Follow the steps to fill out the MS-2126 Notification of Facility Admission/Discharge online.

1. Click ‘Get Form’ button to access the form online.
2. Begin with Section I: Resident Information. Fill in the resident’s name, Social Security Number (SSN), date of birth, sex, Client ID number, responsible person or agency, their relationship to the resident, and their address.
3. Proceed to Section II: Facility Information. Enter the facility name and location, phone number, name of the agency or person placing the resident, and whether CARE or screening has been completed. Provide the name of the responsible person and their fax number if applicable.
4. In Section III: Facility Placement/Discharge, complete the admission details. Specify the admission date, the place the resident was admitted from, and the anticipated length of stay. Select the appropriate checkboxes for the type of previous stay and payment status on admission.
5. Continue in Section III to indicate the current level of care in your facility by selecting the appropriate option.
6. For discharge information, complete the discharge details by indicating where the resident is being discharged to, the discharge date, and any relevant details if discharged to another facility or hospital.
7. If applicable, complete Section IV: Hospital Leave for absences longer than 30 days, including the hospital name, admission date, and estimated discharge date.
8. Review all the information for accuracy and completeness. Ensure all sections that are required are filled out as applicable.
9. Finally, save your changes. You can download, print, or share the completed form as necessary, and ensure that the original form is retained by the facility and a copy is submitted to the Kancare Clearinghouse.

Complete your MS-2126 Notification of Facility Admission/Discharge online to ensure timely processing.