Follow the steps to effectively complete the discharge report

1. Click ‘Get Form’ button to obtain the form and open it for editing.
2. Enter the facility information, including the CCN number, facility name, address, city, state, and ZIP code, along with the date of reporting.
3. Fill out the discharged patient information by providing the patient's name and date of birth.
4. Select the appropriate reason for discharge from the options provided. Make sure to check the box that corresponds to the reason that applies.
5. Provide detailed information regarding the circumstances surrounding the discharge as required.
6. Complete the required discharge notifications section by indicating the actions taken and the respective dates. Document everything clearly, including notifications to the medical director and any attempts to place the patient in another facility.
7. Ensure that the required documentation, including the physician's order and the notice provided to the ESRD Network, is noted with the corresponding dates.
8. Fill out the facility administrator's information, including name, title, phone number, fax number, and email.
9. Sign the form and date it accordingly.
10. Finally, scan the completed report as a PDF and send it via email to BCHS-CMSCertification@Michigan.gov.

Complete your discharge reports online today to ensure compliance and effective patient management.