Please complete all four pages of this application to be considered for the 2017 HealthInsight Nursing Home Quality Award. If completing online, the tab key may be used to navigate to the next field. You must complete the entire form at one time, as your application cannot be saved until completed. Please write the agency's name as the agency would like it to appear on the award in the event that the agency is a recipient.
Note: Please do not send protected health information (PHI) with your report. Please de-identify your reports of any patient identifiers.
HealthInsight 2017 Nursing Home Quality Award Application Deadlines:
New Mexico: Friday, July 21, 2017
Nevada: Friday, August 18, 2017
Utah: Friday, August 18, 2017