Forms and Instructions

HCCIS Forms and Instructions

Hospitals
Freestanding Outpatient Surgical Centers (FOSC)
Diagnostic Imaging Facilities
Dental CBCT Facilities
Health Care System Capital Expenditure Report
Process for Amending Hospital Data (PDF)

Events and Deadlines

  • Acute and Psych/Specialty Hospitals
    • Hospital Formset Training
      HAR Webinar Training
      Wednesday January 12, 2022 - 1:00 - 2:00 pm
      Contact Jenny Sanislo at jsanislo@mnhospitals.org or 651-659-1440 to pre-register.
    • Feb. 1, 2022 - First and Second Quarter FYE hospitals' 2021 annual reports due to MHA.
    • April 1, 2022 - Third Quarter FYE hospitals' 2021 annual reports due to MHA.
    • July 1, 2022 - Fourth Quarter FYE hospitals' 2021 annual reports due to MHA.

  • Freestanding Outpatient Surgical Centers (FOSC)
    • March 1, 2022 - 2021 annual reports due to MDH.

  • Diagnostic Imaging Facilities
    • March 1, 2022 - 2021 annual reports due to MDH.

  • Dental CBCT Facilities
    • March 1, 2022 - 2021 annual reports due to MDH.

  • Health Care System Capital Expenditure Commitment
    • March 1, 2022 - 2021 annual reports due to MDH.

Hospitals

2021 Hospital Annual Report (HAR)

2021 HAR Training Materials
2020 Hospital Annual Report (HAR) 2020 HAR Training Materials

2019 Hospital Annual Report (HAR) 2018 Hospital Annual Report (HAR) 2017 Hospital Annual Report (HAR)

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Freestanding Outpatient Surgical Center (FOSC)

2021 FOSC Financial, Utilization and Services Report

  • Formset - Excel
  • Instructions - PDF
  • Notification Letter - PDF
  • Note new filing fee submission requirement in the instructions.
    You will be invoiced and fees should be submitted to:
    ATTN: Minnesota Department of Health
    Health Economics Program/HCCIS
    Financial Management
    P.O. Box 64975
    St. Paul, MN 55164-0975
    Please include your HCCIS ID on your remittance.

2020 FOSC Financial, Utilization and Services Report
2019 FOSC Financial, Utilization and Services Report
2018 FOSC Financial, Utilization and Services Report
2017 FOSC Financial, Utilization and Services Report

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Diagnostic Imaging Facility

2021 Diagnostic Imaging Facility Utilization Report
(see Minnesota Statutes, section 144.565 and Minnesota Statues, section 144.1225).


2020 Diagnostic Imaging Facility Utilization Report


2019 Diagnostic Imaging Facility Utilization Report


2018 Diagnostic Imaging Facility Utilization Report
2017 Diagnostic Imaging Facility Utilization Report

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Dental CBCT Facility

2021 Dental CBCT Facility Utilization Report
(see Minnesota Statutes, section 144.565)


2020 Dental CBCT Facility Utilization Report


2019 Dental CBCT Facility Utilization Report


2018 Dental CBCT Facility Utilization Report
2017 Dental CBCT Facility Utilization Report

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Capital Expenditure Commitments

2021 Health Care System or Other Provider Capital Expenditure Commitment Report


2020 Health Care System or Other Provider Capital Expenditure Commitment Report
2019 Health Care System or Other Provider Capital Expenditure Commitment Report
2018 Health Care System or Other Provider Capital Expenditure Commitment Report
2017 Health Care System or Other Provider Capital Expenditure Commitment Report

More information about Capital Expenditure Reporting

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Updated Friday, August 12, 2022 at 01:13PM