Skilled Nursing Facility Benchmarking Program Registration Form

1. Who will be entering data for this facility? (Limit one person per facility. This person also has access to all comparisons and reports for the facility.)

2. In addition to the person above, who should have access to see the data and reports for this facility? (List all people in your organization who should have read-only access to your facility benchmarking data.) 

3. Name, e-mail, and phone number of the person completing this form: