Cms Forms and Templates
CMS forms, or Centers for Medicare and Medicaid Services forms, are used for various purposes related to healthcare services in the United States. These forms are primarily used to collect and document information required by CMS for different programs and services. They serve as a means of communication between healthcare providers, patients, and CMS for the administration of Medicare and Medicaid programs. CMS forms cover a wide range of topics, including applications for healthcare services, claims submission, compliance reporting, and quality assessment.
Documents:
33
PDF 
Word
This Form is used for observing and evaluating the kitchen and food service areas in healthcare facilities to ensure compliance with relevant regulations and standards.
This Form is used for evaluating psychiatric unit criteria.
This is a legal document which must be completed to prove the group health plan coverage based on your or your spouse's current employment.
This Form is used for requesting information about employment.
This form is used for requesting third party premium billing for Medicare services. It allows the individual or organization to request payment directly from a third party payer for services provided to Medicare beneficiaries.
This form is used for the transfer of appeal rights in the CMS-20031 form. It allows individuals to transfer their rights to appeal a decision to someone else.
This is a document developed for nursing facilities which are supposed to be filed during standard or extended health surveys.
This form is used for evaluating the fire safety of small intermediate care facilities for individuals with intellectual disabilities based on the 2012 Life Safety Code.
This form is used for determining the evacuation capability of existing intermediate care facilities for individuals with intellectual disabilities. It is based on the 2012 Life Safety Code.
This is a legal document that any Medicare enrollee may use to terminate hospital insurance and supplementary medical insurance. This form was released by the U.S. Department of Health and Human Services.
This form is used for requesting identification of extension locations in the CMS-381 Model Letter.
This form is used for reporting deaths in hospitals that are associated with the use of restraints or seclusion.
This form is used for conducting a fire safety survey for intermediate care facilities with intellectual disabilities that are apartment houses. It follows the 2012 Life Safety Code.
This form is used for reporting fire safety surveys in large facilities that provide intermediate care for individuals with intellectual disabilities. It follows the guidelines of the 2012 Life Safety Code.
This form is used for reporting the results of the fire safety survey conducted in ambulatory health care facilities. It follows the guidelines set by the 2012 Life Safety Code.
This Form is used for reporting the results of fire safety surveys in small intermediate care facilities for individuals with intellectual disabilities. It follows the 2012 Life Safety Code guidelines.
This Form is used for providing consent to appoint a representative to assist with Medicare-related matters in larger print format.
This form is used for reporting state buy-in problems to the Centers for Medicare and Medicaid Services (CMS). It helps to identify and address issues related to the state buy-in program.
This document is used for authorizing Medicare to release personal health information to a designated individual or organization.
