Monthly Data Reporting for Star and Rural Bridge Sites


By the 10th of each month, California Bridge sites must submit the required data from their patient contacts for the reporting period (monthly) to the Bridge team at the Public Health Institute.  We can only accept aggregate data for patient totals that are specified in the contracts with each site. We cannot accept individual patient level data at this time. Please look forward to an updated system in the coming months.

Please use the data form below for Star and Rural Bridge site-level aggregate patient data and send any questions via email to data@BridgeToTreatment.org.


Data Form for Star and Rural Bridge Sites

  • Note: If any patient was served twice in the reporting period, the SUN should only count that patient ONCE per reporting period.

  • Enter numbers only; a field at the bottom of this page is available for comments or explanations.

  • Please do not leave any fields blank. Enter ‘0’ for zero or none, and enter ‘unknown’ if the response is not known.

* Indicates required field.

Electronic Medical Record Data Abstraction: It is highly encouraged that prior to the 10th of the month, designated staff will run a query on the hospital EMR, pharmacy or Pixis to generate the following counts for the preceding calendar month. *** If information technology (IT) collaboration is a barrier this requirement can be waived ***
Electronic Medical Record Data Abstraction: It is highly encouraged that prior to the 10th of the month, designated staff will run a query on the hospital EMR, pharmacy or Pixis to generate the following counts for the preceding calendar month. *** If information technology (IT) collaboration is a barrier this requirement can be waived ***
Electronic Medical Record Data Abstraction: It is highly encouraged that prior to the 10th of the month, designated staff will run a query on the hospital EMR, pharmacy or Pixis to generate the following counts for the preceding calendar month. *** If information technology (IT) collaboration is a barrier this requirement can be waived ***
Electronic Medical Record Data Abstraction: It is highly encouraged that prior to the 10th of the month, designated staff will run a query on the hospital EMR, pharmacy or Pixis to generate the following counts for the preceding calendar month. *** If information technology (IT) collaboration is a barrier this requirement can be waived ***
Electronic Medical Record Data Abstraction: OPTIONAL DATA *** These totals are for optional reporting to improve patient care ***
Electronic Medical Record Data Abstraction: OPTIONAL DATA *** These totals are for optional reporting to improve patient care ***
Electronic Medical Record Data Abstraction: OPTIONAL DATA *** These totals are for optional reporting to improve patient care ***
Electronic Medical Record Data Abstraction: OPTIONAL DATA *** These totals are for optional reporting to improve patient care ***
REQUIRED - Assessment of activities to promote clinicians to obtain a DEA X-Waiver: Prior to the 10th of each month, the hospital champion will assess (or delegate assessment of) program activities from the prior month and report on the following measures and update the numbers each month (these are cumulative totals).
REQUIRED - Assessment of activities to promote clinicians to obtain a DEA X-Waiver: Prior to the 10th of each month, the hospital champion will assess (or delegate assessment of) program activities from the prior month and report on the following measures and update the numbers each month (these are cumulative totals).
REQUIRED - Assessment of activities to promote clinicians to obtain a DEA X-Waiver: Prior to the 10th of each month, the hospital champion will assess (or delegate assessment of) program activities from the prior month and report on the following measures and update the numbers each month (these are cumulative totals).

Additional tools to support data collection

These tools can help with site-level data collection. Please remember to send only aggregate total numbers to the Bridge Program until further notice.