Get and Sign Cms 671 Fillable Form
Following forms and/or documentation: 1. Form CMS-671, Long Term Care Facility Application for Medicare and Medicaid (enclosed); 2. Three (3) signed originals of the Form HHS-690, Assurance of Compliance (enclosed); 3. Three (3) signed originals of the Form CMS-1561, Health Insurance Benefit Agreement (enclosed); 4. Documentation of compliance with Civil Rights requirements (forms and instructions enclosed); 5. State Form 4332, Bed Inventory (enclosed); 6. Facility floor plan on 8 ½” x 11”...
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