Follow the instructions, filling it out completely.
Only your hospice agency name and information should appear on this form.
This form asks for a data administrator. This should be someone from your hospice agency. Do not put Pinnacle Quality Insight anywhere on this form.
This form does not need to be notarized. You can email it directly to the RAND Corp at the email address listed on the form. (OR) You can mail the form.
After RAND receives this form, it will email you instructions on how to register for the Data Warehouse. After registering, you will be able to view your compliance history and track the CAHPS Hospice quarterly data that Pinnacle submits.
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