Neonatal Transport Data System
California Perinatal Transport System (CPeTS) Network Database
Managed by California Perinatal Quality Care Collaborative (CPQCC)
Manual of Definitions
For Infants Born in 2015
Version 13
October 2014
2015 Manual of Definitions – Neonatal Transport Data Collection Tool
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Table of Contents
I.
II.
III.
IV.
REFERRAL…………………………..………………………………………………………...
5
Note to Imbedded NICUs……………………………………………………………………
Special Situation Overrides………………………………………………………………..
Transport Type……………………………………………………………………………….
Requested Delivery Attendance…………………………………………………………..
Emergent
Urgent………………………………………………………………………………………..
Scheduled Neonatal………………………………………………………………………..
Other…………………………………………………………………………………………
Indication for Transport…………………………………………………………………….
Medical Dx/Rx Services……………………………………………………………………
Surgery………………………………………………………………………………………
Insurance…………………………………………………………………………………….
Bed Availability………………………………………………………………………………
5
5
6
PATIENT IDENTIFICATION: HISTORY...………………………………………………….
7
Birth weight……………………………………………………………………………………
Gestational Age………………………………………………………………………………
Sex………………………………………………………………………………………………
Prenatally Diagnosed Congenital Anomalies…………………………………………...
Description of Prenatal Diagnosis of Major Birth Defects/Congenital Anomalies
Code 504 – Other Chromosomal Anomaly………………………………………………
Code 601 – Skeletal Dysplasia…………………………………………………………….
Code 605 – Inborn Error of Metabolism…………………………………………………..
Code 150 – Other Central Nervous System Defects……………………………………
Code 200 – Other Cardiac Defects……………………………………………………….
Code 300 – Other Gastro-Intestinal Defects……………………………………………..
Code 400 – Other Genito-Urinary Defects……………………………………………….
Code 800 – Other Pulmonary Defects……………………………………………………
Code 900 – Other Vascular or Lymphatic Defects………………………………………
Mother’s Gravida……………………...........................................................................
Antenatal Steroids……………………………………………………………………………
Surfactant Given……………………………………………………………………………..
7
7
7
7
8
TIME SEQUENCE………………………………………………...…………………………..
9
Date/Time of Maternal Admission to Perinatal Unit or Labor & Delivery…………..
Date/Time Infant Birth……………………………………………………………………….
Date/Time First Surfactant Dose…………………………………………………………..
Date/Time Referral Time (and Referral Hospital Evaluation)………………………..
Date/Time Acceptance Time……………………………………………………………….
Date/Time Transport Team Departure from Transport Team Office/NICU for
referring Hospital.......................................................................................................
Date/Time Arrival of Team at Referral Hospital/Patient Bedside and Initial
Transport Evaluation………………………………………………………………………..
Date/Time Initial Transport Team Evaluation………………………………………..
Date/Time Arrival at Receiving NICU and Initial NICU Evaluation…………………..
9
9
9
9
9
10
INFANT CONDITION……………………………………..................................................
10
Date/Times at which Infant Condition was evaluated…………………………………
Date/Time of Initial Evaluation by Transport Team…………………………………….
Date/Time of NICU Evaluation……………………………………………………………..
Responsiveness at time of referral, initial transport and NICU admit………………….
10
10
10
11
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8
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10
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V.
VI.
Temperature at time of referral, initial transport and NICU admit……………………….
Heart Rate at time of referral, initial and NICU admit……………………………………..
Respiratory Rate at time of referral, initial and NICU admit……………………………..
Oxygen Saturation at time of referral, initial and NICU admit…………………………..
Respiratory Status at time of referral, initial and NICU admit…………………………..
FiO2 at time of referral, initial and NICU admit…………………………………………….
Respiratory Support at referral, initial and NICU admit………………………………….
Blood Pressure systolic/diastolic and mean at referral, initial and NICU admit……….
Pressors at time of referral, initial and NICU admit…………………………………….....
11
11
11
11
11
12
12
12
12
REFERRAL PROCESS…………………………………………………...........................
12
Referring Hospital……………………………………………………………………………
Was the Infant Previously Transported………………………………………………….
Previous Transfer Referring Hospital…………………………………………………….
Location of Birth…………………………………………………………………………..,,,
Transport Team On-Site Leader...............................................................................
Transport Team From……………………………………………………………………….
Mode of Transport……………………………………………………………………………
12
13
13
13
13
14
14
CLINICAL INFORMATION (ALL CALIFORNIA TRANSPORT FORM
ONLY)………………………………………………………………………………..
16
VII. NON-CORE FORM - ADDITIONAL CLINICAL INFORMATION……………..
17
VIII. REFERRING PHYSICIAN AND FACILITY INFORMATION…………………..
19
IX.
CARE PROVIDERS……………………………………………………............….
19
X.
COMMENTS…………………………………………………………………………
19
XI.
INFORMATION MATERIALS TO BE SENT WITH TRANSPORT
TEAM…………………………………………………………………………………
19
XII. TRANSPORT ISSUES WITH IMPROVEMENT POTENTIAL…………………
19
APPENDICES
Please go to www.perinatal.org for all appendices under Neonatal Transport
Data System 2014 materials
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APPENDIX A: CPETS CORE FORM
APPENDIX B: BIRTH DEFECT CODES FOR CCNTF ITEM C.6
APPENDIX C: OSHPD FACILITY CODES
APPENDIX D: FAHRENHEIT TO CENTRIGRADE CONVERSION TAB
APPENDIX E: CPeTS/CPQCC Neonatal Transport Data Report Request 2015
APPENDIX F: CALIFORNIA PERINATAL TRANSPORT SYSTEM
NEONATAL TRIPS SCORE CALCULATIONS FORM – 2015
CPeTS STAFF:
Ron Cohen, MD. Director, Northern Division
D. Lisa Bollman, RN, MSN, CPHQ Director, Southern Division
Michelle Padreddii, RN, BSN, Data Manager for Northern California
Kevin Van Otterloo, MPA Program Manager for Southern California
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I.
REFERRAL
Note: Items with “*” represent those that MUST be filled out on the online Transport form in
order to propagate specific item numbers on the online Admission/Discharge (A/D) Form.
The Admission/Discharge (A/D) related Items will be listed as “(A/D Item#)”.
Note: Infants admitted to embedded NICUs (e.g. an NICU owned and managed by one
organization located within a delivery facility owned and managed by another hospital) is not
considered an acute inter-facility transport for the purpose of the Transport Data System.
No TRS form is required.
Situational Overrides (applicable to Acute Inter-facility Neonatal Transports)
Unique situations can complicate the data collection required for Acute Inter-Facility
Neonatal Transports. Several situations have been identified that will alter the data required
(see below). Refer to Appendix J for the summary table.
 Requested Delivery Attendance:
When the referring hospitals requests that the
receiving NICU transport team attend the delivery of a suspected high-risk infant
(formerly called Delivery Room Attendance Requested) then the referring hospital
evaluation (TRIPS Score) C.20a-30a (previously T.15a-25a) are not applicable. When this
special situation is selected this area will gray and not be required.
 Transport by Referring Center (Self-Transport): When the referring hospital transport
team will be used to transport the infant several sections are gray as they are not
applicable. These include: C.16 (previously 2), C.17 (previously 3) Date/Time of
Transport Team Arrival at Referring Hospital, C.18 (previously T.14b) Transport Team
Departure for Referring Facility, and C20b-30b (previously T.15b-25b) Initial Transport
Team Evaluation (TRIPS Score).
 Transport from Emergency Department (ER) or other non-perinatal setting: When infants
are transported from non-perinatal settings some data may be not applicable or not
available. In this case the following items will gray out: C.10 (previously T.5) Date/Time of
Mother’s admission to L&D, C.12 (previously T.6) Date/Time of Birth, C.6a (previously
T.10) Prenatally diagnosed congenital anomalies, C.7 (previously T.11) Maternal Gravida,
C.8 Antenatal Steroids. Use the current birth weight in C.3 (previously T.7).
 Safe Surrender Infants: Infants left at designated Safe Surrender sites frequently have
little to no known information about their mother or delivery. In this case the following
areas are grayed: C.10 (previously T.5) Date/Time of Mother’s admission to L&D, C.6a
(previously T.10) Prenatally diagnosed congenital anomalies, C.7 (previously T.11)
Maternal Gravida, C.8 (previously T.12a) Antenatal Steroids, C.9 (previously T.13a/b)
Surfactant Administration, C.10 (previously T.5) Maternal Admission to Perinatal Unit or
Labor and Delivery, C.33 (previously T.28) Birth Hospital. Other information may need to
be estimated such as: C.3 (previously T.7) Birth weight (use current weight if unknown),
C.4 (previously T.8) Gestational Age, C.12 (previously T.6) Infant birth date and time.
C.1 Transport Type
A CPeTS Acute Inter-facility Transport is defined as any infant that requires medical,
diagnostic, or surgical therapy that is not provided, or that cannot be provided due to
temporary staffing/census issues, or due to insurance restrictions at the referring hospital.
A CPeTS Acute Inter-facility Transports do not include infants transported solely for feeding
and growing or hospice care.
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Check type of transport requested.
Requested Delivery Attendance. Check if neonatal transport team was initially requested to
attend the delivery.
Emergent. Check if the infant was an emergent transport. Immediate response is requested.
Urgent. Check if response within 6 hours was needed.
Scheduled Neonatal. Check if the infant transport was planned or scheduled. A scheduled
transport is selected for an infant whose initial medical/surgical needs have been met, whose
condition has been stabilized and who is transferred to a facility in order to obtain planned
diagnostic or surgical intervention. The medical needs may be extensive and extremely
complex care (e.g., an infant with lethal anomalies).
Other. Check other if the transport does not conform to other definitions.
indication.
Describe
C.2 Indication for Transport.
Medical Services. Check if the infant was transported for medical problems that require
acute resolution.
Surgery. Check if the infant was transported primarily for major invasive surgery (requiring
general anesthesia, or its equivalent).
Insurance. Check if the infant was transported for insurance purposes.
Bed Availability. Check if the infant was transported due to bed availability issues at the
referring facility.
II.
PATIENT IDENTIFICATION: HISTORY
C.3
Birth Weight (A/D Item 1).
Record the birth weight in grams. Since many weights may be obtained on an infant shortly
after birth, enter the weight from the Labor and Delivery record if available and judged to be
accurate. If unavailable or judged to be inaccurate, use the weight on admission to the
neonatal unit or lastly, the weight obtained on autopsy (if the infant expired within 24 hours of
birth). (See Appendix J for Pounds to Grams Conversion Table)
C.4 Best Estimate of Gestational Age (A/D Item 3).
Record the best available estimate of gestational age in weeks and days. Where sources
disagree, use the following hierarchy: 1. Obstetric measures, based on last menstrual
period, obstetrical parameters, or prenatal ultrasound as recorded in the maternal chart. 2.
Neonatologist's estimate, based on physical or neurologic examination, combined physical
and gestational age exam (Ballard/Dubowitz), or examination of the lens.
Record
gestational age in weeks and days. In cases when the best estimate of gestational age is an
exact number of weeks, enter the number of weeks in the space provided for weeks and
enter 0 in the space provided for days. Do not leave the number of days blank.
C.5
Infant Sex (A/D Item 5).
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Check Male or Female. Check Unk if sex cannot be determined.
C.6 Congenital Anomalies that were Diagnosed Prenatally (A/D
Item 49a).
Check Yes if the infant had one or more clinically significant birth defects that were
diagnosed during the prenatal period. Do not check yes if infant was identified to have
congenital anomalies following delivery that were not diagnosed prenatally.
Check No if an infant was not prenatally diagnosed as having one or more of birth defects.
Check Unk if this information cannot be obtained.
Describe: Enter up to 5 Birth Defect Codes that were all
Diagnosed Prenatally (A/D Item 49b).
In the spaces provided, you may enter as many as five 3-digit code numbers of birth defects
from the list in Appendix D. Do not use general descriptions such as multiple congenital
anomalies or complex congenital heart disease .
The following Birth Defect Codes require a detailed description in the space provided:
Code 504 - Other Chromosomal Anomaly
Code 601 - Skeletal Dysplasia
Code 605 - Inborn Error of Metabolism
Code 150 - Other Central Nervous System Defects
Code 200 - Other Cardiac Defects
Code 300 - Other Gastro-Intestinal Defects
Code 400 - Other Genito-Urinary Defects
Code 800 - Other Pulmonary Defects
Code 900 - Other Vascular or Lymphatic Defects
The following conditions should NOT be coded as Major Birth Defects:
Extreme Prematurity
Intrauterine Growth Retardation
Small Size for Gestational Age
Fetal Alcohol Syndrome
Hypothyroidism
Intrauterine Infection
Cleft Lip without Cleft Palate
Club Feet
Congenital Dislocation of the Hips
C.7a Maternal Date of Birth
C.7b Maternal Gravida
Enter total number of pregnancies (including current pregnancy)
regardless of outcome.
Note: Only the total number (Gravida) needs to be filled out on-line. The
numbers for (P/Ab/L) are to be filled out on the All California Neonatal
Transport Form.
P. Enter number of birth experiences (>20 weeks)
Ab. Enter total number of spontaneous or therapeutic abortions
L. Enter number of living children
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C.8a Antenatal Steroids (A/D Item 13).
Note: Corticosteroids include Betamethasone, Dexamethasone, and Hydrocortisone.
Check Yes if corticosteroids were administered IM or IV to the mother during pregnancy at
any time prior to delivery.
Check No if no corticosteroids were administered IM or IV to the mother during pregnancy at
any time prior to delivery.
Check Unk if this information cannot be obtained.
C.8b Magnesium Sulfate
Check Yes if magnesium sulfate was administered to the mother during the pregnancy at any
time prior to delivery.
Check No if no magnesium sulfate was administered to the mother during the pregnancy at
any time prior to delivery.
Check unk if this information cannot be obtained.
C.9c Birth Head Circumference (OFC)
C.9 Surfactant Given (A/D Item 21).
Check Yes, No or UNK. Yes if the infant received an exogenous surfactant at any time.
Include this information even if it occurred at the birth hospital prior to transport to your
center. Given in Delivery room or Nursery?
III.
TIME SEQUENCE
C.10 Date and Time of Maternal Admission to Perinatal Unit or
Labor and Delivery.
Enter the date using MM/DD/YYYY and time using a 24-hour clock (egg, 11:30 PM = 2330) of
mother’s admission to hospital of delivery. If mother was admitted directly to Labor and
Delivery Unit state this date and time. If mother was initially admitted to the Emergency
Department, received care and either delivered there or was subsequently transferred to the
Labor and Delivery Unit state this date and time.
Enter Unk for TIME ONLY if this information is unavailable (Online only).
C.11 Antenatal Steroid Administration
(A/D Item 13).
Check Yes, No or UNK if the infant received antenatal steroid at any time. Include this
information even if it occurred at the birth hospital prior to transport to your center. Given in
Delivery room or Nursery?
C.12 Infant Birth Date and Time (A/D Item 4).
Enter the date of birth using MM/DD/YYYY. Enter the time of birth using a 24-hour clock (egg,
11:30 PM = 2330). Enter UNK if unknown (Online only)
C.13 Date and Time of First Dose Surfactant Administration.
Enter date/time at First Dose. Enter the date using MM/DDYY. Enter the time using a 24-hour
clock (egg, 11:30 PM = 2330).
Note: the first dose may have occurred prior to or after NICU admission, and may have
occurred before transfer, during transport or at your hospital. Check DR if the first dose was
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administered in the Delivery Room. Check Nsy if the first dose was administered in the
Nursery. Check NICU if first dose administered in the NICU.
Check No if the infant never received an exogenous surfactant.
Check Unk/N/A if this information cannot be obtained.
C.14 Referral (and Referring Hospital Evaluation Time).
Enter the date and time of the initial referral communication between referring and receiving
providers/facilities. Time should be reported using MM/DD/YYYY and the 24-hour clock (egg,
11:30 PM = 2330). The same time is used for the referral evaluation which should be done
within 15 minutes. Enter UNK if unknown (Online only)
C.15 Acceptance Date and Time.
Enter the date and time of the transport acceptance using MM/DD/YYYY and 24-hour clock
(ex. 11:30 PM = 23:30). Enter UNK if unknown (Online only)
C.16 Date/Time of Transport Team Departure from Transport
Team Office/NICU for Referring Hospital.
Enter the date using MM/DD/YYYY and time using a 24-hour clock (ex. 11:30 PM = 23:30)
Enter UNK if unknown (Online only)
C.17/C.18 Date/Time of Arrival of Team at Referring
Hospital/Patient Bedside and Initial Transport Team Evaluation.
Enter the date using MM/DD/YYYY and time using a 24-hour clock (ex. 11:30 PM = 23:30)
Enter UNK if unknown (Online only)
C.19 Date and Time of NICU Evaluation within 15 minutes of
Arrival at Receiving Hospital.
Enter the date and time of the infant’s NICU evaluation within 15 minutes of the arrival at the
Receiving Hospital. Time should be reported on the 24-hour clock. Enter UNK if unknown
(Online only)
IV.
INFANT CONDITION
This section of the record provides consistent information at three specific times for
evaluation of overall stability. They should be recorded at referral, within 15 minutes of
arrival of the Transport team and then again within 15 minutes of arrival into the receiving
NICU.
Date/Times at which infant condition was evaluated (For each of these items, items C.20 through
C.29 need to be filled out).
C.14 Referral (and Referring Hospital Evaluation Time)
Enter the date and time of the initial referral communication between referring and receiving
providers/facilities. Time should be reported on the 24-hour clock. The same time is used
for the referral evaluation which should be done within 15 minutes. Enter UNK if unknown
(Online only)
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C.18 Date and Time of Arrival of Transport Team at Referring
Hospital/Patient Bedside and Initial Transport Evaluation.
Enter the date and time that the transport team arrived at the referring hospital. Time should
be reported on the 24-hour clock. The same time is used for the initial transport team
evaluation which should be done within 15 minutes. Enter UNK if unknown (Online only)
C.19 Date and Time of Arrival at Receiving NICU and Initial Evaluation
Enter the date and time that the transport team arrived at the receiving hospital NICU. Time
should be reported on the 24-hour clock. The same time is used for the initial NICU
evaluation which should be done within 15 minutes. Enter UNK if unknown (Online only)
C.20 Responsiveness.
Write the number 0 (zero) in the designated space if the infant died prior to evaluation, 1
(one) demonstrated no responsiveness, seizures or received muscle relaxants at the time of
referral for transport.
Note: Seizures include compelling clinical evidence of seizures, or of focal or multifocal,
clonic or tonic seizures, as well as EEG evidence of seizures, regardless of clinical status.
Write the number 2 (two) in the designated space if the infant appeared lethargic or had no
cry at the time of referral for transport. Write the number 3 (three) in the designated space
vigorously withdraws or cries. This also refers to normal age appropriate behavior. Enter
UNK if unknown (Online only)
C.21 Temperature (20.0 to 45.0 C or 68 to 113 F).
If the infant’s core body temperature was measured and recorded at the time of referral for
transport, enter the infant’s temperature in degrees centigrade to the nearest tenth of a
degree. For centers that measure temperature in degrees Fahrenheit, a Fahrenheit-toCentigrade conversion table is provided in Appendix K. Use rectal temperature or, if not
available, esophageal temperature, tympanic temperature or axillary temperature, in that
order. If the infant’s body temperature was not measured leave this item blank.
If the infant is being actively cooled please enter the infant’s actual temperature.
If the infant was undergoing intentional cooling for therapeutic purposes, indicate Yes on the
second line and select type of cooling if applicable: Passive, Selective Head, Selective Body,
Other or Unknown.
If the infant was not undergoing intentional cooling, indicate No and skip the method of
cooling.
If the infants core body temperature is too low to register please check the box. Enter UNK if
unknown (Online only)
C.22 Heart Rate (0 to 250).
Indicate infant’s heart rate. Enter UNK if unknown (Online only)
C.23 Respiratory Rate (0 to 400 HIFI/OSC).
Indicate infant’s respiratory rate.
Note: this rate may be spontaneous or assisted by ventilator. Enter UNK if unknown (Online
only)
C.24 Oxygen Saturation (SaO2) (0 to 100).
Indicate average oxygen saturation in percentage. If unknown, indicate UNK (Online only).
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C.25 Respiratory Status.
Write the number 1 (one) in the designated space if the infant was on the respirator at the
time of referral for transport. Write the number 2 (two) in the designated space if the infant
had severe respiratory complications, including: apnea, gasping, or was intubated but not on
mechanical respirator. Write the number 3 (three) in the designated space for all other
respiratory status (including none or mild respiratory complications). Enter UNK if unknown
(Online only)
C.26 Inspired Oxygen Concentration
Inspired Oxygen Concentration (FiO2) (21-100). Indicate inspired oxygen concentration (21100%). If the infant was given supplemental oxygen, write the FIO2 (percentage of oxygen) in
the designated space. If the infant was not given supplemental oxygen, leave the designated
space blank. Enter UNK if unknown (Online only)
C.27 Respiratory Support.
Write None (0) if required no respiratory support. Write Hood/NC (1) in the designated space
if the infant had spontaneous breathing and was supported using an oxygen hood or nasal
cannula. Write NCPAP (2) in the designated space if the infant was provided with continuous
positive airway pressure (CPAP) using nasal CPAP. Write ETT (3) in the designated space if
the infant was ventilated using an endotracheal tube. Do not enter ETT if an endotracheal
tube was placed only for suctioning and assisted ventilation was not given through the tube.
Write Unk in the designated space if this information cannot be obtained. Enter UNK if
unknown (Online only)
C.28 Blood Pressure.
Indicate infant’s systolic, diastolic and mean blood pressures.
If too low to register please check the box in the online form. Enter UNK if unknown (Online
only)
C.29 Use of Pressors.
Indicate Y (Yes) or N (No) whether vasopressors were administered.
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V.
REFERRAL PROCESS
C.30 Referring Hospital.
Write the name of the referring hospital in the designated space. Write the referring
hospital’s CPQCC membership number in the designated space. Please refer to the current
Membership Directory on the CPQCC website (www.cpqcc.org) when answering this
question. If the referring hospital is not a CPQCC member hospital, this item is not
applicable and may be left blank.
C.31a Was the infant Previously Transported?
Check Yes if the infant was transported previously from another hospital to the referring
hospital.
Check No if the infant was not transported previously from another hospital to the referring
hospital.
C.31b From If transported previously is answered Yes , write the name of the original
hospital and its CPQCC membership number in the designated spaces. If the original
hospital is not a CPQCC member hospital, this item is not applicable and may be left blank.
C.32 Location of Birth (A/D Form Item 7c).
Write the name of the birth hospital in the designated space. Write the telephone number of
the Nursery/NICU of the birth hospital in the designated space. Write the birth hospital’s
CPQCC membership number in the designated space. Please refer to the current
Membership Directory on the CPQCC website (www.cpqcc.org) when answering this
question. If the birth hospital is not a CPQCC member hospital, this item is not applicable
and may be left blank.
C.33 Transport Team On-Site Leader.
Choose only one of the following responses:
Check Sub-specialist MD for Neonatologist
Check Peds for pediatrician.
Check NNP for Neonatal Nurse Practitioner.
Check Transport Specialist for Registered Nurse or Respiratory Therapist specializing in
Neonatal/Pediatric Transport Services, Practicing under standardized procedures.
Check Nurse for Neonatal Registered Nurse.
Check Other and specify what type of staff member this is in the space provided.
C.34a Transport Team From.
Choose one of the following responses:
Check Receiving Hospital if the transport team is part of the receiving hospital’s staff
(including those used for both Neonatal and Pediatric Transports and based in NICU,
Pediatrics, PICU, Emergency Department, etc.)
Check Referring Hospital if the transport team is part of the referring hospital’s staff.
Check Contract Service if the transport team is not on staff at the receiving hospital. This
may include contracted transport teams from another facility inside or outside of the hospital
system of the receiving facility. Please describe.
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C.34b Amended list of Contract Services.
The list has been amended with the list of fixed wing ambulance services in California from
the Association of Air Medical Services (www.aams.org). The additional codes are as
follows:
800000 = Other Contract Service
800001 = Aeromedevac, Inc.
800002 = Air Rescue - AirRescue International
800003 = CALSTAR - California Shock Trauma Air Rescue
800004 = PHI Air Medical
800005 = Life Flight - Stanford Life Flight Transport Program
800006 = REACH - REACH Air Medical Services, Mediplane, Inc.
800007 = Sierra LifeFlight
800008 = Pro Transport
C.35 Mode of Transport.
Select type of transport used. Select only one. Primary type of transport used. (e.g. patient
was transported by ambulance to airfield or heliport for helicopter transport, would be
coded as helicopter).
Ground for ambulance transport or ambulatory transport (e.g. crossing from one hospital to
another immediately adjacent facility).
Helicopter for rotor wing transport.
Fixed Wing for airplane transport.
Death. Indicate No if the infant did not die.
Check Yes if the infant died between the time of referral for transport and prior to arriving at
the receiving NICU. Indicate whether the infant died prior to transport team arrival, prior to
departure or prior to admission to receiving NICU. Do not collect the CPeTS.
Enter the date of death using MM/DD/YY. Enter the time of death using a 24-hour clock (ex.
11:30 PM = 2330).
Write the name and telephone number of the Referring Transport Coordinator in the
designated space.
Comments. Please add any comments from the transport team of incidents relevant to this
transport.
Modified TRIPS Score
The severity of the infant condition is very important to assess quickly and can dictate the
composition of the transport team and the type of transport requested. Being able to assess
the infant condition at different times and then predict mortality or even death is part of
California Perinatal Transport System. The assessment of the infant condition at referral,
initial transport and NICU admission using the Modified TRIPS Score can be used to
calculate the risk of death of the infant within 7 days of transport. The TRIPS methodology in
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California is a physiology-based assessment comprised of temperature, blood pressure,
response to noxious stimuli, respiratory status, use of pressors to support blood pressure
and use of a ventilator. It is used both for the infant condition and as an assessment of the
quality of care at the referral center by assessing changes in the infant condition between
Referral and Initial Modified TRIPS Score. It is also used to assess the quality of the neonatal
transport by assessing change in the Modified TRIPS Score during the actual transport.
Reviewing the Modified TRIPS Score helps identify quality improvement initiatives.
An online trips score / risk of mortality calculator suitable for smart phones is available at
http://www.health-info-solutions.com/CPQCC-CPeTS/tripsmobile/tripsmobile.html
( google TRIPS SCORE CALCULATOR ) .
VI. CLINICAL INFORMATION (ALL CALIFORNIA TRANSPORT FORM ONLY)
This information is helpful to provide continuity of care.
Infant name
Singleton/Multiple Births.
(a) Check Singleton for any birth
(b) Check Multiple for any birth involving more than a singleton infant and for any multifetal
gestation.
(c) If Multiple Birth, indicate the infant’s birth order (first, second, etc) as well as the total
number of infants actually delivered (count both live born and still born infants). For
example, the second infant born of triplets would be entered as 2 of 3.
Note: Count both live births and stillbirths at the time of delivery but do not count fetuses
which have been reabsorbed in utero and are not delivered.
Current Weight in grams
Diagnosis
Allergies. Check Yes if the infant has known allergies, and write in what type of allergies
the infant has. Check No if the infant has no known allergies. Check Unk if there is no
indication in the record regarding whether or not the infant has known allergies.
Any Surgeries Enter Yes if infant underwent surgery at any time. Enter No if infant has not
undergone
surgery.
If
Yes,
note
indication.
Mother’s Name
Mother’s Birth Date. Enter the date of mother’s birth using MM/DD/YYYY.
Insurance Type. Enter the Insurance of the Mother if known.
2015 Manual of Definitions – Neonatal Transport Data Collection Tool
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Note: For transports within the first month of life, Mother’s insurance type is assumed to be
the infant’s insurance type as well.
Medical Record Number at Delivery Hospital
Gravida, Para, Abortions, Living
Rupture of Membranes
(a) Enter the date using MM/DD/YYYY and time using a 24-hour clock (ex. 11:30 PM = 23:30)
of rupture of membranes.
(b) Record Duration of ruptured membranes in hours (last completed whole hour).
(c) Record fluid appearance, check Clear if fluid is clear of meconium or Meconium if
meconium is present in the amniotic fluid on rupture.
Antenatal conditions- see CPQCC Admission/Discharge Form
This question focuses on antenatal events that may affect the pregnancy and/or delivery of
the infant. Check all conditions in the category, which were present in the antenatal period.
Check None if none of the listed conditions were present. Check None only if you have
access to a reliable and complete prenatal/medical record or history. Check Unk if the
information is not obtainable. If a mother presents with no prenatal care and no available
medical history, this section should be marked, Unk. If a mother presents with no prenatal
care, but there is a medical history present on her chart, applicable items may be selected
as appropriate.
Hypertension. The medical record should state the diagnosis of hypertension, pregnancyinduced hypertension, eclampsia, preeclampsia, seizures, toxemia, or HELLP syndrome.
Diabetes. Maternal diabetes of any type and severity
Infection. Includes intrauterine infections of the amniotic sac and fluid (amnionitis,
chorioamnionitis) and those of the uterine wall (endometritis) as well as other infections
such as which complicate the pregnancy or delivery. Includes Herpes, HIV, or other
sexually-transmitted diseases (STD).
Preterm Labor. Uterine contractions resulting in dilation of the cervix at a gestational age of
less than 37 completed weeks of gestation.
Bleeding/Abruption/Previa. Bleeding related to complications with the placenta. Placental
abruption refers to premature detachment of the placenta from the uterine wall. Placenta
previa refers to low implantation of the placenta in the uterus, usually over the cervix.
Other Maternal. Other antenatal maternal complications affecting the infant’s health or the
course of delivery. Specify the complication in the space provided.
Unknown. Information not obtainable.
Antepartum or Intrapartum Significant Intrapartum Issues. Describe intrapartum
complications affecting the infant’s health or the course of delivery.
Specify the
complication in the space provided.
2015 Manual of Definitions – Neonatal Transport Data Collection Tool
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Intrapartum Antibiotics. Indicate Yes if maternal antibiotics were given during the current
intrapartum admission, and specify type. Indicate No if no antibiotics were given during the
current intrapartum admission and Unk if the information is not obtainable.
Delivery Type.
Choose only one of the following responses:
Check Spontaneous (Spont) Vaginal for a normal vaginal delivery. This is any vaginal
delivery for which instruments were not used. This includes cases where manual rotations
or other head or shoulder maneuvers were used, provided instruments were not also used.
Check Operative (Op) Vaginal for any vaginal delivery for which any instrumentation was
used.
Episiotomies are not considered operative deliveries.
Indicate type of
instrumentation: Forceps, Vacuum
Check Cesarean for any cesarean delivery (elective or emergent). Indicate Primary or
Repeat.
Apgar Scores.
Enter the Apgar score at 1 minute and at 5 minutes as noted in the Labor and Delivery
record. Enter the additional Apgar scores every 5 minutes (if 5 minute Apgar was <7), if
available. Check Unk for any score that is unknown. If Apgar score was not done, select Not
Done (N/D).
Note: In general, Apgar scores are repeated every 5 minutes until the infant’s score is
greater than or equal to 7, or the infant has been moved to the NICU for ongoing
resuscitation and critical care. If you do not see a 10-minute Apgar score on the infant’s
chart, but the 5-minute Apgar score is 7 or higher, you can assume that a 10-minute Apgar
score was not done, and mark Not Done on the form. If the 5-minute Apgar score is less
than 7, there should have been a 10-minute Apgar score done. If you are unable to find it in
the record, mark Unk.
2015 Manual of Definitions – Neonatal Transport Data Collection Tool
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VII. NON CORE FORM - ADDITIONAL CLINICAL INFORMATION
Ventilator Settings
Enter the Type or Mode of ventilation along with Oxygen %, Pressures, Rate and
Inspiratory/Expiratory times
Blood Gas Results at time of referral, initial transport or NICU admit.
If arterial blood gas results were clinically indicated and obtained for transport, indicate
results. If blood gases not obtained leave this space blank.
a. pH
b. PCO2
c. BE (Base Excess/Deficit)
Intravenous and Fluid Administration.
If applicable document IV Type, Fluids, Rate and Times
Hemoglobin/Hematocrit.
Enter the date using MM/DD/YYYY and time using a 24-hour clock (ex. 11:30 PM = 23:30) and
results.
Blood Culture.
Enter the date using MM/DD/YYYY and time using a 24-hour clock (ex 11:30 PM = 23:30) and
results.
Imaging.
Enter type of imagining done and results as well as the date using MM/DD/YYYY and time
using a 24-hour clock (ex. 11:30 PM = 23:30).
Chest X-Ray.
Enter results as well as the date using MM/DD/YYYY and time using a 24-hour clock (ex. 11:30
PM = 23:30).
Bilirubin.
Enter the date using MM/DD/YYYY and time using a 24-hour clock (ex. 11:30 PM = 23:30) and
results.
Neonatal Screening. Hearing. Indicate Yes if screening completed, No if screening not
completed and Unk if the information is not obtainable.
Metabolic (PKU, T4, Galactosemia, Hemoglobinopathies). Indicate Yes if screening
completed, No if screening not completed and Unk if the information is not obtainable.
Substance Exposure. Indicate Yes if screening completed and provide results, No if
screening not completed and Unk if the information is not obtainable.
Medication Administration
If applicable document any medications given in the delivery room, last doses of medication
given at the referral center and medications given en route.
2015 Manual of Definitions – Neonatal Transport Data Collection Tool
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Enter the date using MM/DD/YYYY and time using a 24-hour clock (ex. 11:30 PM = 23:30).
Medication name, Dose and Route
Enteral Feeding.
First Enteral Feeding. Enter the type (Human Milk Only, Human Milk plus Fortifier, or
Formula), route administered (PO- oral, OG- oral gavage, NG – nasal gavage, GT –
gastrostomy tube, Other – all other enteral feeding routes), and the amount in cc’s. Indicate
date using MM/DD/YY and time of the first enteral feeding using a 24-hour clock (egg, 11:30
PM = 2330).
If the infant has not yet received his first enteral feeding, this item is not applicable and may
be left blank.
Last Enteral Feeding Prior to Transport. Enter the type (Human Milk Only, Human Milk plus
Fortifier, or Formula), route administered (PO- oral, OG- oral gavage, NG – nasal gavage, GT
– gastrostomy tube, Other – all other enteral feeding routes), and the amount in cc’s.
Indicate date using MM/DD/YY and time of the last enteral feeding prior to transport using a
24-hour clock (ex. 11:30 PM = 23:30).
If the infant has not yet received his first enteral feeding, this item is not applicable and may
be left blank.
Last Urine.
Enter the date using MM/DD/YYYY and time using a 24-hour clock (ex. 11:30 PM = 23:30)
Last Stool.
Enter the date using MM/DD/YYYY and time using a 24-hour clock (ex. 11:30 PM = 23:30)
Other Clinical Information.
Blood Transfusion.
Enter the date using MM/DD/YYYY and time using a 24-hour clock (ex. 11:30 PM = 23:30
2015 Manual of Definitions – Neonatal Transport Data Collection Tool
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VIII. REFERRING PHYSICIAN AND FACILITY INFORMATION
Write the name of the referring hospital in the designated space. Write the telephone
number of the NICU of the referring hospital in the designated space. This should include
the OB, Pediatrician and Informant. Write the referring hospital’s CPQCC membership
number in the designated space. Please refer to the current Membership Directory on the
CPQCC website (www.cpqcc.org) when answering this question. If the referring hospital is
not a CPQCC member hospital, this item is not applicable and may be left blank. Write the
name of the accepting Physician in the designated space. Write the telephone number of the
accepting Physician in the designated space.
IX.
CARE PROVIDERS
Referring Hospital.
Enter the date using MM/DD/YYYY and time using a 24-hour clock (egg, 11:30 PM = 2330)
Transport Team.
Enter the date using MM/DD/YYYY and time using a 24-hour clock (egg, 11:30 PM = 2330)
X.
COMMENTS
Please provide your comments in this section.
XI.
INFORMATION/MATERIALS TO BE SENT WITH TRANSPORT TEAM
Information/Materials to be Sent with Transport Team.
Indicate all materials and information provided by referring hospital to transport team.
Chart (Patient Record).
Check Maternal and/or Neonatal
Blood Specimen.
Check Maternal and/or Neonatal
Imaging Copies.
Other.
Specify all additional items transported with infant
XII.
TRANSPORT ISSUES WITH IMPROVEMENT POTENTIAL
Transport Issues with Improvement Potential Form allows providers form both referring and
receiving hospitals, as well as the transport team, to identify aspects of the transport that
were either problematic or didn’t go as expected, thereby subject to quality improvement.
This form is intended for internal use only (i.e., it should not be filed with the infant’s chart or
submitted to CPeTS) and should be used to alert providers to issues that may benefit from
internal Quality Improvement strategies.
2015 Manual of Definitions – Neonatal Transport Data Collection Tool
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Delay in Transport:
Check Delay in transport if a transport delay occurred. Describe the situation that resulted
in the transport delay in the space provided. Check Amb./vehicle issues if the delay was
related to problems with the transportation rig or vendor. Check Traffic is the delay was
related to traffic issues out of the control of the transport team. Check Missed opportunity
for maternal transport if the delay was related to either an unwitting or deliberate failure to
identify a patient who could benefit from maternal transport in time to safely affect that
transport. Check Delay in transferring infant if the delay was related to either an unwitting or
deliberate failure to identify a patient who could benefit from neonatal transport in time to
safely affect that transport.
Transport Team Difficulties:
Check Transport Team Difficulties, if they occurred, and describe these difficulties in the
space provided.
Equipment Difficulties:
Check Equipment Difficulties, if they occurred, and describe these difficulties in the space
provided.
Unplanned Intervention During Transport:
Check Unplanned Intervention During Transport if any unplanned intervention was required.
Describe the situation that resulted in the unplanned intervention in the space provided.
Check Airway if the intervention involved the establishment or maintenance of a patent
airway. Check Vascular Access if the intervention involved establishing or maintaining
functional vascular access. Check Return to Referring Hospital if a situation arose requiring
that the transport team and infant return to the referring hospital. This may involve a
problem with the infant, the transport equipment, the transport rig, or the transport team.
Check Other if some other situation arose requiring that the transport team and infant return
to the referring hospital, and describe the situation in the space provided.
CPR During Transport:
Check CPR during transport if the infant required resuscitation during transport.
Death Prior to Admission to Receiving NICU:
Check Death prior to admission to receiving NICU, if the infant being transported expires
during the actual transport (i.e., after leaving the referring hospital but before being
admitted to the receiving hospital). Please note the Special Instructions at the bottom of this
form: For all deaths prior to being admitted at the receiving NICU, complete paper transport
form and fax to the CPQCC Data Center at (510) 620-3144.
None:
Check None is there were no identified neonatal transport issues with improvement potential
identified during the transport.
Other:
Check Other if any issues, other than those identified above, arose during the transport, and
describe the situation in the space provided.
Comments:
2015 Manual of Definitions – Neonatal Transport Data Collection Tool
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Please provide your comments in this section.
Referral to Joint Mortality/Morbidity Review:
Check “Y” if the transport was referred for Joint Mortality/Morbidity Review by either the
referring or receiving hospital, or both. Check “N” if the transport was not referred for Joint
Mortality/Morbidity Review by either the referring or receiving hospital, or both. Check
“Unk” if you do not know whether or not the transport was referred for Joint
Mortality/Morbidity Review by either the referring or receiving hospital, or both.
If the transport was referred for Joint Mortality and Morbidity Review, write the date of the
review in the space provided.
Outcome of Review: Check Policy/Procedure Change if the M&M Review requested a
change in unit policy and/or procedure. Check Joint QI Project if the M&M Review
recommended or resulted in a joint QI project between the referring and receiving hospital,
and/or the transport team. Check Education Offering if the M&M Review recommended or
resulted in continuing education or in-service being offered to appropriate providers and/or
staff at the referring and/or receiving hospital, or to the neonatal transport team. Check
Consultation if the M&M review recommended or resulted in obtaining appropriate
consultation for the referring and/or receiving hospital, or the neonatal transport team.
Check Other if the M&M Review resulted in any other outcomes not listed above, and
describe these outcomes in the space provided.
Follow up: Record the outcome of the quality improvement process stimulated by this
worksheet in the space provided. Record any follow up or additional strategies planned to
deal with the QI issue identified.
2015 Manual of Definitions – Neonatal Transport Data Collection Tool
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APPENDICES
APPENDIX A
CORE CPETS ACUTE INTER-FACILITY- NEONATAL TRANSPORT FORM – 2015
PRINT ELIGIBLY
PLEASE
REFERRAL
Special Situations:  None  Delivery Attendance  Transport by Referring Facility  Transport from ER
Surrender
C.1 Transport type  Requested Delivery Attendance  Emergent  Urgent Maternal Date of Birth
 Scheduled
C.2. Indication  Medical Services  Surgery  Insurance  Bed Availability Unknown
 Safe

PATIENT IDENTIFICATION/HISTORY:
C.3 Birth weight ___ ___ ___ ___ grams
C.4 Gestational Age ___ ___weeks____ days
C.5  Male
Female Unknown
C.6 Prenatally Diagnosed Congenital Anomalies  Yes  No  Unknown Describe:
C.7 a.Maternal Gravida
Steroids Yes No  Unknown Antenatal Magnesium Sulfate Yes No 
Unknown
C.9 Surfactant Given Yes No Unknown
 Delivery Room
Birth Head Circumference (OFC)
 Nursery
cm
TIME SEQUENCE
Date
Time
C.10 Maternal Admission to Perinatal Unit or Labor & Delivery
C.11 Last Antenatal Steroid Administration (last dose)
Unknown
C.12 Infant Birth
 N/A

C.13 Surfactant (first dose)
Unknown
C.14 Referral (and Referring Hospital Evaluation)
 N/A

C.15
Acceptance
C.16 Transport Team Departure from Transport Team Office/NICU for Referring
Hospital
C.17 Arrival of Team at Referring Hospital/Patient Bedside and Initial Transport
Evaluation
C.18 Initial Transport Team Evaluation
C.19 Arrival at Receiving NICU and Initial Evaluation
INFANT CONDITION
REFERRAL PROCESS
Modified TRIPS Score: to be recorded on referral, within 15 C.30 Referring Hospital Name
minutes of arrival at referring hospital and admit to NICU.
Previous CPQCC ID#
Referral
Initial
NICU
C.31 Previously Transported? Yes
Transport
Admit
No From:
C.32 Birth Hospital Name
Time (24 hour)
C.14
C.18
C.19
Yes
Yes
Yes
Y N
YN
Y N
C.20 Responsiveness
C.21 Temperature C°
Too low to register
Was the infant cooled?
Method of cooling
C.33Transport Team On-Site Leader (check only one)
Sub-specialist Physician Pediatrician Other
MD/Resident
Neonatal Nurse Practitioner Transport Specialist
Nurse
C.34Team
From
Receiving
Hospital
Referring Hospital
Contract Service
Describe:
C.35 Mode Ground Helicopter Fixed Wing
2015 Manual of Definitions – Neonatal Transport Data Collection Tool
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DeathNo Yes
Prior to Team Arrival  Prior to
Departure from Referring Hospital  Prior to Arrival at
Receiving NICU
Transport Team RN Signature
C.22 Heart Rate
C.23 Respiratory Rate
C.24 Oxygen Saturation
C.25 Respiratory Status 
C.26 Inspired Oxygen
Concentration
C.27 Respiratory Support 
Referring Hospital Transport Nursing Contact
Information
Name:
Telephone
C.28 Blood Pressure
Systolic/ Diastolic,
Mean
Comments
Too low to register
C.29 Pressors
Yes
Yes
Y N
YN
Yes
Y N
Responsiveness: 0=Death 1=None, Seizure, Muscle Relaxant
2=Lethargic,
no cry
3=Vigorously withdraws, cry
Method of cooling: Passive, Selective Head, Selective Body, Other, Unknown
Respiratory Status: 1=Respirator 2= Severe (apnea, gasping, intubated not
on respirator)
3=Other
Respiratory Support: 0 = None, 1 = Hood/Nasal Cannula. 2 = Nasal
Continuous Positive
Airway Pressure, 3 = Endotracheal Tube
Patient Identification Stamp
This data is mandatory for all infants transported in the State of California per California Perinatal Transport System.
Rev 10/2014
2015 Manual of Definitions – Neonatal Transport Data Collection Tool
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APPENDIX B
BIRTH DEFECTS CODES FOR ITEM 49
Code Other Lethal or Life Threatening Birth Defect
100 Other Lethal or Life-Threatening Birth Defect which is not listed below
Code Central Nervous System Defects
100 Other lethal or life threatening CNS Defects (DESCRIBE)
101 Anencephaly
102 Meningomyelocele
103 Hydranencephaly
104 Congenital Hydrocephalus
105 Holoprosencephaly
Code
Congenital Heart Defects
200 Other lethal or life threatening congenital heart defects
(DESCRIBE)
201 Truncus Arteriosus
202 Transposition of the Great Vessels
203 Tetralogy of Fallot
204 Single Ventricle
205 Double Outlet Right Ventricle
206 Complete Atrio-Ventricular Canal
207 Pulmonary Atresia with intact ventricular septum
208 Tricuspid Atresia
209 Hypoplastic Left Heart Syndrome
210 Interrupted Aortic Arch
211 Total Anomalous Pulmonary Venous Return
212 Penatalogy of Cantrell (Thoraco-Abdominal Ectopia Cordis)
Code
Gastro-Intestinal Defects
300 Other lethal or life threatening GI Defects (DESCRIBE)
301 Cleft Palate
302 Tracheo-Esophageal Fistula
303 Esophageal Atresia
304 Duodenal Atresia
305 Jejunal Atresia
306 Ileal Atresia
307 Atresia of Large Bowel or Rectum
308 Imperforate Anus
309 Omphalocele
310 Gastroschisis
311 Biliary Atresia
Code
Genito-Urinary Defects
401 Bilateral Renal Agenesis
402 Bilateral Polycystic, Multicystic, or Dysplastic Kidneys
403 Obstructive Uropathy with Congenital Hydronephrosis
404 Exstrophy of the Urinary Bladder
400 Other Lethal or Life Threatening Genito-Urinary defects not
listed above (DESCRIBE)
Code
Chromosomal Abnormalities
501 Trisomy 13
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502 Trisomy 18
503 Trisomy 21
505 Triploidy
Code
Other Birth Defects
601 Skeletal Dysplasia (DESCRIBE)
602 Congenital Diaphragmatic Hernia
603 Hydrops Fetalis with anasarca and one or more of the
following: ascites, pleural effusion, pericardial effusion
604 Oligohydramnios sequence including all 3 of the following: (1)
Oligohydramnios documented by antenatal ultrasound 5 or
more days prior to delivery, (2) evidence of fetal constraint on
postnatal physical exam (such as Potter’s facies,
contractures, or positional deformities of limbs), and (3)
postnatal respiratory failure requiring endotracheal intubation
and assisted ventilation.
605 Inborn Error of Metabolism (description required)
606 Myotonic Dystrophy requiring endotracheal intubation and
assisted ventilation
607 Conjoined Twins
608 Trachael Agenesis or Atresia
609 Thanatophoric Dysplasia Types 1 and 2
610 Hemoglobin Barts
Code
Pulmonary Defects
800 Other Lethal or Life Threatening Pulmonary Malformation
(DESCRIBE)
801 Congenital Cystic Adenomatoid Malformation of the Lung
2015 Manual of Definitions – Neonatal Transport Data Collection Tool
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APPENDIX C
OSHPD # HOSPITAL NAME
010735
ALAMEDA HOSPITAL
010989
ALAMEDA HOSPITAL AT WATERS EDGE
010956
ALAMEDA HOSPITAL-SOUTH SHORE CONVALESCENT
HOSPITAL
190017
ALHAMBRA HOSPITAL MEDICAL CENTER
250956
MODOC MEDICAL CENTER
301097
ANAHEIM GENERAL HOSPITAL
301098
ANAHEIM REGIONAL MEDICAL CENTER
304409
KAISER FND HOSP - ORANGE COUNTY - ANAHEIM
301132
KAISER FND HOSP - ORANGE COUNTY - LAKEVIEW
301379
WEST ANAHEIM MEDICAL CENTER
301188
WESTERN MEDICAL CENTER ANAHEIM
074097
KAISER FND HOSP - ANTIOCH
070934
SUTTER DELTA MEDICAL CENTER
361343
ST. MARY MEDICAL CENTER IN APPLE VALLEY
CITY
ALAMEDA
ALAMEDA
ALAMEDA
COUNTY
ALAMEDA
ALAMEDA
ALAMEDA
ALHAMBRA
ALTURAS
ANAHEIM
ANAHEIM
ANAHEIM
ANAHEIM
ANAHEIM
ANAHEIM
ANTIOCH
ANTIOCH
APPLE VALLEY
LOS ANGELES
MODOC
ORANGE
ORANGE
ORANGE
ORANGE
ORANGE
ORANGE
CONTRA COSTA
CONTRA COSTA
SAN
BERNARDINO
LOS ANGELES
HUMBOLDT
SAN LUIS OBISPO
SAN LUIS OBISPO
PLACER
LOS ANGELES
KERN
KERN
KERN
KERN
KERN
KERN
KERN
KERN
KERN
KERN
LOS ANGELES
LOS ANGELES
RIVERSIDE
SAN
BERNARDINO
LOS ANGELES
LOS ANGELES
ALAMEDA
ALAMEDA
SAN
190529
121002
400466
400683
310791
190045
154101
150722
154160
150775
154044
154022
150736
150761
154108
150788
196035
190049
331326
364430
METHODIST HOSPITAL OF SOUTHERN CALIFORNIA
MAD RIVER COMMUNITY HOSPITAL
MARIAN REGIONAL MEDICAL CENTER, ARROYO GRANDE
ATASCADERO STATE HOSPITAL
SUTTER AUBURN FAITH HOSPITAL
CATALINA ISLAND MEDICAL CENTER
BAKERSFIELD HEART HOSPITAL
BAKERSFIELD MEMORIAL HOSPITAL
CRESTWOOD PSYCHIATRIC HEALTH FACILITY 2
GOOD SAMARITAN HOSPITAL-BAKERSFIELD
GOOD SAMARITAN HOSPITAL-SOUTHWEST D/P APH
HEALTHSOUTH BAKERSFIELD REHABILITATION HOSPITAL
KERN MEDICAL CENTER
MERCY HOSPITAL - BAKERSFIELD
MERCY SOUTHWEST HOSPITAL
SAN JOAQUIN COMMUNITY HOSPITAL
KAISER FND HOSP - BALDWIN PARK
KINDRED HOSPITAL BALDWIN PARK
SAN GORGONIO MEMORIAL HOSPITAL
BARSTOW COMMUNITY HOSPITAL
ARCADIA
ARCATA
ARROYO GRANDE
ATASCADERO
AUBURN
AVALON
BAKERSFIELD
BAKERSFIELD
BAKERSFIELD
BAKERSFIELD
BAKERSFIELD
BAKERSFIELD
BAKERSFIELD
BAKERSFIELD
BAKERSFIELD
BAKERSFIELD
BALDWIN PARK
BALDWIN PARK
BANNING
BARSTOW
190066
194044
010844
010739
361110
BELLFLOWER MEDICAL CENTER
BELLWOOD HEALTH CENTER
ALTA BATES SUMMIT MED CTR-HERRICK CAMPUS
ALTA BATES SUMMIT MEDICAL CENTER
BEAR VALLEY COMMUNITY HOSPITAL
BELLFLOWER
BELLFLOWER
BERKELEY
BERKELEY
BIG BEAR LAKE
2015 Manual of Definitions – Neonatal Transport Data Collection Tool
26
141273
331288
OSHPD #
130760
301127
301109
190758
413500
410852
560508
434051
190859
344170
340950
014233
250955
504081
190184
321016
044006
040828
040962
044011
364050
NORTHERN INYO HOSPITAL
PALO VERDE HOSPITAL
HOSPITAL NAME
PIONEERS MEMORIAL HEALTHCARE DISTRICT
KINDRED HOSPITAL BREA
ANAHEIM GENERAL HOSPITAL - BUENA PARK CAMPUS
PROVIDENCE ST. JOSEPH MEDICAL CENTER
BURLINGAME HEALTH CARE CENTER D/P SNF
MILLS-PENINSULA MEDICAL CENTER
ST. JOHN'S PLEASANT VALLEY HOSPITAL
CHILDRENS RECOVERY CENTER OF NORTHERN CALIFORNIA
WEST HILLS HOSPITAL AND MEDICAL CENTER
CRESTWOOD PSYCHIATRIC HEALTH FACILITY-CARMICHAEL
MERCY SAN JUAN MEDICAL CENTER
EDEN MEDICAL CENTER
SURPRISE VALLEY COMMUNITY HOSPITAL
TELECARE STANISLAUS COUNTY PHF
COLLEGE HOSPITAL
SENECA HEALTHCARE DISTRICT
BUTTE COUNTY MENTAL HEALTH SERVICES
ENLOE MEDICAL CENTER - COHASSET
ENLOE MEDICAL CENTER- ESPLANADE
ENLOE REHABILITATION CENTER
CANYON RIDGE HOSPITAL
BISHOP
BLYTHE
CITY
BRAWLEY
BREA
BUENA PARK
BURBANK
BURLINGAME
BURLINGAME
CAMARILLO
CAMPBELL
CANOGA PARK
CARMICHAEL
CARMICHAEL
CASTRO VALLEY
CEDARVILLE
CERES
CERRITOS
CHESTER
CHICO
CHICO
CHICO
CHICO
CHINO
361144
CHINO VALLEY MEDICAL CENTER
CHINO
370775
370658
370875
171049
100005
100697
105051
364231
PARADISE VALLEY HSP D/P APH BAYVIEW BEH HLTH
SCRIPPS MERCY HOSPITAL CHULA VISTA
SHARP CHULA VISTA MEDICAL CENTER
ST. HELENA HOSPITAL - CLEARLAKE
CLOVIS COMMUNITY MEDICAL CENTER
COALINGA REGIONAL MEDICAL CENTER
DEPARTMENT OF STATE HOSPITAL - COALINGA
ARROWHEAD REGIONAL MEDICAL CENTER
CHULA VISTA
CHULA VISTA
CHULA VISTA
CLEARLAKE
CLOVIS
COALINGA
COALINGA
COLTON
060870
074039
071018
331145
331152
370689
374321
COLUSA REGIONAL MEDICAL CENTER
JOHN MUIR BEHAVIORAL HEALTH CENTER
JOHN MUIR MEDICAL CENTER-CONCORD CAMPUS
CORONA REGIONAL MEDICAL CENTER-MAGNOLIA
CORONA REGIONAL MEDICAL CENTER-MAIN
SHARP CORONADO HOSPITAL AND HEALTHCARE CENTER
VILLA CORONADO CONVALESCENT (DP/SNF)
COLUSA
CONCORD
CONCORD
CORONA
CORONA
CORONADO
CORONADO
2015 Manual of Definitions – Neonatal Transport Data Collection Tool
27
BERNARDINO
INYO
RIVERSIDE
COUNTY
IMPERIAL
ORANGE
ORANGE
LOS ANGELES
SAN MATEO
SAN MATEO
VENTURA
SANTA CLARA
LOS ANGELES
SACRAMENTO
SACRAMENTO
ALAMEDA
MODOC
STANISLAUS
LOS ANGELES
PLUMAS
BUTTE
BUTTE
BUTTE
BUTTE
SAN
BERNARDINO
SAN
BERNARDINO
SAN DIEGO
SAN DIEGO
SAN DIEGO
LAKE
FRESNO
FRESNO
FRESNO
SAN
BERNARDINO
COLUSA
CONTRA COSTA
CONTRA COSTA
RIVERSIDE
RIVERSIDE
SAN DIEGO
SAN DIEGO
301155
301781
190163
190413
084001
OSHPD #
197931
190110
410817
574010
150706
196403
191306
190243
190176
130699
491267
371394
120981
124004
121080
481357
450936
370704
370705
344029
344035
361223
COLLEGE HOSPITAL COSTA MESA
FAIRVIEW DEVELOPMENTAL CENTER
AURORA CHARTER OAK
CITRUS VALLEY MEDICAL CENTER - IC CAMPUS
SUTTER COAST HOSPITAL
HOSPITAL NAME
EXODUS RECOVERY P.H.F.
SOUTHERN CALIFORNIA HOSPITAL AT CULVER CITY
SETON MEDICAL CENTER
SUTTER DAVIS HOSPITAL
DELANO REGIONAL MEDICAL CENTER
KAISER FND HOSP - DOWNEY
LAC/RANCHO LOS AMIGOS NATIONAL REHAB CENTER
PIH HOSPITAL - DOWNEY
CITY OF HOPE HELFORD CLINICAL RESEARCH HOSPITAL
EL CENTRO REGIONAL MEDICAL CENTER
SONOMA DEVELOPMENTAL CENTER
RADY CHILDREN’S HOSPITAL SAN DIEGO AT SCRIPPS
ENCINITAS (RCHSD)
ENCINO HOSPITAL MEDICAL CENTER
PALOMAR MEDICAL CENTER
RADY CHILDREN’S NICU AT PALOMAR MEDICAL CENTER
(RCHSD)
GENERAL HOSPITAL, THE
SEMPERVIRENS P.H.F.
ST. JOSEPH HOSPITAL - EUREKA
NORTHBAY MEDICAL CENTER
MAYERS MEMORIAL HOSPITAL
FALLBROOK HOSP DISTRICT SKILLED NURSING FACILITY
FALLBROOK HOSPITAL DISTRICT
MERCY HOSPITAL - FOLSOM
VIBRA HOSPITAL OF SACRAMENTO
KAISER FND HOSP - FONTANA
231013
121051
301175
MENDOCINO COAST DISTRICT HOSPITAL
FORT BRAGG
REDWOOD MEMORIAL HOSPITAL
FORTUNA
FOUNTAIN VALLEY REGIONAL HOSPITAL & MEDICAL CENTER FOUNTAIN VALLEY
HUMBOLDT
HUMBOLDT
HUMBOLDT
SOLANO
SHASTA
SAN DIEGO
SAN DIEGO
SACRAMENTO
SACRAMENTO
SAN
BERNARDINO
MENDOCINO
HUMBOLDT
ORANGE
304039
300225
014034
014132
010987
391010
FOUNTAIN VALLEY RGNL HOSP AND MED CTR - WARNER
ORANGE COAST MEMORIAL MEDICAL CENTER
FREMONT HOSPITAL
KAISER FND HOSP - FREMONT
WASHINGTON HOSPITAL - FREMONT
SAN JOAQUIN GENERAL HOSPITAL
ORANGE
ORANGE
ALAMEDA
ALAMEDA
ALAMEDA
SAN JOAQUIN
190280
374382
370755
2015 Manual of Definitions – Neonatal Transport Data Collection Tool
COSTA MESA
COSTA MESA
COVINA
COVINA
CRESCENT CITY
CITY
CULVER CITY
CULVER CITY
DALY CITY
DAVIS
DELANO
DOWNEY
DOWNEY
DOWNEY
DUARTE
EL CENTRO
ELDRIDGE
ENCINITAS
ORANGE
ORANGE
LOS ANGELES
LOS ANGELES
DEL NORTE
COUNTY
LOS ANGELES
LOS ANGELES
SAN MATEO
YOLO
KERN
LOS ANGELES
LOS ANGELES
LOS ANGELES
LOS ANGELES
IMPERIAL
SONOMA
SAN DIEGO
ENCINO
ESCONDIDO
ESCONDIDO
LOS ANGELES
SAN DIEGO
SAN DIEGO
EUREKA
EUREKA
EUREKA
FAIRFIELD
FALL RIVER MILLS
FALLBROOK
FALLBROOK
FOLSOM
FOLSOM
FONTANA
FOUNTAIN VALLEY
FOUNTAIN VALLEY
FREMONT
FREMONT
FREMONT
FRENCH CAMP
28
100899
CHILDREN’S HOSPITAL CENTRAL CALIFORNIA- ST. AGNES
HOSPITAL (CHCC)
104008
COMMUNITY BEHAVIORAL HEALTH CENTER
100717
COMMUNITY REGIONAL MEDICAL CENTER (CRMC)
100718
COMMUNITY SUBACUTE AND TRANSITIONAL CARE CENTER
104089
CRESTWOOD PSYCHIATRIC HEALTH FACILITY-FRESNO
OSHPD # HOSPITAL NAME
105029
FRESNO HEART AND SURGICAL HOSPITAL
104047
FRESNO SURGICAL HOSPITAL
104062
KAISER FND HOSP - FRESNO
104023
SAN JOAQUIN VALLEY REHABILITATION HOSPITAL
301342
ST. JUDE MEDICAL CENTER
121031
JEROLD PHELPS COMMUNITY HOSPITAL
301283
GARDEN GROVE HOSPITAL AND MEDICAL CENTER
190196
KINDRED HOSPITAL SOUTH BAY
190521
MEMORIAL HOSPITAL OF GARDENA
494047
WOODLANDS PSYCHIATRIC HEALTH FACILITY
434138
ST. LOUISE REGIONAL HOSPITAL
190323
GLENDALE ADVENTIST MEDICAL CENTER
190522
GLENDALE MEMORIAL HOSPITAL AND HEALTH CENTER
190818
USC VERDUGO HILLS HOSPITAL
190298
FOOTHILL PRESBYTERIAN HOSPITAL-JOHNSTON MEMORIAL
190328
GLENDORA COMMUNITY HOSPITAL
291023
SIERRA NEVADA MEMORIAL HOSPITAL
211006
MARIN GENERAL HOSPITAL
040802
BIGGS GRIDLEY MEMORIAL HOSPITAL
164029
ADVENTIST MEDICAL CENTER
160787
CENTRAL VALLEY GENERAL HOSPITAL
190431
KAISER FND HOSP - SOUTH BAY
190159
GARDENS REGIONAL HOSPITAL AND MEDICAL CENTER
FRESNO
FRESNO
FRESNO
FRESNO
FRESNO
FRESNO
COUNTY
FRESNO
FRESNO
FRESNO
FRESNO
ORANGE
HUMBOLDT
ORANGE
LOS ANGELES
LOS ANGELES
SONOMA
SANTA CLARA
LOS ANGELES
LOS ANGELES
LOS ANGELES
LOS ANGELES
LOS ANGELES
NEVADA
MARIN
BUTTE
KINGS
KINGS
LOS ANGELES
LOS ANGELES
190523
FRESNO
FRESNO
FRESNO
FRESNO
CITY
FRESNO
FRESNO
FRESNO
FRESNO
FULLERTON
GARBERVILLE
GARDEN GROVE
GARDENA
GARDENA
GEYSERVILLE
GILROY
GLENDALE
GLENDALE
GLENDALE
GLENDORA
GLENDORA
GRASS VALLEY
GREENBRAE
GRIDLEY
HANFORD
HANFORD
HARBOR CITY
HAWAIIAN
GARDENS
HAWTHORNE
HAYWARD
HEALDSBURG
HEMET
HEMET
HOLLISTER
HOLLISTER
HOLLYWOOD
HUNTINGTON
BEACH
HUNTINGTON
PARK
29
ALAMEDA
SONOMA
RIVERSIDE
RIVERSIDE
SAN BENITO
SAN BENITO
LOS ANGELES
ORANGE
010967
490964
334032
331194
350784
351814
190380
301209
LOS ANGELES METROPOLITAN MED CTR-HAWTHORNE
CAMPUS
ST. ROSE HOSPITAL
HEALDSBURG DISTRICT HOSPITAL
HEMET VALLEY HEALTH CARE CENTER
HEMET VALLEY MEDICAL CENTER
HAZEL HAWKINS MEMORIAL HOSPITAL
HAZEL HAWKINS MEMORIAL HOSPITAL D/P SNF
SOUTHERN CALIFORNIA HOSPITAL AT HOLLYWOOD
HUNTINGTON BEACH HOSPITAL
190197
COMMUNITY HOSPITAL OF HUNTINGTON PARK
2015 Manual of Definitions – Neonatal Transport Data Collection Tool
LOS ANGELES
LOS ANGELES
331216
334457
JOHN F KENNEDY MEMORIAL HOSPITAL
TELECARE RIVERSIDE COUNTY PSYCHIATRIC HEALTH FACILITY
INDIO
INDIO
RIVERSIDE
RIVERSIDE
190148
304045
304460
304306
034002
OSHPD #
362041
CENTINELA HOSPITAL MEDICAL CENTER
HOAG HOSPITAL IRVINE
HOAG ORTHOPEDIC INSTITUTE
KAISER FND HOSP - ORANGE COUNTY - IRVINE
SUTTER AMADOR HOSPITAL
HOSPITAL NAME
HI-DESERT MEDICAL CENTER
INGLEWOOD
IRVINE
IRVINE
IRVINE
JACKSON
CITY
JOSHUA TREE
210993
270777
370771
KENTFIELD
KING CITY
LA JOLLA
LA JOLLA
LA JOLLA
SAN DIEGO
SAN DIEGO
370749
370714
190449
301234
301337
301317
361266
KENTFIELD REHABILITATION & SPECIALTY HOSPITAL
GEORGE L MEE MEMORIAL HOSPITAL
RADY CHILDREN’S HOSPITAL SAN DIEGO AT SCRIPPS LA
JOLLA (RCHSD)
SCRIPPS GREEN HOSPITAL
UCSD-LA JOLLA, JOHN M/SALLY B THORNTON HOSP &
SULPIZO CARDIO
ALVARADO PARKWAY INSTITUTE B.H.S.
SHARP GROSSMONT HOSPITAL, WOMEN’S HEALTH CENTER
KINDRED HOSPITAL - LA MIRADA
LA PALMA INTERCOMMUNITY HOSPITAL
MISSION HOSPITAL LAGUNA BEACH
SADDLEBACK MEMORIAL HOSPITAL
MOUNTAINS COMMUNITY HOSPITAL
LOS ANGELES
ORANGE
ORANGE
ORANGE
AMADOR
COUNTY
SAN
BERNARDINO
MARIN
MONTEREY
SAN DIEGO
LA MESA
LA MESA
LA MIRADA
LA PALMA
LAGUNA BEACH
LAGUNA HILLS
LAKE ARROWHEAD
150737
171395
190240
190034
010983
390923
390922
361245
KERN VALLEY HEALTHCARE DISTRICT
SUTTER LAKESIDE HOSPITAL
LAKEWOOD REGIONAL MEDICAL CENTER
ANTELOPE VALLEY HOSPITAL
VALLEY MEMORIAL HOSPITAL
LODI MEMORIAL HOSPITAL
LODI MEMORIAL HOSPITAL - WEST
LOMA LINDA UNIV. MED. CENTER EAST CAMPUS HOSPITAL
LAKE ISABELLA
LAKEPORT
LAKEWOOD
LANCASTER
LIVERMORE
LODI
LODI
LOMA LINDA
364502
LOMA LINDA UNIVERSITY CHILDREN'S HOSPITAL
LOMA LINDA
361246
LOMA LINDA UNIVERSITY MEDICAL CENTER
LOMA LINDA
364451
TOTALLY KIDS REHABILITATION HOSPITAL
LOMA LINDA
420491
420552
LOMPOC VALLEY MEDICAL CENTER
LOMPOC VALLEY MEDICAL CENTER COMPREHENSIVE CARE
CENTER D/P S
LOMPOC
LOMPOC
SAN DIEGO
SAN DIEGO
LOS ANGELES
ORANGE
ORANGE
ORANGE
SAN
BERNARDINO
KERN
LAKE
LOS ANGELES
LOS ANGELES
ALAMEDA
SAN JOAQUIN
SAN JOAQUIN
SAN
BERNARDINO
SAN
BERNARDINO
SAN
BERNARDINO
SAN
BERNARDINO
SANTA BARBARA
SANTA BARBARA
371256
374141
2015 Manual of Definitions – Neonatal Transport Data Collection Tool
30
424102
141338
190587
190477
190475
194981
190525
196168
THE CHAMPION CENTER
SOUTHERN INYO HOSPITAL
COLLEGE MEDICAL CENTER
COLLEGE MEDICAL CENTER SOUTH CAMPUS D/P APH
COMMUNITY HOSPITAL LONG BEACH
LA CASA PSYCHIATRIC HEALTH FACILITY
LONG BEACH MEMORIAL MEDICAL CENTER
MILLER CHILDREN’S HOSPITAL AT LONG BEACH MEMORIAL
HOSPITAL
190053
ST. MARY MEDICAL CENTER
191225
TOM REDGATE MEMORIAL RECOVERY CENTER
301248
LOS ALAMITOS MEDICAL CENTER
190052
BARLOW RESPIRATORY HOSPITAL
190125
CALIFORNIA HOSPITAL MEDICAL CENTER - LOS ANGELES
OSHPD # HOSPITAL NAME
190555
CEDARS-SINAI MEDICAL CENTER
190155
CENTURY CITY DOCTORS HOSPITAL
190170
CHILDREN’S HOSPITAL LOS ANGELES
190256
EAST LOS ANGELES DOCTORS HOSPITAL
190317
GATEWAYS HOSPITAL AND MENTAL HEALTH CENTER
190392
GOOD SAMARITAN HOSPITAL, LOS ANGELES
190382
HOLLYWOOD PRESBYTERIAN MEDICAL CENTER
190646
KAISER FND HOSP - MENTAL HEALTH CENTER
190429
KAISER FND HOSP - SUNSET/LOS ANGELES
190434
KAISER FND HOSP - WEST LOS ANGELES
194219
KECK HOSPITAL OF USC
190150
KEDREN COMMUNITY MENTAL HEALTH CENTER
190305
KINDRED HOSPITAL - LOS ANGELES
191228
LAC/USC (LOS ANGELES COUNTY, UNIVERSITY SOUTHERN
CALIFORNIA MEDICAL CENTER)
190198
LOS ANGELES COMMUNITY HOSPITAL
190854
LOS ANGELES METROPOLITAN MEDICAL CENTER
190796
MATTEL CHILDREN’S HOSPITAL AT RONALD REAGAN UCLA
190681
MIRACLE MILE MEDICAL CENTER
190534
OLYMPIA MEDICAL CENTER
190307
PACIFIC ALLIANCE MEDICAL CENTER
190468
PROMISE HOSPITAL OF EAST LOS ANGELES-EAST L.A.
CAMPUS
190930
RESNICK NEUROPSYCHIATRIC HOSPITAL AT UCLA
190712
SHRINERS HOSPITAL FOR CHILDREN
190661
SILVER LAKE MEDICAL CENTER-DOWNTOWN CAMPUS
190762
ST. VINCENT MEDICAL CENTER
191216
USC KENNETH NORRIS, JR. CANCER HOSPITAL
2015 Manual of Definitions – Neonatal Transport Data Collection Tool
LOMPOC
LONE PINE
LONG BEACH
LONG BEACH
LONG BEACH
LONG BEACH
LONG BEACH
LONG BEACH
SANTA BARBARA
INYO
LOS ANGELES
LOS ANGELES
LOS ANGELES
LOS ANGELES
LOS ANGELES
LOS ANGELES
LONG BEACH
LONG BEACH
LOS ALAMITOS
LOS ANGELES
LOS ANGELES
CITY
LOS ANGELES
LOS ANGELES
LOS ANGELES
LOS ANGELES
LOS ANGELES
LOS ANGELES
LOS ANGELES
LOS ANGELES
LOS ANGELES
LOS ANGELES
LOS ANGELES
LOS ANGELES
LOS ANGELES
LOS ANGELES
LOS ANGELES
LOS ANGELES
ORANGE
LOS ANGELES
LOS ANGELES
COUNTY
LOS ANGELES
LOS ANGELES
LOS ANGELES
LOS ANGELES
LOS ANGELES
LOS ANGELES
LOS ANGELES
LOS ANGELES
LOS ANGELES
LOS ANGELES
LOS ANGELES
LOS ANGELES
LOS ANGELES
LOS ANGELES
LOS ANGELES
LOS ANGELES
LOS ANGELES
LOS ANGELES
LOS ANGELES
LOS ANGELES
LOS ANGELES
LOS ANGELES
LOS ANGELES
LOS ANGELES
LOS ANGELES
LOS ANGELES
LOS ANGELES
LOS ANGELES
LOS ANGELES
LOS ANGELES
LOS ANGELES
LOS ANGELES
LOS ANGELES
LOS ANGELES
LOS ANGELES
LOS ANGELES
LOS ANGELES
LOS ANGELES
31
190878
240924
430743
430915
462284
190754
204019
201281
260011
392287
394009
190500
220733
070924
580996
600001
OSHPD #
414018
244027
240942
190385
304113
LOS ANGELES
LOS BANOS
LOS GATOS
LOS GATOS
LOYALTON
LYNWOOD
MADERA
MADERA
MAMMOTH LAKES
MANTECA
MANTECA
MARINA DEL REY
MARIPOSA
MARTINEZ
MARYSVILLE
MEDFORD
CITY
MENLO PARK
MERCED
MERCED
MISSION HILLS
MISSION VIEJO
LOS ANGELES
MERCED
SANTA CLARA
SANTA CLARA
SIERRA
LOS ANGELES
MADERA
MADERA
MONO
SAN JOAQUIN
SAN JOAQUIN
LOS ANGELES
MARIPOSA
CONTRA COSTA
YUBA
MISSION VIEJO
MODESTO
MODESTO
MODESTO
ORANGE
STANISLAUS
STANISLAUS
STANISLAUS
504042
500939
504038
190541
361166
WHITE MEMORIAL MEDICAL CENTER
MEMORIAL HOSPITAL LOS BANOS
EL CAMINO HOSPITAL LOS GATOS
MISSION OAKS HOSPITAL
EASTERN PLUMAS HOSPITAL-LOYALTON CAMPUS D/P SNF
ST. FRANCIS MEDICAL CENTER
CHILDREN’S HOSPITAL CENTRAL CALIFORNIA, (CHCC)
MADERA COMMUNITY HOSPITAL
MAMMOTH HOSPITAL
DOCTORS HOSPITAL OF MANTECA
KAISER FND HOSP - MANTECA
MARINA DEL REY HOSPITAL
JOHN C FREMONT HEALTHCARE DISTRICT
CONTRA COSTA REGIONAL MEDICAL CENTER
RIDEOUT MEMORIAL HOSPITAL
ROGUE REGIONAL MEDICAL CENTER
HOSPITAL NAME
MENLO PARK SURGICAL HOSPITAL
MARIE GREEN PSYCHIATRIC CENTER - P H F
MERCY MEDICAL CENTER - MERCED
PROVIDENCE HOLY CROSS MEDICAL CENTER
CHILDREN’S HOSPITAL OF ORANGE COUNTY (CHOC) AT
MISSION HOSPITAL
MISSION HOSPITAL REGIONAL MEDICAL CENTER
CENTRAL VALLEY SPECIALTY HOSPITAL
DOCTORS MEDICAL CENTER OF MODESTO
DOCTORS MEDICAL CENTER-BEHAVIORAL HEALTH
DEPARTMENT
KAISER FND HOSP - MODESTO
MEMORIAL MEDICAL CENTER, MODESTO
STANISLAUS SURGICAL HOSPITAL
MONROVIA MEMORIAL HOSPITAL
MONTCLAIR HOSPITAL MEDICAL CENTER
MODESTO
MODESTO
MODESTO
MONROVIA
MONTCLAIR
190081
270744
190315
190547
334048
334487
410828
470871
430763
334589
BEVERLY HOSPITAL
COMMUNITY HOSPITAL OF THE MONTEREY PENINSULA
GARFIELD MEDICAL CENTER
MONTEREY PARK HOSPITAL
KAISER FND HOSP - MORENO VALLEY
RIVERSIDE COUNTY REGIONAL MEDICAL CENTER
SETON COASTSIDE
MERCY MEDICAL CENTER MT. SHASTA
EL CAMINO HOSPITAL
LOMA LINDA UNIVERSITY MEDICAL CENTER-MURRIETA
MONTEBELLO
MONTEREY
MONTEREY PARK
MONTEREY PARK
MORENO VALLEY
MORENO VALLEY
MOSS BEACH
MOUNT SHASTA
MOUNTAIN VIEW
MURRIETA
32
STANISLAUS
STANISLAUS
STANISLAUS
LOS ANGELES
SAN
BERNARDINO
LOS ANGELES
MONTEREY
LOS ANGELES
LOS ANGELES
RIVERSIDE
RIVERSIDE
SAN MATEO
SISKIYOU
SANTA CLARA
RIVERSIDE
301262
500954
500852
501016
2015 Manual of Definitions – Neonatal Transport Data Collection Tool
COUNTY
SAN MATEO
MERCED
MERCED
LOS ANGELES
ORANGE
334068
281266
281047
370759
361458
SOUTHWEST HEALTHCARE SYSTEM-MURRIETA
NAPA STATE HOSPITAL
QUEEN OF THE VALLEY HOSPITAL - NAPA
PARADISE VALLEY HOSPITAL
COLORADO RIVER MEDICAL CENTER
HOAG MEMORIAL HOSPITAL, PRESBYTERIAN
NEWPORT BAY HOSPITAL
NORTHRIDGE HOSPITAL MEDICAL CENTER
COAST PLAZA HOSPITAL
DEPARTMENT OF STATE HOSPITAL-METROPOLITAN
NORWALK COMMUNITY HOSPITAL
NOVATO COMMUNITY HOSPITAL
OAK VALLEY CARE CENTER D/P SNF
OAK VALLEY DISTRICT HOSPITAL (2-RH)
ALTA BATES SUMMIT MED CTR-SUMMIT CAMPUSHAWTHORNE
013626
ALTA BATES SUMMIT MED CTR-SUMMIT CAMPUS-SUMMIT
OSHPD # HOSPITAL NAME
010776
CHILDREN’S HOSPITAL & RESEARCH CENTER - OAKLAND
010846
HIGHLAND HOSPITAL
014326
KAISER PERMANENTE - OAKLAND
013687
MPI CHEMICAL DEPENDENCY RECOVERY HOSPITAL
014207
TELECARE HERITAGE PSYCHIATRIC HEALTH FACILITY
010782
THUNDER ROAD CHEMICAL DEPENDENCY RECOVERY
HOSPITAL
370780
TRI-CITY MEDICAL CENTER
560500
OJAI MANOR CONVALESCENT HOSPITAL
560501
OJAI VALLEY COMMUNITY HOSPITAL
364265
KAISER FND HOSP - ONTARIO
NEWPORT BEACH
NEWPORT BEACH
NORTHRIDGE
NORWALK
NORWALK
NORWALK
NOVATO
OAKDALE
OAKDALE
OAKLAND
RIVERSIDE
NAPA
NAPA
SAN DIEGO
SAN
BERNARDINO
ORANGE
ORANGE
LOS ANGELES
LOS ANGELES
LOS ANGELES
LOS ANGELES
MARIN
STANISLAUS
STANISLAUS
ALAMEDA
OAKLAND
CITY
OAKLAND
OAKLAND
OAKLAND
OAKLAND
OAKLAND
OAKLAND
ALAMEDA
COUNTY
ALAMEDA
ALAMEDA
ALAMEDA
ALAMEDA
ALAMEDA
ALAMEDA
OCEANSIDE
OJAI
OJAI
ONTARIO
361274
KINDRED HOSPITAL ONTARIO
ONTARIO
301140
300032
304159
301340
301279
040937
560838
560529
331164
196405
CHAPMAN MEDICAL CENTER
CHILDREN’S HOSPITAL OF ORANGE COUNTY (CHOC )
HEALTHBRIDGE CHILDREN'S HOSPITAL-ORANGE
ST. JOSEPH HOSPITAL - ORANGE
UNIVERSITY OF CALIFORNIA, IRVINE MEDICAL CENTER (UCI)
OROVILLE HOSPITAL
PACIFIC SHORES HOSPITAL
ST. JOHN’S REGIONAL MEDICAL CENTER
DESERT REGIONAL MEDICAL CENTER
PALMDALE REGIONAL MEDICAL CENTER
ORANGE
ORANGE
ORANGE
ORANGE
ORANGE
OROVILLE
OXNARD
OXNARD
PALM SPRINGS
PALMDALE
SAN DIEGO
VENTURA
VENTURA
SAN
BERNARDINO
SAN
BERNARDINO
ORANGE
ORANGE
ORANGE
ORANGE
ORANGE
BUTTE
VENTURA
VENTURA
RIVERSIDE
LOS ANGELES
301205
301304
190568
190766
190958
190570
214034
501352
500967
010937
2015 Manual of Definitions – Neonatal Transport Data Collection Tool
MURRIETA
NAPA
NAPA
NATIONAL CITY
NEEDLES
33
434040
PALO ALTO
SANTA CLARA
PALO ALTO
PANORAMA CITY
PANORAMA CITY
PARADISE
PARAMOUNT
SANTA CLARA
LOS ANGELES
LOS ANGELES
BUTTE
LOS ANGELES
190462
190400
361768
LUCILE PACKARD CHILDREN’S HOSPITAL AT STANFORD,
(LPCH)
STANFORD HOSPITAL
KAISER FND HOSP - PANORAMA CITY
MISSION COMMUNITY HOSPITAL - PANORAMA CAMPUS
FEATHER RIVER HOSPITAL
PROMISE HOSPITAL OF EAST LOS ANGELES-SUBURBAN
CAMPUS
AURORA LAS ENCINAS HOSPITAL
HUNTINGTON MEMORIAL HOSPITAL
PATTON STATE HOSPITAL
PASADENA
PASADENA
PATTON
332172
491001
301297
094002
090933
014050
194010
190137
191014
OSHPD #
190630
541123
540798
320859
370977
320986
364188
KINDRED HOSPITAL RIVERSIDE
PETALUMA VALLEY HOSPITAL
PLACENTIA LINDA HOSPITAL
EL DORADO COUNTY P H F
MARSHALL MEDICAL CENTER (1-RH)
VALLEYCARE MEDICAL CENTER
AMERICAN RECOVERY CENTER
CASA COLINA HOSPITAL FOR REHAB MEDICINE
LANTERMAN DEVELOPMENTAL CENTER
HOSPITAL NAME
POMONA VALLEY HOSPITAL MEDICAL CENTER
PORTERVILLE DEVELOPMENTAL CENTER
SIERRA VIEW MEDICAL CENTER
EASTERN PLUMAS HOSPITAL-PORTOLA CAMPUS
POMERADO HOSPITAL
PLUMAS DISTRICT HOSPITAL
KINDRED HOSPITAL RANCHO
330120
331168
521041
450949
454013
454068
451019
450940
454012
364014
BETTY FORD CENTER AT EISENHOWER, THE
EISENHOWER MEDICAL CENTER
ST. ELIZABETH COMMUNITY HOSPITAL
MERCY MEDICAL CENTER, REDDING
PATIENTS' HOSPITAL OF REDDING
RESTPADD PSYCHIATRIC HEALTH FACILITY
SHASTA COUNTY P H F
SHASTA REGIONAL MEDICAL CENTER
VIBRA HOSPITAL OF NORTHERN CALIFORNIA
LOMA LINDA UNIVERSITY BEHAVIORAL MEDICINE CENTER
PERRIS
PETALUMA
PLACENTIA
PLACERVILLE
PLACERVILLE
PLEASANTON
POMONA
POMONA
POMONA
CITY
POMONA
PORTERVILLE
PORTERVILLE
PORTOLA
POWAY
QUINCY
RANCHO
CUCAMONGA
RANCHO MIRAGE
RANCHO MIRAGE
RED BLUFF
REDDING
REDDING
REDDING
REDDING
REDDING
REDDING
REDLANDS
364268
LOMA LINDA UNIVERSITY HEART AND SURGICAL HOSPITAL
REDLANDS
LOS ANGELES
LOS ANGELES
SAN
BERNARDINO
RIVERSIDE
SONOMA
ORANGE
EL DORADO
EL DORADO
ALAMEDA
LOS ANGELES
LOS ANGELES
LOS ANGELES
COUNTY
LOS ANGELES
TULARE
TULARE
PLUMAS
SAN DIEGO
PLUMAS
SAN
BERNARDINO
RIVERSIDE
RIVERSIDE
TEHAMA
SHASTA
SHASTA
SHASTA
SHASTA
SHASTA
SHASTA
SAN
BERNARDINO
SAN
BERNARDINO
430905
190432
190524
040875
190599
2015 Manual of Definitions – Neonatal Transport Data Collection Tool
34
361308
REDLANDS COMMUNITY HOSPITAL
KAISER FND HOSP - REDWOOD CITY
LUCILE PACKARD CHILDREN’S SPECIAL CARE NURSERY AT
SEQUOIA HOSPITAL, (LPCH)
100797
ADVENTIST MEDICAL CENTER - REEDLEY
196404
JOYCE EISENBERG KEEFER MEDICAL CENTER
074093
KAISER FND HOSP - RICHMOND CAMPUS
150782
RIDGECREST REGIONAL HOSPITAL
334025
KAISER FND HOSP - RIVERSIDE
331293
PARKVIEW COMMUNITY HOSPITAL
331312
RIVERSIDE COMMUNITY HOSPITAL
331314
RIVERSIDE COUNTY REGIONAL MEDICAL CENTER - D/P APH
331226
VISTA BEHAVIORAL HOSPITAL
190020
BHC ALHAMBRA HOSPITAL
190410
SILVER LAKE MEDICAL CENTER-INGLESIDE CAMPUS
314024
KAISER PERMANENTE - ROSEVILLE
311000
SUTTER ROSEVILLE MEDICAL CENTER
314029
TELECARE PLACER COUNTY PSYCHIATRIC HEALTH FACILITY
344188
CRESTWOOD PSYCHIATRIC HEALTH FACILITY-SACRAMENTO
344021
HERITAGE OAKS HOSPITAL
340913
KAISER FND HOSP - SACRAMENTO
342344
KAISER FND HOSP - SOUTH SACRAMENTO
340947
MERCY GENERAL HOSPITAL
OSHPD # HOSPITAL NAME
340951
METHODIST HOSPITAL OF SACRAMENTO
344011
SACRAMENTO MENTAL HEALTH TREATMENT CENTER
344114
SHRINERS HOSPITALS FOR CHILDREN NORTHERN CALIF.
342392
SIERRA VISTA HOSPITAL
344017
SUTTER CENTER FOR PSYCHIATRY
341051
SUTTER GENERAL HOSPITAL
341052
SUTTER MEDICAL CENTER SACRAMENTO
341006
UNIVERSITY OF CALIFORNIA, DAVIS CHILDREN’S HOSPITAL
(UCD)
274043
NATIVIDAD MEDICAL CENTER
270875
SALINAS VALLEY MEMORIAL HEALTHCARE SYSTEM
050932
MARK TWAIN MEDICAL CENTER
364121
BALLARD REHABILITATION HOSP
REDWOOD CITY
REDWOOD CITY
SAN
BERNARDINO
SAN MATEO
SAN MATEO
REEDLEY
RESEDA
RICHMOND
RIDGECREST
RIVERSIDE
RIVERSIDE
RIVERSIDE
RIVERSIDE
RIVERSIDE
ROSEMEAD
ROSEMEAD
ROSEVILLE
ROSEVILLE
ROSEVILLE
SACRAMENTO
SACRAMENTO
SACRAMENTO
SACRAMENTO
SACRAMENTO
CITY
SACRAMENTO
SACRAMENTO
SACRAMENTO
SACRAMENTO
SACRAMENTO
SACRAMENTO
SACRAMENTO
SACRAMENTO
FRESNO
LOS ANGELES
CONTRA COSTA
KERN
RIVERSIDE
RIVERSIDE
RIVERSIDE
RIVERSIDE
RIVERSIDE
LOS ANGELES
LOS ANGELES
PLACER
PLACER
PLACER
SACRAMENTO
SACRAMENTO
SACRAMENTO
SACRAMENTO
SACRAMENTO
COUNTY
SACRAMENTO
SACRAMENTO
SACRAMENTO
SACRAMENTO
SACRAMENTO
SACRAMENTO
SACRAMENTO
SACRAMENTO
SALINAS
SALINAS
SAN ANDREAS
SAN BERNARDINO
361323
COMMUNITY HOSPITAL OF SAN BERNARDINO
SAN BERNARDINO
361339
ST. BERNARDINE MEDICAL CENTER
SAN BERNARDINO
301325
SADDLEBACK MEMORIAL MEDICAL CENTER - SAN CLEMENTE
SAN CLEMENTE
MONTEREY
MONTEREY
CALAVERAS
SAN
BERNARDINO
SAN
BERNARDINO
SAN
BERNARDINO
ORANGE
410804
410891
2015 Manual of Definitions – Neonatal Transport Data Collection Tool
REDLANDS
35
370652
374063
374024
370730
370721
370787
370673
374055
370744
370695
374049
370694
370745
370782
ALVARADO HOSPITAL MEDICAL CENTER
ALVARADO HOSPITAL MEDICAL CENTER
AURORA SAN DIEGO
KAISER FND HOSP - SAN DIEGO
KINDRED HOSPITAL - SAN DIEGO
PROMISE HOSPITAL OF SAN DIEGO
RADY CHILDREN’S HOSPITAL SAN DIEGO (RCHSD)
SAN DIEGO COUNTY PSYCHIATRIC HOSPITAL
SCRIPPS MERCY HOSPITAL, SAN DIEGO
SHARP MARY BIRCH HOSPITAL FOR WOMEN
SHARP MCDONALD CENTER
SHARP MEMORIAL HOSPITAL
SHARP MESA VISTA HOSPITAL
UNIVERSITY OF CALIFORNIA, SAN DIEGO MEDICAL CENTER
(UCSD)
374094
VIBRA HOSPITAL OF SAN DIEGO
190673
SAN DIMAS COMMUNITY HOSPITAL
380826
CALIFORNIA PACIFIC MED CTR-CALIFORNIA EAST
380933
CALIFORNIA PACIFIC MED CTR-DAVIES CAMPUS
380929
CALIFORNIA PACIFIC MED CTR-PACIFIC CAMPUS
380964
CALIFORNIA PACIFIC MEDICAL CENTER - ST. LUKE'S CAMPUS
380777
CALIFORNIA PACIFIC MEDICAL CENTER (CPMC)
382715
CHINESE HOSPITAL
380842
JEWISH HOME
380857
KAISER PERMANENTE - SAN FRANCISCO
OSHPD # HOSPITAL NAME
380865
LAGUNA HONDA HOSPITAL AND REHABILITATION CENTER
380868
LANGLEY PORTER PSYCHIATRIC INSTITUTE
380939
SAN FRANCISCO GENERAL HOSPITAL (SFGH)
380960
ST. FRANCIS MEMORIAL HOSPITAL
380965
ST. MARY'S MEDICAL CENTER, SAN FRANCISCO
380895
UCSF MEDICAL CENTER AT MOUNT ZION
381154
UNIVERSITY OF CALIFORNIA, SAN FRANCISCO MEDICAL
CENTER (UCSF)
190200
SAN GABRIEL VALLEY MEDICAL CENTER
434220
CRESTWOOD PSYCHIATRIC HEALTH FACILITY-SAN JOSE
430779
GOOD SAMARITAN HOSPITAL (HCA), SAN JOSE
431506
KAISER FND HOSP - SAN JOSE
430837
O’CONNOR HOSPITAL
430705
REGIONAL MEDICAL CENTER OF SAN JOSE
430883
SANTA CLARA VALLEY MEDICAL CENTER (SCVMC)
010811
FAIRMONT HOSPITAL
014337
KAISER PERMANENTE - SAN LEANDRO
010887
KINDRED HOSPITAL - SAN FRANCISCO BAY AREA
2015 Manual of Definitions – Neonatal Transport Data Collection Tool
SAN DIEGO
SAN DIEGO
SAN DIEGO
SAN DIEGO
SAN DIEGO
SAN DIEGO
SAN DIEGO
SAN DIEGO
SAN DIEGO
SAN DIEGO
SAN DIEGO
SAN DIEGO
SAN DIEGO
SAN DIEGO
SAN DIEGO
SAN DIEGO
SAN DIEGO
SAN DIEGO
SAN DIEGO
SAN DIEGO
SAN DIEGO
SAN DIEGO
SAN DIEGO
SAN DIEGO
SAN DIEGO
SAN DIEGO
SAN DIEGO
SAN DIEGO
SAN DIEGO
SAN DIMAS
SAN FRANCISCO
SAN FRANCISCO
SAN FRANCISCO
SAN FRANCISCO
SAN FRANCISCO
SAN FRANCISCO
SAN FRANCISCO
SAN FRANCISCO
CITY
SAN FRANCISCO
SAN FRANCISCO
SAN FRANCISCO
SAN FRANCISCO
SAN FRANCISCO
SAN FRANCISCO
SAN FRANCISCO
SAN DIEGO
LOS ANGELES
SAN FRANCISCO
SAN FRANCISCO
SAN FRANCISCO
SAN FRANCISCO
SAN FRANCISCO
SAN FRANCISCO
SAN FRANCISCO
SAN FRANCISCO
COUNTY
SAN FRANCISCO
SAN FRANCISCO
SAN FRANCISCO
SAN FRANCISCO
SAN FRANCISCO
SAN FRANCISCO
SAN FRANCISCO
SAN GABRIEL
SAN JOSE
SAN JOSE
SAN JOSE
SAN JOSE
SAN JOSE
SAN JOSE
SAN LEANDRO
SAN LEANDRO
SAN LEANDRO
36
LOS ANGELES
SANTA CLARA
SANTA CLARA
SANTA CLARA
SANTA CLARA
SANTA CLARA
SANTA CLARA
ALAMEDA
ALAMEDA
ALAMEDA
013619
014226
400480
404046
400524
410742
410782
070904
190680
190362
SAN LEANDRO HOSPITAL
TELECARE WILLOW ROCK CENTER
FRENCH HOSPITAL MEDICAL CENTER
SAN LUIS OBISPO CO PSYCHIATRIC HEALTH FACILITY
SIERRA VISTA REGIONAL MEDICAL CENTER
MILLS HEALTH CENTER
SAN MATEO MEDICAL CENTER
DOCTORS MEDICAL CENTER - SAN PABLO
PROVIDENCE LITTLE COMPANY OF MARY MC - SAN PEDRO
PROVIDENCE LITTLE COMPANY OF MARY SUBACUTE CARE
CENTER
210992
KAISER FND HOSP - SAN RAFAEL
074017
SAN RAMON REGIONAL MEDICAL CENTER
074011
SAN RAMON REGIONAL MEDICAL CENTER SOUTH BUILDING
301258
COASTAL COMMUNITIES HOSPITAL
301167
KINDRED HOSPITAL - SANTA ANA
301566
WESTERN MEDICAL CENTER, SANTA ANA
420514
COTTAGE HOSPITAL, SANTA BARBARA
424047
COTTAGE REHABILITATION HOSPITAL
420483
GOLETA VALLEY COTTAGE HOSPITAL
424002
SANTA BARBARA PSYCHIATRIC HEALTH FACILITY
434153
KAISER PERMANENTE - SANTA CLARA
434218
KAISER PERMANENTE P.H.F - SANTA CLARA
440755
DOMINICAN HOSPITAL
444012
SUTTER MATERNITY AND SURGERY CENTER OF SANTA CRUZ
OSHPD # HOSPITAL NAME
444029
TELECARE SANTA CRUZ PHF
420493
MARIAN REGIONAL MEDICAL CENTER
190687
SANTA MONICA-UCLA MEDICAL CENTER & ORTHOPEDIC
HOSPITAL
190756
ST. JOHN’S HEALTH CENTER
560521
VENTURA COUNTY MEDICAL CENTER - SANTA PAULA
HOSPITAL
494048
AURORA BEHAVIORAL HEALTHCARE-SANTA ROSA, LLC
494019
KAISER FND HOSP - SANTA ROSA
491064
SANTA ROSA MEMORIAL HOSPITAL
490907
SANTA ROSA MEMORIAL HOSPITAL-SOTOYOME
494106
SUTTER MEDICAL CENTER OF SANTA ROSA
374497
EDGEMOOR GERIATRIC HOSPITAL
491338
PALM DRIVE HOSPITAL
100793
ADVENTIST MEDICAL CENTER-SELMA
190708
SHERMAN OAKS HOSPITAL
560525
SIMI VALLEY HOSPITAL AND HEALTH CARE SVCS-SYCAMORE
2015 Manual of Definitions – Neonatal Transport Data Collection Tool
SAN LEANDRO
SAN LEANDRO
SAN LUIS OBISPO
SAN LUIS OBISPO
SAN LUIS OBISPO
SAN MATEO
SAN MATEO
SAN PABLO
SAN PEDRO
SAN PEDRO
ALAMEDA
ALAMEDA
SAN LUIS OBISPO
SAN LUIS OBISPO
SAN LUIS OBISPO
SAN MATEO
SAN MATEO
CONTRA COSTA
LOS ANGELES
LOS ANGELES
SAN RAFAEL
SAN RAMON
SAN RAMON
SANTA ANA
SANTA ANA
SANTA ANA
SANTA BARBARA
SANTA BARBARA
SANTA BARBARA
SANTA BARBARA
SANTA CLARA
SANTA CLARA
SANTA CRUZ
SANTA CRUZ
CITY
SANTA CRUZ
SANTA MARIA
SANTA MONICA
MARIN
CONTRA COSTA
CONTRA COSTA
ORANGE
ORANGE
ORANGE
SANTA BARBARA
SANTA BARBARA
SANTA BARBARA
SANTA BARBARA
SANTA CLARA
SANTA CLARA
SANTA CRUZ
SANTA CRUZ
COUNTY
SANTA CRUZ
SANTA BARBARA
LOS ANGELES
SANTA MONICA
SANTA PAULA
LOS ANGELES
VENTURA
SANTA ROSA
SANTA ROSA
SANTA ROSA
SANTA ROSA
SANTA ROSA
SANTEE
SEBASTOPOL
SELMA
SHERMAN OAKS
SIMI VALLEY
SONOMA
SONOMA
SONOMA
SONOMA
SONOMA
SAN DIEGO
SONOMA
FRESNO
LOS ANGELES
VENTURA
37
420522
491076
552209
554011
551035
190352
090793
SANTA YNEZ VALLEY COTTAGE HOSPITAL
SONOMA VALLEY HOSPITAL
SONORA REGIONAL MEDICAL CENTER - FAIRVIEW
SONORA REGIONAL MEDICAL CENTER - GREENLEY
SONORA REGIONAL MEDICAL CENTER D/P SNF (UNIT 6 AND
7)
GREATER EL MONTE COMMUNITY HOSPITAL
BARTON MEMORIAL HOSPITAL
410806
KAISER FND HOSP - SOUTH SAN FRANCISCO
281078
390846
394003
392232
391042
334018
190696
184008
191231
190517
190782
150808
334564
400548
560492
564121
ST. HELENA HOSPITAL
DAMERON HOSPITAL ASSOCIATION (DHA)
SAN JOAQUIN COUNTY P.H.F.
ST. JOSEPH'S BEHAVIORAL HEALTH CENTER
ST. JOSEPH’S MEDICAL CENTER, STOCKTON
MENIFEE VALLEY MEDICAL CENTER
PACIFICA HOSPITAL OF THE VALLEY
BANNER LASSEN MEDICAL CENTER
OLIVE VIEW UCLA MEDICAL CENTER
PROVIDENCE TARZANA MEDICAL CENTER
TARZANA TREATMENT CENTER
TEHACHAPI HOSPITAL
TEMECULA VALLEY HOSPITAL
TWIN CITIES COMMUNITY HOSPITAL
LOS ROBLES REGIONAL HOSPITAL & MEDICAL CENTER
THOUSAND OAKS SURGICAL HOSPITAL, A CAMPUS OF LOS
ROBLES HOSP
OSHPD # HOSPITAL NAME
190232
DEL AMO HOSPITAL
191227
HARBOR UCLA MEDICAL CENTER
190470
PROVIDENCE LITTLE COMPANY OF MARY MEDICAL CENTER TORRANCE
190702
PROVIDENCE LITTLE COMPANY OF MARY TRANSITIONAL
CARE CENTER
194967
STAR VIEW ADOLESCENT - P H F
190422
TORRANCE MEMORIAL MEDICAL CENTER
391056
SUTTER TRACY COMMUNITY HOSPITAL
291053
TAHOE FOREST HOSPITAL
540816
TULARE REGIONAL MEDICAL CENTER
500867
EMANUEL MEDICAL CENTER
304079
HEALTHSOUTH TUSTIN REHABILITATION HOSPITAL
301357
NEWPORT SPECIALTY HOSPITAL
231396
UKIAH VALLEY MEDICAL CENTER
2015 Manual of Definitions – Neonatal Transport Data Collection Tool
SOLVANG
SONOMA
SONORA
SONORA
SONORA
SANTA BARBARA
SONOMA
TUOLUMNE
TUOLUMNE
TUOLUMNE
SOUTH EL MONTE
SOUTH LAKE
TAHOE
SOUTH SAN
FRANCISCO
ST. HELENA
STOCKTON
STOCKTON
STOCKTON
STOCKTON
SUN CITY
SUN VALLEY
SUSANVILLE
SYLMAR
TARZANA
TARZANA
TEHACHAPI
TEMECULA
TEMPLETON
THOUSAND OAKS
THOUSAND OAKS
LOS ANGELES
EL DORADO
CITY
TORRANCE
TORRANCE
TORRANCE
COUNTY
LOS ANGELES
LOS ANGELES
LOS ANGELES
TORRANCE
LOS ANGELES
TORRANCE
TORRANCE
TRACY
TRUCKEE
TULARE
TURLOCK
TUSTIN
TUSTIN
UKIAH
LOS ANGELES
LOS ANGELES
SAN JOAQUIN
NEVADA
TULARE
STANISLAUS
ORANGE
ORANGE
MENDOCINO
38
SAN MATEO
NAPA
SAN JOAQUIN
SAN JOAQUIN
SAN JOAQUIN
SAN JOAQUIN
RIVERSIDE
LOS ANGELES
LASSEN
LOS ANGELES
LOS ANGELES
LOS ANGELES
KERN
RIVERSIDE
SAN LUIS OBISPO
VENTURA
VENTURA
361318
SAN ANTONIO COMMUNITY HOSPITAL
UPLAND
484044
484001
190949
484062
480989
481015
481094
190814
190812
560203
560473
560481
364144
KAISER FND HOSP - VACAVILLE
NORTH BAY VACAVALLEY HOSPITAL
HENRY MAYO NEWHALL MEMORIAL HOSPITAL
CRESTWOOD SOLANO PSYCHIATRIC HEALTH FACILITY
KAISER FND HOSP - REHABILITATION CENTER VALLEJO
ST. HELENA HOSPITAL CENTER FOR BEHAVIORAL HEALTH
SUTTER SOLANO MEDICAL CENTER
SOUTHERN CALIFORNIA HOSPITAL AT VAN NUYS D/P APH
VALLEY PRESBYTERIAN HOSPITAL
AURORA VISTA DEL MAR HOSPITAL
COMMUNITY MEMORIAL HOSPITAL OF VENTURA
VENTURA COUNTY MEDICAL CENTER (VCMC)
DESERT VALLEY HOSPITAL
VACAVILLE
VACAVILLE
VALENCIA
VALLEJO
VALLEJO
VALLEJO
VALLEJO
VAN NUYS
VAN NUYS
VENTURA
VENTURA
VENTURA
VICTORVILLE
361370
VICTOR VALLEY GLOBAL MEDICAL CENTER
VICTORVILLE
544009
540734
544075
540827
070988
070990
444013
531059
190636
190857
190458
564018
OSHPD #
301380
190631
190883
334001
230949
110889
571086
191450
190552
474007
510882
514033
514030
KAWEAH DELTA MENTAL HEALTH HOSPITAL D/P APH
KAWEAH DELTA HEALTHCARE DISTRICT
KAWEAH DELTA REHABILITATION HOSPITAL
KAWEAH DELTA SKILLED NURSING FACILITY
JOHN MUIR HEALTH, WALNUT CREEK CAMPUS
KAISER PERMANENTE - WALNUT CREEK
WATSONVILLE COMMUNITY HOSPITAL
TRINITY HOSPITAL
CITRUS VALLEY MEDICAL CENTER
DOCTORS HOSPITAL OF WEST COVINA, INC
KINDRED HOSPITAL - SAN GABRIEL VALLEY
LOS ROBLES HOSPITAL & MEDICAL CENTER - EAST CAMPUS
HOSPITAL NAME
KINDRED HOSPITAL WESTMINSTER
PRESBYTERIAN INTER. HOSPITAL (PIH) HEALTH HOSPITAL
WHITTIER HOSPITAL MEDICAL CENTER
SOUTHWEST HEALTHCARE SYSTEM-WILDOMAR
FRANK R HOWARD MEMORIAL HOSPITAL
GLENN MEDICAL CENTER
WOODLAND MEMORIAL HOSPITAL
KAISER FND HOSP - WOODLAND HILLS
MOTION PICTURE AND TELEVISION HOSPITAL
FAIRCHILD MEDICAL CENTER
FREMONT MEDICAL CENTER
NORTH VALLEY BEHAVIORAL HEALTH
SUTTER SURGICAL HOSPITAL-NORTH VALLEY
VISALIA
VISALIA
VISALIA
VISALIA
WALNUT CREEK
WALNUT CREEK
WATSONVILLE
WEAVERVILLE
WEST COVINA
WEST COVINA
WEST COVINA
WESTLAKE VILAGE
CITY
WESTMINSTER
WHITTIER
WHITTIER
WILDOMAR
WILLITS
WILLOWS
WOODLAND
WOODLAND HILLS
WOODLAND HILLS
YREKA
YUBA CITY
YUBA CITY
YUBA CITY
2015 Manual of Definitions – Neonatal Transport Data Collection Tool
39
SAN
BERNARDINO
SOLANO
SOLANO
LOS ANGELES
SOLANO
SOLANO
SOLANO
SOLANO
LOS ANGELES
LOS ANGELES
VENTURA
VENTURA
VENTURA
SAN
BERNARDINO
SAN
BERNARDINO
TULARE
TULARE
TULARE
TULARE
CONTRA COSTA
CONTRA COSTA
SANTA CRUZ
TRINITY
LOS ANGELES
LOS ANGELES
LOS ANGELES
VENTURA
COUNTY
ORANGE
LOS ANGELES
LOS ANGELES
RIVERSIDE
MENDOCINO
GLENN
YOLO
LOS ANGELES
LOS ANGELES
SISKIYOU
SUTTER
SUTTER
SUTTER
514001
700564
700597
700431
700103
890096
890097
890000
890095
890099
890094
700501
700112
700461
700502
777777
880096
880097
880000
880095
880099
880094
900099
999999
700330
700473
700474
700602
700659
700664
SUTTER-YUBA PSYCHIATRIC HEALTH FACILITY
30TH MEDICAL GROUP HOSPITAL
60TH MEDICAL GROUP HOSPITAL
722ND MEDICAL GROUP
95TH MEDICAL GROUP - EDWARDS AIR FORCE BASE
CALIFORNIA - CLINIC
CALIFORNIA - EMERGENCY ROOM
CALIFORNIA - HOME BIRTH
CALIFORNIA - MD OFFICE
CALIFORNIA - OTHER IN/PATIENT SETTING
CALIFORNIA - OTHER OUT/PATIENT SETTING
NAVAL HOSPITAL - CAMP PENDLETON
NAVAL HOSPITAL - LEMOORE
NAVAL HOSPITAL - TWENTYNINE PALM
NAVAL MEDICAL CENTER (BALBOA)
NOT APPLICABLE
OUT OF STATE - CLINIC
OUT OF STATE - EMERGENCY ROOM
OUT OF STATE - HOME BIRTH
OUT OF STATE - MD OFFICE
OUT OF STATE - OTHER IN/PATIENT SETTING
OUT OF STATE - OTHER OUT/PATIENT SETTING
SAFE SURRENDER
UNKNOWN
US ARMY AIR FORCE HOSPITAL
US ARMY HOSPITAL
US INFIMARY AIR FORCE BASE
US NAVAL HOSPITAL
US NAVAL STATION HOSPITAL
USAF HOSPITAL - MARYSVILLE
2015 Manual of Definitions – Neonatal Transport Data Collection Tool
YUBA CITY
40
SUTTER
APPENDIX D-FAHRENHEIT TO CENTRIGRADE CONVERSION TABLE
2015 Manual of Definitions – Neonatal Transport Data Collection Tool
41
CPeTS/CPQCC Neonatal Transport Data Report Request 2015
Name of Person Requesting Data
Hospital Affiliation/Region
Full Hospital Address
E-mail Address to send report to
Date Needed (allow 2 weeks)
Please be as specific as possible when requesting reports. Please check all applicable and complete one set of
information for each report requested. Send completed request to Lisa@perinatalnetwork.org
Select One From Below
Select One Transport Type
CPQCC Member Facility Number
All Transports
Non-CPQCC Facility OSHPD Number
Delivery Room Requested
Perinatal Region (specify)
Emergent
Select One
Urgent
Transport In
Scheduled
Transport Out
Select One Transport Provider Type
Select One Data Year
Receiving Facility
2014
Referring Facility
2013
Contract Service
2012
Select One From Below
CPQCC Member Facility Number
Non-CPQCC Facility OSHPD Number
Perinatal Region
Select One
Transport In
Transport Out
Select One Data Year
2014
2013
2012
Select One Transport Type
All Transports
Delivery Room Requested
Emergent
Urgent
Scheduled
Select One Transport Provider Type
Receiving Facility
Referring Facility
Contract Service
Select One From Below
CPQCC Member Facility Number
Non-CPQCC Facility OSHPD Number
Perinatal Region
Select One
Transport In
Transport Out
Select One Data Year
2014
2013
2012
Revised 10/2014
Select One Transport Type
All Transports
Delivery Room Requested
Emergent
Urgent
Scheduled
Select One Transport Provider Type
Receiving Facility
Referring Facility
Contract Service
2015 Manual of Definitions – Neonatal Transport Data Collection Tool
42
APPENDIX F
CALIFORNIA PERINATAL TRANSPORT SYSTEM
NEONATAL TRIPS SCORE CALCULATIONS FORM – 2015
To calculate a TRIPS Score for a neonate being transported in California:
• Obtain TRIPS score information from the CORE Neonatal Transport form (maybe entered on Table A
or B)
• Use point scores from Table C to calculate total score
• Identify Risk of Mortality in first 7 days following transport using Table D.
To use an electronic application to identify California TRIPS Score and associated risk please visit:
http://www.health-info-solutions.com/CPQCC-CPeTS/tripsmobile/tripsmobile.html
Table A: California TRIPS Score: to be recorded on referral, within
15 minutes of arrival at referring hospital and admit to NICU.*
Referral
Initial
Transport
NICU
Admit
C.14
C.18
C.19
2
2
2
C.21 Temperature C°
37.6
37.7
37.8
Too low to register
Was the infant cooled?
Yes
Yes
Y XX N
Y XX N
Y XX N
C.22 Heart Rate
165
172
170
C.23 Respiratory Rate
C.24 Oxygen Saturation
80
60
60
84
89
90
C.25 Respiratory Status 
C.26 Inspired Oxygen
Concentration
C.27 Respiratory Support 
C.28 Blood Pressure
Systolic / Diastolic,
Mean
Too low to register
2
100
1
95
1
90
3
28/17
3
32/22
3
34/23
Yes
Yes
Time (24 hour)
C.20 Responsiveness
Yes
Method of cooling
C.29 Pressors
XX Y N
XX YN
Yes
XX Y N
Responsiveness: 0=Death 1=None, Seizure, Muscle Relaxant 2=Lethargic,
no cry 3=Vigorously withdraws, cry
Method of cooling: Passive, Selective Head, Selective Body, Other, Unknown
Respiratory Status: 1=Respirator 2= Severe (apnea, gasping, intubated not
on respirator) 3=Other
Respiratory Support: 0 = None, 1 = Hood/Nasal Cannula. 2 = Nasal
Continuous Positive Airway Pressure, 3 = Endotracheal Tube
*Shaded areas not used for TRIPS Score calculations
Table B: TRIPS Score Components Used for Identifying
Risk of Mortality within
7 Days After Transport
2015 Manual of Definitions – Neonatal Transport Data Collection Tool
43
C.20 Responsiveness
Value
2
Points
10
C.21 Temperature C°
37.7
6
C.25 Respiratory Status 
C.26 Inspired Oxygen Concentration
C.28 Blood Pressure Systolic/
Diastolic, Mean
C.29 Pressors
1
95
32/22
20
YES
TOTAL SCORE
8
5
49
Table C: Model Used for Calculating California TRIPS
TRIPS
Points
Risk Factor
Responsiveness
Temperature
(°C)
Respiratory
Status
Systolic Blood
Pressure
(mmHg)
Pressors
None, seizure, muscle relaxant (1)
Lethargic, no cry (2)
Vigorously Withdraws, Cry (3)
36.1 to 37.6
<36.1 or >37.6
None or mild respiratory symptoms (3)
Moderate (apnea, gasping, not on
respirator) (2)
Severe (on respirator) (1)
with FiO2 < 50
with FiO2 50 to <75
with FiO2 75-100
under 20
20-30
30-40
>40
Not Used
Used
14
10
0
0
6
0
21
15
18
20
24
19
8
0
0
5
49
Table D: California TRIPS Score Risk
Points
Risk of Death within
7 Days of Transport
0 to 8
0.4 to 0.9%
9 to 16
0.9 to 1.9%
17 to 24
2.1 to 4.0%
25 to 34
4.4 to 10.2%
35 to 44
11.1 to 23.4%
45 to 70
25.2 to 80.1%
2015 Manual of Definitions – Neonatal Transport Data Collection Tool
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2015 Manual of Definitions – Neonatal Transport Data Collection Tool
45