(CMS-R-10) Advanced Directives (Medicare and Medicard)

OMB 0938-0610

Certain Medicare and Medicaid organizations are responsible for collecting and documenting in a prominent place in medical records whether an individual has executed an advanced directive. This document indicates the individual's preference if he/she is incapacitated.

The latest form for (CMS-R-10) Advanced Directives (Medicare and Medicard) expires 2020-09-30 and can be found here.

Latest Forms, Documents, and Supporting Material

Document Name
CMS R-10 Response to Public Comments.docx Supplementary Document
CMS-R-10 AdvancedDirectives FINAL 8-28-17.docx Supporting Statement A
CMS-R-10 Form 83 - Part II (Policies and Procedures)
CMS-R-10 Form 83 - Part II (Documenting Advanced Directive)
CMS-R-10 Form 83 - Part II (Developing Advanced Directive)
CMS-R-10 Form 83 - Part II (Annual Update)

All Historical Document Collections

201702-0938-011 Approved with change	Extension without change of a currently approved collection	2017-02-27
201312-0938-008 Approved without change	Reinstatement with change of a previously approved collection	2013-12-09
200810-0938-019 Approved with change	Extension without change of a currently approved collection	2008-10-31
200508-0938-001 Approved without change	Extension without change of a currently approved collection	2005-08-05
200205-0938-007 Approved without change	Extension without change of a currently approved collection	2002-05-10
199903-0938-005 Approved without change	Extension without change of a currently approved collection	1999-03-15
199605-0938-009 Approved without change	Extension without change of a currently approved collection	1996-05-31
199304-0938-002 Approved without change	Revision of a currently approved collection	1993-04-19
199204-0938-001 Approved without change	New collection (Request for a new OMB Control Number)	1992-04-17

OMB Details

CMS-R-10 Form 83 - Part II (Annual Update)

Federal Enterprise Architecture: Health - Health Care Services