Document
Medical Record Abstraction Form
ICR 201504-0920-005 · OMB 0920-1011 · Object 55211501.
This document may belong to an older filing. More recent activity for OMB 0920-1011:
Document Viewer [doc]
Status: The document is viewable, but some background extraction is still pending.
Queue: Repair is in progress, but the document is still incomplete and remains in the worker queue. (priority 70 · next 2026-06-08 16:42:56)
Missing: html
Download: Source copy (doc)
Loading document viewer…
Document Metadata
| File Type | application/msword |
|---|---|
| File Title | Medical Record Abstraction Form |
| Author | deocadmin |
| Last Modified By | CDC |
| File Modified | 2014-05-23 |
| File Created | 2014-05-23 |
| Conversion State | partial |