Follow the steps to successfully complete the form online.

1. Click the ‘Get Form’ button to obtain the Measure Exception Form and open it in your preferred editing tool.
2. Identify the measures for which you are requesting exceptions by selecting the appropriate checkboxes. Each measure is outlined clearly on the form, including perinatal care, emergency department admissions, and surgical site infections.
3. For each selected measure, specify the applicable quarter(s) for the Measure Exception request. Enter the Calendar Year in the designated field and select the relevant time frame.
4. Complete the fields marked with an asterisk (*) as these are required. Include your facility contact information, such as the CMS Certification Number (CCN), facility name, and contact details of the CEO or designee.
5. Certify the application by providing your name, position, and signature in the relevant sections, confirming that the facility meets the exception criteria.
6. Once all sections are completed, review the form for accuracy. After confirming that all information is correct, you can save any changes, download the form for your records, or print it out.
7. Submit the completed form through the provided methods, which include emailing it, sending it via secure fax, or utilizing the QualityNet Secure Portal.

Start completing your Quality Reporting Center Measure Exception Form online today!