Medicare admissions form 2026

1. Click ‘Get Form’ to open the Medicare admissions form in our editor.
2. Begin by filling out the 'Accepting Transfer From' section, indicating the admit date and selecting either 'Hospital' or 'Other'. Provide the facility name if applicable.
3. In the 'Admit Information' section, enter the facility name, city, contact details, level of care (Acute, Subacute, LTAC), phone number, diagnosis, and fax number.
4. Complete the 'Member Information' section with the patient's name, ID number, date of birth, and phone number. Include family contact information and advanced directive status.
5. For therapy information, specify therapy goals and ambulation distance. Indicate assistance levels for transfers/mobility and bathing/grooming.
6. Fill out discharge planning updates including anticipated discharge site and caregiver support status. Ensure to complete follow-up appointments and service referrals made.

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