Promoting Excellence : Chart Review Cost Data Collection Form

Cardinal Glennon Footprints: Chart Review Cost Data Collection Form

This form is used for determining costs of care and/or service utilization.

Evaluation Tools - Cost/Utilization

SSM Cardinal Glennon Children's Hospital
1465 South Grand Boulevard
St. Louis, MO 63104

Mary Ann Collins, MHA
[email protected]

How the grantee used this instrument:
The form was used in collecting data from 1998 records of all inpatient visits of children who have died.

pediatrics, costs of care form, cost analysis, utilization data

To use this tool:
You may print and copy this tool for your own use from this site. Please credit source.

Developed specifically for this project by the project team. Copyright 2001 Footprints at SSM Cardinal Glennon Children's Hospital. All Right Reserved.

To view this tool:
To view the tool in your browser left-click on the link below or to download to your computer right-click on the link.
pdf PDF 112 KB / 4 pages

Posted June 30, 2003

SSM Cardinal Glennon Children's Hospital overview page

# GLEN10, type:cost/utilization

Promoting Excellence in End-of-Life Care was a national program of the Robert Wood Johnson Foundation dedicated to long-term changes in health care institutions to substantially improve care for dying persons and their families. Visit for more resources.

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