Notification of Extraordinary Circumstances Exceptions 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 a waiver. Hospitals will need to complete the Extraordinary Circumstances Exceptions form (PDF-71 KB) and submit the form with any supporting documentation within 90 days of the date of the extraordinary circumstance. These documents must be submitted to the Hospital OQR Support Contractor (SC) via one of the following:

  • the QualityNet Secure Portal, Secure File Transfer – Waiver Exception Withholding group
  • email to QRSupport@hcqis.org
  • secure fax to (877) 789-4443
  • conventional mail to:
    Hospital OQR Support Contractor
    3000 Bayport Drive, Suite 300
    Tampa, FL 33607

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 Exemption form.

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