January 2008

Information Bulletin 08-01

The Nursing Home Federal Quality Indicator Survey (QIS)
Information Facilities Need to Provide to the Survey Team


The purpose of this information bulletin is to inform providers and the public of the information that the facility will need to provide to the surveyor team at each QIS survey within the first 24 hours of the survey.

While many of the same items are also requested during the Traditional Survey Process, the specific forms attached to this information bulletin apply only to the QIS survey.

Implementation Date:

MDH will begin conducting a limited number of QIS surveys on January 28, 2008.

Required Information:

Facilities will be required to submit the information listed on the Entrance Conference Worksheet to surveyors within four specific time frames in the first 24 hours of the survey. The required items and time frames are listed on the Entrance Conference Worksheet.

  • Note: Item number 2 refers to a New Admission Information Form. The survey team will hand deliver this form to the facility at the entrance conference. The facility will be asked to identify resident names as they are identified on the MDS, date of birth, gender, unit # and room # for new admissions within 30 days prior to the date identified on the form.

The attached documents do not reference an additional piece of information that will be required by the surveyors at the entrance conference. The surveyors will also need to know where the information on the residentsí weights for the previous six months is located.

The Entrance Conference Worksheet - QIS Facility Copy  (PDF:159K: 3 pages) will be presented to the facility at the entrance conference.
Tuesday, March 01, 2011 at 10:22AM