CMS-10106.Crosswalk 2025

CMS-10106.Crosswalk 2025.xlsx

Medicare Authorization to Disclose Personal Health Information (CMS-10106)

CMS-10106.Crosswalk 2025

OMB: 0938-0930

Document [xlsx]
Download: xlsx | pdf
# Form Change Lead Component Attachment? Current Location Reason

CMS 10160 Added HHS logo OC, Samuel Jenkins CMS-10106-508C page 1 Updates according to CMS style guide
1 CMS 10160 Moved instructions OC, Samuel Jenkins CMS-10106-508C pages 1-2 Updates according to CMS style guide
2 CMS 10160 Reformated from column format to paragraph format OC, Samuel Jenkins CMS-10106-508C page 1 Better flow
3 CMS 10160 Plain language review and updates OC, Samuel Jenkins CMS-10106-508C throughout the form Updates according to CMS style guide
4 CMS 10160 Added email collection OC, Samuel Jenkins CMS-10106-508C page 2 To collect email address from the beneficiary
File Typeapplication/vnd.openxmlformats-officedocument.spreadsheetml.sheet
File Modified0000-00-00
File Created0000-00-00

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