Surveillance for Dialysis Patient Influenza Vaccination

• Coming soon

• Dialysis Patient Influenza Vaccination Protocol pdf icon[PDF – 162 KB]

All Data Collection Forms are Print-only

Survey

• 57.500 Outpatient Dialysis Center Practices Survey Form January 2020 pdf icon[PDF – 250 KB]

Reporting Plan

• 57.501 Dialysis Component Monthly Reporting Plan form January 2020 pdf icon[PDF – 100 KB]
  • Customizable form word icon[DOCX – 80 KB]

Denominator Form

• 57.506 Dialysis Patient Influenza Vaccination Denominator Form January 2020 pdf icon[PDF – 100 KB]
  • Customizable form word icon[DOCX – 80 KB]

Event Form

• 57.505 Dialysis Patient Influenza Vaccination Event Form January 2020 pdf icon[PDF – 100 KB]
  • Customizable form word icon[DOCX – 80 KB]

• Healthcare Facility HAI Reporting Requirements to CMS via NHSN Current and Proposed Requirements September 2015 pdf icon[PDF – 102K]
• Reporting Requirements and Deadlines in NHSN per CMS Current Rules September 2015 pdf icon[PDF – 157K]
• FAQs about NHSN and CMS ESRD QIP Rule
• For more information about the CMS rule, go to End Stage Renal Disease (ESRD) Quality Incentive Program (QIP)external icon
• QIP Questions? Email CMS ESRD QIP Helpdesk at ESRDQIP@cms.hhs.gov

• Joining a Group and Conferring Rights for Outpatient Dialysis pdf icon[PDF – 889K]
• Changing Your Email Address in NHSN: Guidance for Current NHSN Users. January 2017 pdf icon[PDF – 349K]

  These instructions are for existing users of NHSN who need guidance updating their e-mail address in NHSN.

• FAQs about NHSN and CMS ESRD QIP Rule
• FAQs About NHSN Security