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An official website of the Department of Health & Human Services

AHRQ: Agency for Healthcare Research and Quality

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888-324-9790

DatabasesOnSafetyCulture@westat.com

OMB Control Number: 0935-0242
Expiration Date: 10/31/2024



SOPS Ambulatory Surgery Center Survey Eligibility Form

We welcome your interest! To determine your organization's eligibility for participation in the SOPS Ambulatory Surgery Center Database, we need to collect some information about you and your survey.

A field with an asterisk (*) before it is a required field.
* 1. Which of the following do you represent?




   
* 2. Will you have completed survey data collection and be able to submit your final electronic data file
       by June 22, 2023?

     
*
       
* 4. Have you used the Action Planning Tool for the AHRQ Surveys on Patient Safety Culture?

   
* 5. Did you make any changes to the SOPS Ambulatory Surgery Center Questionnaire?