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5-Step Enrollment for Outpatient Dialysis Facilities - CMS QIP

For complete detailed enrollment instructions please download the NHSN Facility Administrator Enrollment Guide [PDF - 496 KB] October 2011. Please see FAQs about NHSN and the CMS ESRD QIP Rule.

Step 1: Training and Preparation

training

Print and follow detailed checklist [PDF - 213 KB] to ensure successful and efficient enrollment.

Complete required training and Outpatient Dialysis Center Practices Survey [PDF - 68 KB]. Be sure to check trusted websites and spam blockers.

Time to complete step 1: 4 hours, 15 minutes

down arrow

Step 2: Register

Rules of behavior screen

Agree to Rules of Behavior and register facility with NHSN using CMS Certification Number (CCN).

Time to complete step 2: 10 minutes

blue barAfter registration, you will receive two emails: ‘Welcome to NHSN!’
arrives from NHSN immediately and ‘Invitation to Register’
arrives from SAMS-no-reply within 24 hours.down arrow

Step 3a: Register with SAMS

training

From the ‘Invitation to Register’ email, log in to SAMS with your username (i.e., email address) and temporary password provided. Accept the SAMS Rules of Behavior and complete the online SAMS registration form.

Time to complete step 3a: 16 minutes

blue bar down arrowWithin 24 hours of successful online registration, receive SAMS ‘Identity Verification Request’ email.

Step 3b: Complete and Submit Identity Proofing Verification

calendar pages

From the ‘Identity Verification Request’ email, print the Identity Verification Form, complete it, and take it to a notary public for endorsement. Fax the form and supporting documentation to CDC. You will receive ‘SAMS Account Activation’ and ‘SAMS Activity Authorization’ emails when your access is approved.

To access SAMS, you must receive your SAMS grid card, which will be delivered to your home address via U.S. mail within 7-10 days of your SAMS approval email. If you do not receive your grid card within 10 days, please contact nhsn@cdc.gov for assistance.

Time to complete step 3b: 35 minutes

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Step 4: Submit NHSN Forms Electronically

training

Log in to SAMS using your password and SAMS grid card and select ‘NHSN Enrollment.’ Submit required NHSN forms, including facility contact information and Outpatient Dialysis Center Practices Survey.

Tip: Facility type must be ‘AMB-HEMO - Hemodialysis Center’ and component is ‘Dialysis.’

Time to complete step 4: 32 minutes

blue barImmediately after submitting forms, receive NHSN email,
subject "NHSN facility enrollment submitted." down arrow

Step 5: Sign and Send Consent

monitor and envelop

Using the above NHSN email, open, print, and sign the consent form. Ensure two signatures are on the form and fax to CDC.

Tip: To open the consent form, you may need to log in to SAMS using your grid card and password, and then copy and paste the link into that browser window.

Time to complete step 5: 10 minutes

blue barWithin 3 business days, receive NHSN email, subject ‘NHSN enrollment approved.’down arrow

Congratulations, enrollment is complete!

Continue to NHSN SET-UP (required before beginning reporting)

 

 

CMS requirements click here for more information

CDA
Contact NHSN:
  • Centers for Disease Control and Prevention
    National Healthcare Safety Network
    MS-A24
    1600 Clifton Rd
    Atlanta, GA 30333
  • Contact NHSN@cdc.gov
     
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