Cms 672 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering the Provider Number and total residents in Block F75 to F78, ensuring accurate counts for Medicare, Medicaid, and other payers.
3. For Activities of Daily Living (ADLs), fill out fields F79 to F93. Assess each resident's independence level in bathing, dressing, transferring, toilet use, and eating over the past week.
4. In Section A for Bowel/Bladder Status (F94-F99), indicate the number of residents with catheters and those on toileting programs. Ensure you count only those present at admission.
5. Continue through Sections B to G, documenting mobility, mental status, skin integrity, special care needs, medications received, and other characteristics as specified.
6. Finally, certify the information accuracy by signing and dating at the bottom of the form before submission.

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