QR9000 Findings

Provider/Agency Name: Provider/Agency Representative:

Form # of #

Exit date:

Date(s) of Review: -

Lead/Reviewer(s):

Plan of Correction due date:

Remediation/Documentation due date:

1. For findings that require a plan of correction (POC), a POC Form QR1900 must be submitted to the Bureau of Quality Management (BQM) within 14 days of the review exit (due date shown above). (Refer to POC Form QR1900 for more information.)
2. All documentation to support the completion of the Plan of Correction (for example:, a new or revised policy, training outline and sign in sheet, completed background check and so on) is to be submitted to BQM within 60 days of the review exit (due date shown above).
3. Documentation must be submitted to DHS/DDD Bureau of Quality Management, Quality Review Section.
4. Submit 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

Notes: ____