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 19, 2017 - 9:00 - 10:00 am
            Contact Jenny Sanislo at jsanislo@mnhospitals.org or 651-659-1440 to pre-register.
    • Feb. 1, 2017 - First and Second Quarter FYE hospitals' 2016 annual reports due to MHA.
    • April 1, 2017 - Third Quarter FYE hospitals' 2016 annual reports due to MHA.
    • July 1, 2017 - Fourth Quarter FYE hospitals' 2016 annual reports due to MHA.
  • Freestanding Outpatient Surgical Centers (FOSC)
    • March 1, 2017 - 2016 annual reports due to MDH.
  • Diagnostic Imaging Facilities
    • March 1, 2017 - 2016 annual reports due to MDH.
  • Dental CBCT Facilities
    • March 1, 2017 - 2016 annual reports due to MDH.

Acute Care Hospitals

2016 Hospital Annual Report (HAR)

2016 HAR Training Materials
  • Available Soon

2015 Hospital Annual Report (HAR) 2015 HAR Training Materials

2014 Hospital Annual Report (HAR) 2014 HAR Training Materials

2013 Hospital Annual Report (HAR) 2013 HAR Training Materials
2012 Hospital Annual Report (HAR) 2012 HAR Training Materials
2011 Hospital Annual Report (HAR) 2011 HAR Training Materials

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Psych/Specialty Hospitals

2016 Hospital Annual Report (HAR)
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.

2015 Hospital Annual Report (HAR) 2014 Psych/Specialty 2013 Psych/Specialty 2012 Psych/Specialty 2011 Psych/Specialty

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Freestanding Outpatient Surgical Center (FOSC)

2016 FOSC Financial, Utilization and Services Report

2015 FOSC Financial, Utilization and Services Report

2014 FOSC Financial, Utilization and Services Report 2013 FOSC Financial, Utilization and Services Report 2012 FOSC Financial, Utilization and Services Report 2011 FOSC Financial, Utilization and Services Report

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Diagnostic Imaging Facility

2016 Utilization Report
(see Minnesota Statutes, section 144.565)

2015 Utilization Report

2014 Utilization Report
2013 Utilization Report 2012 Utilization Report 2011 Utilization Report

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Dental CBCT Facility

2016 Utilization Report
(see Minnesota Statutes, section 144.565)

2015 Utilization Report

2014 Utilization Report

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Capital Expenditure Commitments

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 2013 Health Care System or Other Provider Capital Expenditure Commitment Report 2012 Health Care System or Other Provider Capital Expenditure Commitment Report 2011 Health Care System or Other Provider Capital Expenditure Commitment Report More information about Capital Expenditure Reporting

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Updated Monday, December 05, 2016 at 08:25AM