Forms
Hospital Quality Alliance (HQA)
The following forms are used in the HQA initiative:
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HQA Pledge of Participation, PDF (04/17/08) — must be completed for a hospital to begin participation in the HQA initiative. For more information about the initiative, see the HQA Overview: Data Collection, Transmission and Reporting, PDF.
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Hospital Compare Request For Withholding Data From Public Reporting, PDF-39 KB (07/09/10) — must be completed by a hospital requesting that the data it has submitted for a specific measure(s) be withheld from Public Reporting for the reporting period.
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HQA Withdrawal of Participation, PDF-37 KB (02/04/10) — must be completed for a hospital to withdraw from participation in the HQA initiative.