ANGELES DOCTORS HOSPITAL LOS ANGELES LOS ANGELES EASTERN PLUMAS HOSPITAL-PORTOLA CAMPUS PORTOLA PLUMAS EDEN MEDICAL CENTER CASTRO VALLEY ALAMEDA EISENHOWER MEDICAL CENTER RANCHO MIRAGE RIVERSIDE EL CAMINO HOSPITAL MOUNTAIN VIEW SANTA CLARA

22 OSHPD FACILITY CODES Sorted by Hospital (JAN 2018) CPQCC Centers Indicated in Bold Italics OSHPD # HOSPITAL NAME CITY COUNTY EL CAMINO HOSPITAL LOS GATOS LOS GATOS SANTA CLARA EL CENTRO REGIONAL MEDICAL CENTER EL CENTRO IMPERIAL EMANUEL MEDICAL CENTER TURLOCK STANISLAUS ENCINO HOSPITAL MEDICAL CENTER ENCINO LOS ANGELES ENLOE MEDICAL CENTER - COHASSET CHICO BUTTE ENLOE MEDICAL CENTER- ESPLANADE CHICO BUTTE FAIRCHILD MEDICAL CENTER YREKA SISKIYOU FAIRMONT HOSPITAL SAN LEANDRO ALAMEDA FALLBROOK HOSPITAL DISTRICT FALLBROOK SAN DIEGO FEATHER RIVER HOSPITAL PARADISE BUTTE FOOTHILL PRESBYTERIAN HOSPITAL-JOHNSTON MEMORIAL GLENDORA LOS ANGELES FOUNTAIN VALLEY REGIONAL HOSPITAL & MEDICAL CENTER FOUNTAIN VALLEY ORANGE FOUNTAIN VALLEY RGNL HOSP AND MED CTR - WARNER FOUNTAIN VALLEY ORANGE FOWLER MUNICIPAL HOSPITAL FREMONT MEDICAL CENTER YUBA CITY SUTTER FRENCH HOSPITAL MEDICAL CENTER SAN LUIS OBISPO SAN LUIS OBISPO GARDEN GROVE HOSPITAL AND MEDICAL CENTER GARDEN GROVE ORANGE GARDENS REGIONAL HOSPITAL AND MEDICAL CENTER HAWAIIAN GARDENLOS ANGELES GARFIELD MEDICAL CENTER MONTEREY PARK LOS ANGELES GENERAL HOSPITAL, THE EUREKA HUMBOLDT GEORGE L MEE MEMORIAL HOSPITAL KING CITY MONTEREY GLENDALE ADVENTIST MEDICAL CENTER GLENDALE LOS ANGELES GLENDALE MEMORIAL HOSPITAL AND HEALTH CENTER GLENDALE LOS ANGELES GLENDORA COMMUNITY HOSPITAL GLENDORA LOS ANGELES GLENN MEDICAL CENTER WILLOWS GLENN GOLETA VALLEY COTTAGE HOSPITAL SANTA BARBARA SANTA BARBARA GOOD SAMARITAN HOSPITAL (HCA), SAN JOSE SAN JOSE SANTA CLARA GOOD SAMARITAN HOSPITAL-BAKERSFIELD BAKERSFIELD KERN GOOD SAMARITAN HOSPITAL, LOS ANGELES LOS ANGELES LOS ANGELES GREATER EL MONTE COMMUNITY HOSPITAL SOUTH EL MONTE LOS ANGELES HARBOR UCLA MEDICAL CENTER TORRANCE LOS ANGELES HAZEL HAWKINS MEMORIAL HOSPITAL HOLLISTER SAN BENITO HEALDSBURG DISTRICT HOSPITAL HEALDSBURG SONOMA HEALTHBRIDGE CHILDREN'S HOSPITAL-ORANGE ORANGE ORANGE HEMET VALLEY HEALTH CARE CENTER HEMET RIVERSIDE HEMET VALLEY MEDICAL CENTER HEMET RIVERSIDE HENRY MAYO NEWHALL MEMORIAL HOSPITAL VALENCIA LOS ANGELES HI-DESERT MEDICAL CENTER JOSHUA TREE SAN BERNARDINO HIGHLAND HOSPITAL OAKLAND ALAMEDA HOAG HOSPITAL IRVINE IRVINE ORANGE HOAG MEMORIAL HOSPITAL, PRESBYTERIAN NEWPORT BEACH ORANGE HOLLYWOOD PRESBYTERIAN MEDICAL CENTER LOS ANGELES LOS ANGELES HUNTINGTON BEACH HOSPITAL HUNTINGTON BEACORANGE

23 OSHPD FACILITY CODES Sorted by Hospital (JAN 2018) CPQCC Centers Indicated in Bold Italics OSHPD # HOSPITAL NAME CITY COUNTY HUNTINGTON MEMORIAL HOSPITAL PASADENA LOS ANGELES JEROLD PHELPS COMMUNITY HOSPITAL GARBERVILLE HUMBOLDT JOHN C FREMONT HEALTHCARE DISTRICT MARIPOSA MARIPOSA JOHN F KENNEDY MEMORIAL HOSPITAL INDIO RIVERSIDE JOHN MUIR HEALTH, WALNUT CREEK CAMPUS WALNUT CREEK CONTRA COSTA JOHN MUIR MEDICAL CENTER-CONCORD CAMPUS CONCORD CONTRA COSTA KAISER FND HOSP - FREMONT FREMONT ALAMEDA KAISER FND HOSP - FRESNO FRESNO FRESNO KAISER FND HOSP - REHABILITATION CENTER VALLEJO VALLEJO SOLANO KAISER FND HOSP - RICHMOND CAMPUS RICHMOND CONTRA COSTA KAISER FND HOSP - SACRAMENTO SACRAMENTO SACRAMENTO KAISER FND HOSP - SAN JOSE SAN JOSE SANTA CLARA KAISER FND HOSP - SAN RAFAEL SAN RAFAEL MARIN KAISER FND HOSP - SANTA ROSA SANTA ROSA SONOMA KAISER FND HOSP - SOUTH SACRAMENTO SACRAMENTO SACRAMENTO KAISER FND HOSP - SOUTH SAN FRANCISCO SOUTH SAN FRANC SAN MATEO KAISER FND HOSP-MANTECA MANTECA SAN JOAQUIN KAISER FND HOSPITAL - MORENO VALLEY MORENO VALLEY RIVERSIDE KAISER FOUND HSP-ANTIOCH ANTIOCH CONTRA COSTA KAISER FOUNDATION HOSPITAL - VACAVILLE VACAVILLE SOLANO KAISER PERMANENTE - MODESTO MODESTO STANISLAUS KAISER PERMANENTE - OAKLAND OAKLAND ALAMEDA KAISER PERMANENTE - ROSEVILLE ROSEVILLE PLACER KAISER PERMANENTE - SAN FRANCISCO SAN FRANCISCO SAN FRANCISCO KAISER PERMANENTE - SAN LEANDRO SAN LEANDRO ALAMEDA KAISER PERMANENTE - SANTA CLARA SANTA CLARA SANTA CLARA KAISER PERMANENTE - WALNUT CREEK WALNUT CREEK CONTRA COSTA KAWEAH DELTA MENTAL HEALTH HOSPITAL D/P APH VISALIA TULARE KAWEAH DELTA HEALTHCARE DISTRICT VISALIA TULARE KECK HOSPITAL OF USC LOS ANGELES LOS ANGELES KERN MEDICAL CENTER BAKERSFIELD KERN KERN VALLEY HEALTHCARE DISTRICT LAKE ISABELLA KERN KFH BALDWIN PARK BALDWIN PARK LOS ANGELES KFH DOWNEY DOWNEY LOS ANGELES KFH FONTANA FONTANA SAN BERNARDINO KFH LOS ANGELES LOS ANGELES LOS ANGELES KFH OC ANAHEIM ANAHEIM ORANGE KFH OC IRVINE IRVINE ORANGE KFH ONTARIO ONTARIO SAN BERNARDINO KFH PANORAMA CITY PANORAMA CITY LOS ANGELES KFH REDWOOD CITY KFH RIVERSIDE RIVERSIDE RIVERSIDE KFH SAN DIEGO SAN DIEGO SAN DIEGO

24 OSHPD FACILITY CODES Sorted by Hospital (JAN 2018) CPQCC Centers Indicated in Bold Italics OSHPD # HOSPITAL NAME CITY COUNTY KFH SOUTH BAY HARBOR CITY LOS ANGELES KFH WEST LOS ANGELES LOS ANGELES LOS ANGELES KFH WOODLAND HILLS WOODLAND HILLS LOS ANGELES KINDRED HOSPITAL - LA MIRADA LA MIRADA LOS ANGELES KINDRED HOSPITAL - LOS ANGELES LOS ANGELES LOS ANGELES KINDRED HOSPITAL - SAN DIEGO SAN DIEGO SAN DIEGO KINDRED HOSPITAL - SAN FRANCISCO BAY AREA SAN LEANDRO ALAMEDA KINDRED HOSPITAL - SAN GABRIEL VALLEY WEST COVINA LOS ANGELES KINDRED HOSPITAL - SANTA ANA SANTA ANA ORANGE KINDRED HOSPITAL BALDWIN PARK BALDWIN PARK LOS ANGELES KINDRED HOSPITAL BREA BREA ORANGE KINDRED HOSPITAL ONTARIO ONTARIO SAN BERNARDINO KINDRED HOSPITAL RANCHO RANCHO CUCAMOSAN BERNARDINO KINDRED HOSPITAL RIVERSIDE PERRIS RIVERSIDE KINDRED HOSPITAL SOUTH BAY GARDENA LOS ANGELES KINDRED HOSPITAL WESTMINSTER WESTMINSTER ORANGE LA PALMA INTERCOMMUNITY HOSPITAL LA PALMA ORANGE LAC/RANCHO LOS AMIGOS NATIONAL REHAB CENTER DOWNEY LOS ANGELES LAC/USC (LOS ANGELES COUNTY, UNIVERSITY SOUTHERN CALIFORNIA MEDICAL CENTER) LOS ANGELES LOS ANGELES LAGUNA HONDA HOSPITAL AND REHABILITATION CENTER SAN FRANCISCO SAN FRANCISCO LAKEWOOD REGIONAL MEDICAL CENTER LAKEWOOD LOS ANGELES LETTERMAN ARMY MEDICAL CENTER LODI MEMORIAL HOSPITAL LODI SAN JOAQUIN LOMA LINDA UNIV. MED. CENTER EAST CAMPUS HOSPITAL LOMA LINDA SAN BERNARDINO LOMA LINDA UNIVERSITY CHILDREN'S HOSPITAL LOMA LINDA SAN BERNARDINO LOMA LINDA UNIVERSITY MEDICAL CENTER-MURRIETA MURRIETA RIVERSIDE LOMPOC VALLEY MEDICAL CENTER LOMPOC SANTA BARBARA LONG BEACH MEMORIAL MEDICAL CENTER LONG BEACH LOS ANGELES LOS ALAMITOS MEDICAL CENTER LOS ALAMITOS ORANGE LOS ANGELES COMMUNITY HOSPITAL LOS ANGELES LOS ANGELES LOS ANGELES COMMUNITY HOSPITAL AT BELLFLOWER BELLFLOWER LOS ANGELES LOS ANGELES METROPOLITAN MED CTR-HAWTHORNE CAMPUS HAWTHORNE LOS ANGELES LOS ANGELES METROPOLITAN MEDICAL CENTER LOS ANGELES LOS ANGELES LOS ROBLES HOSPITAL & MEDICAL CENTER - EAST CAMPUS WESTLAKE VILAGE VENTURA LOS ROBLES REGIONAL HOSPITAL & MEDICAL CENTER THOUSAND OAKS VENTURA LUCILE PACKARD CHILDREN S HOSPITAL AT STANFORD, (LPCH) PALO ALTO SANTA CLARA LUCILE PACKARD CHILDREN S SPECIAL CARE NURSERY REDWOOD CITY SAN MATEO AT SEQUOIA HOSPITAL, (LPCH) MAD RIVER COMMUNITY HOSPITAL ARCATA HUMBOLDT MADERA COMMUNITY HOSPITAL MADERA MADERA MAMMOTH HOSPITAL MAMMOTH LAKES MONO MARIAN REGIONAL MEDICAL CENTER SANTA MARIA SANTA BARBARA

25 OSHPD FACILITY CODES Sorted by Hospital (JAN 2018) CPQCC Centers Indicated in Bold Italics OSHPD # HOSPITAL NAME CITY COUNTY MARIAN REGIONAL MEDICAL CENTER, ARROYO GRANDE ARROYO GRANDE SAN LUIS OBISPO MARIN GENERAL HOSPITAL GREENBRAE MARIN MARINA DEL REY HOSPITAL MARINA DEL REY LOS ANGELES MARK TWAIN MEDICAL CENTER SAN ANDREAS CALAVERAS MARSHALL MEDICAL CENTER (1-RH) PLACERVILLE EL DORADO MAYERS MEMORIAL HOSPITAL FALL RIVER MILLS SHASTA MEMORIAL HOSPITAL LOS BANOS LOS BANOS MERCED MEMORIAL HOSPITAL OF GARDENA GARDENA LOS ANGELES MEMORIAL MEDICAL CENTER, MODESTO MODESTO STANISLAUS MENDOCINO COAST DISTRICT HOSPITAL FORT BRAGG MENDOCINO MENIFEE VALLEY MEDICAL CENTER SUN CITY RIVERSIDE MERCY GENERAL HOSPITAL SACRAMENTO SACRAMENTO MERCY HOSPITAL - BAKERSFIELD BAKERSFIELD KERN MERCY MEDICAL CENTER - MERCED MERCED MERCED MERCY MEDICAL CENTER MT. SHASTA MOUNT SHASTA SISKIYOU MERCY MEDICAL CENTER, REDDING REDDING SHASTA MERCY SAN JUAN MEDICAL CENTER CARMICHAEL SACRAMENTO MERCY SOUTHWEST HOSPITAL BAKERSFIELD KERN METHODIST HOSPITAL OF SACRAMENTO SACRAMENTO SACRAMENTO METHODIST HOSPITAL OF SOUTHERN CALIFORNIA ARCADIA LOS ANGELES MILLER CHILDREN S AND WOMEN'S HOSPITAL AT LONG LONG BEACH LOS ANGELES BEACH MEMORIAL HOSPITAL MILLS-PENINSULA MEDICAL CENTER BURLINGAME SAN MATEO MIRACLE MILE MEDICAL CENTER LOS ANGELES LOS ANGELES MISSION COMMUNITY HOSPITAL - PANORAMA CAMPUS PANORAMA CITY LOS ANGELES MISSION HOSPITAL LAGUNA BEACH LAGUNA BEACH ORANGE MISSION HOSPITAL REGIONAL MEDICAL CENTER MISSION VIEJO ORANGE MISSION OAKS HOSPITAL LOS GATOS SANTA CLARA MODOC MEDICAL CENTER ALTURAS MODOC MONROVIA MEMORIAL HOSPITAL MONROVIA LOS ANGELES MONTCLAIR HOSPITAL MEDICAL CENTER MONTCLAIR SAN BERNARDINO MONTEREY PARK HOSPITAL MONTEREY PARK LOS ANGELES MOTION PICTURE AND TELEVISION HOSPITAL WOODLAND HILLS LOS ANGELES MOUNTAINS COMMUNITY HOSPITAL LAKE ARROWHEAD SAN BERNARDINO NATIVIDAD MEDICAL CENTER SALINAS MONTEREY NAVAL HOSPITAL - CAMP PENDLETON NAVAL HOSPITAL - LEMOORE NAVAL HOSPITAL - TWENTYNINE PALM NAVAL HOSPITAL: OAKLAND NAVAL MEDICAL CENTER (BALBOA) NORTH BAY VACAVALLEY HOSPITAL VACAVILLE SOLANO NORTHBAY MEDICAL CENTER FAIRFIELD SOLANO NORTHERN INYO HOSPITAL BISHOP INYO

26 OSHPD FACILITY CODES Sorted by Hospital (JAN 2018) CPQCC Centers Indicated in Bold Italics OSHPD # HOSPITAL NAME CITY COUNTY NORTHRIDGE HOSPITAL MEDICAL CENTER NORTHRIDGE LOS ANGELES NORWALK COMMUNITY HOSPITAL NORWALK LOS ANGELES NOT APPLICABLE NOVATO COMMUNITY HOSPITAL NOVATO MARIN O CONNOR HOSPITAL SAN JOSE SANTA CLARA OAK VALLEY HOSPITAL DISTRICT OAKDALE STANISLAUS OJAI VALLEY COMMUNITY HOSPITAL OJAI VENTURA OLIVE VIEW UCLA MEDICAL CENTER SYLMAR LOS ANGELES OLYMPIA MEDICAL CENTER LOS ANGELES LOS ANGELES ORANGE COAST MEMORIAL MEDICAL CENTER FOUNTAIN VALLEY ORANGE ORANGE COUNTY GLOBAL MEDICAL CENTER SANTA ANA ORANGE ORCHARD HOSPITAL GRIDLEY BUTTE OROVILLE HOSPITAL OROVILLE BUTTE OUT OF STATE - CLINIC OUT OF STATE - EMERGENCY ROOM OUT OF STATE - HOME BIRTH OUT OF STATE - MD OFFICE OUT OF STATE - OTHER IN/PATIENT SETTING OUT OF STATE - OTHER OUT/PATIENT SETTING PACIFICA HOSPITAL OF THE VALLEY SUN VALLEY LOS ANGELES PALM DRIVE HOSPITAL SEBASTOPOL SONOMA PALMDALE REGIONAL MEDICAL CENTER PALMDALE LOS ANGELES PALO VERDE HOSPITAL BLYTHE RIVERSIDE PALOMAR MEDICAL CENTER ESCONDIDO SAN DIEGO PALOMAR MEDICAL CENTER POWAY SAN DIEGO PARADISE VALLEY HOSPITAL NATIONAL CITY SAN DIEGO PARKVIEW COMMUNITY HOSPITAL RIVERSIDE RIVERSIDE PATIENTS' HOSPITAL OF REDDING REDDING SHASTA PETALUMA VALLEY HOSPITAL PETALUMA SONOMA PIH HEALTH HOSPITAL - WHITTIER WHITTIER LOS ANGELES PIH HOSPITAL - DOWNEY DOWNEY LOS ANGELES PIONEERS MEMORIAL HEALTHCARE DISTRICT BRAWLEY IMPERIAL PLACENTIA LINDA HOSPITAL PLACENTIA ORANGE PLUMAS DISTRICT HOSPITAL QUINCY PLUMAS POMONA VALLEY HOSPITAL MEDICAL CENTER POMONA LOS ANGELES PORTERVILLE DEVELOPMENTAL CENTER PORTERVILLE TULARE PROMISE HOSPITAL OF EAST LOS ANGELES-EAST L.A. CAMPUS LOS ANGELES LOS ANGELES PROMISE HOSPITAL OF EAST LOS ANGELES-SUBURBAN CAMPUS PARAMOUNT LOS ANGELES PROVIDENCE HOLY CROSS MEDICAL CENTER MISSION HILLS LOS ANGELES PROVIDENCE LITTLE COMPANY OF MARY MC - SAN PEDRO SAN PEDRO LOS ANGELES PROVIDENCE LITTLE COMPANY OF MARY MEDICAL CENTER - TORRANCE TORRANCE LOS ANGELES PROVIDENCE LITTLE COMPANY OF MARY MEDICAL CENTER - TORRANCE TORRANCE LOS ANGELES

27 OSHPD FACILITY CODES Sorted by Hospital (JAN 2018) CPQCC Centers Indicated in Bold Italics OSHPD # HOSPITAL NAME CITY COUNTY PROVIDENCE ST. JOSEPH MEDICAL CENTER BURBANK LOS ANGELES PROVIDENCE TARZANA MEDICAL CENTER TARZANA LOS ANGELES QUEEN OF THE VALLEY HOSPITAL - NAPA NAPA NAPA RADY CHILDREN'S AT SCRIPPS MERCY HOSPITAL SAN DIEGO (RCHSD) SAN DIEGO SAN DIEGO RADY CHILDREN'S AT SCRIPPS MERCY HOSPITAL CHULA VISTA (RCHSD) CHULA VISTA SAN DIEGO RADY CHILDREN S AT PALOMAR MEDICAL CENTER ESCONDIDO ESCONDIDO SAN DIEGO RADY CHILDREN S AT RANCHO SPRINGS (RCHSD) MURRIETA RIVERSIDE RADY CHILDREN S AT SCRIPPS MEMORIAL HOSPITAL ENCINITAS (RCHSD) RADY CHILDREN S AT SCRIPPS MEMORIAL HOSPITAL LA JOLLA (RCHSD) ENCINITAS LA JOLLA SAN DIEGO SAN DIEGO RADY CHILDREN S HOSPITAL SAN DIEGO (RCHSD) SAN DIEGO SAN DIEGO REDLANDS COMMUNITY HOSPITAL REDLANDS SAN BERNARDINO REDWOOD MEMORIAL HOSPITAL FORTUNA HUMBOLDT REGIONAL MEDICAL CENTER OF SAN JOSE SAN JOSE SANTA CLARA RIDEOUT MEMORIAL HOSPITAL MARYSVILLE YUBA RIDGECREST REGIONAL HOSPITAL RIDGECREST KERN RIVERSIDE COMMUNITY HOSPITAL RIVERSIDE RIVERSIDE RIVERSIDE UNIVERSAL HEALTH SYSTEM MEDICAL CENTER MORENO VALLEY RIVERSIDE ROGUE REGIONAL MEDICAL CENTER MEDFORD SADDLEBACK MEMORIAL HOSPITAL LAGUNA HILLS ORANGE SADDLEBACK MEMORIAL MEDICAL CENTER - SAN CLEMENTE SAN CLEMENTE ORANGE SAFE SURRENDER SALINAS VALLEY MEMORIAL HOSPITAL SALINAS MONTEREY SAN ANTONIO REGIONAL HOSPITAL UPLAND SAN BERNARDINO SAN DIMAS COMMUNITY HOSPITAL SAN DIMAS LOS ANGELES SAN GABRIEL VALLEY MEDICAL CENTER SAN GABRIEL LOS ANGELES SAN GORGONIO MEMORIAL HOSPITAL BANNING RIVERSIDE SAN JOAQUIN COMMUNITY HOSPITAL BAKERSFIELD KERN SAN JOAQUIN GENERAL HOSPITAL FRENCH CAMP SAN JOAQUIN SAN JOAQUIN VALLEY REHABILITATION HOSPITAL FRESNO FRESNO SAN LEANDRO HOSPITAL SAN LEANDRO ALAMEDA SAN MATEO MEDICAL CENTER SAN MATEO SAN MATEO SAN RAMON REGIONAL MEDICAL CENTER SAN RAMON CONTRA COSTA SAN RAMON REGIONAL MEDICAL CENTER SOUTH BUILDING SAN RAMON CONTRA COSTA SANTA CLARA VALLEY MEDICAL CENTER (SCVMC) SAN JOSE SANTA CLARA SANTA MONICA-UCLA MEDICAL CENTER & ORTHOPEDIC HOSPITAL SANTA MONICA LOS ANGELES SANTA ROSA MEMORIAL HOSPITAL SANTA ROSA SONOMA SANTA ROSA MEMORIAL HOSPITAL-SOTOYOME SANTA ROSA SONOMA SANTA YNEZ VALLEY COTTAGE HOSPITAL SOLVANG SANTA BARBARA

28 OSHPD FACILITY CODES Sorted by Hospital (JAN 2018) CPQCC Centers Indicated in Bold Italics OSHPD # HOSPITAL NAME CITY COUNTY SCRIPPS GREEN HOSPITAL LA JOLLA SAN DIEGO SENECA HEALTHCARE DISTRICT CHESTER PLUMAS SETON COASTSIDE MOSS BEACH SAN MATEO SETON MEDICAL CENTER DALY CITY SAN MATEO SHARP CHULA VISTA MEDICAL CENTER CHULA VISTA SAN DIEGO SHARP CORONADO HOSPITAL AND HEALTHCARE CENTER CORONADO SAN DIEGO SHARP GROSSMONT HOSPITAL, WOMEN S HEALTH CENTER LA MESA SAN DIEGO SHARP MARY BIRCH HOSPITAL FOR WOMEN SAN DIEGO SAN DIEGO SHARP MEMORIAL HOSPITAL SAN DIEGO SAN DIEGO SHASTA REGIONAL MEDICAL CENTER REDDING SHASTA SHERMAN OAKS HOSPITAL SHERMAN OAKS LOS ANGELES SHRINERS HOSPITAL FOR CHILDREN LOS ANGELES LOS ANGELES SHRINERS HOSPITALS FOR CHILDREN NORTHERN CALIF. SACRAMENTO SACRAMENTO SIERRA NEVADA MEMORIAL HOSPITAL GRASS VALLEY NEVADA SIERRA VIEW MEDICAL CENTER PORTERVILLE TULARE SIERRA VISTA HOSPITAL SACRAMENTO SACRAMENTO SIERRA VISTA REGIONAL MEDICAL CENTER SAN LUIS OBISPO SAN LUIS OBISPO SILAS B. HAYS ARMY HOSPITAL SILVER LAKE MEDICAL CENTER-DOWNTOWN CAMPUS LOS ANGELES LOS ANGELES SILVER LAKE MEDICAL CENTER-INGLESIDE CAMPUS ROSEMEAD LOS ANGELES SIMI VALLEY HOSPITAL AND HEALTH CARE SVCS-SYCAMORE SIMI VALLEY VENTURA SONOMA DEVELOPMENTAL CENTER ELDRIDGE SONOMA SONOMA VALLEY HOSPITAL SONOMA SONOMA SONORA REGIONAL MEDICAL CENTER - GREENLEY SONORA TUOLUMNE SOUTHERN CALIFORNIA HOSPITAL AT CULVER CITY CULVER CITY LOS ANGELES SOUTHERN CALIFORNIA HOSPITAL AT HOLLYWOOD HOLLYWOOD LOS ANGELES SOUTHERN INYO HOSPITAL LONE PINE INYO SOUTHWEST HEALTHCARE SYSTEM-WILDOMAR WILDOMAR RIVERSIDE ST. BERNARDINE MEDICAL CENTER SAN BERNARDINO SAN BERNARDINO ST. ELIZABETH COMMUNITY HOSPITAL RED BLUFF TEHAMA ST. FRANCIS MEDICAL CENTER LYNWOOD LOS ANGELES ST. FRANCIS MEMORIAL HOSPITAL SAN FRANCISCO SAN FRANCISCO ST. HELENA HOSPITAL ST. HELENA NAPA ST. HELENA HOSPITAL - CLEARLAKE CLEARLAKE LAKE ST. JOHN'S PLEASANT VALLEY HOSPITAL CAMARILLO VENTURA ST. JOHN S HEALTH CENTER SANTA MONICA LOS ANGELES ST. JOHN S REGIONAL MEDICAL CENTER OXNARD VENTURA ST. JOSEPH HOSPITAL - EUREKA EUREKA HUMBOLDT ST. JOSEPH HOSPITAL - ORANGE ORANGE ORANGE ST. JOSEPH S MEDICAL CENTER, STOCKTON STOCKTON SAN JOAQUIN ST. JUDE MEDICAL CENTER FULLERTON ORANGE ST. LOUISE REGIONAL HOSPITAL GILROY SANTA CLARA ST. MARY MEDICAL CENTER LONG BEACH LOS ANGELES

29 OSHPD FACILITY CODES Sorted by Hospital (JAN 2018) CPQCC Centers Indicated in Bold Italics OSHPD # HOSPITAL NAME CITY COUNTY ST. MARY MEDICAL CENTER IN APPLE VALLEY APPLE VALLEY SAN BERNARDINO ST. MARY'S MEDICAL CENTER, SAN FRANCISCO SAN FRANCISCO SAN FRANCISCO ST. ROSE HOSPITAL HAYWARD ALAMEDA ST. VINCENT MEDICAL CENTER LOS ANGELES LOS ANGELES STANFORD HEALTH CARE PALO ALTO SANTA CLARA SURPRISE VALLEY COMMUNITY HOSPITAL CEDARVILLE MODOC SUTTER AMADOR HOSPITAL JACKSON AMADOR SUTTER AUBURN FAITH HOSPITAL AUBURN PLACER SUTTER COAST HOSPITAL CRESCENT CITY DEL NORTE SUTTER DAVIS HOSPITAL DAVIS YOLO SUTTER DELTA MEDICAL CENTER ANTIOCH CONTRA COSTA SUTTER GENERAL HOSPITAL SACRAMENTO SACRAMENTO SUTTER LAKESIDE HOSPITAL LAKEPORT LAKE SUTTER MATERNITY AND SURGERY CENTER OF SANTA CRUZ SANTA CRUZ SANTA CRUZ SUTTER ROSEVILLE MEDICAL CENTER ROSEVILLE PLACER SUTTER SANTA ROSA REGIONAL HOSPITAL SANTA ROSA SONOMA SUTTER SOLANO MEDICAL CENTER VALLEJO SOLANO SUTTER TRACY COMMUNITY HOSPITAL TRACY SAN JOAQUIN TAHOE FOREST HOSPITAL TRUCKEE NEVADA TEMECULA VALLEY HOSPITAL TEMECULA RIVERSIDE TORRANCE MEMORIAL MEDICAL CENTER TORRANCE LOS ANGELES TRI-CITY MEDICAL CENTER OCEANSIDE SAN DIEGO TRINITY HOSPITAL WEAVERVILLE TRINITY TULARE REGIONAL MEDICAL CENTER TULARE TULARE TWIN CITIES COMMUNITY HOSPITAL TEMPLETON SAN LUIS OBISPO UCLA MATTEL CHILDREN'S HOSPITAL LOS ANGELES LOS ANGELES UCSD-LA JOLLA, JOHN M/SALLY B THORNTON HOSP & SULPIZO CARDIO LA JOLLA SAN DIEGO UCSF BENIOFF CHILDREN'S HOSPTIAL - OAKLAND OAKLAND ALAMEDA UCSF BENIOFF CHILDREN'S HOSPTIAL - SAN FRANCISCO SAN FRANCISCO SAN FRANCISCO UKIAH VALLEY MEDICAL CENTER UKIAH MENDOCINO UNIVERSITY OF CALIFORNIA, DAVIS CHILDREN S HOSPITAL (UCD) SACRAMENTO SACRAMENTO UNIVERSITY OF CALIFORNIA, IRVINE MEDICAL CENTER (UCI) ORANGE ORANGE UNIVERSITY OF CALIFORNIA, SAN DIEGO MEDICAL CENTER (UCSDSAN DIEGO SAN DIEGO UNKNOWN US ARMY AIR FORCE HOSPITAL US LEWIS MEMORIAL HOSPITAL USAF HOSPITAL - MARYSVILLE USAF HOSPITAL: 83RD MEDICAL GRO USAF HOSPITAL: 93RD STRATEGIC USAF HOSPITAL: MATHER USC VERDUGO HILLS HOSPITAL GLENDALE LOS ANGELES VALLEY CHILDREN'S HOSPITAL MADERA MADERA VALLEY CHILDREN'S HOSPITAL - ST. AGNES HOSPITAL FRESNO FRESNO

30 OSHPD OTHER CODES --- Sorted by OSHPD (JAN 2018) CPQCC Centers Indicated in Bold Italics OSHPD # HOSPITAL NAME NOT APPLICABLE OUT OF STATE - HOME BIRTH OUT OF STATE - OTHER OUT/PATIENT SETTING OUT OF STATE - MD OFFICE OUT OF STATE - CLINIC OUT OF STATE - EMERGENCY ROOM OUT OF STATE - OTHER IN/PATIENT SETTING CALIFORNIA - HOME BIRTH CALIFORNIA - OTHER OUT/PATIENT SETTING CALIFORNIA - MD OFFICE CALIFORNIA - CLINIC CALIFORNIA - EMERGENCY ROOM CALIFORNIA - OTHER IN/PATIENT SETTING SAFE SURRENDER UNKNOWN

31 OSHPD FACILITY CODES Sorted by Hospital (JAN 2018) CPQCC Centers Indicated in Bold Italics OSHPD # HOSPITAL NAME CITY COUNTY VALLEY MEMORIAL HOSPITAL LIVERMORE ALAMEDA VALLEY PRESBYTERIAN HOSPITAL VAN NUYS LOS ANGELES VALLEYCARE MEDICAL CENTER PLEASANTON ALAMEDA VENTURA COUNTY MEDICAL CENTER - SANTA PAULA HOSPITAL SANTA PAULA VENTURA VENTURA COUNTY MEDICAL CENTER (VCMC) VENTURA VENTURA VIBRA HOSPITAL OF NORTHERN CALIFORNIA REDDING SHASTA VIBRA HOSPITAL OF SACRAMENTO FOLSOM SACRAMENTO VIBRA HOSPITAL OF SAN DIEGO SAN DIEGO SAN DIEGO VICTOR VALLEY GLOBAL MEDICAL CENTER VICTORVILLE SAN BERNARDINO WASHINGTON HOSPITAL HEALTHCARE SYSTEM - FREMONT FREMONT ALAMEDA WATSONVILLE COMMUNITY HOSPITAL WATSONVILLE SANTA CRUZ WEED ARMY COMMUNITY HOSPITAL WEST ANAHEIM MEDICAL CENTER ANAHEIM ORANGE WEST COVINA MEDICAL CENTER WEST COVINA LOS ANGELES WEST HILLS HOSPITAL AND MEDICAL CENTER CANOGA PARK LOS ANGELES WESTERN MEDICAL CENTER ANAHEIM ANAHEIM ORANGE WHITE MEMORIAL MEDICAL CENTER LOS ANGELES LOS ANGELES WHITTIER HOSPITAL MEDICAL CENTER WHITTIER LOS ANGELES WOODLAND MEMORIAL HOSPITAL WOODLAND YOLO ZUCKERBERG SAN FRANCISCO GENERAL HOSPITAL AND TRAUMA CENTER SAN FRANCISCO SAN FRANCISCO

32 Appendix H - Calculation Charts for Date of Day 28 ã 2018 CPQCC, Stanford University

33 CALCULATION CHARTS FOR DATE OF DAY 28 IN 2018 Jan DOB DAY28 Feb DOB DAY28 Mar DOB DAY28 Apr DOB DAY28 May DOB DAY28 Jun DOB DAY28 01/01/18 01/28/18 02/01/18 02/28/18 03/01/18 03/28/18 04/01/18 04/28/18 05/01/18 05/28/18 06/01/18 06/28/18 01/02/18 01/29/18 02/02/18 03/01/18 03/02/18 03/29/18 04/02/18 04/29/18 05/02/18 05/29/18 06/02/18 06/29/18 01/03/18 01/30/18 02/03/18 03/02/18 03/03/18 03/30/18 04/03/18 04/30/18 05/03/18 05/30/18 06/03/18 06/30/18 01/04/18 01/31/18 02/04/18 03/03/18 03/04/18 03/31/18 04/04/18 05/01/18 05/04/18 05/31/18 06/04/18 07/01/18 01/05/18 02/01/18 02/05/18 03/04/18 03/05/18 04/01/18 04/05/18 05/02/18 05/05/18 06/01/18 06/05/18 07/02/18 01/06/18 02/02/18 02/06/18 03/05/18 03/06/18 04/02/18 04/06/18 05/03/18 05/06/18 06/02/18 06/06/18 07/03/18 01/07/18 02/03/18 02/07/18 03/06/18 03/07/18 04/03/18 04/07/18 05/04/18 05/07/18 06/03/18 06/07/18 07/04/18 01/08/18 02/04/18 02/08/18 03/07/18 03/08/18 04/04/18 04/08/18 05/05/18 05/08/18 06/04/18 06/08/18 07/05/18 01/09/18 02/05/18 02/09/18 03/08/18 03/09/18 04/05/18 04/09/18 05/06/18 05/09/18 06/05/18 06/09/18 07/06/18 01/10/18 02/06/18 02/10/18 03/09/18 03/10/18 04/06/18 04/10/18 05/07/18 05/10/18 06/06/18 06/10/18 07/07/18 01/11/18 02/07/18 02/11/18 03/10/18 03/11/18 04/07/18 04/11/18 05/08/18 05/11/18 06/07/18 06/11/18 07/08/18 01/12/18 02/08/18 02/12/18 03/11/18 03/12/18 04/08/18 04/12/18 05/09/18 05/12/18 06/08/18 06/12/18 07/09/18 01/13/18 02/09/18 02/13/18 03/12/18 03/13/18 04/09/18 04/13/18 05/10/18 05/13/18 06/09/18 06/13/18 07/10/18 01/14/18 02/10/18 02/14/18 03/13/18 03/14/18 04/10/18 04/14/18 05/11/18 05/14/18 06/10/18 06/14/18 07/11/18 01/15/18 02/11/18 02/15/18 03/14/18 03/15/18 04/11/18 04/15/18 05/12/18 05/15/18 06/11/18 06/15/18 07/12/18 01/16/18 02/12/18 02/16/18 03/15/18 03/16/18 04/12/18 04/16/18 05/13/18 05/16/18 06/12/18 06/16/18 07/13/18 01/17/18 02/13/18 02/17/18 03/16/18 03/17/18 04/13/18 04/17/18 05/14/18 05/17/18 06/13/18 06/17/18 07/14/18 01/18/18 02/14/18 02/18/18 03/17/18 03/18/18 04/14/18 04/18/18 05/15/18 05/18/18 06/14/18 06/18/18 07/15/18 01/19/18 02/15/18 02/19/18 03/18/18 03/19/18 04/15/18 04/19/18 05/16/18 05/19/18 06/15/18 06/19/18 07/16/18 01/20/18 02/16/18 02/20/18 03/19/18 03/20/18 04/16/18 04/20/18 05/17/18 05/20/18 06/16/18 06/20/18 07/17/18 01/21/18 02/17/18 02/21/18 03/20/18 03/21/18 04/17/18 04/21/18 05/18/18 05/21/18 06/17/18 06/21/18 07/18/18 01/22/18 02/18/18 02/22/18 03/21/18 03/22/18 04/18/18 04/22/18 05/19/18 05/22/18 06/18/18 06/22/18 07/19/18 01/23/18 02/19/18 02/23/18 03/22/18 03/23/18 04/19/18 04/23/18 05/20/18 05/23/18 06/19/18 06/23/18 07/20/18 01/24/18 02/20/18 02/24/18 03/23/18 03/24/18 04/20/18 04/24/18 05/21/18 05/24/18 06/20/18 06/24/18 07/21/18 01/25/18 02/21/18 02/25/18 03/24/18 03/25/18 04/21/18 04/25/18 05/22/18 05/25/18 06/21/18 06/25/18 07/22/18 01/26/18 02/22/18 02/26/18 03/25/18 03/26/18 04/22/18 04/26/18 05/23/18 05/26/18 06/22/18 06/26/18 07/23/18 01/27/18 02/23/18 02/27/18 03/26/18 03/27/18 04/23/18 04/27/18 05/24/18 05/27/18 06/23/18 06/27/18 07/24/18 01/28/18 02/24/18 02/28/18 03/27/18 03/28/18 04/24/18 04/28/18 05/25/18 05/28/18 06/24/18 06/28/18 07/25/18 01/29/18 02/25/18 03/29/18 04/25/18 04/29/18 05/26/18 05/29/18 06/25/18 06/29/18 07/26/18 01/30/18 02/26/18 03/30/18 04/26/18 04/30/18 05/27/18 05/30/18 06/26/18 06/30/18 07/27/18 01/31/18 02/27/18 03/31/18 04/27/18 05/31/18 06/27/18 To use this chart: Find the Date of Birth in the month column. The correctly calculated Date of Day 28 is to the right of the Date of Birth. Example: If the Date of Birth is 4/23/18, then the Date of Day 28 is 5/20/18.

34 CALCULATION CHARTS FOR DATE OF DAY 28 IN 2018 July DOB DAY28 Aug DOB DAY28 Sept DOB DAY28 Oct DOB DAY28 Nov DOB DAY28 Dec DOB DAY28 07/01/18 07/28/18 08/01/18 08/28/18 09/01/18 09/28/18 10/01/18 10/28/18 11/01/18 11/28/18 12/01/18 12/28/18 07/02/18 07/29/18 08/02/18 08/29/18 09/02/18 09/29/18 10/02/18 10/29/18 11/02/18 11/29/18 12/02/18 12/29/18 07/03/18 07/30/18 08/03/18 08/30/18 09/03/18 09/30/18 10/03/18 10/30/18 11/03/18 11/30/18 12/03/18 12/30/18 07/04/18 07/31/18 08/04/18 08/31/18 09/04/18 10/01/18 10/04/18 10/31/18 11/04/18 12/01/18 12/04/18 12/31/18 07/05/18 08/01/18 08/05/18 09/01/18 09/05/18 10/02/18 10/05/18 11/01/18 11/05/18 12/02/18 12/05/18 01/01/19 07/06/18 08/02/18 08/06/18 09/02/18 09/06/18 10/03/18 10/06/18 11/02/18 11/06/18 12/03/18 12/06/18 01/02/19 07/07/18 08/03/18 08/07/18 09/03/18 09/07/18 10/04/18 10/07/18 11/03/18 11/07/18 12/04/18 12/07/18 01/03/19 07/08/18 08/04/18 08/08/18 09/04/18 09/08/18 10/05/18 10/08/18 11/04/18 11/08/18 12/05/18 12/08/18 01/04/19 07/09/18 08/05/18 08/09/18 09/05/18 09/09/18 10/06/18 10/09/18 11/05/18 11/09/18 12/06/18 12/09/18 01/05/19 07/10/18 08/06/18 08/10/18 09/06/18 09/10/18 10/07/18 10/10/18 11/06/18 11/10/18 12/07/18 12/10/18 01/06/19 07/11/18 08/07/18 08/11/18 09/07/18 09/11/18 10/08/18 10/11/18 11/07/18 11/11/18 12/08/18 12/11/18 01/07/19 07/12/18 08/08/18 08/12/18 09/08/18 09/12/18 10/09/18 10/12/18 11/08/18 11/12/18 12/09/18 12/12/18 01/08/19 07/13/18 08/09/18 08/13/18 09/09/18 09/13/18 10/10/18 10/13/18 11/09/18 11/13/18 12/10/18 12/13/18 01/09/19 07/14/18 08/10/18 08/14/18 09/10/18 09/14/18 10/11/18 10/14/18 11/10/18 11/14/18 12/11/18 12/14/18 01/10/19 07/15/18 08/11/18 08/15/18 09/11/18 09/15/18 10/12/18 10/15/18 11/11/18 11/15/18 12/12/18 12/15/18 01/11/19 07/16/18 08/12/18 08/16/18 09/12/18 09/16/18 10/13/18 10/16/18 11/12/18 11/16/18 12/13/18 12/16/18 01/12/19 07/17/18 08/13/18 08/17/18 09/13/18 09/17/18 10/14/18 10/17/18 11/13/18 11/17/18 12/14/18 12/17/18 01/13/19 07/18/18 08/14/18 08/18/18 09/14/18 09/18/18 10/15/18 10/18/18 11/14/18 11/18/18 12/15/18 12/18/18 01/14/19 07/19/18 08/15/18 08/19/18 09/15/18 09/19/18 10/16/18 10/19/18 11/15/18 11/19/18 12/16/18 12/19/18 01/15/19 07/20/18 08/16/18 08/20/18 09/16/18 09/20/18 10/17/18 10/20/18 11/16/18 11/20/18 12/17/18 12/20/18 01/16/19 07/21/18 08/17/18 08/21/18 09/17/18 09/21/18 10/18/18 10/21/18 11/17/18 11/21/18 12/18/18 12/21/18 01/17/19 07/22/18 08/18/18 08/22/18 09/18/18 09/22/18 10/19/18 10/22/18 11/18/18 11/22/18 12/19/18 12/22/18 01/18/19 07/23/18 08/19/18 08/23/18 09/19/18 09/23/18 10/20/18 10/23/18 11/19/18 11/23/18 12/20/18 12/23/18 01/19/19 07/24/18 08/20/18 08/24/18 09/20/18 09/24/18 10/21/18 10/24/18 11/20/18 11/24/18 12/21/18 12/24/18 01/20/19 07/25/18 08/21/18 08/25/18 09/21/18 09/25/18 10/22/18 10/25/18 11/21/18 11/25/18 12/22/18 12/25/18 01/21/19 07/26/18 08/22/18 08/26/18 09/22/18 09/26/18 10/23/18 10/26/18 11/22/18 11/26/18 12/23/18 12/26/18 01/22/19 07/27/18 08/23/18 08/27/18 09/23/18 09/27/18 10/24/18 10/27/18 11/23/18 11/27/18 12/24/18 12/27/18 01/23/19 07/28/18 08/24/18 08/28/18 09/24/18 09/28/18 10/25/18 10/28/18 11/24/18 11/28/18 12/25/18 12/28/18 01/24/19 07/29/18 08/25/18 08/29/18 09/25/18 09/29/18 10/26/18 10/29/18 11/25/18 11/29/18 12/26/18 12/29/18 01/25/19 07/30/18 08/26/18 08/30/18 09/26/18 09/30/18 10/27/18 10/30/18 11/26/18 11/30/18 12/27/18 12/30/18 01/26/19 07/31/18 08/27/18 08/31/18 09/27/18 10/31/18 11/27/18 12/31/18 01/27/19 To use this chart: Find the Date of Birth in the month column. The correctly calculated Date of Day 28 is to the right of the Date of Birth. Example: If the Date of Birth is 4/23/18, then the Date of Day 28 is 5/20/18.

35 Appendix I - Calculation Charts for Date of Week 36 (Please use new calculator tool) ã 2018 CPQCC, Stanford University

36 Appendix J - Day Number Chart ã 2018 CPQCC, Stanford University

37 DAY NUMBER CHART FOR CALCULATING LENGTH OF STAY FOR INFANTS BORN IN 2018 DATE DAY # DATE DAY # DATE DAY # January 1, February 1, March 1, January 2, February 2, March 2, January 3, February 3, March 3, January 4, February 4, March 4, January 5, February 5, March 5, January 6, February 6, March 6, January 7, February 7, March 7, January 8, February 8, March 8, January 9, February 9, March 9, January 10, February 10, March 10, January 11, February 11, March 11, January 12, February 12, March 12, January 13, February 13, March 13, January 14, February 14, March 14, January 15, February 15, March 15, January 16, February 16, March 16, January 17, February 17, March 17, January 18, February 18, March 18, January 19, February 19, March 19, January 20, February 20, March 20, January 21, February 21, March 21, January 22, February 22, March 22, January 23, February 23, March 23, January 24, February 24, March 24, January 25, February 25, March 25, January 26, February 26, March 26, January 27, February 27, March 27, January 28, February 28, March 28, January 29, March 29, January 30, March 30, January 31, March 31,

38 DAY NUMBER CHART FOR CALCULATING LENGTH OF STAY FOR INFANTS BORN IN 2018 DATE DAY # DATE DAY # DATE DAY # April 1, May 1, June 1, April 2, May 2, June 2, April 3, May 3, June 3, April 4, May 4, June 4, April 5, May 5, June 5, April 6, May 6, June 6, April 7, May 7, June 7, April 8, May 8, June 8, April 9, May 9, June 9, April 10, May 10, June 10, April 11, May 11, June 11, April 12, May 12, June 12, April 13, May 13, June 13, April 14, May 14, June 14, April 15, May 15, June 15, April 16, May 16, June 16, April 17, May 17, June 17, April 18, May 18, June 18, April 19, May 19, June 19, April 20, May 20, June 20, April 21, May 21, June 21, April 22, May 22, June 22, April 23, May 23, June 23, April 24, May 24, June 24, April 25, May 25, June 25, April 26, May 26, June 26, April 27, May 27, June 27, April 28, May 28, June 28, April 29, May 29, June 29, April 30, May 30, June 30, May 31,

39 DAY NUMBER CHART FOR CALCULATING LENGTH OF STAY FOR INFANTS BORN IN 2018 DATE DAY # DATE DAY # DATE DAY # July 1, August 1, September 1, July 2, August 2, September 2, July 3, August 3, September 3, July 4, August 4, September 4, July 5, August 5, September 5, July 6, August 6, September 6, July 7, August 7, September 7, July 8, August 8, September 8, July 9, August 9, September 9, July 10, August 10, September 10, July 11, August 11, September 11, July 12, August 12, September 12, July 13, August 13, September 13, July 14, August 14, September 14, July 15, August 15, September 15, July 16, August 16, September 16, July 17, August 17, September 17, July 18, August 18, September 18, July 19, August 19, September 19, July 20, August 20, September 20, July 21, August 21, September 21, July 22, August 22, September 22, July 23, August 23, September 23, July 24, August 24, September 24, July 25, August 25, September 25, July 26, August 26, September 26, July 27, August 27, September 27, July 28, August 28, September 28, July 29, August 29, September 29, July 30, August 30, September 30, July 31, August 31,

40 DAY NUMBER CHART FOR CALCULATING LENGTH OF STAY FOR INFANTS BORN IN 2018 DATE DAY # DATE DAY # DATE DAY # October 1, November 1, December 1, October 2, November 2, December 2, October 3, November 3, December 3, October 4, November 4, December 4, October 5, November 5, December 5, October 6, November 6, December 6, October 7, November 7, December 7, October 8, November 8, December 8, October 9, November 9, December 9, October 10, November 10, December 10, October 11, November 11, December 11, October 12, November 12, December 12, October 13, November 13, December 13, October 14, November 14, December 14, October 15, November 15, December 15, October 16, November 16, December 16, October 17, November 17, December 17, October 18, November 18, December 18, October 19, November 19, December 19, October 20, November 20, December 20, October 21, November 21, December 21, October 22, November 22, December 22, October 23, November 23, December 23, October 24, November 24, December 24, October 25, November 25, December 25, October 26, November 26, December 26, October 27, November 27, December 27, October 28, November 28, December 28, October 29, November 29, December 29, October 30, November 30, December 30, October 31, December 31,

41 DAY NUMBER CHART FOR CALCULATING LENGTH OF STAY FOR INFANTS BORN IN 2018 DATE DAY # DATE DAY # DATE DAY # January 1, February 1, March 1, January 2, February 2, March 2, January 3, February 3, March 3, January 4, February 4, March 4, January 5, February 5, March 5, January 6, February 6, March 6, January 7, February 7, March 7, January 8, February 8, March 8, January 9, February 9, March 9, January 10, February 10, March 10, January 11, February 11, March 11, January 12, February 12, March 12, January 13, February 13, March 13, January 14, February 14, March 14, January 15, February 15, March 15, January 16, February 16, March 16, January 17, February 17, March 17, January 18, February 18, March 18, January 19, February 19, March 19, January 20, February 20, March 20, January 21, February 21, March 21, January 22, February 22, March 22, January 23, February 23, March 23, January 24, February 24, March 24, January 25, February 25, March 25, January 26, February 26, March 26, January 27, February 27, March 27, January 28, February 28, March 28, January 29, March 29, January 30, March 30, January 31, March 31,

42 DAY NUMBER CHART FOR CALCULATING LENGTH OF STAY FOR INFANTS BORN IN 2018 DATE DAY # DATE DAY # DATE DAY # April 1, May 1, June 1, April 2, May 2, June 2, April 3, May 3, June 3, April 4, May 4, June 4, April 5, May 5, June 5, April 6, May 6, June 6, April 7, May 7, June 7, April 8, May 8, June 8, April 9, May 9, June 9, April 10, May 10, June 10, April 11, May 11, June 11, April 12, May 12, June 12, April 13, May 13, June 13, April 14, May 14, June 14, April 15, May 15, June 15, April 16, May 16, June 16, April 17, May 17, June 17, April 18, May 18, June 18, April 19, May 19, June 19, April 20, May 20, June 20, April 21, May 21, June 21, April 22, May 22, June 22, April 23, May 23, June 23, April 24, May 24, June 24, April 25, May 25, June 25, April 26, May 26, June 26, April 27, May 27, June 27, April 28, May 28, June 28, April 29, May 29, June 29, April 30, May 30, June 30, May 31,

43 DAY NUMBER CHART FOR CALCULATING LENGTH OF STAY FOR INFANTS BORN IN 2018 DATE DAY # DATE DAY # DATE DAY # July 1, August 1, September 1, July 2, August 2, September 2, July 3, August 3, September 3, July 4, August 4, September 4, July 5, August 5, September 5, July 6, August 6, September 6, July 7, August 7, September 7, July 8, August 8, September 8, July 9, August 9, September 9, July 10, August 10, September 10, July 11, August 11, September 11, July 12, August 12, September 12, July 13, August 13, September 13, July 14, August 14, September 14, July 15, August 15, September 15, July 16, August 16, September 16, July 17, August 17, September 17, July 18, August 18, September 18, July 19, August 19, September 19, July 20, August 20, September 20, July 21, August 21, September 21, July 22, August 22, September 22, July 23, August 23, September 23, July 24, August 24, September 24, July 25, August 25, September 25, July 26, August 26, September 26, July 27, August 27, September 27, July 28, August 28, September 28, July 29, August 29, September 29, July 30, August 30, September 30, July 31, August 31,

44 DAY NUMBER CHART FOR CALCULATING LENGTH OF STAY FOR INFANTS BORN IN 2018 DATE DAY # DATE DAY # DATE DAY # October 1, November 1, December 1, October 2, November 2, December 2, October 3, November 3, December 3, October 4, November 4, December 4, October 5, November 5, December 5, October 6, November 6, December 6, October 7, November 7, December 7, October 8, November 8, December 8, October 9, November 9, December 9, October 10, November 10, December 10, October 11, November 11, December 11, October 12, November 12, December 12, October 13, November 13, December 13, October 14, November 14, December 14, October 15, November 15, December 15, October 16, November 16, December 16, October 17, November 17, December 17, October 18, November 18, December 18, October 19, November 19, December 19, October 20, November 20, December 20, October 21, November 21, December 21, October 22, November 22, December 22, October 23, November 23, December 23, October 24, November 24, December 24, October 25, November 25, December 25, October 26, November 26, December 26, October 27, November 27, December 27, October 28, November 28, December 28, October 29, November 29, December 29, October 30, November 30, December 30, October 31, December 31,

45 Appendix K - Fahrenheit to Centigrade Conversion Table ã 2018 CPQCC, Stanford University

46 Fahrenheit to Centigrade Conversion Table Degrees Fahrenheit Degrees Centigrade Degrees Fahrenheit Degrees Centigrade Degrees Fahrenheit Degrees Centigrade Degrees Fahrenheit Degrees Centigrade Degrees Fahrenheit Degrees Centigrade

47 Appendix L - HRIF Medical Eligibility Criteria ã 2018 CPQCC, Stanford University

48 CCS HRIF PROGRAM MEDICAL ELIGIBILITY CRITERIA Data should be collected on infants/children under three years of age who meet California Children s Services (CCS) HRIF medical eligibility criteria and who met CCS medical eligibility criteria for Neonatal Intensive Care Unit (NICU) care OR had a CCS eligible medical condition at some time during their stay in a CCS- approved NICU, even if they were never a CCS client. Infants are medically eligible for the HRIF Program when the infant: Met CCS medical eligible criteria for NICU care, in a CCS Program- approved NICU, regardless of length of stay, (as per Number Letter , Medical Eligibility in a CCS Program- approved NICU or the most current N.L.). NOTE: Medical eligibility includes neonates who require direct admit to a CCS- approved PICU, who are never admitted to a CCS Program- approved NICU, but who otherwise meet all medical eligibility criteria for HRIF services. OR Had a CCS Program- eligible medical condition in a CCS Program- approved NICU, regardless of length of stay, even if they were never CCS Program Clients during their stay, (as per California Code of Regulations, Title 22, Section through , CCS Program Medical Eligibility Regulations). AND MET ONE OF THE FOLLOWING: UPDATED 01/2017 Birth weight 1500 grams or the gestational age at birth < 32 weeks. HRIF Program Referral Process: Communication is between the CCS Program- approved NICU and HRIF Program. 1. The discharging/referring NICU/Hospital will refer eligible infants to the HRIF Program at the time of discharge to home, and complete the Referral/Registration (RR) Form via the web- based HRIF- QCI Reporting System. 2. The discharging/referring NICU/Hospital or HRIF Program will submit a Service Authorization Request (SAR) to the local CCS Office for HRIF Services. (Service Code Group [SCG] 06, should be requested). ols.aspx 3. The discharging/referring NICU/Hospital will send a copy of the Discharge Summary to the HRIF Program. OR Medical eligibility for the HRIF Program is determined by the County CCS Program or Regional Office staff. The CCS Program is also required to determine residential eligibility. As the HRIF Program is a diagnostic service, there is no financial eligibility determination performed at the time of referral to CCS. However, insurance information shall be obtained by CCS. An infant or child is eligible for the HRIF Program from birth up to 3 years of age. Birth weight > 1500 grams and the gestational age at birth 32 weeks and one of the following criteria was met during the NICU stay: 1. ph less than 7.0 on an umbilical blood sample or a blood gas obtained within one hour of life) or an Apgar score of less than or equal to three at five minutes or an Apgar score less than 5 at 10 minutes. 2. An unstable infant manifested by hypoxia, acidemia, hypoglycemia and/or hypotension requiring pressor support. 3. Persistent apnea which required caffeine or other simulant medication for the treatment of apnea at discharge. 4. Required oxygen for more than 28 days of hospital stay and had radiographic finding consistent with chronic lung disease (CLD). 5. Infants placed on extracorporeal membrane oxygenation (ECMO). 6. Infants who received inhaled nitric oxide greater than four hours, and/or treatment during hospitalization with sildenafil or other pulmonary vasodilatory medications for pulmonary hypertension. 7. Congenital heart disease requiring surgery or minimally invasive intervention. 8. History of observed clinical or electroencephalograhic (EEG) seizure activity or receiving antiepileptic medication(s) at time of discharge. 9. Evidence of intracranial pathology, including but not limited to, intracranial hemorrhage (grade II or worse), white matter injury including periventricular leukomalacia (PVL), cerebral thrombosis, cerebral infarction or stroke, congenital structural central nervous system (CNS) abnormality or other CNS problems associated with adverse neurologic outcome. 10. Clinical history and/or physical exam findings consistent with neonatal encephalopathy. 11. Other documented problems that could result in neurologic abnormality, such as: history of CNS infection, documented sepsis, bilirubin at excessive levels concerning for brain injury as determined by NICU medical staff, history of cardiovascular in stability as determined by NICU medical staff due to: sepsis, congential heart disease, patent ductus arteriosus (PDA), necrotizing enterocolitis, other documented conditions.

49 Appendix M - CPQCC Satellite NICU MEMO ã 2018 CPQCC, Stanford University

50 CPQCC Data Center CPQCC Satellite NICUs Version 16.1, April 28,

51 Dear CPQCC Participant, You are receiving this memo because you are one of the nine Satellite NICUs participating in CPQCC. We are addressing the special circumstances affecting Satellite NICUs and the implications for the CPQCC data collection and reporting. These changes were first introduced into the CPQCC Network Database on March 1, , and updated on April 16, , January 24, , March 3, and April 28, I. Satellite NICUs Definition Starting with the 2010 CPQCC Network Database, a Satellite NICU (or an Embedded NICU) is defined as a NICU owned and managed by one organization (Main NICU) located within a delivery facility owned and managed by another hospital (Co-Located Hospital). CPQCC uses OSHPD IDs to capture an infant s location: birth location (birthlocation, Item 7c and C.32), transport location (xferlocation, Item 59), hospital that discharged infant home (lasthospital, Item 52), referring location (T_referringHospital, Item C.30) and previous transport referring hospital (T_prevHospital, Item C.31). As for most Satellite NICUs, OSHPD reporting is consolidated with OSHPD reporting of the main NICU, Satellite NICUs typically do not have their own OSHPD ID. Starting in May 2012, in order to capture correct infant location variables we introduced fake OSHPD IDs for all Satellite NICUs in the CPQCC Manual of Definitions. 3 Note that we currently use fake OSHPD IDs for military hospitals, birthing centers that do not report to OSHPD and non-hospital or out-of-state hospital locations as well. 3 We continue to update this list according to member requests for the specific Satellite NICU setup or member requests for the addition of non-cpqcc member Satellite NICUs of their main NICU. 5 Table 1: CPQCC Satellite NICUs below shows for each of the 11 Satellite NICUs that are currently incorporated into the CPQCC data collection, the associated main NICU and the hospital where the Satellite is located. The location codes (OSHPD IDs or fake OSHPD IDs) are shown in parenthesis for each location

52 Table 1: CPQCC Satellite NICUs SATELLITE NICU MAIN NICU CO-LOCATED HOSPITAL Children s Hospital of Children s Hospital Mission Hospital Orange County (CHOC) of Orange County, Regional Medical at Mission (304113) CHCC (300032) Center (301262) Lucille Packard Children s Special Care Nursery at Sequoia Hospital, LPCH (750002) Lucille Packard Children s Special Care Nursery at Washington Hospital, LPCH (750003) Rady Children s Hospital San Diego at Scripps La Jolla (750005) Rady Children s Hospital San Diego at Scripps Encinitas (750004) Lucille Packard Children s Hospital at Stanford, LPCH (434040) Lucille Packard Children s Hospital at Stanford, LPCH (434040) Rady Children s Hospital San Diego (370673) Rady Children s Hospital San Diego (370673) Sequoia Hospital (410891) Washington Hospital Fremont (010987) Scripps Memorial Hospital La Jolla (370771) Scripps Memorial Hospital Encinitas (371394) COMMENTS This NICU is no longer owned by LPCH and is therefore no longer a Satellite. Rady Children s NICU at Palomar Medical Center (750006) Rady Children s NICU at Rancho Springs Medical Center in Murrieta (750007) 4 Rady Children s Hospital San Diego (370673) Rady Children s Hospital San Diego (370673) Palomar Medical Center (370755) Rancho Springs Medical Center in Murrieta (334068) - 3 -

53 SATELLITE NICU MAIN NICU CO-LOCATED HOSPITAL Rady Children s NICU at Rady Children s Scripps Mercy San Scripps Mercy San Diego Hospital San Diego Diego (750010) 5 (370673) COMMENTS New in 2016 Rady Children s NICU at Scripps Mercy Chula Vista (750011) 5 Rady Children s Hospital San Diego (370673) Scripps Mercy Chula Vista New in 2016 Valley Children s Hospital at St. Agnes Medical Center (750001) Children s Hospital Central California, CHCC (204019) St. Agnes Medical Center (100899) Valley Children s Hospital at Adventist Medical Center, Hanford (750008) 4 Valley Children s Hospital at Mercy Medical Center, Merced (750009) 5 Children s Hospital Central California, CHCC (204019) Children s Hospital Central California, CHCC (204019) Adventist Medical Center, Hanford (160787) Mercy Medical Center, Merced (240942) Non-CPQCC Member Non-CPQCC Member II. Coding Instructions in A. Item 7a. Location of Birth 1 1. Inborn Infant. For Satellite NICUs the Inborn option is not available. 2. Infant Born at Co-Located Hospital. Infants who are delivered at the Co-Located Hospital and then transferred to the Satellite NICU are considered infants Born at the Co-Located Hospital. Select Born at Co-Located Hospital (Satellite NICUs Only) from the drop-down box 5 if your center is a Satellite NICU and the infant was delivered in the Co-Located hospital. This includes any location within the Co-Located hospital, e.g., Labor & Delivery, Antepartum unit, - 4 -

54 Emergency Room. For non-satellite NICUs, the Infant born at Co-Located Hospital is not available. 3. Outborn Infant. Select Outborn if the infant was born in another facility OR at any location outside the Co-Located hospital OR home at any time after birth. Any infant requiring ambulance transport is considered Outborn. When completing the Admission/Discharge data forms for Outborn infants, use all information available from the hospital from which the infant was transported to your center as well as from your own center. Specifically: Outborn should always be used for an infant who was previously home. Infants who are delivered at the Main NICU and then transported to a Main NICU s Satellite NICU are considered Outborn infants for the Satellite NICU. Satellite NICU infants who are born at the Co-Located hospital are coded as follows: Item 7a. If a Satellite NICU is entering data for an infant born at the Co-Located Hospital who is then transferred to the Satellite NICU, code the infant as Born at Co-Located Hospital in Item 7a. Location of Birth. NOTE: For non-satellite NICUs the last option (Born at Co-Located Hospital) is not available; for Satellite NICUs the Inborn option is not available

55 Item 7b. For Small Babies, Item 7b. Age in Days at Admission to the Satellite NICU is set to 1. Item 7c. Once Born at Co-Located Hospital in Item 7a is selected, the system automatically sets Item 7c. Select the hospital of birth to the Co-Located Hospital s OSHPD ID number. The birth location is grayed out, and it cannot be changed by the Data Contact. B. CPeTS Form: Items C.30, C.31, 52 and 59 - OSHPD List 2, 4 After the initial system update that introduced revised data capture for Satellite NICUs, it was brought to our attention that Main NICUs wanted to be able to distinguish an infant that was transported to the Co-Located Hospital s Well-baby nursery FROM an infant that was transported to the Satellite NICU at the Co-Located Hospital. Prior to the systems update in January 2011, Data Contacts were instructed to use the OSHPD ID of the Co-Located Hospital regardless of the location of transport. Subsequently, we updated the hospital code list for the following Items: C.30, C.31, 52 and 59. Specifically, we used the fake OSHPD ID codes created for the Satellite NICUs (see Table 1: CPQCC Satellite NICUs). 5 This change did not affect the OSHPD list for the Birth Location (Items C.32 and 7C). Finally, note that the CPeTS form supports easy data entry of the referring location for infants born at a Co-Located hospital (see screenshot below)