Cms 671 form 2026

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Click ‘Get Form’ to open the cms 671 form in our editor.
Begin by entering the official name of the facility in the designated field. Ensure accuracy for business and mailing purposes.
Fill in the Provider Number if applicable, leaving it blank for initial certifications. For recertifications, include the six-digit provider code.
Complete the address section with the street name, city, state, county, and zip code. Make sure to use the physical location rather than a mailing address.
Indicate whether your facility is hospital-based by selecting 'Yes' or 'No' and provide the Hospital Provider Number if applicable.
In sections F9 to F23, specify the number of beds for dedicated special care units as required. Use our platform's features to easily input this data.
Review all entries for accuracy before saving or submitting your completed form using our platform’s intuitive tools.

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