Get Cms 671 Facility Staffing Form

Filling out the Cms 671 Facility Staffing Form online is a crucial step for long-term care facilities participating in Medicare and Medicaid programs. This guide aims to provide you with clear, step-by-step instructions for completing each section of the form with ease.

Follow the steps to successfully complete the Cms 671 Facility Staffing Form online

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by providing the facility name and provider number in the designated fields, ensuring accuracy for business and mailing purposes.
3. Fill in the fiscal year ending date as well as the facility's complete street address, including city, county, state, and zip code.
4. Enter the facility's telephone number and the associated state or county code, leaving the state and region code blank for the state survey office to complete.
5. Indicate the number of Medicare and Medicaid certified beds by filling out fields F8a, F8b, F8c, and F8d with total residents.
6. Select the type of facility by entering the appropriate code in field F9, which could be '01' for skilled nursing facility, '02' for nursing facility, or '03' for both.
7. Answer whether the facility is hospital-based by marking 'yes' or 'no' in field F10.
8. Identify the ownership type in field F12 by selecting the designation that appropriately describes the facility's control.
9. If the facility is owned or leased by a multi-facility organization, check ‘yes’ in field F13, otherwise check ‘no’.
10. Complete the sections for dedicated special care units (F15-F23) by entering the number of beds for each type of specialized unit as applicable.
11. Indicate if the facility has organized groups for residents and family members in fields F24 and F25.
12. If applicable, provide details on any staffing waivers in fields F28-F31, ensuring to enter dates and hours waived.
13. Check whether there is an approved nurse aide training program in field F32 by selecting 'yes' or 'no.'
14. Finally, ensure all information is accurate, and then save your changes before downloading, printing, or sharing the form.

Complete your Cms 671 Facility Staffing Form online to ensure compliance and streamline your facility's operations.