QAPI Self-Assessment Tool

12% of survey complete.

Thank you for completing the CMS QAPI self-assessment and submitting to Primaris, CMS’ designated quality improvement organization for Missouri. We will maintain your assessment in strictest confidence.

Primaris staff is available to consult with you during the preparation of the assessment of after completion. To arrange assistance or review, please call Deborah Finley at 573-817-8300 ext 133.

Question Title

* 1. Nursing Home Information

Name of Person Completing: *

Nursing Home Name: *

Address: *

Address 2:

City/Town: *

State: *

ZIP: *

Email Address: *

Phone Number: *