Plan of Correction QR1900

Plan of Correction for BQM Review Finding

REVISED 10/29/24

Provider/Agency:

Email: ___

Address: ___

The Findings report (QR9000 BQM Review Findings Report) provided to you summarizes the results from your recent BQM review. Please submit this POC form for each finding on the report identified as requiring a Plan of Correction. If applicable, similar/related findings can be combined onto one POC form if the plan of correction is similar (for example, multiple revisions needed for an Implementation Strategy, or various background checks). Do not submit a POC form for areas that were remediated prior to the end of the review or those items identified for your information only. If you have any questions, please contact the lead reviewer who conducted your exit.

Plan of Correction form(s) are due within 14 calendar days of the review exit date.
Documentation supporting the remediation of a finding is due within 60 calendar days of the review exit date.

Submit POC forms and documents via fax (217-782-9444), email DHS.BQMQR@illinois.gov or via USPS to:

Bureau of Quality Management, Quality Review Section
600 East Ash Street, Building 400, Mail Stop 2N
Springfield, IL 62703

For each finding, please complete the following fields. Use additional sheets, if necessary, for more space or additional findings.