Attestation of Electronic Plan of Correction (ePOC) Facility User Enrollment

Dear Facility Administrator,

In order to receive the statement of deficiency (SOD) for future surveys, your facility is required to have at least a single user successfully enrolled in the ePOC system. To enroll, a user must:

1)Apply for, and receive, the two required logins for the ePOC system. Instructions for the enrollment process are available on the program website: www.ct.gov/dph/epoc

PLEASE NOTE: User's must complete ALL steps in the instructions to successfully enroll.

2)Successfully sign in to the ePOC facility system using the above two logins.

Starting Oct 1, 2017 DPH sends out SOD's exclusively through the ePOC system. Facilities that do not have at least a single user successfully enrolled by the time DPH is ready to submit the statement of deficiency (SOD) will be unable to access their SOD and risk being out of compliance with survey deadlines. As such, the facility administrator (or acting facility authority) is required to attest below that they are aware of the need to have at least one user enrolled in the ePOC system.

Question Title

* 1. I hereby attest that I am aware of my responsibility to enroll at least one facility user for the ePOC system in order to receive the statement of deficiency

Facility Name

Facility Administrator Name

Telephone Number

Email

Date

Question Title

* 2. I hereby attest that I am aware of my responsibility to enroll at least one facility user for the ePOC system in order to receive the statement of deficiency

I have at least one user enrolled and that user has logged in successfully today

I have a user who has accessed the registration site and is in the process of enrolling

I have a user who will be accessing the registration site and enrolling within two business days

Please do not hesitate to contact Surjit Sethuraman at surjit.sethuraman@ct.gov with any questions.