The Roster/Sample Matrix form (CMS-802 ) is used by the facility to list all current ... There is not a federal requirement for automation of Form CMS-802.
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How to fill out the Roster Sample Matrix online
The Roster Sample Matrix (CMS-802) is an essential document used to list the current residents of a facility and their pertinent care categories. This guide will provide detailed, step-by-step instructions on how to fill out this form effectively.
Follow the steps to complete the Roster Sample Matrix online.
- Click the ‘Get Form’ button to access the Roster Sample Matrix. This will allow you to download and open the form for editing.
- Begin by entering the name and room number of each resident in the designated fields. Ensure that all information is current as of the survey date.
- Proceed to complete the appropriate columns (6-30) for each resident, marking all pertinent care categories relevant to their needs. Ensure that you refer to the specific instructions provided for each column.
- Review the definitions for each category carefully to ensure that you are accurately representing the resident's status. Utilize your facility's MDS data as a reference but do not copy it directly.
- After filling out all sections, verify that all information is correct. It is essential that a knowledgeable staff member reviews the form before finalizing.
- Once all necessary fields are completed, you can choose to save the changes, download, print, or share the filled form as needed.
Complete your Roster Sample Matrix online to ensure accurate documentation of your facility's residents.
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What is a roster matrix?
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.
What is a matrix in a nursing home?
The Matrix is used to identify pertinent care categories for: 1) newly admitted residents in the last 30 days who are still residing in the facility, and 2) all other residents. The facility completes the resident name, resident room number and columns 1–21, which are described in detail below.
What is a 802 report?
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.
What is a 802 cms?
CENTERS FOR MEDICARE & MEDICAID SERVICES. ROSTER/SAMPLE MATRIX INSTRUCTIONS FOR PROVIDERS. (use with Form CMS-802) The Roster/Sample Matrix form (CMSY802 ) is used to list all current residents (including residents on bedYhold) and to note pertinent care categories.
What is a matrix in long term care?
The Matrix is used to identify pertinent care categories for: 1) newly admitted residents in the last 30 days who are still residing in the facility, and 2) all other residents. The facility completes the resident name, resident room number and columns 1–21, which are described in detail below.
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