Documents
64
Form CMS-853 "Certificate of Medical Necessity"
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(4.3 / 5) 58 votes Size: 63 KB
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File this form to document that the use of the medical equipment used for enteral nutrition is justified. This part of the procedure is called the medical necessity, which is a way to have Medicare compensate the costs of items and services that are considered necessary.
Form CMS-485 "Home Health Certification and Plan of Care"
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(4.4 / 5) 42 votes Size: 31 KB
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This form is filled out by the patient's attending physician and used as a fiduciary document in order to authorize professional health services.
Form CMS-1763 "Request for Termination of Premium Hospital and/or Supplementary Medical Insurance"
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(4.6 / 5) 98 votes Size: 65 KB
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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-671 "Long-Term Care Facility Application for Medicare and Medicaid"
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(4.8 / 5) 59 votes Size: 66 KB
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Formulario CMS-40B "Solicitud De Inscripcion Para Medicare Parte B (Seguro Medico)" (Spanish)
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(4.4 / 5) 69 votes Size: 62 KB
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Form CMS-116 "Clinical Laboratory Improvement Amendments (Clia) - Application for Certification"
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(4.6 / 5) 25 votes Size: 267 KB
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Form CMS-849 "Certificate of Medical Necessity - Seat Lift Mechanisms"
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(4.3 / 5) 79 votes Size: 142 KB
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Form CMS-846 "Certificate of Medical Necessity - Pneumatic Compression Devices"
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(4.8 / 5) 36 votes Size: 108 KB
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Form CMS-848 "Certificate of Medical Necessity - Transcutaneous Electrical Nerve Stimulator (Tens)"
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(4.3 / 5) 77 votes Size: 133 KB
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Form CMS-854 "Certificate of Medical Necessity -continuation Form"
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(4.8 / 5) 59 votes Size: 117 KB
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Form CMS-847 "Certificate of Medical Necessity - Osteogenesis Stimulators"
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(4.4 / 5) 44 votes Size: 179 KB
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Formulario CMS-L564 "Solicitud De Informacion Sobre El Empleo" (Spanish)
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(4.6 / 5) 97 votes Size: 70 KB
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Form CMS-672 "Resident Census and Conditions of Residents"
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(4.4 / 5) 86 votes Size: 360 KB
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Form CMS-381 "Model Letter Requesting Identification of Extension Locations"
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(4.7 / 5) 63 votes Size: 54 KB
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Form HCFA-605 "Request for Approval as a Hospital Provider of Extended Care Services (Swing-Bed) in the Medicare and Medicaid Programs"
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(4.7 / 5) 57 votes Size: 18 KB
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Form CMS-R285 "Request for Retirement Benefit Information"
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(4.5 / 5) 42 votes Size: 68 KB
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Form CMS-437B "Rehabilitation Hospital Criteria Work Sheet"
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(4.7 / 5) 79 votes Size: 171 KB
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Form CMS-855I "Medicare Enrollment Application - Physicians and Non-physician Practitioners"
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(4.6 / 5) 102 votes Size: 374 KB
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Form CMS1696 "Appointment of Representative - Large Print"
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(4.4 / 5) 63 votes Size: 27 KB
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Formulario CMS-1696 "Nombramiento De Un Representante" (Spanish)
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(4.8 / 5) 42 votes Size: 47 KB
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Form CMS-437b "Rehabilitation Hospital Criteria Work Sheet"
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(4.5 / 5) 42 votes Size: 161 KB
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Form CMS-437A "Rehabilitation Unit Criteria Work Sheet"
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(4.8 / 5) 52 votes Size: 184 KB
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Form CMS-3427 "End Stage Renal Disease Application and Survey and Certification Report"
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(4.7 / 5) 18 votes Size: 172 KB
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Form CMS-10106 "1-800-medicare Authorization to Disclosure Personal Health Information"
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(4.5 / 5) 48 votes Size: 284 KB
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Form CMS-2786Y "Fire Safety Evaluation System - Intermediate Care Facilities for Individuals With Intellectual Disabilities (Small Facilities) - 2012 Life Safety Code"
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(4.3 / 5) 44 votes Size: 121 KB
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Form CMS-2786T "Fire Safety Evaluation System - Health Care Facilities - 2012 Life Safety Code"
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(4.5 / 5) 82 votes Size: 310 KB
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Form CMS-2786X "Fire Safety Survey Report - Intermediate Care Facilities With Intellectual Disabilities (Apartment House) - 2012 Life Safety Code"
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(4.3 / 5) 65 votes Size: 1 MB
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