Michigan involuntary 2026

1. Click ‘Get Form’ to open the Michigan Involuntary Discharge Report in the editor.
2. Begin by entering the Facility Information, including CCN #, Facility Name, and Address. Ensure all details are accurate for proper identification.
3. Fill in the Discharged Patient Information section. Enter the patient's Name and Date of Birth. Select the applicable reason for discharge from the provided options.
4. In the Required Discharge Notifications Made by Facility section, document each step taken regarding notifications. Include dates and ensure that all required actions are noted.
5. Complete the Facility Administrator Information at the bottom of the form. Provide your Name, Title, Phone, Fax, Email, and Signature along with the Date.
6. Once completed, scan your document as a PDF and email it to BCHS-CMSCertification@Michigan.gov for submission.

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