Iv 66 form 2026

1. Click ‘Get Form’ to open the iv 66 form in the editor.
2. Begin by filling out the 'Assessment Information' section. Indicate whether this is an admission, re-admission, or SCSA, and provide the resident's name along with the assessment reference date.
3. In the 'Resident Information' section, enter details such as name, age, sex, diagnosis, medical record number, and contact information for both hospital/SNF and prior SNF/swing bed use.
4. Proceed to 'Medicare Technical Eligibility'. Check 'Yes' or 'No' for each eligibility criterion and indicate the last treatment date.
5. Complete the sections on rehabilitation services by checking applicable conditions and providing dates of service as required.
6. Finally, review all entries for accuracy before saving or exporting your completed form directly from our platform.

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