The Monthly Data Form by Physician form allows practices to track metrics for a specific physician over time. The available measures are limited to those metrics over which a physician has direct control.
A printable version of the Monthly Data Form by Physician Form is available for your workflow processes and should not be submitted to the ACR.
There are several dependencies and requirements for the Monthly Data Form by Physician:
A Facility form must exist for the same year as the Monthly Data Form by Physician.
The physician must be designated as a GRID participant in the Physician directory.
You may not restore a cancelled monthly form until an annual Facility form has been submitted for the same year. If the Facility form's status is Cancelled or In Progress, the Restore link will not appear for the cancelled Monthly Data Form by Physician.
You may not cancel a Facility form until all monthly forms have been cancelled for the same year.
You cannot enter more than one monthly form for a given facility, year, month and physician.
When completing the form be sure to follow the Manual Data Entry guidelines for working with online forms. More detailed information on the data to be entered is available in the GRID Data Dictionary. Complete each of the sections, as follows:
This field is filled in automatically, as determined by the user’s profile
The physician’s name must be selected from the drop-down list. In order for a physician’s name to appear in the list, he or she must be listed as a GRID participant in the Physicians Dictionary. Refer to Manage Physicians to learn how to add a Physician to your facility's dictionary, and Add Physicians to an Individual Registry to learn how to list a physician as a GRID participant.
Month / Year
Enter the month and year for which you will be entering data.
Note: You cannot add a form for the same month, year and physician for which another form exists, even if it is cancelled. If you want to enter data for a month, year and physician for which a cancelled form exists you must restore the cancelled form and change the data to how they should appear on the new version of the form.
If you checked Not Applicable for certain procedures in the Volume section of the Facility form then the corresponding fields on this form are disabled. Enter time values in hours.
If you checked Not Applicable for certain procedures in the Volume section of the Facility form then the corresponding fields on this form are disabled.
Name of person who completed this paper form
If this name has not been previously entered for this field for a previous GRID form, select Add New and enter the person’s first and last name. In the future, the name will appear in the drop-down list for this field. If the name has been previously entered, click the arrow and select it from the drop-down list.
Note: Please populate this field even if paper forms were not used; you may use the name of the person completing the on-line data submission.
To delete a name from the list, select it and then click the Delete Person button.
Name of person submitting form
These fields are filled in automatically
Click the Submit button. You must correct any errors before the form will be accepted. If no errors are detected, a confirmation message appears and the form moves to Completed status.
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Monthly Data by Facility
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