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Annual Facility Questionnaires

SCHEDULE FOR CALENDAR YEAR 2016 DATA COLLECTION

QUESTIONS: CALL 217-782-3516 or EMAIL DPH.FacilitySurvey@illinois.gov


ANNUAL END-STAGE RENAL DIALYSIS (ESRD) FACILITY SURVEY

Scheduled Distribution Date: February 3, 2017
Scheduled Deadline for Completion: March 3, 2017

ESRD Questionnaire Worksheet (PDF)

The link to the Online ESRD form was included in the email distributed February 3, 2017.  Please contact us if you did not receive the ESRD link via email.


ANNUAL AMBULATORY SURGICAL CENTER QUESTIONNAIRE

Distribution Date: February 10, 2017
Due Date for Completion: March 10, 2017

ASTC Questionnaire Worksheet (PDF)

The link to the Online ASTC form was included in the email distributed February 10, 2017. Please contact us if you did not receive the ASTC link via email.


ANNUAL HOSPITAL BED REPORT

Distribution Date: February 17, 2017
Due Date for Completion: March 17, 2017

Annual Bed Report Instructions

The link to the ABR spreadsheet for each facility was included in the email distributed February 17, 2017. Please contact us if you did not receive the ABR spreadsheet link via email.

 

ANNUAL HOSPITAL QUESTIONNAIRE

Distribution Date: February 17, 2017
Due Date for Completion extended to March 24, 2017

Annual Hospital Questionnaire Worksheet

The link to the Online AHQ form was included in the email distributed February 17, 2017. Please contact us if you did not receive the AHQ link via email.


ANNUAL LONG-TERM CARE FACILITY QUESTIONNAIRE

Distribution Date: February 24, 2017
Due Date for Completion extended to March 31, 2017

Please choose the appropriate Long-Term Care Facility Questionnaire Worksheet for your facility:

Worksheet for Hospital-based Skilled Care Units

Worksheet for Facilities with Skilled < 22 beds

Worksheet for Facilities with less than 30 Intermediate DD beds

Worksheet for Facilities with 30 or more Intermediate DD beds

Worksheet for Facilities with Skilled or Intermediate Nursing beds

The link to the Online LTC form will be included in the email distributed February 24, 2017. Please contact us if you do not receive the LTC link via email.