Crosswalk

IPFQR PRA Package

Crosswalk Summary of IPFQR Collection Forms

Form	Notes
HBIPS measure data collection form	Form reflects minor changes to contact information
EHR & Patient Experience data collection form	Newly proposed measures
TOB & IMM data collection form	Newly proposed measures
Vendor authorization form	Form reflects minor changes to contact information
Notice of Participation Agreement	Form reflects minor changes to contact information
Data Accuracy Acknowledgement	Form reflects minor changes to contact information
Extraordinary circumstances form	This form has been revised from last year and will be submitted with IQR PRA package. Cindy Tourison and Suzanna Fowler-Pollitt are contacts.
Reconsideration request form	This form has been revised from last year and will be submitted with IQR PRA package. Cindy Tourison and Suzanna Fowler-Pollitt are contacts.

Last revised on 4/21/2014