Form A: FLS Annual Enrolment data April 1, 2021 to Mar 31, 2022 (Mini-audit Spring 2022)

Section 1: Information about your FLS
Within OC’s FLS Registry and for the purposes of this audit, FLSs are assessed by individual hospital sites. For hospital corporations which may operate an FLS at two or more separate sites, a separate submission form must be filled out for each individual FLS site. For any questions in filling out this questionnaire, please contact Luanne Schenkels at lschenkels@osteoporosis.ca
FLS site information
Person submitting this form:
First name Last name
Email of submitter
1. Name of your hospital/site, exactly as it should appear on the OC FLS Registry:

a. Dedicated FLS coordinator’s name:
Is there more than one FLS Coordinator working at your site?
- No
- Yes, there are additional FLS Coordinators working at our site. Please provide details in the comments section.
Comments (name of additional FLS Coordinators and FTE status):
b. FLS Medical Lead's name:
Medical lead's specialty or background (e.g. osteoporosis specialist, orthopaedic surgeon, care of the elderly physician, family physician, other):

Section 2: Annual FLS enrollment reporting
In the event that a patient presents with two different acute fractures at the same time (e.g., a hip fracture and a pelvic fracture occurring from the same fall), the patient can only be counted once. For instructions on how to categorize such patients who present with more than one fracture, please refer to page 10 of KPI v. 3.0.
2. a. How many fragility fracture patients (aged 50 and up) were newly enrolled in your FLS between April 1, 2021 and March 31, 2022?
2. b. i) Of the patients in "a" (above), how many were hip (proximal femur) fractures?
2. b. ii) Of the patients in "a" (above), how many were wrist (distal radius) fractures?
2. b. iii) Of the patients in "a" (above), how many were shoulder (proximal humerus) fractures?
2. b. iv) Of the patients in "a" (above), how many were pelvic fractures?
2. b. v) Of the patients in "a" (above), how many were vertebral fractures?
2. b. vi) Of the patients in "a" (above), how many were other fracture types?
For b. vi), please list other fracture types (if applicable):

Section 3: FLS Details Type
1. Our FLS type:
(Click only one answer)
- A. Inpatient-only FLS (i.e. the FLS coordinator first meets the patient directly on the orthopaedic inpatient ward). Our FLS enrolls only hip fracture patients.
- B. Inpatient-only FLS (i.e. the FLS coordinator first meets the patient directly in the inpatient ward). Our FLS enrolls more than just hip fracture patients.
- C. Outpatient only FLS (i.e. the FLS coordinator first meets the patient directly in the orthopaedic outpatient clinics).
- D. Combined inpatient/outpatient FLS (i.e. the FLS coordinator does systematic and pro-active case finding both on the orthopaedic inpatient ward AND in the orthopaedic outpatient clinics. Some patients, e.g. hip fracture patients, are first seen in person while still on the orthopaedic ward and others, e.g. wrist fracture patients, are first seen in person during their visit to the orthopaedic outpatient clinic).
- E. Other
If you have clicked on 'e" above, before going any further with this questionnaire...
...please provide a brief overview of your program to Luanne Schenkels at Lschenkels@osteoporosis.ca and you will be contacted promptly with guidance for your specific program.

Section 5: Permission
Thank you for your collaboration. By submitting this form, you are authorizing Osteoporosis Canada (OC) to include the information provided within an aggregate overview of FLS in Canada. No individual FLS data will be divulged.

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Section 1: Information about your FLS