HCQ Public Information Request Form

DHCQ Public Information

The Public Information Unit responds to requests pertaining to healthcare facilities licensed by the Department and/or certified to participate in the Medicare and/or Medicaid program. These facilities include hospitals, nursing homes, rest homes, home health agencies, clinics, and laboratories. Requests for copies of materials contained in the Division's files may be submitted by e-mail, fax or in writing. When a request for public information involves staff research time and/or substantial amount of hard copy material, a fee may be applied.

Write request to:
Division of Health Care Quality
99 Chauncy Street
Boston, MA 02111
Attn: Public Information Unit

Telephone: (617) 753-8000

Fax request to: (617) 753-8095

E-Mail Click Here

Licensing Regulations

To obtain Massachusetts Licensing Regulations contact the State House Book Store at:
State Bookstore
Secretary of the State
Room 116, State House
Boston, MA 02133
(617) 727-2834
or
Western Office of
the Secretary of the State
436 Dwight Street
Springfield, MA 01103
(413) 784-1376

Fee Schedule:
If you have questions about the fees, call the Division at the above telephone number.
Staff Time: $13.00 per hour
Copy Fee: $0.20 per page
Postage: by weight
Fees under $50.00 will be billed at the time the information is sent.
Fees over $50.00 will require pre-payment prior to release of information

DHCQ Request for Information

Complete the request for information below.
Click the Submit button at the bottom of this form to send your request.
Click the Clear Form button you wish to cancel your request or start over.
Be sure to enter the correct e-mail address to ensure proper notification.
Be sure to enter your full telephone number for contact if necessary.

Name: (required)

Street: (required)

City/ State: (required)
-
Zip Code: (required)

Phone: (required)

Email Address:

Survey Performance Tool for Nursing Homes
Most Recent Standard Survey Reports (deficiency statements and plans of correction)
Complaint Reports (investigations in the last 6 months)
For the following facilities:
Facility Name - City/ Town
1. -
2. -
3. -
4. -
5. -
Other Information, explain:

Name: (required) Street: (required) City/ State: (required) -	Zip Code: (required) Phone: (required) Email Address:
Survey Performance Tool for Nursing Homes Most Recent Standard Survey Reports (deficiency statements and plans of correction) Complaint Reports (investigations in the last 6 months) For the following facilities: Facility Name - City/ Town 1. - 2. - 3. - 4. - 5. - Other Information, explain: