Medicare Outpatient Observation Notice (MOON) (CMS-10611)

ICR 202212-0938-016

OMB: 0938-1308

Federal Form Document

Forms and Documents

Document Name	Status
Form CMS-10611 Medicare Outpatient Observation Notice Form	Unchanged
CMS-10611_Supporting Statement_.docx Supporting Statement A	2023-01-04
2022Crosswalk for CMS-10611_SPANISH.xlsx Supplementary Document	2022-12-16
(0938-1308) Nonsub Memo_CMS-10611.docx Justification for No Material/Nonsubstantive Change	2023-01-04

IC Document Collections

IC ID	Document Title	Status
221292	Medicare Outpatient Observation Notice Form	Unchanged