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Texas Hospital Questionnaire

1.In which county is the hospital facility located?(Required.)
2.For the county listed above, what is the population?(Required.)
3.How many beds is the hospital facility licensed for by the Texas Department of State Health Services (TxDSHS)?(Required.)
4.What is the average daily census for this hospital facility?(Required.)
5.How many of the licensed beds are designated ICU beds for this hospital facility?(Required.)
6.What is the average daily census for the ICU designated beds for this hospital facility?(Required.)
7.What is the average length of stay for patients admitted to this hospital facility?(Required.)
8.Is this hospital facility designated by the Centers for Medicare and Medicaid Services (CMS) as one of the following?(Required.)
9.Does this hospital facility's pharmacy hold an amended pharmacy license approved by the Texas State Board of Pharmacy (TSBP) allowing pharmacy technicians to perform certain duties without direct pharmacist supervision? (i.e., Rural Hospital Technician Program)(Required.)
10.Is prospective drug utilization review conducted by a pharmacist at this hospital facility?(Required.)
11.Please specify the number of hours per week that a pharmacist is available to conduct prospective drug utilization review.(Required.)
12.On average, within how many hours does a pharmacist perform a retrospective drug utilization review at your hospital facility?(Required.)
13.What electronic medical record system does this hospital facility use? (e.g. Cerner, Epic, Meditech)(Required.)
14.Is the hospital facility affiliated with a larger hospital system?(Required.)
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