Form CMS-20049 Family Interview

Form CMS-20049 Family Interview

What Is Form CMS-20049?

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, 2012 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-20049?
A: Form CMS-20049 is the Family Interview form.

Q: Who uses Form CMS-20049?
A: Form CMS-20049 is used by individuals and families.

Q: What is the purpose of the Family Interview?
A: The purpose of the Family Interview is to gather information about the individual or family's health care needs.

Q: What information is required on the form?
A: The form requires information such as the individual's name, address, date of birth, and current health care coverage.

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Form Details:

  • Released on July 1, 2012;
  • 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-20049 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-20049 Family Interview

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