Forms, Instructions, and Training Materials for HCCIS

Forms and Instructions

Acute Care Hospitals
Psych/Specialty Hospitals
Freestanding Outpatient Surgical Centers (FOSC)
Diagnostic Imaging Facilities
Dental CBCT Facilities
Health Care System Capital Expenditure Report

Process for Amending Hospital Data

Events and Deadlines

  • Acute and Psych/Specialty Hospitals
    • Hospital Formset Training
         HAR Webinar Training
            Thursday January 18, 2018 - time TBD
            Contact Jenny Sanislo at jsanislo@mnhospitals.org or 651-659-1440 to pre-register.
    • Feb. 1, 2018 - First and Second Quarter FYE hospitals' 2017 annual reports due to MHA.
    • April 1, 2018 - Third Quarter FYE hospitals' 2017 annual reports due to MHA.
    • July 1, 2018 - Fourth Quarter FYE hospitals' 2017 annual reports due to MHA.
  • Freestanding Outpatient Surgical Centers (FOSC)
    • March 1, 2018 - 2017 annual reports due to MDH.
  • Diagnostic Imaging Facilities
    • March 1, 2018 - 2017 annual reports due to MDH.
  • Dental CBCT Facilities
    • March 1, 2018 - 2017 annual reports due to MDH.

Acute Care Hospitals

2017 Hospital Annual Report (HAR)

2017 HAR Training Materials
  • Available Soon

2016 Hospital Annual Report (HAR) 2016 HAR Training Materials

2015 Hospital Annual Report (HAR) 2015 HAR Training Materials

2014 Hospital Annual Report (HAR) 2014 HAR Training Materials

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Psych/Specialty Hospitals

2017 Psych/Specialty
This is included with the Hospital formset. There are specific instructions and coding built into the formset that will guide the Psychiatric and Specialty hospitals through the completion of the report.

2016 Psych/Specialty 2015 Psych/Specialty 2014 Psych/Specialty

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Freestanding Outpatient Surgical Center (FOSC)

2017 FOSC Financial, Utilization and Services Report

2016 FOSC Financial, Utilization and Services Report

2015 FOSC Financial, Utilization and Services Report

2014 FOSC Financial, Utilization and Services Report

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Diagnostic Imaging Facility

2017 Diagnostic Imaging Facility Utilization Report
(see Minnesota Statutes, section 144.565)

2016 Diagnostic Imaging Facility Utilization Report

2015 Diagnostic Imaging Facility Utilization Report

2014 Diagnostic Imaging Facility Utilization Report

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Dental CBCT Facility

2017 Dental CBCT Facility Utilization Report
(see Minnesota Statutes, section 144.565)

2016 Dental CBCT Facility Utilization Report

2015 Dental CBCT Facility Utilization Report

2014 Dental CBCT Facility Utilization Report

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Capital Expenditure Commitments

2017 Health Care System or Other Provider Capital Expenditure Commitment Report

2016 Health Care System or Other Provider Capital Expenditure Commitment Report

2015 Health Care System or Other Provider Capital Expenditure Commitment Report 2014 Health Care System or Other Provider Capital Expenditure Commitment Report More information about Capital Expenditure Reporting

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Updated Monday, December 04, 2017 at 11:05AM