PSRC Pulmonary Rehab Project
Please fill in the following information COMPLETELY for each patient. If you have any questions or problems, contact Tom Lamphere (PSRC Executive Director) via email at ExecutiveDirector@psrc.net or by phone at 215-687-2904. Thanks!
1. Hospital ID (given to you by Project Coordinator)
2. Patient ID Number (Do NOT Enter Any Names)
3. Patient Gender (Male / Female)
4. Age (at time of starting rehab)
5. Enter the number of ER admissions (using ER discharge or Hospital admission diagnosis) for respiratory related diagnosis in the 12 month period prior to starting date of Pulmonary Rehab Program.
6. Enter the number of HOSPITAL admissions for respiratory related diagnosis (using discharge diagnosis) in the 12 month period prior to starting date of Pulmonary Rehab Program.
7. Enter the number of ER admissions (using ER discharge or Hospital admission diagnosis) for respiratory related diagnosis in the 12 month period following graduation date of Pulmonary Rehab Program.
8. Enter the number of HOSPITAL admissions for respiratory related diagnosis (using discharge diagnosis) in the 12 month period following the graduation date from Pulmonary Rehab Program.
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