Hospital Notices: IM / DND (CMS-10065/10066)

OMB 0938-1019

For all Medicare beneficiaries, hospitals must deliver valid, written notice of a beneficiary's rights as a hospital inpatient, including discharge appeal rights. The hospital must use a standardized notice, as specified by CMS. This is satisfied by IM delivery. When a QIO notifies a hospital that a beneficiary has requested an expedited discharge, the hospital must deliver a detailed notice to the beneficiary as soon as possible but no later than noon of the day after the QIO's notification. This is satisfied by DND delivery.

The latest form for Hospital Notices: IM / DND (CMS-10065/10066) expires 2022-12-31 and can be found here.

Latest Forms, Documents, and Supporting Material

Document Name
CMS-10065-10066_SupportingStatement_.docx Supporting Statement A
(0938-1019) Nonsub Memo_CMS-10065 & 10066.docx Justification for No Material/Nonsubstantive Change
2022Crosswalk for CMS-10065-10066_SPANISH.xlsx Supplementary Document
Important Message From Medicare Instruction
Hospital Discharges Detailed Notice of Discharge Instruction

All Historical Document Collections

202212-0938-017 Approved without change	No material or nonsubstantive change to a currently approved collection	2023-01-05
202212-0938-014 Improperly submitted and continue	No material or nonsubstantive change to a currently approved collection	2022-12-19
202208-0938-019 Approved without change	Extension without change of a currently approved collection	2022-08-26
201912-0938-004 Approved without change	No material or nonsubstantive change to a currently approved collection	2019-12-04
201908-0938-010 Approved without change	Revision of a currently approved collection	2019-09-04
201607-0938-010 Approved without change	Extension without change of a currently approved collection	2016-07-20
201305-0938-015 Approved without change	Extension without change of a currently approved collection	2013-05-22
201005-0938-006 Approved without change	Extension without change of a currently approved collection	2010-05-13
200706-0938-008 Approved without change	No material or nonsubstantive change to a currently approved collection	2007-06-28
200704-0938-010 Approved with change	New collection (Request for a new OMB Control Number)	2007-04-25

OMB Details

Medicare and Medicare Advantage Programs; Notification Procedures for Hospital Discharges Detailed Notice of Discharge (CMS-10065/10066)

Federal Enterprise Architecture: Health - Health Care Services

Form CMS-10065/10066	Detailed Notice of Discharge	Paper Only	Form and instruction
Form CMS-100065/10066	Detailed Notice of Discharge (Spanish)	Paper Only	Form and instruction

Review document collections for all forms, instructions, and supporting documents - including paper/printable forms.