Health Facilities and Services Review Board
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ANNUAL FACILITY QUESTIONNAIRES
SCHEDULE FOR CALENDAR YEAR 2015 DATA COLLECTION


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


ANNUAL END-STAGE RENAL DIALYSIS (ESRD) FACILITY SURVEY
Distribution Date: February 1, 2016
Deadline for Completion: March 4, 2016
SURVEY WORKSHEET AND DEFINITIONS

The link to the Online ESRD form will be included in the email distributed February 1, 2016
Please contact us if you do not receive the ESRD link via email.


ANNUAL AMBULATORY SURGICAL CENTER QUESTIONNAIRE
Distribution Date: February 8, 2016
Deadline for Completion: March 11, 2016
SURVEY WORKSHEET AND DEFINITIONS
SPREADSHEET FOR REPORTING PATIENT ORIGIN INFORMATION

The link to the Online ASTC form will be included in the email distributed February 8, 2016
Please contact us if you did not receive the LTC link via email.


ANNUAL HOSPITAL BED REPORT
Distribution Date: February 16, 2016
Deadline for Completion: March 18, 2016
BED REPORT INSTRUCTIONS AND DEFINITIONS
The link to ABR spreadsheet will be included in the email distributed February 16, 2016
Please contact us if you did not receive the ABR link via email.

ANNUAL HOSPITAL QUESTIONNAIRE
Distribution Date: February 16, 2016
Deadline for Completion: March 18, 2016
SURVEY WORKSHEET AND DEFINITIONS
The link to the Online AHQ form will be included in the email distributed February 16, 2016
Please contact us if you did not receive the AHQ link via email.


ANNUAL LONG-TERM CARE FACILITY QUESTIONNAIRE
Distribution Date: February 29, 2016
Deadline for Completion: April 1, 2016
Due to issues with coding of diagnoses, Question 6 has been removed from the questionnaire.
Updated worksheets are available below.

Worksheets, including Online Screens and Definitions, by Facility Type
Worksheet for Nursing Care (Skilled and Intermediate) Facilities
Updated March 2, 2016
Worksheet for Hospital-Based LTC Facilities
Updated March 2, 2016
Worksheet for Facilities Providing Skilled Under 22 Care
Worksheet for Facilities Providing ICF DD Care

The link to the Online LTC form will be included in the email distributed February 22, 2016
Please contact us if you did not receive the LTC link via email.


Illinois Health Facilities and Services Review Board
2nd Floor
525 West Jefferson Street
Springfield, Illinois 62761
Phone 217-782-3516
Fax 217-785-4111
TTY 800-547-0466
Questions or Comments