NOTE: You must upload your completed census list using the link in the blue button below. You cannot email your census list.

CLICK HERE TO UPLOAD

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).

The census list templates are available below. Please be sure to use the correct template for your facility type.

Nursing Home Template - NOTE: 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:

• Nursing facility 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.
• Other residents at your facility are not eligible to complete the family survey.

Please note:

For nursing facility 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.