This field is filled in automatically, as determined by the user’s profile
The physician’s name must be selected from the drop-down list. In order for a physician’s name to appear in the list, he or she must be listed as a GRID participant in the Physicians Dictionary. Refer to Manage Physicians to learn how to add a Physician to your facility's dictionary, and Add Physicians to an Individual Registry to learn how to list a physician as a GRID participant.
Month / Year
Enter the month and year for which you will be entering data.
Note: You cannot add a form for the same month, year and physician for which another form exists, even if it is cancelled. If you want to enter data for a month, year and physician for which a cancelled form exists you must restore the cancelled form and change the data to how they should appear on the new version of the form.
If you checked Not Applicable for certain procedures in the Volume section of the Facility form then the corresponding fields on this form are disabled. Enter time values in hours.
If you checked Not Applicable for certain procedures in the Volume section of the Facility form then the corresponding fields on this form are disabled.
Name of person who completed this paper form
If this name has not been previously entered for this field for a previous GRID form, select Add New and enter the person’s first and last name. In the future, the name will appear in the drop-down list for this field. If the name has been previously entered, click the arrow and select it from the drop-down list.
Note: Please populate this field even if paper forms were not used; you may use the name of the person completing the on-line data submission.
To delete a name from the list, select it and then click the Delete Person button.
Name of person submitting form
These fields are filled in automatically