Cms 1572-2026

1. Click ‘Get Form’ to open the cms 1572 in the editor.
2. Begin with Part 1, where facility staff must fill in the Name of Facility, Provider Number, Street Address, Telephone, and Name of Administrator. Ensure all information is accurate and up-to-date.
3. In the Administrator Qualification section, select the appropriate qualification type by marking '1' for RN or other relevant options.
4. Indicate if there has been a change of ownership since the last survey by selecting 'Yes' or 'No'.
5. If applicable, provide details about co-located hospice services and any branch locations operated by your agency.
6. For Services Provided, indicate how each service is delivered by selecting from options such as HHA staff or Under Arrangement.
7. List full-time equivalents for staffing under both Direct Hire Staff and Staff Under Arrangement in the designated sections.
8. Finally, complete the form by entering your name, title, and date completed before saving your work.

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