Get Cms-2786y 2007

Filling out the CMS-2786Y form online is essential for documenting fire safety information for intermediate care facilities. This guide provides step-by-step instructions to help users navigate the form efficiently.

Follow the steps to successfully complete your CMS-2786Y form online.

1. Click ‘Get Form’ button to access the CMS-2786Y form.
2. In the first section, enter the provider number and the Medicaid identification number. Make sure to check for accuracy before proceeding.
3. Identify the facility by entering the name and complete address, including street, city, state, and zip code. This information is crucial for official records.
4. Indicate the date of the survey and the date of plan approval. These dates help document compliance timelines.
5. Specify the survey type by checking one of the options for small facilities, either 2000 new or 2000 existing.
6. Detail the bed composition by providing the total number of beds and the number of ICF/MR beds certified for Medicaid.
7. Confirm compliance by checking all applicable options that indicate whether the facility meets or does not meet the fire safety standards.
8. Ensure to sign and date the form in the designated spaces for both the surveyor and the fire authority official.
9. After completing all sections, save your changes, and consider downloading or printing the form for your records.

Complete your CMS-2786Y form online today to ensure compliance with fire safety regulations in your facility.