Notification of Extraordinary Circumstances Extension or Waiver Form
Hospital Outpatient Quality Reporting (OQR) Program
In the event that a hospital is unable to submit data or access medical records due to an extraordinary circumstance, such as a natural disaster, the hospital may request an extension or waiver. Hospitals will need to complete the
Extraordinary Circumstances Extension or Waiver form (PDF-127 KB) and submit the form and any supporting documentation within 45 days of the date of the extraordinary circumstance. These documents must be submitted to the Hospital OQR Support Contractor via fax (877-789-4443) or by conventional mail to:
Hospital OQR SC
5201 West Kennedy Blvd., Suite 900
Tampa, FL 33609
Hospitals that are included under a blanket waiver by CMS (due to widespread natural disasters such as hurricanes, tornadoes, etc.) will not be required to submit the Extraordinary Circumstances Extension or Waiver form.