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Center for Health Statistics PATIENT ID NUMBER: / DATE TERMINATION PERFORMED: / (Month/Day/Year) (Patient ID/Facility Chart/Case No.) REPORT OF INDUCED TERMINATION OF PREGNANCY Facility Worksheet
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Facility worksheet - public is a document used to report information about public facilities.
Public facility owners or operators are required to file facility worksheet - public.
Facility worksheet - public can be filled out by providing information about the facility, such as location, size, and activities.
The purpose of facility worksheet - public is to gather information about public facilities for regulatory or planning purposes.
Information such as facility name, address, contact information, type of facility, and any hazardous materials stored or used on site must be reported on facility worksheet - public.
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