- Provider Name:
- Location (ICF Site Name):
- Number of people residing at the location as of 11/30/24:
- The number of people at the location not covered by Medicaid (i.e., # of Private Pay clients) as of 11/30/24:
- The number of DOH citation related to infection control at each location from 2020 to date and the tag number:
- Has this site participated with the RISE program?
You may supply the data by typing the responses after each question in an email reply, or by attaching a spreadsheet with the following columns completed:
|
Facility Name |
Location / Site Name |
Number of Residents as of 11/30/24 |
Number of Private Pay Residents as of 11/30/24 |
No. of DOH Citations related to Infection Control from 2020 to date |
Tag Numbers for DOH Citations related to Infection Control from 2020 to date |
Has this facility participated in the RISE program? |
Please send your responses to Lisa Wagner, [email protected] by the end of business on Friday December 6th.
