This fillable PDF was developed by Mountain-Pacific Quality Health, a Centers for Medicare & Medicaid Services Quality Innovation Network-Quality Improvement Organization, to help nursing homes track measures related to COVID-19 vaccination and boosters including:
- Date of last positive test from unvaccinated resident
- Date of last positive test from vaccinated resident
- Date of last hospitalization of unvaccinated resident
- Date of last death of unvaccinated resident
- Last COVID-19 hospitalization of vaccinated resident
- Last COVID-19 death of vaccinated resident
- Date since last positive test of unvaccinated staff member
- Date since last positive test of vaccinated staff member
- Number of residents vaccinated
- Number of residents with a booster
- Number of staff vaccinated
- Number of staff with a booster
The infographic is intended to be posted within facilities where it can be seen.
Intended Audience
QIN-QIO
HQIC
AIANHQI
Health Care Providers
Provided by
Mountain-Pacific Quality Health
Last Updated:
July 18, 2023