On-Line Reporting
Welcome to AHCA's portal for on-line filing of required forms. This web site is designed to allow submission of Code 15 and Annual Reports for hospitals and ambulatory surgical centers via the internet. If you have problems or need immediate assistance, call (850) 922-6089 or (850) 955-5599. If you forget your user ID or password send your request to Brenda Sneed at sneedb@ahca.myflorida.com, if you have questions about a specific Code 15 Report already entered send your questions to Etsuko Sudano at sudanoe@ahca.myflorida.com, or if you have general comments or suggestions for improvement send your correspondence to Marie Kokol at kokolm@ahca.myflorida.com. The fax number for sending anything from a Risk Management Department by fax is (850) 921-5459.
Read and agree to the terms below to access AHCA on-line filing system.
WARNING!
By accessing this site you are consenting and agreeing to follow the Agency for Health Care
Administration's policies regarding acceptable use, protection of information resources and
confidential health care information.
By submitting electronic reports, you are affirming that the information contained in the
report is true, correct, and can be relied upon by the recipient pursuant to Florida Law.
“Please note, the system may time out if the On-line reporting is not completed within 20 minutes”
Downloads:
New User Application [90kb .doc] - This form must be sent in every time there is a change at the facility in Risk Manager or Designee. The form must be signed by the Risk Manager of record - if the form is being sent in due to a new Risk Manager being hired, then the Administrator of record for the facility must sign the form. This signature is in addition to the information and signature of the new user. If you have any question, please do not hesitate to contact the office at the above number.
Reporting Tips:
On-Line Instructions [71kb .pdf]
Security requirements for users of the on-line reporting system.
Where to Get Help:
Marie Kokol, LHRM
Program Administrator
Any questions, suggestions, or requests for assistance.
(850) 922-5599
kokolm@ahca.myflorida.com
Etsuko Sudano, RN Specialist
Reviews Code 15 Reports, Extension Requests
(850) 414-9475
sudanoe@ahca.myflorida.com
Brenda Sneed, Research Assistant
Requests for User ID's, Passwords for Internet Access,
prepares reports using queries, excel, or access
(850) 922-5529
sneedb@ahca.myflorida.com
Updated January 16, 2009
