Participation in NCHS surveys is strictly voluntary and information collected on facilities and individuals is confidential. HIPAA allows health establishments to disclose protected health information without patient authorization for public health purposes and for research that has been approved by an institutional review board with a waiver of patient authorization. NCHS enforces strict procedures to prevent the disclosure of confidential data in survey operations and data dissemination. In accordance with NCHS’ confidentiality mandate [Section 308(d) of the Public Health Service Act (42 U.S.C. 242m)], no information collected in NSRCF may be used for any purpose other than the purpose for which it was collected. Such information may not be published or released in any form if the individual or establishment is identifiable unless consent to do so has been obtained in writing from the sampled individual or establishment. The survey data were also collected in accordance with the requirements specified by the Confidential Information Protection and Statistical Efficiency Act of 2002. Because NSRCF does not involve collecting protected health information (e.g., personal identifiers such as name, Social Security number, birth date, or Medicare/Medicaid numbers), the survey is not subject to the Privacy Rule mandated by HIPAA. The NSRCF protocol was approved by the NCHS Research ERB. The information provided by the facilities sampled in NSRCF is used for statistical research and reporting purposes only.