U.S. Department of Health and Human Services - Centers for Medicare and Medicaid Services Forms

This document is for submitting an application for in-person visitation during the Covid-19 pandemic.

This document is designed to aid health professionals during in-person consultations for patients using Positive Airway Pressure devices for Obstructive Sleep Apnea. It provides a structured template for capturing vital patient data, diagnosis, and treatment plan.

This Form is used for applying for aid for in-person visitation during the Covid-19 pandemic.

This document is meant to aid and guide in the creation of a comprehensive plan for transitioning patients from a healthcare facility back to their homes or another type of care facility, ensuring that all their care needs will be met upon discharge.

This document is for keeping track of patient's health progress and details during non-emergency ambulance transportations. It is useful for medical practitioners to communicate the patient's condition and any potential changes during transportation.

This document is a template for recording progress notes related to the use and management of a ventilator. It helps healthcare professionals track and document important information about a patient's respiratory status and treatment progress.

This document provides a template for recording progress notes on vitamin and metabolic assays.

This document is a progress note form used for documenting patient progress in a paper format.

This document is used by healthcare providers to document necessary details about a patient's face-to-face encounter, crucial for determining the requirement and plan for home health services.

This document is designed to facilitate healthcare providers in recording patient progress and pertinent details regarding the use of therapeutic shoes for individuals suffering from Diabetes, helping in treatment and monitoring.

This document is designed for healthcare professionals to monitor and record the progress of patients undergoing treatment with immunosuppressive drugs, including changes in medication, symptoms, and patient responses.

This Form is used for conducting surveys and reporting deficiencies in hospice facilities.

This document is a survey report form used by home health agencies to report their survey findings. It provides information about the agency's compliance with regulations and the quality of care provided to patients.

This application is supposed to be used by individuals when they want to apply for enrollment in Medicare Part B, insurance which provides outpatient medical coverage.

This is a document developed for nursing facilities which are supposed to be filed during standard or extended health surveys.

Medicare beneficiaries may use this form to authorize individuals or organizations they trust to examine their medical records and learn their protected health information.