All approved survey vendors contracting with hospices to implement the CAHPS Hospice Survey must have user account information and be granted access to the CAHPS Hospice Survey Data Warehouse. The CAHPS Hospice Survey Data Warehouse is maintained by the RAND Corporation.  

Survey vendors require access to the CAHPS Hospice Survey Data Warehouse in order to submit data files in accordance with the requirements of the survey file layouts by the data submission deadlines. The survey vendor will be able to review the CAHPS Hospice Survey Data Submission Reports and confirm successful upload of contracted hospices’ data files to the CAHPS Hospice Survey Data Warehouse.

Organizations completing the CAHPS Hospice Survey Data Warehouse Access Form must provide contact information for your organization’s Data Administrator and Back-up Data Administrator. Complete contact information is required to authorize a user account.  

Please note: By submitting a new form, your organization is indicating a change to its Data Administrator and/or Back-up Data Administrator.  Administrators listed on prior Data Warehouse Access Forms will no longer have access to the Data Warehouse.

Unique Report ID : 1308

1. Vendor Information

Vendor Name * Vendor Name is required.

2. Data Administrator

First Name * First Name is required.

Last Name * Last Name is required.

Phone Number * Phone Number is required.

Phone Extension

Email * Email is required.

3. Back-up Data Administrator

First Name * First Name is required.

Last Name * Last Name is required.

Phone Number * Phone Number is required.

Phone Extension

Email * Email is required.

4. Additional Data Administrator (Optional)

First Name

Last Name

Phone Number

Phone Extension

Email

5. Acknowledgement

Vendor Name

In this role the Authorized Data Administrator will be responsible for:

1) Designating an individual within the organization to serve as the main point of contact with the CAHPS Hospice Survey Project Team.

2) Notifying the CAHPS Hospice Survey Project Team if my role as the CAHPS Survey Data Administrator for the organization will no longer be valid and identifying my successor by submitting a new Data Warehouse Access Form.

By checking this box, I certify that I am authorized to complete this form on behalf of this agency.* Checkbox is required.

Authorized Administrator Name * Authorized Administrator Name is required.

Authorized Administrator Signature

Date

By checking this box, I agree that the electronic signature is the equivalent of my manual signature on this agreement.* Checkbox is required.

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Note: Please print completed Data Warehouse Access form before submitting.

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