Documents
33
Form CMS-671 "Long-Term Care Facility Application for Medicare and Medicaid"
Size: 66 KB
3 pages
This is a document developed for nursing facilities which are supposed to be filed during standard or extended health surveys.
Form CMS L564 "Request for Employment Information"
Size: 88 KB
3 pages
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.
Form CMS-1763 "Request for Termination of Premium Hospital and/or Supplementary Medical Insurance"
Size: 65 KB
1 page
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.
Form CMS-846 "Certificate of Medical Necessity - Pneumatic Compression Devices"
Size: 122 KB
2 pages
