Get Ms Dom-1166 A 2018-2025

The MS DOM-1166 A form is crucial for managing hospice discharge and revocation processes. This guide will help you navigate the form step-by-step, ensuring that you complete it accurately and efficiently.

Follow the steps to complete the MS DOM-1166 A form online.

1. Click ‘Get Form’ button to obtain the form and open it in the editing platform.
2. Begin by filling in the beneficiary information section. Include the beneficiary's name, address, and contact number. Ensure that the details are accurate to avoid any processing delays.
3. Next, provide the name of the guardian or legal representative along with their relationship to the beneficiary. This is crucial for legal verification.
4. Indicate the attending physician's name and contact number, as well as details regarding the hospice provider such as name and address.
5. Choose the reason for discharge by checking the appropriate box. If required, elaborate on reasons that may need further explanation, such as safety concerns or beneficiary non-compliance.
6. Complete the beneficiary revocation statement if applicable. This step includes signing the statement to confirm an understanding of the terms of hospice coverage.
7. After filling out all necessary sections, review the information for accuracy and completeness.
8. Save the completed changes. You may also download, print, or share the form as needed.

Complete your hospice discharge or revocation paperwork online today.