The Division of
Health Care Policy and Research
&
Centers for Medicare & Medicaid
QIS Resource Manual Overview
Tab 9: QIS Stage II Review Forms
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- All Critical Element Pathways, and Unnecessary Drug Review, which are also available electronically.
- Stage II Care Area Investigation Key (color-coded key indicates which tool to use for each type of investigation.
- Tab 9: QIS Stage II Review Forms (.zip)
- CMS-20065 Activities CE (.pdf)
- CMS-20066 ADL-ROM CE (.pdf)
- CMS-20067 Behavioral-Emotional CE (.pdf)
- CMS-20068 Bowel-Bladder-Catheter CE (.pdf)
- CMS-20069 Comm-Sensory Problems CE (.pdf)
- CMS-20070 Dental CE (.pdf)
- CMS-20071 Dialysis CE (.pdf)
- CMS-20072 General CE (.pdf)
- CMS-20073 Hospice CE (.pdf)
- CMS-20074 Hosp Death CE (.pdf)
- CMS-20075 Nutrition-Hydration-Tube Feeding CE (.pdf)
- CMS-20076 Pain Mgt CE (.pdf)
- CMS-20077 Physical Restraints CE (.pdf)
- CMS-20078 Pressure Ulcers CE (.pdf)
- CMS-20079 Psych Meds CE (.pdf)
- CMS-20080 Rehab-Comm DC CE (.pdf)
- CMS-20081 Vent CE (.pdf)
- CMS-20082 Unnec Drugs Review (.pdf)
- QIS Extended Survey (.pdf)
- Stage II Care Area Investigation Key 082907 (.pdf)
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