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Open PDF File, 72 29 KB, for RY2021 Hospital Quality Contact Form 2021-2023

Open PDF File, 72 29 KB, for RY2021 Hospital Quality Contact Form 2021-2023

Name: Open PDF File, 72 29 KB, for RY2021 Hospital Quality Contact Form - Fill Out and Sign Printable PDF Template | signNow
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Name MassHealth NHSN Contact Name Data Vendor User Name Agency Key Representative Signature Date Signed MAILING INSTRUCTION Please mail the completed form with a typed cover letter on hospital stationery to the address shown on the right. Print Clear form RY2021 MassHealth Acute Hospital Pay-for-Performance Program Hospital Quality Contacts Form INSTRUCTIONS Pursuant to the Acute Hospital RFA Section 7 each hospital must complete and submit information on staff involved in quality reporting...

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