Quality Measures and Procedures for Hospital Reporting of Quality Data

Documents and forms in this information collection

Document Name	Document Type
Form CMS-10210 Data Accuracy and Completeness Form Quality Measures and Procedures for Hospital Reporting of Quality Data	Form and Instruction
Form CMS-10210 Hospital VPB Review and Corrections Form Quality Measures and Procedures for Hospital Reporting of Quality Data	Form and Instruction
Form CMS-10210 Extraordinary Circumstances Form Quality Measures and Procedures for Hospital Reporting of Quality Data	Form and Instruction
Form CMS-10210 Inpatient Withholding Data form Quality Measures and Procedures for Hospital Reporting of Quality Data	Form and Instruction
Form CMS-10210 IQR Measure Exception Form Quality Measures and Procedures for Hospital Reporting of Quality Data	Form and Instruction
Form CMS-10210 IQR Notice of Participation Form Quality Measures and Procedures for Hospital Reporting of Quality Data	Form and Instruction
Form CMS-10210 IQR Reconsideration Request Form Quality Measures and Procedures for Hospital Reporting of Quality Data	Form and Instruction
Form CMS-10210 CAUTI Validation Template Quality Measures and Procedures for Hospital Reporting of Quality Data	Form and Instruction
Form CMS-10210 CDI Validation Template Quality Measures and Procedures for Hospital Reporting of Quality Data	Form and Instruction
Form CMS-10210 CLABSI Validation Template 1Q18-2Q18 Quality Measures and Procedures for Hospital Reporting of Quality Data	Form and Instruction
Form CMS-10210 MRSA Validation Template Quality Measures and Procedures for Hospital Reporting of Quality Data	Form and Instruction
Form CMS-10210 Validation Review for Reconsideration Request Quality Measures and Procedures for Hospital Reporting of Quality Data	Form and Instruction
Form CMS-10210 VBP Appeal Request Form Quality Measures and Procedures for Hospital Reporting of Quality Data	Form and Instruction
Form CMS-10210 HVBP CMS Independent Review Form Quality Measures and Procedures for Hospital Reporting of Quality Data	Form and Instruction
Form CMS-10210 CLABSI Validation Template 3Q17-4Q17 Quality Measures and Procedures for Hospital Reporting of Quality Data	Form and Instruction
Form CMS-10210 Validation Educational Review Form Quality Measures and Procedures for Hospital Reporting of Quality Data	Form and Instruction
CMS-10210 Data Accuracy and Completeness Form IQR_DACA__PY 2019_vFinal_3.3.2017(508).pdf	Form and Instruction
CMS-10210 Hospital VPB Review and Corrections Form HVBP_Review_and_Corrections_Request_Form_Final_3.3.2017.(508).pdf	Form and Instruction
CMS-10210 Extraordinary Circumstances Form HQR ECE Request Form Final 3.3.2017(508ff).pdf	Form and Instruction
CMS-10210 Inpatient Withholding Data form PR_Oct2017_IP HC Withholding Request_Form_Final 3-1-2017rev 5-5-2017.(508).pdf	Form and Instruction
CMS-10210 IQR Measure Exception Form IPPS_MeasureExceptionForm_3.3.2017 ff.(508).pdf	Form and Instruction
CMS-10210 IQR Notice of Participation Form IQR NOP Text 3.3.2017.(508).pdf	Form and Instruction
CMS-10210 IQR Reconsideration Request Form IQR_Form_ReconsiderationRequest_3.6.2017_Final(508).pdf	Form and Instruction
CMS-10210 CAUTI Validation Template FY20_CAUTI_ValidationTemplate_20170303.xlsx	Form and Instruction
CMS-10210 CDI Validation Template FY20_CDI_ValidationTemplate_20170303.xlsx	Form and Instruction
CMS-10210 CLABSI Validation Template 1Q18-2Q18 FY20_CLABSI_ValidationTemplate_1Q18-2Q18_20170303.xlsx	Form and Instruction
CMS-10210 MRSA Validation Template FY20_MRSA_ValidationTemplate_20170303.xlsx	Form and Instruction
CMS-10210 Validation Review for Reconsideration Request IQR_Form_ValidnReviewReq_3.6.2017_Final.( 508 )ff.pdf	Form and Instruction
CMS-10210 VBP Appeal Request Form HVBP Appeal Request Form Final 3.6.2017.(508)ff.pdf	Form and Instruction
CMS-10210 HVBP CMS Independent Review Form HVBP CMS Independent Review Form_3.6.2017_Final.(508)ff.pdf	Form and Instruction
CMS-10210 CLABSI Validation Template 3Q17-4Q17 FY20_CLABSI_ValidationTemplate_3Q17-4Q17_201703030.xlsx	Form and Instruction
CMS-10210 Validation Educational Review Form VAL_IQR_EducReviewForm_3.3.2017.pdf	Form and Instruction
2017 08 04 FY 2018 Final Rule Summary of HIQR Information Collection Forms.docx Summary of HIQR Information Collection Forms: Updates for the	IC Document

            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.