Data Collection Forms

Data Collection Forms are specific for each country, as well as split for Inpatient and Ambulatory.  If you require further clarification on which form to download, contact aroc@uow.edu.au.

AUSTRALIA

INPATIENT V4

• Direct inpatient care, pathway 3 (8 pages total: 4 data collection pages, 3 appendices)
• Direct inpatient care WA, pathway 3 (8 pages total: 4 data collection pages, 3 appendices)
• In-Reach rehabilitation care, pathway 2  (5 pages total: 3 data collection pages, 2 appendices)
• Consult liaison; one off assessment, pathway 1  (4 pages total: 2 data collection pages, 2 appendices)

AMBULATORY V4.1

• Ambulatory direct care, pathway 4  (10 pages total: 6 data collection pages, 4 appendices)

PAEDIATRIC V1

• Inpatient direct care - Paediatric  (7 pages total: 4 data collection pages, 2 appendices)
• Ambulatory direct care - Paediatric  (7 pages total: 4 data collection pages, 2 appendices)

NEW ZEALAND

INPATIENT V4

• Direct inpatient care, pathway 3  (9 pages total: 5 data collection pages, 3 appendices)
• In-Reach rehabilitation care, pathway 2  (5 pages total: 3 data collection pages, 2 appendices)
• Consult liaison; one off assessment, pathway 1  (4 pages total: 2 data collection pages, 2 appendices)

AMBULATORY V4.1

• Ambulatory direct care, pathway 4  (8 pages total: 6 data collection pages, 2 appendices)

PAEDIATRIC V1

• Inpatient direct care - Paediatric  (6 pages total: 5 data collection pages, 1 appendix)
• Ambulatory direct care - Paediatric  (6 pages total: 5 data collection pages, 1 appendix)

APPENDICES (INCLUDED WITH FORM)

• AROC impairment codes - Adult (1 page)
  • AROC impairment coding guidelines  (14 pages)
• AROC impairment codes - Paediatric (1 page)
• List of health funds  (2 pages)
• Phases of amputee care  (1 page)