Items to remember when completing this report

Review and change any incorrect information.  If you add or delete a patient we must have a date.  Without a date, we cannot make the change in our database.

Please make your changes with the enclosed red pen.

Verify the Social Security Numbers.

When adding a Medicare number, make sure to include the BIC (A, B, T, etc.) Do not list health insurance numbers other than Medicare.

Do not include patients who have been at your center less than 30 days.

Please remember that this report will be returned to you if all the necessary fields are not completed.

This report must be returned (MAILED) to the Network Office by March 1, 2006 .

Please do not fax this report.  

Before you make any changes, please review the instructions included for reminders, appropriate field entries and descriptions.  When you have completed the necessary changes, mail the Patient Census Report to the Network office.

Please do not fax this report! 

Please remember that this is a required Network report and will be tracked for receipt.  If the deadline poses a problem or if you have any questions, please call us at 804-794-3757.