Submission info
Do not include PHI; note that data is not saved and cannot be retrieved. PDFs are sent to the email entered and are not stored in the database; if you do not receive a generated PDF within 5 minutes check spam and make sure [email protected] is added to your whitelist (you will need to complete the form again).
CQI Info
Specific to Virginia only, you must maintain a CQI log in accordance with 18VAC110-20-418. Patient information is not required in this log, but error resolution and prevention is required. See here for a sample blank CQI log. This form is mainly intended to help with internal tracking and resolution (the what, where, when, and why) and satisfies the initial documentation requirement of 18VAC110-20-418.
