Nursing Home Surveyor Guide to Calling an Immediate Jeopardy

In an effort to clearly and concisely communicate a finding of IJ, survey teams must use the IJ Template attached to appendix Q to determine if IJ exists, and the SA must provide the completed IJ template to the entity when IJ is called – in most cases this will be before the surveyor/survey team exits.

If an IJ is identified through the survey process, surveyors will follow guidelines consistent with QSO memo 19-09. Surveyors will complete the IJ template which is consistent with the QSO-19-09.

The link for the IJ template: CMS, Center for Clinical Standards and Quality/Quality, Safety & Oversight Group memo QSO-19-09: Revisions to Appendix Q, Guidance on Immediate Jeopardy

Please refer to the Appendix Q subparts for appropriate, provider-specific instruction.

Please note that all italicized language is from QSO-19-09.