CMS 802 Form – Fill Out and Use This PDF

CMS 802 Form PDF Details

The CMS 802 form is an official care matrix from the Centers for Medicare & Medicaid Services (CMS). Skilled nursing facilities and long-term care homes use it to track resident care needs.

The form covers two resident groups. The first group is newly admitted residents within the last 30 days who are still in the facility. The second group is all other current residents.

Staff who know each resident best complete the CMS 802. The matrix documents data across 20 care categories. These include Alzheimer's disease and dementia diagnoses, insulin and anticoagulant use, and antibiotic therapy. The form also tracks pressure ulcers, weight loss, physical restraints, falls, dialysis treatment, hospice care, palliative care, tracheostomy care, and infectious disease management.

The completed CMS 802 matrix helps state survey agencies evaluate care quality during inspections. It captures a snapshot of resident needs at a specific point in time. Accuracy is critical because the data supports care planning and regulatory compliance.

Official instructions for the CMS 802 are published on the Centers for Medicare & Medicaid Services website.

Related forms include the CMS 671 form for long-term care facility information and the resident assessment form. For Medicare enrollment, you may also need a Medicare consent form or the CMS 40B form.