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 (below). 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:

• Nursing Home short-stay residents are defined as residents whose intended length of stay is 30 days or less (the actual length of stay may be longer).
  • No resident representative information is needed for short-stay residents.
• 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.
  • If you do not have the requested representative information, please mark as N/A
  • Residents at your facility are not eligible to complete the family survey, and should not be listed as representatives.
  • If a resident is their own representative, please mark as N/A and do not include them as a representative.

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. Do not exclude any resident for any reason (including length of stay, physical condition, or cognitive ability).

Upload your completed census by clicking the blue button below. Please do not email your census:

Please note:

For Nursing Home census information, resident name, date of birth, and admission date are used for quality assurance purposes, as well as matching the collected survey data to Minimum Data Set (MDS) assessment information for risk adjustment.