Click Here for the Census List Template

in accordance with HIPAA and the HITECH Act, all resident census lists must be submitted using our secure upload link (above). Do not email any identifying resident or representative information via email; doing so is a HIPAA violation and would be a reportable data breach.

Prior to submitting your facility census and representative contact list, please remember the following:

• Please list one representative per resident. Choose the person most familiar with their care who can best answer questions about it (e.g. a family member, friend, guardian, or professional representative).
• The representative does not necessarily make decisions for the resident. Other residents at your facility are not eligible to complete the family survey; residents cannot serve as representatives for other residents and residents cannot serve as their own representative.
• Do not exclude any resident for any reason (including length of stay, physical condition, or cognitive ability).

Submitting your census:

Please upload census and representative contact list two weeks before your facility's scheduled interview date. It is important to review for accuracy prior to submitting .

Upload your completed census list using the link in the blue button below. Please do not email your census list