IPRO, your friendly quality improvement organization (QIO) is here to help. Along with education, technical assistance and resources, we keep providers current on changes and updates coming out of CMS. Currently, an area of special focus is ensuring that all providers have updated COVID policies and training. Please take a few moments to complete these questions. 

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1. Today's Date (Required.)

Date

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2. Your Name (Required.)

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3. Your Telephone Number (Required.)

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4. Your Email Address (Required.)

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5. List the Organization Name. If completing for multiple facilities, please list each. (Required.)

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6. What is the CCN for each organization? - I don't know my CCN? (Required.)

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7. State (This organization is in the State of ...) (Required.)

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8. Do you have an established/documented safe visitor policy? (Required.)

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9. Do you have an established/documented cohorting plan? (Required.)

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10. Have 75% of staff, both managers and frontline staff completed an Infection Prevention & Control training program? (Required.)

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11. If you know which one, please add below:

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12. Do you have an Emergency Preparedness Plan (EPP)? (Required.)

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13. Within the last year, have you reviewed your EPP?

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14. Have you completed the Risk Assessment within the last year? (Required.)

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15. Does your plan outline individual roles, both clinical and non-clinical, during an emergency? (Required.)

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16. Do you have an agreement with community facilities and transportation? (Required.)

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17. Does your facility have a post-evacuation plan/policy? (Required.)

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18. Does your EPP have an elopement policy (lost/missing resident)? (Required.)

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19. Do you have a communication plan? (Required.)

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20. Are you training all staff members upon hire, annually, and with changes? (Required.)

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21. Does your facility conduct a Full-Scale, Functional Exercise, or Table-Top Exercise at least once annually? (Required.)

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22. Is a Hazard Vulnerability Assessment (HVA) completed and used to identify potential gaps in your EPP? (Required.)

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23. Have you attended any state, local, or national COVID education programs in the last 18 months? (Required.)

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24. Do you need support or resources with your EPP? (Required.)

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25. If yes, how can we help?

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