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The Minimum Date Set (MDS) is a Centers for Medicare and Medicaid (CMS) tool for implementing standardized assessment and for facilitating care management in nursing homes (NHs) and non-critical access hospital swing beds (SBs).
The Roster/Sample Matrix form (CMS-802 ) is used by the facility to list all current residents (including residents on bedhold) and to note pertinent care categories. The facility completes the following: resident name, resident room, and columns 6\u201333, which are described below.
The Roster/Sample Matrix form (CMS-802 ) is used by the facility to list all current residents (including residents on bedhold) and to note pertinent care categories. The facility completes the following: resident name, resident room, and columns 6\u201333, which are described below.
CMS 672. Form Title. Resident Census and Conditions of Residents.
Form CMS-671, Long-Term Care Facility Application for Medicare and Medicaid, is a document developed for nursing facilities that are supposed to be filed during standard or extended health surveys.
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(use with CMS-671 Long Term Care Facility Application for Medicare and Medicaid) This form is to be completed by the Facility. For the purpose of this form \u201cthe facility\u201d equals certified beds (i.e., Medicare and/or Medicaid certified beds).
This form is used for proof of group health care coverage based on current employment. This information is needed to process your Medicare enrollment application. The employer that provides the group health plan coverage completes the information about your health care coverage and dates of employment.

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