Cms proof of representation 2026

1. Click ‘Get Form’ to open the cms proof of representation document in the editor.
2. Begin by selecting the type of representative you are (Individual, Attorney, Guardian, Conservator, or Power of Attorney) and check the appropriate box.
3. Fill in the representative's name and relationship to the Medicare beneficiary in the designated fields.
4. Provide the firm or company name if applicable, along with the complete address and telephone number of your representative.
5. Next, enter the Medicare beneficiary's information: their name as shown on their Medicare card and their Health Insurance Claim Number.
6. Indicate the date of illness or injury related to the claim and ensure both beneficiary and representative sign and date where indicated.

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