Annual Facility Questionnaires

SCHEDULE FOR CALENDAR YEAR 2017 DATA COLLECTION

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


ANNUAL END-STAGE RENAL DIALYSIS (ESRD) FACILITY SURVEY

 Distribution Date: February 2, 2018
 Due Date for Return of Completed Form: March 9, 2018

If you need a blank copy of the Annual ESRD Questionnaire, please Click Here


ANNUAL AMBULATORY SURGICAL CENTER QUESTIONNAIRE

Distribution Date: February 9, 2018
Due Date for Completion: March 16, 2018

Blank Copy of Annual ASTC Questionnaire Form - Click Here

Blank Copy of ASTC Patient Origin Reporting Form - Click Here


ANNUAL HOSPITAL BED REPORT

Distribution Date: February 16, 2018
Due Date for Completion: April 2, 2018

All hospitals should receive an Email with a link to the Annual Hospital Bed Report form for their facilty. If you have any questions or problems, please contact Mike Mitchell at 217-782-3516 or send Email to DPH.FacilitySurvey@illinois.gov.

ANNUAL HOSPITAL QUESTIONNAIRE

Distribution Date: February 16, 2018
Due Date for Completion:  April 2, 2018

Blank Copy of Annual Hospital Questionnaire - Click Here


ANNUAL LONG-TERM CARE FACILITY QUESTIONNAIRE

Distribution Date: TBA
Due Date for Completion: TBA


ANNUAL HOSPITAL COMMUNITY BENEFITS REPORT

Distribution Date:    TBA
Due Date for Completion:    TBA