Use This Census Template » Upload Your Completed Census »

The template includes the required fields of: Resident Last Name, Resident First Name, Date of Birth, Admission Date, Room Number, Short-Term Y/N, Assisted Living Waiver Program Y/N.

Upload two weeks before your scheduled interview date.

If your facility is co-located (e.g., the Nursing Facility and Residential Care Facility are at different locations), you will need to upload a separate list for each.

Do not exclude any resident for any reason, including length of stay, physical condition, or cognitive ability. Learn more about interviewing residents with dementia and/or cognitive impairment.

Short-term residents are defined as residents whose intended length of stay is 30 days or less (the actual length of stay may be longer).

Resident name, date of birth, and admission date are used for quality assurance purposes, as well as matching the collected survey data to MDS for risk adjustment.

In accordance with HIPAA and the HITECH Act, all resident census lists must be submitted using our secure upload link. Do not email any resident information.