Attached are forms that are required to be completed and given to the State Agency during recertification surveys. They are being posted in a format that can be saved and provided to the survey team upon entrance.

Please note the Entrance Conference Worksheet for NHA is being provided in addition to a State Entrance Conference Checklist and a SNF Beneficiary Protection Notification form.

Please note the Matrix with Instructions.pdf (CMS-802 (11/2018)) must be used instead of earlier versions.