Survey Preparation References
CMS 802 Form
Completed automatically with VistaKEANE Resident Assesment

The CMS-672 and CMS-802 are forms that surveyors request when they arrive onsite.

VistaKEANE Resident Assessment accommodates the forms and completes the CMS 672/802 forms based on data shown in the 672/802 screen.

To be ready for surveyors at all times, you can enter changes that occur after a residents last MDS. Use the CMS 672/802 screen to update individual items on the forms.

You can view the CMS 672 and 802 forms plus Provider Instructions (revised April 2000) on the Keane Care Web site and on CMSs Web sites. The Instructions include the crosswalk between the MDS assessment and 672/8/02 forms-the specific MDS items that trigger items in the 672/802.

www.hcfa.gov/medicaid/mds20/mdsforms.htm

Here is an example of the instructions for one item:
21. Physical Restraints - If the resident has a physical restraint, check this column.
- Mark N for non-siderail devices and S for siderails.

Crosswalk:
If P4 c, d, or e are greater than 0, then 802 - 21 = N. If P4a or b are greater than 0 and G6b not checked, then 802 - 21 = S.

Completing the Form with VistaKEANE

In addition to being the window where you can update MDS data, the CMS 672/802 window also displays which MDS items trigger responses for each column (the Crosswalk information from the revised CMS Provider Instructions).

With VistaKEANE Resident Assessment you can update both the CMS-672 and 802 on the fly you can enter changes in condition as they occur directly into the CMS-672/802 window, rather than waiting for the next MDS assessment.

Data entered directly into the CMS-672/802 window is pulled into open MDS assessments. If a resident does not have an open assessment, the data is held for the next assessment.

When the Forms are Needed

Facility staff are required to provide the CMS-802 by the end of the surveyors Initial Tour. It must represent resident status on the first day of the survey.

The CMS-672 form (Resident Census and Conditions of Residents) is to be provided by the facility within 24 hours.

Some facilities use the CMS-672/802 feature for ongoing quality assurance. They use the forms to measure their outcomes and identify trends. The information is also valuable for spotting potential problem areas before a survey.