Facility Data Reports

The Agency is striving to meet all of your data needs. Please take the time to send a note, fax, or e-mail message indicating the data you would like to have available and a time frame needed and staff will evaluate the possibility of capturing this data.

"A health care reporter required to file a Mandatory Report shall maintain a current listing with the Agency of the name, title, phone number and e-mail address of at least two individuals designated as the contact of record for purposes of all reports filed with the Agncy and shall designate at least one such contact person as the primary contact in each report that is filed.  The failure to maintain a current contact listing shall not constitute grouns for the waiver of any penalties imposed under this rule."  Ala. Admin. r 410-1-3-.11 (3) (7)

Should there be a need to change the contact of record for the purposes of the mandatory report, a form can be found on the page linked to below.

CON Forms

Below the report listings is a link for Adobe Acrobat Reader if you need this application as it is required to view the files.

To obtain a report click on the year link and the regular report will open in a new window for printing.

To obtain the interactive form that you can type your data into and then print for signature before mailing to the Agency click on the year-I link

Please note: Any data entered into the interactive form cannot be saved to your computer unless you have full version Adobe Acrobat software.  If you are using Adobe Reader to access the interactive form, please make sure to print out one copy to mail, and another to save in a file for future reference.  Thank you.

(example: 2008-I under hospital is the interactive form)

Page last updated: 02/27/2017

Facility Annual Report Forms
         
Report Type Introduction Letter Printable Report Interactive Report Instructions
         
Hospital (Form BHD-134A)        
    2009 2009-I 2009
    2010 2010-I 2010
    2011 2011-I 2011
    2012 2012-I 2012
  2013 2013 2013-I 2013
  2014 2014 2014-I 2014
2015 2015-I 2015
  2016   2016-I (Full Report)
2016-I (Annual Report ONLY)
2016 (Patient Origin ONLY)
2016
Memo RE: Outpatient Surgery Definition        
Memo RE: Outpatient Surgery Data Submission        
Memo RE: Alternative Reporting Periods        
Training Webinar PowerPoint        
         
Nursing Home (Form SNF-F1)        
    2010 2010-I 2010
    2011 2011-I 2011
    2012 2012-I 2012
  2013 2013 2013-I 2013
  2014 2014 2014-I 2014
  2015   2015-I 2015
  2016   2016-I 2016
         
Home Health (Form DM-1)        
    2010 2010-I 2010
    2011 2011-I  
    2012 2012-I 2012
  2013 2013 2013-I 2013
  2014 2014 2014-I 2014
2015 2015-I 2015
  2016   2016-I 2016
         
Ambulatory Surgery Center (Form ASC-1)        
    2008 2008-I  
    2009 2009-I  
    2010 2010-I 2010
    2011 2011-I  
    2012 2012-I 2012
    2013 2013-I 2013
  2014 2014 2014-I 2014
  2015 2015-I 2015
  2016   2016-I 2016
         
Hospice (Form HPCE-2)        
    2007 2007-I 2007-2008
    2008 2008-I  
         
Hospice (CON Application Appendix B/C)        
    2007 2007-I 2007-2008
    2008 2008-I  
         
Inpatient Hospice (Form HPCE-3)        
    2007 2007-I  
    2008 2008-I  
         
Hospice (Form HPCE-4)        
    2009 2009-I 2009
    2010 2010-I  
    2011 2011-I 2011 & Checklist
    2012 2012-I 2012 & Checklist
         
In-home Hospice (Form HPCE4-INHM)        
  2013 2013 2013-I 2013
         
Hospice with Inpatient Facility (Form HPCE-4)        
  2013 2013 2013-I 2013
         
Hospice        
  2014   2014-I 2014
  2015   2015-I 2015
  2016   2016-I 2016
         
Specialty Care Assisted Living Facility (Form SCALF-1)        
    2009 2009-I  
    2010 2010-I  
    2011 2011-I  
    2012 2012-I 2012
    2013 2013-I 2013
  2014 2014 2014-I 2014
  2015   2015 2015
2016 2016-I 2016
  2017   2017-I 2017
         
Opiate Replacement Treatment Facility (Form ORT-1)        
  2011-2013 2011 2011-I  
    2012 2012-I  
    2013 2013-I  

 

Hospital Patient Origin Survey
     
Submission Year Packet for Quarter Excel Template
     
2011
3rd Quarter Template
4th Quarter Template
2012
1st Quarter Template
2nd Quarter Template
3rd Quarter Template
4th Quarter Template
2013
1st Quarter Template
2nd Quarter Template
3rd Quarter Template
4th Quarter Template
2014
1st Quarter Template
2nd Quarter Template
  3rd Quarter Template