MDS 672 Form Revisions 2010-004-2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering the Provider Number at the top of the form. This is essential for identifying your facility.
3. In Block F75, input the number of residents whose primary payer is Medicare. Repeat this for Blocks F76 and F77 for Medicaid and other payers respectively.
4. For total residents (Block F78), include all residents present on the survey day, even those temporarily away.
5. Proceed to fill out the Activities of Daily Living (ADLs) sections (F79-F93). Assess each resident's ability in bathing, dressing, transferring, toilet use, and eating based on their condition over the past week.
6. Continue with sections A through G, documenting bowel/bladder status, mobility, mental status, skin integrity, special care needs, medications received, and other characteristics as per definitions provided in the form.
7. Finally, ensure that you sign and date the form at the bottom to certify its accuracy before submission.

Start using our platform today to streamline your document editing and form completion process for free!