| # |
Form |
Change |
Current Location |
Reason |
| 1 |
CMS 10160 |
Changed instructions. Step 1 - removed example of social security number text from the end of the sentence. |
1st page Instructions |
CMS No longer needs this information in the form Medicare number will soon change. |
| 2 |
CMS 10160 |
Inserted Step 4 |
1st page Instructions |
Additional instruction due to section 4 being added to the Authorization Form |
| 3 |
CMS 10160 |
Changed instructions numbering. Step 3 to Step 4 |
1st page Instructions |
Move down a line due to addition of Step 4 to the Authorization Form instructions. |
| 4 |
CMS 10160 |
Changed instructions numbering. Step 4 to Step 5 |
2nd page Instructions |
Move down a line due to addition of Step 4 to the Authorization Form instructions. |
| 5 |
CMS 10160 |
Changed instructions numbering. Step 5 to Step 6 |
2nd page Instructions |
Move down a line due to addition of Step 4 to the Authorization Form instructions. |
| 6 |
CMS 10160 |
Changed instructions numbering. Step 6 to Step 7 |
2nd page Instructions |
Move down a line due to addition of Step 4 to the Authorization Form instructions. |
| 6 |
CMS 10160 |
Changed instructions numbering. Step 7 to Step 8 |
2nd page Instructions |
Move down a line due to addition of Step 4 to the Authorization Form instructions. |
| 7 |
CMS 10160 |
Changed Authorization Form. Inserted section 4 Fill in the reason for the disclosure (you may write "at my request") to the Authorization Form and inserted two lines for the information. |
Authorization Form 2nd page |
Move down a line due to addition of section 4 to the Authorization Form |
| 8 |
CMS 10160 |
Changed Authorization Form. Changed number 5 to number 4. |
Authorization Form 2nd page |
Move down a line due to addition of section 4 to the Authorization Form |
| 9 |
CMS 10160 |
Changed Authorization Form. Changed number 6 to number 5. |
Authorization Form 3rd page |
Move down a line due to addition of section 4 to the Authorization Form |
| 10 |
CMS 10160 |
Changed Authorization Form. Changed number 7 to number 6. |
Authorization Form 4th page |
Move down a line due to addition of section 4 to the Authorization Form |
| 11 |
CMS 10160 |
Changed Authorization Form. Replaced PRA disclosure with updated PRA disclosure |
Authorization Form 4th page |
Required language update per PRA Reports Clearance Office |