Provider Template Download
Click here to download the template file
Use the Quality and Performance Criteria Data Template and complete the measures information for each Veteran in the received letter request.
Perform medical records review, data abstraction and complete the Excel form for the requested Veterans and each of the quality and performance measures requested in the letter.
Save to your local drive.
Enter the "reference number" provided in the upper right corner of the letter.
Once the reference number is validated by the system, attach the completed Excel template file with the Veteran information from your local drive.
When the submitted file is successfully received by the system you will receive a confirmation message.
Reference Number from Letter
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Provider Template Upload
Please attach your document and Submit. Only XLS and XLSX file types will be allowed.