HOS Field Test

Medicare Health Outcomes Survey Field Test (CMS-10861)

OMB: 0938-1464

IC ID: 263064

Documents and Forms

Document Name Document Type
Form CMS-10861 HOS Field Test Form and Instruction
CMS-10861 Medicare Health Outcomes Survey (HOS) Field Test Questionnaire Version A CMS HOS Attachment A.pdf Form and Instruction
CMS-10861 Medicare Health Outcomes Survey (HOS) Field Test Questionnaire Version B CMS HOS Attachment B.pdf Form and Instruction
CMS-10861 HOS Field Test Item Differences by Questionnaire CMS HOS Attachment C.pdf Form and Instruction