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
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
Step 2: Register
Agree to Rules of Behavior and register facility with NHSN using CMS Certification Number (CCN).
Time to complete step 2: 10 minutes
After 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.
Step 3a: Register with SAMS
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
Within 24 hours of successful online registration, receive SAMS ‘Identity Verification Request’ email.
Step 3b: Complete and Submit Identity Proofing Verification
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 email@example.com for assistance.
Time to complete step 3b: 35 minutes
Step 4: Submit NHSN Forms Electronically
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
Immediately after submitting forms, receive NHSN email,
subject "NHSN facility enrollment submitted."
Step 5: Sign and Send Consent
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
Within 3 business days, receive NHSN email, subject ‘NHSN enrollment approved.’
Congratulations, enrollment is complete!
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National Healthcare Safety Network
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- Contact NHSN@cdc.gov