Follow the steps to successfully complete the Measure Exception Form.

1. Press the ‘Get Form’ button to access the Measure Exception Form and open it for editing.
2. Begin by filling out the 'IPPS Measure Exception Information' section. Select all applicable measures based on your facility's circumstances. Make sure to specify the correct calendar year and applicable quarter(s).
3. For the Perinatal Care (PC-01) measure, indicate if the hospital has an obstetrics department and enter the required calendar year and selected quarters.
4. For the Emergency Department measures (ED-1 and ED-2), indicate if the hospital provides emergency care and fill out the relevant timeframes.
5. If applicable, complete the section for Specified Colon and Abdominal Hysterectomy Surgical Procedures, noting the procedures performed in the prior calendar year and requesting exclusions as necessary.
6. Complete the sections for Catheter-Associated Urinary Tract Infection (CAUTI) and Central Line-Associated Bloodstream Infection (CLABSI) by confirming whether your hospital has the required facilities for these infections and detailing the appropriate year and quarters.
7. Fill out the Facility Contact Information section, providing the CMS Certification Number, facility name, and contact details for the CEO or designee. All fields marked with an asterisk (*) are mandatory.
8. Review the certification statement to ensure that all the information is accurate and that the facility meets the exception criteria.
9. Once all sections are completed, you can proceed to submit the form. Save your changes, and choose to download, print, or share the document as needed. Ensure it is submitted via email, secure fax, or the designated portal.

Complete your Measure Exception Form online to ensure timely submission and compliance.