Updated CMS Matrix Form & Instructions

Lisa Volk and Jackie Pappalardi in Clinical & Quality

CMS – The (CMS- 802) Matrix Form and Instructions for Providers has now been updated to include SARS-CoV-2 suspected or confirmed-COVID. The Matrix is used to identify pertinent care categories for: 1) newly admitted residents in the last 30 days who are still residing in the facility, and 2) all other residents. All information entered into the form should be verified by a staff member knowledgeable about the resident population. Information must be reflective of all residents as of the day of survey

See updated instructions and form attached


Lisa Volk, RN, B.P.S., LNHA
Director, Clinical & Quality Services
518-462-4800 x15

Jackie Pappalardi, RN, BSN
Executive Director
518-462-4800 x16