Hea 7713-2025

1. Click ‘Get Form’ to open the HEA 7713 in the editor.
2. Begin with Section I, where you will enter your facility information. Fill in the Facility Name, Medicare Number, Street Address, City, County, Telephone, and FAX. Ensure all fields are completed accurately to avoid delays.
3. Next, provide details about the Type of Facility by selecting the appropriate checkbox. Include the names of both the Home Administrator and Director of Nursing along with their License Numbers.
4. Move on to Section II for Nurse Aide Information. List all nurse aides used by your facility since the last survey. For each aide, include their Name (Last, First), NAR Number, Street Address, City, Date of Hire, County, State, and Last Date Used.
5. Double-check that no fields are left blank or marked as 'current' in the Last Date Used box. This ensures accurate data submission.
6. Once all sections are filled out correctly, save your document and proceed to submit it as required by your facility's protocol.

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