Hospital Quality Contacts Form - Mass - mass 2026

1. Click ‘Get Form’ to open the Hospital Quality Contacts Form in the editor.
2. Begin by entering the 'Hospital Name' in the designated field. Ensure that all information is accurate and up-to-date.
3. Fill in the 'Hospital CEO Name', followed by the 'Street Address', 'Phone', 'City', 'State', 'Fax', and 'Zip Code'. Each field should be completed with precise details.
4. In the section for 'Hospital Key Quality Contact', provide the name, title/department, address, email, phone, fax, city, state, and zip code of your key quality contact. Repeat this for each required contact.
5. Next, complete the fields for the 'Acute Hospital RFA Contract Manager' with similar details as above.
6. For 'MassQEX Portal Registered Users', enter information for up to three users including their names, titles/departments, emails, phones, and faxes.
7. Finally, indicate any changes effective date at the end of the form and ensure you sign as an authorized quality contact before submission.

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