Form CMS-2786M Worksheet for Determining Evacuation Capability - Intermediate Care Facilities for Individuals With Intellectual Disabilities (Existing Facilities Only) - 2012 Life Safety Code

Form CMS-2786M Worksheet for Determining Evacuation Capability - Intermediate Care Facilities for Individuals With Intellectual Disabilities (Existing Facilities Only) - 2012 Life Safety Code

What Is Form CMS-2786M?

This is a legal form that was released by the U.S. Department of Health and Human Services - Centers for Medicare and Medicaid Services on July 1, 2018 and used country-wide. As of today, no separate filing guidelines for the form are provided by the issuing department.

FAQ

Q: What is Form CMS-2786M?
A: Form CMS-2786M is a worksheet for determining evacuation capability for Intermediate Care Facilities for Individuals With Intellectual Disabilities.

Q: Who is this form for?
A: This form is for existing Intermediate Care Facilities for Individuals With Intellectual Disabilities.

Q: What is the purpose of this form?
A: The purpose of this form is to determine the evacuation capability of these facilities in accordance with the 2012 Life Safety Code.

Q: What is an Intermediate Care Facility for Individuals With Intellectual Disabilities?
A: An Intermediate Care Facility for Individuals With Intellectual Disabilities is a residential facility that provides care and services to individuals with intellectual disabilities.

Q: What is the 2012 Life Safety Code?
A: The 2012 Life Safety Code is a set of safety standards for buildings and facilities, including healthcare facilities.

Q: Why is evacuation capability important?
A: Evacuation capability is important to ensure the safety of residents in the event of an emergency or disaster.

Q: What information does this form require?
A: This form requires information about the facility's evacuation plan, staff training, and equipment.

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Form Details:

  • Released on July 1, 2018;
  • The latest available edition released by the U.S. Department of Health and Human Services - Centers for Medicare and Medicaid Services;
  • Easy to use and ready to print;
  • Yours to fill out and keep for your records;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of Form CMS-2786M by clicking the link below or browse more documents and templates provided by the U.S. Department of Health and Human Services - Centers for Medicare and Medicaid Services.

Download Form CMS-2786M Worksheet for Determining Evacuation Capability - Intermediate Care Facilities for Individuals With Intellectual Disabilities (Existing Facilities Only) - 2012 Life Safety Code

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  • Form CMS-2786M Worksheet for Determining Evacuation Capability - Intermediate Care Facilities for Individuals With Intellectual Disabilities (Existing Facilities Only) - 2012 Life Safety Code

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  • Form CMS-2786M Worksheet for Determining Evacuation Capability - Intermediate Care Facilities for Individuals With Intellectual Disabilities (Existing Facilities Only) - 2012 Life Safety Code, Page 2

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  • Form CMS-2786M Worksheet for Determining Evacuation Capability - Intermediate Care Facilities for Individuals With Intellectual Disabilities (Existing Facilities Only) - 2012 Life Safety Code, Page 3

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  • Form CMS-2786M Worksheet for Determining Evacuation Capability - Intermediate Care Facilities for Individuals With Intellectual Disabilities (Existing Facilities Only) - 2012 Life Safety Code, Page 4

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  • Form CMS-2786M Worksheet for Determining Evacuation Capability - Intermediate Care Facilities for Individuals With Intellectual Disabilities (Existing Facilities Only) - 2012 Life Safety Code, Page 5

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  • Form CMS-2786M Worksheet for Determining Evacuation Capability - Intermediate Care Facilities for Individuals With Intellectual Disabilities (Existing Facilities Only) - 2012 Life Safety Code, Page 1
  • Form CMS-2786M Worksheet for Determining Evacuation Capability - Intermediate Care Facilities for Individuals With Intellectual Disabilities (Existing Facilities Only) - 2012 Life Safety Code, Page 2
  • Form CMS-2786M Worksheet for Determining Evacuation Capability - Intermediate Care Facilities for Individuals With Intellectual Disabilities (Existing Facilities Only) - 2012 Life Safety Code, Page 3
  • Form CMS-2786M Worksheet for Determining Evacuation Capability - Intermediate Care Facilities for Individuals With Intellectual Disabilities (Existing Facilities Only) - 2012 Life Safety Code, Page 4
  • Form CMS-2786M Worksheet for Determining Evacuation Capability - Intermediate Care Facilities for Individuals With Intellectual Disabilities (Existing Facilities Only) - 2012 Life Safety Code, Page 5
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