DATA_TYPE	96 FIELD NAME	LABEL	FIELD_DESCRIPTION 	WKSHT_CD	LINE_NUM	CLMN_NUM
HOSPITAL IDENTIFICATION INFORMATION						
						
	 					
ID	RPT_REC_NUM	RPT_REC_NUM	Report Record Number			
ID	PRVDR_NUM	PRVDR_NUM	Hospital Provider Number 			
ID	FI_NUM	FI_NUM	Fiscal Intermediary Number			
ID	RPT_STUS_CD	RPT_STUS_CD	Report Status Code			
ID	FI_CREAT_DT	FI_CREAT_DT	Fiscal Intermediary/MAC Create Date			
ID	FY_BGN_DT	FY_BGN_DT	Fiscal Year Begin Date 			
ID	FY_END_DT	FY_END_DT	Fiscal Year End Date 			
ID	UTIL_CODE	UTIL_CODE	Utilization Code (L/N/F)			
ID	TRNSMTL_NUM	NOT IN THIS FILE	NOT IN THIS FILE			
						
ID	MSA	10 FIELD NAME	Geographic MSA	From MSABEA file		
						
ID	ST_CTY_CD	ST_CTY_CD	SSA State County Code	From OSCAR		
ID	STATE	STATE	SSA State Code	From OSCAR		
ID	CENSUS	CENSUS	Census Division Code	From OSCAR		
ID	REGION	REGION	CMS Region Code	From OSCAR		
ID	SUB3	SUB3	Subprovider III Indicator	SAS CODE		
						
						
						
						
						
ADDED NEW FIELDS HERE FOR EASE OF FINDING THEM (3/26/15)						
DATA TYPE	96 FIELD NAME	10 FIELD NAME	FIELD DESCRIPTION 	WKSHT CD	LINE	COLUMN
NUMERIC		E30A182_03101_00100		E30A182	3101	100
NUMERIC		E30A183_03201_00100		E30A183	3201	100
NUMERIC		E30B182_03101_00100		E30B182	3101	100
NUMERIC		E30C183_03201_00100		E30C183	3201	100
NUMERIC		E30E186_01501_00100		E30E186	1501	100
NUMERIC		H410182_03101_00100		H410182	3101	100
NUMERIC		H410182_03101_00200		H410182	3101	200
NUMERIC		H420182_03101_00100		H420182	3101	100
NUMERIC		H420182_03101_00200		H420182	3101	200
NUMERIC		H430182_03101_00100		H430182	3101	100
NUMERIC		H430182_03101_00200		H430182	3101	200
NUMERIC		E00A181_02899_00100		E00A181	2899	100
NUMERIC		E30A182_03101_00100		E30A182	3101	100
NUMERIC		E30A183_03201_00100		E30A183	3201	100
NUMERIC		E30B182_03101_00100		E30B182	3101	100
NUMERIC		E30C183_03201_00100		E30C183	3201	100
NUMERIC		E30E186_01501_00100		E30E186	1501	100
NUMERIC		H410182_03101_00100		H410182	3101	100
NUMERIC		H410182_03101_00200		H410182	3101	200
NUMERIC		H420182_03101_00100		H420182	3101	100
NUMERIC		H420182_03101_00200		H420182	3101	200
NUMERIC		H420182_03101_00100		H430182	3101	100
NUMERIC		H430182_03101_00200		H430182	3101	200
NUMERIC		H440182_03101_00100		H440182	3101	100
NUMERIC		H440182_03101_00200		H440182	3101	200
NUMERIC		H450182_03101_00100		H450182	3101	100
NUMERIC		H450182_03101_00200		H450182	3101	200
NUMERIC		E00A18A_07089_00100		E00A18A	7089	100
NUMERIC		E00A18A_07090_00100		E00A18A	7090	100
NUMERIC		E00A18A_07091_00100		E00A18A	7091	100
NUMERIC		E00A18A_07098_00100		E00A18A	7098	100
NUMERIC		E00A18A_07099_00100		E00A18A	7099	100
NUMERIC		E00B18B_04001_00100		E00B18B	4001	100
NUMERIC		E00B18B_03950_00100		E00B18B	3950	100
						
						
						
						
						
"IDENTIFICATION INFORMATION, WORKSHEET S-2, PART I"						
						
DATA TYPE	96 FIELD NAME	10 FIELD NAME	FIELD DESCRIPTION 	WKSHT CD	LINE	COLUMN
						
ALPHANUMERIC	S2_C1_1	S2_1_C1_1	Hospital Street Address	S200001	100	100
ALPHANUMERIC	S2_C2_1	S2_1_C2_1	Hospital PO Box	S200001	100	200
ALPHANUMERIC	S2_C1_101	S2_1_C1_2	Hospital City	S200001	200	100
ALPHANUMERIC	S2_C2_101	S2_1_C2_2	Hospital State	S200001	200	200
ALPHANUMERIC	S2_C3_101	S2_1_C3_2	Hospital Zip Code	S200001	200	300
ALPHANUMERIC	S2_C4_101	S2_1_C4_2	Hospital County	S200001	200	400
ALPHANUMERIC	S2_C1_2 	S2_1_C1_3	Hospital Name 	S200001	300	100
ALPHANUMERIC	not on old form	S2_1_C1_4	IPF Provider Number	S200001	400	100
ALPHANUMERIC	not on old form	S2_1_C1_5	IRF Provider Number	S200001	500	100
ALPHANUMERIC	S2_C2_3	S2_1_C2_6	Subprovider 1 Provider Number	S200001	600	200
ALPHANUMERIC	S2_C2_301	S2_1_C2_601	Subprovider 2 Provider Number	S200001	601	200
ALPHANUMERIC	S2_C2_4	S2_1_C2_7	Swing Bed SNF Provider Number	S200001	700	200
ALPHANUMERIC	S2_C2_5	S2_1_C2_8	Swing Bed NF Provider Number	S200001	800	200
ALPHANUMERIC	S2_C2_6	S2_1_C2_9	SNF Provider Number	S200001	900	200
ALPHANUMERIC	S2_C2_7	S2_1_C2_10	NF Provider Number	S200001	1000	200
ALPHANUMERIC	S2_C2_701	S2_1_C2_1001	ICF Provider Number	S200001	1001	200
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
"IDENTIFICATION INFORMATION, WORKSHEET S-2, PART I"						
						
DATA TYPE	96 FIELD NAME	10 FIELD NAME	FIELD DESCRIPTION 	WKSHT CD	LINE	COLUMN
						
ALPHANUMERIC	S2_C2_9	S2_1_C2_12	HHA 1 Provider Number	S200001	1200	200
ALPHANUMERIC	S2_C2_901	S2_1_C2_1201	HHA 2 Provider Number	S200001	1201	200
ALPHANUMERIC	S2_C2_902	S2_1_C2_1202	HHA 3 Provider Number	S200001	1202	200
ALPHANUMERIC	S2_C2_903	S2_1_C2_1203	HHA 4 Provider Number	S200001	1203	200
ALPHANUMERIC	S2_C2_904	S2_1_C2_1204	HHA 5 Provider Number	S200001	1204	200
ALPHANUMERIC	S2_C2_905	S2_1_C2_1205	HHA 6 Provider Number	S200001	1205	200
ALPHANUMERIC	S2_C2_906	S2_1_C2_1206	HHA 7 Provider Number	S200001	1206	200
ALPHANUMERIC	S2_C2_907	S2_1_C2_1207	HHA 8 Provider Number	S200001	1207	200
ALPHANUMERIC	S2_C2_908	S2_1_C2_1208	HHA 9 Provider Number	S200001	1208	200
ALPHANUMERIC	S2_C2_909	S2_1_C2_1209	HHA 10 Provider Number	S200001	1209	200
ALPHANUMERIC	S2_C2_11	S2_1_C2_13	ASC 1 Provider Number	S200001	1300	200
ALPHANUMERIC	S2_C2_1101	S2_1_C2_1301	ASC 2 Provider Number	S200001	1301	200
ALPHANUMERIC	S2_C2_1102	S2_1_C2_1302	ASC 3 Provider Number	S200001	1302	200
ALPHANUMERIC	S2_C2_1103	S2_1_C2_1303	ASC 4 Provider Number	S200001	1303	200
ALPHANUMERIC	S2_C2_1104	S2_1_C2_1304	ASC 5 Provider Number	S200001	1304	200
ALPHANUMERIC	S2_C2_1105	S2_1_C2_1305	ASC 6 Provider Number	S200001	1305	200
ALPHANUMERIC	S2_C2_1106	S2_1_C2_1306	ASC 7 Provider Number	S200001	1306	200
ALPHANUMERIC	S2_C2_1107	S2_1_C2_1307	ASC 8 Provider Number	S200001	1307	200
ALPHANUMERIC	S2_C2_1108	S2_1_C2_1308	ASC 9 Provider Number	S200001	1308	200
ALPHANUMERIC	S2_C2_1109	S2_1_C2_1309	ASC 10 Provider Number	S200001	1309	200
ALPHANUMERIC	S2_C2_12	S2_1_C2_14	Hospice 1 Provider Number	S200001	1400	200
ALPHANUMERIC	S2_C2_1201	S2_1_C2_1401	Hospice 2 Provider Number	S200001	1401	200
ALPHANUMERIC	S2_C2_1202	S2_1_C2_1402	Hospice 3 Provider Number	S200001	1402	200
ALPHANUMERIC	S2_C2_1203	S2_1_C2_1403	Hospice 4 Provider Number	S200001	1403	200
ALPHANUMERIC	S2_C2_1204	S2_1_C2_1404	Hospice 5 Provider Number	S200001	1404	200
ALPHANUMERIC	S2_C2_1205	S2_1_C2_1405	Hospice 6 Provider Number	S200001	1405	200
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
"IDENTIFICATION INFORMATION, WORKSHEET S-2, PART I"						
						
DATA TYPE	96 FIELD NAME	10 FIELD NAME	FIELD DESCRIPTION 	WKSHT CD	LINE	COLUMN
						
ALPHANUMERIC	S2_C2_14	S2_1_C2_15	RHC 1 Provider Number	S200001	1500	200
ALPHANUMERIC	S2_C2_1401	S2_1_C2_1501	RHC 2 Provider Number	S200001	1501	200
ALPHANUMERIC	S2_C2_1402	S2_1_C2_1502	RHC 3 Provider Number	S200001	1502	200
ALPHANUMERIC	S2_C2_1403	S2_1_C2_1503	RHC 4 Provider Number	S200001	1503	200
ALPHANUMERIC	S2_C2_1404	S2_1_C2_1504	RHC 5 Provider Number	S200001	1504	200
ALPHANUMERIC	S2_C2_1405	S2_1_C2_1505	RHC 6 Provider Number	S200001	1505	200
ALPHANUMERIC	S2_C2_1406	S2_1_C2_1506	RHC 7 Provider Number	S200001	1506	200
ALPHANUMERIC	S2_C2_1407	S2_1_C2_1507	RHC 8 Provider Number	S200001	1507	200
ALPHANUMERIC	S2_C2_1408	S2_1_C2_1508	RHC 9 Provider Number	S200001	1508	200
ALPHANUMERIC	S2_C2_1409	S2_1_C2_1509	RHC 10 Provider Number	S200001	1509	200
ALPHANUMERIC	S2_C2_1435	S2_1_C2_1510	RHC 11 Provider Number	S200001	1510	200
ALPHANUMERIC	S2_C2_1436	S2_1_C2_1511	RHC 12 Provider Number	S200001	1511	200
ALPHANUMERIC	S2_C2_1437	S2_1_C2_1512	RHC 13 Provider Number	S200001	1512	200
ALPHANUMERIC	S2_C2_1438	S2_1_C2_1513	RHC 14 Provider Number	S200001	1513	200
ALPHANUMERIC	S2_C2_1439	S2_1_C2_1514	RHC 15 Provider Number	S200001	1514	200
ALPHANUMERIC	S2_C2_1440	S2_1_C2_1515	RHC 16 Provider Number	S200001	1515	200
ALPHANUMERIC	S2_C2_1441	S2_1_C2_1516	RHC 17 Provider Number	S200001	1516	200
ALPHANUMERIC	S2_C2_1442	S2_1_C2_1517	RHC 18 Provider Number	S200001	1517	200
ALPHANUMERIC	S2_C2_1443	S2_1_C2_1518	RHC 19 Provider Number	S200001	1518	200
ALPHANUMERIC	S2_C2_1444	S2_1_C2_1519	RHC 20 Provider Number	S200001	1519	200
ALPHANUMERIC	S2_C2_1445	S2_1_C2_1520	RHC 21 Provider Number	S200001	1520	200
ALPHANUMERIC	S2_C2_1446	S2_1_C2_1521	RHC 22 Provider Number	S200001	1521	200
ALPHANUMERIC	S2_C2_1447	S2_1_C2_1522	RHC 23 Provider Number	S200001	1522	200
ALPHANUMERIC	S2_C2_1448	S2_1_C2_1523	RHC 24 Provider Number	S200001	1523	200
ALPHANUMERIC	S2_C2_1449	S2_1_C2_1524	RHC 25 Provider Number	S200001	1524	200
ALPHANUMERIC	S2_C2_1410	S2_1_C2_16	FQHC 1 Provider Number	S200001	1600	200
ALPHANUMERIC	S2_C2_1411	S2_1_C2_1601	FQHC 2 Provider Number	S200001	1601	200
ALPHANUMERIC	S2_C2_1412	S2_1_C2_1602	FQHC 3 Provider Number	S200001	1602	200
ALPHANUMERIC	S2_C2_1413	S2_1_C2_1603	FQHC 4 Provider Number	S200001	1603	200
ALPHANUMERIC	S2_C2_1414	S2_1_C2_1604	FQHC 5 Provider Number	S200001	1604	200
ALPHANUMERIC	S2_C2_1415	S2_1_C2_1605	FQHC 6 Provider Number	S200001	1605	200
ALPHANUMERIC	S2_C2_1416	S2_1_C2_1606	FQHC 7 Provider Number	S200001	1606	200
ALPHANUMERIC	S2_C2_1417	S2_1_C2_1607	FQHC 8 Provider Number	S200001	1607	200
ALPHANUMERIC	S2_C2_1418	S2_1_C2_1608	FQHC 9 Provider Number	S200001	1608	200
ALPHANUMERIC	S2_C2_1419	S2_1_C2_1609	FQHC 10 Provider Number	S200001	1609	200
ALPHANUMERIC	S2_C2_1420	S2_1_C2_1610	FQHC 11 Provider Number	S200001	1610	200
ALPHANUMERIC	S2_C2_1421	S2_1_C2_1611	FQHC 12 Provider Number	S200001	1611	200
ALPHANUMERIC	S2_C2_1422	S2_1_C2_1612	FQHC 13 Provider Number	S200001	1612	200
ALPHANUMERIC	S2_C2_1423	S2_1_C2_1613	FQHC 14 Provider Number	S200001	1613	200
ALPHANUMERIC	S2_C2_1424	S2_1_C2_1614	FQHC 15 Provider Number	S200001	1614	200
ALPHANUMERIC	S2_C2_1425	S2_1_C2_1615	FQHC 16 Provider Number	S200001	1615	200
ALPHANUMERIC	S2_C2_1426	S2_1_C2_1616	FQHC 17 Provider Number	S200001	1616	200
ALPHANUMERIC	S2_C2_1427	S2_1_C2_1617	FQHC 18 Provider Number	S200001	1617	200
ALPHANUMERIC	S2_C2_1428	S2_1_C2_1618	FQHC 19 Provider Number	S200001	1618	200
ALPHANUMERIC	S2_C2_1429	S2_1_C2_1619	FQHC 20 Provider Number	S200001	1619	200
ALPHANUMERIC	S2_C2_1430	S2_1_C2_1620	FQHC 21 Provider Number	S200001	1620	200
ALPHANUMERIC	S2_C2_1431	S2_1_C2_1621	FQHC 22 Provider Number	S200001	1621	200
ALPHANUMERIC	S2_C2_1432	S2_1_C2_1622	FQHC 23 Provider Number	S200001	1622	200
ALPHANUMERIC	S2_C2_1433	S2_1_C2_1623	FQHC 24 Provider Number	S200001	1623	200
ALPHANUMERIC	S2_C2_1434	S2_1_C2_1624	FQHC 25 Provider Number	S200001	1624	200
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
"IDENTIFICATION INFORMATION, WORKSHEET S-2, PART I"						
						
DATA TYPE	96 FIELD NAME	10 FIELD NAME	FIELD DESCRIPTION 	WKSHT CD	LINE	COLUMN
						
ALPHANUMERIC	S2_C2_1510	S2_1_C2_17	CMHC 1 Provider Number	S200001	1700	200
ALPHANUMERIC	S2_C2_1511	S2_1_C2_1701	CMHC 2 Provider Number	S200001	1701	200
ALPHANUMERIC	S2_C2_1512	S2_1_C2_1702	CMHC 3 Provider Number	S200001	1702	200
ALPHANUMERIC	S2_C2_1513	S2_1_C2_1703	CMHC 4 Provider Number	S200001	1703	200
ALPHANUMERIC	S2_C2_1514	S2_1_C2_1704	CMHC 5 Provider Number	S200001	1704	200
ALPHANUMERIC	S2_C2_1515	S2_1_C2_1705	CMHC 6 Provider Number	S200001	1705	200
ALPHANUMERIC	S2_C2_1516	S2_1_C2_1706	CMHC 7 Provider Number	S200001	1706	200
ALPHANUMERIC	S2_C2_1517	S2_1_C2_1707	CMHC 8 Provider Number	S200001	1707	200
ALPHANUMERIC	S2_C2_1518	S2_1_C2_1708	CMHC 9 Provider Number	S200001	1708	200
ALPHANUMERIC	S2_C2_1519	S2_1_C2_1709	CMHC 10 Provider Number	S200001	1709	200
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
"IDENTIFICATION INFORMATION, WORKSHEET S-2, PART I"						
						
DATA TYPE	96 FIELD NAME	10 FIELD NAME	FIELD DESCRIPTION 	WKSHT CD	LINE	COLUMN
						
ALPHANUMERIC	S2_C2_16	S2_1_C2_18	Renal 1 Provider Number	S200001	1800	200
ALPHANUMERIC	S2_C2_1601	S2_1_C2_1801	Renal 2 Provider Number	S200001	1801	200
ALPHANUMERIC	S2_C2_1602	S2_1_C2_1802	Renal 3 Provider Number	S200001	1802	200
ALPHANUMERIC	S2_C2_1603	S2_1_C2_1803	Renal 4 Provider Number	S200001	1803	200
ALPHANUMERIC	S2_C2_1604	S2_1_C2_1804	Renal 5 Provider Number	S200001	1804	200
ALPHANUMERIC	S2_C2_1605	S2_1_C2_1805	Renal 6 Provider Number	S200001	1805	200
ALPHANUMERIC	S2_C2_1606	S2_1_C2_1806	Renal 7 Provider Number	S200001	1806	200
ALPHANUMERIC	S2_C2_1607	S2_1_C2_1807	Renal 8 Provider Number	S200001	1807	200
ALPHANUMERIC	S2_C2_1608	S2_1_C2_1808	Renal 9 Provider Number	S200001	1808	200
ALPHANUMERIC	S2_C2_1609	S2_1_C2_1809	Renal 10 Provider Number	S200001	1809	200
						
ALPHANUMERIC	S2_C5_2	S2_1_C7_3	Hospital Title 18 Payment System (P/T/O)	S200001	300	700
ALPHANUMERIC	S2_C5_3	S2_1_C7_6	Sub 1 Title 18 Payment System (P/T/O)	S200001	600	700
ALPHANUMERIC	S2_C5_301	S2_1_C7_601	Sub 2 Title 18 Payment System (P/T/O)	S200001	601	700
						
NUMERIC	S2_C1_18	S2_1_C1_21	Type of Control of Hospital (See Table I)	S200001	2100	100
NUMERIC	S2_C1_19	NOT ON FORM	Type of Hospital  (See Table II)	NOT ON FORM		
NUMERIC	S2_C1_20	NOT ON FORM	Type of Subprovider 1  (See Table II)	NOT ON FORM		
NUMERIC	S2_C1_2001	NOT ON FORM	Type of Subprovider 2  (See Table II)	NOT ON FORM		
						
			Is the Hospital Urban (1) or Rural (2)  			
ALPHANUMERIC	S2_C1_21	NOT ON FORM	(See Below)	NOT ON FORM		
						
			Is the facility geographically located in a 			
			rural area and contains 100 or fewer beds 			
ALPHANUMERIC	S2_C2_21	NOT ON FORM	(Y/N)	NOT ON FORM		
						
ALPHANUMERIC	S2_C1_2101	S2_1_C1_22	"Does the facility qualify and is it receiving payments for 
disproportionate share? (Y/N)"	S200001	2200	100
						
			Has the facility received a geographic reclassification 			
			after the first day of the cost reporting period from rural			
ALPHANUMERIC	S2_C1_2102	NOT ON FORM	to urban or vise versa? (Y/N)	NOT ON FORM		
						
ALPHANUMERIC	S2_C2_2102	NOT ON FORM	"Effective Date if 21.02, Col 1 is Yes"	NOT ON FORM		
						
			Is the Hospital Urban (1) or Rural (2)?   			
NUMERIC	S2_C1_2103	NOT ON FORM	(See Below)	NOT ON FORM		
						
						
			Have you received either a wage or  			
			standard geographic reclassification  			
ALPHANUMERIC	S2_C2_2103	NOT ON FORM	to a Rural location? (Y/N)	NOT ON FORM		
						
						
ALPHANUMERIC	S2_C3_2103	NOT ON FORM	"Effective Date if 21.03, Col 2 is Yes"	NOT ON FORM		
						
			Does the facility contain 100 or fewer  			
ALPHANUMERIC	S2_C4_2103	NOT ON FORM	beds (Y/N)	NOT ON FORM		
						
						
NUMERIC	not on old form	S2_1_C1_24	In State Medicaid paid days	S200001	2400	100
NUMERIC	not on old form	S2_1_C2_24	In State Medicaid eligible days	S200001	2400	200
NUMERIC	not on old form	S2_1_C3_24	Out of State Medicaid paid days	S200001	2400	300
NUMERIC	not on old form	S2_1_C4_24	Out of State Medicaid eligible days	S200001	2400	400
NUMERIC	not on old form	S2_1_C5_24	Medicaid HMO Days	S200001	2400	500
NUMERIC	not on old form	S2_1_C6_24	Other Medicaid Days	S200001	2400	600
						
						
						
						
						
						
"IDENTIFICATION INFORMATION, WORKSHEET S-2, PART I"						
						
DATA TYPE	96 FIELD NAME	10 FIELD NAME	FIELD DESCRIPTION 	WKSHT CD	LINE	COLUMN
						
						
ALPHANUMERIC	S2_C5_2103	S2_1_C3_3	Provider's actual MSA or CBSA	S200001	300	300
						
			"For the standard geographic classfication,"			
			what is your status at the beginning or  			
NUMERIC	S2_C1_2104	NOT ON FORM	the period Urban (1) or Rural (2)	NOT ON FORM		
						
						
NUMERIC		S2_1_C1_26	Urban/Rural Indicator at beginning	S200001	2600	100
						
						
			"For the standard geographic classification, "			
			what is your status at the end of the period 			
NUMERIC	S2_C1_2105	S2_1_C1_27	Urban (1) or Rural (2)	S200001	2700	100
						
						
						
ALPHANUMERIC	S2_C1_2106	NOT ON FORM	"Does the hospital qualify for the 3 yr transition of hold harmless payments for small rural  hospitals under the PPS for hospital outpatient department services under DRA, section 5105 or the extension of this provision under MIPPA, section 147 effective for services rendered from 1/1/09 thru 12/31/09? (Y/N)"	NOT ON FORM		
						
						
ALPHANUMERIC	S2_C1_22	S2_1_C1_116	Is this hospital classified as a referral center? (Y/N)	S200001	11600	100
						
NUMERIC		S2_1_C1_11801	Premiums	S200001	11801	100
NUMERIC		S2_1_C2_11801	Paid Losses	S200001	11801	200
NUMERIC		S2_1_C3_11801	Self Insurance	S200001	11801	300
						
						
						
						
ALPHANUMERIC	S2_C1_23	S2_1_C1_125	"Does this facility operate 
transplant center? (Y/N)"	S200001	12500	100
						
ALPHANUMERIC	S2_C2_2301	S2_1_C1_126	"Medicare certified kidney 
transplant center cert date "	S200001	12600	100
						
ALPHANUMERIC	S2_C2_2302	S2_1_C1_127	"Medicare certified heart
transplant center cert date  "	S200001	12700	100
						
ALPHANUMERIC	S2_C2_2303	S2_1_C1_128	"Medical certified liver 
transplant center cert date  "	S200001	12800	100
						
ALPHANUMERIC	S2_C2_2304	S2_1_C1_129	"Medical certified lung
transplant center cert date  "	S200001	12900	100
						
ALPHANUMERIC	S2_C2_2305	NOT ON FORM	"If Medicare pancreas transplant were  performed enter the more recent date of July 1, 1999 or the certification dates for the kidney transplant  "	NOT ON FORM		
						
						
						
						
						
						
						
						
						
			Medicare certified intestinal transplant			
ALPHANUMERIC	S2_C2_2306	S2_1_C1_131	certification date	S200001	13100	100
						
			Medicare certified Islet transplant 			
ALPHANUMERIC	S2_C2_2307	S2_1_C1_132	certification date	S200001	13200	100
						
ALPHANUMERIC	S2_C3_2301 	S2_1_C2_126	Medicare Certified Kidney TC term date	S200001	12600	200
ALPHANUMERIC	S2_C3_2302	S2_1_C2_127	Medicare Certified Heart TC term date	S200001	12700	200
ALPHANUMERIC	S2_C3_2303	S2_1_C2_128	Medicare Certified Liver TC term date	S200001	12800	200
ALPHANUMERIC	S2_C3_2304	S2_1_C2_129	Medicare Certified Lung TC term date	S200001	12900	200
ALPHANUMERIC	S2_C3_2305	S2_1_C2_130	Medicare Certified Pancreas TC term date	S200001	13000	200
ALPHANUMERIC	S2_C3_2306	S2_1_C2_131	Medicare Certified Intestinal TC term date	S200001	13100	200
ALPHANUMERIC	S2_C3_2307	S2_1_C2_132	Medicare Certified Islet TC term date	S200001	13200	200
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
"IDENTIFICATION INFORMATION, WORKSHEET S-2, PART I"						
						
DATA TYPE	96 FIELD NAME	10 FIELD NAME	FIELD DESCRIPTION 	WKSHT CD	LINE	COLUMN
						
ALPHANUMERIC	S2_C2_24 	S2_1_C1_134	"If an Organ Procurement Organization, enter the OPO number"	S200001	13400	100
						
						
ALPHANUMERIC	S2_C3_24	S2_1_C2_134	OPO Term Date 	S200001	13400	200
				 		
						
			"Is this a Medicare transplant center, "			
ALPHANUMERIC	S2_C2_2401	NOT ON FORM	enter the CCN	NOT ON FORM		
						
						
			Certification date or recertification date			
ALPHANUMERIC	S2_C3_2401	NOT ON FORM	after 12/26/07	NOT ON FORM		
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
"IDENTIFICATION INFORMATION, WORKSHEET S-2, PART I"						
						
DATA TYPE	96 FIELD NAME	10 FIELD NAME	FIELD DESCRIPTION 	WKSHT CD	LINE	COLUMN
						
ALPHANUMERIC	S2_C1_25	S2_1_C1_56	"Is this a teaching hospital or
affiliated with a teaching hospital? (Y/N)"	S200001	5600	100
						
NUMERIC	S2_C1_26	S2_1_C1_35	"If (SCH), enter the # of periods."	S200001	3500	100
						
ALPHANUMERIC	S2_C1_2601	S2_1_C1_36	Beginning Date of SCH status  	S200001	3600	100
ALPHANUMERIC	S2_C2_2601	S2_1_C2_36	Ending Date of SCH status  	S200001	3600	200
ALPHANUMERIC	S2_C1_2602	S2_1_C1_3601	Beginning Date of SCH status 	S200001	3601	100
ALPHANUMERIC	S2_C2_2602	S2_1_C2_3601	Ending Date of SCH status  	S200001	3601	200
						
ALPHANUMERIC	S2_C1_27	NOT ON FORM	"Does this hospital have an 
agreement under either section 1883
or 1913 for swing beds? (Y/N)"	NOT ON FORM		
						
ALPHANUMERIC	S2_C2_27	NOT ON FORM	"If Line 27, Col 1 is yes, enter the agreement data  "	NOT ON FORM		
						
ALPHANUMERIC	S2_C1_28	NOT ON FORM	"If the hospital contains a SNF, are all patients under managed care or there were no Medicare utilization? (Y/N)"	NOT ON FORM		
						
ALPHANUMERIC	S2_C1_29	NOT ON FORM	Is there a Rural Hospital with a certified SNF which has fewer than 50 beds (Y/N)	NOT ON FORM		
						
ALPHANUMERIC	S2_C2_29	NOT ON FORM	"If, Line 29, Col 1 is Y, enter SNF provider number"	NOT ON FORM		
						
ALPHANUMERIC	S2_C1_30	S2_1_C1_105	Does the hospital qualify as RPCH/CAH? (Y/N)	S200001	10500	100
						
ALPHANUMERIC	S2_C1_3001	NOT ON FORM	Is this cost reporting period initial 12 month period for which the facility operated as RPCH/CAH? (Y/N)	NOT ON FORM		
						
ALPHANUMERIC	S2_C1_3002	S2_1_C1_106	"If this facility qualifies as a RPCH/CAH, has it elected the all inclusive payment for outpatient service? (Y/N)"	S200001	10600	100
						
ALPHANUMERIC	S2_C1_31	S2_1_C1_108	Is this a rural hospital qualifying for an exception to the certified registered nurse anesthetist the CRNA fee schedule? (Y/N)	S200001	10800	100
						
ALPHANUMERIC	S2_C1_32	S2_1_C1_115	Is this hospital an All-Inclusive rate provider? (Y/N)	S200001	11500	100
						
ALPHANUMERIC	S2_C2_32	S2_1_C2_115	"If Line 32, Col 1 is yes, enter the method used: (A, B, or E only)"	S200001	11500	200
						
						
						
						
						
						
						
						
						
						
						
						
"IDENTIFICATION INFORMATION, WORKSHEET S-2, PART I"						
						
DATA TYPE 	96 FIELD NAME	10 FIELD NAME	FIELD DESCRIPTION 	WKSHT CD	LINE	COLUMN
						
ALPHANUMERIC	S2_C1_33	S2_1_C1_47	"Is this a New Hospital under
42 CFR 412.300 PPS capital
(Y/N)"	S200001	4700	100
						
ALPHANUMERIC	S2_C1_34	S2_1_C1_85	Is this a New Hospital under 42 CFR 413.40(f)(1)(I) (TEFRA)? (Y/N)	S200001	8500	100
						
ALPHANUMERIC	S2_C1_35	S2_1_C1_86	Have you established a new subprovider excluded unit under 42 CFR 413.40(f)(1)(I)?(Y/N)	S200001	8600	100
						
						
ALPHANUMERIC	S2_C2_36	S2_1_C1_48	Does the hospital elect a fully prospective payment method for capital costs? (Y/N)	S200001	4800	100
						
ALPHANUMERIC	S2_C2_3601	S2_1_C1_22	Does the facility qualify and receive payment for disproportionate share in accordance with 42 CFR 412.320?(Y/N/P)	S200001	2200	100
						
ALPHANUMERIC	S2_C2_37	NOT ON FORM	"Does the hospital elect a hold harmless
payment method for capital costs? (Y/N)"	NOT ON FORM		
						
ALPHANUMERIC	S2_C2_3701	NOT ON FORM	"If 37 is yes, is this hospital filing on the basis 100% of the federal rate? (Y/N)"	NOT ON FORM		
						
ALPHANUMERIC	S2_C1_38	NOT ON FORM	"Does the hospital Title XIX inpatient
hospital services? (Y/N)"	NOT ON FORM		
						
ALPHANUMERIC	S2_C1_3803	S2_1_C1_92	Are Title XIX NF patients occupying Title XVIII SNF beds? (Y/N)	S200001	9200	100
						
ALPHANUMERIC	S2_C1_3804	S2_1_C1_93	Does the facility operate an ICF/MR facility for purposes of Title XIX? (Y/N)	S200001	9300	100
						
ALPHANUMERIC	S2_C1_40	S2_1_C1_140	"Are there any related organization or how office costs as defined in HCFA Pub. 15-I, chapter 10? (Y/N)"	S200001	14000	100
						
						
ALPHANUMERIC	S2_C2_40	S2_1_C2_140	Home Office Provider Number	S200001	14000	200
						
ALPHANUMERIC	S2_C1_4001	S2_1_C1_141	Home Office Name	S200001	14100	100
ALPHANUMERIC	S2_C2_4001	S2_1_C2_140	FI/Contractor's Name	S200001	14000	200
ALPHANUMERIC	S2_C3_4001	S2_1_C3_140	FI/Contractor's Number	S200001	14000	300
ALPHANUMERIC	S2_C1_4002	S2_1_C1_142	Home Office Street	S200001	14200	100
ALPHANUMERIC	S2_C2_4002	S2_1_C2_142	Home Office PO Box	S200001	14200	200
ALPHANUMERIC	S2_C1_4003	S2_1_C1_143	City 	S200001	14300	100
ALPHANUMERIC	S2_C2_4003	S2_1_C2_143	State	S200001	14300	200
ALPHANUMERIC	S2_C3_4003	S2_1_C3_143	Zip Code	S200001	14300	300
						
ALPHANUMERIC	S2_C1_41	S2_1_C1_144	Are provider based physicians' costs included in Worksheet A? (Y/N)	S200001	14400	100
						
						
						
						
						
						
						
						
						
						
"IDENTIFICATION INFORMATION, WORKSHEET S-2, PART I"						
						
DATA TYPE	96 FIELD NAME	10 FIELD NAME	FIELD DESCRIPTION 	WKSHT CD	LINE	COLUMN
						
ALPHANUMERIC	S2_C1_42	NOT ON FORM	"Are physical therapy services
provided by outside supplies? (Y/N)"	NOT ON FORM		
						
ALPHANUMERIC	S2_C1_4201	NOT ON FORM	Are occupational therapy services provided by outside suppliers? (Y/N)	NOT ON FORM		
						
ALPHANUMERIC	S2_C1_4202	NOT ON FORM	"Are speech pathology services 
provided by outside suppliers? (Y/N)"	NOT ON FORM		
						
ALPHANUMERIC	S2_C1_43	NOT ON FORM	Are respiratory therapy services provided by outside suppliers? (Y/N)	NOT ON FORM		
						
ALPHANUMERIC	S2_C1_44	S2_1_C1_145	"If this Hospital is claiming cost for renal services on Worksheet A, are they inpatient services only? (Y/N)"	S200001	14500	100
						
NUMERIC	S2_C1_46	NOT ON FORM	"If participating in the NHCMQ Demonstration, enter the Phase Number"	NOT ON FORM		
						
ALPHANUMERIC	S2_C1_52	NOT ON FORM	Does hospital claim expenditures for extraordinary circumstances in accordance with 42 CFR 412.348(e)? (Y/N)	NOT ON FORM		
						
NUMERIC	S2_C1_53	S2_1_C1_37	Number of periods hospital was in MDH status	S200001	3700	100
						
ALPHANUMERIC	S2_C1_5301	S2_1_C1_38	MDH status beginning date (MM/DD/YY)	S200001	3800	100
ALPHANUMERIC	S2_C2_5301	S2_1_C2_38	MDH status ending date (MM/DD/YY)	S200001	3800	200
ALPHANUMERIC	S2_C1_5302	S2_1_C1_3801	MDH status beginning date  (MM/DD/YY)	S200001	3801	100
ALPHANUMERIC	S2_C2_5302	S2_1_C2_3801	MDH status ending date (MM/DD/YY)	S200001	3801	200
						
NUMERIC	S2_C1_54	NOT ON FORM	Malpractice premium amount	NOT ON FORM		
NUMERIC	S2_C2_54	NOT ON FORM	Malpractice Paid Losses amount	NOT ON FORM		
NUMERIC	S2_C3_54	NOT ON FORM	Malpractice Self Insurance amount 	NOT ON FORM		
						
ALPHANUMERIC	S2_C1_5401	NOT ON FORM	Are malpractice premiums and paid losses reported in other than Administrative and General cost center? (Y/N)	NOT ON FORM		
						
ALPHANUMERIC	S2_C1_55	NOT ON FORM	Does facility qualify for additional prospective payment in accordance with 42 CFR 412.107? (Y/N)	NOT ON FORM		
						
ALPHANUMERIC	S2_C1_56	NOT ON FORM	"Are you claiming ambulance
 costs? (Y/N)"	NOT ON FORM		
						
NUMERIC	S2_C2_56	NOT ON FORM	"If yes, enter the payment limit"	NOT ON FORM		
						
ALPHANUMERIC	S2_C3_56	NOT ON FORM	"If Line 56, Column 1 is 'Y', is this your first year of operation for rendering ambulance services? (Y/N)"	NOT ON FORM		
						
NUMERIC	S2_C2_5601	NOT ON FORM	"Subsequent ambulance
payment limit"	NOT ON FORM		
						
						
ALPHANUMERIC		S2_1_C1_60	or allied health costs?	S200001	6000	100
						
ALPHANUMERIC		S2_1_C1_107		S200001	10700	100
ALPHANUMERIC		S2_1_C2_107		S200001	10700	200
						
"UTILIZATION DATA, WORKSHEET S-3, PART I"						
						
DATA TYPE	96 FIELD NAME	10 FIELD NAME	FIELD DESCRIPTION 	WKSHT CD	LINE	COLUMN
						
	Number of Beds					
						
NUMERIC	S3_1_C1_1	S3_1_C2_1	Hospital Adults & Pediatrics	S300001	100	200
NUMERIC		S3_1_C2_7	Total	S300001	700	200
ROLLUP	S3_1_C1_6	S3_1_C2_8	Intensive Care Unit	S300001	800	200
ROLLUP	S3_1_C1_7	S3_1_C2_9	Coronary Care Unit	S300001	900	200
ROLLUP	S3_1_C1_8	S3_1_C2_10	Burn Intensive Care Unit	S300001	1000	200
ROLLUP	S3_1_C1_9	S3_1_C2_11	Surgical Intensive Care Unit	S300001	1100	200
ROLLUP	S3_1_C1_10	S3_1_C2_12	Other Special Care	S300001	1200	200
NUMERIC	S3_1_C1_11	S3_1_C2_13	Nursery	S300001	1300	200
NUMERIC	S3_1_C1_12	S3_1_C2_14	Total Hospital	S300001	1400	200
NUMERIC	NOT ON OLD FORM	S3_1_C2_16	IPF	S300001	1600	200
NUMERIC	NOT ON OLD FORM	S3_1_C2_17	IRF	S300001	1700	200
NUMERIC	S3_1_C1_14	S3_1_C2_18	Subprovider 1	S300001	1800	200
NUMERIC	S3_1_C1_1401	S3_1_C2_1801	Subprovider 2	S300001	1801	200
NUMERIC	S3_1_C1_15	S3_1_C2_19	SNF	S300001	1900	200
NUMERIC	S3_1_C1_16	S3_1_C2_20	NF	S300001	2000	200
NUMERIC	S3_1_C1_1601	S3_1_C2_2001	ICF	S300001	2001	200
NUMERIC	S3_1_C1_17	S3_1_C2_21	OLTC	S300001	2100	200
ROLLUP	S3_1_C1_21	S3_1_C2_24	Hospice	S300001	2400	200
NUMERIC	S3_1_C1_25	S3_1_C2_27	Total Facility	S300001	2700	200
						
	Bed Days Available					
						
NUMERIC	S3_1_C2_1	S3_1_C3_1	Hospital Adults & Pediatrics	S300001	100	300
NUMERIC		S3_1_C3_7	Total Hospital	S300001	700	300
ROLLUP	S3_1_C2_6	S3_1_C3_8	Intensive Care Unit	S300001	800	300
ROLLUP	S3_1_C2_7	S3_1_C3_9	Coronary Care Unit	S300001	900	300
ROLLUP	S3_1_C2_8	S3_1_C3_10	Burn Intensive Care Unit	S300001	1000	300
ROLLUP	S3_1_C2_9	S3_1_C3_11	Surgical Intensive Care Unit	S300001	1100	300
ROLLUP	S3_1_C2_10	S3_1_C3_12	Other Special Care	S300001	1200	300
NUMERIC	S3_1_C2_11	S3_1_C3_13	Nursery	S300001	1300	300
NUMERIC	S3_1_C2_12	S3_1_C3_14	Total Hospital	S300001	1400	300
NUMERIC	NOT ON OLD FORM	S3_1_C3_16	IPF	S300001	1600	300
NUMERIC	NOT ON OLD FORM	S3_1_C3_17	IRF	S300001	1700	300
NUMERIC	S3_1_C2_14	S3_1_C3_18	Subprovider 1	S300001	1800	300
NUMERIC	S3_1_C2_1401	S3_1_C3_1801	Subprovider 2	S300001	1801	300
NUMERIC	S3_1_C2_15	S3_1_C3_19	SNF	S300001	1900	300
NUMERIC	S3_1_C2_16	S3_1_C3_20	NF	S300001	2000	300
NUMERIC	S3_1_C2_1601	S3_1_C3_2001	ICF	S300001	2001	300
NUMERIC	S3_1_C2_17	S3_1_C3_21	OLTC	S300001	2100	300
ROLLUP	S3_1_C2_21	S3_1_C3_24	Hospice	S300001	2400	300
						
						
						
NUMERIC		S3_1_C4_1	Hospital Adults & Pediatrics	S300001	100	400
NUMERIC		S3_1_C4_7	Total Hospital	S300001	700	400
ROLLUP		S3_1_C4_8	Intensive Care Unit	S300001	800	400
ROLLUP		S3_1_C4_9	Coronary Care Unit	S300001	900	400
ROLLUP		S3_1_C4_10	Burn Intensive Care Unit	S300001	1000	400
ROLLUP		S3_1_C4_11	Surgical Intensive Care Unit	S300001	1100	400
ROLLUP		S3_1_C4_12	Other Special Care	S300001	1200	400
NUMERIC		S3_1_C4_14	Total Hospital	S300001	1400	400
						
						
						
						
						
						
						
						
						
						
						
						
						
NUMERIC		S3_1_C5_1	Hospital Adults & Pediatrics	S300001	100	500
NUMERIC		S3_1_C5_6		S300001	600	500
NUMERIC		S3_1_C5_7	Total Hospital	S300001	700	500
ROLLUP		S3_1_C5_8	Intensive Care Unit	S300001	800	500
ROLLUP		S3_1_C5_9	Coronary Care Unit	S300001	900	500
ROLLUP		S3_1_C5_10	Burn Intensive Care Unit	S300001	1000	500
ROLLUP		S3_1_C5_11	Surgical Intensive Care Unit	S300001	1100	500
ROLLUP		S3_1_C5_12	Other Special Care	S300001	1200	500
NUMERIC		S3_1_C5_13	Nursery	S300001	1300	500
NUMERIC		S3_1_C5_14	Total Hospital	S300001	1400	500
NUMERIC		S3_1_C5_15		S300001	1500	500
NUMERIC		S3_1_C5_16	IPF	S300001	1600	500
NUMERIC		S3_1_C5_17	IRF	S300001	1700	500
NUMERIC		S3_1_C5_18	Subprovider 1	S300001	1800	500
NUMERIC		S3_1_C5_1801	Subprovider 2	S300001	1801	500
NUMERIC		S3_1_C5_19	SNF	S300001	1900	500
NUMERIC		S3_1_C5_20	NF	S300001	2000	500
NUMERIC		S3_1_C5_2001	ICF	S300001	2001	500
ROLLUP		S3_1_C5_22		S300001	2200	500
ROLLUP		S3_1_C5_25		S300001	2500	500
ROLLUP		S3_1_C5_26		S300001	2600	500
						
						
	Medicare Inpatient Days/Outpatient Visits 					
						
NUMERIC	S3_1_C4_1	S3_1_C6_1	Hospital Adults & Pediatrics	S300001	100	600
NUMERIC	S3_1_C4_2	S3_1_C6_2	HMO	S300001	200	600
NUMERIC		S3_1_C6_3		S300001	300	600
NUMERIC		S3_1_C6_4		S300001	400	600
NUMERIC	S3_1_C4_3	S3_1_C6_5	Hospital Adults & Ped Swing Bed SNF	S300001	500	600
NUMERIC	S3_1_C4_5	S3_1_C6_7	Total Adults & Peds	S300001	700	600
ROLLUP	S3_1_C4_6	S3_1_C6_8	Intensive Care Unit	S300001	800	600
ROLLUP	S3_1_C4_7	S3_1_C6_9	Coronary Care Unit	S300001	900	600
ROLLUP	S3_1_C4_8	S3_1_C6_10	Burn Intensive Care Unit	S300001	1000	600
ROLLUP	S3_1_C4_9	S3_1_C6_11	Surgical Intensive Care Unit	S300001	1100	600
ROLLUP	S3_1_C4_10	S3_1_C6_12	Other Special Care	S300001	1200	600
NUMERIC	S3_1_C4_12	S3_1_C6_14	Total Hospital	S300001	1400	600
NUMERIC	S3_1_C4_13	S3_1_C6_15	RPCH/CAH Visits	S300001	1500	600
NUMERIC	NOT ON OLD FORM	S3_1_C6_16	IPF	S300001	1600	600
NUMERIC	NOT ON OLD FORM	S3_1_C6_17	IRF	S300001	1700	600
NUMERIC	S3_1_C4_14	S3_1_C6_18	Subprovider 1	S300001	1800	600
NUMERIC	S3_1_C4_1401	S3_1_C6_1801	Subprovider 2	S300001	1801	600
NUMERIC	S3_1_C4_15	S3_1_C6_19	SNF	S300001	1900	600
ROLLUP	S3_1_C4_18	S3_1_C6_22	HHA	S300001	2200	600
ROLLUP	S3_1_C4_21	S3_1_C6_24	Hospice	S300001	2400	600
ROLLUP		S3_1_C6_25	CMHC	S300001	2500	600
ROLLUP	S3_1_C4_24	S3_1_C6_26	RHC/FQHC Combined	S300001	2600	600
NUMERIC	S3_1_C4_27	S3_1_C6_29	Ambulance Trips	S300001	2900	600
NUMERIC	S3_1_C4_2701	S3_1_C6_2901	Ambulance Trips	S300001	2901	600
NUMERIC		S3_1_C6_33		S300001	3300	600
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
"UTILIZATION DATA, WORKSHEET S-3, PART I"						
						
DATA TYPE	96 FIELD NAME	10 FIELD NAME	FIELD DESCRIPTION 	WKSHT CD	LINE	COLUMN
						
	Medicaid Inpatient Days/Outpatient Visits 					
						
NUMERIC	S3_1_C5_1	S3_1_C7_1	Hospital Adults & Pediatrics	S300001	100	700
NUMERIC	S3_1_C5_2	S3_1_C7_2	HMO	S300001	200	700
NUMERIC		S3_1_C7_3		S300001	300	700
NUMERIC		S3_1_C7_4		S300001	400	700
NUMERIC	S3_1_C5_3	S3_1_C7_5	Hospital Adlts & Ped Swing Bed SNF	S300001	500	700
NUMERIC	S3_1_C5_4	S3_1_C7_6	Hospital Adlts & Ped Swing Bed NF	S300001	600	700
NUMERIC	S3_1_C5_5	S3_1_C7_7	Total Adults & Peds	S300001	700	700
ROLLUP	S3_1_C5_6	S3_1_C7_8	Intensive Care Unit	S300001	800	700
ROLLUP	S3_1_C5_7	S3_1_C7_9	Coronary Care Unit	S300001	900	700
ROLLUP	S3_1_C5_8	S3_1_C7_10	Burn Intensive Care Unit	S300001	1000	700
ROLLUP	S3_1_C5_9	S3_1_C7_11	Surgical Intensive Care Unit	S300001	1100	700
ROLLUP	S3_1_C5_10	S3_1_C7_12	Other Special Care	S300001	1200	700
NUMERIC	S3_1_C5_11	S3_1_C7_13	Nursery	S300001	1300	700
NUMERIC	S3_1_C5_12	S3_1_C7_14	Total Hospital	S300001	1400	700
NUMERIC	S3_1_C5_13	S3_1_C7_15	RPCH/CAH Visits	S300001	1500	700
NUMERIC	NOT ON OLD FORM	S3_1_C7_16	IPF	S300001	1600	700
NUMERIC	NOT ON OLD FORM	S3_1_C7_17	IRF	S300001	1700	700
NUMERIC	S3_1_C5_14	S3_1_C7_18	Subprovider 1	S300001	1800	700
NUMERIC	S3_1_C5_1401	S3_1_C7_1801	Subprovider 2	S300001	1801	700
NUMERIC	S3_1_C5_15	S3_1_C7_19	SNF	S300001	1900	700
NUMERIC	S3_1_C5_16	S3_1_C7_20	NF	S300001	2000	700
NUMERIC	S3_1_C5_1601	S3_1_C7_2001	ICF	S300001	2001	700
ROLLUP	S3_1_C5_18	S3_1_C7_22	HHA	S300001	2200	700
ROLLUP	S3_1_C5_21	S3_1_C7_24	Hospice	S300001	2400	700
ROLLUP	S3_1_C5_23	S3_1_C7_25	Outpatient Rehab Provider	S300001	2500	700
ROLLUP	S3_1_C5_24	S3_1_C7_26	RHC/FQHC Combined	S300001	2600	700
NUMERIC		S3_1_C7_28		S300001	2800	700
NUMERIC	S3_1_C5_29	S3_1_C7_32	Labor and Delivery Days -  Title XIX	S300001	3200	700
						
	Total Inpatient Days/Outpatient Visits 					
						
NUMERIC	S3_1_C6_1  	S3_1_C8_1	Hospital Adults & Pediatrics	S300001	100	800
NUMERIC	S3_1_C6_3	S3_1_C8_5	Hospital Adlts & Ped Swing Bed SNF	S300001	500	800
NUMERIC	S3_1_C6_4	S3_1_C8_6	Hospital Adlts & Ped Swing Bed NF	S300001	600	800
NUMERIC	S3_1_C6_5	S3_1_C8_7	Total Adults & Pediatrics	S300001	700	800
ROLLUP	S3_1_C6_6	S3_1_C8_8	Intensive Care Unit	S300001	800	800
ROLLUP	S3_1_C6_7	S3_1_C8_9	Coronary Care Unit	S300001	900	800
ROLLUP	S3_1_C6_8	S3_1_C8_10	Burn Intensive Care Unit	S300001	1000	800
ROLLUP	S3_1_C6_9	S3_1_C8_11	Surgical Intensive Care Unit	S300001	1100	800
ROLLUP	S3_1_C6_10	S3_1_C8_12	Other Special Care	S300001	1200	800
						
NUMERIC	S3_1_C6_11	S3_1_C8_13	Nursery	S300001	1300	800
NUMERIC	S3_1_C6_12	S3_1_C8_14	Total Hospital	S300001	1400	800
NUMERIC		S3_1_C8_15	CAH Visits	S300001	1500	800
NUMERIC	not on old form	S3_1_C8_16	IPF	S300001	1600	800
NUMERIC	not on old form	S3_1_C8_17	IRF	S300001	1700	800
						
NUMERIC	S3_1_C6_14	S3_1_C8_18	Subprovider 1	S300001	1800	800
NUMERIC	S3_1_C6_1401	S3_1_C8_1801	Subprovider 2	S300001	1801	800
						
NUMERIC	S3_1_C6_15	S3_1_C8_19	SNF	S300001	1900	800
NUMERIC	S3_1_C6_16	S3_1_C8_20	NF	S300001	2000	800
NUMERIC	S3_1_C6_1601	S3_1_C8_2001	ICF	S300001	2001	800
NUMERIC	S3_1_C6_17	S3_1_C8_21	OLTC	S300001	2100	800
ROLLUP	S3_1_C6_18	S3_1_C8_22	HHA	S300001	2200	800
ROLLUP	S3_1_C6_21	S3_1_C8_24	Hospice	S300001	2400	800
ROLLUP	S3_1_C6_23	S3_1_C8_25	Outpatient Rehab Provider	S300001	2500	800
ROLLUP	S3_1_C6_24	S3_1_C8_26	RHC/FQHC Combined	S300001	2600	800
						
NUMERIC	S3_1_C6_26	S3_1_C8_28	Medicaid Observation Days	S300001	2800	800
NUMERIC		S3_1_C8_30		S300001	3000	800
NUMERIC		S3_1_C8_31		S300001	3100	800
NUMERIC	S3_1_C6_29	S3_1_C8_32	Labor and Delivery Days -  Title XIX	S300001	3200	800
						
						
						
						
NUMERIC		S3_1_C9_14	Total Hospital Interns & Residents	S300001	1400	900
NUMERIC		S3_1_C9_16		S300001	1600	900
NUMERIC		S3_1_C9_17		S300001	1700	900
NUMERIC	 	S3_1_C9_18	Total Subprovider I Interns & Residents	S300001	1800	900
NUMERIC		S3_1_C9_1801	Total Subprovider II Interns & Residents	S300001	1801	900
NUMERIC		S3_1_C9_19	SNF	S300001	1900	900
NUMERIC		S3_1_C9_20	NF	S300001	2000	900
NUMERIC		S3_1_C9_2001	ICF	S300001	2001	900
NUMERIC		S3_1_C9_21	OLTC	S300001	2100	900
ROLLUP		S3_1_C9_22	HHA	S300001	2200	900
NUMERIC		S3_1_C9_23		S300001	2300	900
ROLLUP		S3_1_C9_24	Hospice	S300001	2400	900
ROLLUP		S3_1_C9_25	Outpatient Rehab Provider	S300001	2500	900
ROLLUP		S3_1_C9_26	RHC/FQHC Combined	S300001	2600	900
NUMERIC		S3_1_C9_27	Total Facility FTEs 	S300001	2700	900
						
						
NUMERIC		S3_1_C10_14	Total Hospital Interns & Residents	S300001	1400	1000
NUMERIC		S3_1_C10_16		S300001	1600	1000
NUMERIC		S3_1_C10_17		S300001	1700	1000
NUMERIC	 	S3_1_C10_18	Total Subprovider I Interns & Residents	S300001	1800	1000
NUMERIC		S3_1_C10_1801	Total Subprovider II Interns & Residents	S300001	1801	1000
NUMERIC		S3_1_C10_19	SNF	S300001	1900	1000
NUMERIC		S3_1_C10_20	NF	S300001	2000	1000
NUMERIC		S3_1_C10_2001	ICF	S300001	2001	1000
NUMERIC		S3_1_C10_21	OLTC	S300001	2100	1000
ROLLUP		S3_1_C10_22	HHA	S300001	2200	1000
NUMERIC		S3_1_C10_23		S300001	2300	1000
ROLLUP		S3_1_C10_24	Hospice	S300001	2400	1000
ROLLUP		S3_1_C10_25	Outpatient Rehab Provider	S300001	2500	1000
ROLLUP		S3_1_C10_26	RHC/FQHC Combined	S300001	2600	1000
NUMERIC		S3_1_C10_27	Total Facility FTEs 	S300001	2700	1000
						
NUMERIC		S3_1_C11_14	Total Hospital Interns & Residents	S300001	1400	1100
NUMERIC		S3_1_C11_16		S300001	1600	1100
NUMERIC		S3_1_C11_17		S300001	1700	1100
NUMERIC	 	S3_1_C11_18	Total Subprovider I Interns & Residents	S300001	1800	1100
NUMERIC		S3_1_C11_1801	Total Subprovider II Interns & Residents	S300001	1801	1100
NUMERIC		S3_1_C11_19	SNF	S300001	1900	1100
NUMERIC		S3_1_C11_20	NF	S300001	2000	1100
NUMERIC		S3_1_C11_2001	ICF	S300001	2001	1100
NUMERIC		S3_1_C11_21	OLTC	S300001	2100	1100
ROLLUP		S3_1_C11_22	HHA	S300001	2200	1100
NUMERIC		S3_1_C11_23		S300001	2300	1100
ROLLUP		S3_1_C11_24	Hospice	S300001	2400	1100
ROLLUP		S3_1_C11_25	Outpatient Rehab Provider	S300001	2500	1100
ROLLUP		S3_1_C11_26	RHC/FQHC Combined	S300001	2600	1100
NUMERIC		S3_1_C11_27	Total Facility FTEs 	S300001	2700	1100
						
NUMERIC		S3_1_C12_1		S300001	100	1200
NUMERIC		S3_1_C12_14		S300001	1400	1200
NUMERIC		S3_1_C12_16		S300001	1600	1200
NUMERIC		S3_1_C12_17		S300001	1700	1200
NUMERIC	 	S3_1_C12_18		S300001	1800	1200
NUMERIC		S3_1_C12_1801		S300001	1801	1200
						
NUMERIC		S3_1_C13_1		S300001	100	1300
NUMERIC		S3_1_C13_2		S300001	200	1300
NUMERIC		S3_1_C13_14		S300001	1400	1300
NUMERIC		S3_1_C13_16		S300001	1600	1300
NUMERIC		S3_1_C13_17		S300001	1700	1300
NUMERIC	 	S3_1_C13_18		S300001	1800	1300
NUMERIC		S3_1_C13_1801		S300001	1801	1300
						
						
						
						
						
NUMERIC		S3_1_C14_1		S300001	100	1400
NUMERIC		S3_1_C14_14		S300001	1400	1400
NUMERIC		S3_1_C14_16		S300001	1600	1400
NUMERIC		S3_1_C14_17		S300001	1700	1400
NUMERIC	 	S3_1_C14_18		S300001	1800	1400
NUMERIC		S3_1_C14_1801		S300001	1801	1400
						
						
NUMERIC		S3_1_C15_1		S300001	100	1500
NUMERIC		S3_1_C15_14		S300001	1400	1500
NUMERIC		S3_1_C15_16		S300001	1600	1500
NUMERIC		S3_1_C15_17		S300001	1700	1500
NUMERIC	 	S3_1_C15_18		S300001	1800	1500
NUMERIC		S3_1_C15_1801		S300001	1801	1500
NUMERIC		S3_1_C15_21		S300001	2100	1500
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
	HOSPITAL WAGE INDEX DATA					
	"2552-10 WORKSHEET S-3, PART II"					
						
DATA TYPE	96 FIELD NAME	10 FIELD NAME	FIELD DESCRIPTION 	WKSHT CD	LINE	COLUMN
						
	AMOUNT REPORTED					
						
NUMERIC	S3_2_C1_1 	S3_2_C2_1 	Total Salaries	S300002	100	200
NUMERIC	S3_2_C1_2	S3_2_C2_2 	Non-Physician Anesthetist Part A	S300002	200	200
NUMERIC	S3_2_C1_3	S3_2_C2_3	Non-Physician Anesthetist Part B	S300002	300	200
NUMERIC	S3_2_C1_4	S3_2_C2_4	Physician-Part A	S300002	400	200
						
NUMERIC	S3_2_C1_5	S3_2_C2_5 	Physician-Part B	S300002	500	200
NUMERIC	S3_2_C1_501	S3_2_C2_6	Non-Physician Part B	S300002	600	200
NUMERIC	S3_2_C1_6	S3_2_C2_7	Interns & Residents	S300002	700	200
						
NUMERIC	S3_2_C1_7	S3_2_C2_8	Home Office Personnel	S300002	800	200
NUMERIC	S3_2_C1_8	S3_2_C2_9 	SNF	S300002	900	200
NUMERIC	S3_2_C1_801	S3_2_C2_10	Excluded Area Salaries	S300002	1000	200
NUMERIC	S3_2_C1_9	S3_2_C2_11	Contract Labor	S300002	1100	200
						
						
NUMERIC	S3_2_C1_903	S3_2_C2_12	Management and Administrative Services	S300002	1200	200
NUMERIC	S3_2_C1_10	S3_2_C2_13	Contract Labor: Pysician Part A	S300002	1300	200
						
NUMERIC	S3_2_C1_11	S3_2_C2_14 	Home Office Salaries & Wage Related Csts	S300002	1400	200
NUMERIC	S3_2_C1_12	S3_2_C2_15	Home Office:  Physician Part A	S300002	1500	200
NUMERIC	S3_2_C1_1201	S3_2_C2_16	Teaching Physician Salaries	S300002	1600	200
NUMERIC	S3_2_C1_13	S3_2_C2_17 	Wage Related Costs Core	S300002	1700	200
NUMERIC	S3_2_C1_14	S3_2_C2_18 	Wage Related Costs Other	S300002	1800	200
NUMERIC	S3_2_C1_15	S3_2_C2_19	Excluded Areas 	S300002	1900	200
NUMERIC	S3_2_C1_16	S3_2_C2_20	Non-Physician Anesthetist Part A	S300002	2000	200
NUMERIC	S3_2_C1_17	S3_2_C2_21	Non-Physician Anesthetist Part B	S300002	2100	200
NUMERIC	S3_2_C1_18	S3_2_C2_22 	Physician Part A	S300002	2200	200
						
NUMERIC	S3_2_C1_19	S3_2_C2_23	Physician Part B	S300002	2300	200
NUMERIC	S3_2_C1_1901	S3_2_C2_24 	Wage Related Costs RHC/FQHC	S300002	2400	200
NUMERIC	S3_2_C1_20	S3_2_C2_25 	Interns & Residents	S300002	2500	200
NUMERIC	S3_2_C1_21	S3_2_C2_26 	Employee Benefits	S300002	2600	200
NUMERIC	S3_2_C1_22	S3_2_C2_27 	Administrative and General	S300002	2700	200
NUMERIC	S3_2_C1_2201	S3_2_C2_28 	Administrative & General under contract 	S300002	2800	200
NUMERIC	S3_2_C1_23	S3_2_C2_29	Maintenance and Repairs	S300002	2900	200
NUMERIC	S3_2_C1_24	S3_2_C2_30	Operation of Plant	S300002	3000	200
NUMERIC	S3_2_C1_25	S3_2_C2_31	Laundry and Linen Service	S300002	3100	200
NUMERIC	S3_2_C1_26	S3_2_C2_32	Housekeeping	S300002	3200	200
NUMERIC	S3_2_C1_2601	S3_2_C2_33	Housekeeping under contract  	S300002	3300	200
NUMERIC	S3_2_C1_27	S3_2_C2_34	Dietary	S300002	3400	200
NUMERIC	S3_2_C1_2701	S3_2_C2_35	Dietary under contract 	S300002	3500	200
NUMERIC	S3_2_C1_28	S3_2_C2_36	Cafeteria	S300002	3600	200
NUMERIC	S3_2_C1_29	S3_2_C2_37	Maintenance of Personnel	S300002	3700	200
NUMERIC	S3_2_C1_30	S3_2_C2_38	Nursing Administration	S300002	3800	200
NUMERIC	S3_2_C1_31	S3_2_C2_39	Central Services and Supply	S300002	3900	200
NUMERIC	S3_2_C1_32	S3_2_C2_40	Pharmacy   	S300002	4000	200
NUMERIC	S3_2_C1_33	S3_2_C2_41	Medical Records & Med Records Library	S300002	4100	200
NUMERIC	S3_2_C1_34	S3_2_C2_42	Social Service	S300002	4200	200
NUMERIC	S3_2_C1_35	S3_2_C2_43	Other General Service	S300002	4300	200
						
						
						
						
						
						
						
						
						
						
						
						
						
	HOSPITAL WAGE INDEX DATA					
	"2552-10 WORKSHEET S-3, PART II"					
						
DATA TYPE	96 FIELD NAME	10 FIELD NAME	FIELD DESCRIPTION 	WKSHT CD	LINE	COLUMN
						
	ADJUSTED SALARIES					
						
NUMERIC	S3_2_C3_1 	S3_2_C4_1 	Total Salaries	S300002	100	400
NUMERIC	S3_2_C3_2	S3_2_C4_2 	Non-Physician Anesthetist Part A	S300002	200	400
NUMERIC	S3_2_C3_3	S3_2_C4_3	Non-Physician Anesthetist Part B	S300002	300	400
NUMERIC	S3_2_C3_4	S3_2_C4_4	Physician-Part A	S300002	400	400
						
NUMERIC	S3_2_C3_5	S3_2_C4_5 	Physician-Part B	S300002	500	400
NUMERIC	S3_2_C3_501	S3_2_C4_6	Non-Physician Part B	S300002	600	400
NUMERIC	S3_2_C3_6	S3_2_C4_7	Interns & Residents	S300002	700	400
						
NUMERIC	S3_2_C3_7	S3_2_C4_8	Home Office Personnel	S300002	800	400
NUMERIC	S3_2_C3_8	S3_2_C4_9 	SNF	S300002	900	400
NUMERIC	S3_2_C3_801	S3_2_C4_10	Excluded Area Salaries	S300002	1000	400
NUMERIC	S3_2_C3_9	S3_2_C4_11	Contract Labor	S300002	1100	400
						
						
NUMERIC	S3_2_C3_903	S3_2_C4_12	Management and Administrative Services	S300002	1200	400
NUMERIC	S3_2_C3_10	S3_2_C4_13	Contract Labor:  Physician Part A	S300002	1300	400
						
NUMERIC	S3_2_C3_11	S3_2_C4_14 	Home Office Salaries & Wage Related Csts	S300002	1400	400
NUMERIC	S3_2_C3_12	S3_2_C4_15	Home Office:  Physician Part A	S300002	1500	400
NUMERIC	S3_2_C3_1201	S3_2_C4_16	Teaching Physician Salaries	S300002	1600	400
NUMERIC	S3_2_C3_13	S3_2_C4_17 	Wage Related Costs Core	S300002	1700	400
NUMERIC	S3_2_C3_14	S3_2_C4_18 	Wage Related Costs Other	S300002	1800	400
NUMERIC	S3_2_C3_15	S3_2_C4_19	Excluded Areas 	S300002	1900	400
NUMERIC	S3_2_C3_16	S3_2_C4_20	Non-Physician Anesthetist Part A	S300002	2000	400
NUMERIC	S3_2_C3_17	S3_2_C4_21	Non-Physician Anesthetist Part B	S300002	2100	400
NUMERIC	S3_2_C3_18	S3_2_C4_22 	Physician Part A	S300002	2200	400
NUMERIC		S3_2_C4_2201	Physician Part A Teaching	S300002	2201	400
NUMERIC	S3_2_C3_19	S3_2_C4_23	Physician Part B	S300002	2300	400
NUMERIC	S3_2_C3_1901	S3_2_C4_24 	Wage Related Costs RHC/FQHC	S300002	2400	400
NUMERIC	S3_2_C3_20	S3_2_C4_25 	Interns & Residents	S300002	2500	400
NUMERIC	S3_2_C3_21	S3_2_C4_26 	Employee Benefits	S300002	2600	400
NUMERIC	S3_2_C3_22	S3_2_C4_27 	Administrative and General	S300002	2700	400
NUMERIC	S3_2_C3_2201	S3_2_C4_28 	Administrative & General under contract 	S300002	2800	400
NUMERIC	S3_2_C3_23	S3_2_C4_29	Admin & Gen Under Contract	S300002	2900	400
NUMERIC	S3_2_C3_24	S3_2_C4_30	Operation of Plant	S300002	3000	400
NUMERIC	S3_2_C3_25	S3_2_C4_31	Laundry and Linen Service	S300002	3100	400
NUMERIC	S3_2_C3_26	S3_2_C4_32	Housekeeping	S300002	3200	400
NUMERIC	S3_2_C3_2601	S3_2_C4_33	Housekeeping under contract  	S300002	3300	400
NUMERIC	S3_2_C3_27	S3_2_C4_34	Dietary	S300002	3400	400
NUMERIC	S3_2_C3_2701	S3_2_C4_35	Dietary under contract 	S300002	3500	400
NUMERIC	S3_2_C3_28	S3_2_C4_36	Cafeteria	S300002	3600	400
NUMERIC	S3_2_C3_29	S3_2_C4_37	Maintenance of Personnel	S300002	3700	400
NUMERIC	S3_2_C3_30	S3_2_C4_38	Nursing Administration	S300002	3800	400
NUMERIC	S3_2_C3_31	S3_2_C4_39	Central Services and Supply	S300002	3900	400
NUMERIC	S3_2_C3_32	S3_2_C4_40	Pharmacy   	S300002	4000	400
NUMERIC	S3_2_C3_33	S3_2_C4_41	Medical Records & Med Records Library	S300002	4100	400
NUMERIC	S3_2_C3_34	S3_2_C4_42	Social Service	S300002	4200	400
NUMERIC	S3_2_C3_35	S3_2_C4_43	Other General Service	S300002	4300	400
						
						
						
						
						
						
						
						
						
						
						
						
						
						
	HOSPITAL WAGE INDEX DATA					
	"2552-10 WORKSHEET S-3, PART II"					
						
DATA TYPE	96 FIELD NAME	10 FIELD NAME	FIELD DESCRIPTION 	WKSHT CD	LINE	COLUMN
						
	PAID HOURS RELATED TO SALARIES					
						
NUMERIC	S3_2_C4_1 	S3_2_C5_1 	Total Salaries	S300002	100	500
NUMERIC	S3_2_C4_2	S3_2_C5_2 	Non-Physician Anesthetist Part A	S300002	200	500
NUMERIC	S3_2_C4_3	S3_2_C5_3	Non-Physician Anesthetist Part B	S300002	300	500
NUMERIC	S3_2_C4_4	S3_2_C5_4	Physician-Part A	S300002	400	500
						
NUMERIC	S3_2_C4_5	S3_2_C5_5 	Physician-Part B	S300002	500	500
NUMERIC	S3_2_C4_501	S3_2_C5_6	Non-Physician Part B	S300002	600	500
NUMERIC	S3_2_C4_6	S3_2_C5_7	Interns & Residents	S300002	700	500
						
NUMERIC	S3_2_C4_7	S3_2_C5_8	Home Office Personnel	S300002	800	500
NUMERIC	S3_2_C4_8	S3_2_C5_9 	SNF	S300002	900	500
NUMERIC	S3_2_C4_801	S3_2_C5_10	Excluded Area Salaries	S300002	1000	500
NUMERIC	S3_2_C4_9	S3_2_C5_11	Contract Labor	S300002	1100	500
						
						
NUMERIC	S3_2_C4_903	S3_2_C5_12	Management and Administrative Services	S300002	1200	500
NUMERIC	S3_2_C4_10	S3_2_C5_13	Contract Labor:  Physician Part A	S300002	1300	500
						
NUMERIC	S3_2_C4_11	S3_2_C5_14 	Home Office Salaries & Wage Related Csts	S300002	1400	500
NUMERIC	S3_2_C4_12	S3_2_C5_15	Home Office:  Physician Part A	S300002	1500	500
NUMERIC	S3_2_C4_1201	S3_2_C5_16	Teaching Physician Salaries	S300002	1600	500
NUMERIC	S3_2_C4_21	S3_2_C5_26 	Employee Benefits	S300002	2600	500
NUMERIC	S3_2_C4_22	S3_2_C5_27 	Administrative and General	S300002	2700	500
NUMERIC	S3_2_C4_2201	S3_2_C5_28 	Administrative and General under Contract	S300002	2800	500
NUMERIC	S3_2_C4_23	S3_2_C5_29	Admin & Gen Under Contract	S300002	2900	500
NUMERIC	S3_2_C4_24	S3_2_C5_30	Operation of Plant	S300002	3000	500
NUMERIC	S3_2_C4_25	S3_2_C5_31	Laundry and Linen Service	S300002	3100	500
NUMERIC	S3_2_C4_26	S3_2_C5_32	Housekeeping	S300002	3200	500
NUMERIC	S3_2_C4_2601	S3_2_C5_33	Housekeeping under Contract	S300002	3300	500
NUMERIC	S3_2_C4_27	S3_2_C5_34	Dietary   	S300002	3400	500
NUMERIC	S3_2_C4_2701	S3_2_C5_35	Dietary under Contract	S300002	3500	500
NUMERIC	S3_2_C4_28	S3_2_C5_36	Cafeteria	S300002	3600	500
NUMERIC	S3_2_C4_29	S3_2_C5_37	Maintenance of Personnel	S300002	3700	500
NUMERIC	S3_2_C4_30	S3_2_C5_38	Nursing Administration	S300002	3800	500
NUMERIC	S3_2_C4_31	S3_2_C5_39	Central Services and Supply	S300002	3900	500
NUMERIC	S3_2_C4_32	S3_2_C5_40	Pharmacy   	S300002	4000	500
NUMERIC	S3_2_C4_33	S3_2_C5_41	Medical Records & Med Records Library	S300002	4100	500
NUMERIC	S3_2_C4_34	S3_2_C5_42	Social Service	S300002	4200	500
NUMERIC	S3_2_C4_35	S3_2_C5_43	Other General Service	S300002	4300	500
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
	HOSPITAL WAGE INDEX DATA					
	"2552-10 WORKSHEET S-3, PART II"					
						
DATA TYPE	96 FIELD NAME	10 FIELD NAME	FIELD DESCRIPTION 	WKSHT CD	LINE	COLUMN
						
	AVERAGE HOURLY WAGE					
						
NUMERIC	S3_2_C5_1 	S3_2_C6_1 	Total Salaries	S300002	100	600
NUMERIC	S3_2_C5_2	S3_2_C6_2 	Non-Physician Anesthetist Part A	S300002	200	600
NUMERIC	S3_2_C5_3	S3_2_C6_3	Non-Physician Anesthetist Part B	S300002	300	600
NUMERIC	S3_2_C5_4	S3_2_C6_4	Physician-Part A	S300002	400	600
						
NUMERIC	S3_2_C5_5	S3_2_C6_5 	Physician-Part B	S300002	500	600
NUMERIC	S3_2_C5_501	S3_2_C6_6	Non-Physician Part B	S300002	600	600
NUMERIC	S3_2_C5_6	S3_2_C6_7	Interns & Residents	S300002	700	600
						
NUMERIC	S3_2_C5_7	S3_2_C6_8	Home Office Personnel	S300002	800	600
NUMERIC	S3_2_C5_8	S3_2_C6_9 	SNF	S300002	900	600
NUMERIC	S3_2_C5_801	S3_2_C6_10	Excluded Area Salaries	S300002	1000	600
NUMERIC	S3_2_C5_9	S3_2_C6_11	Contract Labor	S300002	1100	600
						
						
NUMERIC	S3_2_C5_903	S3_2_C6_12	Management and Administrative Services	S300002	1200	600
NUMERIC	S3_2_C5_10	S3_2_C6_13	Contract Labor:  Physician Part A	S300002	1300	600
						
NUMERIC	S3_2_C5_11	S3_2_C6_14 	Home Office Salaries & Wage Related Csts	S300002	1400	600
NUMERIC	S3_2_C5_12	S3_2_C6_15	Home Office:  Physician Part A	S300002	1500	600
NUMERIC	S3_2_C5_1201	S3_2_C6_16	Teaching Physician Salaries	S300002	1600	600
NUMERIC	S3_2_C5_21	S3_2_C6_26 	Employee Benefits	S300002	2600	600
NUMERIC	S3_2_C5_22	S3_2_C6_27 	Administrative and General	S300002	2700	600
NUMERIC	S3_2_C5_2201	S3_2_C6_28 	Administrative and General under Contract	S300002	2800	600
NUMERIC	S3_2_C5_23	S3_2_C6_29	Admin & Gen Under Contract	S300002	2900	600
NUMERIC	S3_2_C5_24	S3_2_C6_30	Operation of Plant	S300002	3000	600
NUMERIC	S3_2_C5_25	S3_2_C6_31	Laundry and Linen Service	S300002	3100	600
NUMERIC	S3_2_C5_26	S3_2_C6_32	Housekeeping	S300002	3200	600
NUMERIC	S3_2_C5_2601	S3_2_C6_33	Housekeeping under Contract	S300002	3300	600
NUMERIC	S3_2_C5_27	S3_2_C6_34	Dietary	S300002	3400	600
NUMERIC	S3_2_C5_2701	S3_2_C6_35	Dietary under Contract	S300002	3500	600
NUMERIC	S3_2_C5_28	S3_2_C6_36	Cafeteria	S300002	3600	600
NUMERIC	S3_2_C5_29	S3_2_C6_37	Maintenance of Personnel	S300002	3700	600
NUMERIC	S3_2_C5_30	S3_2_C6_38	Nursing Administration	S300002	3800	600
NUMERIC	S3_2_C5_31	S3_2_C6_39	Central Services and Supply	S300002	3900	600
NUMERIC	S3_2_C5_32	S3_2_C6_40	Pharmacy   	S300002	4000	600
NUMERIC	S3_2_C5_33	S3_2_C6_41	Medical Records & Med Records Library	S300002	4100	600
NUMERIC	S3_2_C5_34	S3_2_C6_42	Social Service	S300002	4200	600
NUMERIC	S3_2_C5_35	S3_2_C6_43	Other General Service	S300002	4300	600
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
	HOSPITAL WAGE INDEX DATA					
	"2552-10 WORKSHEET S-3, PART III"					
						
DATA TYPE	96 FIELD NAME	10 FIELD NAME	FIELD DESCRIPTION 	WKSHT CD	LINE	COLUMN
						
	AMOUNT REPORTED					
						
NUMERIC	S3_3_C2_1	S3_3_C2_1	Net Salaries	S300003	100	200
NUMERIC	S3_3_C2_2	S3_3_C2_2	Excluded Area Salaries	S300003	200	200
NUMERIC	S3_3_C2_3	S3_3_C2_3	Subtotal Salaries	S300003	300	200
NUMERIC	S3_3_C2_4	S3_3_C2_4	Subtotal Other Wages and Related Csts	S300003	400	200
NUMERIC	S3_3_C2_5	S3_3_C2_5	Subtotal Wage Related Csts	S300003	500	200
NUMERIC	S3_3_C2_6	S3_3_C2_6	Total	S300003	600	200
NUMERIC	S3_3_C2_13	S3_3_C2_7	Total Overhead Costs	S300003	700	100
						
						
						
						
						
						
						
	ADJUSTED SALARIES					
						
NUMERIC	S3_3_C3_1	S3_3_C4_1	Net Salaries	S300003	100	400
NUMERIC	S3_3_C3_2	S3_3_C4_2	Excluded Area Salaries	S300003	200	400
NUMERIC	S3_3_C3_3	S3_3_C4_3	Subtotal Salaries	S300003	300	400
NUMERIC	S3_3_C3_4	S3_3_C4_4	Subtotal Other Wages and Related Csts	S300003	400	400
NUMERIC	S3_3_C3_5	S3_3_C4_5	Subtotal Wage Related Csts	S300003	500	400
NUMERIC	S3_3_C3_6	S3_3_C4_6	Total	S300003	600	400
NUMERIC	S3_3_C3_13	S3_3_C4_7	Total Overhead Costs	S300003	700	400
						
						
						
						
						
						
						
	PAID HOURS RELATED TO SALARIES					
						
NUMERIC	S3_3_C4_1	S3_3_C5_1	Net Salaries	S300003	100	500
NUMERIC	S3_3_C4_2	S3_3_C5_2	Excluded Area Salaries	S300003	200	500
NUMERIC	S3_3_C4_3	S3_3_C5_3	Subtotal Salaries	S300003	300	500
NUMERIC	S3_3_C4_4	S3_3_C5_4	Subtotal Other Wages and Related Csts	S300003	400	500
NUMERIC	S3_3_C4_5	S3_3_C5_5	Subtotal Wage Related Csts	S300003	500	500
NUMERIC	S3_3_C4_6	S3_3_C5_6	Total	S300003	600	500
NUMERIC	S3_3_C4_13	S3_3_C5_7	Total Overhead Costs	S300003	700	500
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
	HOSPITAL WAGE INDEX DATA					
	"2552-10 WORKSHEET S-3, PART III"					
						
DATA TYPE	96 FIELD NAME	10 FIELD NAME	FIELD DESCRIPTION 	WKSHT CD	LINE	COLUMN
						
	AVERAGE HOURLY WAGE					
						
NUMERIC	S3_3_C5_1	S3_3_C6_1	Net Salaries	S300003	100	600
NUMERIC	S3_3_C5_2	S3_3_C6_2	Excluded Area Salaries	S300003	200	600
NUMERIC	S3_3_C5_3	S3_3_C6_3	Subtotal Salaries	S300003	300	600
NUMERIC	S3_3_C5_4	S3_3_C6_4	Subtotal Other Wages and Related Csts	S300003	400	600
NUMERIC	S3_3_C5_5	S3_3_C6_5	Subtotal Wage Related Csts	S300003	500	600
NUMERIC	S3_3_C5_6	S3_3_C6_6	Total	S300003	600	600
NUMERIC	S3_3_C5_13	S3_3_C6_7	Total Overhead Costs	S300003	700	600
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
	HOSPITAL CONTRACT LABOR AND BENEFIT COST					
	"2552-10 WORKSHEET S-3, PART V"					
						
DATA TYPE	96 FIELD NAME	10 FIELD NAME	FIELD DESCRIPTION 	WKSHT CD	LINE	COLUMN
						
NUMERIC		S3_5_C1_1		S300005	100	100
NUMERIC		S3_5_C1_2		S300005	200	100
NUMERIC		S3_5_C1_3		S300005	300	100
NUMERIC		S3_5_C1_4		S300005	400	100
NUMERIC		S3_5_C1_5		S300005	500	100
NUMERIC		S3_5_C1_6		S300005	600	100
NUMERIC		S3_5_C1_7		S300005	700	100
NUMERIC		S3_5_C1_8		S300005	800	100
NUMERIC		S3_5_C1_9		S300005	900	100
NUMERIC		S3_5_C1_10		S300005	1000	100
NUMERIC		S3_5_C1_11		S300005	1100	100
NUMERIC		S3_5_C1_12		S300005	1200	100
NUMERIC		S3_5_C1_13		S300005	1300	100
NUMERIC		S3_5_C1_14		S300005	1400	100
NUMERIC		S3_5_C1_15		S300005	1500	100
NUMERIC		S3_5_C1_16		S300005	1600	100
NUMERIC		S3_5_C1_17		S300005	1700	100
NUMERIC		S3_5_C1_18		S300005	1800	100
						
NUMERIC		S3_5_C2_1		S300005	100	200
NUMERIC		S3_5_C2_2		S300005	200	200
NUMERIC		S3_5_C2_3		S300005	300	200
NUMERIC		S3_5_C2_4		S300005	400	200
NUMERIC		S3_5_C2_5		S300005	500	200
NUMERIC		S3_5_C2_6		S300005	600	200
NUMERIC		S3_5_C2_7		S300005	700	200
NUMERIC		S3_5_C2_8		S300005	800	200
NUMERIC		S3_5_C2_9		S300005	900	200
NUMERIC		S3_5_C2_10		S300005	1000	200
NUMERIC		S3_5_C2_11		S300005	1100	200
NUMERIC		S3_5_C2_12		S300005	1200	200
NUMERIC		S3_5_C2_13		S300005	1300	200
NUMERIC		S3_5_C2_14		S300005	1400	200
NUMERIC		S3_5_C2_15		S300005	1500	200
NUMERIC		S3_5_C2_16		S300005	1600	200
NUMERIC		S3_5_C2_17		S300005	1700	200
NUMERIC		S3_5_C2_18		S300005	1800	200
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
	HHA STATISTICAL DATA					
	2552-10 WORKSHEET S-4					
						
DATA TYPE	96 FIELD NAME	10 FIELD NAME	FIELD DESCRIPTION 	WKSHT CD	LINE	COLUMN
						
	HHA I					
						
NUMERIC	S4_HHA1_C1_33	S4_HHA1_C1_33	Without Outliers:  Total Visits	S410000	3300	100
NUMERIC	S4_HHA1_C1_34	S4_HHA1_C1_34	Without Outliers:  Other Charges	S410000	3400	100
NUMERIC	S4_HHA1_C1_35	S4_HHA1_C1_35	Without Outliers:  Total Charges	S410000	3500	100
NUMERIC	S4_HHA1_C1_36	S4_HHA1_C1_36	W/Out Outliers:  Number of Episodes	S410000	3600	100
NUMERIC	S4_HHA1_C1_38	S4_HHA1_C1_38	Without Outliers:  Non Routine Med Sup Chgs	S410000	3800	100
NUMERIC	S4_HHA1_C2_33	S4_HHA1_C2_33	With Outliers:  Total Visits	S410000	3300	200
NUMERIC	S4_HHA1_C2_34	S4_HHA1_C2_34	With Outliers:  Other Charges  	S410000	3400	200
NUMERIC	S4_HHA1_C2_35	S4_HHA1_C2_35	With Outliers:  Total Charges	S410000	3500	200
NUMERIC	S4_HHA1_C2_37	S4_HHA1_C2_37	With Outliers:  Number of Episodes	S410000	3700	200
NUMERIC	S4_HHA1_C2_38	S4_HHA1_C2_38	With Outliers:  Non Routine Med Sup Chgs	S410000	3800	200
NUMERIC	S4_HHA1_C3_33	S4_HHA1_C3_33	LUPA Episodes:  Total Visits	S410000	3300	300
NUMERIC	S4_HHA1_C3_34	S4_HHA1_C3_34	LUPA Episodes:  Other Charges	S410000	3400	300
NUMERIC	S4_HHA1_C3_35	S4_HHA1_C3_35	Total Charges:  LUPA Episodes	S410000	3500	300
NUMERIC	S4_HHA1_C3_36	S4_HHA1_C3_36	LUPA Episodes:  Total Number of Episodes	S410000	3600	300
NUMERIC	S4_HHA1_C3_38	S4_HHA1_C3_38	LUPA:  Total Non Routine Med Sup Chgs	S410000	3800	300
NUMERIC	S4_HHA1_C4_33	S4_HHA1_C4_33	PEP Episodes:  Total Visits	S410000	3300	400
NUMERIC	S4_HHA1_C4_34	S4_HHA1_C4_34	PEP Episodes:  Other Charges 	S410000	3400	400
NUMERIC	S4_HHA1_C4_35	S4_HHA1_C4_35	PEP Episodes:  Total Charges:	S410000	3500	400
NUMERIC	S4_HHA1_C4_36	S4_HHA1_C4_36	PEP Episodes:  Total Number of Episodes  	S410000	3600	400
NUMERIC	S4_HHA1_C4_37	S4_HHA1_C4_37	PEP:  Total Number of Outlier Episodes	S410000	3700	400
NUMERIC	S4_HHA1_C4_38	S4_HHA1_C4_38	PEP:  Total Non Routine Med Supply Chgs	S410000	3800	400
NUMERIC	S4_HHA1_C7_33	S4_HHA1_C5_33	Total Visits	S410000	3300	500
NUMERIC	S4_HHA1_C7_34	S4_HHA1_C5_34	Total Other Charges	S410000	3400	500
NUMERIC	S4_HHA1_C7_35	S4_HHA1_C5_35	Total Charges 	S410000	3500	500
NUMERIC	S4_HHA1_C7_36	S4_HHA1_C5_36	Total Number of Episodes	S410000	3600	500
NUMERIC	S4_HHA1_C7_37	S4_HHA1_C5_37	Total Number of Outlier Episodes	S410000	3700	500
NUMERIC	S4_HHA1_C7_38	S4_HHA1_C5_38	Total Non Routine Medical  Supply Charges	S410000	3800	500
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
	HHA STATISTICAL DATA					
	2552-10 WORKSHEET S-4					
						
DATA TYPE	96 FIELD NAME	10 FIELD NAME	FIELD DESCRIPTION 	WKSHT CD	LINE	COLUMN
						
	HHA II					
						
NUMERIC	S4_HHA2_C1_33	S4_HHA2_C1_33	Without Outliers:  Total Visits	S420000	3300	100
NUMERIC	S4_HHA2_C1_34	S4_HHA2_C1_34	Without Outliers:  Other Charges	S420000	3400	100
NUMERIC	S4_HHA2_C1_35	S4_HHA2_C1_35	Without Outliers:  Total Charges	S420000	3500	100
NUMERIC	S4_HHA2_C1_36	S4_HHA2_C1_36	W/Out Outliers:  Number of Episodes	S420000	3600	100
NUMERIC	S4_HHA2_C1_38	S4_HHA2_C1_38	Without Outliers:  Non Routine Med Sup Chgs	S420000	3800	100
NUMERIC	S4_HHA2_C2_33	S4_HHA2_C2_33	With Outliers:  Total Visits	S420000	3300	200
NUMERIC	S4_HHA2_C2_34	S4_HHA2_C2_34	With Outliers:  Other Charges  	S420000	3400	200
NUMERIC	S4_HHA2_C2_35	S4_HHA2_C2_35	With Outliers:  Total Charges	S420000	3500	200
NUMERIC	S4_HHA2_C2_37	S4_HHA2_C2_37	With Outliers:  Number of Episodes	S420000	3700	200
NUMERIC	S4_HHA2_C2_38	S4_HHA2_C2_38	With Outliers:  Non Routine Med Sup Chgs	S420000	3800	200
NUMERIC	S4_HHA2_C3_33	S4_HHA2_C3_33	LUPA Episodes:  Total Visits	S420000	3300	300
NUMERIC	S4_HHA2_C3_34	S4_HHA2_C3_34	LUPA Episodes:  Other Charges	S420000	3400	300
NUMERIC	S4_HHA2_C3_35	S4_HHA2_C3_35	Total Charges:  LUPA Episodes	S420000	3500	300
NUMERIC	S4_HHA2_C3_36	S4_HHA2_C3_36	LUPA Episodes:  Total Number of Episodes	S420000	3600	300
NUMERIC	S4_HHA2_C3_38	S4_HHA2_C3_38	LUPA:  Total Non Routine Med Sup Chgs	S420000	3800	300
NUMERIC	S4_HHA2_C4_33	S4_HHA2_C4_33	PEP Episodes:  Total Visits	S420000	3300	400
NUMERIC	S4_HHA2_C4_34	S4_HHA2_C4_34	PEP Episodes:  Other Charges 	S420000	3400	400
NUMERIC	S4_HHA2_C4_35	S4_HHA2_C4_35	PEP Episodes:  Total Charges:	S420000	3500	400
NUMERIC	S4_HHA2_C4_36	S4_HHA2_C4_36	PEP Episodes:  Total Number of Episodes  	S420000	3600	400
NUMERIC	S4_HHA2_C4_37	S4_HHA2_C4_37	PEP:  Total Number of Outlier Episodes	S420000	3700	400
NUMERIC	S4_HHA2_C4_38	S4_HHA2_C4_38	PEP:  Total Non Routine Med Supply Chgs	S420000	3800	400
NUMERIC	S4_HHA2_C7_33	S4_HHA2_C5_33	Total Visits	S420000	3300	500
NUMERIC	S4_HHA2_C7_34	S4_HHA2_C5_34	Total Other Charges	S420000	3400	500
NUMERIC	S4_HHA2_C7_35	S4_HHA2_C5_35	Total Charges 	S420000	3500	500
NUMERIC	S4_HHA2_C7_36	S4_HHA2_C5_36	Total Number of Episodes	S420000	3600	500
NUMERIC	S4_HHA2_C7_37	S4_HHA2_C5_37	Total Number of Outlier Episodes	S420000	3700	500
NUMERIC	S4_HHA2_C7_38	S4_HHA2_C5_38	Total Non Routine Medical  Supply Charges	S420000	3800	500
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
	HHA STATISTICAL DATA					
	2552-10 WORKSHEET S-4					
						
DATA TYPE	96 FIELD NAME	10 FIELD NAME	FIELD DESCRIPTION 	WKSHT CD	LINE	COLUMN
						
	HHA III					
						
NUMERIC	S4_HHA3_C1_33	S4_HHA3_C1_33	Without Outliers:  Total Visits	S430000	3300	100
NUMERIC	S4_HHA3_C1_34	S4_HHA3_C1_34	Without Outliers:  Other Charges	S430000	3400	100
NUMERIC	S4_HHA3_C1_35	S4_HHA3_C1_35	Without Outliers:  Total Charges	S430000	3500	100
NUMERIC	S4_HHA3_C1_36	S4_HHA3_C1_36	W/Out Outliers:  Number of Episodes	S430000	3600	100
NUMERIC	S4_HHA3_C1_38	S4_HHA3_C1_38	Without Outliers:  Non Routine Med Sup Chgs	S430000	3800	100
NUMERIC	S4_HHA3_C2_33	S4_HHA3_C2_33	With Outliers:  Total Visits	S430000	3300	200
NUMERIC	S4_HHA3_C2_34	S4_HHA3_C2_34	With Outliers:  Other Charges  	S430000	3400	200
NUMERIC	S4_HHA3_C2_35	S4_HHA3_C2_35	With Outliers:  Total Charges	S430000	3500	200
NUMERIC	S4_HHA3_C2_37	S4_HHA3_C2_37	With Outliers:  Number of Episodes	S430000	3700	200
NUMERIC	S4_HHA3_C2_38	S4_HHA3_C2_38	With Outliers:  Non Routine Med Sup Chgs	S430000	3800	200
NUMERIC	S4_HHA3_C3_33	S4_HHA3_C3_33	LUPA Episodes:  Total Visits	S430000	3300	300
NUMERIC	S4_HHA3_C3_34	S4_HHA3_C3_34	LUPA Episodes:  Other Charges	S430000	3400	300
NUMERIC	S4_HHA3_C3_35	S4_HHA3_C3_35	Total Charges:  LUPA Episodes	S430000	3500	300
NUMERIC	S4_HHA3_C3_36	S4_HHA3_C3_36	LUPA Episodes:  Total Number of Episodes	S430000	3600	300
NUMERIC	S4_HHA3_C3_38	S4_HHA3_C3_38	LUPA:  Total Non Routine Med Sup Chgs	S430000	3800	300
NUMERIC	S4_HHA3_C4_33	S4_HHA3_C4_33	PEP Episodes:  Total Visits	S430000	3300	400
NUMERIC	S4_HHA3_C4_34	S4_HHA3_C4_34	PEP Episodes:  Other Charges 	S430000	3400	400
NUMERIC	S4_HHA3_C4_35	S4_HHA3_C4_35	PEP Episodes:  Total Charges:	S430000	3500	400
NUMERIC	S4_HHA3_C4_36	S4_HHA3_C4_36	PEP Episodes:  Total Number of Episodes  	S430000	3600	400
NUMERIC	S4_HHA3_C4_37	S4_HHA3_C4_37	PEP:  Total Number of Outlier Episodes	S430000	3700	400
NUMERIC	S4_HHA3_C4_38	S4_HHA3_C4_38	PEP:  Total Non Routine Med Supply Chgs	S430000	3800	400
NUMERIC	S4_HHA3_C7_33	S4_HHA3_C5_33	Total Visits	S430000	3300	500
NUMERIC	S4_HHA3_C7_34	S4_HHA3_C5_34	Total Other Charges	S430000	3400	500
NUMERIC	S4_HHA3_C7_35	S4_HHA3_C5_35	Total Charges 	S430000	3500	500
NUMERIC	S4_HHA3_C7_36	S4_HHA3_C5_36	Total Number of Episodes	S430000	3600	500
NUMERIC	S4_HHA3_C7_37	S4_HHA3_C5_37	Total Number of Outlier Episodes	S430000	3700	500
NUMERIC	S4_HHA3_C7_38	S4_HHA3_C5_38	Total Non Routine Medical  Supply Charges	S430000	3800	500
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
	HHA STATISTICAL DATA					
	2552-10 WORKSHEET S-4					
						
DATA TYPE	96 FIELD NAME	10 FIELD NAME	FIELD DESCRIPTION 	WKSHT CD	LINE	COLUMN
						
	HHA IV					
						
NUMERIC	S4_HHA4_C1_33	S4_HHA4_C1_33	Without Outliers:  Total Visits	S440000	3300	100
NUMERIC	S4_HHA4_C1_34	S4_HHA4_C1_34	Without Outliers:  Other Charges	S440000	3400	100
NUMERIC	S4_HHA4_C1_35	S4_HHA4_C1_35	Without Outliers:  Total Charges	S440000	3500	100
NUMERIC	S4_HHA4_C1_36	S4_HHA4_C1_36	W/Out Outliers:  Number of Episodes	S440000	3600	100
NUMERIC	S4_HHA4_C1_38	S4_HHA4_C1_38	Without Outliers:  Non Routine Med Sup Chgs	S440000	3800	100
NUMERIC	S4_HHA4_C2_33	S4_HHA4_C2_33	With Outliers:  Total Visits	S440000	3300	200
NUMERIC	S4_HHA4_C2_34	S4_HHA4_C2_34	With Outliers:  Other Charges  	S440000	3400	200
NUMERIC	S4_HHA4_C2_35	S4_HHA4_C2_35	With Outliers:  Total Charges	S440000	3500	200
NUMERIC	S4_HHA4_C2_37	S4_HHA4_C2_37	With Outliers:  Number of Episodes	S440000	3700	200
NUMERIC	S4_HHA4_C2_38	S4_HHA4_C2_38	With Outliers:  Non Routine Med Sup Chgs	S440000	3800	200
NUMERIC	S4_HHA4_C3_33	S4_HHA4_C3_33	LUPA Episodes:  Total Visits	S440000	3300	300
NUMERIC	S4_HHA4_C3_34	S4_HHA4_C3_34	LUPA Episodes:  Other Charges	S440000	3400	300
NUMERIC	S4_HHA4_C3_35	S4_HHA4_C3_35	Total Charges:  LUPA Episodes	S440000	3500	300
NUMERIC	S4_HHA4_C3_36	S4_HHA4_C3_36	LUPA Episodes:  Total Number of Episodes	S440000	3600	300
NUMERIC	S4_HHA4_C3_38	S4_HHA4_C3_38	LUPA:  Total Non Routine Med Sup Chgs	S440000	3800	300
NUMERIC	S4_HHA4_C4_33	S4_HHA4_C4_33	PEP Episodes:  Total Visits	S440000	3300	400
NUMERIC	S4_HHA4_C4_34	S4_HHA4_C4_34	PEP Episodes:  Other Charges 	S440000	3400	400
NUMERIC	S4_HHA4_C4_35	S4_HHA4_C4_35	PEP Episodes:  Total Charges:	S440000	3500	400
NUMERIC	S4_HHA4_C4_36	S4_HHA4_C4_36	PEP Episodes:  Total Number of Episodes  	S440000	3600	400
NUMERIC	S4_HHA4_C4_37	S4_HHA4_C4_37	PEP:  Total Number of Outlier Episodes	S440000	3700	400
NUMERIC	S4_HHA4_C4_38	S4_HHA4_C4_38	PEP:  Total Non Routine Med Supply Chgs	S440000	3800	400
NUMERIC	S4_HHA4_C7_33	S4_HHA4_C5_33	Total Visits	S440000	3300	500
NUMERIC	S4_HHA4_C7_34	S4_HHA4_C5_34	Total Other Charges	S440000	3400	500
NUMERIC	S4_HHA4_C7_35	S4_HHA4_C5_35	Total Charges 	S440000	3500	500
NUMERIC	S4_HHA4_C7_36	S4_HHA4_C5_36	Total Number of Episodes	S440000	3600	500
NUMERIC	S4_HHA4_C7_37	S4_HHA4_C5_37	Total Number of Outlier Episodes	S440000	3700	500
NUMERIC	S4_HHA4_C7_38	S4_HHA4_C5_38	Total Non Routine Medical  Supply Charges	S440000	3800	500
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
	HHA STATISTICAL DATA					
	2552-10 WORKSHEET S-4					
						
DATA TYPE	96 FIELD NAME	10 FIELD NAME	FIELD DESCRIPTION 	WKSHT CD	LINE	COLUMN
						
	HHA V					
						
NUMERIC	S4_HHA5_C1_33	S4_HHA5_C1_33	Without Outliers:  Total Visits	S450000	3300	100
NUMERIC	S4_HHA5_C1_34	S4_HHA5_C1_34	Without Outliers:  Other Charges	S450000	3400	100
NUMERIC	S4_HHA5_C1_35	S4_HHA5_C1_35	Without Outliers:  Total Charges	S450000	3500	100
NUMERIC	S4_HHA5_C1_36	S4_HHA5_C1_36	W/Out Outliers:  Number of Episodes	S450000	3600	100
NUMERIC	S4_HHA5_C1_38	S4_HHA5_C1_38	Without Outliers:  Non Routine Med Sup Chgs	S450000	3800	100
NUMERIC	S4_HHA5_C2_33	S4_HHA5_C2_33	With Outliers:  Total Visits	S450000	3300	200
NUMERIC	S4_HHA5_C2_34	S4_HHA5_C2_34	With Outliers:  Other Charges  	S450000	3400	200
NUMERIC	S4_HHA5_C2_35	S4_HHA5_C2_35	With Outliers:  Total Charges	S450000	3500	200
NUMERIC	S4_HHA5_C2_37	S4_HHA5_C2_37	With Outliers:  Number of Episodes	S450000	3700	200
NUMERIC	S4_HHA5_C2_38	S4_HHA5_C2_38	With Outliers:  Non Routine Med Sup Chgs	S450000	3800	200
NUMERIC	S4_HHA5_C3_33	S4_HHA5_C3_33	LUPA Episodes:  Total Visits	S450000	3300	300
NUMERIC	S4_HHA5_C3_34	S4_HHA5_C3_34	LUPA Episodes:  Other Charges	S450000	3400	300
NUMERIC	S4_HHA5_C3_35	S4_HHA5_C3_35	Total Charges:  LUPA Episodes	S450000	3500	300
NUMERIC	S4_HHA5_C3_36	S4_HHA5_C3_36	LUPA Episodes:  Total Number of Episodes	S450000	3600	300
NUMERIC	S4_HHA5_C3_38	S4_HHA5_C3_38	LUPA:  Total Non Routine Med Sup Chgs	S450000	3800	300
NUMERIC	S4_HHA5_C4_33	S4_HHA5_C4_33	PEP Episodes:  Total Visits	S450000	3300	400
NUMERIC	S4_HHA5_C4_34	S4_HHA5_C4_34	PEP Episodes:  Other Charges 	S450000	3400	400
NUMERIC	S4_HHA5_C4_35	S4_HHA5_C4_35	PEP Episodes:  Total Charges:	S450000	3500	400
NUMERIC	S4_HHA5_C4_36	S4_HHA5_C4_36	PEP Episodes:  Total Number of Episodes  	S450000	3600	400
NUMERIC	S4_HHA5_C4_37	S4_HHA5_C4_37	PEP:  Total Number of Outlier Episodes	S450000	3700	400
NUMERIC	S4_HHA5_C4_38	S4_HHA5_C4_38	PEP:  Total Non Routine Med Supply Chgs	S450000	3800	400
NUMERIC	S4_HHA5_C7_33	S4_HHA5_C5_33	Total Visits	S450000	3300	500
NUMERIC	S4_HHA5_C7_34	S4_HHA5_C5_34	Total Other Charges	S450000	3400	500
NUMERIC	S4_HHA5_C7_35	S4_HHA5_C5_35	Total Charges 	S450000	3500	500
NUMERIC	S4_HHA5_C7_36	S4_HHA5_C5_36	Total Number of Episodes	S450000	3600	500
NUMERIC	S4_HHA5_C7_37	S4_HHA5_C5_37	Total Number of Outlier Episodes	S450000	3700	500
NUMERIC	S4_HHA5_C7_38	S4_HHA5_C5_38	Total Non Routine Medical  Supply Charges	S450000	3800	500
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
	HHA STATISTICAL DATA					
	2552-10 WORKSHEET S-4					
						
DATA TYPE	96 FIELD NAME	10 FIELD NAME	FIELD DESCRIPTION 	WKSHT CD	LINE	COLUMN
	HHA VI					
						
NUMERIC	S4_HHA6_C1_33	S4_HHA6_C1_33	Without Outliers:  Total Visits	S460000	3300	100
NUMERIC	S4_HHA6_C1_34	S4_HHA6_C1_34	Without Outliers:  Other Charges	S460000	3400	100
NUMERIC	S4_HHA6_C1_35	S4_HHA6_C1_35	Without Outliers:  Total Charges	S460000	3500	100
NUMERIC	S4_HHA6_C1_36	S4_HHA6_C1_36	W/Out Outliers:  Number of Episodes	S460000	3600	100
NUMERIC	S4_HHA6_C1_38	S4_HHA6_C1_38	Without Outliers:  Non Routine Med Sup Chgs	S460000	3800	100
NUMERIC	S4_HHA6_C2_33	S4_HHA6_C2_33	With Outliers:  Total Visits	S460000	3300	200
NUMERIC	S4_HHA6_C2_34	S4_HHA6_C2_34	With Outliers:  Other Charges  	S460000	3400	200
NUMERIC	S4_HHA6_C2_35	S4_HHA6_C2_35	With Outliers:  Total Charges	S460000	3500	200
NUMERIC	S4_HHA6_C2_37	S4_HHA6_C2_37	With Outliers:  Number of Episodes	S460000	3700	200
NUMERIC	S4_HHA6_C2_38	S4_HHA6_C2_38	With Outliers:  Non Routine Med Sup Chgs	S460000	3800	200
NUMERIC	S4_HHA6_C3_33	S4_HHA6_C3_33	LUPA Episodes:  Total Visits	S460000	3300	300
NUMERIC	S4_HHA6_C3_34	S4_HHA6_C3_34	LUPA Episodes:  Other Charges	S460000	3400	300
NUMERIC	S4_HHA6_C3_35	S4_HHA6_C3_35	Total Charges:  LUPA Episodes	S460000	3500	300
NUMERIC	S4_HHA6_C3_36	S4_HHA6_C3_36	LUPA Episodes:  Total Number of Episodes	S460000	3600	300
NUMERIC	S4_HHA6_C3_38	S4_HHA6_C3_38	LUPA:  Total Non Routine Med Sup Chgs	S460000	3800	300
NUMERIC	S4_HHA6_C4_33	S4_HHA6_C4_33	PEP Episodes:  Total Visits	S460000	3300	400
NUMERIC	S4_HHA6_C4_34	S4_HHA6_C4_34	PEP Episodes:  Other Charges 	S460000	3400	400
NUMERIC	S4_HHA6_C4_35	S4_HHA6_C4_35	PEP Episodes:  Total Charges:	S460000	3500	400
NUMERIC	S4_HHA6_C4_36	S4_HHA6_C4_36	PEP Episodes:  Total Number of Episodes  	S460000	3600	400
NUMERIC	S4_HHA6_C4_37	S4_HHA6_C4_37	PEP:  Total Number of Outlier Episodes	S460000	3700	400
NUMERIC	S4_HHA6_C4_38	S4_HHA6_C4_38	PEP:  Total Non Routine Med Supply Chgs	S460000	3800	400
NUMERIC	S4_HHA6_C7_33	S4_HHA6_C5_33	Total Visits	S460000	3300	500
NUMERIC	S4_HHA6_C7_34	S4_HHA6_C5_34	Total Other Charges	S460000	3400	500
NUMERIC	S4_HHA6_C7_35	S4_HHA6_C5_35	Total Charges 	S460000	3500	500
NUMERIC	S4_HHA6_C7_36	S4_HHA6_C5_36	Total Number of Episodes	S460000	3600	500
NUMERIC	S4_HHA6_C7_37	S4_HHA6_C5_37	Total Number of Outlier Episodes	S460000	3700	500
NUMERIC	S4_HHA6_C7_38	S4_HHA6_C5_38	Total Non Routine Medical  Supply Charges	S460000	3800	500
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
	HHA STATISTICAL DATA					
	2552-10 WORKSHEET S-4					
						
DATA TYPE	96 FIELD NAME	10 FIELD NAME	FIELD DESCRIPTION 	WKSHT CD	LINE	COLUMN
						
	HHA VII					
						
NUMERIC	S4_HHA7_C1_33	S4_HHA7_C1_33	Without Outliers:  Total Visits	S470000	3300	100
NUMERIC	S4_HHA7_C1_34	S4_HHA7_C1_34	Without Outliers:  Other Charges	S470000	3400	100
NUMERIC	S4_HHA7_C1_35	S4_HHA7_C1_35	Without Outliers:  Total Charges	S470000	3500	100
NUMERIC	S4_HHA7_C1_36	S4_HHA7_C1_36	W/Out Outliers:  Number of Episodes	S470000	3600	100
NUMERIC	S4_HHA7_C1_38	S4_HHA7_C1_38	Without Outliers:  Non Routine Med Sup Chgs	S470000	3800	100
NUMERIC	S4_HHA7_C2_33	S4_HHA7_C2_33	With Outliers:  Total Visits	S470000	3300	200
NUMERIC	S4_HHA7_C2_34	S4_HHA7_C2_34	With Outliers:  Other Charges  	S470000	3400	200
NUMERIC	S4_HHA7_C2_35	S4_HHA7_C2_35	With Outliers:  Total Charges	S470000	3500	200
NUMERIC	S4_HHA7_C2_37	S4_HHA7_C2_37	With Outliers:  Number of Episodes	S470000	3700	200
NUMERIC	S4_HHA7_C2_38	S4_HHA7_C2_38	With Outliers:  Non Routine Med Sup Chgs	S470000	3800	200
NUMERIC	S4_HHA7_C3_33	S4_HHA7_C3_33	LUPA Episodes:  Total Visits	S470000	3300	300
NUMERIC	S4_HHA7_C3_34	S4_HHA7_C3_34	LUPA Episodes:  Other Charges	S470000	3400	300
NUMERIC	S4_HHA7_C3_35	S4_HHA7_C3_35	Total Charges:  LUPA Episodes	S470000	3500	300
NUMERIC	S4_HHA7_C3_36	S4_HHA7_C3_36	LUPA Episodes:  Total Number of Episodes	S470000	3600	300
NUMERIC	S4_HHA7_C3_38	S4_HHA7_C3_38	LUPA:  Total Non Routine Med Sup Chgs	S470000	3800	300
NUMERIC	S4_HHA7_C4_33	S4_HHA7_C4_33	PEP Episodes:  Total Visits	S470000	3300	400
NUMERIC	S4_HHA7_C4_34	S4_HHA7_C4_34	PEP Episodes:  Other Charges 	S470000	3400	400
NUMERIC	S4_HHA7_C4_35	S4_HHA7_C4_35	PEP Episodes:  Total Charges:	S470000	3500	400
NUMERIC	S4_HHA7_C4_36	S4_HHA7_C4_36	PEP Episodes:  Total Number of Episodes  	S470000	3600	400
NUMERIC	S4_HHA7_C4_37	S4_HHA7_C4_37	PEP:  Total Number of Outlier Episodes	S470000	3700	400
NUMERIC	S4_HHA7_C4_38	S4_HHA7_C4_38	PEP:  Total Non Routine Med Supply Chgs	S470000	3800	400
NUMERIC	S4_HHA7_C7_33	S4_HHA7_C5_33	Total Visits	S470000	3300	500
NUMERIC	S4_HHA7_C7_34	S4_HHA7_C5_34	Total Other Charges	S470000	3400	500
NUMERIC	S4_HHA7_C7_35	S4_HHA7_C5_35	Total Charges 	S470000	3500	500
NUMERIC	S4_HHA7_C7_36	S4_HHA7_C5_36	Total Number of Episodes	S470000	3600	500
NUMERIC	S4_HHA7_C7_37	S4_HHA7_C5_37	Total Number of Outlier Episodes	S470000	3700	500
NUMERIC	S4_HHA7_C7_38	S4_HHA7_C5_38	Total Non Routine Medical  Supply Charges	S470000	3800	500
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
	HHA STATISTICAL DATA					
	2552-10 WORKSHEET S-4					
						
DATA TYPE	96 FIELD NAME	10 FIELD NAME	FIELD DESCRIPTION 	WKSHT CD	LINE	COLUMN
						
	HHA VIII					
						
NUMERIC	S4_HHA8_C1_33	S4_HHA8_C1_33	Without Outliers:  Total Visits	S480000	3300	100
NUMERIC	S4_HHA8_C1_34	S4_HHA8_C1_34	Without Outliers:  Other Charges	S480000	3400	100
NUMERIC	S4_HHA8_C1_35	S4_HHA8_C1_35	Without Outliers:  Total Charges	S480000	3500	100
NUMERIC	S4_HHA8_C1_36	S4_HHA8_C1_36	W/Out Outliers:  Number of Episodes	S480000	3600	100
NUMERIC	S4_HHA8_C1_38	S4_HHA8_C1_38	Without Outliers:  Non Routine Med Sup Chgs	S480000	3800	100
NUMERIC	S4_HHA8_C2_33	S4_HHA8_C2_33	With Outliers:  Total Visits	S480000	3300	200
NUMERIC	S4_HHA8_C2_34	S4_HHA8_C2_34	With Outliers:  Other Charges  	S480000	3400	200
NUMERIC	S4_HHA8_C2_35	S4_HHA8_C2_35	With Outliers:  Total Charges	S480000	3500	200
NUMERIC	S4_HHA8_C2_37	S4_HHA8_C2_37	With Outliers:  Number of Episodes	S480000	3700	200
NUMERIC	S4_HHA8_C2_38	S4_HHA8_C2_38	With Outliers:  Non Routine Med Sup Chgs	S480000	3800	200
NUMERIC	S4_HHA8_C3_33	S4_HHA8_C3_33	LUPA Episodes:  Total Visits	S480000	3300	300
NUMERIC	S4_HHA8_C3_34	S4_HHA8_C3_34	LUPA Episodes:  Other Charges	S480000	3400	300
NUMERIC	S4_HHA8_C3_35	S4_HHA8_C3_35	Total Charges:  LUPA Episodes	S480000	3500	300
NUMERIC	S4_HHA8_C3_36	S4_HHA8_C3_36	LUPA Episodes:  Total Number of Episodes	S480000	3600	300
NUMERIC	S4_HHA8_C3_38	S4_HHA8_C3_38	LUPA:  Total Non Routine Med Sup Chgs	S480000	3800	300
NUMERIC	S4_HHA8_C4_33	S4_HHA8_C4_33	PEP Episodes:  Total Visits	S480000	3300	400
NUMERIC	S4_HHA8_C4_34	S4_HHA8_C4_34	PEP Episodes:  Other Charges 	S480000	3400	400
NUMERIC	S4_HHA8_C4_35	S4_HHA8_C4_35	PEP Episodes:  Total Charges:	S480000	3500	400
NUMERIC	S4_HHA8_C4_36	S4_HHA8_C4_36	PEP Episodes:  Total Number of Episodes  	S480000	3600	400
NUMERIC	S4_HHA8_C4_37	S4_HHA8_C4_37	PEP:  Total Number of Outlier Episodes	S480000	3700	400
NUMERIC	S4_HHA8_C4_38	S4_HHA8_C4_38	PEP:  Total Non Routine Med Supply Chgs	S480000	3800	400
NUMERIC	S4_HHA8_C7_33	S4_HHA8_C5_33	Total Visits	S480000	3300	500
NUMERIC	S4_HHA8_C7_34	S4_HHA8_C5_34	Total Other Charges	S480000	3400	500
NUMERIC	S4_HHA8_C7_35	S4_HHA8_C5_35	Total Charges 	S480000	3500	500
NUMERIC	S4_HHA8_C7_36	S4_HHA8_C5_36	Total Number of Episodes	S480000	3600	500
NUMERIC	S4_HHA8_C7_37	S4_HHA8_C5_37	Total Number of Outlier Episodes	S480000	3700	500
NUMERIC	S4_HHA8_C7_38	S4_HHA8_C5_38	Total Non Routine Medical  Supply Charges	S480000	3800	500
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
	HHA STATISTICAL DATA					
	2552-10 WORKSHEET S-4					
						
DATA TYPE	96 FIELD NAME	10 FIELD NAME	FIELD DESCRIPTION 	WKSHT CD	LINE	COLUMN
						
	HHA IX					
						
NUMERIC	S4_HHA9_C1_33	S4_HHA9_C1_33	Without Outliers:  Total Visits	S490000	3300	100
NUMERIC	S4_HHA9_C1_34	S4_HHA9_C1_34	Without Outliers:  Other Charges	S490000	3400	100
NUMERIC	S4_HHA9_C1_35	S4_HHA9_C1_35	Without Outliers:  Total Charges	S490000	3500	100
NUMERIC	S4_HHA9_C1_36	S4_HHA9_C1_36	W/Out Outliers:  Number of Episodes	S490000	3600	100
NUMERIC	S4_HHA9_C1_38	S4_HHA9_C1_38	Without Outliers:  Non Routine Med Sup Chgs	S490000	3800	100
NUMERIC	S4_HHA9_C2_33	S4_HHA9_C2_33	With Outliers:  Total Visits	S490000	3300	200
NUMERIC	S4_HHA9_C2_34	S4_HHA9_C2_34	With Outliers:  Other Charges  	S490000	3400	200
NUMERIC	S4_HHA9_C2_35	S4_HHA9_C2_35	With Outliers:  Total Charges	S490000	3500	200
NUMERIC	S4_HHA9_C2_37	S4_HHA9_C2_37	With Outliers:  Number of Episodes	S490000	3700	200
NUMERIC	S4_HHA9_C2_38	S4_HHA9_C2_38	With Outliers:  Non Routine Med Sup Chgs	S490000	3800	200
NUMERIC	S4_HHA9_C3_33	S4_HHA9_C3_33	LUPA Episodes:  Total Visits	S490000	3300	300
NUMERIC	S4_HHA9_C3_34	S4_HHA9_C3_34	LUPA Episodes:  Other Charges	S490000	3400	300
NUMERIC	S4_HHA9_C3_35	S4_HHA9_C3_35	Total Charges:  LUPA Episodes	S490000	3500	300
NUMERIC	S4_HHA9_C3_36	S4_HHA9_C3_36	LUPA Episodes:  Total Number of Episodes	S490000	3600	300
NUMERIC	S4_HHA9_C3_38	S4_HHA9_C3_38	LUPA:  Total Non Routine Med Sup Chgs	S490000	3800	300
NUMERIC	S4_HHA9_C4_33	S4_HHA9_C4_33	PEP Episodes:  Total Visits	S490000	3300	400
NUMERIC	S4_HHA9_C4_34	S4_HHA9_C4_34	PEP Episodes:  Other Charges 	S490000	3400	400
NUMERIC	S4_HHA9_C4_35	S4_HHA9_C4_35	PEP Episodes:  Total Charges:	S490000	3500	400
NUMERIC	S4_HHA9_C4_36	S4_HHA9_C4_36	PEP Episodes:  Total Number of Episodes  	S490000	3600	400
NUMERIC	S4_HHA9_C4_37	S4_HHA9_C4_37	PEP:  Total Number of Outlier Episodes	S490000	3700	400
NUMERIC	S4_HHA9_C4_38	S4_HHA9_C4_38	PEP:  Total Non Routine Med Supply Chgs	S490000	3800	400
NUMERIC	S4_HHA9_C7_33	S4_HHA9_C5_33	Total Visits	S490000	3300	500
NUMERIC	S4_HHA9_C7_34	S4_HHA9_C5_34	Total Other Charges	S490000	3400	500
NUMERIC	S4_HHA9_C7_35	S4_HHA9_C5_35	Total Charges 	S490000	3500	500
NUMERIC	S4_HHA9_C7_36	S4_HHA9_C5_36	Total Number of Episodes	S490000	3600	500
NUMERIC	S4_HHA9_C7_37	S4_HHA9_C5_37	Total Number of Outlier Episodes	S490000	3700	500
NUMERIC	S4_HHA9_C7_38	S4_HHA9_C5_38	Total Non Routine Medical  Supply Charges	S490000	3800	500
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
	HHA STATISTICAL DATA					
	2552-10 WORKSHEET S-4					
						
DATA TYPE	96 FIELD NAME	10 FIELD NAME	FIELD DESCRIPTION 	WKSHT CD	LINE	COLUMN
						
	HHA X					
						
NUMERIC	S4_HHA10_C1_33	S4_HHA10_C1_33	Without Outliers:  Total Visits	S400000	3300	100
NUMERIC	S4_HHA10_C1_34	S4_HHA10_C1_34	Without Outliers:  Other Charges	S400000	3400	100
NUMERIC	S4_HHA10_C1_35	S4_HHA10_C1_35	Without Outliers:  Total Charges	S400000	3500	100
NUMERIC	S4_HHA10_C1_36	S4_HHA10_C1_36	W/Out Outliers:  Number of Episodes	S400000	3600	100
NUMERIC	S4_HHA10_C1_38	S4_HHA10_C1_38	Without Outliers:  Non Routine Med Sup Chgs	S400000	3800	100
NUMERIC	S4_HHA10_C2_33	S4_HHA10_C2_33	With Outliers:  Total Visits	S400000	3300	200
NUMERIC	S4_HHA10_C2_34	S4_HHA10_C2_34	With Outliers:  Other Charges  	S400000	3400	200
NUMERIC	S4_HHA10_C2_35	S4_HHA10_C2_35	With Outliers:  Total Charges	S400000	3500	200
NUMERIC	S4_HHA10_C2_37	S4_HHA10_C2_37	With Outliers:  Number of Episodes	S400000	3700	200
NUMERIC	S4_HHA10_C2_38	S4_HHA10_C2_38	With Outliers:  Non Routine Med Sup Chgs	S400000	3800	200
NUMERIC	S4_HHA10_C3_33	S4_HHA10_C3_33	LUPA Episodes:  Total Visits	S400000	3300	300
NUMERIC	S4_HHA10_C3_34	S4_HHA10_C3_34	LUPA Episodes:  Other Charges	S400000	3400	300
NUMERIC	S4_HHA10_C3_35	S4_HHA10_C3_35	Total Charges:  LUPA Episodes	S400000	3500	300
NUMERIC	S4_HHA10_C3_36	S4_HHA10_C3_36	LUPA Episodes:  Total Number of Episodes	S400000	3600	300
NUMERIC	S4_HHA10_C3_38	S4_HHA10_C3_38	LUPA:  Total Non Routine Med Sup Chgs	S400000	3800	300
NUMERIC	S4_HHA10_C4_33	S4_HHA10_C4_33	PEP Episodes:  Total Visits	S400000	3300	400
NUMERIC	S4_HHA10_C4_34	S4_HHA10_C4_34	PEP Episodes:  Other Charges 	S400000	3400	400
NUMERIC	S4_HHA10_C4_35	S4_HHA10_C4_35	PEP Episodes:  Total Charges:	S400000	3500	400
NUMERIC	S4_HHA10_C4_36	S4_HHA10_C4_36	PEP Episodes:  Total Number of Episodes  	S400000	3600	400
NUMERIC	S4_HHA10_C4_37	S4_HHA10_C4_37	PEP:  Total Number of Outlier Episodes	S400000	3700	400
NUMERIC	S4_HHA10_C4_38	S4_HHA10_C4_38	PEP:  Total Non Routine Med Supply Chgs	S400000	3800	400
NUMERIC	S4_HHA10_C7_33	S4_HHA10_C5_33	Total Visits	S400000	3300	500
NUMERIC	S4_HHA10_C7_34	S4_HHA10_C5_34	Total Other Charges	S400000	3400	500
NUMERIC	S4_HHA10_C7_35	S4_HHA10_C5_35	Total Charges 	S400000	3500	500
NUMERIC	S4_HHA10_C7_36	S4_HHA10_C5_36	Total Number of Episodes	S400000	3600	500
NUMERIC	S4_HHA10_C7_37	S4_HHA10_C5_37	Total Number of Outlier Episodes	S400000	3700	500
NUMERIC	S4_HHA10_C7_38	S4_HHA10_C5_38	Total Non Routine Medical  Supply Charges	S400000	3800	500
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
	RENAL STATISTICAL DATA					
	2552-10 WORKSHEET S-5					
						
DATA TYPE	96 FIELD NAME	10 FIELD NAME	FIELD DESCRIPTION 	WKSHT CD	LINE	COLUMN
						
ALPHANUMERIC	S5_C1_15	S5_C1_21	MCP Physician Payment Method (Y/N)	S500000	2100	100
						
ALPHANUMERIC	S5_C2_15	S5_C2_21	Initial Physician Payment Method (Y/N)	S500000	2100	200
						
NUMERIC	S5_C1_1	S5_C1_1	"Number of patients in program at 
end of cost reporting period"	S500000	100	100
NUMERIC	S5_C1_2	S5_C1_2	Number of Times per week Patient receives Dialysis	S500000	200	100
NUMERIC	S5_C1_3	S5_C1_3	"Average patient dialysis time 
including setup"	S500000	300	100
						
NUMERIC	S5_C1_5	S5_C1_5	"Number of days in year dialysis 
furnished"	S500000	500	100
						
NUMERIC	S5_C1_6	S5_C1_6	Number of stations	S500000	600	100
						
NUMERIC	S5_C1_7	S5_C1_7	"Treatment capacity per day per
station"	S500000	700	100
						
NUMERIC	S5_C1_8	S5_C1_8	Utilization	S500000	800	100
						
NUMERIC	S5_C1_9	S5_C1_9	Average times dialyzers re-used	S500000	900	100
						
NUMERIC	S5_C1_10	S5_C1_10	"Percentage of patients re-using
dialyzers"	S500000	1000	100
						
NUMERIC	S5_C1_13	S5_C1_13	"Net costs of Epoietin furnished to
all maintenance dialysis patients
by the provider"	S500000	1300	100
						
NUMERIC	S5_C1_1301	S5_C1_14	"Epoietin amount form worksheet A
for home dialysis program"	S500000	1400	100
NUMERIC	S5_C1_14	S5_C1_15	Number of EPO units furnished for Line 13	S500000	1500	100
						
NUMERIC	S5_C2_1	S5_C2_1	"Number of patients in program at 
end of cost reporting period"	S500000	100	200
						
NUMERIC	S5_C2_2	S5_C2_2	"Number of Times per week
 Patient receives Dialysis"	S500000	200	200
						
NUMERIC	S5_C2_3	S5_C2_3	"Average patient dialysis time 
including setup"	S500000	300	200
						
NUMERIC	S5_C2_5	S5_C2_5	"Number of days in year dialysis 
furnished"	S500000	500	200
						
						
						
						
						
						
						
						
						
						
	RENAL STATISTICAL DATA					
	2552-10 WORKSHEET S-5					
						
DATA TYPE	96 FIELD NAME	10 FIELD NAME	FIELD DESCRIPTION 	WKSHT CD	LINE	COLUMN
						
NUMERIC	S5_C2_6	S5_C2_6	Number of stations	S500000	600	200
						
NUMERIC	S5_C2_7	S5_C2_7	"Treatment capacity per day per
station"	S500000	700	200
						
NUMERIC	S5_C2_8	S5_C2_8	Utilization	S500000	800	200
						
NUMERIC	S5_C2_9	S5_C2_9	Average times dialyzers re-used	S500000	900	200
						
NUMERIC	S5_C2_10	S5_C2_10	"Percentage of patients re-using
dialyzers"	S500000	1000	200
						
NUMERIC	S5_C3_1	S5_C3_1	"Number of patients in program at 
end of cost reporting period"	S500000	100	300
						
NUMERIC	S5_C3_2	S5_C3_2	"Number of Times per week 
Patient receives Dialysis"	S500000	200	300
						
NUMERIC	S5_C3_3	S5_C3_3	"Average patient dialysis time 
including setup"	S500000	300	300
						
NUMERIC	S5_C3_6	S5_C3_6	Number of stations	S500000	600	300
						
NUMERIC	S5_C4_1	S5_C4_1	"Number of patients in program at 
end of cost reporting period"	S500000	100	400
						
NUMERIC	S5_C4_2	S5_C4_2	"Number of Times per week
 Patient receives Dialysis"	S500000	200	400
						
NUMERIC	S5_C4_3	S5_C4_3	"Average patient dialysis time 
including setup"	S500000	300	400
						
NUMERIC	S5_C4_4	S5_C4_4	CAPD exchanges per day	S500000	400	400
						
NUMERIC	S5_C4_6	S5_C4_6	Number of stations	S500000	600	400
						
NUMERIC	S5_C5_1	S5_C5_1	"Number of patients in program at 
end of cost reporting period"	S500000	100	500
						
NUMERIC	S5_C5_2	S5_C5_2	"Number of days in year dialysis 
furnished"	S500000	200	500
						
NUMERIC	S5_C6_1	S5_C6_1	"Number of patients in program at 
end of cost reporting period"	S500000	100	600
						
						
						
						
						
						
	RENAL STATISTICAL DATA					
	2552-10 WORKSHEET S-5					
						
DATA TYPE	96 FIELD NAME	10 FIELD NAME	FIELD DESCRIPTION 	WKSHT CD	LINE	COLUMN
						
NUMERIC	S5_C6_2	S5_C6_2	"Number of Times per week
 Patient receives Dialysis"	S500000	200	600
						
NUMERIC	S5_C6_4	S5_C6_4	CAPD exchanges per day	S500000	400	600
						
NUMERIC	S5_C1_11	S5_C1_11	"Number of patients on transplant 
list"	S500000	1100	100
						
NUMERIC	S5_C1_12	S5_C1_12	"Number of patients transplanted 
during fiscal year"	S500000	1200	100
						
						
						
						
DATA TYPE	96 FIELD NAME	10 FIELD NAME	FIELD DESCRIPTION 	WKSHT CD	LINE	COLUMN
						
NUMERIC	 	S10_C1_1	 	S100000	100	100
NUMERIC		S10_C1_2		S100000	200	100
ALPHANUMERIC		S10_C1_3		S100000	300	100
ALPHANUMERIC		S10_C1_4		S100000	400	100
NUMERIC		S10_C1_5		S100000	500	100
NUMERIC		S10_C1_6		S100000	600	100
NUMERIC		S10_C1_7		S100000	700	100
NUMERIC		S10_C1_8		S100000	800	100
NUMERIC		S10_C1_9		S100000	900	100
NUMERIC		S10_C1_10		S100000	1000	100
NUMERIC		S10_C1_11		S100000	1100	100
NUMERIC		S10_C1_12		S100000	1200	100
NUMERIC		S10_C1_13		S100000	1300	100
NUMERIC		S10_C1_14		S100000	1400	100
NUMERIC		S10_C1_15		S100000	1500	100
NUMERIC		S10_C1_16		S100000	1600	100
NUMERIC		S10_C1_17		S100000	1700	100
NUMERIC		S10_C1_18		S100000	1800	100
NUMERIC		S10_C1_19		S100000	1900	100
NUMERIC		S10_C1_20		S100000	2000	100
NUMERIC		S10_C2_20		S100000	2000	200
NUMERIC		S10_C3_20		S100000	2000	300
NUMERIC		S10_C1_21		S100000	2100	100
NUMERIC		S10_C2_21		S100000	2100	200
NUMERIC		S10_C3_21		S100000	2100	300
NUMERIC		S10_C1_22		S100000	2200	100
NUMERIC		S10_C2_22		S100000	2200	200
NUMERIC		S10_C3_22		S100000	2200	300
NUMERIC		S10_C1_23		S100000	2300	100
NUMERIC		S10_C2_23		S100000	2300	200
NUMERIC		S10_C3_23		S100000	2300	300
ALPHANUMERIC		S10_C1_24		S100000	2400	100
NUMERIC		S10_C1_25		S100000	2500	100
NUMERIC		S10_C1_26		S100000	2600	100
NUMERIC		S10_C1_27		S100000	2700	100
NUMERIC		S10_C1_28		S100000	2800	100
NUMERIC		S10_C1_29		S100000	2900	100
NUMERIC		S10_C1_30		S100000	3000	100
NUMERIC		S10_C1_31		S100000	3100	100
						
						
						
						
						
						
						
						
	TRIAL BALANCE OF EXPENSE ACCOUNTS					
	2552-10 WORKSHEET A					
						
DATA TYPE	96 FIELD NAME	10 FIELD NAME	FIELD DESCRIPTION 	WKSHT CD	LINE	COLUMN
						
NUMERIC	NOT ON OLD FORM	A_C1_3	Other Capital	A000000	300	100
ROLLUP	A_C1_5	A_C1_4	Employee Benefits	A000000	400	100
ROLLUP	A_C1_6	A_C1_5	Administrative and General	A000000	500	100
ROLLUP	A_C1_7	A_C1_6	Maintenance and Repairs	A000000	600	100
ROLLUP	A_C1_8	A_C1_7	Operation of Plant	A000000	700	100
ROLLUP	A_C1_9	A_C1_8	Laundry and Linen Service	A000000	800	100
ROLLUP	A_C1_10	A_C1_9	Housekeeping	A000000	900	100
ROLLUP	A_C1_11	A_C1_10	Dietary	A000000	1000	100
ROLLUP	A_C1_12	A_C1_11 	Cafeteria	A000000	1100	100
ROLLUP	A_C1_13	A_C1_12	Maintenance of Personnel	A000000	1200	100
ROLLUP	A_C1_14	A_C1_13	Nursing Administration	A000000	1300	100
ROLLUP	A_C1_15	A_C1_14	Central Services and Supply	A000000	1400	100
ROLLUP	A_C1_16	A_C1_15	Pharmacy	A000000	1500	100
ROLLUP	A_C1_17	A_C1_16	Medical Records and Medical Rec. Library	A000000	1600	100
ROLLUP	A_C1_18	A_C1_17	Social Service	A000000	1700	100
ROLLUP	A_C1_19	A_C1_18	Other General Service	A000000	1800	100
ROLLUP	A_C1_20	A_C1_19	Nonphysician Anesthetists	A000000	1900	100
ROLLUP	A_C1_21	A_C1_20	Nursing School	A000000	2000	100
ROLLUP	A_C1_22	A_C1_21	Interns & Res Salary and Fringe Benefits	A000000	2100	100
ROLLUP	A_C1_23	A_C1_22	Interns & Res Other Program Costs	A000000	2200	100
ROLLUP	A_C1_24	A_C1_23	Paramedical Education	A000000	2300	100
NUMERIC	A_C1_25	A_C1_30	Adults and Pediatrics	A000000	3000	100
ROLLUP	A_C1_26	A_C1_31	Intensive Care Unit	A000000	3100	100
ROLLUP	A_C1_27	A_C1_32	Coronary Care Unit	A000000	3200	100
ROLLUP	A_C1_28	A_C1_33	Burn Intensive Care Unit	A000000	3300	100
ROLLUP	A_C1_29	A_C1_34	Surgical Intensive Care Unit	A000000	3400	100
ROLLUP	A_C1_30	A_C1_35	Other Special Care Unit	A000000	3500	100
NUMERIC	NOT ON OLD FORM	A_C1_40	Subprovider-IPF	A000000	4000	100
NUMERIC	NOT ON OLD FORM	A_C1_41	Subprovider-IRF	A000000	4100	100
NUMERIC	A_C1_31	A_C1_42	Subprovider I	A000000	4200	100
NUMERIC	A_C1_3101	A_C1_4201	Subprovider II	A000000	4201	100
NUMERIC	A_C1_33	A_C1_43	Nursery	A000000	4300	100
NUMERIC	A_C1_34	A_C1_44	SNF	A000000	4400	100
NUMERIC	A_C1_35	A_C1_45	NF	A000000	4500	100
NUMERIC	A_C1_3501	A_C1_4501	ICF	A000000	4501	100
NUMERIC	A_C1_36	A_C1_46	OLTC	A000000	4600	100
ROLLUP	A_C1_37	A_C1_50	Operating Room	A000000	5000	100
ROLLUP	A_C1_38	A_C1_51	Recovery Room	A000000	5100	100
ROLLUP	A_C1_39	A_C1_52	Delivery Room and Labor Room	A000000	5200	100
ROLLUP	A_C1_40	A_C1_53	Anesthesiology	A000000	5300	100
ROLLUP	A_C1_41	A_C1_54	Radiology-Diagnostic	A000000	5400	100
ROLLUP	A_C1_42	A_C1_55	Radiology-Therapeutic	A000000	5500	100
ROLLUP	A_C1_43	A_C1_56	Radioisotope	A000000	5600	100
ROLLUP	NOT ON OLD FORM	A_C1_57	CT Scan	A000000	5700	100
ROLLUP	NOT ON OLD FORM	A_C1_58	MRI	A000000	5800	100
ROLLUP	NOT ON OLD FORM	A_C1_59	Cardiac Catheterization	A000000	5900	100
ROLLUP	A_C1_44	A_C1_60	Laboratory	A000000	6000	100
NUMERIC	A_C1_45	A_C1_61	PBP Clinical Lab Services Program Only	A000000	6100	100
ROLLUP	A_C1_46	A_C1_62	Whole Blood & Packed Red Blood Cells	A000000	6200	100
ROLLUP	A_C1_4630	A_C1_6250	Blood Clotting Factors for Hemoph.	A000000	6250	100
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
	TRIAL BALANCE OF EXPENSE ACCOUNTS					
	2552-10 WORKSHEET A					
						
DATA TYPE	96 FIELD NAME	10 FIELD NAME	FIELD DESCRIPTION 	WKSHT CD	LINE	COLUMN
						
ROLLUP	A_C1_47	A_C1_63	"Blood Storing, Processing, Trans"	A000000	6300	100
ROLLUP	A_C1_48	A_C1_64	Intravenous Therapy	A000000	6400	100
ROLLUP	A_C1_49	A_C1_65	Respiratory Therapy	A000000	6500	100
ROLLUP	A_C1_50	A_C1_66	Physical Therapy	A000000	6600	100
ROLLUP	A_C1_51	A_C1_67	Occupational Therapy	A000000	6700	100
ROLLUP	A_C1_52	A_C1_68	Speech Pathology	A000000	6800	100
ROLLUP	A_C1_53	A_C1_69	Electrocardiology	A000000	6900	100
ROLLUP	A_C1_54	A_C1_70	Electroencephalography	A000000	7000	100
ROLLUP	A_C1_55	A_C1_71	Medical Supplies Charged to Patients	A000000	7100	100
ROLLUP	A_C1_5530	A_C1_72	Impl. Dev. Charged to Patients 	A000000	7200	100
ROLLUP	A_C1_56	A_C1_73	Drugs Charged to Patients	A000000	7300	100
NUMERIC	A_C1_57	A_C1_74	Renal Dialysis	A000000	7400	100
ROLLUP	A_C1_58	A_C1_75	ASC (Non Distinct Part)	A000000	7500	100
ROLLUP	A_C1_59	A_C1_76	Other Ancillary	A000000	7600	100
ROLLUP	A_C1_6350	A_C1_88	RHC	A000000	8800	100
ROLLUP	A_C1_6360	A_C1_89	FQHC	A000000	8900	100
ROLLUP	A_C1_60	A_C1_90	Clinic	A000000	9000	100
ROLLUP	A_C1_61	A_C1_91	Emergency	A000000	9100	100
NUMERIC		A_C1_92  	Observation Bed (NON Distinct)	A000000	9200	100
ROLLUP	A_C1_6201	A_C1_9201	Observation Beds (Distinct Unit)	A000000	9201	100
ROLLUP	A_C1_63	A_C1_93	Other Outpatient Services	A000000	9300	100
NUMERIC	A_C1_64	A_C1_94	Home Program Dialysis	A000000	9400	100
NUMERIC	A_C1_65	A_C1_95	Ambulance Services	A000000	9500	100
ROLLUP	A_C1_66	A_C1_96	Durable Medical Equipment Rented	A000000	9600	100
ROLLUP	A_C1_67	A_C1_97	Durable Medical Equipment Sold	A000000	9700	100
ROLLUP	A_C1_68	A_C1_98	Other Reimbursable	A000000	9800	100
ROLLUP	A_C1_6910	A_C1_99	CMHC	A000000	9900	100
ROLLUP	A_C1_69	A_C1_9910	CORF	A000000	9910	100
ROLLUP	A_C1_6920	A_C1_9920	OPT	A000000	9920	100
ROLLUP	A_C1_6930	A_C1_9930	OOT	A000000	9930	100
ROLLUP	A_C1_6940	A_C1_9940	OSP	A000000	9940	100
NUMERIC	A_C1_70	A_C1_100	Int & Res (non approved teaching program	A000000	10000	100
ROLLUP	A_C1_71	A_C1_101	HHA	A000000	10100	100
NUMERIC	A_C1_83	A_C1_105	Kidney Acquisition	A000000	10500	100
NUMERIC	A_C1_85	A_C1_106	Heart Acquisition	A000000	10600	100
NUMERIC	A_C1_84	A_C1_107	Liver Acquisition	A000000	10700	100
NUMERIC	A_C1_82	A_C1_108	Lung  Acquisition	A000000	10800	100
NUMERIC	A_C1_8501	A_C1_109	Pancreas Acquisition	A000000	10900	100
NUMERIC	A_C1_8502	A_C1_110	Intestinal Acquisition	A000000	11000	100
NUMERIC	NOT ON OLD FORM	A_C1_111	Islet Acquisition	A000000	11100	100
ROLLUP	A_C1_86	A_C1_112	Other Organ Acquisition	A000000	11200	100
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
	TRIAL BALANCE OF EXPENSE ACCOUNTS					
	2552-10 WORKSHEET A					
						
DATA TYPE	96 FIELD NAME	10 FIELD NAME	FIELD DESCRIPTION 	WKSHT CD	LINE	COLUMN
						
NUMERIC	A_C1_88	A_C1_113	Interest Expense	A000000	11300	100
NUMERIC	A_C1_89	A_C1_114	Utilization Review SNF	A000000	11400	100
ROLLUP	A_C1_92	A_C1_115	ASC (Distinct Part)	A000000	11500	100
ROLLUP	A_C1_93	A_C1_116	Hospice	A000000	11600	100
ROLLUP	A_C1_94	A_C1_117	Other Special Purpose	A000000	11700	100
ROLLUP	A_C1_96	A_C1_190	"Gift, Flower, Coffee Shop, Canteen"	A000000	19000	100
ROLLUP	A_C1_97	A_C1_191	Research	A000000	19100	100
ROLLUP	A_C1_98	A_C1_192	Physicians' Private Office	A000000	19200	100
ROLLUP	A_C1_99	A_C1_193	Nonpaid Workers	A000000	19300	100
ROLLUP	A_C1_100	A_C1_194	Other Nonreimbursable	A000000	19400	100
NUMERIC	A_C1_101	A_C1_200	Total Salaries	A000000	20000	100
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
	TRIAL BALANCE OF EXPENSE ACCOUNTS					
	2552-10 WORKSHEET A					
						
DATA TYPE	96 FIELD NAME	10 FIELD NAME	FIELD DESCRIPTION 	WKSHT CD	LINE	COLUMN
						
ROLLUP	A_C2_3	A_C2_1	New Capital Buildings and Fixtures	A000000	100	200
ROLLUP	A_C2_4	A_C2_2	New Capital Equipment	A000000	200	200
NUMERIC	NOT ON OLD FORM	A_C2_3	Other Capital	A000000	300	200
ROLLUP	A_C2_5	A_C2_4	Employee Benefits	A000000	400	200
ROLLUP	A_C2_6	A_C2_5	Administrative and General	A000000	500	200
ROLLUP	A_C2_7	A_C2_6	Maintenance and Repairs	A000000	600	200
ROLLUP	A_C2_8	A_C2_7	Operation of Plant	A000000	700	200
ROLLUP	A_C2_9	A_C2_8	Laundry and Linen Service	A000000	800	200
ROLLUP	A_C2_10	A_C2_9	Housekeeping	A000000	900	200
ROLLUP	A_C2_11	A_C2_10	Dietary	A000000	1000	200
ROLLUP	A_C2_12	A_C2_11 	Cafeteria	A000000	1100	200
ROLLUP	A_C2_13	A_C2_12	Maintenance of Personnel	A000000	1200	200
ROLLUP	A_C2_14	A_C2_13	Nursing Administration	A000000	1300	200
ROLLUP	A_C2_15	A_C2_14	Central Services and Supply	A000000	1400	200
ROLLUP	A_C2_16	A_C2_15	Pharmacy	A000000	1500	200
ROLLUP	A_C2_17	A_C2_16	Medical Records and Medical Rec. Library	A000000	1600	200
ROLLUP	A_C2_18	A_C2_17	Social Service	A000000	1700	200
ROLLUP	A_C2_19	A_C2_18	Other General Service	A000000	1800	200
ROLLUP	A_C2_20	A_C2_19	Nonphysician Anesthetists	A000000	1900	200
ROLLUP	A_C2_21	A_C2_20	Nursing School	A000000	2000	200
ROLLUP	A_C2_22	A_C2_21	Interns & Res Salary and Fringe Benefits	A000000	2100	200
ROLLUP	A_C2_23	A_C2_22	Interns & Res Other Program Costs	A000000	2200	200
ROLLUP	A_C2_24	A_C2_23	Paramedical Education	A000000	2300	200
NUMERIC	A_C2_25	A_C2_30	Adults and Pediatrics	A000000	3000	200
ROLLUP	A_C2_26	A_C2_31	Intensive Care Unit	A000000	3100	200
ROLLUP	A_C2_27	A_C2_32	Coronary Care Unit	A000000	3200	200
ROLLUP	A_C2_28	A_C2_33	Burn Intensive Care Unit	A000000	3300	200
ROLLUP	A_C2_29	A_C2_34	Surgical Intensive Care Unit	A000000	3400	200
ROLLUP	A_C2_30	A_C2_35	Other Special Care Unit	A000000	3500	200
NUMERIC	NOT ON OLD FORM	A_C2_40	Subprovider-IPF	A000000	4000	200
NUMERIC	NOT ON OLD FORM	A_C2_41	Subprovider-IRF	A000000	4100	200
NUMERIC	A_C2_31	A_C2_42	Subprovider I	A000000	4200	200
NUMERIC	A_C2_3101	A_C2_4201	Subprovider II	A000000	4201	200
NUMERIC	A_C2_33	A_C2_43	Nursery	A000000	4300	200
NUMERIC	A_C2_34	A_C2_44	SNF	A000000	4400	200
NUMERIC	A_C2_35	A_C2_45	NF	A000000	4500	200
NUMERIC	A_C2_3501	A_C2_4501	ICF	A000000	4501	200
NUMERIC	A_C2_36	A_C2_46	OLTC	A000000	4600	200
ROLLUP	A_C2_37	A_C2_50	Operating Room	A000000	5000	200
ROLLUP	A_C2_38	A_C2_51	Recovery Room	A000000	5100	200
ROLLUP	A_C2_39	A_C2_52	Delivery Room and Labor Room	A000000	5200	200
ROLLUP	A_C2_40	A_C2_53	Anesthesiology	A000000	5300	200
ROLLUP	A_C2_41	A_C2_54	Radiology-Diagnostic	A000000	5400	200
ROLLUP	A_C2_42	A_C2_55	Radiology-Therapeutic	A000000	5500	200
ROLLUP	A_C2_43	A_C2_56	Radioisotope	A000000	5600	200
ROLLUP	NOT ON OLD FORM	A_C2_57	CT Scan	A000000	5700	200
ROLLUP	NOT ON OLD FORM	A_C2_58	MRI	A000000	5800	200
ROLLUP	NOT ON OLD FORM	A_C2_59	Cardiac Catheterization	A000000	5900	200
ROLLUP	A_C2_44	A_C2_60	Laboratory	A000000	6000	200
NUMERIC	A_C2_45	A_C2_61	PBP Clinical Lab Services Program Only	A000000	6100	200
ROLLUP	A_C2_46	A_C2_62	Whole Blood & Packed Red Blood Cells	A000000	6200	200
ROLLUP	A_C2_4630	A_C2_6250	Blood Clotting Factors for Hemoph.	A000000	6250	200
						
						
						
						
						
						
						
						
						
						
						
						
						
	TRIAL BALANCE OF EXPENSE ACCOUNTS					
	2552-10 WORKSHEET A					
						
DATA TYPE	96 FIELD NAME	10 FIELD NAME	FIELD DESCRIPTION 	WKSHT CD	LINE	COLUMN
						
ROLLUP	A_C2_47	A_C2_63	"Blood Storing, Processing, Trans"	A000000	6300	200
ROLLUP	A_C2_48	A_C2_64	Intravenous Therapy	A000000	6400	200
ROLLUP	A_C2_49	A_C2_65	Respiratory Therapy	A000000	6500	200
ROLLUP	A_C2_50	A_C2_66	Physical Therapy	A000000	6600	200
ROLLUP	A_C2_51	A_C2_67	Occupational Therapy	A000000	6700	200
ROLLUP	A_C2_52	A_C2_68	Speech Pathology	A000000	6800	200
ROLLUP	A_C2_53	A_C2_69	Electrocardiology	A000000	6900	200
ROLLUP	A_C2_54	A_C2_70	Electroencephalography	A000000	7000	200
ROLLUP	A_C2_55	A_C2_71	Medical Supplies Charged to Patients	A000000	7100	200
ROLLUP	A_C2_5530	A_C2_72	Impl. Dev. Charged to Patients 	A000000	7200	200
ROLLUP	A_C2_56	A_C2_73	Drugs Charged to Patients	A000000	7300	200
NUMERIC	A_C2_57	A_C2_74	Renal Dialysis	A000000	7400	200
ROLLUP	A_C2_58	A_C2_75	ASC (Non Distinct Part)	A000000	7500	200
ROLLUP	A_C2_59	A_C2_76	Other Ancillary	A000000	7600	200
ROLLUP	A_C2_6350	A_C2_88	RHC	A000000	8800	200
ROLLUP	A_C2_6360	A_C2_89	FQHC	A000000	8900	200
ROLLUP	A_C2_60	A_C2_90	Clinic	A000000	9000	200
ROLLUP	A_C2_61	A_C2_91	Emergency	A000000	9100	200
NUMERIC		A_C2_92	Observation Beds (Non Distinct Unit)	A000000	9200	200
ROLLUP	A_C2_6201	A_C2_9201		A000000	9201	200
ROLLUP	A_C2_63	A_C2_93	Other Outpatient Services	A000000	9300	200
NUMERIC	A_C2_64	A_C2_94	Home Program Dialysis	A000000	9400	200
NUMERIC	A_C2_65	A_C2_95	Ambulance Services	A000000	9500	200
ROLLUP	A_C2_66	A_C2_96	Durable Medical Equipment Rented	A000000	9600	200
ROLLUP	A_C2_67	A_C2_97	Durable Medical Equipment Sold	A000000	9700	200
ROLLUP	A_C2_68	A_C2_98	Other Reimbursable	A000000	9800	200
ROLLUP	A_C2_6910	A_C2_99	CMHC	A000000	9900	200
ROLLUP	A_C2_69	A_C2_9910	CORF	A000000	9910	200
ROLLUP	A_C2_6920	A_C2_9920	OPT	A000000	9920	200
ROLLUP	A_C2_6930	A_C2_9930	OOT	A000000	9930	200
ROLLUP	A_C2_6940	A_C2_9940	OSP	A000000	9940	200
NUMERIC	A_C2_70	A_C2_100	Int & Res (non approved teaching program	A000000	10000	200
ROLLUP	A_C2_71	A_C2_101	HHA	A000000	10100	200
NUMERIC	A_C2_83	A_C2_105	Kidney Acquisition	A000000	10500	200
NUMERIC	A_C2_85	A_C2_106	Heart Acquisition	A000000	10600	200
NUMERIC	A_C2_84	A_C2_107	Liver Acquisition	A000000	10700	200
NUMERIC	A_C2_82	A_C2_108	Lung  Acquisition	A000000	10800	200
NUMERIC	A_C2_8501	A_C2_109	Pancreas Acquisition	A000000	10900	200
NUMERIC	A_C2_8502	A_C2_110	Intestinal Acquisition	A000000	11000	200
NUMERIC	NOT ON OLD FORM	A_C2_111	Islet Acquisition	A000000	11100	200
ROLLUP	A_C2_86	A_C2_112	Other Organ Acquisition	A000000	11200	200
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
	TRIAL BALANCE OF EXPENSE ACCOUNTS					
	2552-10 WORKSHEET A					
						
DATA TYPE	96 FIELD NAME	10 FIELD NAME	FIELD DESCRIPTION 	WKSHT CD	LINE	COLUMN
						
NUMERIC	A_C2_88	A_C2_113	Interest Expense	A000000	11300	200
NUMERIC	A_C2_89	A_C2_114	Utilization Review SNF	A000000	11400	200
ROLLUP	A_C2_92	A_C2_115	ASC (Distinct Part)	A000000	11500	200
ROLLUP	A_C2_93	A_C2_116	Hospice	A000000	11600	200
ROLLUP	A_C2_94	A_C2_117	Other Special Purpose	A000000	11700	200
ROLLUP	A_C2_96	A_C2_190	"Gift, Flower, Coffee Shop, Canteen"	A000000	19000	200
ROLLUP	A_C2_97	A_C2_191	Research	A000000	19100	200
ROLLUP	A_C2_98	A_C2_192	Physicians' Private Office	A000000	19200	200
ROLLUP	A_C2_99	A_C2_193	Nonpaid Workers	A000000	19300	200
ROLLUP	A_C2_100	A_C2_194	Other Nonreimbursable	A000000	19400	200
NUMERIC	A_C2_101	A_C2_200	Total Salaries	A000000	20000	200
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
	TRIAL BALANCE OF EXPENSE ACCOUNTS					
	2552-10 WORKSHEET A					
						
DATA TYPE	96 FIELD NAME	10 FIELD NAME	FIELD DESCRIPTION 	WKSHT CD	LINE	COLUMN
						
ROLLUP	A_C6_3	A_C6_1	New Capital Buildings and Fixtures	A000000	100	600
ROLLUP	A_C6_4	A_C6_2	New Capital Equipment	A000000	200	600
NUMERIC	NOT ON OLD FORM	A_C6_3	Other Capital	A000000	300	600
ROLLUP	A_C6_5	A_C6_4	Employee Benefits	A000000	400	600
ROLLUP	A_C6_6	A_C6_5	Administrative and General	A000000	500	600
ROLLUP	A_C6_7	A_C6_6	Maintenance and Repairs	A000000	600	600
ROLLUP	A_C6_8	A_C6_7	Operation of Plant	A000000	700	600
ROLLUP	A_C6_9	A_C6_8	Laundry and Linen Service	A000000	800	600
ROLLUP	A_C6_10	A_C6_9	Housekeeping	A000000	900	600
ROLLUP	A_C6_11	A_C6_10	Dietary	A000000	1000	600
ROLLUP	A_C6_12	A_C6_11 	Cafeteria	A000000	1100	600
ROLLUP	A_C6_13	A_C6_12	Maintenance of Personnel	A000000	1200	600
ROLLUP	A_C6_14	A_C6_13	Nursing Administration	A000000	1300	600
ROLLUP	A_C6_15	A_C6_14	Central Services and Supply	A000000	1400	600
ROLLUP	A_C6_16	A_C6_15	Pharmacy	A000000	1500	600
ROLLUP	A_C6_17	A_C6_16	Medical Records and Medical Rec. Library	A000000	1600	600
ROLLUP	A_C6_18	A_C6_17	Social Service	A000000	1700	600
ROLLUP	A_C6_19	A_C6_18	Other General Service	A000000	1800	600
ROLLUP	A_C6_20	A_C6_19	Nonphysician Anesthetists	A000000	1900	600
ROLLUP	A_C6_21	A_C6_20	Nursing School	A000000	2000	600
ROLLUP	A_C6_22	A_C6_21	Interns & Res Salary and Fringe Benefits	A000000	2100	600
ROLLUP	A_C6_23	A_C6_22	Interns & Res Other Program Costs	A000000	2200	600
ROLLUP	A_C6_24	A_C6_23	Paramedical Education	A000000	2300	600
NUMERIC	A_C6_25	A_C6_30	Adults and Pediatrics	A000000	3000	600
ROLLUP	A_C6_26	A_C6_31	Intensive Care Unit	A000000	3100	600
ROLLUP	A_C6_27	A_C6_32	Coronary Care Unit	A000000	3200	600
ROLLUP	A_C6_28	A_C6_33	Burn Intensive Care Unit	A000000	3300	600
ROLLUP	A_C6_29	A_C6_34	Surgical Intensive Care Unit	A000000	3400	600
ROLLUP	A_C6_30	A_C6_35	Other Special Care Unit	A000000	3500	600
NUMERIC	NOT ON OLD FORM	A_C6_40	Subprovider-IPF	A000000	4000	600
NUMERIC	NOT ON OLD FORM	A_C6_41	Subprovider-IRF	A000000	4100	600
NUMERIC	A_C6_31	A_C6_42	Subprovider I	A000000	4200	600
NUMERIC	A_C6_3101	A_C6_4201	Subprovider II	A000000	4201	600
NUMERIC	A_C6_33	A_C6_43	Nursery	A000000	4300	600
NUMERIC	A_C6_34	A_C6_44	SNF	A000000	4400	600
NUMERIC	A_C6_35	A_C6_45	NF	A000000	4500	600
NUMERIC	A_C6_3501	A_C6_4501	ICF	A000000	4501	600
NUMERIC	A_C6_36	A_C6_46	OLTC	A000000	4600	600
ROLLUP	A_C6_37	A_C6_50	Operating Room	A000000	5000	600
ROLLUP	A_C6_38	A_C6_51	Recovery Room	A000000	5100	600
ROLLUP	A_C6_39	A_C6_52	Delivery Room and Labor Room	A000000	5200	600
ROLLUP	A_C6_40	A_C6_53	Anesthesiology	A000000	5300	600
ROLLUP	A_C6_41	A_C6_54	Radiology-Diagnostic	A000000	5400	600
ROLLUP	A_C6_42	A_C6_55	Radiology-Therapeutic	A000000	5500	600
ROLLUP	A_C6_43	A_C6_56	Radioisotope	A000000	5600	600
ROLLUP	NOT ON OLD FORM	A_C6_57	CT Scan	A000000	5700	600
ROLLUP	NOT ON OLD FORM	A_C6_58	MRI	A000000	5800	600
ROLLUP	NOT ON OLD FORM	A_C6_59	Cardiac Catheterization	A000000	5900	600
ROLLUP	A_C6_44	A_C6_60	Laboratory	A000000	6000	600
NUMERIC	A_C6_45	A_C6_61	PBP Clinical Lab Services Program Only	A000000	6100	600
ROLLUP	A_C6_46	A_C6_62	Whole Blood & Packed Red Blood Cells	A000000	6200	600
ROLLUP	A_C6_4630	A_C6_6250	Blood Clotting Factors for Hemoph.	A000000	6250	600
						
						
						
						
						
						
						
						
						
						
						
						
						
	TRIAL BALANCE OF EXPENSE ACCOUNTS					
	2552-10 WORKSHEET A					
						
DATA TYPE	96 FIELD NAME	10 FIELD NAME	FIELD DESCRIPTION 	WKSHT CD	LINE	COLUMN
						
ROLLUP	A_C6_47	A_C6_63	"Blood Storing, Processing, Trans"	A000000	6300	600
ROLLUP	A_C6_48	A_C6_64	Intravenous Therapy	A000000	6400	600
ROLLUP	A_C6_49	A_C6_65	Respiratory Therapy	A000000	6500	600
ROLLUP	A_C6_50	A_C6_66	Physical Therapy	A000000	6600	600
ROLLUP	A_C6_51	A_C6_67	Occupational Therapy	A000000	6700	600
ROLLUP	A_C6_52	A_C6_68	Speech Pathology	A000000	6800	600
ROLLUP	A_C6_53	A_C6_69	Electrocardiology	A000000	6900	600
ROLLUP	A_C6_54	A_C6_70	Electroencephalography	A000000	7000	600
ROLLUP	A_C6_55	A_C6_71	Medical Supplies Charged to Patients	A000000	7100	600
ROLLUP	A_C6_5530	A_C6_72	Impl. Dev. Charged to Patients 	A000000	7200	600
ROLLUP	A_C6_56	A_C6_73	Drugs Charged to Patients	A000000	7300	600
NUMERIC	A_C6_57	A_C6_74	Renal Dialysis	A000000	7400	600
ROLLUP	A_C6_58	A_C6_75	ASC (Non Distinct Part)	A000000	7500	600
ROLLUP	A_C6_59	A_C6_76	Other Ancillary	A000000	7600	600
ROLLUP	A_C6_6350	A_C6_88	RHC	A000000	8800	600
ROLLUP	A_C6_6360	A_C6_89	FQHC	A000000	8900	600
ROLLUP	A_C6_60	A_C6_90	Clinic	A000000	9000	600
ROLLUP	A_C6_61	A_C6_91	Emergency	A000000	9100	600
NUMERIC		A_C6_92	Observation Beds (Non Distinct Unit)	A000000	9200	600
ROLLUP	A_C6_6201	A_C6_9201	Observation Beds (Distinct Unit)	A000000	9201	600
ROLLUP	A_C6_63	A_C6_93	Other Outpatient Services	A000000	9300	600
NUMERIC	A_C6_64	A_C6_94	Home Program Dialysis	A000000	9400	600
NUMERIC	A_C6_65	A_C6_95	Ambulance Services	A000000	9500	600
ROLLUP	A_C6_66	A_C6_96	Durable Medical Equipment Rented	A000000	9600	600
ROLLUP	A_C6_67	A_C6_97	Durable Medical Equipment Sold	A000000	9700	600
ROLLUP	A_C6_68	A_C6_98	Other Reimbursable	A000000	9800	600
ROLLUP	A_C6_6910	A_C6_99	CMHC	A000000	9900	600
ROLLUP	A_C6_69	A_C6_9910	CORF	A000000	9910	600
ROLLUP	A_C6_6920	A_C6_9920	OPT	A000000	9920	600
ROLLUP	A_C6_6930	A_C6_9930	OOT	A000000	9930	600
ROLLUP	A_C6_6940	A_C6_9940	OSP	A000000	9940	600
NUMERIC	A_C6_70	A_C6_100	Int & Res (non approved teaching program	A000000	10000	600
ROLLUP	A_C6_71	A_C6_101	HHA	A000000	10100	600
NUMERIC	A_C6_83	A_C6_105	Kidney Acquisition	A000000	10500	600
NUMERIC	A_C6_85	A_C6_106	Heart Acquisition	A000000	10600	600
NUMERIC	A_C6_84	A_C6_107	Liver Acquisition	A000000	10700	600
NUMERIC	A_C6_82	A_C6_108	Lung  Acquisition	A000000	10800	600
NUMERIC	A_C6_8501	A_C6_109	Pancreas Acquisition	A000000	10900	600
NUMERIC	A_C6_8502	A_C6_110	Intestinal Acquisition	A000000	11000	600
NUMERIC	NOT ON OLD FORM	A_C6_111	Islet Acquisition	A000000	11100	600
ROLLUP	A_C6_86	A_C6_112	Other Organ Acquisition	A000000	11200	600
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
	TRIAL BALANCE OF EXPENSE ACCOUNTS					
	2552-10 WORKSHEET A					
						
DATA TYPE	96 FIELD NAME	10 FIELD NAME	FIELD DESCRIPTION 	WKSHT CD	LINE	COLUMN
						
NUMERIC	A_C6_88	A_C6_113	Interest Expense	A000000	11300	600
NUMERIC	A_C6_89	A_C6_114	Utilization Review SNF	A000000	11400	600
ROLLUP	A_C6_92	A_C6_115	ASC (Distinct Part)	A000000	11500	600
ROLLUP	A_C6_93	A_C6_116	Hospice	A000000	11600	600
ROLLUP	A_C6_94	A_C6_117	Other Special Purpose	A000000	11700	600
ROLLUP	A_C6_96	A_C6_190	"Gift, Flower, Coffee Shop, Canteen"	A000000	19000	600
ROLLUP	A_C6_97	A_C6_191	Research	A000000	19100	600
ROLLUP	A_C6_98	A_C6_192	Physicians' Private Office	A000000	19200	600
ROLLUP	A_C6_99	A_C6_193	Nonpaid Workers	A000000	19300	600
ROLLUP	A_C6_100	A_C6_194	Other Nonreimbursable	A000000	19400	600
NUMERIC	A_C6_101	A_C6_200	Total Salaries	A000000	20000	600
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
	ANALYSIS OF CHANGES IN NEW CAPITAL BALANCES					
	"2552-10 WORKSHEET A-7, PART II"					
						
DATA TYPE	96 FIELD NAME	10 FIELD NAME	FIELD DESCRIPTION 	WKSHT CD	LINE	COLUMN
						
	Column 1 (Beginning Balances)					
						
NUMERIC	A7_2_C1_1	A7_1_C1_1	Land 	A700001	100	100
NUMERIC	A7_2_C1_2	A7_1_C1_2	Land Improvements	A700001	200	100
NUMERIC	A7_2_C1_3	A7_1_C1_3	Buildings and Fixtures	A700001	300	100
NUMERIC	A7_2_C1_4	A7_1_C1_4	Building Improvements	A700001	400	100
NUMERIC	A7_2_C1_5	A7_1_C1_5	Fixed Equipment	A700001	500	100
NUMERIC	A7_2_C1_6	A7_1_C1_6	Movable Equipment	A700001	600	100
NUMERIC	A7_2_C1_7	A7_1_C1_8	Subtotal	A700001	800	100
NUMERIC	A7_2_C1_9	A7_1_C1_10	Total	A700001	1000	100
						
	Column 2 (Purchases)					
						
NUMERIC	A7_2_C2_1	A7_1_C2_1	Land 	A700001	100	200
NUMERIC	A7_2_C2_2	A7_1_C2_2	Land Improvements	A700001	200	200
NUMERIC	A7_2_C2_3	A7_1_C2_3	Buildings and Fixtures	A700001	300	200
NUMERIC	A7_2_C2_4	A7_1_C2_4	Building Improvements	A700001	400	200
NUMERIC	A7_2_C2_5	A7_1_C2_5	Fixed Equipment	A700001	500	200
NUMERIC	A7_2_C2_6	A7_1_C2_6	Movable Equipment	A700001	600	200
NUMERIC	A7_2_C2_7	A7_1_C2_8	Subtotal	A700001	800	200
NUMERIC	A7_2_C2_9	A7_1_C2_10	Total	A700001	1000	200
						
	Column 3 (Donations)					
						
NUMERIC	A7_2_C3_1	A7_1_C3_1	Land 	A700001	100	300
NUMERIC	A7_2_C3_2	A7_1_C3_2	Land Improvements	A700001	200	300
NUMERIC	A7_2_C3_3	A7_1_C3_3	Buildings and Fixtures	A700001	300	300
NUMERIC	A7_2_C3_4	A7_1_C3_4	Building Improvements	A700001	400	300
NUMERIC	A7_2_C3_5	A7_1_C3_5	Fixed Equipment	A700001	500	300
NUMERIC	A7_2_C3_6	A7_1_C3_6	Movable Equipment	A700001	600	300
NUMERIC	A7_2_C3_7	A7_1_C3_8	Subtotal	A700001	800	300
NUMERIC	A7_2_C3_9	A7_1_C3_10	Total	A700001	1000	300
						
	Column 5 (Disposals and Retirements)					
						
NUMERIC	A7_2_C5_1	A7_1_C5_1	Land 	A700001	100	500
NUMERIC	A7_2_C5_2	A7_1_C5_2	Land Improvements	A700001	200	500
NUMERIC	A7_2_C5_3	A7_1_C5_3	Buildings and Fixtures	A700001	300	500
NUMERIC	A7_2_C5_4	A7_1_C5_4	Building Improvements	A700001	400	500
NUMERIC	A7_2_C5_5	A7_1_C5_5	Fixed Equipment	A700001	500	500
NUMERIC	A7_2_C5_6	A7_1_C5_6	Movable Equipment	A700001	600	500
NUMERIC	A7_2_C5_7	A7_1_C5_8	Subtotal	A700001	800	500
NUMERIC	A7_2_C5_9	A7_1_C5_10	Total	A700001	1000	500
						
	Column 7 (Fully Depreciated Assets)					
						
NUMERIC	A7_2_C7_1	A7_1_C7_1	Land 	A700001	100	700
NUMERIC	A7_2_C7_2	A7_1_C7_2	Land Improvements	A700001	200	700
NUMERIC	A7_2_C7_3	A7_1_C7_3	Buildings and Fixtures	A700001	300	700
NUMERIC	A7_2_C7_4	A7_1_C7_4	Building Improvements	A700001	400	700
NUMERIC	A7_2_C7_5	A7_1_C7_5	Fixed Equipment	A700001	500	700
NUMERIC	A7_2_C7_6	A7_1_C7_6	Movable Equipment	A700001	600	700
NUMERIC	A7_2_C7_7	A7_1_C7_8	Subtotal	A700001	800	700
NUMERIC	A7_2_C7_9	A7_1_C7_10	Total	A700001	1000	700
						
						
						
						
						
						
						
						
						
						
						
	RECONCILIATION OF CAPITAL COST CENTERS					
	"2552-10 WORKSHEET A-7, PART III"					
						
DATA TYPE	96 FIELD NAME	10 FIELD NAME	FIELD DESCRIPTION 	WKSHT CD	LINE	COLUMN
						
	Column 5 (Insurance) 					
						
ROLLUP	A7_3_C5_3	A7_3_C5_1	New Cap Related Csts Bldg & Fixtures	A700003	100	500
ROLLUP	A7_3_C5_4	A7_3_C5_2	New Cap Related Csts Movable Equipment	A700003	200	500
NUMERIC	A7_3_C5_5	A7_3_C5_3	Total	A700003	300	500
						
	Column 6 (Taxes) 					
						
ROLLUP	A7_3_C6_3	A7_3_C6_1	New Cap Related Csts Bldg & Fixtures	A700003	100	600
ROLLUP	A7_3_C6_4	A7_3_C6_2	New Cap Related Csts Movable Equipment	A700003	200	600
NUMERIC	A7_3_C6_5	A7_3_C6_3	Total	A700003	300	600
						
	Column 7 (Other Capital Related Costs)					
						
ROLLUP	A7_3_C7_3	A7_3_C7_1	New Cap Related Csts Bldg & Fixtures	A700003	100	700
ROLLUP	A7_3_C7_4	A7_3_C7_2	New Cap Related Csts Movable Equipment	A700003	200	700
NUMERIC	A7_3_C7_5	A7_3_C7_3	Total	A700003	300	700
						
	Column 9 (Depreciation)					
						
ROLLUP	A7_3_C9_3	A7_3_C9_1	New Cap Related Csts Bldg & Fixtures	A700003	100	900
ROLLUP	A7_3_C9_4	A7_3_C9_2	New Cap Related Csts Movable Equipment	A700003	200	900
NUMERIC	A7_3_C9_5	A7_3_C9_3	Total	A700003	300	900
						
	Column 10 (Lease) 					
						
ROLLUP	A7_3_C10_3	A7_3_C10_1	New Cap Related Csts Bldg & Fixtures	A700003	100	1000
ROLLUP	A7_3_C10_4	A7_3_C10_2	New Cap Related Csts Movable Equipment	A700003	200	1000
NUMERIC	A7_3_C10_5	A7_3_C10_3	Total	A700003	300	1000
						
	Column 11 (Interest) 					
						
ROLLUP	A7_3_C11_3	A7_3_C11_1	New Cap Related Csts Bldg & Fixtures	A700003	100	1100
ROLLUP	A7_3_C11_4	A7_3_C11_2	New Cap Related Csts Movable Equipment	A700003	200	1100
NUMERIC	A7_3_C11_5	A7_3_C11_3	Total	A700003	300	1100
						
	Column 15 (Total)					
						
ROLLUP	A7_3_C15_3	A7_3_C15_1	New Cap Related Csts Bldg & Fixtures	A700003	100	1500
ROLLUP	A7_3_C15_4	A7_3_C15_2	New Cap Related Csts Movable Equipment	A700003	200	1500
NUMERIC	A7_3_C15_5	A7_3_C15_3	Total	A700003	300	1500
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
	ADJUSTMENTS					
	2552-10 WORKSHEET A-8					
						
DATA TYPE	96 FIELD NAME	10 FIELD NAME	FIELD DESCRIPTION 	WKSHT CD	LINE	COLUMN
						
NUMERIC	A8_C2_3	A8_C2_1	Investment Income-New Bldgs & Fixtures	A800000	100	200
NUMERIC	A8_C2_4	A8_C2_2	Investment Income-New Movable Equip	A800000	200	200
NUMERIC	A8_C2_5	A8_C2_3	Investment Income-Other	A800000	300	200
NUMERIC	A8_C2_6	A8_C2_4	"Trade, Quantity, and Time Discounts"	A800000	400	200
NUMERIC	A8_C2_7	A8_C2_5	Refunds and Rebates of Expenses	A800000	500	200
NUMERIC	A8_C2_8	A8_C2_6	Rental of Provider space by suppliers	A800000	600	200
NUMERIC	A8_C2_9	A8_C2_7	Telephone Services	A800000	700	200
NUMERIC	A8_C2_10	A8_C2_8	Television and Radio Service	A800000	800	200
NUMERIC	A8_C2_11	A8_C2_9	Parking Lot	A800000	900	200
NUMERIC	A8_C2_12	A8_C2_10	Provider-based physician adjustment	A800000	1000	200
NUMERIC	A8_C2_13	A8_C2_11	"Sale of scrap, waste, etc. "	A800000	1100	200
NUMERIC	A8_C2_14	A8_C2_12	Related Organization Transactions	A800000	1200	200
NUMERIC	A8_C2_15	A8_C2_13	Laundry and Linen Service	A800000	1300	200
NUMERIC	A8_C2_16	A8_C2_14	Cafeteria employees and guests	A800000	1400	200
NUMERIC	A8_C2_17	A8_C2_15	Rental of quarters to employee and oths	A800000	1500	200
NUMERIC	A8_C2_18	A8_C2_16	Sale of medical and surgical supplies to 	A800000	1600	200
NUMERIC	A8_C2_19	A8_C2_17	Sale of drugs to other than patients	A800000	1700	200
NUMERIC	A8_C2_20	A8_C2_18	Sale of medical records and abstracts	A800000	1800	200
NUMERIC	A8_C2_21	A8_C2_19	Nursing School	A800000	1900	200
NUMERIC	A8_C2_22	A8_C2_20	Vending Machines	A800000	2000	200
NUMERIC	A8_C2_23	A8_C2_21	"Income from imposition of interest, finance"	A800000	2100	200
NUMERIC	A8_C2_24	A8_C2_22	Interest expense on Medicare Overpaymts	A800000	2200	200
NUMERIC	A8_C2_25	A8_C2_23	Adj for Respiratory therapy costs in excess 	A800000	2300	200
NUMERIC	A8_C2_26	A8_C2_24	Adj for Physical therapy costs in excess 	A800000	2400	200
NUMERIC	A8_C2_28	A8_C2_25	Utilization Review-physicians compens	A800000	2500	200
NUMERIC	A8_C2_31	A8_C2_26	Depreciation-New Bldgs & Fixtures	A800000	2600	200
NUMERIC	A8_C2_32	A8_C2_27	Depreciation-New Movable Equipment	A800000	2700	200
NUMERIC	A8_C2_33	A8_C2_28	Non-physician Anesthetist	A800000	2800	200
NUMERIC	A8_C2_34	A8_C2_29	Physicians' Assistant	A800000	2900	200
NUMERIC	A8_C2_35	A8_C2_30	Adj for Occupational therapy in excess of li	A800000	3000	200
NUMERIC	A8_C2_36	A8_C2_31	Adj for Speech therapy in excess of lim	A800000	3100	200
ROLLUP	NOT IN 96 SAS FILE	A8_C2_33	Other Adjustments (Summed)	A800000	3300	200
NUMERIC	A8_C2_50	A8_C2_50	Total	A800000	5000	200
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
	COST ALLOCATION					
	"2552-10 WORKSHEET B, PART I"					
						
DATA TYPE	96 FIELD NAME	10 FIELD NAME	FIELD DESCRIPTION 	WKSHT CD	LINE	COLUMN
						
	Net Expense for Cost Allocation					
						
ROLLUP	B_1_C0_3	B_1_C0_1	New Capital Buildings and Fixtures	B000001	100	0
ROLLUP	B_1_C0_4	B_1_C0_2	New Capital Equipment	B000001	200	0
NUMERIC	NOT ON OLD FORM	B_1_C0_3	Other Capital	B000001	300	0
ROLLUP	B_1_C0_5	B_1_C0_4	Employee Benefits	B000001	400	0
ROLLUP	B_1_C0_6	B_1_C0_5	Administrative and General	B000001	500	0
ROLLUP	B_1_C0_7	B_1_C0_6	Maintenance and Repairs	B000001	600	0
ROLLUP	B_1_C0_8	B_1_C0_7	Operation of Plant	B000001	700	0
ROLLUP	B_1_C0_9	B_1_C0_8	Laundry and Linen Service	B000001	800	0
ROLLUP	B_1_C0_10	B_1_C0_9	Housekeeping	B000001	900	0
ROLLUP	B_1_C0_11	B_1_C0_10	Dietary	B000001	1000	0
ROLLUP	B_1_C0_12	B_1_C0_11 	Cafeteria	B000001	1100	0
ROLLUP	B_1_C0_13	B_1_C0_12	Maintenance of Personnel	B000001	1200	0
ROLLUP	B_1_C0_14	B_1_C0_13	Nursing Administration	B000001	1300	0
ROLLUP	B_1_C0_15	B_1_C0_14	Central Services and Supply	B000001	1400	0
ROLLUP	B_1_C0_16	B_1_C0_15	Pharmacy	B000001	1500	0
ROLLUP	B_1_C0_17	B_1_C0_16	Medical Records and Medical Rec. Library	B000001	1600	0
ROLLUP	B_1_C0_18	B_1_C0_17	Social Service	B000001	1700	0
ROLLUP	B_1_C0_19	B_1_C0_18	Other General Service	B000001	1800	0
ROLLUP	B_1_C0_20	B_1_C0_19	Nonphysician Anesthetists	B000001	1900	0
ROLLUP	B_1_C0_21	B_1_C0_20	Nursing School	B000001	2000	0
ROLLUP	B_1_C0_22	B_1_C0_21	Interns & Res Salary and Fringe Benefits	B000001	2100	0
ROLLUP	B_1_C0_23	B_1_C0_22	Interns & Res Other Program Costs	B000001	2200	0
ROLLUP	B_1_C0_24	B_1_C0_23	Paramedical Education	B000001	2300	0
NUMERIC	B_1_C0_25	B_1_C0_30	Adults and Pediatrics	B000001	3000	0
ROLLUP	B_1_C0_26	B_1_C0_31	Intensive Care Unit	B000001	3100	0
ROLLUP	B_1_C0_27	B_1_C0_32	Coronary Care Unit	B000001	3200	0
ROLLUP	B_1_C0_28	B_1_C0_33	Burn Intensive Care Unit	B000001	3300	0
ROLLUP	B_1_C0_29	B_1_C0_34	Surgical Intensive Care Unit	B000001	3400	0
ROLLUP	B_1_C0_30	B_1_C0_35	Other Special Care Unit	B000001	3500	0
NUMERIC	NOT ON OLD FORM	B_1_C0_40	Subprovider-IPF	B000001	4000	0
NUMERIC	NOT ON OLD FORM	B_1_C0_41	Subprovider-IRF	B000001	4100	0
NUMERIC	B_1_C0_31	B_1_C0_42	Subprovider I	B000001	4200	0
NUMERIC	B_1_C0_3101	B_1_C0_4201	Subprovider II	B000001	4201	0
NUMERIC	B_1_C0_33	B_1_C0_43	Nursery	B000001	4300	0
NUMERIC	B_1_C0_34	B_1_C0_44	SNF	B000001	4400	0
NUMERIC	B_1_C0_35	B_1_C0_45	NF	B000001	4500	0
NUMERIC	B_1_C0_3501	B_1_C0_4501	ICF	B000001	4501	0
NUMERIC	B_1_C0_36	B_1_C0_46	OLTC	B000001	4600	0
ROLLUP	B_1_C0_37	B_1_C0_50	Operating Room	B000001	5000	0
ROLLUP	B_1_C0_38	B_1_C0_51	Recovery Room	B000001	5100	0
ROLLUP	B_1_C0_39	B_1_C0_52	Delivery Room and Labor Room	B000001	5200	0
ROLLUP	B_1_C0_40	B_1_C0_53	Anesthesiology	B000001	5300	0
ROLLUP	B_1_C0_41	B_1_C0_54	Radiology-Diagnostic	B000001	5400	0
ROLLUP	B_1_C0_42	B_1_C0_55	Radiology-Therapeutic	B000001	5500	0
ROLLUP	B_1_C0_43	B_1_C0_56	Radioisotope	B000001	5600	0
ROLLUP	NOT ON OLD FORM	B_1_C0_57	CT Scan	B000001	5700	0
ROLLUP	NOT ON OLD FORM	B_1_C0_58	MRI	B000001	5800	0
ROLLUP	NOT ON OLD FORM	B_1_C0_59	Cardiac Catheterization	B000001	5900	0
ROLLUP	B_1_C0_44	B_1_C0_60	Laboratory	B000001	6000	0
NUMERIC	B_1_C0_45	B_1_C0_61	PBP Clinical Lab Services Program Only	B000001	6100	0
ROLLUP	B_1_C0_46	B_1_C0_62	Whole Blood & Packed Red Blood Cells	B000001	6200	0
ROLLUP	B_1_C0_4630	B_1_C0_6250	Blood Clotting Factors for Hemoph.	B000001	6250	0
						
						
						
						
						
						
						
						
						
						
	COST ALLOCATION					
	"2552-10 WORKSHEET B, PART I"					
						
DATA TYPE	96 FIELD NAME	10 FIELD NAME	FIELD DESCRIPTION 	WKSHT CD	LINE	COLUMN
						
	Net Expense for Cost Allocation					
						
ROLLUP	B_1_C0_47	B_1_C0_63	"Blood Storing, Processing, Trans"	B000001	6300	0
ROLLUP	B_1_C0_48	B_1_C0_64	Intravenous Therapy	B000001	6400	0
ROLLUP	B_1_C0_49	B_1_C0_65	Respiratory Therapy	B000001	6500	0
ROLLUP	B_1_C0_50	B_1_C0_66	Physical Therapy	B000001	6600	0
ROLLUP	B_1_C0_51	B_1_C0_67	Occupational Therapy	B000001	6700	0
ROLLUP	B_1_C0_52	B_1_C0_68	Speech Pathology	B000001	6800	0
ROLLUP	B_1_C0_53	B_1_C0_69	Electrocardiology	B000001	6900	0
ROLLUP	B_1_C0_54	B_1_C0_70	Electroencephalography	B000001	7000	0
ROLLUP	B_1_C0_55	B_1_C0_71	Medical Supplies Charged to Patients	B000001	7100	0
ROLLUP	B_1_C0_5530	B_1_C0_72	Impl. Dev. Charged to Patients 	B000001	7200	0
ROLLUP	B_1_C0_56	B_1_C0_73	Drugs Charged to Patients	B000001	7300	0
NUMERIC	B_1_C0_57	B_1_C0_74	Renal Dialysis	B000001	7400	0
ROLLUP	B_1_C0_58	B_1_C0_75	ASC (Non Distinct Part)	B000001	7500	0
ROLLUP	B_1_C0_59	B_1_C0_76	Other Ancillary	B000001	7600	0
ROLLUP	B_1_C0_6350	B_1_C0_88	RHC	B000001	8800	0
ROLLUP	B_1_C0_6360	B_1_C0_89	FQHC	B000001	8900	0
ROLLUP	B_1_C0_60	B_1_C0_90	Clinic	B000001	9000	0
ROLLUP	B_1_C0_61	B_1_C0_91	Emergency	B000001	9100	0
NUMERIC		B_1_C0_92	Observation Beds (non Distinct Unit)	B000001	9200	0
ROLLUP	B_1_C0_6201	B_1_C0_9201	Observation Beds (Distinct Unit)	B000001	9201	0
ROLLUP	B_1_C0_63	B_1_C0_93	Other Outpatient Services	B000001	9300	0
NUMERIC	B_1_C0_64	B_1_C0_94	Home Program Dialysis	B000001	9400	0
NUMERIC	B_1_C0_65	B_1_C0_95	Ambulance Services	B000001	9500	0
ROLLUP	B_1_C0_66	B_1_C0_96	Durable Medical Equipment Rented	B000001	9600	0
ROLLUP	B_1_C0_67	B_1_C0_97	Durable Medical Equipment Sold	B000001	9700	0
ROLLUP	B_1_C0_68	B_1_C0_98	Other Reimbursable	B000001	9800	0
ROLLUP	B_1_C0_6910	B_1_C0_99	CMHC	B000001	9900	0
ROLLUP	B_1_C0_69	B_1_C0_9910	CORF	B000001	9910	0
ROLLUP	B_1_C0_6920	B_1_C0_9920	OPT	B000001	9920	0
ROLLUP	B_1_C0_6930	B_1_C0_9930	OOT	B000001	9930	0
ROLLUP	B_1_C0_6940	B_1_C0_9940	OSP	B000001	9940	0
NUMERIC	B_1_C0_70	B_1_C0_100	Int & Res (non approved teaching program	B000001	10000	0
ROLLUP	B_1_C0_71	B_1_C0_101	HHA	B000001	10100	0
NUMERIC	B_1_C0_83	B_1_C0_105	Kidney Acquisition	B000001	10500	0
NUMERIC	B_1_C0_85	B_1_C0_106	Heart Acquisition	B000001	10600	0
NUMERIC	B_1_C0_84	B_1_C0_107	Liver Acquisition	B000001	10700	0
NUMERIC	B_1_C0_82	B_1_C0_108	Lung  Acquisition	B000001	10800	0
NUMERIC	B_1_C0_8501	B_1_C0_109	Pancreas Acquisition	B000001	10900	0
NUMERIC	B_1_C0_8502	B_1_C0_110	Intestinal Acquisition	B000001	11000	0
NUMERIC	NOT ON OLD FORM	B_1_C0_111	Islet Acquisition	B000001	11100	0
ROLLUP	B_1_C0_86	B_1_C0_112	Other Organ Acquisition	B000001	11200	0
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
	COST ALLOCATION					
	"2552-10 WORKSHEET B, PART I"					
						
DATA TYPE	96 FIELD NAME	10 FIELD NAME	FIELD DESCRIPTION 	WKSHT CD	LINE	COLUMN
						
	Net Expense for Cost Allocation					
						
						
NUMERIC	B_1_C0_88	B_1_C0_113	Interest Expense	B000001	11300	0
NUMERIC	B_1_C0_89	B_1_C0_114	Utilization Review SNF	B000001	11400	0
ROLLUP	B_1_C0_92	B_1_C0_115	ASC (Distinct Part)	B000001	11500	0
ROLLUP	B_1_C0_93	B_1_C0_116	Hospice	B000001	11600	0
ROLLUP	B_1_C0_94	B_1_C0_117	Other Special Purpose	B000001	11700	0
ROLLUP	B_1_C0_96	B_1_C0_190	"Gift, Flower, Coffee Shop, Canteen"	B000001	19000	0
ROLLUP	B_1_C0_97	B_1_C0_191	Research	B000001	19100	0
ROLLUP	B_1_C0_98	B_1_C0_192	Physicians' Private Office	B000001	19200	0
ROLLUP	B_1_C0_99	B_1_C0_193	Nonpaid Workers	B000001	19300	0
ROLLUP	B_1_C0_100	B_1_C0_194	Other Nonreimbursable	B000001	19400	0
NUMERIC	B_1_C0_101	B_1_C0_200	Total	B000001	20200	0
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
	COST ALLOCATION					
	"2552-10 WORKSHEET B, PART I"					
						
DATA TYPE	96 FIELD NAME	10 FIELD NAME	FIELD DESCRIPTION 	WKSHT CD	LINE	COLUMN
						
NUMERIC	B_1_C27_25	B_1_C26_30	Adults and Pediatrics	B000001	3000	2600
ROLLUP	B_1_C27_26	B_1_C26_31	Intensive Care Unit	B000001	3100	2600
ROLLUP	B_1_C27_27	B_1_C26_32	Coronary Care Unit	B000001	3200	2600
ROLLUP	B_1_C27_28	B_1_C26_33	Burn Intensive Care Unit	B000001	3300	2600
ROLLUP	B_1_C27_29	B_1_C26_34	Surgical Intensive Care Unit	B000001	3400	2600
ROLLUP	B_1_C27_30	B_1_C26_35	Other Special Care Unit	B000001	3500	2600
NUMERIC	NOT ON OLD FORM	B_1_C26_40	Subprovider-IPF	B000001	4000	2600
NUMERIC	NOT ON OLD FORM	B_1_C26_41	Subprovider-IRF	B000001	4100	2600
NUMERIC	B_1_C27_31	B_1_C26_42	Subprovider I	B000001	4200	2600
NUMERIC	B_1_C27_3101	B_1_C26_4201	Subprovider II	B000001	4201	2600
NUMERIC	B_1_C27_33	B_1_C26_43	Nursery	B000001	4300	2600
NUMERIC	B_1_C27_34	B_1_C26_44	SNF	B000001	4400	2600
NUMERIC	B_1_C27_35	B_1_C26_45	NF	B000001	4500	2600
NUMERIC	B_1_C27_3501	B_1_C26_4501	ICF	B000001	4501	2600
NUMERIC	B_1_C27_36	B_1_C26_46	OLTC	B000001	4600	2600
ROLLUP	B_1_C27_37	B_1_C26_50	Operating Room	B000001	5000	2600
ROLLUP	B_1_C27_38	B_1_C26_51	Recovery Room	B000001	5100	2600
ROLLUP	B_1_C27_39	B_1_C26_52	Delivery Room and Labor Room	B000001	5200	2600
ROLLUP	B_1_C27_40	B_1_C26_53	Anesthesiology	B000001	5300	2600
ROLLUP	B_1_C27_41	B_1_C26_54	Radiology-Diagnostic	B000001	5400	2600
ROLLUP	B_1_C27_42	B_1_C26_55	Radiology-Therapeutic	B000001	5500	2600
ROLLUP	B_1_C27_43	B_1_C26_56	Radioisotope	B000001	5600	2600
ROLLUP	NOT ON OLD FORM	B_1_C26_57	CT Scan	B000001	5700	2600
ROLLUP	NOT ON OLD FORM	B_1_C26_58	MRI	B000001	5800	2600
ROLLUP	NOT ON OLD FORM	B_1_C26_59	Cardiac Catheterization	B000001	5900	2600
ROLLUP	B_1_C27_44	B_1_C26_60	Laboratory	B000001	6000	2600
NUMERIC	B_1_C27_45	B_1_C26_61	PBP Clinical Lab Services Program Only	B000001	6100	2600
ROLLUP	B_1_C27_46	B_1_C26_62	Whole Blood & Packed Red Blood Cells	B000001	6200	2600
ROLLUP	B_1_C27_4630	B_1_C26_6250	Blood Clotting Factors for Hemoph.	B000001	6250	2600
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
	COST ALLOCATION					
	"2552-10 WORKSHEET B, PART I"					
						
DATA TYPE	96 FIELD NAME	10 FIELD NAME	FIELD DESCRIPTION 	WKSHT CD	LINE	COLUMN
						
ROLLUP	B_1_C27_47	B_1_C26_63	"Blood Storing, Processing, Trans"	B000001	6300	2600
ROLLUP	B_1_C27_48	B_1_C26_64	Intravenous Therapy	B000001	6400	2600
ROLLUP	B_1_C27_49	B_1_C26_65	Respiratory Therapy	B000001	6500	2600
ROLLUP	B_1_C27_50	B_1_C26_66	Physical Therapy	B000001	6600	2600
ROLLUP	B_1_C27_51	B_1_C26_67	Occupational Therapy	B000001	6700	2600
ROLLUP	B_1_C27_52	B_1_C26_68	Speech Pathology	B000001	6800	2600
ROLLUP	B_1_C27_53	B_1_C26_69	Electrocardiology	B000001	6900	2600
ROLLUP	B_1_C27_54	B_1_C26_70	Electroencephalography	B000001	7000	2600
ROLLUP	B_1_C27_55	B_1_C26_71	Medical Supplies Charged to Patients	B000001	7100	2600
ROLLUP	B_1_C27_5530	B_1_C26_72	Impl. Dev. Charged to Patients 	B000001	7200	2600
ROLLUP	B_1_C27_56	B_1_C26_73	Drugs Charged to Patients	B000001	7300	2600
NUMERIC	B_1_C27_57	B_1_C26_74	Renal Dialysis	B000001	7400	2600
ROLLUP	B_1_C27_58	B_1_C26_75	ASC (Non Distinct Part)	B000001	7500	2600
ROLLUP	B_1_C27_59	B_1_C26_76	Other Ancillary	B000001	7600	2600
ROLLUP	B_1_C27_6350	B_1_C26_88	RHC	B000001	8800	2600
ROLLUP	B_1_C27_6360	B_1_C26_89	FQHC	B000001	8900	2600
ROLLUP	B_1_C27_60	B_1_C26_90	Clinic	B000001	9000	2600
ROLLUP	B_1_C27_61	B_1_C26_91	Emergency	B000001	9100	2600
ROLLUP	B_1_C27_6201	B_1_C26_9201	Observation Beds (Distinct Unit)	B000001	9201	2600
ROLLUP	B_1_C27_63	B_1_C26_93	Other Outpatient Services	B000001	9300	2600
NUMERIC	B_1_C27_64	B_1_C26_94	Home Program Dialysis	B000001	9400	2600
NUMERIC	B_1_C27_65	B_1_C26_95	Ambulance Services	B000001	9500	2600
ROLLUP	B_1_C27_66	B_1_C26_96	Durable Medical Equipment Rented	B000001	9600	2600
ROLLUP	B_1_C27_67	B_1_C26_97	Durable Medical Equipment Sold	B000001	9700	2600
ROLLUP	B_1_C27_68	B_1_C26_98	Other Reimbursable	B000001	9800	2600
ROLLUP	B_1_C27_6910	B_1_C26_99	CMHC	B000001	9900	2600
ROLLUP	B_1_C27_69	B_1_C26_9910	CORF	B000001	9910	2600
ROLLUP	B_1_C27_6920	B_1_C26_9920	OPT	B000001	9920	2600
ROLLUP	B_1_C27_6930	B_1_C26_9930	OOT	B000001	9930	2600
ROLLUP	B_1_C27_6940	B_1_C26_9940	OSP	B000001	9940	2600
NUMERIC	B_1_C27_70	B_1_C26_100	Int & Res (non approved teaching program	B000001	10000	2600
ROLLUP	B_1_C27_71	B_1_C26_101	HHA	B000001	10100	2600
NUMERIC	B_1_C27_83	B_1_C26_105	Kidney Acquisition	B000001	10500	2600
NUMERIC	B_1_C27_85	B_1_C26_106	Heart Acquisition	B000001	10600	2600
NUMERIC	B_1_C27_84	B_1_C26_107	Liver Acquisition	B000001	10700	2600
NUMERIC	B_1_C27_82	B_1_C26_108	Lung  Acquisition	B000001	10800	2600
NUMERIC	B_1_C27_8501	B_1_C26_109	Pancreas Acquisition	B000001	10900	2600
NUMERIC	B_1_C27_8502	B_1_C26_110	Intestinal Acquisition	B000001	11000	2600
NUMERIC	NOT ON OLD FORM	B_1_C26_111	Islet Acquisition	B000001	11100	2600
ROLLUP	B_1_C27_86	B_1_C26_112	Other Organ Acquisition	B000001	11200	2600
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
	COST ALLOCATION					
	"2552-10 WORKSHEET B, PART I"					
						
DATA TYPE	96 FIELD NAME	10 FIELD NAME	FIELD DESCRIPTION 	WKSHT CD	LINE	COLUMN
						
NUMERIC	B_1_C27_88	B_1_C26_113	Interest Expense	B000001	11300	2600
NUMERIC	B_1_C27_89	B_1_C26_114	Utilization Review SNF	B000001	11400	2600
ROLLUP	B_1_C27_92	B_1_C26_115	ASC (Distinct Part)	B000001	11500	2600
ROLLUP	B_1_C27_93	B_1_C26_116	Hospice	B000001	11600	2600
ROLLUP	B_1_C27_94	B_1_C26_117	Other Special Purpose	B000001	11700	2600
ROLLUP	B_1_C27_96	B_1_C26_190	"Gift, Flower, Coffee Shop, Canteen"	B000001	19000	2600
ROLLUP	B_1_C27_97	B_1_C26_191	Research	B000001	19100	2600
ROLLUP	B_1_C27_98	B_1_C26_192	Physicians' Private Office	B000001	19200	2600
ROLLUP	B_1_C27_99	B_1_C26_193	Nonpaid Workers	B000001	19300	2600
ROLLUP	B_1_C27_100	B_1_C26_194	Other Nonreimbursable	B000001	19400	2600
NUMERIC	B_1_C27_101	B_1_C26_200	Cross Foot Adjustments	B000001	20000	2600
NUMERIC	B_1_C27_102	B_1_C26_201	Negative Cost Centers	B000001	20100	2600
NUMERIC	B_1_C27_103	B_1_C26_202	Total  	B000001	20200	2600
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
	COST ALLOCATION					
	"2552-10 WORKSHEET B, PART I"					
						
DATA TYPE	96 FIELD NAME	10 FIELD NAME	FIELD DESCRIPTION 	WKSHT CD	LINE	COLUMN
						
	Allocation of Interns & Residents Salary and Fringes					
						
ROLLUP	B_1_C22_22	B_1_C21_21	Interns & Res Salary and Fringe Benefits	B000001	2100	2100
NUMERIC	B_1_C22_25	B_1_C21_30	Adults and Pediatrics	B000001	3000	2100
ROLLUP	B_1_C22_26	B_1_C21_31	Intensive Care Unit	B000001	3100	2100
ROLLUP	B_1_C22_27	B_1_C21_32	Coronary Care Unit	B000001	3200	2100
ROLLUP	B_1_C22_28	B_1_C21_33	Burn Intensive Care Unit	B000001	3300	2100
ROLLUP	B_1_C22_29	B_1_C21_34	Surgical Intensive Care Unit	B000001	3400	2100
ROLLUP	B_1_C22_30	B_1_C21_35	Other Special Care Unit	B000001	3500	2100
NUMERIC	NOT ON OLD FORM	B_1_C21_40	Subprovider-IPF	B000001	4000	2100
NUMERIC	NOT ON OLD FORM	B_1_C21_41	Subprovider-IRF	B000001	4100	2100
NUMERIC	B_1_C22_31	B_1_C21_42	Subprovider I	B000001	4200	2100
NUMERIC	B_1_C22_3101	B_1_C21_4201	Subprovider II	B000001	4201	2100
NUMERIC	B_1_C22_33	B_1_C21_43	Nursery	B000001	4300	2100
NUMERIC	B_1_C22_34	B_1_C21_44	SNF	B000001	4400	2100
NUMERIC	B_1_C22_35	B_1_C21_45	NF	B000001	4500	2100
NUMERIC	B_1_C22_3501	B_1_C21_4501	ICF	B000001	4501	2100
NUMERIC	B_1_C22_36	B_1_C21_46	OLTC	B000001	4600	2100
ROLLUP	B_1_C22_37	B_1_C21_50	Operating Room	B000001	5000	2100
ROLLUP	B_1_C22_38	B_1_C21_51	Recovery Room	B000001	5100	2100
ROLLUP	B_1_C22_39	B_1_C21_52	Delivery Room and Labor Room	B000001	5200	2100
ROLLUP	B_1_C22_40	B_1_C21_53	Anesthesiology	B000001	5300	2100
ROLLUP	B_1_C22_41	B_1_C21_54	Radiology-Diagnostic	B000001	5400	2100
ROLLUP	B_1_C22_42	B_1_C21_55	Radiology-Therapeutic	B000001	5500	2100
ROLLUP	B_1_C22_43	B_1_C21_56	Radioisotope	B000001	5600	2100
ROLLUP	NOT ON OLD FORM	B_1_C21_57	CT Scan	B000001	5700	2100
ROLLUP	NOT ON OLD FORM	B_1_C21_58	MRI	B000001	5800	2100
ROLLUP	NOT ON OLD FORM	B_1_C21_59	Cardiac Catheterization	B000001	5900	2100
ROLLUP	B_1_C22_44	B_1_C21_60	Laboratory	B000001	6000	2100
NUMERIC	B_1_C22_45	B_1_C21_61	PBP Clinical Lab Services Program Only	B000001	6100	2100
ROLLUP	B_1_C22_46	B_1_C21_62	Whole Blood & Packed Red Blood Cells	B000001	6200	2100
ROLLUP	B_1_C22_4630	B_1_C21_6250	Blood Clotting Factors for Hemoph.	B000001	6250	2100
ROLLUP	B_1_C22_47	B_1_C21_63	"Blood Storing, Processing, Trans"	B000001	6300	2100
ROLLUP	B_1_C22_48	B_1_C21_64	Intravenous Therapy	B000001	6400	2100
ROLLUP	B_1_C22_49	B_1_C21_65	Respiratory Therapy	B000001	6500	2100
ROLLUP	B_1_C22_50	B_1_C21_66	Physical Therapy	B000001	6600	2100
ROLLUP	B_1_C22_51	B_1_C21_67	Occupational Therapy	B000001	6700	2100
ROLLUP	B_1_C22_52	B_1_C21_68	Speech Pathology	B000001	6800	2100
ROLLUP	B_1_C22_53	B_1_C21_69	Electrocardiology	B000001	6900	2100
ROLLUP	B_1_C22_54	B_1_C21_70	Electroencephalography	B000001	7000	2100
ROLLUP	B_1_C22_55	B_1_C21_71	Medical Supplies Charged to Patients	B000001	7100	2100
ROLLUP	B_1_C22_5530	B_1_C21_72	Impl. Dev. Charged to Patients 	B000001	7200	2100
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
	COST ALLOCATION					
	"2552-10 WORKSHEET B, PART I"					
						
DATA TYPE	96 FIELD NAME	10 FIELD NAME	FIELD DESCRIPTION 	WKSHT CD	LINE	COLUMN
						
ROLLUP	B_1_C22_56	B_1_C21_73	Drugs Charged to Patients	B000001	7300	2100
NUMERIC	B_1_C22_57	B_1_C21_74	Renal Dialysis	B000001	7400	2100
ROLLUP	B_1_C22_58	B_1_C21_75	ASC (Non Distinct Part)	B000001	7500	2100
ROLLUP	B_1_C22_59	B_1_C21_76	Other Ancillary	B000001	7600	2100
ROLLUP	B_1_C22_6350	B_1_C21_88	RHC	B000001	8800	2100
ROLLUP	B_1_C22_6360	B_1_C21_89	FQHC	B000001	8900	2100
ROLLUP	B_1_C22_60	B_1_C21_90	Clinic	B000001	9000	2100
ROLLUP	B_1_C22_61	B_1_C21_91	Emergency	B000001	9100	2100
ROLLUP	B_1_C22_6201	B_1_C21_9201	Observation Beds (Distinct Unit)	B000001	9201	2100
ROLLUP	B_1_C22_63	B_1_C21_93	Other Outpatient Services	B000001	9300	2100
NUMERIC	B_1_C22_64	B_1_C21_94	Home Program Dialysis	B000001	9400	2100
NUMERIC	B_1_C22_65	B_1_C21_95	Ambulance Services	B000001	9500	2100
ROLLUP	B_1_C22_66	B_1_C21_96	Durable Medical Equipment Rented	B000001	9600	2100
ROLLUP	B_1_C22_67	B_1_C21_97	Durable Medical Equipment Sold	B000001	9700	2100
ROLLUP	B_1_C22_68	B_1_C21_98	Other Reimbursable	B000001	9800	2100
ROLLUP	B_1_C22_6910	B_1_C21_99	CMHC	B000001	9900	2100
ROLLUP	B_1_C22_69	B_1_C21_9910	CORF	B000001	9910	2100
ROLLUP	B_1_C22_6920	B_1_C21_9920	OPT	B000001	9920	2100
ROLLUP	B_1_C22_6930	B_1_C21_9930	OOT	B000001	9930	2100
ROLLUP	B_1_C22_6940	B_1_C21_9940	OSP	B000001	9940	2100
NUMERIC	B_1_C22_70	B_1_C21_100	Int & Res (non approved teaching program	B000001	10000	2100
ROLLUP	B_1_C22_71	B_1_C21_101	HHA	B000001	10100	2100
NUMERIC	B_1_C22_83	B_1_C21_105	Kidney Acquisition	B000001	10500	2100
NUMERIC	B_1_C22_85	B_1_C21_106	Heart Acquisition	B000001	10600	2100
NUMERIC	B_1_C22_84	B_1_C21_107	Liver Acquisition	B000001	10700	2100
NUMERIC	B_1_C22_82	B_1_C21_108	Lung  Acquisition	B000001	10800	2100
NUMERIC	B_1_C22_8501	B_1_C21_109	Pancreas Acquisition	B000001	10900	2100
NUMERIC	B_1_C22_8502	B_1_C21_110	Intestinal Acquisition	B000001	11000	2100
NUMERIC	NOT ON OLD FORM	B_1_C21_111	Islet Acquisition	B000001	11100	2100
ROLLUP	B_1_C22_86	B_1_C21_112	Other Organ Acquisition	B000001	11200	2100
NUMERIC	B_1_C22_88	B_1_C21_113	Interest Expense	B000001	11300	2100
NUMERIC	B_1_C22_89	B_1_C21_114	Utilization Review SNF	B000001	11400	2100
ROLLUP	B_1_C22_92	B_1_C21_115	ASC (Distinct Part)	B000001	11500	2100
ROLLUP	B_1_C22_93	B_1_C21_116	Hospice	B000001	11600	2100
ROLLUP	B_1_C22_94	B_1_C21_117	Other Special Purpose	B000001	11700	2100
ROLLUP	B_1_C22_96	B_1_C21_190	"Gift, Flower, Coffee Shop, Canteen"	B000001	19000	2100
ROLLUP	B_1_C22_97	B_1_C21_191	Research	B000001	19100	2100
ROLLUP	B_1_C22_98	B_1_C21_192	Physicians' Private Office	B000001	19200	2100
ROLLUP	B_1_C22_99	B_1_C21_193	Nonpaid Workers	B000001	19300	2100
ROLLUP	B_1_C22_100	B_1_C21_194	Other Nonreimbursable	B000001	19400	2100
ROLLUP	B_1_C22_102	B_1_C21_201	Negative Cost Centers	B000001	20100	2100
ROLLUP	B_1_C22_103	B_1_C21_202	Total	B000001	20200	2100
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
	"2552-10 WORKSHEET B, PART I"					
						
DATA TYPE	96 FIELD NAME	10 FIELD NAME	FIELD DESCRIPTION 	WKSHT CD	LINE	COLUMN
						
	Allocation of Interns & Residents Program Costs					
						
NUMERIC	B_1_C23_25	B_1_C22_30	Adults and Pediatrics	B000001	3000	2200
ROLLUP	B_1_C23_26	B_1_C22_31	Intensive Care Unit	B000001	3100	2200
ROLLUP	B_1_C23_27	B_1_C22_32	Coronary Care Unit	B000001	3200	2200
ROLLUP	B_1_C23_28	B_1_C22_33	Burn Intensive Care Unit	B000001	3300	2200
ROLLUP	B_1_C23_29	B_1_C22_34	Surgical Intensive Care Unit	B000001	3400	2200
ROLLUP	B_1_C23_30	B_1_C22_35	Other Special Care Unit	B000001	3500	2200
NUMERIC	NOT ON OLD FORM	B_1_C22_40	Subprovider-IPF	B000001	4000	2200
NUMERIC	NOT ON OLD FORM	B_1_C22_41	Subprovider-IRF	B000001	4100	2200
NUMERIC	B_1_C23_31	B_1_C22_42	Subprovider I	B000001	4200	2200
NUMERIC	B_1_C23_3101	B_1_C22_4201	Subprovider II	B000001	4201	2200
NUMERIC	B_1_C23_33	B_1_C22_43	Nursery	B000001	4300	2200
NUMERIC	B_1_C23_34	B_1_C22_44	SNF	B000001	4400	2200
NUMERIC	B_1_C23_35	B_1_C22_45	NF	B000001	4500	2200
NUMERIC	B_1_C23_3501	B_1_C22_4501	ICF	B000001	4501	2200
NUMERIC	B_1_C23_36	B_1_C22_46	OLTC	B000001	4600	2200
ROLLUP	B_1_C23_37	B_1_C22_50	Operating Room	B000001	5000	2200
ROLLUP	B_1_C23_38	B_1_C22_51	Recovery Room	B000001	5100	2200
ROLLUP	B_1_C23_39	B_1_C22_52	Delivery Room and Labor Room	B000001	5200	2200
ROLLUP	B_1_C23_40	B_1_C22_53	Anesthesiology	B000001	5300	2200
ROLLUP	B_1_C23_41	B_1_C22_54	Radiology-Diagnostic	B000001	5400	2200
ROLLUP	B_1_C23_42	B_1_C22_55	Radiology-Therapeutic	B000001	5500	2200
ROLLUP	B_1_C23_43	B_1_C22_56	Radioisotope	B000001	5600	2200
ROLLUP	NOT ON OLD FORM	B_1_C22_57	CT Scan	B000001	5700	2200
ROLLUP	NOT ON OLD FORM	B_1_C22_58	MRI	B000001	5800	2200
ROLLUP	NOT ON OLD FORM	B_1_C22_59	Cardiac Catheterization	B000001	5900	2200
ROLLUP	B_1_C23_44	B_1_C22_60	Laboratory	B000001	6000	2200
NUMERIC	B_1_C23_45	B_1_C22_61	PBP Clinical Lab Services Program Only	B000001	6100	2200
ROLLUP	B_1_C23_46	B_1_C22_62	Whole Blood & Packed Red Blood Cells	B000001	6200	2200
ROLLUP	B_1_C23_4630	B_1_C22_6250	Blood Clotting Factors for Hemoph.	B000001	6250	2200
ROLLUP	B_1_C23_47	B_1_C22_63	"Blood Storing, Processing, Trans"	B000001	6300	2200
ROLLUP	B_1_C23_48	B_1_C22_64	Intravenous Therapy	B000001	6400	2200
ROLLUP	B_1_C23_49	B_1_C22_65	Respiratory Therapy	B000001	6500	2200
ROLLUP	B_1_C23_50	B_1_C22_66	Physical Therapy	B000001	6600	2200
ROLLUP	B_1_C23_51	B_1_C22_67	Occupational Therapy	B000001	6700	2200
ROLLUP	B_1_C23_52	B_1_C22_68	Speech Pathology	B000001	6800	2200
ROLLUP	B_1_C23_53	B_1_C22_69	Electrocardiology	B000001	6900	2200
ROLLUP	B_1_C23_54	B_1_C22_70	Electroencephalography	B000001	7000	2200
ROLLUP	B_1_C23_55	B_1_C22_71	Medical Supplies Charged to Patients	B000001	7100	2200
ROLLUP	B_1_C23_5530	B_1_C22_72	Impl. Dev. Charged to Patients 	B000001	7200	2200
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
	COST ALLOCATION					
	"2552-10 WORKSHEET B, PART I"					
						
DATA TYPE	96 FIELD NAME	10 FIELD NAME	FIELD DESCRIPTION 	WKSHT CD	LINE	COLUMN
						
ROLLUP	B_1_C23_56	B_1_C22_73	Drugs Charged to Patients	B000001	7300	2200
NUMERIC	B_1_C23_57	B_1_C22_74	Renal Dialysis	B000001	7400	2200
ROLLUP	B_1_C23_58	B_1_C22_75	ASC (Non Distinct Part)	B000001	7500	2200
ROLLUP	B_1_C23_59	B_1_C22_76	Other Ancillary	B000001	7600	2200
ROLLUP	B_1_C23_6350	B_1_C22_88	RHC	B000001	8800	2200
ROLLUP	B_1_C23_6360	B_1_C22_89	FQHC	B000001	8900	2200
ROLLUP	B_1_C23_60	B_1_C22_90	Clinic	B000001	9000	2200
ROLLUP	B_1_C23_61	B_1_C22_91	Emergency	B000001	9100	2200
ROLLUP	B_1_C23_6201	B_1_C22_9201	Observation Beds (Distinct Unit)	B000001	9201	2200
ROLLUP	B_1_C23_63	B_1_C22_93	Other Outpatient Services	B000001	9300	2200
NUMERIC	B_1_C23_64	B_1_C22_94	Home Program Dialysis	B000001	9400	2200
NUMERIC	B_1_C23_65	B_1_C22_95	Ambulance Services	B000001	9500	2200
ROLLUP	B_1_C23_66	B_1_C22_96	Durable Medical Equipment Rented	B000001	9600	2200
ROLLUP	B_1_C23_67	B_1_C22_97	Durable Medical Equipment Sold	B000001	9700	2200
ROLLUP	B_1_C23_68	B_1_C22_98	Other Reimbursable	B000001	9800	2200
ROLLUP	B_1_C23_6910	B_1_C22_99	CMHC	B000001	9900	2200
ROLLUP	B_1_C23_69	B_1_C22_9910	CORF	B000001	9910	2200
ROLLUP	B_1_C23_6920	B_1_C22_9920	OPT	B000001	9920	2200
ROLLUP	B_1_C23_6930	B_1_C22_9930	OOT	B000001	9930	2200
ROLLUP	B_1_C23_6940	B_1_C22_9940	OSP	B000001	9940	2200
NUMERIC	B_1_C23_70	B_1_C22_100	Int & Res (non approved teaching program	B000001	10000	2200
ROLLUP	B_1_C23_71	B_1_C22_101	HHA	B000001	10100	2200
NUMERIC	B_1_C23_83	B_1_C22_105	Kidney Acquisition	B000001	10500	2200
NUMERIC	B_1_C23_85	B_1_C22_106	Heart Acquisition	B000001	10600	2200
NUMERIC	B_1_C23_84	B_1_C22_107	Liver Acquisition	B000001	10700	2200
NUMERIC	B_1_C23_82	B_1_C22_108	Lung  Acquisition	B000001	10800	2200
NUMERIC	B_1_C23_8501	B_1_C22_109	Pancreas Acquisition	B000001	10900	2200
NUMERIC	B_1_C23_8502	B_1_C22_110	Intestinal Acquisition	B000001	11000	2200
NUMERIC	NOT ON OLD FORM	B_1_C22_111	Islet Acquisition	B000001	11100	2200
ROLLUP	B_1_C23_86	B_1_C22_112	Other Organ Acquisition	B000001	11200	2200
NUMERIC	B_1_C23_88	B_1_C22_113	Interest Expense	B000001	11300	2200
NUMERIC	B_1_C23_89	B_1_C22_114	Utilization Review SNF	B000001	11400	2200
ROLLUP	B_1_C23_92	B_1_C22_115	ASC (Distinct Part)	B000001	11500	2200
ROLLUP	B_1_C23_93	B_1_C22_116	Hospice	B000001	11600	2200
ROLLUP	B_1_C23_94	B_1_C22_117	Other Special Purpose	B000001	11700	2200
ROLLUP	B_1_C23_96	B_1_C22_190	"Gift, Flower, Coffee Shop, Canteen"	B000001	19000	2200
ROLLUP	B_1_C23_97	B_1_C22_191	Research	B000001	19100	2200
ROLLUP	B_1_C23_98	B_1_C22_192	Physicians' Private Office	B000001	19200	2200
ROLLUP	B_1_C23_99	B_1_C22_193	Nonpaid Workers	B000001	19300	2200
ROLLUP	B_1_C23_100	B_1_C22_194	Other Nonreimbursable	B000001	19400	2200
ROLLUP	B_1_C23_102	B_1_C22_201	Negative Cost Centers	B000001	20100	2200
ROLLUP	B_1_C23_103	B_1_C22_202	Total	B000001	20200	2200
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
	COST ALLOCATION					
	"2552-10 WORKSHEET B, PART I"					
						
DATA TYPE	96 FIELD NAME	10 FIELD NAME	FIELD DESCRIPTION 	WKSHT CD	LINE	COLUMN
						
	Total Costs					
						
ROLLUP	B_1_C20_103	B_1_C19_202	Total NonPhysican Anesthetist	B000001	20200	1900
ROLLUP	B_1_C21_103	B_1_C20_202	Total Nursing School	B000001	20200	2000
ROLLUP	B_1_C24_103	B_1_C23_202	Total Paramedical Education	B000001	20200	2300
						
ROLLUP		B_1_C23_200	Crossfoot Adj- Paramedical Ed	B000001	20000	2300
ROLLUP		B_1_C23_201	Negative Cost Cntr- Paramedical Ed	B000001	20100	2300
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
	ALLOCATION OF NEW CAPITAL COSTS					
	"2552-10 WORKSHEET B, PART II"					
						
DATA TYPE	96 FIELD NAME	10 FIELD NAME	FIELD DESCRIPTION 	WKSHT CD	LINE	COLUMN
						
	TOTAL CAPITAL COSTS AFTER COST ALLOCATION					
						
NUMERIC	B_3_C0_103	B_2_C0_202	Total Directly Assigned New Cap Rel Csts 	B000002	20200	0
NUMERIC	B_3_C27_25	B_2_C26_30	Adults & Pediatrics	B000002	3000	2600
ROLLUP	B_3_C27_26	B_2_C26_31	Intensive Care Unit	B000002	3100	2600
ROLLUP	B_3_C27_27	B_2_C26_32	Coronary Care Unit	B000002	3200	2600
ROLLUP	B_3_C27_28	B_2_C26_33	Burn Intensive Care Unit	B000002	3300	2600
ROLLUP	B_3_C27_29	B_2_C26_34	Surgical Intensive Care Unit	B000002	3400	2600
ROLLUP	B_3_C27_30	B_2_C26_35	Other Special Care Unit	B000002	3500	2600
NUMERIC	NOT ON OLD FORM	B_2_C26_40	Subprovider-IPF	B000002	4000	2600
NUMERIC	NOT ON OLD FORM	B_2_C26_41	Subprovider-IRF	B000002	4100	2600
NUMERIC	B_3_C27_31	B_2_C26_42	Subprovider I	B000002	4200	2600
NUMERIC	B_3_C27_3101	B_2_C26_4201	Subprovider II	B000002	4201	2600
NUMERIC	B_3_C27_33	B_2_C26_43	Nursery	B000002	4300	2600
NUMERIC	B_3_C27_34	B_2_C26_44	SNF	B000002	4400	2600
NUMERIC	B_3_C27_35	B_2_C26_45	NF	B000002	4500	2600
NUMERIC	B_3_C27_3501	B_2_C26_4501	ICF	B000002	4501	2600
NUMERIC	B_3_C27_36	B_2_C26_46	OLTC	B000002	4600	2600
ROLLUP	B_3_C27_37	B_2_C26_50	Operating Room	B000002	5000	2600
ROLLUP	B_3_C27_38	B_2_C26_51	Recovery Room	B000002	5100	2600
ROLLUP	B_3_C27_39	B_2_C26_52	Delivery Room and Labor Room	B000002	5200	2600
ROLLUP	B_3_C27_40	B_2_C26_53	Anesthesiology	B000002	5300	2600
ROLLUP	B_3_C27_41	B_2_C26_54	Radiology-Diagnostic	B000002	5400	2600
ROLLUP	B_3_C27_42	B_2_C26_55	Radiology-Therapeutic	B000002	5500	2600
ROLLUP	B_3_C27_43	B_2_C26_56	Radioisotope	B000002	5600	2600
ROLLUP	NOT ON OLD FORM	B_2_C26_57	CT Scan	B000002	5700	2600
ROLLUP	NOT ON OLD FORM	B_2_C26_58	MRI	B000002	5800	2600
ROLLUP	NOT ON OLD FORM	B_2_C26_59	Cardiac Catheterization	B000002	5900	2600
ROLLUP	B_3_C27_44	B_2_C26_60	Laboratory	B000002	6000	2600
NUMERIC	B_3_C27_45	B_2_C26_61	PBP Clinical Lab Services Program Only	B000002	6100	2600
ROLLUP	B_3_C27_46	B_2_C26_62	Whole Blood & Packed Red Blood Cells	B000002	6200	2600
ROLLUP	B_3_C27_4630	B_2_C26_6250	Blood Clotting Factors for Hemoph.	B000002	6250	2600
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
	ALLOCATION OF NEW CAPITAL COSTS					
	"2552-10 WORKSHEET B, PART II"					
						
DATA TYPE	96 FIELD NAME	10 FIELD NAME	FIELD DESCRIPTION 	WKSHT CD	LINE	COLUMN
						
ROLLUP	B_3_C27_47	B_2_C26_63	"Blood Storing, Processing, Trans"	B000002	6300	2600
ROLLUP	B_3_C27_48	B_2_C26_64	Intravenous Therapy	B000002	6400	2600
ROLLUP	B_3_C27_49	B_2_C26_65	Respiratory Therapy	B000002	6500	2600
ROLLUP	B_3_C27_50	B_2_C26_66	Physical Therapy	B000002	6600	2600
ROLLUP	B_3_C27_51	B_2_C26_67	Occupational Therapy	B000002	6700	2600
ROLLUP	B_3_C27_52	B_2_C26_68	Speech Pathology	B000002	6800	2600
ROLLUP	B_3_C27_53	B_2_C26_69	Electrocardiology	B000002	6900	2600
ROLLUP	B_3_C27_54	B_2_C26_70	Electroencephalography	B000002	7000	2600
ROLLUP	B_3_C27_55	B_2_C26_71	Medical Supplies Charged to Patients	B000002	7100	2600
ROLLUP	B_3_C27_5530	B_2_C26_72	Impl. Dev. Charged to Patients 	B000002	7200	2600
ROLLUP	B_3_C27_56	B_2_C26_73	Drugs Charged to Patients	B000002	7300	2600
NUMERIC	B_3_C27_57	B_2_C26_74	Renal Dialysis	B000002	7400	2600
ROLLUP	B_3_C27_58	B_2_C26_75	ASC (Non Distinct Part)	B000002	7500	2600
ROLLUP	B_3_C27_59	B_2_C26_76	Other Ancillary	B000002	7600	2600
ROLLUP	B_3_C27_6350	B_2_C26_88	RHC	B000002	8800	2600
ROLLUP	B_3_C27_6360	B_2_C26_89	FQHC	B000002	8900	2600
ROLLUP	B_3_C27_60	B_2_C26_90	Clinic	B000002	9000	2600
ROLLUP	B_3_C27_61	B_2_C26_91	Emergency	B000002	9100	2600
ROLLUP	B_3_C27_6201	B_2_C26_9201	Observation Beds (Distinct Unit)	B000002	9201	2600
ROLLUP	B_3_C27_63	B_2_C26_93	Other Outpatient Services	B000002	9300	2600
NUMERIC	B_3_C27_64	B_2_C26_94	Home Program Dialysis	B000002	9400	2600
NUMERIC	B_3_C27_65	B_2_C26_95	Ambulance Services	B000002	9500	2600
ROLLUP	B_3_C27_66	B_2_C26_96	Durable Medical Equipment Rented	B000002	9600	2600
ROLLUP	B_3_C27_67	B_2_C26_97	Durable Medical Equipment Sold	B000002	9700	2600
ROLLUP	B_3_C27_68	B_2_C26_98	Other Reimbursable	B000002	9800	2600
ROLLUP	B_3_C27_6910	B_2_C26_99	CMHC	B000002	9900	2600
ROLLUP	B_3_C27_69	B_2_C26_9910	CORF	B000002	9910	2600
ROLLUP	B_3_C27_6920	B_2_C26_9920	OPT	B000002	9920	2600
ROLLUP	B_3_C27_6930	B_2_C26_9930	OOT	B000002	9930	2600
ROLLUP	B_3_C27_6940	B_2_C26_9940	OSP	B000002	9940	2600
NUMERIC	B_3_C27_70	B_2_C26_100	Int & Res (non approved teaching program	B000002	10000	2600
ROLLUP	B_3_C27_71	B_2_C26_101	HHA	B000002	10100	2600
NUMERIC	B_3_C27_83	B_2_C26_105	Kidney Acquisition	B000002	10500	2600
NUMERIC	B_3_C27_85	B_2_C26_106	Heart Acquisition	B000002	10600	2600
NUMERIC	B_3_C27_84	B_2_C26_107	Liver Acquisition	B000002	10700	2600
NUMERIC	B_3_C27_82	B_2_C26_108	Lung  Acquisition	B000002	10800	2600
NUMERIC	B_3_C27_8501	B_2_C26_109	Pancreas Acquisition	B000002	10900	2600
NUMERIC	B_3_C27_8502	B_2_C26_110	Intestinal Acquisition	B000002	11000	2600
NUMERIC	NOT ON OLD FORM	B_2_C26_111	Islet Acquisition	B000002	11100	2600
ROLLUP	B_3_C27_86	B_2_C26_112	Other Organ Acquisition	B000002	11200	2600
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
	ALLOCATION OF NEW CAPITAL COSTS					
	"2552-10 WORKSHEET B, PART II"					
						
DATA TYPE	96 FIELD NAME	10 FIELD NAME	FIELD DESCRIPTION 	WKSHT CD	LINE	COLUMN
						
NUMERIC	B_3_C27_88	B_2_C26_113	Interest Expense	B000002	11300	2600
NUMERIC	B_3_C27_89	B_2_C26_114	Utilization Review SNF	B000002	11400	2600
ROLLUP	B_3_C27_92	B_2_C26_115	ASC (Distinct Part)	B000002	11500	2600
ROLLUP	B_3_C27_93	B_2_C26_116	Hospice	B000002	11600	2600
ROLLUP	B_3_C27_94	B_2_C26_117	Other Special Purpose	B000002	11700	2600
ROLLUP	B_3_C27_96	B_2_C26_190	"Gift, Flower, Coffee Shop, Canteen"	B000002	19000	2600
ROLLUP	B_3_C27_97	B_2_C26_191	Research	B000002	19100	2600
ROLLUP	B_3_C27_98	B_2_C26_192	Physicians' Private Office	B000002	19200	2600
ROLLUP	B_3_C27_99	B_2_C26_193	Nonpaid Workers	B000002	19300	2600
ROLLUP	B_3_C27_100	B_2_C26_194	Other Nonreimbursable	B000002	19400	2600
NUMERIC	B_3_C27_101	B_2_C26_200	Cross Foot Adjustments	B000002	20000	2600
NUMERIC	B_3_C27_102	B_2_C26_201	Negative Cost Centers	B000002	20100	2600
NUMERIC	B_3_C27_103	B_2_C26_202	Total  	B000002	20200	2600
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
	COMPUTATION OF RATIO OF COST TO CHARGES					
	"2552-10 WORKSHEET C, PART I"					
						
DATA TYPE	96 FIELD NAME	10 FIELD NAME	FIELD DESCRIPTION 	WKSHT CD	LINE	COLUMN
						
ROLLUP	C_1_C2_49	C_1_C2_65	Respiratory Therapy	C000001	6500	200
ROLLUP	C_1_C2_50	C_1_C2_66	Physical Therapy	C000001	6600	200
ROLLUP	C_1_C2_51	C_1_C2_67	Occupational Therapy	C000001	6700	200
ROLLUP	C_1_C2_52	C_1_C2_68	Speech Pathology	C000001	6800	200
						
						
NUMERIC	C_1_C5_25	C_1_C5_30	Adults & Pediatrics	C000001	3000	500
ROLLUP	C_1_C5_26	C_1_C5_31	Intensive Care Unit	C000001	3100	500
ROLLUP	C_1_C5_27	C_1_C5_32	Coronary Care Unit	C000001	3200	500
ROLLUP	C_1_C5_28	C_1_C5_33	Burn Intensive Care Unit	C000001	3300	500
ROLLUP	C_1_C5_29	C_1_C5_34	Surgical Intensive Care Unit	C000001	3400	500
ROLLUP	C_1_C5_30	C_1_C5_35	Other Special Care Unit	C000001	3500	500
NUMERIC	NOT ON OLD FORM	C_1_C5_40	Subprovider-IPF	C000001	4000	500
NUMERIC	NOT ON OLD FORM	C_1_C5_41	Subprovider-IRF	C000001	4100	500
NUMERIC	C_1_C5_31	C_1_C5_42	Subprovider I	C000001	4200	500
NUMERIC	C_1_C5_3101	C_1_C5_4201	Subprovider II	C000001	4201	500
NUMERIC	C_1_C5_33	C_1_C5_43	Nursery	C000001	4300	500
NUMERIC	C_1_C5_34	C_1_C5_44	SNF	C000001	4400	500
NUMERIC	C_1_C5_35	C_1_C5_45	NF	C000001	4500	500
NUMERIC	C_1_C5_3501	C_1_C5_4501	ICF	C000001	4501	500
NUMERIC	C_1_C5_36	C_1_C5_46	OLTC	C000001	4600	500
ROLLUP	C_1_C5_37	C_1_C5_50	Operating Room	C000001	5000	500
ROLLUP	C_1_C5_38	C_1_C5_51	Recovery Room	C000001	5100	500
ROLLUP	C_1_C5_39	C_1_C5_52	Delivery Room and Labor Room	C000001	5200	500
ROLLUP	C_1_C5_40	C_1_C5_53	Anesthesiology	C000001	5300	500
ROLLUP	C_1_C5_41	C_1_C5_54	Radiology-Diagnostic	C000001	5400	500
ROLLUP	C_1_C5_42	C_1_C5_55	Radiology-Therapeutic	C000001	5500	500
ROLLUP	C_1_C5_43	C_1_C5_56	Radioisotope	C000001	5600	500
ROLLUP	NOT ON OLD FORM	C_1_C5_57	CT Scan	C000001	5700	500
ROLLUP	NOT ON OLD FORM	C_1_C5_58	MRI	C000001	5800	500
ROLLUP	NOT ON OLD FORM	C_1_C5_59	Cardiac Catheterization	C000001	5900	500
ROLLUP	C_1_C5_44	C_1_C5_60	Laboratory	C000001	6000	500
NUMERIC	C_1_C5_45	C_1_C5_61	PBP Clinical Lab Services Program Only	C000001	6100	500
ROLLUP	C_1_C5_46	C_1_C5_62	Whole Blood & Packed Red Blood Cells	C000001	6200	500
ROLLUP	C_1_C5_4630	C_1_C5_6250	Blood Clotting Factors for Hemoph.	C000001	6250	500
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
	COMPUTATION OF RATIO OF COST TO CHARGES					
	"2552-10 WORKSHEET C, PART I"					
						
DATA TYPE	96 FIELD NAME	10 FIELD NAME	FIELD DESCRIPTION 	WKSHT CD	LINE	COLUMN
						
ROLLUP	C_1_C5_47	C_1_C5_63	"Blood Storing, Processing, Trans"	C000001	6300	500
ROLLUP	C_1_C5_48	C_1_C5_64	Intravenous Therapy	C000001	6400	500
ROLLUP	C_1_C5_49	C_1_C5_65	Respiratory Therapy	C000001	6500	500
ROLLUP	C_1_C5_50	C_1_C5_66	Physical Therapy	C000001	6600	500
ROLLUP	C_1_C5_51	C_1_C5_67	Occupational Therapy	C000001	6700	500
ROLLUP	C_1_C5_52	C_1_C5_68	Speech Pathology	C000001	6800	500
ROLLUP	C_1_C5_53	C_1_C5_69	Electrocardiology	C000001	6900	500
ROLLUP	C_1_C5_54	C_1_C5_70	Electroencephalography	C000001	7000	500
ROLLUP	C_1_C5_55	C_1_C5_71	Medical Supplies Charged to Patients	C000001	7100	500
ROLLUP	C_1_C5_5530	C_1_C5_72	Impl. Dev. Charged to Patients 	C000001	7200	500
ROLLUP	C_1_C5_56	C_1_C5_73	Drugs Charged to Patients	C000001	7300	500
NUMERIC	C_1_C5_57	C_1_C5_74	Renal Dialysis	C000001	7400	500
ROLLUP	C_1_C5_58	C_1_C5_75	ASC (Non Distinct Part)	C000001	7500	500
ROLLUP	C_1_C5_59	C_1_C5_76	Other Ancillary	C000001	7600	500
ROLLUP	C_1_C5_6350	C_1_C5_88	RHC	C000001	8800	500
ROLLUP	C_1_C5_6360	C_1_C5_89	FQHC	C000001	8900	500
ROLLUP	C_1_C5_60	C_1_C5_90	Clinic	C000001	9000	500
ROLLUP	C_1_C5_61	C_1_C5_91	Emergency	C000001	9100	500
ROLLUP	C_1_C5_6201	C_1_C5_9201	Observation Beds (Distinct Unit)	C000001	9201	500
ROLLUP	C_1_C5_63	C_1_C5_93	Other Outpatient Services	C000001	9300	500
NUMERIC	C_1_C5_64	C_1_C5_94	Home Program Dialysis	C000001	9400	500
NUMERIC	C_1_C5_65	C_1_C5_95	Ambulance Services	C000001	9500	500
ROLLUP	C_1_C5_66	C_1_C5_96	Durable Medical Equipment Rented	C000001	9600	500
ROLLUP	C_1_C5_67	C_1_C5_97	Durable Medical Equipment Sold	C000001	9700	500
ROLLUP	C_1_C5_68	C_1_C5_98	Other Reimbursable	C000001	9800	500
ROLLUP	NOT ON OLD FORM	C_1_C5_99	CMHC	C000001	9900	500
ROLLUP	NOT ON OLD FORM	C_1_C5_9910	CORF	C000001	9910	500
ROLLUP	NOT ON OLD FORM	C_1_C5_9920	OPT	C000001	9920	500
ROLLUP	NOT ON OLD FORM	C_1_C5_9930	OOT	C000001	9930	500
ROLLUP	NOT ON OLD FORM	C_1_C5_9940	OSP	C000001	9940	500
NUMERIC	NOT ON OLD FORM	C_1_C5_100	Int & Res (non approved teaching program	C000001	10000	500
ROLLUP	NOT ON OLD FORM	C_1_C5_101	HHA	C000001	10100	500
NUMERIC	NOT ON OLD FORM	C_1_C5_105	Kidney Acquisition	C000001	10500	500
NUMERIC	NOT ON OLD FORM	C_1_C5_106	Heart Acquisition	C000001	10600	500
NUMERIC	NOT ON OLD FORM	C_1_C5_107	Liver Acquisition	C000001	10700	500
NUMERIC	NOT ON OLD FORM	C_1_C5_108	Lung  Acquisition	C000001	10800	500
NUMERIC	NOT ON OLD FORM	C_1_C5_109	Pancreas Acquisition	C000001	10900	500
NUMERIC	NOT ON OLD FORM	C_1_C5_110	Intestinal Acquisition	C000001	11000	500
NUMERIC	NOT ON OLD FORM	C_1_C5_111	Islet Acquisition	C000001	11100	500
ROLLUP	NOT ON OLD FORM	C_1_C5_112	Other Organ Acquisition	C000001	11200	500
NUMERIC	NOT ON OLD FORM	C_1_C5_113	Interest Expense	C000001	11300	500
NUMERIC	NOT ON OLD FORM	C_1_C5_114	Utilization Review SNF	C000001	11400	500
ROLLUP	NOT ON OLD FORM	C_1_C5_115	ASC (Distinct Part)	C000001	11500	500
ROLLUP	NOT ON OLD FORM	C_1_C5_116	Hospice	C000001	11600	500
ROLLUP	NOT ON OLD FORM	C_1_C5_117	Other Special Purpose	C000001	11700	500
NUMERIC	C_1_C5_101	C_1_C5_200	Subtotal	C000001	20000	500
NUMERIC	C_1_C5_102	C_1_C5_201	Less Observation Beds	C000001	20100	500
NUMERIC	C_1_C5_103	C_1_C5_202	Total	C000001	20200	500
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
	COMPUTATION OF RATIO OF COST TO CHARGES					
	"2552-10 WORKSHEET C, PART I"					
						
DATA TYPE	96 FIELD NAME	10 FIELD NAME	FIELD DESCRIPTION 	WKSHT CD	LINE	COLUMN
						
	Total Inpatient Charges					
						
NUMERIC	C_1_C6_25	C_1_C6_30	Adults & Pediatrics	C000001	3000	600
ROLLUP	C_1_C6_26	C_1_C6_31	Intensive Care Unit	C000001	3100	600
ROLLUP	C_1_C6_27	C_1_C6_32	Coronary Care Unit	C000001	3200	600
ROLLUP	C_1_C6_28	C_1_C6_33	Burn Intensive Care Unit	C000001	3300	600
ROLLUP	C_1_C6_29	C_1_C6_34	Surgical Intensive Care Unit	C000001	3400	600
ROLLUP	C_1_C6_30	C_1_C6_35	Other Special Care Unit	C000001	3500	600
NUMERIC	NOT ON OLD FORM	C_1_C6_40	Subprovider-IPF	C000001	4000	600
NUMERIC	NOT ON OLD FORM	C_1_C6_41	Subprovider-IRF	C000001	4100	600
NUMERIC	C_1_C6_31	C_1_C6_42	Subprovider I	C000001	4200	600
NUMERIC	C_1_C6_3101	C_1_C6_4201	Subprovider II	C000001	4201	600
NUMERIC	C_1_C6_33	C_1_C6_43	Nursery	C000001	4300	600
NUMERIC	C_1_C6_34	C_1_C6_44	SNF	C000001	4400	600
NUMERIC	C_1_C6_35	C_1_C6_45	NF	C000001	4500	600
NUMERIC	C_1_C6_3501	C_1_C6_4501	ICF	C000001	4501	600
NUMERIC	C_1_C6_36	C_1_C6_46	OLTC	C000001	4600	600
ROLLUP	C_1_C6_37	C_1_C6_50	Operating Room	C000001	5000	600
ROLLUP	C_1_C6_38	C_1_C6_51	Recovery Room	C000001	5100	600
ROLLUP	C_1_C6_39	C_1_C6_52	Delivery Room and Labor Room	C000001	5200	600
ROLLUP	C_1_C6_40	C_1_C6_53	Anesthesiology	C000001	5300	600
ROLLUP	C_1_C6_41	C_1_C6_54	Radiology-Diagnostic	C000001	5400	600
ROLLUP	C_1_C6_42	C_1_C6_55	Radiology-Therapeutic	C000001	5500	600
ROLLUP	C_1_C6_43	C_1_C6_56	Radioisotope	C000001	5600	600
ROLLUP	NOT ON OLD FORM	C_1_C6_57	CT Scan	C000001	5700	600
ROLLUP	NOT ON OLD FORM	C_1_C6_58	MRI	C000001	5800	600
ROLLUP	NOT ON OLD FORM	C_1_C6_59	Cardiac Catheterization	C000001	5900	600
ROLLUP	C_1_C6_44	C_1_C6_60	Laboratory	C000001	6000	600
NUMERIC	C_1_C6_45	C_1_C6_61	PBP Clinical Lab Services Program Only	C000001	6100	600
ROLLUP	C_1_C6_46	C_1_C6_62	Whole Blood & Packed Red Blood Cells	C000001	6200	600
ROLLUP	C_1_C6_4630	C_1_C6_6250	Blood Clotting Factors for Hemoph.	C000001	6250	600
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
	COMPUTATION OF RATIO OF COST TO CHARGES					
	"2552-10 WORKSHEET C, PART I"					
						
DATA TYPE	96 FIELD NAME	10 FIELD NAME	FIELD DESCRIPTION 	WKSHT CD	LINE	COLUMN
						
ROLLUP	C_1_C6_47	C_1_C6_63	"Blood Storing, Processing, Trans"	C000001	6300	600
ROLLUP	C_1_C6_48	C_1_C6_64	Intravenous Therapy	C000001	6400	600
ROLLUP	C_1_C6_49	C_1_C6_65	Respiratory Therapy	C000001	6500	600
ROLLUP	C_1_C6_50	C_1_C6_66	Physical Therapy	C000001	6600	600
ROLLUP	C_1_C6_51	C_1_C6_67	Occupational Therapy	C000001	6700	600
ROLLUP	C_1_C6_52	C_1_C6_68	Speech Pathology	C000001	6800	600
ROLLUP	C_1_C6_53	C_1_C6_69	Electrocardiology	C000001	6900	600
ROLLUP	C_1_C6_54	C_1_C6_70	Electroencephalography	C000001	7000	600
ROLLUP	C_1_C6_55	C_1_C6_71	Medical Supplies Charged to Patients	C000001	7100	600
ROLLUP	C_1_C6_5530	C_1_C6_72	Impl. Dev. Charged to Patients 	C000001	7200	600
ROLLUP	C_1_C6_56	C_1_C6_73	Drugs Charged to Patients	C000001	7300	600
NUMERIC	C_1_C6_57	C_1_C6_74	Renal Dialysis	C000001	7400	600
ROLLUP	C_1_C6_58	C_1_C6_75	ASC (Non Distinct Part)	C000001	7500	600
ROLLUP	C_1_C6_59	C_1_C6_76	Other Ancillary	C000001	7600	600
ROLLUP	C_1_C6_6350	C_1_C6_88	RHC	C000001	8800	600
ROLLUP	C_1_C6_6360	C_1_C6_89	FQHC	C000001	8900	600
ROLLUP	C_1_C6_60	C_1_C6_90	Clinic	C000001	9000	600
ROLLUP	C_1_C6_61	C_1_C6_91	Emergency	C000001	9100	600
ROLLUP	C_1_C6_6201	C_1_C6_9201	Observation Beds (Distinct Unit)	C000001	9201	600
ROLLUP	C_1_C6_63	C_1_C6_93	Other Outpatient Services	C000001	9300	600
NUMERIC	C_1_C6_64	C_1_C6_94	Home Program Dialysis	C000001	9400	600
NUMERIC	C_1_C6_65	C_1_C6_95	Ambulance Services	C000001	9500	600
ROLLUP	C_1_C6_66	C_1_C6_96	Durable Medical Equipment Rented	C000001	9600	600
ROLLUP	C_1_C6_67	C_1_C6_97	Durable Medical Equipment Sold	C000001	9700	600
ROLLUP	C_1_C6_68	C_1_C6_98	Other Reimbursable	C000001	9800	600
ROLLUP	NOT ON OLD FORM	C_1_C6_99	CMHC	C000001	9900	600
ROLLUP	NOT ON OLD FORM	C_1_C6_9910	CORF	C000001	9910	600
ROLLUP	NOT ON OLD FORM	C_1_C6_9920	OPT	C000001	9920	600
ROLLUP	NOT ON OLD FORM	C_1_C6_9930	OOT	C000001	9930	600
ROLLUP	NOT ON OLD FORM	C_1_C6_9940	OSP	C000001	9940	600
NUMERIC	NOT ON OLD FORM	C_1_C6_100	Int & Res (non approved teaching program	C000001	10000	600
ROLLUP	NOT ON OLD FORM	C_1_C6_101	HHA	C000001	10100	600
NUMERIC	NOT ON OLD FORM	C_1_C6_105	Kidney Acquisition	C000001	10500	600
NUMERIC	NOT ON OLD FORM	C_1_C6_106	Heart Acquisition	C000001	10600	600
NUMERIC	NOT ON OLD FORM	C_1_C6_107	Liver Acquisition	C000001	10700	600
NUMERIC	NOT ON OLD FORM	C_1_C6_108	Lung  Acquisition	C000001	10800	600
NUMERIC	NOT ON OLD FORM	C_1_C6_109	Pancreas Acquisition	C000001	10900	600
NUMERIC	NOT ON OLD FORM	C_1_C6_110	Intestinal Acquisition	C000001	11000	600
NUMERIC	NOT ON OLD FORM	C_1_C6_111	Islet Acquisition	C000001	11100	600
ROLLUP	NOT ON OLD FORM	C_1_C6_112	Other Organ Acquisition	C000001	11200	600
NUMERIC	NOT ON OLD FORM	C_1_C6_113	Interest Expense	C000001	11300	600
NUMERIC	NOT ON OLD FORM	C_1_C6_114	Utilization Review SNF	C000001	11400	600
ROLLUP	NOT ON OLD FORM	C_1_C6_115	ASC (Distinct Part)	C000001	11500	600
ROLLUP	NOT ON OLD FORM	C_1_C6_116	Hospice	C000001	11600	600
ROLLUP	NOT ON OLD FORM	C_1_C6_117	Other Special Purpose	C000001	11700	600
NUMERIC		C_1_C6_200		C000001	20000	600
NUMERIC		C_1_C6_201		C000001	20100	600
NUMERIC	C_1_C6_103	C_1_C6_202	Total	C000001	20200	600
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
	COMPUTATION OF RATIO OF COST TO CHARGES					
	"2552-10 WORKSHEET C, PART I"					
						
DATA TYPE	96 FIELD NAME	10 FIELD NAME	FIELD DESCRIPTION 	WKSHT CD	LINE	COLUMN
						
	Total Outpatient Charges					
						
						
NUMERIC	C_1_C7_25	C_1_C7_30	Adults & Pediatrics	C000001	3000	700
ROLLUP	C_1_C7_26	C_1_C7_31	Intensive Care Unit	C000001	3100	700
ROLLUP	C_1_C7_27	C_1_C7_32	Coronary Care Unit	C000001	3200	700
ROLLUP	C_1_C7_28	C_1_C7_33	Burn Intensive Care Unit	C000001	3300	700
ROLLUP	C_1_C7_29	C_1_C7_34	Surgical Intensive Care Unit	C000001	3400	700
ROLLUP	C_1_C7_30	C_1_C7_35	Other Special Care Unit	C000001	3500	700
NUMERIC	NOT ON OLD FORM	C_1_C7_40	Subprovider-IPF	C000001	4000	700
NUMERIC	NOT ON OLD FORM	C_1_C7_41	Subprovider-IRF	C000001	4100	700
NUMERIC	C_1_C7_31	C_1_C7_42	Subprovider I	C000001	4200	700
NUMERIC	C_1_C7_3101	C_1_C7_4201	Subprovider II	C000001	4201	700
NUMERIC	C_1_C7_33	C_1_C7_43	Nursery	C000001	4300	700
NUMERIC	C_1_C7_34	C_1_C7_44	SNF	C000001	4400	700
NUMERIC	C_1_C7_35	C_1_C7_45	NF	C000001	4500	700
NUMERIC	C_1_C7_3501	C_1_C7_4501	ICF	C000001	4501	700
NUMERIC	C_1_C7_36	C_1_C7_46	OLTC	C000001	4600	700
ROLLUP	C_1_C7_37	C_1_C7_50	Operating Room	C000001	5000	700
ROLLUP	C_1_C7_38	C_1_C7_51	Recovery Room	C000001	5100	700
ROLLUP	C_1_C7_39	C_1_C7_52	Delivery Room and Labor Room	C000001	5200	700
ROLLUP	C_1_C7_40	C_1_C7_53	Anesthesiology	C000001	5300	700
ROLLUP	C_1_C7_41	C_1_C7_54	Radiology-Diagnostic	C000001	5400	700
ROLLUP	C_1_C7_42	C_1_C7_55	Radiology-Therapeutic	C000001	5500	700
ROLLUP	C_1_C7_43	C_1_C7_56	Radioisotope	C000001	5600	700
ROLLUP	NOT ON OLD FORM	C_1_C7_57	CT Scan	C000001	5700	700
ROLLUP	NOT ON OLD FORM	C_1_C7_58	MRI	C000001	5800	700
ROLLUP	NOT ON OLD FORM	C_1_C7_59	Cardiac Catheterization	C000001	5900	700
ROLLUP	C_1_C7_44	C_1_C7_60	Laboratory	C000001	6000	700
NUMERIC	C_1_C7_45	C_1_C7_61	PBP Clinical Lab Services Program Only	C000001	6100	700
ROLLUP	C_1_C7_46	C_1_C7_62	Whole Blood & Packed Red Blood Cells	C000001	6200	700
ROLLUP	C_1_C7_4630	C_1_C7_6250	Blood Clotting Factors for Hemoph.	C000001	6250	700
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
	COMPUTATION OF RATIO OF COST TO CHARGES					
	"2552-10 WORKSHEET C, PART I"					
						
DATA TYPE	96 FIELD NAME	10 FIELD NAME	FIELD DESCRIPTION 	WKSHT CD	LINE	COLUMN
						
ROLLUP	C_1_C7_47	C_1_C7_63	"Blood Storing, Processing, Trans"	C000001	6300	700
ROLLUP	C_1_C7_48	C_1_C7_64	Intravenous Therapy	C000001	6400	700
ROLLUP	C_1_C7_49	C_1_C7_65	Respiratory Therapy	C000001	6500	700
ROLLUP	C_1_C7_50	C_1_C7_66	Physical Therapy	C000001	6600	700
ROLLUP	C_1_C7_51	C_1_C7_67	Occupational Therapy	C000001	6700	700
ROLLUP	C_1_C7_52	C_1_C7_68	Speech Pathology	C000001	6800	700
ROLLUP	C_1_C7_53	C_1_C7_69	Electrocardiology	C000001	6900	700
ROLLUP	C_1_C7_54	C_1_C7_70	Electroencephalography	C000001	7000	700
ROLLUP	C_1_C7_55	C_1_C7_71	Medical Supplies Charged to Patients	C000001	7100	700
ROLLUP	C_1_C7_5530	C_1_C7_72	Impl. Dev. Charged to Patients 	C000001	7200	700
ROLLUP	C_1_C7_56	C_1_C7_73	Drugs Charged to Patients	C000001	7300	700
NUMERIC	C_1_C7_57	C_1_C7_74	Renal Dialysis	C000001	7400	700
ROLLUP	C_1_C7_58	C_1_C7_75	ASC (Non Distinct Part)	C000001	7500	700
ROLLUP	C_1_C7_59	C_1_C7_76	Other Ancillary	C000001	7600	700
ROLLUP	C_1_C7_6350	C_1_C7_88	RHC	C000001	8800	700
ROLLUP	C_1_C7_6360	C_1_C7_89	FQHC	C000001	8900	700
ROLLUP	C_1_C7_60	C_1_C7_90	Clinic	C000001	9000	700
ROLLUP	C_1_C7_61	C_1_C7_91	Emergency	C000001	9100	700
ROLLUP	C_1_C7_6201	C_1_C7_9201	Observation Beds (Distinct Unit)	C000001	9201	700
ROLLUP	C_1_C7_63	C_1_C7_93	Other Outpatient Services	C000001	9300	700
NUMERIC	C_1_C7_64	C_1_C7_94	Home Program Dialysis	C000001	9400	700
NUMERIC	C_1_C7_65	C_1_C7_95	Ambulance Services	C000001	9500	700
ROLLUP	C_1_C7_66	C_1_C7_96	Durable Medical Equipment Rented	C000001	9600	700
ROLLUP	C_1_C7_67	C_1_C7_97	Durable Medical Equipment Sold	C000001	9700	700
ROLLUP	C_1_C7_68	C_1_C7_98	Other Reimbursable	C000001	9800	700
ROLLUP	NOT ON OLD FORM	C_1_C7_99	CMHC	C000001	9900	700
ROLLUP	NOT ON OLD FORM	C_1_C7_9910	CORF	C000001	9910	700
ROLLUP	NOT ON OLD FORM	C_1_C7_9920	OPT	C000001	9920	700
ROLLUP	NOT ON OLD FORM	C_1_C7_9930	OOT	C000001	9930	700
ROLLUP	NOT ON OLD FORM	C_1_C7_9940	OSP	C000001	9940	700
NUMERIC	NOT ON OLD FORM	C_1_C7_100	Int & Res (non approved teaching program	C000001	10000	700
ROLLUP	NOT ON OLD FORM	C_1_C7_101	HHA	C000001	10100	700
NUMERIC	NOT ON OLD FORM	C_1_C7_105	Kidney Acquisition	C000001	10500	700
NUMERIC	NOT ON OLD FORM	C_1_C7_106	Heart Acquisition	C000001	10600	700
NUMERIC	NOT ON OLD FORM	C_1_C7_107	Liver Acquisition	C000001	10700	700
NUMERIC	NOT ON OLD FORM	C_1_C7_108	Lung  Acquisition	C000001	10800	700
NUMERIC	NOT ON OLD FORM	C_1_C7_109	Pancreas Acquisition	C000001	10900	700
NUMERIC	NOT ON OLD FORM	C_1_C7_110	Intestinal Acquisition	C000001	11000	700
NUMERIC	NOT ON OLD FORM	C_1_C7_111	Islet Acquisition	C000001	11100	700
ROLLUP	NOT ON OLD FORM	C_1_C7_112	Other Organ Acquisition	C000001	11200	700
NUMERIC	NOT ON OLD FORM	C_1_C7_113	Interest Expense	C000001	11300	700
NUMERIC	NOT ON OLD FORM	C_1_C7_114	Utilization Review SNF	C000001	11400	700
ROLLUP	NOT ON OLD FORM	C_1_C7_115	ASC (Distinct Part)	C000001	11500	700
ROLLUP	NOT ON OLD FORM	C_1_C7_116	Hospice	C000001	11600	700
ROLLUP	NOT ON OLD FORM	C_1_C7_117	Other Special Purpose	C000001	11700	700
NUMERIC		C_1_C7_200		C000001	20000	700
NUMERIC		C_1_C7_201		C000001	20100	700
NUMERIC	C_1_C7_103	C_1_C7_202	Total	C000001	20200	700
						
						
						
	COMPUTATION OF OUTPATIENT SERVICE COST TO CHARGE RATIOS NET OF REDUCTIONS					
	"2552-10 WORKSHEET C, PART II"					
						
DATA TYPE	96 FIELD NAME		FIELD DESCRIPTION 	WKSHT CD	LINE	COLUMN
						
NUMERIC	C_2_C4_103	C_2_C4_202	Total	C000002	20200	400
NUMERIC	C_2_C5_103	C_2_C5_202	Total 	C000002	20200	500
						
						
						
						
						
						
						
	APPORTIONMENT OF INPATIENT ROUTINE SERVICE CAPITAL COSTS					
	"2552-10 WORKSHEET D, PART I"					
						
DATA TYPE	96 FIELD NAME	10 FIELD NAME	FIELD DESCRIPTION 	WKSHT CD	LINE	COLUMN
						
NUMERIC	D_1_HOS_C7_25	D_1_HOS_C4_30	Adults & Pediatrics	D00A181	3000	400
ROLLUP	D_1_HOS_C7_26	D_1_HOS_C4_31	Intensive Care Unit	D00A181	3100	400
ROLLUP	D_1_HOS_C7_27	D_1_HOS_C4_32	Coronary Intensive Care Unit	D00A181	3200	400
ROLLUP	D_1_HOS_C7_28	D_1_HOS_C4_33	Burn Intensive Care Unit	D00A181	3300	400
ROLLUP	D_1_HOS_C7_29	D_1_HOS_C4_34	Surgical Intensive Care Unit	D00A181	3400	400
ROLLUP	D_1_HOS_C7_30	D_1_HOS_C4_35	Other Special Care Unit	D00A181	3500	400
NUMERIC	NOT ON OLD FORM	D_1_HOS_C4_40	Subprovider-IPF	D00A181	4000	400
NUMERIC	NOT ON OLD FORM	D_1_HOS_C4_41	Subprovider-IRF	D00A181	4100	400
NUMERIC	D_1_HOS_C7_31	D_1_HOS_C4_42	Subprovider I	D00A181	4200	400
NUMERIC	D_1_HOS_C7_3101	D_1_HOS_C4_4201	Subprovider II	D00A181	4201	400
NUMERIC	D_1_HOS_C7_33	D_1_HOS_C4_43	Nursery	D00A181	4300	400
NUMERIC	D_1_HOS_C7_101	D_1_HOS_C4_200	Total	D00A181	20000	400
						
NUMERIC	D_1_HOS_C8_25	D_1_HOS_C6_30	Adults & Pediatrics	D00A181	3000	600
ROLLUP	D_1_HOS_C8_26	D_1_HOS_C6_31	Intensive Care Unit	D00A181	3100	600
ROLLUP	D_1_HOS_C8_27	D_1_HOS_C6_32	Coronary Intensive Care Unit	D00A181	3200	600
ROLLUP	D_1_HOS_C8_28	D_1_HOS_C6_33	Burn Intensive Care Unit	D00A181	3300	600
ROLLUP	D_1_HOS_C8_29	D_1_HOS_C6_34	Surgical Intensive Care Unit	D00A181	3400	600
ROLLUP	D_1_HOS_C8_30	D_1_HOS_C6_35	Other Special Care Unit	D00A181	3500	600
NUMERIC	NOT ON OLD FORM	D_1_HOS_C6_40	Subprovider-IPF	D00A181	4000	600
NUMERIC	NOT ON OLD FORM	D_1_HOS_C6_41	Subprovider-IRF	D00A181	4100	600
NUMERIC	D_1_HOS_C8_31	D_1_HOS_C6_42	Subprovider I	D00A181	4200	600
NUMERIC	D_1_HOS_C8_3101	D_1_HOS_C6_4201	Subprovider II	D00A181	4201	600
NUMERIC	D_1_HOS_C8_33	D_1_HOS_C6_43	Nursery	D00A181	4300	600
NUMERIC	D_1_HOS_C8_101	D_1_HOS_C6_200	Total	D00A181	20000	600
 						
						
NUMERIC	D_1_HOS_C12_25	D_1_HOS_C7_30	Adults & Pediatrics	D00A181	3000	700
ROLLUP	D_1_HOS_C12_26	D_1_HOS_C7_31	Intensive Care Unit	D00A181	3100	700
ROLLUP	D_1_HOS_C12_27	D_1_HOS_C7_32	Coronary Intensive Care Unit	D00A181	3200	700
ROLLUP	D_1_HOS_C12_28	D_1_HOS_C7_33	Burn Intensive Care Unit	D00A181	3300	700
ROLLUP	D_1_HOS_C12_29	D_1_HOS_C7_34	Surgical Intensive Care Unit	D00A181	3400	700
ROLLUP	D_1_HOS_C12_30	D_1_HOS_C7_35	Other Special Care Unit	D00A181	3500	700
NUMERIC	NOT ON OLD FORM	D_1_HOS_C7_40	Subprovider-IPF	D00A181	4000	700
NUMERIC	NOT ON OLD FORM	D_1_HOS_C7_41	Subprovider-IRF	D00A181	4100	700
NUMERIC	D_1_HOS_C12_31	D_1_HOS_C7_42	Subprovider I	D00A181	4200	700
NUMERIC	D_1_HOS_C12_3101	D_1_HOS_C7_4201	Subprovider II	D00A181	4201	700
NUMERIC	D_1_HOS_C12_33	D_1_HOS_C7_43	Nursery	D00A181	4300	700
NUMERIC	D_1_HOS_C12_101	D_1_HOS_C7_200	Total	D00A181	20000	700
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
	APPORTIONMENT OF INPATIENT ANCILLARY SERVICE CAPITAL COSTS					
	"2552-10 WORKSHEET D, PART II FOR THE HOSPITAL"					
"NOTE:  D, Part II has changed between reports.  "						
						
						
DATA TYPE	96 FIELD NAME	10 FIELD NAME	FIELD DESCRIPTION 	WKSHT CD	LINE	COLUMN
						
ROLLUP		D_2_HOS_C5_50		D00A182	5000	500
ROLLUP		D_2_HOS_C5_51		D00A182	5100	500
ROLLUP		D_2_HOS_C5_52		D00A182	5200	500
ROLLUP		D_2_HOS_C5_53		D00A182	5300	500
ROLLUP		D_2_HOS_C5_54		D00A182	5400	500
ROLLUP		D_2_HOS_C5_55		D00A182	5500	500
ROLLUP		D_2_HOS_C5_56		D00A182	5600	500
ROLLUP		D_2_HOS_C5_57		D00A182	5700	500
ROLLUP		D_2_HOS_C5_58		D00A182	5800	500
ROLLUP		D_2_HOS_C5_59		D00A182	5900	500
ROLLUP		D_2_HOS_C5_60		D00A182	6000	500
NUMERIC		D_2_HOS_C5_61		D00A182	6100	500
ROLLUP		D_2_HOS_C5_62		D00A182	6200	500
ROLLUP		D_2_HOS_C5_6250		D00A182	6250	500
ROLLUP		D_2_HOS_C5_63		D00A182	6300	500
ROLLUP		D_2_HOS_C5_64		D00A182	6400	500
ROLLUP		D_2_HOS_C5_65		D00A182	6500	500
ROLLUP		D_2_HOS_C5_66		D00A182	6600	500
ROLLUP		D_2_HOS_C5_67		D00A182	6700	500
ROLLUP		D_2_HOS_C5_68		D00A182	6800	500
ROLLUP		D_2_HOS_C5_69		D00A182	6900	500
ROLLUP		D_2_HOS_C5_70		D00A182	7000	500
ROLLUP		D_2_HOS_C5_71		D00A182	7100	500
ROLLUP		D_2_HOS_C5_72		D00A182	7200	500
ROLLUP		D_2_HOS_C5_73		D00A182	7300	500
NUMERIC		D_2_HOS_C5_74		D00A182	7400	500
ROLLUP		D_2_HOS_C5_75		D00A182	7500	500
ROLLUP		D_2_HOS_C5_76		D00A182	7600	500
ROLLUP		D_2_HOS_C5_88		D00A182	8800	500
ROLLUP		D_2_HOS_C5_89		D00A182	8900	500
ROLLUP		D_2_HOS_C5_90		D00A182	9000	500
ROLLUP		D_2_HOS_C5_91		D00A182	9100	500
NUMERIC		D_2_HOS_C5_92		D00A182	9200	500
ROLLUP		D_2_HOS_C5_9201		D00A182	9201	500
ROLLUP		D_2_HOS_C5_93		D00A182	9300	500
NUMERIC		D_2_HOS_C5_94		D00A182	9400	500
NUMERIC		D_2_HOS_C5_95		D00A182	9500	500
ROLLUP		D_2_HOS_C5_96		D00A182	9600	500
ROLLUP		D_2_HOS_C5_97		D00A182	9700	500
ROLLUP		D_2_HOS_C5_98		D00A182	9800	500
NUMERIC		D_2_HOS_C5_200		D00A182	20000	500
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
	APPORTIONMENT OF INPATIENT ANCILLARY SERVICE CAPITAL COSTS					
	"2552-10 WORKSHEET D, PART II FOR THE IPF"					
"NOTE:  D, Part II has changed between reports.  "						
						
						
DATA TYPE	96 FIELD NAME	10 FIELD NAME	FIELD DESCRIPTION 	WKSHT CD	LINE	COLUMN
						
ROLLUP		D_2_IPF_C5_50		D00B182	5000	500
ROLLUP		D_2_IPF_C5_51		D00B182	5100	500
ROLLUP		D_2_IPF_C5_52		D00B182	5200	500
ROLLUP		D_2_IPF_C5_53		D00B182	5300	500
ROLLUP		D_2_IPF_C5_54		D00B182	5400	500
ROLLUP		D_2_IPF_C5_55		D00B182	5500	500
ROLLUP		D_2_IPF_C5_56		D00B182	5600	500
ROLLUP		D_2_IPF_C5_57		D00B182	5700	500
ROLLUP		D_2_IPF_C5_58		D00B182	5800	500
ROLLUP		D_2_IPF_C5_59		D00B182	5900	500
ROLLUP		D_2_IPF_C5_60		D00B182	6000	500
NUMERIC		D_2_IPF_C5_61		D00B182	6100	500
ROLLUP		D_2_IPF_C5_62		D00B182	6200	500
ROLLUP		D_2_IPF_C5_6250		D00B182	6250	500
ROLLUP		D_2_IPF_C5_63		D00B182	6300	500
ROLLUP		D_2_IPF_C5_64		D00B182	6400	500
ROLLUP		D_2_IPF_C5_65		D00B182	6500	500
ROLLUP		D_2_IPF_C5_66		D00B182	6600	500
ROLLUP		D_2_IPF_C5_67		D00B182	6700	500
ROLLUP		D_2_IPF_C5_68		D00B182	6800	500
ROLLUP		D_2_IPF_C5_69		D00B182	6900	500
ROLLUP		D_2_IPF_C5_70		D00B182	7000	500
ROLLUP		D_2_IPF_C5_71		D00B182	7100	500
ROLLUP		D_2_IPF_C5_72		D00B182	7200	500
ROLLUP		D_2_IPF_C5_73		D00B182	7300	500
NUMERIC		D_2_IPF_C5_74		D00B182	7400	500
ROLLUP		D_2_IPF_C5_75		D00B182	7500	500
ROLLUP		D_2_IPF_C5_76		D00B182	7600	500
ROLLUP		D_2_IPF_C5_88		D00B182	8800	500
ROLLUP		D_2_IPF_C5_89		D00B182	8900	500
ROLLUP		D_2_IPF_C5_90		D00B182	9000	500
ROLLUP		D_2_IPF_C5_91		D00B182	9100	500
NUMERIC		D_2_IPF_C5_92		D00B182	9200	500
ROLLUP		D_2_IPF_C5_9201		D00B182	9201	500
ROLLUP		D_2_IPF_C5_93		D00B182	9300	500
NUMERIC		D_2_IPF_C5_94		D00B182	9400	500
NUMERIC		D_2_IPF_C5_95		D00B182	9500	500
ROLLUP		D_2_IPF_C5_96		D00B182	9600	500
ROLLUP		D_2_IPF_C5_97		D00B182	9700	500
ROLLUP		D_2_IPF_C5_98		D00B182	9800	500
NUMERIC		D_2_IPF_C5_200		D00B182	20000	500
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
	APPORTIONMENT OF INPATIENT ANCILLARY SERVICE CAPITAL COSTS					
	"2552-10 WORKSHEET D, PART II FOR THE IRF"					
"NOTE:  D, Part II has changed between reports.  "						
						
						
DATA TYPE	96 FIELD NAME	10 FIELD NAME	FIELD DESCRIPTION 	WKSHT CD	LINE	COLUMN
						
ROLLUP		D_2_IRF_C5_50		D00C182	5000	500
ROLLUP		D_2_IRF_C5_51		D00C182	5100	500
ROLLUP		D_2_IRF_C5_52		D00C182	5200	500
ROLLUP		D_2_IRF_C5_53		D00C182	5300	500
ROLLUP		D_2_IRF_C5_54		D00C182	5400	500
ROLLUP		D_2_IRF_C5_55		D00C182	5500	500
ROLLUP		D_2_IRF_C5_56		D00C182	5600	500
ROLLUP		D_2_IRF_C5_57		D00C182	5700	500
ROLLUP		D_2_IRF_C5_58		D00C182	5800	500
ROLLUP		D_2_IRF_C5_59		D00C182	5900	500
ROLLUP		D_2_IRF_C5_60		D00C182	6000	500
NUMERIC		D_2_IRF_C5_61		D00C182	6100	500
ROLLUP		D_2_IRF_C5_62		D00C182	6200	500
ROLLUP		D_2_IRF_C5_6250		D00C182	6250	500
ROLLUP		D_2_IRF_C5_63		D00C182	6300	500
ROLLUP		D_2_IRF_C5_64		D00C182	6400	500
ROLLUP		D_2_IRF_C5_65		D00C182	6500	500
ROLLUP		D_2_IRF_C5_66		D00C182	6600	500
ROLLUP		D_2_IRF_C5_67		D00C182	6700	500
ROLLUP		D_2_IRF_C5_68		D00C182	6800	500
ROLLUP		D_2_IRF_C5_69		D00C182	6900	500
ROLLUP		D_2_IRF_C5_70		D00C182	7000	500
ROLLUP		D_2_IRF_C5_71		D00C182	7100	500
ROLLUP		D_2_IRF_C5_72		D00C182	7200	500
ROLLUP		D_2_IRF_C5_73		D00C182	7300	500
NUMERIC		D_2_IRF_C5_74		D00C182	7400	500
ROLLUP		D_2_IRF_C5_75		D00C182	7500	500
ROLLUP		D_2_IRF_C5_76		D00C182	7600	500
ROLLUP		D_2_IRF_C5_88		D00C182	8800	500
ROLLUP		D_2_IRF_C5_89		D00C182	8900	500
ROLLUP		D_2_IRF_C5_90		D00C182	9000	500
ROLLUP		D_2_IRF_C5_91		D00C182	9100	500
NUMERIC		D_2_IRF_C5_92		D00C182	9200	500
ROLLUP		D_2_IRF_C5_9201		D00C182	9201	500
ROLLUP		D_2_IRF_C5_93		D00C182	9300	500
NUMERIC		D_2_IRF_C5_94		D00C182	9400	500
NUMERIC		D_2_IRF_C5_95		D00C182	9500	500
ROLLUP		D_2_IRF_C5_96		D00C182	9600	500
ROLLUP		D_2_IRF_C5_97		D00C182	9700	500
ROLLUP		D_2_IRF_C5_98		D00C182	9800	500
NUMERIC		D_2_IRF_C5_200		D00C182	20000	500
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
	APPORTIONMENT OF INPATIENT ANCILLARY SERVICE CAPITAL COSTS					
	"2552-10 WORKSHEET D, PART II FOR THE IPF SUB1"					
"NOTE:  D, Part II has changed between reports.  "						
						
						
DATA TYPE	96 FIELD NAME	10 FIELD NAME	FIELD DESCRIPTION 	WKSHT CD	LINE	COLUMN
						
ROLLUP		D_2_SUB1_C5_50		D01D182	5000	500
ROLLUP		D_2_SUB1_C5_51		D01D182	5100	500
ROLLUP		D_2_SUB1_C5_52		D01D182	5200	500
ROLLUP		D_2_SUB1_C5_53		D01D182	5300	500
ROLLUP		D_2_SUB1_C5_54		D01D182	5400	500
ROLLUP		D_2_SUB1_C5_55		D01D182	5500	500
ROLLUP		D_2_SUB1_C5_56		D01D182	5600	500
ROLLUP		D_2_SUB1_C5_57		D01D182	5700	500
ROLLUP		D_2_SUB1_C5_58		D01D182	5800	500
ROLLUP		D_2_SUB1_C5_59		D01D182	5900	500
ROLLUP		D_2_SUB1_C5_60		D01D182	6000	500
NUMERIC		D_2_SUB1_C5_61		D01D182	6100	500
ROLLUP		D_2_SUB1_C5_62		D01D182	6200	500
ROLLUP		D_2_SUB1_C5_6250		D01D182	6250	500
ROLLUP		D_2_SUB1_C5_63		D01D182	6300	500
ROLLUP		D_2_SUB1_C5_64		D01D182	6400	500
ROLLUP		D_2_SUB1_C5_65		D01D182	6500	500
ROLLUP		D_2_SUB1_C5_66		D01D182	6600	500
ROLLUP		D_2_SUB1_C5_67		D01D182	6700	500
ROLLUP		D_2_SUB1_C5_68		D01D182	6800	500
ROLLUP		D_2_SUB1_C5_69		D01D182	6900	500
ROLLUP		D_2_SUB1_C5_70		D01D182	7000	500
ROLLUP		D_2_SUB1_C5_71		D01D182	7100	500
ROLLUP		D_2_SUB1_C5_72		D01D182	7200	500
ROLLUP		D_2_SUB1_C5_73		D01D182	7300	500
NUMERIC		D_2_SUB1_C5_74		D01D182	7400	500
ROLLUP		D_2_SUB1_C5_75		D01D182	7500	500
ROLLUP		D_2_SUB1_C5_76		D01D182	7600	500
ROLLUP		D_2_SUB1_C5_88		D01D182	8800	500
ROLLUP		D_2_SUB1_C5_89		D01D182	8900	500
ROLLUP		D_2_SUB1_C5_90		D01D182	9000	500
ROLLUP		D_2_SUB1_C5_91		D01D182	9100	500
NUMERIC		D_2_SUB1_C5_92		D01D182	9200	500
ROLLUP		D_2_SUB1_C5_9201		D01D182	9201	500
ROLLUP		D_2_SUB1_C5_93		D01D182	9300	500
NUMERIC		D_2_SUB1_C5_94		D01D182	9400	500
NUMERIC		D_2_SUB1_C5_95		D01D182	9500	500
ROLLUP		D_2_SUB1_C5_96		D01D182	9600	500
ROLLUP		D_2_SUB1_C5_97		D01D182	9700	500
ROLLUP		D_2_SUB1_C5_98		D01D182	9800	500
NUMERIC		D_2_SUB1_C5_200		D01D182	20000	500
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
	APPORTIONMENT OF INPATIENT ANCILLARY SERVICE CAPITAL COSTS					
	"2552-10 WORKSHEET D, PART II FOR THE IPF SUB2"					
"NOTE:  D, Part II has changed between reports.  "						
						
						
DATA TYPE	96 FIELD NAME	10 FIELD NAME	FIELD DESCRIPTION 	WKSHT CD	LINE	COLUMN
						
ROLLUP		D_2_SUB2_C5_50		D02D182	5000	500
ROLLUP		D_2_SUB2_C5_51		D02D182	5100	500
ROLLUP		D_2_SUB2_C5_52		D02D182	5200	500
ROLLUP		D_2_SUB2_C5_53		D02D182	5300	500
ROLLUP		D_2_SUB2_C5_54		D02D182	5400	500
ROLLUP		D_2_SUB2_C5_55		D02D182	5500	500
ROLLUP		D_2_SUB2_C5_56		D02D182	5600	500
ROLLUP		D_2_SUB2_C5_57		D02D182	5700	500
ROLLUP		D_2_SUB2_C5_58		D02D182	5800	500
ROLLUP		D_2_SUB2_C5_59		D02D182	5900	500
ROLLUP		D_2_SUB2_C5_60		D02D182	6000	500
NUMERIC		D_2_SUB2_C5_61		D02D182	6100	500
ROLLUP		D_2_SUB2_C5_62		D02D182	6200	500
ROLLUP		D_2_SUB2_C5_6250		D02D182	6250	500
ROLLUP		D_2_SUB2_C5_63		D02D182	6300	500
ROLLUP		D_2_SUB2_C5_64		D02D182	6400	500
ROLLUP		D_2_SUB2_C5_65		D02D182	6500	500
ROLLUP		D_2_SUB2_C5_66		D02D182	6600	500
ROLLUP		D_2_SUB2_C5_67		D02D182	6700	500
ROLLUP		D_2_SUB2_C5_68		D02D182	6800	500
ROLLUP		D_2_SUB2_C5_69		D02D182	6900	500
ROLLUP		D_2_SUB2_C5_70		D02D182	7000	500
ROLLUP		D_2_SUB2_C5_71		D02D182	7100	500
ROLLUP		D_2_SUB2_C5_72		D02D182	7200	500
ROLLUP		D_2_SUB2_C5_73		D02D182	7300	500
NUMERIC		D_2_SUB2_C5_74		D02D182	7400	500
ROLLUP		D_2_SUB2_C5_75		D02D182	7500	500
ROLLUP		D_2_SUB2_C5_76		D02D182	7600	500
ROLLUP		D_2_SUB2_C5_88		D02D182	8800	500
ROLLUP		D_2_SUB2_C5_89		D02D182	8900	500
ROLLUP		D_2_SUB2_C5_90		D02D182	9000	500
ROLLUP		D_2_SUB2_C5_91		D02D182	9100	500
NUMERIC		D_2_SUB2_C5_92		D02D182	9200	500
ROLLUP		D_2_SUB2_C5_9201		D02D182	9201	500
ROLLUP		D_2_SUB2_C5_93		D02D182	9300	500
NUMERIC		D_2_SUB2_C5_94		D02D182	9400	500
NUMERIC		D_2_SUB2_C5_95		D02D182	9500	500
ROLLUP		D_2_SUB2_C5_96		D02D182	9600	500
ROLLUP		D_2_SUB2_C5_97		D02D182	9700	500
ROLLUP		D_2_SUB2_C5_98		D02D182	9800	500
NUMERIC		D_2_SUB2_C5_200		D02D182	20000	500
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
	APPORTIONMENT OF INPATIENT ROUTINE SERVICE OTHER PASS THROUGH COSTS					
	"2552-10 WORKSHEET D, PART III"					
						
DATA TYPE	96 FIELD NAME	10 FIELD NAME	FIELD DESCRIPTION 	WKSHT CD	LINE	COLUMN
						
NUMERIC	D_3_HOS_C8_25	D_3_HOS_C9_30	Adults & Pediatrics	D00A183	3000	900
ROLLUP	D_3_HOS_C8_26	D_3_HOS_C9_31	Intensive Care Unit	D00A183	3100	900
ROLLUP	D_3_HOS_C8_27	D_3_HOS_C9_32	Coronary Care Unit	D00A183	3200	900
ROLLUP	D_3_HOS_C8_28	D_3_HOS_C9_33	Burn Intensive Care Unit	D00A183	3300	900
ROLLUP	D_3_HOS_C8_29	D_3_HOS_C9_34	Surgical Intensive Care Unit	D00A183	3400	900
ROLLUP	D_3_HOS_C8_30	D_3_HOS_C9_35	Other Special Care Unit	D00A183	3500	900
NUMERIC	NOT ON OLD FORM	D_3_HOS_C9_40	Subprovider-IPF	D00A183	4000	900
NUMERIC	NOT ON OLD FORM	D_3_HOS_C9_41	Subprovider-IRF	D00A183	4100	900
NUMERIC	D_3_HOS_C8_31	D_3_HOS_C9_42	Subprovider I	D00A183	4200	900
NUMERIC	D_3_HOS_C8_3101	D_3_HOS_C9_4201	Subprovider II	D00A183	4201	900
NUMERIC	D_3_HOS_C8_33	D_3_HOS_C9_43	Nursery	D00A183	4300	900
NUMERIC	D_3_HOS_C8_34	D_3_HOS_C9_44	SNF	D00A183	4400	900
NUMERIC	D_3_HOS_C8_35	D_3_HOS_C9_45	NF	D00A183	4500	900
NUMERIC	D_3_HOS_C8_3501	D_3_HOS_C9_4501	ICF/MR	D00A183	4501	900
NUMERIC	D_3_HOS_C8_101	D_3_HOS_C9_200	Total	D00A183	20000	900
						
NUMERIC	NOT ON OLD FORM	D_3_HOS_C2_200	Total Allied Health Cost	D00A183	20000	200
NUMERIC	NOT ON OLD FORM	D_3_HOS_C3_200	Total Other Medical Education Cost	D00A183	20000	300
NUMERIC	NOT ON OLD FORM	D_3_HOS_C5_200	Total Costs	D00A183	20000	500
NUMERIC	NOT ON OLD FORM	D_3_HOS_C6_200	Total Patient Days	D00A183	20000	600
NUMERIC	NOT ON OLD FORM	D_3_HOS_C8_200	Total Inpatient Program Days	D00A183	20000	800
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
	APPORTIONMENT OF INPATIENT/OUTPATIENT ANCILLARY SERVICE OTH PASS THR  CSTS					
	"2552-10 WORKSHEET D, PART IV FOR THE HOSPITAL"					
						
DATA TYPE	96 FIELD NAME	10 FIELD NAME	FIELD DESCRIPTION 	WKSHT CD	LINE	COLUMN
						
ROLLUP	D_4_HOS_C1_37	D_4_HOS_C1_50	Operating Room	D00A184	5000	100
ROLLUP	D_4_HOS_C1_38	D_4_HOS_C1_51	Recovery Room	D00A184	5100	100
ROLLUP	D_4_HOS_C1_39	D_4_HOS_C1_52	Delivery Room and Labor Room	D00A184	5200	100
ROLLUP	D_4_HOS_C1_40	D_4_HOS_C1_53	Anesthesiology	D00A184	5300	100
ROLLUP	D_4_HOS_C1_41	D_4_HOS_C1_54	Radiology-Diagnostic	D00A184	5400	100
ROLLUP	D_4_HOS_C1_42	D_4_HOS_C1_55	Radiology-Therapeutic	D00A184	5500	100
ROLLUP	D_4_HOS_C1_43	D_4_HOS_C1_56	Radioisotope	D00A184	5600	100
ROLLUP	NOT ON OLD FORM	D_4_HOS_C1_57	CT Scan	D00A184	5700	100
ROLLUP	NOT ON OLD FORM	D_4_HOS_C1_58	MRI	D00A184	5800	100
ROLLUP	NOT ON OLD FORM	D_4_HOS_C1_59	Cardiac Catheterization	D00A184	5900	100
ROLLUP	D_4_HOS_C1_44	D_4_HOS_C1_60	Laboratory	D00A184	6000	100
NUMERIC	D_4_HOS_C1_45	D_4_HOS_C1_61	PBP Clinical Lab Services Program Only	D00A184	6100	100
ROLLUP	D_4_HOS_C1_46	D_4_HOS_C1_62	Whole Blood & Packed Red Blood Cells	D00A184	6200	100
ROLLUP	D_4_HOS_C1_4630	D_4_HOS_C1_6250	Blood Clotting Factors for Hemoph.	D00A184	6250	100
ROLLUP	D_4_HOS_C1_47	D_4_HOS_C1_63	"Blood Storing, Processing, Trans"	D00A184	6300	100
ROLLUP	D_4_HOS_C1_48	D_4_HOS_C1_64	Intravenous Therapy	D00A184	6400	100
ROLLUP	D_4_HOS_C1_49	D_4_HOS_C1_65	Respiratory Therapy	D00A184	6500	100
ROLLUP	D_4_HOS_C1_50	D_4_HOS_C1_66	Physical Therapy	D00A184	6600	100
ROLLUP	D_4_HOS_C1_51	D_4_HOS_C1_67	Occupational Therapy	D00A184	6700	100
ROLLUP	D_4_HOS_C1_52	D_4_HOS_C1_68	Speech Pathology	D00A184	6800	100
ROLLUP	D_4_HOS_C1_53	D_4_HOS_C1_69	Electrocardiology	D00A184	6900	100
ROLLUP	D_4_HOS_C1_54	D_4_HOS_C1_70	Electroencephalography	D00A184	7000	100
ROLLUP	D_4_HOS_C1_55	D_4_HOS_C1_71	Medical Supplies Charged to Patients	D00A184	7100	100
ROLLUP	D_4_HOS_C1_5530	D_4_HOS_C1_72	Impl. Dev. Charged to Patients 	D00A184	7200	100
ROLLUP	D_4_HOS_C1_56	D_4_HOS_C1_73	Drugs Charged to Patients	D00A184	7300	100
NUMERIC	D_4_HOS_C1_57	D_4_HOS_C1_74	Renal Dialysis	D00A184	7400	100
ROLLUP	D_4_HOS_C1_58	D_4_HOS_C1_75	ASC (Non Distinct Part)	D00A184	7500	100
ROLLUP	D_4_HOS_C1_59	D_4_HOS_C1_76	Other Ancillary	D00A184	7600	100
ROLLUP	D_4_HOS_C1_6350	D_4_HOS_C1_88	RHC	D00A184	8800	100
ROLLUP	D_4_HOS_C1_6360	D_4_HOS_C1_89	FQHC	D00A184	8900	100
ROLLUP	D_4_HOS_C1_60	D_4_HOS_C1_90	Clinic	D00A184	9000	100
ROLLUP	D_4_HOS_C1_61	D_4_HOS_C1_91	Emergency	D00A184	9100	100
ROLLUP	D_4_HOS_C1_6201	D_4_HOS_C1_9201	Observation Beds (Distinct Unit)	D00A184	9201	100
ROLLUP	D_4_HOS_C1_63	D_4_HOS_C1_93	Other Outpatient Services	D00A184	9300	100
NUMERIC	D_4_HOS_C1_64	D_4_HOS_C1_94	Home Program Dialysis	D00A184	9400	100
NUMERIC	D_4_HOS_C1_65	D_4_HOS_C1_95	Ambulance Services	D00A184	9500	100
ROLLUP	D_4_HOS_C1_66	D_4_HOS_C1_96	Durable Medical Equipment Rented	D00A184	9600	100
ROLLUP	D_4_HOS_C1_67	D_4_HOS_C1_97	Durable Medical Equipment Sold	D00A184	9700	100
ROLLUP	D_4_HOS_C1_68	D_4_HOS_C1_98	Other Reimbursable	D00A184	9800	100
NUMERIC	D_4_HOS_C1_101	D_4_HOS_C1_200	Total 	D00A184	20000	100
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
	APPORTIONMENT OF INPATIENT/OUTPATIENT ANCILLARY SERVICE OTH PASS THR  CSTS					
	"2552-10 WORKSHEET D, PART IV FOR THE HOSPITAL"					
						
DATA TYPE	96 FIELD NAME	10 FIELD NAME	FIELD DESCRIPTION 	WKSHT CD	LINE	COLUMN
						
ROLLUP	NOT ON OLD FORM	D_4_HOS_C2_50	Operating Room	D00A184	5000	200
ROLLUP	NOT ON OLD FORM	D_4_HOS_C2_51	Recovery Room	D00A184	5100	200
ROLLUP	NOT ON OLD FORM	D_4_HOS_C2_52	Delivery Room and Labor Room	D00A184	5200	200
ROLLUP	NOT ON OLD FORM	D_4_HOS_C2_53	Anesthesiology	D00A184	5300	200
ROLLUP	NOT ON OLD FORM	D_4_HOS_C2_54	Radiology-Diagnostic	D00A184	5400	200
ROLLUP	NOT ON OLD FORM	D_4_HOS_C2_55	Radiology-Therapeutic	D00A184	5500	200
ROLLUP	NOT ON OLD FORM	D_4_HOS_C2_56	Radioisotope	D00A184	5600	200
ROLLUP	NOT ON OLD FORM	D_4_HOS_C2_57	CT Scan	D00A184	5700	200
ROLLUP	NOT ON OLD FORM	D_4_HOS_C2_58	MRI	D00A184	5800	200
ROLLUP	NOT ON OLD FORM	D_4_HOS_C2_59	Cardiac Catheterization	D00A184	5900	200
ROLLUP	NOT ON OLD FORM	D_4_HOS_C2_60	Laboratory	D00A184	6000	200
NUMERIC	NOT ON OLD FORM	D_4_HOS_C2_61	PBP Clinical Lab Services Program Only	D00A184	6100	200
ROLLUP	NOT ON OLD FORM	D_4_HOS_C2_62	Whole Blood & Packed Red Blood Cells	D00A184	6200	200
ROLLUP	NOT ON OLD FORM	D_4_HOS_C2_6250	Blood Clotting Factors for Hemoph.	D00A184	6250	200
ROLLUP	NOT ON OLD FORM	D_4_HOS_C2_63	"Blood Storing, Processing, Trans"	D00A184	6300	200
ROLLUP	NOT ON OLD FORM	D_4_HOS_C2_64	Intravenous Therapy	D00A184	6400	200
ROLLUP	NOT ON OLD FORM	D_4_HOS_C2_65	Respiratory Therapy	D00A184	6500	200
ROLLUP	NOT ON OLD FORM	D_4_HOS_C2_66	Physical Therapy	D00A184	6600	200
ROLLUP	NOT ON OLD FORM	D_4_HOS_C2_67	Occupational Therapy	D00A184	6700	200
ROLLUP	NOT ON OLD FORM	D_4_HOS_C2_68	Speech Pathology	D00A184	6800	200
ROLLUP	NOT ON OLD FORM	D_4_HOS_C2_69	Electrocardiology	D00A184	6900	200
ROLLUP	NOT ON OLD FORM	D_4_HOS_C2_70	Electroencephalography	D00A184	7000	200
ROLLUP	NOT ON OLD FORM	D_4_HOS_C2_71	Medical Supplies Charged to Patients	D00A184	7100	200
ROLLUP	NOT ON OLD FORM	D_4_HOS_C2_72	Impl. Dev. Charged to Patients 	D00A184	7200	200
ROLLUP	NOT ON OLD FORM	D_4_HOS_C2_73	Drugs Charged to Patients	D00A184	7300	200
NUMERIC	NOT ON OLD FORM	D_4_HOS_C2_74	Renal Dialysis	D00A184	7400	200
ROLLUP	NOT ON OLD FORM	D_4_HOS_C2_75	ASC (Non Distinct Part)	D00A184	7500	200
ROLLUP	NOT ON OLD FORM	D_4_HOS_C2_76	Other Ancillary	D00A184	7600	200
ROLLUP	NOT ON OLD FORM	D_4_HOS_C2_88	RHC	D00A184	8800	200
ROLLUP	NOT ON OLD FORM	D_4_HOS_C2_89	FQHC	D00A184	8900	200
ROLLUP	NOT ON OLD FORM	D_4_HOS_C2_90	Clinic	D00A184	9000	200
ROLLUP	NOT ON OLD FORM	D_4_HOS_C2_91	Emergency	D00A184	9100	200
ROLLUP	NOT ON OLD FORM	D_4_HOS_C2_9201	Observation Beds (Distinct Unit)	D00A184	9201	200
ROLLUP	NOT ON OLD FORM	D_4_HOS_C2_93	Other Outpatient Services	D00A184	9300	200
NUMERIC	NOT ON OLD FORM	D_4_HOS_C2_94	Home Program Dialysis	D00A184	9400	200
NUMERIC	NOT ON OLD FORM	D_4_HOS_C2_95	Ambulance Services	D00A184	9500	200
ROLLUP	NOT ON OLD FORM	D_4_HOS_C2_96	Durable Medical Equipment Rented	D00A184	9600	200
ROLLUP	NOT ON OLD FORM	D_4_HOS_C2_97	Durable Medical Equipment Sold	D00A184	9700	200
ROLLUP	NOT ON OLD FORM	D_4_HOS_C2_98	Other Reimbursable	D00A184	9800	200
NUMERIC	NOT ON OLD FORM	D_4_HOS_C2_200	Total 	D00A184	20000	200
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
	APPORTIONMENT OF INPATIENT/OUTPATIENT ANCILLARY SERVICE OTH PASS THR  CSTS					
	"2552-10 WORKSHEET D, PART IV FOR THE HOSPITAL"					
						
DATA TYPE	96 FIELD NAME	10 FIELD NAME	FIELD DESCRIPTION 	WKSHT CD	LINE	COLUMN
						
ROLLUP	NOT ON OLD FORM	D_4_HOS_C3_50	Operating Room	D00A184	5000	300
ROLLUP	NOT ON OLD FORM	D_4_HOS_C3_51	Recovery Room	D00A184	5100	300
ROLLUP	NOT ON OLD FORM	D_4_HOS_C3_52	Delivery Room and Labor Room	D00A184	5200	300
ROLLUP	NOT ON OLD FORM	D_4_HOS_C3_53	Anesthesiology	D00A184	5300	300
ROLLUP	NOT ON OLD FORM	D_4_HOS_C3_54	Radiology-Diagnostic	D00A184	5400	300
ROLLUP	NOT ON OLD FORM	D_4_HOS_C3_55	Radiology-Therapeutic	D00A184	5500	300
ROLLUP	NOT ON OLD FORM	D_4_HOS_C3_56	Radioisotope	D00A184	5600	300
ROLLUP	NOT ON OLD FORM	D_4_HOS_C3_57	CT Scan	D00A184	5700	300
ROLLUP	NOT ON OLD FORM	D_4_HOS_C3_58	MRI	D00A184	5800	300
ROLLUP	NOT ON OLD FORM	D_4_HOS_C3_59	Cardiac Catheterization	D00A184	5900	300
ROLLUP	NOT ON OLD FORM	D_4_HOS_C3_60	Laboratory	D00A184	6000	300
NUMERIC	NOT ON OLD FORM	D_4_HOS_C3_61	PBP Clinical Lab Services Program Only	D00A184	6100	300
ROLLUP	NOT ON OLD FORM	D_4_HOS_C3_62	Whole Blood & Packed Red Blood Cells	D00A184	6200	300
ROLLUP	NOT ON OLD FORM	D_4_HOS_C3_6250	Blood Clotting Factors for Hemoph.	D00A184	6250	300
ROLLUP	NOT ON OLD FORM	D_4_HOS_C3_63	"Blood Storing, Processing, Trans"	D00A184	6300	300
ROLLUP	NOT ON OLD FORM	D_4_HOS_C3_64	Intravenous Therapy	D00A184	6400	300
ROLLUP	NOT ON OLD FORM	D_4_HOS_C3_65	Respiratory Therapy	D00A184	6500	300
ROLLUP	NOT ON OLD FORM	D_4_HOS_C3_66	Physical Therapy	D00A184	6600	300
ROLLUP	NOT ON OLD FORM	D_4_HOS_C3_67	Occupational Therapy	D00A184	6700	300
ROLLUP	NOT ON OLD FORM	D_4_HOS_C3_68	Speech Pathology	D00A184	6800	300
ROLLUP	NOT ON OLD FORM	D_4_HOS_C3_69	Electrocardiology	D00A184	6900	300
ROLLUP	NOT ON OLD FORM	D_4_HOS_C3_70	Electroencephalography	D00A184	7000	300
ROLLUP	NOT ON OLD FORM	D_4_HOS_C3_71	Medical Supplies Charged to Patients	D00A184	7100	300
ROLLUP	NOT ON OLD FORM	D_4_HOS_C3_72	Impl. Dev. Charged to Patients 	D00A184	7200	300
ROLLUP	NOT ON OLD FORM	D_4_HOS_C3_73	Drugs Charged to Patients	D00A184	7300	300
NUMERIC	NOT ON OLD FORM	D_4_HOS_C3_74	Renal Dialysis	D00A184	7400	300
ROLLUP	NOT ON OLD FORM	D_4_HOS_C3_75	ASC (Non Distinct Part)	D00A184	7500	300
ROLLUP	NOT ON OLD FORM	D_4_HOS_C3_76	Other Ancillary	D00A184	7600	300
ROLLUP	NOT ON OLD FORM	D_4_HOS_C3_88	RHC	D00A184	8800	300
ROLLUP	NOT ON OLD FORM	D_4_HOS_C3_89	FQHC	D00A184	8900	300
ROLLUP	NOT ON OLD FORM	D_4_HOS_C3_90	Clinic	D00A184	9000	300
ROLLUP	NOT ON OLD FORM	D_4_HOS_C3_91	Emergency	D00A184	9100	300
ROLLUP	NOT ON OLD FORM	D_4_HOS_C3_9201	Observation Beds (Distinct Unit)	D00A184	9201	300
ROLLUP	NOT ON OLD FORM	D_4_HOS_C3_93	Other Outpatient Services	D00A184	9300	300
NUMERIC	NOT ON OLD FORM	D_4_HOS_C3_94	Home Program Dialysis	D00A184	9400	300
NUMERIC	NOT ON OLD FORM	D_4_HOS_C3_95	Ambulance Services	D00A184	9500	300
ROLLUP	NOT ON OLD FORM	D_4_HOS_C3_96	Durable Medical Equipment Rented	D00A184	9600	300
ROLLUP	NOT ON OLD FORM	D_4_HOS_C3_97	Durable Medical Equipment Sold	D00A184	9700	300
ROLLUP	NOT ON OLD FORM	D_4_HOS_C3_98	Other Reimbursable	D00A184	9800	300
NUMERIC	NOT ON OLD FORM	D_4_HOS_C3_200	Total 	D00A184	20000	300
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
	APPORTIONMENT OF INPATIENT/OUTPATIENT ANCILLARY SERVICE OTH PASS THR  CSTS					
	"2552-10 WORKSHEET D, PART IV FOR THE HOSPITAL"					
						
DATA TYPE	96 FIELD NAME	10 FIELD NAME	FIELD DESCRIPTION 	WKSHT CD	LINE	COLUMN
						
ROLLUP	NOT ON OLD FORM	D_4_HOS_C4_50	Operating Room	D00A184	5000	400
ROLLUP	NOT ON OLD FORM	D_4_HOS_C4_51	Recovery Room	D00A184	5100	400
ROLLUP	NOT ON OLD FORM	D_4_HOS_C4_52	Delivery Room and Labor Room	D00A184	5200	400
ROLLUP	NOT ON OLD FORM	D_4_HOS_C4_53	Anesthesiology	D00A184	5300	400
ROLLUP	NOT ON OLD FORM	D_4_HOS_C4_54	Radiology-Diagnostic	D00A184	5400	400
ROLLUP	NOT ON OLD FORM	D_4_HOS_C4_55	Radiology-Therapeutic	D00A184	5500	400
ROLLUP	NOT ON OLD FORM	D_4_HOS_C4_56	Radioisotope	D00A184	5600	400
ROLLUP	NOT ON OLD FORM	D_4_HOS_C4_57	CT Scan	D00A184	5700	400
ROLLUP	NOT ON OLD FORM	D_4_HOS_C4_58	MRI	D00A184	5800	400
ROLLUP	NOT ON OLD FORM	D_4_HOS_C4_59	Cardiac Catheterization	D00A184	5900	400
ROLLUP	NOT ON OLD FORM	D_4_HOS_C4_60	Laboratory	D00A184	6000	400
NUMERIC	NOT ON OLD FORM	D_4_HOS_C4_61	PBP Clinical Lab Services Program Only	D00A184	6100	400
ROLLUP	NOT ON OLD FORM	D_4_HOS_C4_62	Whole Blood & Packed Red Blood Cells	D00A184	6200	400
ROLLUP	NOT ON OLD FORM	D_4_HOS_C4_6250	Blood Clotting Factors for Hemoph.	D00A184	6250	400
ROLLUP	NOT ON OLD FORM	D_4_HOS_C4_63	"Blood Storing, Processing, Trans"	D00A184	6300	400
ROLLUP	NOT ON OLD FORM	D_4_HOS_C4_64	Intravenous Therapy	D00A184	6400	400
ROLLUP	NOT ON OLD FORM	D_4_HOS_C4_65	Respiratory Therapy	D00A184	6500	400
ROLLUP	NOT ON OLD FORM	D_4_HOS_C4_66	Physical Therapy	D00A184	6600	400
ROLLUP	NOT ON OLD FORM	D_4_HOS_C4_67	Occupational Therapy	D00A184	6700	400
ROLLUP	NOT ON OLD FORM	D_4_HOS_C4_68	Speech Pathology	D00A184	6800	400
ROLLUP	NOT ON OLD FORM	D_4_HOS_C4_69	Electrocardiology	D00A184	6900	400
ROLLUP	NOT ON OLD FORM	D_4_HOS_C4_70	Electroencephalography	D00A184	7000	400
ROLLUP	NOT ON OLD FORM	D_4_HOS_C4_71	Medical Supplies Charged to Patients	D00A184	7100	400
ROLLUP	NOT ON OLD FORM	D_4_HOS_C4_72	Impl. Dev. Charged to Patients 	D00A184	7200	400
ROLLUP	NOT ON OLD FORM	D_4_HOS_C4_73	Drugs Charged to Patients	D00A184	7300	400
NUMERIC	NOT ON OLD FORM	D_4_HOS_C4_74	Renal Dialysis	D00A184	7400	400
ROLLUP	NOT ON OLD FORM	D_4_HOS_C4_75	ASC (Non Distinct Part)	D00A184	7500	400
ROLLUP	NOT ON OLD FORM	D_4_HOS_C4_76	Other Ancillary	D00A184	7600	400
ROLLUP	NOT ON OLD FORM	D_4_HOS_C4_88	RHC	D00A184	8800	400
ROLLUP	NOT ON OLD FORM	D_4_HOS_C4_89	FQHC	D00A184	8900	400
ROLLUP	NOT ON OLD FORM	D_4_HOS_C4_90	Clinic	D00A184	9000	400
ROLLUP	NOT ON OLD FORM	D_4_HOS_C4_91	Emergency	D00A184	9100	400
ROLLUP	NOT ON OLD FORM	D_4_HOS_C4_9201	Observation Beds (Distinct Unit)	D00A184	9201	400
ROLLUP	NOT ON OLD FORM	D_4_HOS_C4_93	Other Outpatient Services	D00A184	9300	400
NUMERIC	NOT ON OLD FORM	D_4_HOS_C4_94	Home Program Dialysis	D00A184	9400	400
NUMERIC	NOT ON OLD FORM	D_4_HOS_C4_95	Ambulance Services	D00A184	9500	400
ROLLUP	NOT ON OLD FORM	D_4_HOS_C4_96	Durable Medical Equipment Rented	D00A184	9600	400
ROLLUP	NOT ON OLD FORM	D_4_HOS_C4_97	Durable Medical Equipment Sold	D00A184	9700	400
ROLLUP	NOT ON OLD FORM	D_4_HOS_C4_98	Other Reimbursable	D00A184	9800	400
NUMERIC	NOT ON OLD FORM	D_4_HOS_C4_200	Total 	D00A184	20000	400
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
	APPORTIONMENT OF INPATIENT/OUTPATIENT ANCILLARY SERVICE OTH PASS THR  CSTS					
	"2552-10 WORKSHEET D, PART IV FOR THE HOSPITAL"					
						
DATA TYPE	96 FIELD NAME	10 FIELD NAME	FIELD DESCRIPTION 	WKSHT CD	LINE	COLUMN
						
ROLLUP	NOT ON OLD FORM	D_4_HOS_C11_50	Operating Room	D00A184	5000	1100
ROLLUP	NOT ON OLD FORM	D_4_HOS_C11_51	Recovery Room	D00A184	5100	1100
ROLLUP	NOT ON OLD FORM	D_4_HOS_C11_52	Delivery Room and Labor Room	D00A184	5200	1100
ROLLUP	NOT ON OLD FORM	D_4_HOS_C11_53	Anesthesiology	D00A184	5300	1100
ROLLUP	NOT ON OLD FORM	D_4_HOS_C11_54	Radiology-Diagnostic	D00A184	5400	1100
ROLLUP	NOT ON OLD FORM	D_4_HOS_C11_55	Radiology-Therapeutic	D00A184	5500	1100
ROLLUP	NOT ON OLD FORM	D_4_HOS_C11_56	Radioisotope	D00A184	5600	1100
ROLLUP	NOT ON OLD FORM	D_4_HOS_C11_57	CT Scan	D00A184	5700	1100
ROLLUP	NOT ON OLD FORM	D_4_HOS_C11_58	MRI	D00A184	5800	1100
ROLLUP	NOT ON OLD FORM	D_4_HOS_C11_59	Cardiac Catheterization	D00A184	5900	1100
ROLLUP	NOT ON OLD FORM	D_4_HOS_C11_60	Laboratory	D00A184	6000	1100
NUMERIC	NOT ON OLD FORM	D_4_HOS_C11_61	PBP Clinical Lab Services Program Only	D00A184	6100	1100
ROLLUP	NOT ON OLD FORM	D_4_HOS_C11_62	Whole Blood & Packed Red Blood Cells	D00A184	6200	1100
ROLLUP	NOT ON OLD FORM	D_4_HOS_C11_6250	Blood Clotting Factors for Hemoph.	D00A184	6250	1100
ROLLUP	NOT ON OLD FORM	D_4_HOS_C11_63	"Blood Storing, Processing, Trans"	D00A184	6300	1100
ROLLUP	NOT ON OLD FORM	D_4_HOS_C11_64	Intravenous Therapy	D00A184	6400	1100
ROLLUP	NOT ON OLD FORM	D_4_HOS_C11_65	Respiratory Therapy	D00A184	6500	1100
ROLLUP	NOT ON OLD FORM	D_4_HOS_C11_66	Physical Therapy	D00A184	6600	1100
ROLLUP	NOT ON OLD FORM	D_4_HOS_C11_67	Occupational Therapy	D00A184	6700	1100
ROLLUP	NOT ON OLD FORM	D_4_HOS_C11_68	Speech Pathology	D00A184	6800	1100
ROLLUP	NOT ON OLD FORM	D_4_HOS_C11_69	Electrocardiology	D00A184	6900	1100
ROLLUP	NOT ON OLD FORM	D_4_HOS_C11_70	Electroencephalography	D00A184	7000	1100
ROLLUP	NOT ON OLD FORM	D_4_HOS_C11_71	Medical Supplies Charged to Patients	D00A184	7100	1100
ROLLUP	NOT ON OLD FORM	D_4_HOS_C11_72	Impl. Dev. Charged to Patients 	D00A184	7200	1100
ROLLUP	NOT ON OLD FORM	D_4_HOS_C11_73	Drugs Charged to Patients	D00A184	7300	1100
NUMERIC	NOT ON OLD FORM	D_4_HOS_C11_74	Renal Dialysis	D00A184	7400	1100
ROLLUP	NOT ON OLD FORM	D_4_HOS_C11_75	ASC (Non Distinct Part)	D00A184	7500	1100
ROLLUP	NOT ON OLD FORM	D_4_HOS_C11_76	Other Ancillary	D00A184	7600	1100
ROLLUP	NOT ON OLD FORM	D_4_HOS_C11_88	RHC	D00A184	8800	1100
ROLLUP	NOT ON OLD FORM	D_4_HOS_C11_89	FQHC	D00A184	8900	1100
ROLLUP	NOT ON OLD FORM	D_4_HOS_C11_90	Clinic	D00A184	9000	1100
ROLLUP	NOT ON OLD FORM	D_4_HOS_C11_91	Emergency	D00A184	9100	1100
ROLLUP	NOT ON OLD FORM	D_4_HOS_C11_9201	Observation Beds (Distinct Unit)	D00A184	9201	1100
ROLLUP	NOT ON OLD FORM	D_4_HOS_C11_93	Other Outpatient Services	D00A184	9300	1100
NUMERIC	NOT ON OLD FORM	D_4_HOS_C11_94	Home Program Dialysis	D00A184	9400	1100
NUMERIC	NOT ON OLD FORM	D_4_HOS_C11_95	Ambulance Services	D00A184	9500	1100
ROLLUP	NOT ON OLD FORM	D_4_HOS_C11_96	Durable Medical Equipment Rented	D00A184	9600	1100
ROLLUP	NOT ON OLD FORM	D_4_HOS_C11_97	Durable Medical Equipment Sold	D00A184	9700	1100
ROLLUP	NOT ON OLD FORM	D_4_HOS_C11_98	Other Reimbursable	D00A184	9800	1100
NUMERIC	NOT ON OLD FORM	D_4_HOS_C11_200	Total 	D00A184	20000	1100
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
	APPORTIONMENT OF INPATIENT/OUTPATIENT ANCILLARY SERVICE OTH PASS THR  CSTS					
	"2552-10 WORKSHEET D, PART IV FOR THE HOSPITAL"					
						
DATA TYPE	96 FIELD NAME	10 FIELD NAME	FIELD DESCRIPTION 	WKSHT CD	LINE	COLUMN
						
ROLLUP	NOT ON OLD FORM	D_4_HOS_C13_50	Operating Room	D00A184	5000	1300
ROLLUP	NOT ON OLD FORM	D_4_HOS_C13_51	Recovery Room	D00A184	5100	1300
ROLLUP	NOT ON OLD FORM	D_4_HOS_C13_52	Delivery Room and Labor Room	D00A184	5200	1300
ROLLUP	NOT ON OLD FORM	D_4_HOS_C13_53	Anesthesiology	D00A184	5300	1300
ROLLUP	NOT ON OLD FORM	D_4_HOS_C13_54	Radiology-Diagnostic	D00A184	5400	1300
ROLLUP	NOT ON OLD FORM	D_4_HOS_C13_55	Radiology-Therapeutic	D00A184	5500	1300
ROLLUP	NOT ON OLD FORM	D_4_HOS_C13_56	Radioisotope	D00A184	5600	1300
ROLLUP	NOT ON OLD FORM	D_4_HOS_C13_57	CT Scan	D00A184	5700	1300
ROLLUP	NOT ON OLD FORM	D_4_HOS_C13_58	MRI	D00A184	5800	1300
ROLLUP	NOT ON OLD FORM	D_4_HOS_C13_59	Cardiac Catheterization	D00A184	5900	1300
ROLLUP	NOT ON OLD FORM	D_4_HOS_C13_60	Laboratory	D00A184	6000	1300
NUMERIC	NOT ON OLD FORM	D_4_HOS_C13_61	PBP Clinical Lab Services Program Only	D00A184	6100	1300
ROLLUP	NOT ON OLD FORM	D_4_HOS_C13_62	Whole Blood & Packed Red Blood Cells	D00A184	6200	1300
ROLLUP	NOT ON OLD FORM	D_4_HOS_C13_6250	Blood Clotting Factors for Hemoph.	D00A184	6250	1300
ROLLUP	NOT ON OLD FORM	D_4_HOS_C13_63	"Blood Storing, Processing, Trans"	D00A184	6300	1300
ROLLUP	NOT ON OLD FORM	D_4_HOS_C13_64	Intravenous Therapy	D00A184	6400	1300
ROLLUP	NOT ON OLD FORM	D_4_HOS_C13_65	Respiratory Therapy	D00A184	6500	1300
ROLLUP	NOT ON OLD FORM	D_4_HOS_C13_66	Physical Therapy	D00A184	6600	1300
ROLLUP	NOT ON OLD FORM	D_4_HOS_C13_67	Occupational Therapy	D00A184	6700	1300
ROLLUP	NOT ON OLD FORM	D_4_HOS_C13_68	Speech Pathology	D00A184	6800	1300
ROLLUP	NOT ON OLD FORM	D_4_HOS_C13_69	Electrocardiology	D00A184	6900	1300
ROLLUP	NOT ON OLD FORM	D_4_HOS_C13_70	Electroencephalography	D00A184	7000	1300
ROLLUP	NOT ON OLD FORM	D_4_HOS_C13_71	Medical Supplies Charged to Patients	D00A184	7100	1300
ROLLUP	NOT ON OLD FORM	D_4_HOS_C13_72	Impl. Dev. Charged to Patients 	D00A184	7200	1300
ROLLUP	NOT ON OLD FORM	D_4_HOS_C13_73	Drugs Charged to Patients	D00A184	7300	1300
NUMERIC	NOT ON OLD FORM	D_4_HOS_C13_74	Renal Dialysis	D00A184	7400	1300
ROLLUP	NOT ON OLD FORM	D_4_HOS_C13_75	ASC (Non Distinct Part)	D00A184	7500	1300
ROLLUP	NOT ON OLD FORM	D_4_HOS_C13_76	Other Ancillary	D00A184	7600	1300
ROLLUP	NOT ON OLD FORM	D_4_HOS_C13_88	RHC	D00A184	8800	1300
ROLLUP	NOT ON OLD FORM	D_4_HOS_C13_89	FQHC	D00A184	8900	1300
ROLLUP	NOT ON OLD FORM	D_4_HOS_C13_90	Clinic	D00A184	9000	1300
ROLLUP	NOT ON OLD FORM	D_4_HOS_C13_91	Emergency	D00A184	9100	1300
ROLLUP	NOT ON OLD FORM	D_4_HOS_C13_9201	Observation Beds (Distinct Unit)	D00A184	9201	1300
ROLLUP	NOT ON OLD FORM	D_4_HOS_C13_93	Other Outpatient Services	D00A184	9300	1300
NUMERIC	NOT ON OLD FORM	D_4_HOS_C13_94	Home Program Dialysis	D00A184	9400	1300
NUMERIC	NOT ON OLD FORM	D_4_HOS_C13_95	Ambulance Services	D00A184	9500	1300
ROLLUP	NOT ON OLD FORM	D_4_HOS_C13_96	Durable Medical Equipment Rented	D00A184	9600	1300
ROLLUP	NOT ON OLD FORM	D_4_HOS_C13_97	Durable Medical Equipment Sold	D00A184	9700	1300
ROLLUP	NOT ON OLD FORM	D_4_HOS_C13_98	Other Reimbursable	D00A184	9800	1300
NUMERIC	NOT ON OLD FORM	D_4_HOS_C13_200	Total 	D00A184	20000	1300
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
	APPORTIONMENT OF INPATIENT/OUTPATIENT ANCILLARY SERVICE OTH PASS THR  CSTS					
	"2552-10 WORKSHEET D, PART IV FOR THE IPF"					
						
DATA TYPE	96 FIELD NAME	10 FIELD NAME	FIELD DESCRIPTION 	WKSHT CD	LINE	COLUMN
						
ROLLUP	NOT ON OLD FORM	D_4_IPF_C11_50	Operating Room	D00B184	5000	1100
ROLLUP	NOT ON OLD FORM	D_4_IPF_C11_51	Recovery Room	D00B184	5100	1100
ROLLUP	NOT ON OLD FORM	D_4_IPF_C11_52	Delivery Room and Labor Room	D00B184	5200	1100
ROLLUP	NOT ON OLD FORM	D_4_IPF_C11_53	Anesthesiology	D00B184	5300	1100
ROLLUP	NOT ON OLD FORM	D_4_IPF_C11_54	Radiology-Diagnostic	D00B184	5400	1100
ROLLUP	NOT ON OLD FORM	D_4_IPF_C11_55	Radiology-Therapeutic	D00B184	5500	1100
ROLLUP	NOT ON OLD FORM	D_4_IPF_C11_56	Radioisotope	D00B184	5600	1100
ROLLUP	NOT ON OLD FORM	D_4_IPF_C11_57	CT Scan	D00B184	5700	1100
ROLLUP	NOT ON OLD FORM	D_4_IPF_C11_58	MRI	D00B184	5800	1100
ROLLUP	NOT ON OLD FORM	D_4_IPF_C11_59	Cardiac Catheterization	D00B184	5900	1100
ROLLUP	NOT ON OLD FORM	D_4_IPF_C11_60	Laboratory	D00B184	6000	1100
NUMERIC	NOT ON OLD FORM	D_4_IPF_C11_61	PBP Clinical Lab Services Program Only	D00B184	6100	1100
ROLLUP	NOT ON OLD FORM	D_4_IPF_C11_62	Whole Blood & Packed Red Blood Cells	D00B184	6200	1100
ROLLUP	NOT ON OLD FORM	D_4_IPF_C11_6250	Blood Clotting Factors for Hemoph.	D00B184	6250	1100
ROLLUP	NOT ON OLD FORM	D_4_IPF_C11_63	"Blood Storing, Processing, Trans"	D00B184	6300	1100
ROLLUP	NOT ON OLD FORM	D_4_IPF_C11_64	Intravenous Therapy	D00B184	6400	1100
ROLLUP	NOT ON OLD FORM	D_4_IPF_C11_65	Respiratory Therapy	D00B184	6500	1100
ROLLUP	NOT ON OLD FORM	D_4_IPF_C11_66	Physical Therapy	D00B184	6600	1100
ROLLUP	NOT ON OLD FORM	D_4_IPF_C11_67	Occupational Therapy	D00B184	6700	1100
ROLLUP	NOT ON OLD FORM	D_4_IPF_C11_68	Speech Pathology	D00B184	6800	1100
ROLLUP	NOT ON OLD FORM	D_4_IPF_C11_69	Electrocardiology	D00B184	6900	1100
ROLLUP	NOT ON OLD FORM	D_4_IPF_C11_70	Electroencephalography	D00B184	7000	1100
ROLLUP	NOT ON OLD FORM	D_4_IPF_C11_71	Medical Supplies Charged to Patients	D00B184	7100	1100
ROLLUP	NOT ON OLD FORM	D_4_IPF_C11_72	Impl. Dev. Charged to Patients 	D00B184	7200	1100
ROLLUP	NOT ON OLD FORM	D_4_IPF_C11_73	Drugs Charged to Patients	D00B184	7300	1100
NUMERIC	NOT ON OLD FORM	D_4_IPF_C11_74	Renal Dialysis	D00B184	7400	1100
ROLLUP	NOT ON OLD FORM	D_4_IPF_C11_75	ASC (Non Distinct Part)	D00B184	7500	1100
ROLLUP	NOT ON OLD FORM	D_4_IPF_C11_76	Other Ancillary	D00B184	7600	1100
ROLLUP	NOT ON OLD FORM	D_4_IPF_C11_88	RHC	D00B184	8800	1100
ROLLUP	NOT ON OLD FORM	D_4_IPF_C11_89	FQHC	D00B184	8900	1100
ROLLUP	NOT ON OLD FORM	D_4_IPF_C11_90	Clinic	D00B184	9000	1100
ROLLUP	NOT ON OLD FORM	D_4_IPF_C11_91	Emergency	D00B184	9100	1100
ROLLUP	NOT ON OLD FORM	D_4_IPF_C11_9201	Observation Beds (Distinct Unit)	D00B184	9201	1100
ROLLUP	NOT ON OLD FORM	D_4_IPF_C11_93	Other Outpatient Services	D00B184	9300	1100
NUMERIC	NOT ON OLD FORM	D_4_IPF_C11_94	Home Program Dialysis	D00B184	9400	1100
NUMERIC	NOT ON OLD FORM	D_4_IPF_C11_95	Ambulance Services	D00B184	9500	1100
ROLLUP	NOT ON OLD FORM	D_4_IPF_C11_96	Durable Medical Equipment Rented	D00B184	9600	1100
ROLLUP	NOT ON OLD FORM	D_4_IPF_C11_97	Durable Medical Equipment Sold	D00B184	9700	1100
ROLLUP	NOT ON OLD FORM	D_4_IPF_C11_98	Other Reimbursable	D00B184	9800	1100
NUMERIC	NOT ON OLD FORM	D_4_IPF_C11_200	Total 	D00B184	20000	1100
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
	APPORTIONMENT OF INPATIENT/OUTPATIENT ANCILLARY SERVICE OTH PASS THR  CSTS					
	"2552-10 WORKSHEET D, PART IV FOR THE IPF"					
						
DATA TYPE	96 FIELD NAME	10 FIELD NAME	FIELD DESCRIPTION 	WKSHT CD	LINE	COLUMN
						
ROLLUP	NOT ON OLD FORM	D_4_IPF_C13_50	Operating Room	D00B184	5000	1300
ROLLUP	NOT ON OLD FORM	D_4_IPF_C13_51	Recovery Room	D00B184	5100	1300
ROLLUP	NOT ON OLD FORM	D_4_IPF_C13_52	Delivery Room and Labor Room	D00B184	5200	1300
ROLLUP	NOT ON OLD FORM	D_4_IPF_C13_53	Anesthesiology	D00B184	5300	1300
ROLLUP	NOT ON OLD FORM	D_4_IPF_C13_54	Radiology-Diagnostic	D00B184	5400	1300
ROLLUP	NOT ON OLD FORM	D_4_IPF_C13_55	Radiology-Therapeutic	D00B184	5500	1300
ROLLUP	NOT ON OLD FORM	D_4_IPF_C13_56	Radioisotope	D00B184	5600	1300
ROLLUP	NOT ON OLD FORM	D_4_IPF_C13_57	CT Scan	D00B184	5700	1300
ROLLUP	NOT ON OLD FORM	D_4_IPF_C13_58	MRI	D00B184	5800	1300
ROLLUP	NOT ON OLD FORM	D_4_IPF_C13_59	Cardiac Catheterization	D00B184	5900	1300
ROLLUP	NOT ON OLD FORM	D_4_IPF_C13_60	Laboratory	D00B184	6000	1300
NUMERIC	NOT ON OLD FORM	D_4_IPF_C13_61	PBP Clinical Lab Services Program Only	D00B184	6100	1300
ROLLUP	NOT ON OLD FORM	D_4_IPF_C13_62	Whole Blood & Packed Red Blood Cells	D00B184	6200	1300
ROLLUP	NOT ON OLD FORM	D_4_IPF_C13_6250	Blood Clotting Factors for Hemoph.	D00B184	6250	1300
ROLLUP	NOT ON OLD FORM	D_4_IPF_C13_63	"Blood Storing, Processing, Trans"	D00B184	6300	1300
ROLLUP	NOT ON OLD FORM	D_4_IPF_C13_64	Intravenous Therapy	D00B184	6400	1300
ROLLUP	NOT ON OLD FORM	D_4_IPF_C13_65	Respiratory Therapy	D00B184	6500	1300
ROLLUP	NOT ON OLD FORM	D_4_IPF_C13_66	Physical Therapy	D00B184	6600	1300
ROLLUP	NOT ON OLD FORM	D_4_IPF_C13_67	Occupational Therapy	D00B184	6700	1300
ROLLUP	NOT ON OLD FORM	D_4_IPF_C13_68	Speech Pathology	D00B184	6800	1300
ROLLUP	NOT ON OLD FORM	D_4_IPF_C13_69	Electrocardiology	D00B184	6900	1300
ROLLUP	NOT ON OLD FORM	D_4_IPF_C13_70	Electroencephalography	D00B184	7000	1300
ROLLUP	NOT ON OLD FORM	D_4_IPF_C13_71	Medical Supplies Charged to Patients	D00B184	7100	1300
ROLLUP	NOT ON OLD FORM	D_4_IPF_C13_72	Impl. Dev. Charged to Patients 	D00B184	7200	1300
ROLLUP	NOT ON OLD FORM	D_4_IPF_C13_73	Drugs Charged to Patients	D00B184	7300	1300
NUMERIC	NOT ON OLD FORM	D_4_IPF_C13_74	Renal Dialysis	D00B184	7400	1300
ROLLUP	NOT ON OLD FORM	D_4_IPF_C13_75	ASC (Non Distinct Part)	D00B184	7500	1300
ROLLUP	NOT ON OLD FORM	D_4_IPF_C13_76	Other Ancillary	D00B184	7600	1300
ROLLUP	NOT ON OLD FORM	D_4_IPF_C13_88	RHC	D00B184	8800	1300
ROLLUP	NOT ON OLD FORM	D_4_IPF_C13_89	FQHC	D00B184	8900	1300
ROLLUP	NOT ON OLD FORM	D_4_IPF_C13_90	Clinic	D00B184	9000	1300
ROLLUP	NOT ON OLD FORM	D_4_IPF_C13_91	Emergency	D00B184	9100	1300
ROLLUP	NOT ON OLD FORM	D_4_IPF_C13_9201	Observation Beds (Distinct Unit)	D00B184	9201	1300
ROLLUP	NOT ON OLD FORM	D_4_IPF_C13_93	Other Outpatient Services	D00B184	9300	1300
NUMERIC	NOT ON OLD FORM	D_4_IPF_C13_94	Home Program Dialysis	D00B184	9400	1300
NUMERIC	NOT ON OLD FORM	D_4_IPF_C13_95	Ambulance Services	D00B184	9500	1300
ROLLUP	NOT ON OLD FORM	D_4_IPF_C13_96	Durable Medical Equipment Rented	D00B184	9600	1300
ROLLUP	NOT ON OLD FORM	D_4_IPF_C13_97	Durable Medical Equipment Sold	D00B184	9700	1300
ROLLUP	NOT ON OLD FORM	D_4_IPF_C13_98	Other Reimbursable	D00B184	9800	1300
NUMERIC	NOT ON OLD FORM	D_4_IPF_C13_200	Total 	D00B184	20000	1300
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
	APPORTIONMENT OF INPATIENT/OUTPATIENT ANCILLARY SERVICE OTH PASS THR  CSTS					
	"2552-10 WORKSHEET D, PART IV FOR THE IRF"					
						
DATA TYPE	96 FIELD NAME	10 FIELD NAME	FIELD DESCRIPTION 	WKSHT CD	LINE	COLUMN
						
ROLLUP	NOT ON OLD FORM	D_4_IRF_C11_50	Operating Room	D00C184	5000	1100
ROLLUP	NOT ON OLD FORM	D_4_IRF_C11_51	Recovery Room	D00C184	5100	1100
ROLLUP	NOT ON OLD FORM	D_4_IRF_C11_52	Delivery Room and Labor Room	D00C184	5200	1100
ROLLUP	NOT ON OLD FORM	D_4_IRF_C11_53	Anesthesiology	D00C184	5300	1100
ROLLUP	NOT ON OLD FORM	D_4_IRF_C11_54	Radiology-Diagnostic	D00C184	5400	1100
ROLLUP	NOT ON OLD FORM	D_4_IRF_C11_55	Radiology-Therapeutic	D00C184	5500	1100
ROLLUP	NOT ON OLD FORM	D_4_IRF_C11_56	Radioisotope	D00C184	5600	1100
ROLLUP	NOT ON OLD FORM	D_4_IRF_C11_57	CT Scan	D00C184	5700	1100
ROLLUP	NOT ON OLD FORM	D_4_IRF_C11_58	MRI	D00C184	5800	1100
ROLLUP	NOT ON OLD FORM	D_4_IRF_C11_59	Cardiac Catheterization	D00C184	5900	1100
ROLLUP	NOT ON OLD FORM	D_4_IRF_C11_60	Laboratory	D00C184	6000	1100
NUMERIC	NOT ON OLD FORM	D_4_IRF_C11_61	PBP Clinical Lab Services Program Only	D00C184	6100	1100
ROLLUP	NOT ON OLD FORM	D_4_IRF_C11_62	Whole Blood & Packed Red Blood Cells	D00C184	6200	1100
ROLLUP	NOT ON OLD FORM	D_4_IRF_C11_6250	Blood Clotting Factors for Hemoph.	D00C184	6250	1100
ROLLUP	NOT ON OLD FORM	D_4_IRF_C11_63	"Blood Storing, Processing, Trans"	D00C184	6300	1100
ROLLUP	NOT ON OLD FORM	D_4_IRF_C11_64	Intravenous Therapy	D00C184	6400	1100
ROLLUP	NOT ON OLD FORM	D_4_IRF_C11_65	Respiratory Therapy	D00C184	6500	1100
ROLLUP	NOT ON OLD FORM	D_4_IRF_C11_66	Physical Therapy	D00C184	6600	1100
ROLLUP	NOT ON OLD FORM	D_4_IRF_C11_67	Occupational Therapy	D00C184	6700	1100
ROLLUP	NOT ON OLD FORM	D_4_IRF_C11_68	Speech Pathology	D00C184	6800	1100
ROLLUP	NOT ON OLD FORM	D_4_IRF_C11_69	Electrocardiology	D00C184	6900	1100
ROLLUP	NOT ON OLD FORM	D_4_IRF_C11_70	Electroencephalography	D00C184	7000	1100
ROLLUP	NOT ON OLD FORM	D_4_IRF_C11_71	Medical Supplies Charged to Patients	D00C184	7100	1100
ROLLUP	NOT ON OLD FORM	D_4_IRF_C11_72	Impl. Dev. Charged to Patients 	D00C184	7200	1100
ROLLUP	NOT ON OLD FORM	D_4_IRF_C11_73	Drugs Charged to Patients	D00C184	7300	1100
NUMERIC	NOT ON OLD FORM	D_4_IRF_C11_74	Renal Dialysis	D00C184	7400	1100
ROLLUP	NOT ON OLD FORM	D_4_IRF_C11_75	ASC (Non Distinct Part)	D00C184	7500	1100
ROLLUP	NOT ON OLD FORM	D_4_IRF_C11_76	Other Ancillary	D00C184	7600	1100
ROLLUP	NOT ON OLD FORM	D_4_IRF_C11_88	RHC	D00C184	8800	1100
ROLLUP	NOT ON OLD FORM	D_4_IRF_C11_89	FQHC	D00C184	8900	1100
ROLLUP	NOT ON OLD FORM	D_4_IRF_C11_90	Clinic	D00C184	9000	1100
ROLLUP	NOT ON OLD FORM	D_4_IRF_C11_91	Emergency	D00C184	9100	1100
ROLLUP	NOT ON OLD FORM	D_4_IRF_C11_9201	Observation Beds (Distinct Unit)	D00C184	9201	1100
ROLLUP	NOT ON OLD FORM	D_4_IRF_C11_93	Other Outpatient Services	D00C184	9300	1100
NUMERIC	NOT ON OLD FORM	D_4_IRF_C11_94	Home Program Dialysis	D00C184	9400	1100
NUMERIC	NOT ON OLD FORM	D_4_IRF_C11_95	Ambulance Services	D00C184	9500	1100
ROLLUP	NOT ON OLD FORM	D_4_IRF_C11_96	Durable Medical Equipment Rented	D00C184	9600	1100
ROLLUP	NOT ON OLD FORM	D_4_IRF_C11_97	Durable Medical Equipment Sold	D00C184	9700	1100
ROLLUP	NOT ON OLD FORM	D_4_IRF_C11_98	Other Reimbursable	D00C184	9800	1100
NUMERIC	NOT ON OLD FORM	D_4_IRF_C11_200	Total 	D00C184	20000	1100
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
	APPORTIONMENT OF INPATIENT/OUTPATIENT ANCILLARY SERVICE OTH PASS THR  CSTS					
	"2552-10 WORKSHEET D, PART IV FOR THE IRF"					
						
DATA TYPE	96 FIELD NAME	10 FIELD NAME	FIELD DESCRIPTION 	WKSHT CD	LINE	COLUMN
						
ROLLUP	NOT ON OLD FORM	D_4_IRF_C13_50	Operating Room	D00C184	5000	1300
ROLLUP	NOT ON OLD FORM	D_4_IRF_C13_51	Recovery Room	D00C184	5100	1300
ROLLUP	NOT ON OLD FORM	D_4_IRF_C13_52	Delivery Room and Labor Room	D00C184	5200	1300
ROLLUP	NOT ON OLD FORM	D_4_IRF_C13_53	Anesthesiology	D00C184	5300	1300
ROLLUP	NOT ON OLD FORM	D_4_IRF_C13_54	Radiology-Diagnostic	D00C184	5400	1300
ROLLUP	NOT ON OLD FORM	D_4_IRF_C13_55	Radiology-Therapeutic	D00C184	5500	1300
ROLLUP	NOT ON OLD FORM	D_4_IRF_C13_56	Radioisotope	D00C184	5600	1300
ROLLUP	NOT ON OLD FORM	D_4_IRF_C13_57	CT Scan	D00C184	5700	1300
ROLLUP	NOT ON OLD FORM	D_4_IRF_C13_58	MRI	D00C184	5800	1300
ROLLUP	NOT ON OLD FORM	D_4_IRF_C13_59	Cardiac Catheterization	D00C184	5900	1300
ROLLUP	NOT ON OLD FORM	D_4_IRF_C13_60	Laboratory	D00C184	6000	1300
NUMERIC	NOT ON OLD FORM	D_4_IRF_C13_61	PBP Clinical Lab Services Program Only	D00C184	6100	1300
ROLLUP	NOT ON OLD FORM	D_4_IRF_C13_62	Whole Blood & Packed Red Blood Cells	D00C184	6200	1300
ROLLUP	NOT ON OLD FORM	D_4_IRF_C13_6250	Blood Clotting Factors for Hemoph.	D00C184	6250	1300
ROLLUP	NOT ON OLD FORM	D_4_IRF_C13_63	"Blood Storing, Processing, Trans"	D00C184	6300	1300
ROLLUP	NOT ON OLD FORM	D_4_IRF_C13_64	Intravenous Therapy	D00C184	6400	1300
ROLLUP	NOT ON OLD FORM	D_4_IRF_C13_65	Respiratory Therapy	D00C184	6500	1300
ROLLUP	NOT ON OLD FORM	D_4_IRF_C13_66	Physical Therapy	D00C184	6600	1300
ROLLUP	NOT ON OLD FORM	D_4_IRF_C13_67	Occupational Therapy	D00C184	6700	1300
ROLLUP	NOT ON OLD FORM	D_4_IRF_C13_68	Speech Pathology	D00C184	6800	1300
ROLLUP	NOT ON OLD FORM	D_4_IRF_C13_69	Electrocardiology	D00C184	6900	1300
ROLLUP	NOT ON OLD FORM	D_4_IRF_C13_70	Electroencephalography	D00C184	7000	1300
ROLLUP	NOT ON OLD FORM	D_4_IRF_C13_71	Medical Supplies Charged to Patients	D00C184	7100	1300
ROLLUP	NOT ON OLD FORM	D_4_IRF_C13_72	Impl. Dev. Charged to Patients 	D00C184	7200	1300
ROLLUP	NOT ON OLD FORM	D_4_IRF_C13_73	Drugs Charged to Patients	D00C184	7300	1300
NUMERIC	NOT ON OLD FORM	D_4_IRF_C13_74	Renal Dialysis	D00C184	7400	1300
ROLLUP	NOT ON OLD FORM	D_4_IRF_C13_75	ASC (Non Distinct Part)	D00C184	7500	1300
ROLLUP	NOT ON OLD FORM	D_4_IRF_C13_76	Other Ancillary	D00C184	7600	1300
ROLLUP	NOT ON OLD FORM	D_4_IRF_C13_88	RHC	D00C184	8800	1300
ROLLUP	NOT ON OLD FORM	D_4_IRF_C13_89	FQHC	D00C184	8900	1300
ROLLUP	NOT ON OLD FORM	D_4_IRF_C13_90	Clinic	D00C184	9000	1300
ROLLUP	NOT ON OLD FORM	D_4_IRF_C13_91	Emergency	D00C184	9100	1300
ROLLUP	NOT ON OLD FORM	D_4_IRF_C13_9201	Observation Beds (Distinct Unit)	D00C184	9201	1300
ROLLUP	NOT ON OLD FORM	D_4_IRF_C13_93	Other Outpatient Services	D00C184	9300	1300
NUMERIC	NOT ON OLD FORM	D_4_IRF_C13_94	Home Program Dialysis	D00C184	9400	1300
NUMERIC	NOT ON OLD FORM	D_4_IRF_C13_95	Ambulance Services	D00C184	9500	1300
ROLLUP	NOT ON OLD FORM	D_4_IRF_C13_96	Durable Medical Equipment Rented	D00C184	9600	1300
ROLLUP	NOT ON OLD FORM	D_4_IRF_C13_97	Durable Medical Equipment Sold	D00C184	9700	1300
ROLLUP	NOT ON OLD FORM	D_4_IRF_C13_98	Other Reimbursable	D00C184	9800	1300
NUMERIC	NOT ON OLD FORM	D_4_IRF_C13_200	Total 	D00C184	20000	1300
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
	APPORTIONMENT OF INPATIENT/OUTPATIENT ANCILLARY SERVICE OTH PASS THR  CSTS					
	"2552-10 WORKSHEET D, PART IV FOR THE SUB1"					
						
DATA TYPE	96 FIELD NAME	10 FIELD NAME	FIELD DESCRIPTION 	WKSHT CD	LINE	COLUMN
						
ROLLUP	NOT ON OLD FORM	D_4_SUB1_C11_50	Operating Room	D01D184	5000	1100
ROLLUP	NOT ON OLD FORM	D_4_SUB1_C11_51	Recovery Room	D01D184	5100	1100
ROLLUP	NOT ON OLD FORM	D_4_SUB1_C11_52	Delivery Room and Labor Room	D01D184	5200	1100
ROLLUP	NOT ON OLD FORM	D_4_SUB1_C11_53	Anesthesiology	D01D184	5300	1100
ROLLUP	NOT ON OLD FORM	D_4_SUB1_C11_54	Radiology-Diagnostic	D01D184	5400	1100
ROLLUP	NOT ON OLD FORM	D_4_SUB1_C11_55	Radiology-Therapeutic	D01D184	5500	1100
ROLLUP	NOT ON OLD FORM	D_4_SUB1_C11_56	Radioisotope	D01D184	5600	1100
ROLLUP	NOT ON OLD FORM	D_4_SUB1_C11_57	CT Scan	D01D184	5700	1100
ROLLUP	NOT ON OLD FORM	D_4_SUB1_C11_58	MRI	D01D184	5800	1100
ROLLUP	NOT ON OLD FORM	D_4_SUB1_C11_59	Cardiac Catheterization	D01D184	5900	1100
ROLLUP	NOT ON OLD FORM	D_4_SUB1_C11_60	Laboratory	D01D184	6000	1100
NUMERIC	NOT ON OLD FORM	D_4_SUB1_C11_61	PBP Clinical Lab Services Program Only	D01D184	6100	1100
ROLLUP	NOT ON OLD FORM	D_4_SUB1_C11_62	Whole Blood & Packed Red Blood Cells	D01D184	6200	1100
ROLLUP	NOT ON OLD FORM	D_4_SUB1_C11_6250	Blood Clotting Factors for Hemoph.	D01D184	6250	1100
ROLLUP	NOT ON OLD FORM	D_4_SUB1_C11_63	"Blood Storing, Processing, Trans"	D01D184	6300	1100
ROLLUP	NOT ON OLD FORM	D_4_SUB1_C11_64	Intravenous Therapy	D01D184	6400	1100
ROLLUP	NOT ON OLD FORM	D_4_SUB1_C11_65	Respiratory Therapy	D01D184	6500	1100
ROLLUP	NOT ON OLD FORM	D_4_SUB1_C11_66	Physical Therapy	D01D184	6600	1100
ROLLUP	NOT ON OLD FORM	D_4_SUB1_C11_67	Occupational Therapy	D01D184	6700	1100
ROLLUP	NOT ON OLD FORM	D_4_SUB1_C11_68	Speech Pathology	D01D184	6800	1100
ROLLUP	NOT ON OLD FORM	D_4_SUB1_C11_69	Electrocardiology	D01D184	6900	1100
ROLLUP	NOT ON OLD FORM	D_4_SUB1_C11_70	Electroencephalography	D01D184	7000	1100
ROLLUP	NOT ON OLD FORM	D_4_SUB1_C11_71	Medical Supplies Charged to Patients	D01D184	7100	1100
ROLLUP	NOT ON OLD FORM	D_4_SUB1_C11_72	Impl. Dev. Charged to Patients 	D01D184	7200	1100
ROLLUP	NOT ON OLD FORM	D_4_SUB1_C11_73	Drugs Charged to Patients	D01D184	7300	1100
NUMERIC	NOT ON OLD FORM	D_4_SUB1_C11_74	Renal Dialysis	D01D184	7400	1100
ROLLUP	NOT ON OLD FORM	D_4_SUB1_C11_75	ASC (Non Distinct Part)	D01D184	7500	1100
ROLLUP	NOT ON OLD FORM	D_4_SUB1_C11_76	Other Ancillary	D01D184	7600	1100
ROLLUP	NOT ON OLD FORM	D_4_SUB1_C11_88	RHC	D01D184	8800	1100
ROLLUP	NOT ON OLD FORM	D_4_SUB1_C11_89	FQHC	D01D184	8900	1100
ROLLUP	NOT ON OLD FORM	D_4_SUB1_C11_90	Clinic	D01D184	9000	1100
ROLLUP	NOT ON OLD FORM	D_4_SUB1_C11_91	Emergency	D01D184	9100	1100
ROLLUP	NOT ON OLD FORM	D_4_SUB1_C11_9201	Observation Beds (Distinct Unit)	D01D184	9201	1100
ROLLUP	NOT ON OLD FORM	D_4_SUB1_C11_93	Other Outpatient Services	D01D184	9300	1100
NUMERIC	NOT ON OLD FORM	D_4_SUB1_C11_94	Home Program Dialysis	D01D184	9400	1100
NUMERIC	NOT ON OLD FORM	D_4_SUB1_C11_95	Ambulance Services	D01D184	9500	1100
ROLLUP	NOT ON OLD FORM	D_4_SUB1_C11_96	Durable Medical Equipment Rented	D01D184	9600	1100
ROLLUP	NOT ON OLD FORM	D_4_SUB1_C11_97	Durable Medical Equipment Sold	D01D184	9700	1100
ROLLUP	NOT ON OLD FORM	D_4_SUB1_C11_98	Other Reimbursable	D01D184	9800	1100
NUMERIC	NOT ON OLD FORM	D_4_SUB1_C11_200	Total 	D01D184	20000	1100
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
	APPORTIONMENT OF INPATIENT/OUTPATIENT ANCILLARY SERVICE OTH PASS THR  CSTS					
	"2552-10 WORKSHEET D, PART IV FOR THE SUB1"					
						
DATA TYPE	96 FIELD NAME	10 FIELD NAME	FIELD DESCRIPTION 	WKSHT CD	LINE	COLUMN
						
ROLLUP	NOT ON OLD FORM	D_4_SUB1_C13_50	Operating Room	D01D184	5000	1300
ROLLUP	NOT ON OLD FORM	D_4_SUB1_C13_51	Recovery Room	D01D184	5100	1300
ROLLUP	NOT ON OLD FORM	D_4_SUB1_C13_52	Delivery Room and Labor Room	D01D184	5200	1300
ROLLUP	NOT ON OLD FORM	D_4_SUB1_C13_53	Anesthesiology	D01D184	5300	1300
ROLLUP	NOT ON OLD FORM	D_4_SUB1_C13_54	Radiology-Diagnostic	D01D184	5400	1300
ROLLUP	NOT ON OLD FORM	D_4_SUB1_C13_55	Radiology-Therapeutic	D01D184	5500	1300
ROLLUP	NOT ON OLD FORM	D_4_SUB1_C13_56	Radioisotope	D01D184	5600	1300
ROLLUP	NOT ON OLD FORM	D_4_SUB1_C13_57	CT Scan	D01D184	5700	1300
ROLLUP	NOT ON OLD FORM	D_4_SUB1_C13_58	MRI	D01D184	5800	1300
ROLLUP	NOT ON OLD FORM	D_4_SUB1_C13_59	Cardiac Catheterization	D01D184	5900	1300
ROLLUP	NOT ON OLD FORM	D_4_SUB1_C13_60	Laboratory	D01D184	6000	1300
NUMERIC	NOT ON OLD FORM	D_4_SUB1_C13_61	PBP Clinical Lab Services Program Only	D01D184	6100	1300
ROLLUP	NOT ON OLD FORM	D_4_SUB1_C13_62	Whole Blood & Packed Red Blood Cells	D01D184	6200	1300
ROLLUP	NOT ON OLD FORM	D_4_SUB1_C13_6250	Blood Clotting Factors for Hemoph.	D01D184	6250	1300
ROLLUP	NOT ON OLD FORM	D_4_SUB1_C13_63	"Blood Storing, Processing, Trans"	D01D184	6300	1300
ROLLUP	NOT ON OLD FORM	D_4_SUB1_C13_64	Intravenous Therapy	D01D184	6400	1300
ROLLUP	NOT ON OLD FORM	D_4_SUB1_C13_65	Respiratory Therapy	D01D184	6500	1300
ROLLUP	NOT ON OLD FORM	D_4_SUB1_C13_66	Physical Therapy	D01D184	6600	1300
ROLLUP	NOT ON OLD FORM	D_4_SUB1_C13_67	Occupational Therapy	D01D184	6700	1300
ROLLUP	NOT ON OLD FORM	D_4_SUB1_C13_68	Speech Pathology	D01D184	6800	1300
ROLLUP	NOT ON OLD FORM	D_4_SUB1_C13_69	Electrocardiology	D01D184	6900	1300
ROLLUP	NOT ON OLD FORM	D_4_SUB1_C13_70	Electroencephalography	D01D184	7000	1300
ROLLUP	NOT ON OLD FORM	D_4_SUB1_C13_71	Medical Supplies Charged to Patients	D01D184	7100	1300
ROLLUP	NOT ON OLD FORM	D_4_SUB1_C13_72	Impl. Dev. Charged to Patients 	D01D184	7200	1300
ROLLUP	NOT ON OLD FORM	D_4_SUB1_C13_73	Drugs Charged to Patients	D01D184	7300	1300
NUMERIC	NOT ON OLD FORM	D_4_SUB1_C13_74	Renal Dialysis	D01D184	7400	1300
ROLLUP	NOT ON OLD FORM	D_4_SUB1_C13_75	ASC (Non Distinct Part)	D01D184	7500	1300
ROLLUP	NOT ON OLD FORM	D_4_SUB1_C13_76	Other Ancillary	D01D184	7600	1300
ROLLUP	NOT ON OLD FORM	D_4_SUB1_C13_88	RHC	D01D184	8800	1300
ROLLUP	NOT ON OLD FORM	D_4_SUB1_C13_89	FQHC	D01D184	8900	1300
ROLLUP	NOT ON OLD FORM	D_4_SUB1_C13_90	Clinic	D01D184	9000	1300
ROLLUP	NOT ON OLD FORM	D_4_SUB1_C13_91	Emergency	D01D184	9100	1300
ROLLUP	NOT ON OLD FORM	D_4_SUB1_C13_9201	Observation Beds (Distinct Unit)	D01D184	9201	1300
ROLLUP	NOT ON OLD FORM	D_4_SUB1_C13_93	Other Outpatient Services	D01D184	9300	1300
NUMERIC	NOT ON OLD FORM	D_4_SUB1_C13_94	Home Program Dialysis	D01D184	9400	1300
NUMERIC	NOT ON OLD FORM	D_4_SUB1_C13_95	Ambulance Services	D01D184	9500	1300
ROLLUP	NOT ON OLD FORM	D_4_SUB1_C13_96	Durable Medical Equipment Rented	D01D184	9600	1300
ROLLUP	NOT ON OLD FORM	D_4_SUB1_C13_97	Durable Medical Equipment Sold	D01D184	9700	1300
ROLLUP	NOT ON OLD FORM	D_4_SUB1_C13_98	Other Reimbursable	D01D184	9800	1300
NUMERIC	NOT ON OLD FORM	D_4_SUB1_C13_200	Total 	D01D184	20000	1300
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
	APPORTIONMENT OF INPATIENT/OUTPATIENT ANCILLARY SERVICE OTH PASS THR  CSTS					
	"2552-10 WORKSHEET D, PART IV FOR THE SUB2"					
						
DATA TYPE	96 FIELD NAME	10 FIELD NAME	FIELD DESCRIPTION 	WKSHT CD	LINE	COLUMN
						
ROLLUP	NOT ON OLD FORM	D_4_SUB2_C11_50	Operating Room	D02D184	5000	1100
ROLLUP	NOT ON OLD FORM	D_4_SUB2_C11_51	Recovery Room	D02D184	5100	1100
ROLLUP	NOT ON OLD FORM	D_4_SUB2_C11_52	Delivery Room and Labor Room	D02D184	5200	1100
ROLLUP	NOT ON OLD FORM	D_4_SUB2_C11_53	Anesthesiology	D02D184	5300	1100
ROLLUP	NOT ON OLD FORM	D_4_SUB2_C11_54	Radiology-Diagnostic	D02D184	5400	1100
ROLLUP	NOT ON OLD FORM	D_4_SUB2_C11_55	Radiology-Therapeutic	D02D184	5500	1100
ROLLUP	NOT ON OLD FORM	D_4_SUB2_C11_56	Radioisotope	D02D184	5600	1100
ROLLUP	NOT ON OLD FORM	D_4_SUB2_C11_57	CT Scan	D02D184	5700	1100
ROLLUP	NOT ON OLD FORM	D_4_SUB2_C11_58	MRI	D02D184	5800	1100
ROLLUP	NOT ON OLD FORM	D_4_SUB2_C11_59	Cardiac Catheterization	D02D184	5900	1100
ROLLUP	NOT ON OLD FORM	D_4_SUB2_C11_60	Laboratory	D02D184	6000	1100
NUMERIC	NOT ON OLD FORM	D_4_SUB2_C11_61	PBP Clinical Lab Services Program Only	D02D184	6100	1100
ROLLUP	NOT ON OLD FORM	D_4_SUB2_C11_62	Whole Blood & Packed Red Blood Cells	D02D184	6200	1100
ROLLUP	NOT ON OLD FORM	D_4_SUB2_C11_6250	Blood Clotting Factors for Hemoph.	D02D184	6250	1100
ROLLUP	NOT ON OLD FORM	D_4_SUB2_C11_63	"Blood Storing, Processing, Trans"	D02D184	6300	1100
ROLLUP	NOT ON OLD FORM	D_4_SUB2_C11_64	Intravenous Therapy	D02D184	6400	1100
ROLLUP	NOT ON OLD FORM	D_4_SUB2_C11_65	Respiratory Therapy	D02D184	6500	1100
ROLLUP	NOT ON OLD FORM	D_4_SUB2_C11_66	Physical Therapy	D02D184	6600	1100
ROLLUP	NOT ON OLD FORM	D_4_SUB2_C11_67	Occupational Therapy	D02D184	6700	1100
ROLLUP	NOT ON OLD FORM	D_4_SUB2_C11_68	Speech Pathology	D02D184	6800	1100
ROLLUP	NOT ON OLD FORM	D_4_SUB2_C11_69	Electrocardiology	D02D184	6900	1100
ROLLUP	NOT ON OLD FORM	D_4_SUB2_C11_70	Electroencephalography	D02D184	7000	1100
ROLLUP	NOT ON OLD FORM	D_4_SUB2_C11_71	Medical Supplies Charged to Patients	D02D184	7100	1100
ROLLUP	NOT ON OLD FORM	D_4_SUB2_C11_72	Impl. Dev. Charged to Patients 	D02D184	7200	1100
ROLLUP	NOT ON OLD FORM	D_4_SUB2_C11_73	Drugs Charged to Patients	D02D184	7300	1100
NUMERIC	NOT ON OLD FORM	D_4_SUB2_C11_74	Renal Dialysis	D02D184	7400	1100
ROLLUP	NOT ON OLD FORM	D_4_SUB2_C11_75	ASC (Non Distinct Part)	D02D184	7500	1100
ROLLUP	NOT ON OLD FORM	D_4_SUB2_C11_76	Other Ancillary	D02D184	7600	1100
ROLLUP	NOT ON OLD FORM	D_4_SUB2_C11_88	RHC	D02D184	8800	1100
ROLLUP	NOT ON OLD FORM	D_4_SUB2_C11_89	FQHC	D02D184	8900	1100
ROLLUP	NOT ON OLD FORM	D_4_SUB2_C11_90	Clinic	D02D184	9000	1100
ROLLUP	NOT ON OLD FORM	D_4_SUB2_C11_91	Emergency	D02D184	9100	1100
ROLLUP	NOT ON OLD FORM	D_4_SUB2_C11_9201	Observation Beds (Distinct Unit)	D02D184	9201	1100
ROLLUP	NOT ON OLD FORM	D_4_SUB2_C11_93	Other Outpatient Services	D02D184	9300	1100
NUMERIC	NOT ON OLD FORM	D_4_SUB2_C11_94	Home Program Dialysis	D02D184	9400	1100
NUMERIC	NOT ON OLD FORM	D_4_SUB2_C11_95	Ambulance Services	D02D184	9500	1100
ROLLUP	NOT ON OLD FORM	D_4_SUB2_C11_96	Durable Medical Equipment Rented	D02D184	9600	1100
ROLLUP	NOT ON OLD FORM	D_4_SUB2_C11_97	Durable Medical Equipment Sold	D02D184	9700	1100
ROLLUP	NOT ON OLD FORM	D_4_SUB2_C11_98	Other Reimbursable	D02D184	9800	1100
NUMERIC	NOT ON OLD FORM	D_4_SUB2_C11_200	Total 	D02D184	20000	1100
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
	APPORTIONMENT OF INPATIENT/OUTPATIENT ANCILLARY SERVICE OTH PASS THR  CSTS					
	"2552-10 WORKSHEET D, PART IV FOR THE SUB2"					
						
DATA TYPE	96 FIELD NAME	10 FIELD NAME	FIELD DESCRIPTION 	WKSHT CD	LINE	COLUMN
						
ROLLUP	NOT ON OLD FORM	D_4_SUB2_C13_50	Operating Room	D02D184	5000	1300
ROLLUP	NOT ON OLD FORM	D_4_SUB2_C13_51	Recovery Room	D02D184	5100	1300
ROLLUP	NOT ON OLD FORM	D_4_SUB2_C13_52	Delivery Room and Labor Room	D02D184	5200	1300
ROLLUP	NOT ON OLD FORM	D_4_SUB2_C13_53	Anesthesiology	D02D184	5300	1300
ROLLUP	NOT ON OLD FORM	D_4_SUB2_C13_54	Radiology-Diagnostic	D02D184	5400	1300
ROLLUP	NOT ON OLD FORM	D_4_SUB2_C13_55	Radiology-Therapeutic	D02D184	5500	1300
ROLLUP	NOT ON OLD FORM	D_4_SUB2_C13_56	Radioisotope	D02D184	5600	1300
ROLLUP	NOT ON OLD FORM	D_4_SUB2_C13_57	CT Scan	D02D184	5700	1300
ROLLUP	NOT ON OLD FORM	D_4_SUB2_C13_58	MRI	D02D184	5800	1300
ROLLUP	NOT ON OLD FORM	D_4_SUB2_C13_59	Cardiac Catheterization	D02D184	5900	1300
ROLLUP	NOT ON OLD FORM	D_4_SUB2_C13_60	Laboratory	D02D184	6000	1300
NUMERIC	NOT ON OLD FORM	D_4_SUB2_C13_61	PBP Clinical Lab Services Program Only	D02D184	6100	1300
ROLLUP	NOT ON OLD FORM	D_4_SUB2_C13_62	Whole Blood & Packed Red Blood Cells	D02D184	6200	1300
ROLLUP	NOT ON OLD FORM	D_4_SUB2_C13_6250	Blood Clotting Factors for Hemoph.	D02D184	6250	1300
ROLLUP	NOT ON OLD FORM	D_4_SUB2_C13_63	"Blood Storing, Processing, Trans"	D02D184	6300	1300
ROLLUP	NOT ON OLD FORM	D_4_SUB2_C13_64	Intravenous Therapy	D02D184	6400	1300
ROLLUP	NOT ON OLD FORM	D_4_SUB2_C13_65	Respiratory Therapy	D02D184	6500	1300
ROLLUP	NOT ON OLD FORM	D_4_SUB2_C13_66	Physical Therapy	D02D184	6600	1300
ROLLUP	NOT ON OLD FORM	D_4_SUB2_C13_67	Occupational Therapy	D02D184	6700	1300
ROLLUP	NOT ON OLD FORM	D_4_SUB2_C13_68	Speech Pathology	D02D184	6800	1300
ROLLUP	NOT ON OLD FORM	D_4_SUB2_C13_69	Electrocardiology	D02D184	6900	1300
ROLLUP	NOT ON OLD FORM	D_4_SUB2_C13_70	Electroencephalography	D02D184	7000	1300
ROLLUP	NOT ON OLD FORM	D_4_SUB2_C13_71	Medical Supplies Charged to Patients	D02D184	7100	1300
ROLLUP	NOT ON OLD FORM	D_4_SUB2_C13_72	Impl. Dev. Charged to Patients 	D02D184	7200	1300
ROLLUP	NOT ON OLD FORM	D_4_SUB2_C13_73	Drugs Charged to Patients	D02D184	7300	1300
NUMERIC	NOT ON OLD FORM	D_4_SUB2_C13_74	Renal Dialysis	D02D184	7400	1300
ROLLUP	NOT ON OLD FORM	D_4_SUB2_C13_75	ASC (Non Distinct Part)	D02D184	7500	1300
ROLLUP	NOT ON OLD FORM	D_4_SUB2_C13_76	Other Ancillary	D02D184	7600	1300
ROLLUP	NOT ON OLD FORM	D_4_SUB2_C13_88	RHC	D02D184	8800	1300
ROLLUP	NOT ON OLD FORM	D_4_SUB2_C13_89	FQHC	D02D184	8900	1300
ROLLUP	NOT ON OLD FORM	D_4_SUB2_C13_90	Clinic	D02D184	9000	1300
ROLLUP	NOT ON OLD FORM	D_4_SUB2_C13_91	Emergency	D02D184	9100	1300
ROLLUP	NOT ON OLD FORM	D_4_SUB2_C13_9201	Observation Beds (Distinct Unit)	D02D184	9201	1300
ROLLUP	NOT ON OLD FORM	D_4_SUB2_C13_93	Other Outpatient Services	D02D184	9300	1300
NUMERIC	NOT ON OLD FORM	D_4_SUB2_C13_94	Home Program Dialysis	D02D184	9400	1300
NUMERIC	NOT ON OLD FORM	D_4_SUB2_C13_95	Ambulance Services	D02D184	9500	1300
ROLLUP	NOT ON OLD FORM	D_4_SUB2_C13_96	Durable Medical Equipment Rented	D02D184	9600	1300
ROLLUP	NOT ON OLD FORM	D_4_SUB2_C13_97	Durable Medical Equipment Sold	D02D184	9700	1300
ROLLUP	NOT ON OLD FORM	D_4_SUB2_C13_98	Other Reimbursable	D02D184	9800	1300
NUMERIC	NOT ON OLD FORM	D_4_SUB2_C13_200	Total 	D02D184	20000	1300
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
	APPORTIONMENT OF INPATIENT/OUTPATIENT ANCILLARY SERVICE OTH PASS THR  CSTS					
	"2552-10 WORKSHEET D, PART IV FOR THE SNF"					
						
DATA TYPE	96 FIELD NAME	10 FIELD NAME	FIELD DESCRIPTION 	WKSHT CD	LINE	COLUMN
						
ROLLUP	NOT ON OLD FORM	D_4_SNF_C11_50	Operating Room	D00E184	5000	1100
ROLLUP	NOT ON OLD FORM	D_4_SNF_C11_51	Recovery Room	D00E184	5100	1100
ROLLUP	NOT ON OLD FORM	D_4_SNF_C11_52	Delivery Room and Labor Room	D00E184	5200	1100
ROLLUP	NOT ON OLD FORM	D_4_SNF_C11_53	Anesthesiology	D00E184	5300	1100
ROLLUP	NOT ON OLD FORM	D_4_SNF_C11_54	Radiology-Diagnostic	D00E184	5400	1100
ROLLUP	NOT ON OLD FORM	D_4_SNF_C11_55	Radiology-Therapeutic	D00E184	5500	1100
ROLLUP	NOT ON OLD FORM	D_4_SNF_C11_56	Radioisotope	D00E184	5600	1100
ROLLUP	NOT ON OLD FORM	D_4_SNF_C11_57	CT Scan	D00E184	5700	1100
ROLLUP	NOT ON OLD FORM	D_4_SNF_C11_58	MRI	D00E184	5800	1100
ROLLUP	NOT ON OLD FORM	D_4_SNF_C11_59	Cardiac Catheterization	D00E184	5900	1100
ROLLUP	NOT ON OLD FORM	D_4_SNF_C11_60	Laboratory	D00E184	6000	1100
NUMERIC	NOT ON OLD FORM	D_4_SNF_C11_61	PBP Clinical Lab Services Program Only	D00E184	6100	1100
ROLLUP	NOT ON OLD FORM	D_4_SNF_C11_62	Whole Blood & Packed Red Blood Cells	D00E184	6200	1100
ROLLUP	NOT ON OLD FORM	D_4_SNF_C11_6250	Blood Clotting Factors for Hemoph.	D00E184	6250	1100
ROLLUP	NOT ON OLD FORM	D_4_SNF_C11_63	"Blood Storing, Processing, Trans"	D00E184	6300	1100
ROLLUP	NOT ON OLD FORM	D_4_SNF_C11_64	Intravenous Therapy	D00E184	6400	1100
ROLLUP	NOT ON OLD FORM	D_4_SNF_C11_65	Respiratory Therapy	D00E184	6500	1100
ROLLUP	NOT ON OLD FORM	D_4_SNF_C11_66	Physical Therapy	D00E184	6600	1100
ROLLUP	NOT ON OLD FORM	D_4_SNF_C11_67	Occupational Therapy	D00E184	6700	1100
ROLLUP	NOT ON OLD FORM	D_4_SNF_C11_68	Speech Pathology	D00E184	6800	1100
ROLLUP	NOT ON OLD FORM	D_4_SNF_C11_69	Electrocardiology	D00E184	6900	1100
ROLLUP	NOT ON OLD FORM	D_4_SNF_C11_70	Electroencephalography	D00E184	7000	1100
ROLLUP	NOT ON OLD FORM	D_4_SNF_C11_71	Medical Supplies Charged to Patients	D00E184	7100	1100
ROLLUP	NOT ON OLD FORM	D_4_SNF_C11_72	Impl. Dev. Charged to Patients 	D00E184	7200	1100
ROLLUP	NOT ON OLD FORM	D_4_SNF_C11_73	Drugs Charged to Patients	D00E184	7300	1100
NUMERIC	NOT ON OLD FORM	D_4_SNF_C11_74	Renal Dialysis	D00E184	7400	1100
ROLLUP	NOT ON OLD FORM	D_4_SNF_C11_75	ASC (Non Distinct Part)	D00E184	7500	1100
ROLLUP	NOT ON OLD FORM	D_4_SNF_C11_76	Other Ancillary	D00E184	7600	1100
ROLLUP	NOT ON OLD FORM	D_4_SNF_C11_88	RHC	D00E184	8800	1100
ROLLUP	NOT ON OLD FORM	D_4_SNF_C11_89	FQHC	D00E184	8900	1100
ROLLUP	NOT ON OLD FORM	D_4_SNF_C11_90	Clinic	D00E184	9000	1100
ROLLUP	NOT ON OLD FORM	D_4_SNF_C11_91	Emergency	D00E184	9100	1100
ROLLUP	NOT ON OLD FORM	D_4_SNF_C11_9201	Observation Beds (Distinct Unit)	D00E184	9201	1100
ROLLUP	NOT ON OLD FORM	D_4_SNF_C11_93	Other Outpatient Services	D00E184	9300	1100
NUMERIC	NOT ON OLD FORM	D_4_SNF_C11_94	Home Program Dialysis	D00E184	9400	1100
NUMERIC	NOT ON OLD FORM	D_4_SNF_C11_95	Ambulance Services	D00E184	9500	1100
ROLLUP	NOT ON OLD FORM	D_4_SNF_C11_96	Durable Medical Equipment Rented	D00E184	9600	1100
ROLLUP	NOT ON OLD FORM	D_4_SNF_C11_97	Durable Medical Equipment Sold	D00E184	9700	1100
ROLLUP	NOT ON OLD FORM	D_4_SNF_C11_98	Other Reimbursable	D00E184	9800	1100
NUMERIC	NOT ON OLD FORM	D_4_SNF_C11_200	Total 	D00E184	20000	1100
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
	APPORTIONMENT OF INPATIENT/OUTPATIENT ANCILLARY SERVICE OTH PASS THR  CSTS					
	"2552-10 WORKSHEET D, PART IV FOR THE SNF"					
						
DATA TYPE	96 FIELD NAME	10 FIELD NAME	FIELD DESCRIPTION 	WKSHT CD	LINE	COLUMN
						
ROLLUP	NOT ON OLD FORM	D_4_SNF_C13_50	Operating Room	D00E184	5000	1300
ROLLUP	NOT ON OLD FORM	D_4_SNF_C13_51	Recovery Room	D00E184	5100	1300
ROLLUP	NOT ON OLD FORM	D_4_SNF_C13_52	Delivery Room and Labor Room	D00E184	5200	1300
ROLLUP	NOT ON OLD FORM	D_4_SNF_C13_53	Anesthesiology	D00E184	5300	1300
ROLLUP	NOT ON OLD FORM	D_4_SNF_C13_54	Radiology-Diagnostic	D00E184	5400	1300
ROLLUP	NOT ON OLD FORM	D_4_SNF_C13_55	Radiology-Therapeutic	D00E184	5500	1300
ROLLUP	NOT ON OLD FORM	D_4_SNF_C13_56	Radioisotope	D00E184	5600	1300
ROLLUP	NOT ON OLD FORM	D_4_SNF_C13_57	CT Scan	D00E184	5700	1300
ROLLUP	NOT ON OLD FORM	D_4_SNF_C13_58	MRI	D00E184	5800	1300
ROLLUP	NOT ON OLD FORM	D_4_SNF_C13_59	Cardiac Catheterization	D00E184	5900	1300
ROLLUP	NOT ON OLD FORM	D_4_SNF_C13_60	Laboratory	D00E184	6000	1300
NUMERIC	NOT ON OLD FORM	D_4_SNF_C13_61	PBP Clinical Lab Services Program Only	D00E184	6100	1300
ROLLUP	NOT ON OLD FORM	D_4_SNF_C13_62	Whole Blood & Packed Red Blood Cells	D00E184	6200	1300
ROLLUP	NOT ON OLD FORM	D_4_SNF_C13_6250	Blood Clotting Factors for Hemoph.	D00E184	6250	1300
ROLLUP	NOT ON OLD FORM	D_4_SNF_C13_63	"Blood Storing, Processing, Trans"	D00E184	6300	1300
ROLLUP	NOT ON OLD FORM	D_4_SNF_C13_64	Intravenous Therapy	D00E184	6400	1300
ROLLUP	NOT ON OLD FORM	D_4_SNF_C13_65	Respiratory Therapy	D00E184	6500	1300
ROLLUP	NOT ON OLD FORM	D_4_SNF_C13_66	Physical Therapy	D00E184	6600	1300
ROLLUP	NOT ON OLD FORM	D_4_SNF_C13_67	Occupational Therapy	D00E184	6700	1300
ROLLUP	NOT ON OLD FORM	D_4_SNF_C13_68	Speech Pathology	D00E184	6800	1300
ROLLUP	NOT ON OLD FORM	D_4_SNF_C13_69	Electrocardiology	D00E184	6900	1300
ROLLUP	NOT ON OLD FORM	D_4_SNF_C13_70	Electroencephalography	D00E184	7000	1300
ROLLUP	NOT ON OLD FORM	D_4_SNF_C13_71	Medical Supplies Charged to Patients	D00E184	7100	1300
ROLLUP	NOT ON OLD FORM	D_4_SNF_C13_72	Impl. Dev. Charged to Patients 	D00E184	7200	1300
ROLLUP	NOT ON OLD FORM	D_4_SNF_C13_73	Drugs Charged to Patients	D00E184	7300	1300
NUMERIC	NOT ON OLD FORM	D_4_SNF_C13_74	Renal Dialysis	D00E184	7400	1300
ROLLUP	NOT ON OLD FORM	D_4_SNF_C13_75	ASC (Non Distinct Part)	D00E184	7500	1300
ROLLUP	NOT ON OLD FORM	D_4_SNF_C13_76	Other Ancillary	D00E184	7600	1300
ROLLUP	NOT ON OLD FORM	D_4_SNF_C13_88	RHC	D00E184	8800	1300
ROLLUP	NOT ON OLD FORM	D_4_SNF_C13_89	FQHC	D00E184	8900	1300
ROLLUP	NOT ON OLD FORM	D_4_SNF_C13_90	Clinic	D00E184	9000	1300
ROLLUP	NOT ON OLD FORM	D_4_SNF_C13_91	Emergency	D00E184	9100	1300
ROLLUP	NOT ON OLD FORM	D_4_SNF_C13_9201	Observation Beds (Distinct Unit)	D00E184	9201	1300
ROLLUP	NOT ON OLD FORM	D_4_SNF_C13_93	Other Outpatient Services	D00E184	9300	1300
NUMERIC	NOT ON OLD FORM	D_4_SNF_C13_94	Home Program Dialysis	D00E184	9400	1300
NUMERIC	NOT ON OLD FORM	D_4_SNF_C13_95	Ambulance Services	D00E184	9500	1300
ROLLUP	NOT ON OLD FORM	D_4_SNF_C13_96	Durable Medical Equipment Rented	D00E184	9600	1300
ROLLUP	NOT ON OLD FORM	D_4_SNF_C13_97	Durable Medical Equipment Sold	D00E184	9700	1300
ROLLUP	NOT ON OLD FORM	D_4_SNF_C13_98	Other Reimbursable	D00E184	9800	1300
NUMERIC	NOT ON OLD FORM	D_4_SNF_C13_200	Total 	D00E184	20000	1300
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
	APPORTIONMENT OF INPATIENT/OUTPATIENT ANCILLARY SERVICE OTH PASS THR CSTS 					
	"2552-10 WORKSHEET D, PART IV FOR THE HOSPITAL"					
						
						
DATA TYPE	96 FIELD NAME	10 FIELD NAME	FIELD DESCRIPTION 	WKSHT CD	LINE	COLUMN
						
NUMERIC	NOT ON OLD FORM	D_4_HOS_C2_200	Total Nursing School	D00A184	20000	200
NUMERIC	NOT ON OLD FORM	D_4_HOS_C3_200	Total Allied Health	D00A184	20000	300
NUMERIC	NOT ON OLD FORM	D_4_HOS_C4_200	Total Other Medical Education	D00A184	20000	400
NUMERIC	D_4_HOS_C9_101	D_4_HOS_C6_200	Total Outpatient Program Pass Thru Cost	D00A184	20000	600
						
						
						
						
	APPORTIONMENT OF INPATIENT/OUTPATIENT ANCILLARY SERVICE OTHER PASS THROUGH  					
	"2552-10 WORKSHEET D, PART IV FOR IPF, IRF, AND SUBPROVIDER I and II"					
						
DATA TYPE	96 FIELD NAME	10 FIELD NAME	FIELD DESCRIPTION 	WKSHT CD	LINE	COLUMN
						
NUMERIC		D_4_IPF_C1_200	Total Nonphysician Anesthetist Cost	D00B184	20000	100
NUMERIC		D_4_IPF_C2_200	Total Nursing School	D00B184	20000	200
NUMERIC		D_4_IPF_C3_200	Total Allied Health	D00B184	20000	300
NUMERIC		D_4_IPF_C4_200	Total Other Medical Education	D00B184	20000	400
NUMERIC		D_4_IPF_C6_200	Total Outpatient Program Pass Thru Cost	D00B184	20000	600
						
						
NUMERIC		D_4_IRF_C1_102	Total Nonphysician Anesthetist Cost	D00C184	20000	100
NUMERIC		D_4_IRF_C2_200	Total Nursing School	D00C184	20000	200
NUMERIC		D_4_IRF_C3_200	Total Allied Health	D00C184	20000	300
NUMERIC		D_4_IRF_C4_200	Total Other Medical Education	D00C184	20000	400
NUMERIC		D_4_IRF_C6_200	Total Outpatient Program Pass Thru Cost	D00C184	20000	600
						
						
						
NUMERIC		D_4_SUB1_C1_200	Total Nonphysician Anesthetist Cost	D01D184	20000	100
NUMERIC		D_4_SUB1_C2_200	Total Nursing School	D01D184	20000	200
NUMERIC		D_4_SUB1_C3_200	Total Allied Health	D01D184	20000	300
NUMERIC		D_4_SUB1_C4_200	Total Other Medical Education	D01D184	20000	400
NUMERIC		D_4_SUB1_C6_200	Total Outpatient Program Pass Thru Cost	D01D184	20000	600
						
						
NUMERIC		D_4_SUB2_C1_102	Total Nonphysician Anesthetist Cost	D02D184	20000	100
NUMERIC		D_4_SUB2_C2_200	Total Nursing School	D02D184	20000	200
NUMERIC		D_4_SUB2_C3_200	Total Allied Health	D02D184	20000	300
NUMERIC		D_4_SUB2_C4_200	Total Other Medical Education	D02D184	20000	400
NUMERIC		D_4_SUB2_C6_200	Total Outpatient Program Pass Thru Cost	D02D184	20000	600
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
	NOTE:  D part V column meanings have changed between forms.  					
						
						
	APPORTIONMENT OF MEDICAL AND OTHER HEALTH SERVICES					
	"2552-10 WORKSHEET D, PART V"					
			PPS REIMBURSED SERVICES -  CHARGES			
						
DATA TYPE	96 FIELD NAME	10 FIELD NAME	FIELD DESCRIPTION 	WKSHT CD	LINE	COLUMN
						
ROLLUP		D_5_HOS_C2_50	Operating Room	D00A185	5000	200
ROLLUP		D_5_HOS_C2_51	Recovery Room	D00A185	5100	200
ROLLUP		D_5_HOS_C2_52	Delivery Room and Labor Room	D00A185	5200	200
ROLLUP		D_5_HOS_C2_53	Anesthesiology	D00A185	5300	200
ROLLUP		D_5_HOS_C2_54	Radiology-Diagnostic	D00A185	5400	200
ROLLUP		D_5_HOS_C2_55	Radiology-Therapeutic	D00A185	5500	200
ROLLUP		D_5_HOS_C2_56	Radioisotope	D00A185	5600	200
ROLLUP		D_5_HOS_C2_57	CT Scan	D00A185	5700	200
ROLLUP		D_5_HOS_C2_58	MRI	D00A185	5800	200
ROLLUP		D_5_HOS_C2_59	Cardiac Catheterization	D00A185	5900	200
ROLLUP		D_5_HOS_C2_60	Laboratory	D00A185	6000	200
NUMERIC		D_5_HOS_C2_61	PBP Clinical Lab Services Program Only	D00A185	6100	200
ROLLUP		D_5_HOS_C2_62	Whole Blood & Packed Red Blood Cells	D00A185	6200	200
ROLLUP		D_5_HOS_C2_6250	Blood Clotting Factors for Hemoph.	D00A185	6250	200
ROLLUP		D_5_HOS_C2_63	"Blood Storing, Processing, Trans"	D00A185	6300	200
ROLLUP		D_5_HOS_C2_64	Intravenous Therapy	D00A185	6400	200
ROLLUP		D_5_HOS_C2_65	Respiratory Therapy	D00A185	6500	200
ROLLUP		D_5_HOS_C2_66	Physical Therapy	D00A185	6600	200
ROLLUP		D_5_HOS_C2_67	Occupational Therapy	D00A185	6700	200
ROLLUP		D_5_HOS_C2_68	Speech Pathology	D00A185	6800	200
ROLLUP		D_5_HOS_C2_69	Electrocardiology	D00A185	6900	200
ROLLUP		D_5_HOS_C2_70	Electroencephalography	D00A185	7000	200
ROLLUP		D_5_HOS_C2_71	Medical Supplies Charged to Patients	D00A185	7100	200
ROLLUP		D_5_HOS_C2_72	Impl. Dev. Charged to Patients 	D00A185	7200	200
ROLLUP		D_5_HOS_C2_73	Drugs Charged to Patients	D00A185	7300	200
NUMERIC		D_5_HOS_C2_74	Renal Dialysis	D00A185	7400	200
ROLLUP		D_5_HOS_C2_75	ASC (Non Distinct Part)	D00A185	7500	200
ROLLUP		D_5_HOS_C2_76	Other Ancillary	D00A185	7600	200
ROLLUP		D_5_HOS_C2_88	RHC	D00A185	8800	200
ROLLUP		D_5_HOS_C2_89	FQHC	D00A185	8900	200
ROLLUP		D_5_HOS_C2_90	Clinic	D00A185	9000	200
ROLLUP		D_5_HOS_C2_91	Emergency	D00A185	9100	200
ROLLUP		D_5_HOS_C2_9201	Observation Beds (Distinct Unit)	D00A185	9201	200
ROLLUP		D_5_HOS_C2_93	Other Outpatient Services	D00A185	9300	200
NUMERIC		D_5_HOS_C2_94	Home Program Dialysis	D00A185	9400	200
NUMERIC		D_5_HOS_C2_95	Ambulance Services	D00A185	9500	200
ROLLUP		D_5_HOS_C2_96	Durable Medical Equipment Rented	D00A185	9600	200
ROLLUP		D_5_HOS_C2_97	Durable Medical Equipment Sold	D00A185	9700	200
ROLLUP		D_5_HOS_C2_98	Other Reimbursable	D00A185	9800	200
NUMERIC		D_5_HOS_C2_200	Total 	D00A185	20000	200
						
						
		E30A182_03101_00100				
		E30A183_03201_00100				
		E30B182_03101_00100				
		E30C183_03201_00100				
		E30E186_01501_00100				
		H410182_03101_00100				
		H410182_03101_00200				
		H420182_03101_00100				
		H420182_03101_00200				
		H430182_03101_00100				
		H430182_03101_00200				
						
						
						
						
						
						
						
	APPORTIONMENT OF MEDICAL AND OTHER HEALTH SERVICES					
	"2552-10 WORKSHEET D, PART V"					
			COST REIMBURSED SERVICES SUBJECT TO DEDUCTIBLES  AND COINSURANCE - CHARGES			
						
DATA TYPE	96 FIELD NAME	10 FIELD NAME	FIELD DESCRIPTION 	WKSHT CD	LINE	COLUMN
						
ROLLUP		D_5_HOS_C3_50	Operating Room	D00A185	5000	300
ROLLUP		D_5_HOS_C3_51	Recovery Room	D00A185	5100	300
ROLLUP		D_5_HOS_C3_52	Delivery Room and Labor Room	D00A185	5200	300
ROLLUP		D_5_HOS_C3_53	Anesthesiology	D00A185	5300	300
ROLLUP		D_5_HOS_C3_54	Radiology-Diagnostic	D00A185	5400	300
ROLLUP		D_5_HOS_C3_55	Radiology-Therapeutic	D00A185	5500	300
ROLLUP		D_5_HOS_C3_56	Radioisotope	D00A185	5600	300
ROLLUP		D_5_HOS_C3_57	CT Scan	D00A185	5700	300
ROLLUP		D_5_HOS_C3_58	MRI	D00A185	5800	300
ROLLUP		D_5_HOS_C3_59	Cardiac Catheterization	D00A185	5900	300
ROLLUP		D_5_HOS_C3_60	Laboratory	D00A185	6000	300
NUMERIC		D_5_HOS_C3_61	PBP Clinical Lab Services Program Only	D00A185	6100	300
ROLLUP		D_5_HOS_C3_62	Whole Blood & Packed Red Blood Cells	D00A185	6200	300
ROLLUP		D_5_HOS_C3_6250	Blood Clotting Factors for Hemoph.	D00A185	6250	300
ROLLUP		D_5_HOS_C3_63	"Blood Storing, Processing, Trans"	D00A185	6300	300
ROLLUP		D_5_HOS_C3_64	Intravenous Therapy	D00A185	6400	300
ROLLUP		D_5_HOS_C3_65	Respiratory Therapy	D00A185	6500	300
ROLLUP		D_5_HOS_C3_66	Physical Therapy	D00A185	6600	300
ROLLUP		D_5_HOS_C3_67	Occupational Therapy	D00A185	6700	300
ROLLUP		D_5_HOS_C3_68	Speech Pathology	D00A185	6800	300
ROLLUP		D_5_HOS_C3_69	Electrocardiology	D00A185	6900	300
ROLLUP		D_5_HOS_C3_70	Electroencephalography	D00A185	7000	300
ROLLUP		D_5_HOS_C3_71	Medical Supplies Charged to Patients	D00A185	7100	300
ROLLUP		D_5_HOS_C3_72	Impl. Dev. Charged to Patients 	D00A185	7200	300
ROLLUP		D_5_HOS_C3_73	Drugs Charged to Patients	D00A185	7300	300
NUMERIC		D_5_HOS_C3_74	Renal Dialysis	D00A185	7400	300
ROLLUP		D_5_HOS_C3_75	ASC (Non Distinct Part)	D00A185	7500	300
ROLLUP		D_5_HOS_C3_76	Other Ancillary	D00A185	7600	300
ROLLUP		D_5_HOS_C3_88	RHC	D00A185	8800	300
ROLLUP		D_5_HOS_C3_89	FQHC	D00A185	8900	300
ROLLUP		D_5_HOS_C3_90	Clinic	D00A185	9000	300
ROLLUP		D_5_HOS_C3_91	Emergency	D00A185	9100	300
ROLLUP		D_5_HOS_C3_9201	Observation Beds (Distinct Unit)	D00A185	9201	300
ROLLUP		D_5_HOS_C3_93	Other Outpatient Services	D00A185	9300	300
NUMERIC		D_5_HOS_C3_94	Home Program Dialysis	D00A185	9400	300
NUMERIC		D_5_HOS_C3_95	Ambulance Services	D00A185	9500	300
ROLLUP		D_5_HOS_C3_96	Durable Medical Equipment Rented	D00A185	9600	300
ROLLUP		D_5_HOS_C3_97	Durable Medical Equipment Sold	D00A185	9700	300
ROLLUP		D_5_HOS_C3_98	Other Reimbursable	D00A185	9800	300
NUMERIC		D_5_HOS_C3_200	Total 	D00A185	20000	300
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
	APPORTIONMENT OF MEDICAL AND OTHER HEALTH SERVICES					
	"2552-10 WORKSHEET D, PART V"					
			COST REIMBURSED SERVICES NOT SUBJECT TO DEDUCTIBLES AND COINSURANCE - CHARGES			
						
DATA TYPE	96 FIELD NAME	10 FIELD NAME	FIELD DESCRIPTION 	WKSHT CD	LINE	COLUMN
						
ROLLUP		D_5_HOS_C4_50	Operating Room	D00A185	5000	400
ROLLUP		D_5_HOS_C4_51	Recovery Room	D00A185	5100	400
ROLLUP		D_5_HOS_C4_52	Delivery Room and Labor Room	D00A185	5200	400
ROLLUP		D_5_HOS_C4_53	Anesthesiology	D00A185	5300	400
ROLLUP		D_5_HOS_C4_54	Radiology-Diagnostic	D00A185	5400	400
ROLLUP		D_5_HOS_C4_55	Radiology-Therapeutic	D00A185	5500	400
ROLLUP		D_5_HOS_C4_56	Radioisotope	D00A185	5600	400
ROLLUP		D_5_HOS_C4_57	CT Scan	D00A185	5700	400
ROLLUP		D_5_HOS_C4_58	MRI	D00A185	5800	400
ROLLUP		D_5_HOS_C4_59	Cardiac Catheterization	D00A185	5900	400
ROLLUP		D_5_HOS_C4_60	Laboratory	D00A185	6000	400
NUMERIC		D_5_HOS_C4_61	PBP Clinical Lab Services Program Only	D00A185	6100	400
ROLLUP		D_5_HOS_C4_62	Whole Blood & Packed Red Blood Cells	D00A185	6200	400
ROLLUP		D_5_HOS_C4_6250	Blood Clotting Factors for Hemoph.	D00A185	6250	400
ROLLUP		D_5_HOS_C4_63	"Blood Storing, Processing, Trans"	D00A185	6300	400
ROLLUP		D_5_HOS_C4_64	Intravenous Therapy	D00A185	6400	400
ROLLUP		D_5_HOS_C4_65	Respiratory Therapy	D00A185	6500	400
ROLLUP		D_5_HOS_C4_66	Physical Therapy	D00A185	6600	400
ROLLUP		D_5_HOS_C4_67	Occupational Therapy	D00A185	6700	400
ROLLUP		D_5_HOS_C4_68	Speech Pathology	D00A185	6800	400
ROLLUP		D_5_HOS_C4_69	Electrocardiology	D00A185	6900	400
ROLLUP		D_5_HOS_C4_70	Electroencephalography	D00A185	7000	400
ROLLUP		D_5_HOS_C4_71	Medical Supplies Charged to Patients	D00A185	7100	400
ROLLUP		D_5_HOS_C4_72	Impl. Dev. Charged to Patients 	D00A185	7200	400
ROLLUP		D_5_HOS_C4_73	Drugs Charged to Patients	D00A185	7300	400
NUMERIC		D_5_HOS_C4_74	Renal Dialysis	D00A185	7400	400
ROLLUP		D_5_HOS_C4_75	ASC (Non Distinct Part)	D00A185	7500	400
ROLLUP		D_5_HOS_C4_76	Other Ancillary	D00A185	7600	400
ROLLUP		D_5_HOS_C4_88	RHC	D00A185	8800	400
ROLLUP		D_5_HOS_C4_89	FQHC	D00A185	8900	400
ROLLUP		D_5_HOS_C4_90	Clinic	D00A185	9000	400
ROLLUP		D_5_HOS_C4_91	Emergency	D00A185	9100	400
ROLLUP		D_5_HOS_C4_9201	Observation Beds (Distinct Unit)	D00A185	9201	400
ROLLUP		D_5_HOS_C4_93	Other Outpatient Services	D00A185	9300	400
NUMERIC		D_5_HOS_C4_94	Home Program Dialysis	D00A185	9400	400
NUMERIC		D_5_HOS_C4_95	Ambulance Services	D00A185	9500	400
ROLLUP		D_5_HOS_C4_96	Durable Medical Equipment Rented	D00A185	9600	400
ROLLUP		D_5_HOS_C4_97	Durable Medical Equipment Sold	D00A185	9700	400
ROLLUP		D_5_HOS_C4_98	Other Reimbursable	D00A185	9800	400
NUMERIC		D_5_HOS_C4_200	Total 	D00A185	20000	400
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
	APPORTIONMENT OF MEDICAL AND OTHER HEALTH SERVICES					
	"2552-10 WORKSHEET D, PART V  "					
			PPS SERVICES COST			
						
DATA TYPE	96 FIELD NAME	10 FIELD NAME	FIELD DESCRIPTION 	WKSHT CD	LINE	COLUMN
						
ROLLUP		D_5_HOS_C5_50	Operating Room	D00A185	5000	500
ROLLUP		D_5_HOS_C5_51	Recovery Room	D00A185	5100	500
ROLLUP		D_5_HOS_C5_52	Delivery Room and Labor Room	D00A185	5200	500
ROLLUP		D_5_HOS_C5_53	Anesthesiology	D00A185	5300	500
ROLLUP		D_5_HOS_C5_54	Radiology-Diagnostic	D00A185	5400	500
ROLLUP		D_5_HOS_C5_55	Radiology-Therapeutic	D00A185	5500	500
ROLLUP		D_5_HOS_C5_56	Radioisotope	D00A185	5600	500
ROLLUP		D_5_HOS_C5_57	CT Scan	D00A185	5700	500
ROLLUP		D_5_HOS_C5_58	MRI	D00A185	5800	500
ROLLUP		D_5_HOS_C5_59	Cardiac Catheterization	D00A185	5900	500
ROLLUP		D_5_HOS_C5_60	Laboratory	D00A185	6000	500
NUMERIC		D_5_HOS_C5_61	PBP Clinical Lab Services Program Only	D00A185	6100	500
ROLLUP		D_5_HOS_C5_62	Whole Blood & Packed Red Blood Cells	D00A185	6200	500
ROLLUP		D_5_HOS_C5_6250	Blood Clotting Factors for Hemoph.	D00A185	6250	500
ROLLUP		D_5_HOS_C5_63	"Blood Storing, Processing, Trans"	D00A185	6300	500
ROLLUP		D_5_HOS_C5_64	Intravenous Therapy	D00A185	6400	500
ROLLUP		D_5_HOS_C5_65	Respiratory Therapy	D00A185	6500	500
ROLLUP		D_5_HOS_C5_66	Physical Therapy	D00A185	6600	500
ROLLUP		D_5_HOS_C5_67	Occupational Therapy	D00A185	6700	500
ROLLUP		D_5_HOS_C5_68	Speech Pathology	D00A185	6800	500
ROLLUP		D_5_HOS_C5_69	Electrocardiology	D00A185	6900	500
ROLLUP		D_5_HOS_C5_70	Electroencephalography	D00A185	7000	500
ROLLUP		D_5_HOS_C5_71	Medical Supplies Charged to Patients	D00A185	7100	500
ROLLUP		D_5_HOS_C5_72	Impl. Dev. Charged to Patients 	D00A185	7200	500
ROLLUP		D_5_HOS_C5_73	Drugs Charged to Patients	D00A185	7300	500
NUMERIC		D_5_HOS_C5_74	Renal Dialysis	D00A185	7400	500
ROLLUP		D_5_HOS_C5_75	ASC (Non Distinct Part)	D00A185	7500	500
ROLLUP		D_5_HOS_C5_76	Other Ancillary	D00A185	7600	500
ROLLUP		D_5_HOS_C5_88	RHC	D00A185	8800	500
ROLLUP		D_5_HOS_C5_89	FQHC	D00A185	8900	500
ROLLUP		D_5_HOS_C5_90	Clinic	D00A185	9000	500
ROLLUP		D_5_HOS_C5_91	Emergency	D00A185	9100	500
ROLLUP		D_5_HOS_C5_9201	Observation Beds (Distinct Unit)	D00A185	9201	500
ROLLUP		D_5_HOS_C5_93	Other Outpatient Services	D00A185	9300	500
NUMERIC		D_5_HOS_C5_94	Home Program Dialysis	D00A185	9400	500
NUMERIC		D_5_HOS_C5_95	Ambulance Services	D00A185	9500	500
ROLLUP		D_5_HOS_C5_96	Durable Medical Equipment Rented	D00A185	9600	500
ROLLUP		D_5_HOS_C5_97	Durable Medical Equipment Sold	D00A185	9700	500
ROLLUP		D_5_HOS_C5_98	Other Reimbursable	D00A185	9800	500
NUMERIC		D_5_HOS_C5_200	Total 	D00A185	20000	500
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
	APPORTIONMENT OF MEDICAL AND OTHER HEALTH SERVICES					
	"2552-10 WORKSHEET D, PART V"					
			COST SERVICES SUBJECT TO DEDUCTIBLES AND COINSURANCE - COST			
						
DATA TYPE	96 FIELD NAME	10 FIELD NAME	FIELD DESCRIPTION 	WKSHT CD	LINE	COLUMN
						
ROLLUP		D_5_HOS_C6_50	Operating Room	D00A185	5000	600
ROLLUP		D_5_HOS_C6_51	Recovery Room	D00A185	5100	600
ROLLUP		D_5_HOS_C6_52	Delivery Room and Labor Room	D00A185	5200	600
ROLLUP		D_5_HOS_C6_53	Anesthesiology	D00A185	5300	600
ROLLUP		D_5_HOS_C6_54	Radiology-Diagnostic	D00A185	5400	600
ROLLUP		D_5_HOS_C6_55	Radiology-Therapeutic	D00A185	5500	600
ROLLUP		D_5_HOS_C6_56	Radioisotope	D00A185	5600	600
ROLLUP		D_5_HOS_C6_57	CT Scan	D00A185	5700	600
ROLLUP		D_5_HOS_C6_58	MRI	D00A185	5800	600
ROLLUP		D_5_HOS_C6_59	Cardiac Catheterization	D00A185	5900	600
ROLLUP		D_5_HOS_C6_60	Laboratory	D00A185	6000	600
NUMERIC		D_5_HOS_C6_61	PBP Clinical Lab Services Program Only	D00A185	6100	600
ROLLUP		D_5_HOS_C6_62	Whole Blood & Packed Red Blood Cells	D00A185	6200	600
ROLLUP		D_5_HOS_C6_6250	Blood Clotting Factors for Hemoph.	D00A185	6250	600
ROLLUP		D_5_HOS_C6_63	"Blood Storing, Processing, Trans"	D00A185	6300	600
ROLLUP		D_5_HOS_C6_64	Intravenous Therapy	D00A185	6400	600
ROLLUP		D_5_HOS_C6_65	Respiratory Therapy	D00A185	6500	600
ROLLUP		D_5_HOS_C6_66	Physical Therapy	D00A185	6600	600
ROLLUP		D_5_HOS_C6_67	Occupational Therapy	D00A185	6700	600
ROLLUP		D_5_HOS_C6_68	Speech Pathology	D00A185	6800	600
ROLLUP		D_5_HOS_C6_69	Electrocardiology	D00A185	6900	600
ROLLUP		D_5_HOS_C6_70	Electroencephalography	D00A185	7000	600
ROLLUP		D_5_HOS_C6_71	Medical Supplies Charged to Patients	D00A185	7100	600
ROLLUP		D_5_HOS_C6_72	Impl. Dev. Charged to Patients 	D00A185	7200	600
ROLLUP		D_5_HOS_C6_73	Drugs Charged to Patients	D00A185	7300	600
NUMERIC		D_5_HOS_C6_74	Renal Dialysis	D00A185	7400	600
ROLLUP		D_5_HOS_C6_75	ASC (Non Distinct Part)	D00A185	7500	600
ROLLUP		D_5_HOS_C6_76	Other Ancillary	D00A185	7600	600
ROLLUP		D_5_HOS_C6_88	RHC	D00A185	8800	600
ROLLUP		D_5_HOS_C6_89	FQHC	D00A185	8900	600
ROLLUP		D_5_HOS_C6_90	Clinic	D00A185	9000	600
ROLLUP		D_5_HOS_C6_91	Emergency	D00A185	9100	600
ROLLUP		D_5_HOS_C6_9201	Observation Beds (Distinct Unit)	D00A185	9201	600
ROLLUP		D_5_HOS_C6_93	Other Outpatient Services	D00A185	9300	600
NUMERIC		D_5_HOS_C6_94	Home Program Dialysis	D00A185	9400	600
NUMERIC		D_5_HOS_C6_95	Ambulance Services	D00A185	9500	600
ROLLUP		D_5_HOS_C6_96	Durable Medical Equipment Rented	D00A185	9600	600
ROLLUP		D_5_HOS_C6_97	Durable Medical Equipment Sold	D00A185	9700	600
ROLLUP		D_5_HOS_C6_98	Other Reimbursable	D00A185	9800	600
NUMERIC		D_5_HOS_C6_200	Total 	D00A185	20000	600
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
	APPORTIONMENT OF MEDICAL AND OTHER HEALTH SERVICES					
	"2552-10 WORKSHEET D, PART V"					
			COST SERVICES NOT SUBJECT TO DEDUCTIBLES AND COINSURANCE - COST			
						
DATA TYPE	96 FIELD NAME	10 FIELD NAME	FIELD DESCRIPTION 	WKSHT CD	LINE	COLUMN
						
ROLLUP		D_5_HOS_C7_50	Operating Room	D00A185	5000	700
ROLLUP		D_5_HOS_C7_51	Recovery Room	D00A185	5100	700
ROLLUP		D_5_HOS_C7_52	Delivery Room and Labor Room	D00A185	5200	700
ROLLUP		D_5_HOS_C7_53	Anesthesiology	D00A185	5300	700
ROLLUP		D_5_HOS_C7_54	Radiology-Diagnostic	D00A185	5400	700
ROLLUP		D_5_HOS_C7_55	Radiology-Therapeutic	D00A185	5500	700
ROLLUP		D_5_HOS_C7_56	Radioisotope	D00A185	5600	700
ROLLUP		D_5_HOS_C7_57	CT Scan	D00A185	5700	700
ROLLUP		D_5_HOS_C7_58	MRI	D00A185	5800	700
ROLLUP		D_5_HOS_C7_59	Cardiac Catheterization	D00A185	5900	700
ROLLUP		D_5_HOS_C7_60	Laboratory	D00A185	6000	700
NUMERIC		D_5_HOS_C7_61	PBP Clinical Lab Services Program Only	D00A185	6100	700
ROLLUP		D_5_HOS_C7_62	Whole Blood & Packed Red Blood Cells	D00A185	6200	700
ROLLUP		D_5_HOS_C7_6250	Blood Clotting Factors for Hemoph.	D00A185	6250	700
ROLLUP		D_5_HOS_C7_63	"Blood Storing, Processing, Trans"	D00A185	6300	700
ROLLUP		D_5_HOS_C7_64	Intravenous Therapy	D00A185	6400	700
ROLLUP		D_5_HOS_C7_65	Respiratory Therapy	D00A185	6500	700
ROLLUP		D_5_HOS_C7_66	Physical Therapy	D00A185	6600	700
ROLLUP		D_5_HOS_C7_67	Occupational Therapy	D00A185	6700	700
ROLLUP		D_5_HOS_C7_68	Speech Pathology	D00A185	6800	700
ROLLUP		D_5_HOS_C7_69	Electrocardiology	D00A185	6900	700
ROLLUP		D_5_HOS_C7_70	Electroencephalography	D00A185	7000	700
ROLLUP		D_5_HOS_C7_71	Medical Supplies Charged to Patients	D00A185	7100	700
ROLLUP		D_5_HOS_C7_72	Impl. Dev. Charged to Patients 	D00A185	7200	700
ROLLUP		D_5_HOS_C7_73	Drugs Charged to Patients	D00A185	7300	700
NUMERIC		D_5_HOS_C7_74	Renal Dialysis	D00A185	7400	700
ROLLUP		D_5_HOS_C7_75	ASC (Non Distinct Part)	D00A185	7500	700
ROLLUP		D_5_HOS_C7_76	Other Ancillary	D00A185	7600	700
ROLLUP		D_5_HOS_C7_88	RHC	D00A185	8800	700
ROLLUP		D_5_HOS_C7_89	FQHC	D00A185	8900	700
ROLLUP		D_5_HOS_C7_90	Clinic	D00A185	9000	700
ROLLUP		D_5_HOS_C7_91	Emergency	D00A185	9100	700
ROLLUP		D_5_HOS_C7_9201	Observation Beds (Distinct Unit)	D00A185	9201	700
ROLLUP		D_5_HOS_C7_93	Other Outpatient Services	D00A185	9300	700
NUMERIC		D_5_HOS_C7_94	Home Program Dialysis	D00A185	9400	700
NUMERIC		D_5_HOS_C7_95	Ambulance Services	D00A185	9500	700
ROLLUP		D_5_HOS_C7_96	Durable Medical Equipment Rented	D00A185	9600	700
ROLLUP		D_5_HOS_C7_97	Durable Medical Equipment Sold	D00A185	9700	700
ROLLUP		D_5_HOS_C7_98	Other Reimbursable	D00A185	9800	700
NUMERIC		D_5_HOS_C7_200	Total 	D00A185	20000	700
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
	COMPUTATION OF INPATIENT OPERATING COSTS					
	2552-10 WORKSHEET D-1 FOR THE HOSPITAL					
						
DATA TYPE	96 FIELD NAME	10 FIELD NAME	FIELD DESCRIPTION 	WKSHT CD	LINE	COLUMN
						
NUMERIC	D1_HOS_C1_26	D1_HOS_C1_26	Total Swing Bed Cost	D10A181	2600	100
						
			General Inpatient Routine Service Cost			
NUMERIC	D1_HOS_C1_27	D1_HOS_C1_27	net of Swing Bed Cost	D10A181	2700	100
						
			General Inpatient Routine Service Cost			
NUMERIC	D1_HOS_C1_37	D1_HOS_C1_37	net of Swing Bed and Private Room Diff	D10A181	3700	100
						
NUMERIC	D1_HOS_C1_41	D1_HOS_C1_41	Total Program General Inpatient Routine 	D10A181	4100	100
						
						
ROLLUP	D1_HOS_C5_43	D1_HOS_C5_43	Intensive Care Unit Program Cost	D10A181	4300	500
ROLLUP	D1_HOS_C5_44	D1_HOS_C5_44	Coronary Care Unit Program Cost	D10A181	4400	500
ROLLUP	D1_HOS_C5_45	D1_HOS_C5_45	Burn Intensive Care Unit Program Cost	D10A181	4500	500
ROLLUP	D1_HOS_C5_46	D1_HOS_C5_46	Surgical Intensive Care Unit Program Cost	D10A181	4600	500
ROLLUP	D1_HOS_C5_47	D1_HOS_C5_47	Other Special Care Unit Program Cost	D10A181	4700	500
NUMERIC	D1_HOS_C1_48	D1_HOS_C1_48	Program Inpatient Ancillary Service Cost	D10A181	4800	100
NUMERIC	D1_HOS_C1_49	D1_HOS_C1_49	Total Program Inpatient Costs	D10A181	4900	100
NUMERIC	D1_HOS_C1_50	D1_HOS_C1_50	Pass through Cost for Program Inpatient Routine 	D10A181	5000	100
NUMERIC	D1_HOS_C1_51	D1_HOS_C1_51	Pass Through Cost for  Program Ancillary	D10A181	5100	100
NUMERIC	D1_HOS_C1_52	D1_HOS_C1_52	Total Program Excludable Costs	D10A181	5200	100
						
			Total Program Inpatient Operating Cost 			
			"excluding Capital Related, Nonphysician "			
NUMERIC	D1_HOS_C1_53	D1_HOS_C1_53	"Anesthetist, and Medical Education Costs"	D10A181	5300	100
						
NUMERIC	D1_HOS_C1_54	D1_HOS_C1_54	Program Discharges	D10A181	5400	100
NUMERIC	D1_HOS_C1_55	D1_HOS_C1_55	Target Amount per Discharge	D10A181	5500	100
NUMERIC	D1_HOS_C1_56	D1_HOS_C1_56	Target Amount   	D10A181	5600	100
						
			Difference between Adjusted Inpatient 			
NUMERIC	D1_HOS_C1_57	D1_HOS_C1_57	Operating Cost and Target Amount	D10A181	5700	100
						
NUMERIC	D1_HOS_C1_58	D1_HOS_C1_58	Bonus Payment	D10A181	5800	100
						
NUMERIC		D1_HOS_C1_62	Relief Payment	D10A181	6200	100
NUMERIC	D1_HOS_C1_59	D1_HOS_C1_63	Allowable Inpatient Cost Plus Incentive Pt	D10A181	6300	100
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
	COMPUTATION OF INPATIENT OPERATING COSTS					
	2552-10 WORKSHEET D-1 FOR IPF					
						
DATA TYPE	96 FIELD NAME	10 FIELD NAME	FIELD DESCRIPTION 	WKSHT CD	LINE	COLUMN
						
			General Inpatient Routine Service Cost			
NUMERIC		D1_IPF_C1_27	net of Swing Bed Cost	D10B181	2700	100
						
			General Inpatient Routine Service Cost			
NUMERIC		D1_IPF_C1_37	net of Swing Bed and Private Room Diff	D10B181	3700	100
						
NUMERIC		D1_IPF_C1_41	Total Program General Inpatient Routine 	D10B181	4100	100
NUMERIC		D1_IPF_C1_48	Program Inpatient Ancillary Service Cost	D10B181	4800	100
NUMERIC		D1_IPF_C1_49	Total Program Inpatient Costs	D10B181	4900	100
NUMERIC		D1_IPF_C1_50	Pass through Cost for Program Inpatient 	D10B181	5000	100
NUMERIC		D1_IPF_C1_51	Pass Through Cost for  Program Ancillary	D10B181	5100	100
NUMERIC		D1_IPF_C1_52	Total Program Excludable Costs	D10B181	5200	100
						
			Total Program Inpatient Operating Cost 			
			"excluding Capital Related, Nonphysician "			
NUMERIC		D1_IPF_C1_53	"Anesthetist, and Medical Education Costs"	D10B181	5300	100
						
NUMERIC		D1_IPF_C1_54	Program Discharges	D10B181	5400	100
NUMERIC		D1_IPF_C1_55	Target Amount per Discharge	D10B181	5500	100
NUMERIC		D1_IPF_C1_56	Target Amount   	D10B181	5600	100
 						
			Difference between Adjusted Inpatient 			
NUMERIC		D1_IPF_C1_57	Operating Cost and Target Amount	D10B181	5700	100
						
						
NUMERIC		D1_IPF_C1_58	Bonus Payment	D10B181	5800	100
						
NUMERIC		D1_IPF_C1_63	Allowable Inpatient Cost Plus Incentive Pt	D10B181	6300	100
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
	COMPUTATION OF INPATIENT OPERATING COSTS					
	2552-10 WORKSHEET D-1 FOR IRF					
						
DATA TYPE	96 FIELD NAME	10 FIELD NAME	FIELD DESCRIPTION 	WKSHT CD	LINE	COLUMN
						
			General Inpatient Routine Service Cost			
NUMERIC		D1_IRF_C1_27	net of Swing Bed Cost	D10C181	2700	100
						
			General Inpatient Routine Service Cost			
NUMERIC		D1_IRF_C1_37	net of Swing Bed and Private Room Diff	D10C181	3700	100
						
NUMERIC		D1_IRF_C1_41	Total Program General Inpatient Routine 	D10C181	4100	100
						
						
NUMERIC		D1_IRF_C1_48	Program Inpatient Ancillary Service Cost	D10C181	4800	100
NUMERIC		D1_IRF_C1_49	Total Program Inpatient Costs	D10C181	4900	100
NUMERIC		D1_IRF_C1_50	Pass through Cost for Program Inpatient 	D10C181	5000	100
NUMERIC		D1_IRF_C1_51	Pass Through Cost for  Program Ancillary	D10C181	5100	100
NUMERIC		D1_IRF_C1_52	Total Program Excludable Costs	D10C181	5200	100
						
			Total Program Inpatient Operating Cost 			
			"excluding Capital Related, Nonphysician "			
NUMERIC		D1_IRF_C1_53	"Anesthetist, and Medical Education Costs"	D10C181	5300	100
						
NUMERIC		D1_IRF_C1_54	Program Discharges	D10C181	5400	100
NUMERIC		D1_IRF_C1_55	Target Amount per Discharge	D10C181	5500	100
NUMERIC		D1_IRF_C1_56	Target Amount   	D10C181	5600	100
						
						
			Difference between Adjusted Inpatient 			
NUMERIC		D1_IRF_C1_57	Operating Cost and Target Amount	D10C181	5700	100
						
NUMERIC		D1_IRF_C1_58	Bonus Payment	D10C181	5800	100
						
NUMERIC		D1_IRF_C1_63	Allowable Inpatient Cost Plus Incentive Payment	D10C181	6300	100
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
	COMPUTATION OF INPATIENT OPERATING COSTS					
	2552-10 WORKSHEET D-1 FOR SUBPROVIDER I					
						
DATA TYPE	96 FIELD NAME	10 FIELD NAME	FIELD DESCRIPTION 	WKSHT CD	LINE	COLUMN
						
			General Inpatient Routine Service Cost			
NUMERIC		D1_SUB1_C1_27	net of Swing Bed Cost	D11D181	2700	100
						
			General Inpatient Routine Service Cost			
NUMERIC		D1_SUB1_C1_37	net of Swing Bed and Private Room Diff	D11D181	3700	100
						
NUMERIC		D1_SUB1_C1_41	Total Program General Inpatient Routine 	D11D181	4100	100
NUMERIC		D1_SUB1_C1_48	Program Inpatient Ancillary Service Cost	D11D181	4800	100
NUMERIC		D1_SUB1_C1_49	Total Program Inpatient Costs	D11D181	4900	100
NUMERIC		D1_SUB1_C1_50	Pass through Cost for Program Inpatient 	D11D181	5000	100
NUMERIC		D1_SUB1_C1_51	Pass Through Cost for  Program Ancillary	D11D181	5100	100
NUMERIC		D1_SUB1_C1_52	Total Program Excludable Costs	D11D181	5200	100
						
			Total Program Inpatient Operating Cost 			
			"excluding Capital Related, Nonphysician "			
NUMERIC		D1_SUB1_C1_53	"Anesthetist, and Medical Education Costs"	D11D181	5300	100
						
NUMERIC		D1_SUB1_C1_54	Program Discharges	D11D181	5400	100
NUMERIC		D1_SUB1_C1_55	Target Amount per Discharge	D11D181	5500	100
NUMERIC		D1_SUB1_C1_56	Target Amount   	D11D181	5600	100
 						
			Difference between Adjusted Inpatient 			
NUMERIC		D1_SUB1_C1_57	Operating Cost and Target Amount	D11D181	5700	100
						
						
NUMERIC		D1_SUB1_C1_58	Bonus Payment	D11D181	5800	100
						
NUMERIC		D1_SUB1_C1_63	Allowable Inpatient Cost Plus Incentive Pt	D11D181	6300	100
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
	COMPUTATION OF INPATIENT OPERATING COSTS					
	2552-10 WORKSHEET D-1 FOR SUBPROVIDER II					
						
DATA TYPE	96 FIELD NAME	10 FIELD NAME	FIELD DESCRIPTION 	WKSHT CD	LINE	COLUMN
						
			General Inpatient Routine Service Cost			
NUMERIC		D1_SUB2_C1_27	net of Swing Bed Cost	D12D181	2700	100
						
			General Inpatient Routine Service Cost			
NUMERIC		D1_SUB2_C1_37	net of Swing Bed and Private Room Diff	D12D181	3700	100
						
NUMERIC		D1_SUB2_C1_41	Total Program General Inpatient Routine 	D12D181	4100	100
						
						
NUMERIC		D1_SUB2_C1_48	Program Inpatient Ancillary Service Cost	D12D181	4800	100
NUMERIC		D1_SUB2_C1_49	Total Program Inpatient Costs	D12D181	4900	100
NUMERIC		D1_SUB2_C1_50	Pass through Cost for Program Inpatient 	D12D181	5000	100
NUMERIC		D1_SUB2_C1_51	Pass Through Cost for  Program Ancillary	D12D181	5100	100
NUMERIC		D1_SUB2_C1_52	Total Program Excludable Costs	D12D181	5200	100
						
			Total Program Inpatient Operating Cost 			
			"excluding Capital Related, Nonphysician "			
NUMERIC		D1_SUB2_C1_53	"Anesthetist, and Medical Education Costs"	D12D181	5300	100
						
NUMERIC		D1_SUB2_C1_54	Program Discharges	D12D181	5400	100
NUMERIC		D1_SUB2_C1_55	Target Amount per Discharge	D12D181	5500	100
NUMERIC		D1_SUB2_C1_56	Target Amount   	D12D181	5600	100
						
						
			Difference between Adjusted Inpatient 			
NUMERIC		D1_SUB2_C1_57	Operating Cost and Target Amount	D12D181	5700	100
						
NUMERIC		D1_SUB2_C1_58	Bonus Payment	D12D181	5800	100
						
NUMERIC		D1_SUB2_C1_63	Allowable Inpatient Cost Plus Incentive Payment	D12D181	6300	100
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
	COMPUTATION OF INPATIENT OPERATING COSTS					
	2552-10 WORKSHEET D-1 FOR THE SNF					
						
DATA TYPE	96 FIELD NAME	10 FIELD NAME	FIELD DESCRIPTION 	WKSHT CD	LINE	COLUMN
						
			General Inpatient Routine Service Cost			
NUMERIC	D1_SNF_C1_37	D1_SNF_C1_37	net of Swing Bed and Private Room Diff	D10E181	3700	100
						
NUMERIC	D1_SNF_C1_70	D1_SNF_C1_74	Total Program General Inp. Rtn Service 	D10E181	7400	100
NUMERIC	D1_SNF_C1_80	D1_SNF_C1_84	Program Ancillary Services 	D10E181	8400	100
NUMERIC	D1_SNF_C1_81	D1_SNF_C1_85	Utilization Review - Physician Compen	D10E181	8500	100
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
	INPATIENT ANCILLARY SERVICE COST APPORTIONMENT					
	2552-10 WORKSHEET D-3 FOR THE HOSPITAL					
						
DATA TYPE	96 FIELD NAME	10 FIELD NAME	FIELD DESCRIPTION 	WKSHT CD	LINE	COLUMN
						
NUMERIC	D4_HOS_C2_25	D3_HOS_C2_30	Adults and Pediatrics	D30A180	3000	200
ROLLUP	D4_HOS_C2_26	D3_HOS_C2_31	Intensive Care Unit	D30A180	3100	200
ROLLUP	D4_HOS_C2_27	D3_HOS_C2_32	Coronary Care Unit	D30A180	3200	200
ROLLUP	D4_HOS_C2_28	D3_HOS_C2_33	Burn Intensive Care Unit	D30A180	3300	200
ROLLUP	D4_HOS_C2_29	D3_HOS_C2_34	Surgical Intensive Care Unit	D30A180	3400	200
ROLLUP	D4_HOS_C2_30	D3_HOS_C2_35	Other Special Care Unit	D30A180	3500	200
NUMERIC	NOT ON OLD FORM	D3_HOS_C2_40	Subprovider-IPF	D30A180	4000	200
NUMERIC	NOT ON OLD FORM	D3_HOS_C2_41	Subprovider-IRF	D30A180	4100	200
NUMERIC	D4_HOS_C2_31	D3_HOS_C2_42	Subprovider I	D30A180	4200	200
NUMERIC	D4_HOS_C2_3101	D3_HOS_C2_4201	Subprovider II	D30A180	4201	200
NUMERIC	D4_HOS_C2_33	D3_HOS_C2_43	Nursery	D30A180	4300	200
NUMERIC	D4_HOS_C2_34	D3_HOS_C2_44	SNF	D30A180	4400	200
NUMERIC	D4_HOS_C2_35	D3_HOS_C2_45	NF	D30A180	4500	200
NUMERIC	D4_HOS_C2_3501	D3_HOS_C2_4501	ICF	D30A180	4501	200
NUMERIC	D4_HOS_C2_36	D3_HOS_C2_46	OLTC	D30A180	4600	200
ROLLUP	D4_HOS_C2_37	D3_HOS_C2_50	Operating Room	D30A180	5000	200
ROLLUP	D4_HOS_C2_38	D3_HOS_C2_51	Recovery Room	D30A180	5100	200
ROLLUP	D4_HOS_C2_39	D3_HOS_C2_52	Delivery Room and Labor Room	D30A180	5200	200
ROLLUP	D4_HOS_C2_40	D3_HOS_C2_53	Anesthesiology	D30A180	5300	200
ROLLUP	D4_HOS_C2_41	D3_HOS_C2_54	Radiology-Diagnostic	D30A180	5400	200
ROLLUP	D4_HOS_C2_42	D3_HOS_C2_55	Radiology-Therapeutic	D30A180	5500	200
ROLLUP	D4_HOS_C2_43	D3_HOS_C2_56	Radioisotope	D30A180	5600	200
ROLLUP	NOT ON OLD FORM	D3_HOS_C2_57	CT Scan	D30A180	5700	200
ROLLUP	NOT ON OLD FORM	D3_HOS_C2_58	MRI	D30A180	5800	200
ROLLUP	NOT ON OLD FORM	D3_HOS_C2_59	Cardiac Catheterization	D30A180	5900	200
ROLLUP	D4_HOS_C2_44	D3_HOS_C2_60	Laboratory	D30A180	6000	200
NUMERIC	D4_HOS_C2_45	D3_HOS_C2_61	PBP Clinical Lab Services Program Only	D30A180	6100	200
ROLLUP	D4_HOS_C2_46	D3_HOS_C2_62	Whole Blood & Packed Red Blood Cells	D30A180	6200	200
ROLLUP	D4_HOS_C2_4630	D3_HOS_C2_6250	Blood Clotting Factors for Hemoph.	D30A180	6250	200
ROLLUP	D4_HOS_C2_47	D3_HOS_C2_63	"Blood Storing, Processing, Trans"	D30A180	6300	200
ROLLUP	D4_HOS_C2_48	D3_HOS_C2_64	Intravenous Therapy	D30A180	6400	200
ROLLUP	D4_HOS_C2_49	D3_HOS_C2_65	Respiratory Therapy	D30A180	6500	200
ROLLUP	D4_HOS_C2_50	D3_HOS_C2_66	Physical Therapy	D30A180	6600	200
ROLLUP	D4_HOS_C2_51	D3_HOS_C2_67	Occupational Therapy	D30A180	6700	200
ROLLUP	D4_HOS_C2_52	D3_HOS_C2_68	Speech Pathology	D30A180	6800	200
ROLLUP	D4_HOS_C2_53	D3_HOS_C2_69	Electrocardiology	D30A180	6900	200
ROLLUP	D4_HOS_C2_54	D3_HOS_C2_70	Electroencephalography	D30A180	7000	200
ROLLUP	D4_HOS_C2_55	D3_HOS_C2_71	Medical Supplies Charged to Patients	D30A180	7100	200
ROLLUP	D4_HOS_C2_5530	D3_HOS_C2_72	Impl. Dev. Charged to Patients 	D30A180	7200	200
ROLLUP	D4_HOS_C2_56	D3_HOS_C2_73	Drugs Charged to Patients	D30A180	7300	200
NUMERIC	D4_HOS_C2_57	D3_HOS_C2_74	Renal Dialysis	D30A180	7400	200
ROLLUP	D4_HOS_C2_58	D3_HOS_C2_75	ASC (Non Distinct Part)	D30A180	7500	200
ROLLUP	D4_HOS_C2_59	D3_HOS_C2_76	Other Ancillary	D30A180	7600	200
ROLLUP	D4_HOS_C2_6350	D3_HOS_C2_88	RHC	D30A180	8800	200
ROLLUP	D4_HOS_C2_6360	D3_HOS_C2_89	FQHC	D30A180	8900	200
ROLLUP	D4_HOS_C2_60	D3_HOS_C2_90	Clinic	D30A180	9000	200
ROLLUP	D4_HOS_C2_61	D3_HOS_C2_91	Emergency	D30A180	9100	200
ROLLUP	D4_HOS_C2_6201	D3_HOS_C2_9201	Observation Beds (Distinct Unit)	D30A180	9201	200
ROLLUP	D4_HOS_C2_63	D3_HOS_C2_93	Other Outpatient Services	D30A180	9300	200
NUMERIC	D4_HOS_C2_64	D3_HOS_C2_94	Home Program Dialysis	D30A180	9400	200
NUMERIC	D4_HOS_C2_65	D3_HOS_C2_95	Ambulance Services	D30A180	9500	200
ROLLUP	D4_HOS_C2_66	D3_HOS_C2_96	Durable Medical Equipment Rented	D30A180	9600	200
ROLLUP	D4_HOS_C2_67	D3_HOS_C2_97	Durable Medical Equipment Sold	D30A180	9700	200
ROLLUP	D4_HOS_C2_68	D3_HOS_C2_98	Other Reimbursable	D30A180	9800	200
NUMERIC		D3_HOS_C2_200		D30A180	20000	200
NUMERIC		D3_HOS_C2_201		D30A180	20100	200
NUMERIC		D3_HOS_C2_202		D30A180	20200	200
						
						
						
						
						
						
						
						
	INPATIENT ANCILLARY SERVICE COST APPORTIONMENT					
	2552-10 WORKSHEET D-3 FOR THE HOSPITAL					
						
DATA TYPE	96 FIELD NAME	10 FIELD NAME	FIELD DESCRIPTION 	WKSHT CD	LINE	COLUMN
						
NUMERIC	D4_HOS_C3_25	D3_HOS_C3_30	Adults and Pediatrics	D30A180	3000	300
ROLLUP	D4_HOS_C3_26	D3_HOS_C3_31	Intensive Care Unit	D30A180	3100	300
ROLLUP	D4_HOS_C3_27	D3_HOS_C3_32	Coronary Care Unit	D30A180	3200	300
ROLLUP	D4_HOS_C3_28	D3_HOS_C3_33	Burn Intensive Care Unit	D30A180	3300	300
ROLLUP	D4_HOS_C3_29	D3_HOS_C3_34	Surgical Intensive Care Unit	D30A180	3400	300
ROLLUP	D4_HOS_C3_30	D3_HOS_C3_35	Other Special Care Unit	D30A180	3500	300
NUMERIC	NOT ON OLD FORM	D3_HOS_C3_40	Subprovider-IPF	D30A180	4000	300
NUMERIC	NOT ON OLD FORM	D3_HOS_C3_41	Subprovider-IRF	D30A180	4100	300
NUMERIC	D4_HOS_C3_31	D3_HOS_C3_42	Subprovider I	D30A180	4200	300
NUMERIC	D4_HOS_C3_3101	D3_HOS_C3_4201	Subprovider II	D30A180	4201	300
NUMERIC	D4_HOS_C3_33	D3_HOS_C3_43	Nursery	D30A180	4300	300
NUMERIC	D4_HOS_C3_34	D3_HOS_C3_44	SNF	D30A180	4400	300
NUMERIC	D4_HOS_C3_35	D3_HOS_C3_45	NF	D30A180	4500	300
NUMERIC	D4_HOS_C3_3501	D3_HOS_C3_4501	ICF	D30A180	4501	300
NUMERIC	D4_HOS_C3_36	D3_HOS_C3_46	OLTC	D30A180	4600	300
ROLLUP	D4_HOS_C3_37	D3_HOS_C3_50	Operating Room	D30A180	5000	300
ROLLUP	D4_HOS_C3_38	D3_HOS_C3_51	Recovery Room	D30A180	5100	300
ROLLUP	D4_HOS_C3_39	D3_HOS_C3_52	Delivery Room and Labor Room	D30A180	5200	300
ROLLUP	D4_HOS_C3_40	D3_HOS_C3_53	Anesthesiology	D30A180	5300	300
ROLLUP	D4_HOS_C3_41	D3_HOS_C3_54	Radiology-Diagnostic	D30A180	5400	300
ROLLUP	D4_HOS_C3_42	D3_HOS_C3_55	Radiology-Therapeutic	D30A180	5500	300
ROLLUP	D4_HOS_C3_43	D3_HOS_C3_56	Radioisotope	D30A180	5600	300
ROLLUP	NOT ON OLD FORM	D3_HOS_C3_57	CT Scan	D30A180	5700	300
ROLLUP	NOT ON OLD FORM	D3_HOS_C3_58	MRI	D30A180	5800	300
ROLLUP	NOT ON OLD FORM	D3_HOS_C3_59	Cardiac Catheterization	D30A180	5900	300
ROLLUP	D4_HOS_C3_44	D3_HOS_C3_60	Laboratory	D30A180	6000	300
NUMERIC	D4_HOS_C3_45	D3_HOS_C3_61	PBP Clinical Lab Services Program Only	D30A180	6100	300
ROLLUP	D4_HOS_C3_46	D3_HOS_C3_62	Whole Blood & Packed Red Blood Cells	D30A180	6200	300
ROLLUP	D4_HOS_C3_4630	D3_HOS_C3_6250	Blood Clotting Factors for Hemoph.	D30A180	6250	300
ROLLUP	D4_HOS_C3_47	D3_HOS_C3_63	"Blood Storing, Processing, Trans"	D30A180	6300	300
ROLLUP	D4_HOS_C3_48	D3_HOS_C3_64	Intravenous Therapy	D30A180	6400	300
ROLLUP	D4_HOS_C3_49	D3_HOS_C3_65	Respiratory Therapy	D30A180	6500	300
ROLLUP	D4_HOS_C3_50	D3_HOS_C3_66	Physical Therapy	D30A180	6600	300
ROLLUP	D4_HOS_C3_51	D3_HOS_C3_67	Occupational Therapy	D30A180	6700	300
ROLLUP	D4_HOS_C3_52	D3_HOS_C3_68	Speech Pathology	D30A180	6800	300
ROLLUP	D4_HOS_C3_53	D3_HOS_C3_69	Electrocardiology	D30A180	6900	300
ROLLUP	D4_HOS_C3_54	D3_HOS_C3_70	Electroencephalography	D30A180	7000	300
ROLLUP	D4_HOS_C3_55	D3_HOS_C3_71	Medical Supplies Charged to Patients	D30A180	7100	300
ROLLUP	D4_HOS_C3_5530	D3_HOS_C3_72	Impl. Dev. Charged to Patients 	D30A180	7200	300
ROLLUP	D4_HOS_C3_56	D3_HOS_C3_73	Drugs Charged to Patients	D30A180	7300	300
NUMERIC	D4_HOS_C3_57	D3_HOS_C3_74	Renal Dialysis	D30A180	7400	300
ROLLUP	D4_HOS_C3_58	D3_HOS_C3_75	ASC (Non Distinct Part)	D30A180	7500	300
ROLLUP	D4_HOS_C3_59	D3_HOS_C3_76	Other Ancillary	D30A180	7600	300
ROLLUP	D4_HOS_C3_6350	D3_HOS_C3_88	RHC	D30A180	8800	300
ROLLUP	D4_HOS_C3_6360	D3_HOS_C3_89	FQHC	D30A180	8900	300
ROLLUP	D4_HOS_C3_60	D3_HOS_C3_90	Clinic	D30A180	9000	300
ROLLUP	D4_HOS_C3_61	D3_HOS_C3_91	Emergency	D30A180	9100	300
ROLLUP	D4_HOS_C3_6201	D3_HOS_C3_9201	Observation Beds (Distinct Unit)	D30A180	9201	300
ROLLUP	D4_HOS_C3_63	D3_HOS_C3_93	Other Outpatient Services	D30A180	9300	300
NUMERIC	D4_HOS_C3_64	D3_HOS_C3_94	Home Program Dialysis	D30A180	9400	300
NUMERIC	D4_HOS_C3_65	D3_HOS_C3_95	Ambulance Services	D30A180	9500	300
ROLLUP	D4_HOS_C3_66	D3_HOS_C3_96	Durable Medical Equipment Rented	D30A180	9600	300
ROLLUP	D4_HOS_C3_67	D3_HOS_C3_97	Durable Medical Equipment Sold	D30A180	9700	300
ROLLUP	D4_HOS_C3_68	D3_HOS_C3_98	Other Reimbursable	D30A180	9800	300
NUMERIC		D3_HOS_C3_200	TOTAL	D30A180	20000	300
						
						
						
						
						
						
						
						
						
						
	INPATIENT ANCILLARY SERVICE COST APPORTIONMENT					
	2552-10 WORKSHEET D-3 FOR IPF					
						
DATA TYPE	96 FIELD NAME		FIELD DESCRIPTION 	WKSHT CD	LINE	COLUMN
						
ROLLUP		D3_IPF_C2_31	Intensive Care Unit	D30B180	3100	200
ROLLUP		D3_IPF_C2_32	Coronary Care Unit	D30B180	3200	200
ROLLUP		D3_IPF_C2_33	Burn Intensive Care Unit	D30B180	3300	200
ROLLUP		D3_IPF_C2_34	Surgical Intensive Care Unit	D30B180	3400	200
ROLLUP		D3_IPF_C2_35	Other Special Care Unit	D30B180	3500	200
NUMERIC		D3_IPF_C2_40	Subprovider-IPF	D30B180	4000	200
NUMERIC		D3_IPF_C2_41	Subprovider-IRF	D30B180	4100	200
NUMERIC		D3_IPF_C2_42	Subprovider I	D30B180	4200	200
NUMERIC		D3_IPF_C2_4201	Subprovider II	D30B180	4201	200
NUMERIC		D3_IPF_C2_43	Nursery	D30B180	4300	200
NUMERIC		D3_IPF_C2_44	SNF	D30B180	4400	200
NUMERIC		D3_IPF_C2_45	NF	D30B180	4500	200
NUMERIC		D3_IPF_C2_4501	ICF	D30B180	4501	200
NUMERIC		D3_IPF_C2_46	OLTC	D30B180	4600	200
ROLLUP		D3_IPF_C2_50	Operating Room	D30B180	5000	200
ROLLUP		D3_IPF_C2_51	Recovery Room	D30B180	5100	200
ROLLUP		D3_IPF_C2_52	Delivery Room and Labor Room	D30B180	5200	200
ROLLUP		D3_IPF_C2_53	Anesthesiology	D30B180	5300	200
ROLLUP		D3_IPF_C2_54	Radiology-Diagnostic	D30B180	5400	200
ROLLUP		D3_IPF_C2_55	Radiology-Therapeutic	D30B180	5500	200
ROLLUP		D3_IPF_C2_56	Radioisotope	D30B180	5600	200
ROLLUP		D3_IPF_C2_57	CT Scan	D30B180	5700	200
ROLLUP		D3_IPF_C2_58	MRI	D30B180	5800	200
ROLLUP		D3_IPF_C2_59	Cardiac Catheterization	D30B180	5900	200
ROLLUP		D3_IPF_C2_60	Laboratory	D30B180	6000	200
NUMERIC		D3_IPF_C2_61	PBP Clinical Lab Services Program Only	D30B180	6100	200
ROLLUP		D3_IPF_C2_62	Whole Blood & Packed Red Blood Cells	D30B180	6200	200
ROLLUP		D3_IPF_C2_6250	Blood Clotting Factors for Hemoph.	D30B180	6250	200
ROLLUP		D3_IPF_C2_63	"Blood Storing, Processing, Trans"	D30B180	6300	200
ROLLUP		D3_IPF_C2_64	Intravenous Therapy	D30B180	6400	200
ROLLUP		D3_IPF_C2_65	Respiratory Therapy	D30B180	6500	200
ROLLUP		D3_IPF_C2_66	Physical Therapy	D30B180	6600	200
ROLLUP		D3_IPF_C2_67	Occupational Therapy	D30B180	6700	200
ROLLUP		D3_IPF_C2_68	Speech Pathology	D30B180	6800	200
ROLLUP		D3_IPF_C2_69	Electrocardiology	D30B180	6900	200
ROLLUP		D3_IPF_C2_70	Electroencephalography	D30B180	7000	200
ROLLUP		D3_IPF_C2_71	Medical Supplies Charged to Patients	D30B180	7100	200
ROLLUP		D3_IPF_C2_72	Impl. Dev. Charged to Patients 	D30B180	7200	200
ROLLUP		D3_IPF_C2_73	Drugs Charged to Patients	D30B180	7300	200
NUMERIC		D3_IPF_C2_74	Renal Dialysis	D30B180	7400	200
ROLLUP		D3_IPF_C2_75	ASC (Non Distinct Part)	D30B180	7500	200
ROLLUP		D3_IPF_C2_76	Other Ancillary	D30B180	7600	200
ROLLUP		D3_IPF_C2_88	RHC	D30B180	8800	200
ROLLUP		D3_IPF_C2_89	FQHC	D30B180	8900	200
ROLLUP		D3_IPF_C2_90	Clinic	D30B180	9000	200
ROLLUP		D3_IPF_C2_91	Emergency	D30B180	9100	200
ROLLUP		D3_IPF_C2_9201	Observation Beds (Distinct Unit)	D30B180	9201	200
ROLLUP		D3_IPF_C2_93	Other Outpatient Services	D30B180	9300	200
NUMERIC		D3_IPF_C2_94	Home Program Dialysis	D30B180	9400	200
NUMERIC		D3_IPF_C2_95	Ambulance Services	D30B180	9500	200
ROLLUP		D3_IPF_C2_96	Durable Medical Equipment Rented	D30B180	9600	200
ROLLUP		D3_IPF_C2_97	Durable Medical Equipment Sold	D30B180	9700	200
ROLLUP		D3_IPF_C2_98	Other Reimbursable	D30B180	9800	200
NUMERIC		D3_IPF_C2_200	TOTAL	D30B180	20000	200
						
						
						
						
						
						
						
						
						
						
						
	INPATIENT ANCILLARY SERVICE COST APPORTIONMENT					
	2552-10 WORKSHEET D-3 FOR IPF					
						
DATA TYPE	96 FIELD NAME		FIELD DESCRIPTION 	WKSHT CD	LINE	COLUMN
						
ROLLUP		D3_IPF_C3_31	Intensive Care Unit	D30B180	3100	300
ROLLUP		D3_IPF_C3_32	Coronary Care Unit	D30B180	3200	300
ROLLUP		D3_IPF_C3_33	Burn Intensive Care Unit	D30B180	3300	300
ROLLUP		D3_IPF_C3_34	Surgical Intensive Care Unit	D30B180	3400	300
ROLLUP		D3_IPF_C3_35	Other Special Care Unit	D30B180	3500	300
NUMERIC		D3_IPF_C3_40	Subprovider-IPF	D30B180	4000	300
NUMERIC		D3_IPF_C3_41	Subprovider-IRF	D30B180	4100	300
NUMERIC		D3_IPF_C3_42	Subprovider I	D30B180	4200	300
NUMERIC		D3_IPF_C3_4201	Subprovider II	D30B180	4201	300
NUMERIC		D3_IPF_C3_43	Nursery	D30B180	4300	300
NUMERIC		D3_IPF_C3_44	SNF	D30B180	4400	300
NUMERIC		D3_IPF_C3_45	NF	D30B180	4500	300
NUMERIC		D3_IPF_C3_4501	ICF	D30B180	4501	300
NUMERIC		D3_IPF_C3_46	OLTC	D30B180	4600	300
ROLLUP		D3_IPF_C3_50	Operating Room	D30B180	5000	300
ROLLUP		D3_IPF_C3_51	Recovery Room	D30B180	5100	300
ROLLUP		D3_IPF_C3_52	Delivery Room and Labor Room	D30B180	5200	300
ROLLUP		D3_IPF_C3_53	Anesthesiology	D30B180	5300	300
ROLLUP		D3_IPF_C3_54	Radiology-Diagnostic	D30B180	5400	300
ROLLUP		D3_IPF_C3_55	Radiology-Therapeutic	D30B180	5500	300
ROLLUP		D3_IPF_C3_56	Radioisotope	D30B180	5600	300
ROLLUP		D3_IPF_C3_57	CT Scan	D30B180	5700	300
ROLLUP		D3_IPF_C3_58	MRI	D30B180	5800	300
ROLLUP		D3_IPF_C3_59	Cardiac Catheterization	D30B180	5900	300
ROLLUP		D3_IPF_C3_60	Laboratory	D30B180	6000	300
NUMERIC		D3_IPF_C3_61	PBP Clinical Lab Services Program Only	D30B180	6100	300
ROLLUP		D3_IPF_C3_62	Whole Blood & Packed Red Blood Cells	D30B180	6200	300
ROLLUP		D3_IPF_C3_6250	Blood Clotting Factors for Hemoph.	D30B180	6250	300
ROLLUP		D3_IPF_C3_63	"Blood Storing, Processing, Trans"	D30B180	6300	300
ROLLUP		D3_IPF_C3_64	Intravenous Therapy	D30B180	6400	300
ROLLUP		D3_IPF_C3_65	Respiratory Therapy	D30B180	6500	300
ROLLUP		D3_IPF_C3_66	Physical Therapy	D30B180	6600	300
ROLLUP		D3_IPF_C3_67	Occupational Therapy	D30B180	6700	300
ROLLUP		D3_IPF_C3_68	Speech Pathology	D30B180	6800	300
ROLLUP		D3_IPF_C3_69	Electrocardiology	D30B180	6900	300
ROLLUP		D3_IPF_C3_70	Electroencephalography	D30B180	7000	300
ROLLUP		D3_IPF_C3_71	Medical Supplies Charged to Patients	D30B180	7100	300
ROLLUP		D3_IPF_C3_72	Impl. Dev. Charged to Patients 	D30B180	7200	300
ROLLUP		D3_IPF_C3_73	Drugs Charged to Patients	D30B180	7300	300
NUMERIC		D3_IPF_C3_74	Renal Dialysis	D30B180	7400	300
ROLLUP		D3_IPF_C3_75	ASC (Non Distinct Part)	D30B180	7500	300
ROLLUP		D3_IPF_C3_76	Other Ancillary	D30B180	7600	300
ROLLUP		D3_IPF_C3_88	RHC	D30B180	8800	300
ROLLUP		D3_IPF_C3_89	FQHC	D30B180	8900	300
ROLLUP		D3_IPF_C3_90	Clinic	D30B180	9000	300
ROLLUP		D3_IPF_C3_91	Emergency	D30B180	9100	300
ROLLUP		D3_IPF_C3_9201	Observation Beds (Distinct Unit)	D30B180	9201	300
ROLLUP		D3_IPF_C3_93	Other Outpatient Services	D30B180	9300	300
NUMERIC		D3_IPF_C3_94	Home Program Dialysis	D30B180	9400	300
NUMERIC		D3_IPF_C3_95	Ambulance Services	D30B180	9500	300
ROLLUP		D3_IPF_C3_96	Durable Medical Equipment Rented	D30B180	9600	300
ROLLUP		D3_IPF_C3_97	Durable Medical Equipment Sold	D30B180	9700	300
ROLLUP		D3_IPF_C3_98	Other Reimbursable	D30B180	9800	300
NUMERIC		D3_IPF_C3_200	TOTAL	D30B180	20000	300
						
						
						
						
						
						
						
						
						
						
						
	INPATIENT ANCILLARY SERVICE COST APPORTIONMENT					
	2552-10 WORKSHEET D-3 FOR IRF					
						
DATA TYPE	96 FIELD NAME		FIELD DESCRIPTION 	WKSHT CD	LINE	COLUMN
						
ROLLUP		D3_IRF_C2_31	Intensive Care Unit	D30C180	3100	200
ROLLUP		D3_IRF_C2_32	Coronary Care Unit	D30C180	3200	200
ROLLUP		D3_IRF_C2_33	Burn Intensive Care Unit	D30C180	3300	200
ROLLUP		D3_IRF_C2_34	Surgical Intensive Care Unit	D30C180	3400	200
ROLLUP		D3_IRF_C2_35	Other Special Care Unit	D30C180	3500	200
NUMERIC		D3_IRF_C2_40	Subprovider-IRF	D30C180	4000	200
NUMERIC		D3_IRF_C2_41	Subprovider-IRF	D30C180	4100	200
NUMERIC		D3_IRF_C2_42	Subprovider I	D30C180	4200	200
NUMERIC		D3_IRF_C2_4201	Subprovider II	D30C180	4201	200
NUMERIC		D3_IRF_C2_43	Nursery	D30C180	4300	200
NUMERIC		D3_IRF_C2_44	SNF	D30C180	4400	200
NUMERIC		D3_IRF_C2_45	NF	D30C180	4500	200
NUMERIC		D3_IRF_C2_4501	ICF	D30C180	4501	200
NUMERIC		D3_IRF_C2_46	OLTC	D30C180	4600	200
ROLLUP		D3_IRF_C2_50	Operating Room	D30C180	5000	200
ROLLUP		D3_IRF_C2_51	Recovery Room	D30C180	5100	200
ROLLUP		D3_IRF_C2_52	Delivery Room and Labor Room	D30C180	5200	200
ROLLUP		D3_IRF_C2_53	Anesthesiology	D30C180	5300	200
ROLLUP		D3_IRF_C2_54	Radiology-Diagnostic	D30C180	5400	200
ROLLUP		D3_IRF_C2_55	Radiology-Therapeutic	D30C180	5500	200
ROLLUP		D3_IRF_C2_56	Radioisotope	D30C180	5600	200
ROLLUP		D3_IRF_C2_57	CT Scan	D30C180	5700	200
ROLLUP		D3_IRF_C2_58	MRI	D30C180	5800	200
ROLLUP		D3_IRF_C2_59	Cardiac Catheterization	D30C180	5900	200
ROLLUP		D3_IRF_C2_60	Laboratory	D30C180	6000	200
NUMERIC		D3_IRF_C2_61	PBP Clinical Lab Services Program Only	D30C180	6100	200
ROLLUP		D3_IRF_C2_62	Whole Blood & Packed Red Blood Cells	D30C180	6200	200
ROLLUP		D3_IRF_C2_6250	Blood Clotting Factors for Hemoph.	D30C180	6250	200
ROLLUP		D3_IRF_C2_63	"Blood Storing, Processing, Trans"	D30C180	6300	200
ROLLUP		D3_IRF_C2_64	Intravenous Therapy	D30C180	6400	200
ROLLUP		D3_IRF_C2_65	Respiratory Therapy	D30C180	6500	200
ROLLUP		D3_IRF_C2_66	Physical Therapy	D30C180	6600	200
ROLLUP		D3_IRF_C2_67	Occupational Therapy	D30C180	6700	200
ROLLUP		D3_IRF_C2_68	Speech Pathology	D30C180	6800	200
ROLLUP		D3_IRF_C2_69	Electrocardiology	D30C180	6900	200
ROLLUP		D3_IRF_C2_70	Electroencephalography	D30C180	7000	200
ROLLUP		D3_IRF_C2_71	Medical Supplies Charged to Patients	D30C180	7100	200
ROLLUP		D3_IRF_C2_72	Impl. Dev. Charged to Patients 	D30C180	7200	200
ROLLUP		D3_IRF_C2_73	Drugs Charged to Patients	D30C180	7300	200
NUMERIC		D3_IRF_C2_74	Renal Dialysis	D30C180	7400	200
ROLLUP		D3_IRF_C2_75	ASC (Non Distinct Part)	D30C180	7500	200
ROLLUP		D3_IRF_C2_76	Other Ancillary	D30C180	7600	200
ROLLUP		D3_IRF_C2_88	RHC	D30C180	8800	200
ROLLUP		D3_IRF_C2_89	FQHC	D30C180	8900	200
ROLLUP		D3_IRF_C2_90	Clinic	D30C180	9000	200
ROLLUP		D3_IRF_C2_91	Emergency	D30C180	9100	200
ROLLUP		D3_IRF_C2_9201	Observation Beds (Distinct Unit)	D30C180	9201	200
ROLLUP		D3_IRF_C2_93	Other Outpatient Services	D30C180	9300	200
NUMERIC		D3_IRF_C2_94	Home Program Dialysis	D30C180	9400	200
NUMERIC		D3_IRF_C2_95	Ambulance Services	D30C180	9500	200
ROLLUP		D3_IRF_C2_96	Durable Medical Equipment Rented	D30C180	9600	200
ROLLUP		D3_IRF_C2_97	Durable Medical Equipment Sold	D30C180	9700	200
ROLLUP		D3_IRF_C2_98	Other Reimbursable	D30C180	9800	200
NUMERIC		D3_IRF_C2_200	TOTAL	D30C180	20000	200
						
						
						
						
						
						
						
						
						
						
						
	INPATIENT ANCILLARY SERVICE COST APPORTIONMENT					
	2552-10 WORKSHEET D-3 FOR IRF					
						
DATA TYPE	96 FIELD NAME		FIELD DESCRIPTION 	WKSHT CD	LINE	COLUMN
						
ROLLUP		D3_IRF_C3_31	Intensive Care Unit	D30C180	3100	300
ROLLUP		D3_IRF_C3_32	Coronary Care Unit	D30C180	3200	300
ROLLUP		D3_IRF_C3_33	Burn Intensive Care Unit	D30C180	3300	300
ROLLUP		D3_IRF_C3_34	Surgical Intensive Care Unit	D30C180	3400	300
ROLLUP		D3_IRF_C3_35	Other Special Care Unit	D30C180	3500	300
NUMERIC		D3_IRF_C3_40	Subprovider-IRF	D30C180	4000	300
NUMERIC		D3_IRF_C3_41	Subprovider-IRF	D30C180	4100	300
NUMERIC		D3_IRF_C3_42	Subprovider I	D30C180	4200	300
NUMERIC		D3_IRF_C3_4201	Subprovider II	D30C180	4201	300
NUMERIC		D3_IRF_C3_43	Nursery	D30C180	4300	300
NUMERIC		D3_IRF_C3_44	SNF	D30C180	4400	300
NUMERIC		D3_IRF_C3_45	NF	D30C180	4500	300
NUMERIC		D3_IRF_C3_4501	ICF	D30C180	4501	300
NUMERIC		D3_IRF_C3_46	OLTC	D30C180	4600	300
ROLLUP		D3_IRF_C3_50	Operating Room	D30C180	5000	300
ROLLUP		D3_IRF_C3_51	Recovery Room	D30C180	5100	300
ROLLUP		D3_IRF_C3_52	Delivery Room and Labor Room	D30C180	5200	300
ROLLUP		D3_IRF_C3_53	Anesthesiology	D30C180	5300	300
ROLLUP		D3_IRF_C3_54	Radiology-Diagnostic	D30C180	5400	300
ROLLUP		D3_IRF_C3_55	Radiology-Therapeutic	D30C180	5500	300
ROLLUP		D3_IRF_C3_56	Radioisotope	D30C180	5600	300
ROLLUP		D3_IRF_C3_57	CT Scan	D30C180	5700	300
ROLLUP		D3_IRF_C3_58	MRI	D30C180	5800	300
ROLLUP		D3_IRF_C3_59	Cardiac Catheterization	D30C180	5900	300
ROLLUP		D3_IRF_C3_60	Laboratory	D30C180	6000	300
NUMERIC		D3_IRF_C3_61	PBP Clinical Lab Services Program Only	D30C180	6100	300
ROLLUP		D3_IRF_C3_62	Whole Blood & Packed Red Blood Cells	D30C180	6200	300
ROLLUP		D3_IRF_C3_6250	Blood Clotting Factors for Hemoph.	D30C180	6250	300
ROLLUP		D3_IRF_C3_63	"Blood Storing, Processing, Trans"	D30C180	6300	300
ROLLUP		D3_IRF_C3_64	Intravenous Therapy	D30C180	6400	300
ROLLUP		D3_IRF_C3_65	Respiratory Therapy	D30C180	6500	300
ROLLUP		D3_IRF_C3_66	Physical Therapy	D30C180	6600	300
ROLLUP		D3_IRF_C3_67	Occupational Therapy	D30C180	6700	300
ROLLUP		D3_IRF_C3_68	Speech Pathology	D30C180	6800	300
ROLLUP		D3_IRF_C3_69	Electrocardiology	D30C180	6900	300
ROLLUP		D3_IRF_C3_70	Electroencephalography	D30C180	7000	300
ROLLUP		D3_IRF_C3_71	Medical Supplies Charged to Patients	D30C180	7100	300
ROLLUP		D3_IRF_C3_72	Impl. Dev. Charged to Patients 	D30C180	7200	300
ROLLUP		D3_IRF_C3_73	Drugs Charged to Patients	D30C180	7300	300
NUMERIC		D3_IRF_C3_74	Renal Dialysis	D30C180	7400	300
ROLLUP		D3_IRF_C3_75	ASC (Non Distinct Part)	D30C180	7500	300
ROLLUP		D3_IRF_C3_76	Other Ancillary	D30C180	7600	300
ROLLUP		D3_IRF_C3_88	RHC	D30C180	8800	300
ROLLUP		D3_IRF_C3_89	FQHC	D30C180	8900	300
ROLLUP		D3_IRF_C3_90	Clinic	D30C180	9000	300
ROLLUP		D3_IRF_C3_91	Emergency	D30C180	9100	300
ROLLUP		D3_IRF_C3_9201	Observation Beds (Distinct Unit)	D30C180	9201	300
ROLLUP		D3_IRF_C3_93	Other Outpatient Services	D30C180	9300	300
NUMERIC		D3_IRF_C3_94	Home Program Dialysis	D30C180	9400	300
NUMERIC		D3_IRF_C3_95	Ambulance Services	D30C180	9500	300
ROLLUP		D3_IRF_C3_96	Durable Medical Equipment Rented	D30C180	9600	300
ROLLUP		D3_IRF_C3_97	Durable Medical Equipment Sold	D30C180	9700	300
ROLLUP		D3_IRF_C3_98	Other Reimbursable	D30C180	9800	300
NUMERIC		D3_IRF_C3_200	TOTAL	D30C180	20000	300
						
						
						
						
						
						
						
						
						
						
						
	INPATIENT ANCILLARY SERVICE COST APPORTIONMENT					
	2552-10 WORKSHEET D-3 FOR SUB1					
						
DATA TYPE	96 FIELD NAME		FIELD DESCRIPTION 	WKSHT CD	LINE	COLUMN
						
ROLLUP		D3_SUB1_C3_31	Intensive Care Unit	D31D180	3100	300
ROLLUP		D3_SUB1_C3_32	Coronary Care Unit	D31D180	3200	300
ROLLUP		D3_SUB1_C3_33	Burn Intensive Care Unit	D31D180	3300	300
ROLLUP		D3_SUB1_C3_34	Surgical Intensive Care Unit	D31D180	3400	300
ROLLUP		D3_SUB1_C3_35	Other Special Care Unit	D31D180	3500	300
NUMERIC		D3_SUB1_C3_40	Subprovider-SUB1	D31D180	4000	300
NUMERIC		D3_SUB1_C3_41	Subprovider-SUB1	D31D180	4100	300
NUMERIC		D3_SUB1_C3_42	Subprovider I	D31D180	4200	300
NUMERIC		D3_SUB1_C3_4201	Subprovider II	D31D180	4201	300
NUMERIC		D3_SUB1_C3_43	Nursery	D31D180	4300	300
NUMERIC		D3_SUB1_C3_44	SNF	D31D180	4400	300
NUMERIC		D3_SUB1_C3_45	NF	D31D180	4500	300
NUMERIC		D3_SUB1_C3_4501	ICF	D31D180	4501	300
NUMERIC		D3_SUB1_C3_46	OLTC	D31D180	4600	300
ROLLUP		D3_SUB1_C3_50	Operating Room	D31D180	5000	300
ROLLUP		D3_SUB1_C3_51	Recovery Room	D31D180	5100	300
ROLLUP		D3_SUB1_C3_52	Delivery Room and Labor Room	D31D180	5200	300
ROLLUP		D3_SUB1_C3_53	Anesthesiology	D31D180	5300	300
ROLLUP		D3_SUB1_C3_54	Radiology-Diagnostic	D31D180	5400	300
ROLLUP		D3_SUB1_C3_55	Radiology-Therapeutic	D31D180	5500	300
ROLLUP		D3_SUB1_C3_56	Radioisotope	D31D180	5600	300
ROLLUP		D3_SUB1_C3_57	CT Scan	D31D180	5700	300
ROLLUP		D3_SUB1_C3_58	MRI	D31D180	5800	300
ROLLUP		D3_SUB1_C3_59	Cardiac Catheterization	D31D180	5900	300
ROLLUP		D3_SUB1_C3_60	Laboratory	D31D180	6000	300
NUMERIC		D3_SUB1_C3_61	PBP Clinical Lab Services Program Only	D31D180	6100	300
ROLLUP		D3_SUB1_C3_62	Whole Blood & Packed Red Blood Cells	D31D180	6200	300
ROLLUP		D3_SUB1_C3_6250	Blood Clotting Factors for Hemoph.	D31D180	6250	300
ROLLUP		D3_SUB1_C3_63	"Blood Storing, Processing, Trans"	D31D180	6300	300
ROLLUP		D3_SUB1_C3_64	Intravenous Therapy	D31D180	6400	300
ROLLUP		D3_SUB1_C3_65	Respiratory Therapy	D31D180	6500	300
ROLLUP		D3_SUB1_C3_66	Physical Therapy	D31D180	6600	300
ROLLUP		D3_SUB1_C3_67	Occupational Therapy	D31D180	6700	300
ROLLUP		D3_SUB1_C3_68	Speech Pathology	D31D180	6800	300
ROLLUP		D3_SUB1_C3_69	Electrocardiology	D31D180	6900	300
ROLLUP		D3_SUB1_C3_70	Electroencephalography	D31D180	7000	300
ROLLUP		D3_SUB1_C3_71	Medical Supplies Charged to Patients	D31D180	7100	300
ROLLUP		D3_SUB1_C3_72	Impl. Dev. Charged to Patients 	D31D180	7200	300
ROLLUP		D3_SUB1_C3_73	Drugs Charged to Patients	D31D180	7300	300
NUMERIC		D3_SUB1_C3_74	Renal Dialysis	D31D180	7400	300
ROLLUP		D3_SUB1_C3_75	ASC (Non Distinct Part)	D31D180	7500	300
ROLLUP		D3_SUB1_C3_76	Other Ancillary	D31D180	7600	300
ROLLUP		D3_SUB1_C3_88	RHC	D31D180	8800	300
ROLLUP		D3_SUB1_C3_89	FQHC	D31D180	8900	300
ROLLUP		D3_SUB1_C3_90	Clinic	D31D180	9000	300
ROLLUP		D3_SUB1_C3_91	Emergency	D31D180	9100	300
ROLLUP		D3_SUB1_C3_9201	Observation Beds (Distinct Unit)	D31D180	9201	300
ROLLUP		D3_SUB1_C3_93	Other Outpatient Services	D31D180	9300	300
NUMERIC		D3_SUB1_C3_94	Home Program Dialysis	D31D180	9400	300
NUMERIC		D3_SUB1_C3_95	Ambulance Services	D31D180	9500	300
ROLLUP		D3_SUB1_C3_96	Durable Medical Equipment Rented	D31D180	9600	300
ROLLUP		D3_SUB1_C3_97	Durable Medical Equipment Sold	D31D180	9700	300
ROLLUP		D3_SUB1_C3_98	Other Reimbursable	D31D180	9800	300
NUMERIC		D3_SUB1_C3_200	TOTAL	D31D180	20000	300
						
						
						
						
						
						
						
						
						
						
						
	INPATIENT ANCILLARY SERVICE COST APPORTIONMENT					
	2552-10 WORKSHEET D-3 FOR SUB II					
						
DATA TYPE	96 FIELD NAME		FIELD DESCRIPTION 	WKSHT CD	LINE	COLUMN
						
ROLLUP		D3_SUB2_C3_31	Intensive Care Unit	D32D180	3100	300
ROLLUP		D3_SUB2_C3_32	Coronary Care Unit	D32D180	3200	300
ROLLUP		D3_SUB2_C3_33	Burn Intensive Care Unit	D32D180	3300	300
ROLLUP		D3_SUB2_C3_34	Surgical Intensive Care Unit	D32D180	3400	300
ROLLUP		D3_SUB2_C3_35	Other Special Care Unit	D32D180	3500	300
NUMERIC		D3_SUB2_C3_40	Subprovider-SUB2	D32D180	4000	300
NUMERIC		D3_SUB2_C3_41	Subprovider-SUB2	D32D180	4100	300
NUMERIC		D3_SUB2_C3_42	Subprovider I	D32D180	4200	300
NUMERIC		D3_SUB2_C3_4201	Subprovider II	D32D180	4201	300
NUMERIC		D3_SUB2_C3_43	Nursery	D32D180	4300	300
NUMERIC		D3_SUB2_C3_44	SNF	D32D180	4400	300
NUMERIC		D3_SUB2_C3_45	NF	D32D180	4500	300
NUMERIC		D3_SUB2_C3_4501	ICF	D32D180	4501	300
NUMERIC		D3_SUB2_C3_46	OLTC	D32D180	4600	300
ROLLUP		D3_SUB2_C3_50	Operating Room	D32D180	5000	300
ROLLUP		D3_SUB2_C3_51	Recovery Room	D32D180	5100	300
ROLLUP		D3_SUB2_C3_52	Delivery Room and Labor Room	D32D180	5200	300
ROLLUP		D3_SUB2_C3_53	Anesthesiology	D32D180	5300	300
ROLLUP		D3_SUB2_C3_54	Radiology-Diagnostic	D32D180	5400	300
ROLLUP		D3_SUB2_C3_55	Radiology-Therapeutic	D32D180	5500	300
ROLLUP		D3_SUB2_C3_56	Radioisotope	D32D180	5600	300
ROLLUP		D3_SUB2_C3_57	CT Scan	D32D180	5700	300
ROLLUP		D3_SUB2_C3_58	MRI	D32D180	5800	300
ROLLUP		D3_SUB2_C3_59	Cardiac Catheterization	D32D180	5900	300
ROLLUP		D3_SUB2_C3_60	Laboratory	D32D180	6000	300
NUMERIC		D3_SUB2_C3_61	PBP Clinical Lab Services Program Only	D32D180	6100	300
ROLLUP		D3_SUB2_C3_62	Whole Blood & Packed Red Blood Cells	D32D180	6200	300
ROLLUP		D3_SUB2_C3_6250	Blood Clotting Factors for Hemoph.	D32D180	6250	300
ROLLUP		D3_SUB2_C3_63	"Blood Storing, Processing, Trans"	D32D180	6300	300
ROLLUP		D3_SUB2_C3_64	Intravenous Therapy	D32D180	6400	300
ROLLUP		D3_SUB2_C3_65	Respiratory Therapy	D32D180	6500	300
ROLLUP		D3_SUB2_C3_66	Physical Therapy	D32D180	6600	300
ROLLUP		D3_SUB2_C3_67	Occupational Therapy	D32D180	6700	300
ROLLUP		D3_SUB2_C3_68	Speech Pathology	D32D180	6800	300
ROLLUP		D3_SUB2_C3_69	Electrocardiology	D32D180	6900	300
ROLLUP		D3_SUB2_C3_70	Electroencephalography	D32D180	7000	300
ROLLUP		D3_SUB2_C3_71	Medical Supplies Charged to Patients	D32D180	7100	300
ROLLUP		D3_SUB2_C3_72	Impl. Dev. Charged to Patients 	D32D180	7200	300
ROLLUP		D3_SUB2_C3_73	Drugs Charged to Patients	D32D180	7300	300
NUMERIC		D3_SUB2_C3_74	Renal Dialysis	D32D180	7400	300
ROLLUP		D3_SUB2_C3_75	ASC (Non Distinct Part)	D32D180	7500	300
ROLLUP		D3_SUB2_C3_76	Other Ancillary	D32D180	7600	300
ROLLUP		D3_SUB2_C3_88	RHC	D32D180	8800	300
ROLLUP		D3_SUB2_C3_89	FQHC	D32D180	8900	300
ROLLUP		D3_SUB2_C3_90	Clinic	D32D180	9000	300
ROLLUP		D3_SUB2_C3_91	Emergency	D32D180	9100	300
ROLLUP		D3_SUB2_C3_9201	Observation Beds (Distinct Unit)	D32D180	9201	300
ROLLUP		D3_SUB2_C3_93	Other Outpatient Services	D32D180	9300	300
NUMERIC		D3_SUB2_C3_94	Home Program Dialysis	D32D180	9400	300
NUMERIC		D3_SUB2_C3_95	Ambulance Services	D32D180	9500	300
ROLLUP		D3_SUB2_C3_96	Durable Medical Equipment Rented	D32D180	9600	300
ROLLUP		D3_SUB2_C3_97	Durable Medical Equipment Sold	D32D180	9700	300
ROLLUP		D3_SUB2_C3_98	Other Reimbursable	D32D180	9800	300
NUMERIC		D3_SUB2_C3_200	TOTAL	D32D180	20000	300
						
						
						
						
						
						
						
						
						
						
						
	INPATIENT ANCILLARY SERVICE COST APPORTIONMENT					
	2552-10 WORKSHEET D-3 FOR THE SNF					
						
DATA TYPE	96 FIELD NAME	10 FIELD NAME	FIELD DESCRIPTION 	WKSHT CD	LINE	COLUMN
						
NUMERIC		D3_SNF_C2_30	Adults and Pediatrics	D30E180	3000	200
ROLLUP		D3_SNF_C2_31	Intensive Care Unit	D30E180	3100	200
ROLLUP		D3_SNF_C2_32	Coronary Care Unit	D30E180	3200	200
ROLLUP		D3_SNF_C2_33	Burn Intensive Care Unit	D30E180	3300	200
ROLLUP		D3_SNF_C2_34	Surgical Intensive Care Unit	D30E180	3400	200
ROLLUP		D3_SNF_C2_35	Other Special Care Unit	D30E180	3500	200
NUMERIC		D3_SNF_C2_40	Subprovider-IPF	D30E180	4000	200
NUMERIC		D3_SNF_C2_41	Subprovider-IRF	D30E180	4100	200
NUMERIC		D3_SNF_C2_42	Subprovider I	D30E180	4200	200
NUMERIC		D3_SNF_C2_4201	Subprovider II	D30E180	4201	200
NUMERIC		D3_SNF_C2_43	Nursery	D30E180	4300	200
NUMERIC		D3_SNF_C2_44	SNF	D30E180	4400	200
NUMERIC		D3_SNF_C2_45	NF	D30E180	4500	200
NUMERIC		D3_SNF_C2_4501	ICF	D30E180	4501	200
NUMERIC		D3_SNF_C2_46	OLTC	D30E180	4600	200
ROLLUP		D3_SNF_C2_50	Operating Room	D30E180	5000	200
ROLLUP		D3_SNF_C2_51	Recovery Room	D30E180	5100	200
ROLLUP		D3_SNF_C2_52	Delivery Room and Labor Room	D30E180	5200	200
ROLLUP		D3_SNF_C2_53	Anesthesiology	D30E180	5300	200
ROLLUP		D3_SNF_C2_54	Radiology-Diagnostic	D30E180	5400	200
ROLLUP		D3_SNF_C2_55	Radiology-Therapeutic	D30E180	5500	200
ROLLUP		D3_SNF_C2_56	Radioisotope	D30E180	5600	200
ROLLUP		D3_SNF_C2_57	CT Scan	D30E180	5700	200
ROLLUP		D3_SNF_C2_58	MRI	D30E180	5800	200
ROLLUP		D3_SNF_C2_59	Cardiac Catheterization	D30E180	5900	200
ROLLUP		D3_SNF_C2_60	Laboratory	D30E180	6000	200
NUMERIC		D3_SNF_C2_61	PBP Clinical Lab Services Program Only	D30E180	6100	200
ROLLUP		D3_SNF_C2_62	Whole Blood & Packed Red Blood Cells	D30E180	6200	200
ROLLUP		D3_SNF_C2_6250	Blood Clotting Factors for Hemoph.	D30E180	6250	200
ROLLUP		D3_SNF_C2_63	"Blood Storing, Processing, Trans"	D30E180	6300	200
ROLLUP		D3_SNF_C2_64	Intravenous Therapy	D30E180	6400	200
ROLLUP		D3_SNF_C2_65	Respiratory Therapy	D30E180	6500	200
ROLLUP		D3_SNF_C2_66	Physical Therapy	D30E180	6600	200
ROLLUP		D3_SNF_C2_67	Occupational Therapy	D30E180	6700	200
ROLLUP		D3_SNF_C2_68	Speech Pathology	D30E180	6800	200
ROLLUP		D3_SNF_C2_69	Electrocardiology	D30E180	6900	200
ROLLUP		D3_SNF_C2_70	Electroencephalography	D30E180	7000	200
ROLLUP		D3_SNF_C2_71	Medical Supplies Charged to Patients	D30E180	7100	200
ROLLUP		D3_SNF_C2_72	Impl. Dev. Charged to Patients 	D30E180	7200	200
ROLLUP		D3_SNF_C2_73	Drugs Charged to Patients	D30E180	7300	200
NUMERIC		D3_SNF_C2_74	Renal Dialysis	D30E180	7400	200
ROLLUP		D3_SNF_C2_75	ASC (Non Distinct Part)	D30E180	7500	200
ROLLUP		D3_SNF_C2_76	Other Ancillary	D30E180	7600	200
ROLLUP		D3_SNF_C2_88	RHC	D30E180	8800	200
ROLLUP		D3_SNF_C2_89	FQHC	D30E180	8900	200
ROLLUP		D3_SNF_C2_90	Clinic	D30E180	9000	200
ROLLUP		D3_SNF_C2_91	Emergency	D30E180	9100	200
ROLLUP		D3_SNF_C2_9201	Observation Beds (Distinct Unit)	D30E180	9201	200
ROLLUP		D3_SNF_C2_93	Other Outpatient Services	D30E180	9300	200
NUMERIC		D3_SNF_C2_94	Home Program Dialysis	D30E180	9400	200
NUMERIC		D3_SNF_C2_95	Ambulance Services	D30E180	9500	200
ROLLUP		D3_SNF_C2_96	Durable Medical Equipment Rented	D30E180	9600	200
ROLLUP		D3_SNF_C2_97	Durable Medical Equipment Sold	D30E180	9700	200
ROLLUP		D3_SNF_C2_98	Other Reimbursable	D30E180	9800	200
NUMERIC		D3_SNF_C2_200		D30E180	20000	200
NUMERIC		D3_SNF_C2_201		D30E180	20100	200
NUMERIC		D3_SNF_C2_202	TOTAL	D30E180	20200	200
						
						
						
						
						
						
						
						
	INPATIENT ANCILLARY SERVICE COST APPORTIONMENT					
	2552-10 WORKSHEET D-3 FOR THE SNF					
						
DATA TYPE	96 FIELD NAME	10 FIELD NAME	FIELD DESCRIPTION 	WKSHT CD	LINE	COLUMN
						
NUMERIC		D3_SNF_C3_30	Adults and Pediatrics	D30E180	3000	300
ROLLUP		D3_SNF_C3_31	Intensive Care Unit	D30E180	3100	300
ROLLUP		D3_SNF_C3_32	Coronary Care Unit	D30E180	3200	300
ROLLUP		D3_SNF_C3_33	Burn Intensive Care Unit	D30E180	3300	300
ROLLUP		D3_SNF_C3_34	Surgical Intensive Care Unit	D30E180	3400	300
ROLLUP		D3_SNF_C3_35	Other Special Care Unit	D30E180	3500	300
NUMERIC		D3_SNF_C3_40	Subprovider-IPF	D30E180	4000	300
NUMERIC		D3_SNF_C3_41	Subprovider-IRF	D30E180	4100	300
NUMERIC		D3_SNF_C3_42	Subprovider I	D30E180	4200	300
NUMERIC		D3_SNF_C3_4201	Subprovider II	D30E180	4201	300
NUMERIC		D3_SNF_C3_43	Nursery	D30E180	4300	300
NUMERIC		D3_SNF_C3_44	SNF	D30E180	4400	300
NUMERIC		D3_SNF_C3_45	NF	D30E180	4500	300
NUMERIC		D3_SNF_C3_4501	ICF	D30E180	4501	300
NUMERIC		D3_SNF_C3_46	OLTC	D30E180	4600	300
ROLLUP		D3_SNF_C3_50	Operating Room	D30E180	5000	300
ROLLUP		D3_SNF_C3_51	Recovery Room	D30E180	5100	300
ROLLUP		D3_SNF_C3_52	Delivery Room and Labor Room	D30E180	5200	300
ROLLUP		D3_SNF_C3_53	Anesthesiology	D30E180	5300	300
ROLLUP		D3_SNF_C3_54	Radiology-Diagnostic	D30E180	5400	300
ROLLUP		D3_SNF_C3_55	Radiology-Therapeutic	D30E180	5500	300
ROLLUP		D3_SNF_C3_56	Radioisotope	D30E180	5600	300
ROLLUP		D3_SNF_C3_57	CT Scan	D30E180	5700	300
ROLLUP		D3_SNF_C3_58	MRI	D30E180	5800	300
ROLLUP		D3_SNF_C3_59	Cardiac Catheterization	D30E180	5900	300
ROLLUP		D3_SNF_C3_60	Laboratory	D30E180	6000	300
NUMERIC		D3_SNF_C3_61	PBP Clinical Lab Services Program Only	D30E180	6100	300
ROLLUP		D3_SNF_C3_62	Whole Blood & Packed Red Blood Cells	D30E180	6200	300
ROLLUP		D3_SNF_C3_6250	Blood Clotting Factors for Hemoph.	D30E180	6250	300
ROLLUP		D3_SNF_C3_63	"Blood Storing, Processing, Trans"	D30E180	6300	300
ROLLUP		D3_SNF_C3_64	Intravenous Therapy	D30E180	6400	300
ROLLUP		D3_SNF_C3_65	Respiratory Therapy	D30E180	6500	300
ROLLUP		D3_SNF_C3_66	Physical Therapy	D30E180	6600	300
ROLLUP		D3_SNF_C3_67	Occupational Therapy	D30E180	6700	300
ROLLUP		D3_SNF_C3_68	Speech Pathology	D30E180	6800	300
ROLLUP		D3_SNF_C3_69	Electrocardiology	D30E180	6900	300
ROLLUP		D3_SNF_C3_70	Electroencephalography	D30E180	7000	300
ROLLUP		D3_SNF_C3_71	Medical Supplies Charged to Patients	D30E180	7100	300
ROLLUP		D3_SNF_C3_72	Impl. Dev. Charged to Patients 	D30E180	7200	300
ROLLUP		D3_SNF_C3_73	Drugs Charged to Patients	D30E180	7300	300
NUMERIC		D3_SNF_C3_74	Renal Dialysis	D30E180	7400	300
ROLLUP		D3_SNF_C3_75	ASC (Non Distinct Part)	D30E180	7500	300
ROLLUP		D3_SNF_C3_76	Other Ancillary	D30E180	7600	300
ROLLUP		D3_SNF_C3_88	RHC	D30E180	8800	300
ROLLUP		D3_SNF_C3_89	FQHC	D30E180	8900	300
ROLLUP		D3_SNF_C3_90	Clinic	D30E180	9000	300
ROLLUP		D3_SNF_C3_91	Emergency	D30E180	9100	300
ROLLUP		D3_SNF_C3_9201	Observation Beds (Distinct Unit)	D30E180	9201	300
ROLLUP		D3_SNF_C3_93	Other Outpatient Services	D30E180	9300	300
NUMERIC		D3_SNF_C3_94	Home Program Dialysis	D30E180	9400	300
NUMERIC		D3_SNF_C3_95	Ambulance Services	D30E180	9500	300
ROLLUP		D3_SNF_C3_96	Durable Medical Equipment Rented	D30E180	9600	300
ROLLUP		D3_SNF_C3_97	Durable Medical Equipment Sold	D30E180	9700	300
ROLLUP		D3_SNF_C3_98	Other Reimbursable	D30E180	9800	300
NUMERIC		D3_SNF_C3_200	TOTAL	D30E180	20000	300
						
						
						
						
						
						
						
						
						
						
	CALCULATION OF REIMBURSMENT SETTLEMENT (PPS)					
	"2552-10 WORKSHEET E, PART A"					
						
DATA TYPE		10 FIELD NAME	FIELD DESCRIPTION 	WKSHT CD	LINE	COLUMN
						
NUMERIC		E_A_HOS_C1_1		E00A18A	100	100
NUMERIC		E_A_HOS_C101_1		E00A18A	100	101
NUMERIC		E_A_HOS_C1_101		E00A18A	101	100
NUMERIC		E_A_HOS_C101_101		E00A18A	101	101
NUMERIC		E_A_HOS_C1_102		E00A18A	102	100
NUMERIC		E_A_HOS_C101_102		E00A18A	102	101
NUMERIC		E_A_HOS_C1_2		E00A18A	200	100
NUMERIC		E_A_HOS_C101_2		E00A18A	200	101
NUMERIC		E_A_HOS_C1_201		E00A18A	201	100
NUMERIC		E_A_HOS_C101_201		E00A18A	201	101
NUMERIC		E_A_HOS_C1_202		E00A18A	202	100
NUMERIC		E_A_HOS_C101_202		E00A18A	202	101
NUMERIC		E_A_HOS_C1_3		E00A18A	300	100
NUMERIC		E_A_HOS_C101_3		E00A18A	300	101
NUMERIC		E_A_HOS_C1_4		E00A18A	400	100
NUMERIC		E_A_HOS_C1_5		E00A18A	500	100
NUMERIC		E_A_HOS_C1_6		E00A18A	600	100
NUMERIC		E_A_HOS_C1_7		E00A18A	700	100
NUMERIC		E_A_HOS_C1_701		E00A18A	701	100
NUMERIC		E_A_HOS_C1_8		E00A18A	800	100
NUMERIC		E_A_HOS_C1_801		E00A18A	801	100
NUMERIC		E_A_HOS_C1_802		E00A18A	802	100
NUMERIC		E_A_HOS_C1_9		E00A18A	900	100
NUMERIC		E_A_HOS_C1_10		E00A18A	1000	100
NUMERIC		E_A_HOS_C1_11		E00A18A	1100	100
NUMERIC		E_A_HOS_C1_12		E00A18A	1200	100
NUMERIC		E_A_HOS_C1_13		E00A18A	1300	100
NUMERIC		E_A_HOS_C1_14		E00A18A	1400	100
NUMERIC		E_A_HOS_C1_15		E00A18A	1500	100
NUMERIC		E_A_HOS_C1_16		E00A18A	1600	100
NUMERIC		E_A_HOS_C1_17		E00A18A	1700	100
NUMERIC		E_A_HOS_C1_18		E00A18A	1800	100
NUMERIC		E_A_HOS_C1_19		E00A18A	1900	100
NUMERIC		E_A_HOS_C1_20		E00A18A	2000	100
NUMERIC		E_A_HOS_C1_21		E00A18A	2100	100
NUMERIC		E_A_HOS_C1_22		E00A18A	2200	100
NUMERIC		E_A_HOS_C101_22		E00A18A	2200	101
NUMERIC		E_A_HOS_C1_23		E00A18A	2300	100
NUMERIC		E_A_HOS_C1_24		E00A18A	2400	100
NUMERIC		E_A_HOS_C1_25		E00A18A	2500	100
NUMERIC		E_A_HOS_C1_26		E00A18A	2600	100
NUMERIC		E_A_HOS_C1_27		E00A18A	2700	100
NUMERIC		E_A_HOS_C1_28		E00A18A	2800	100
NUMERIC		E_A_HOS_C101_28		E00A18A	2800	101
NUMERIC		E_A_HOS_C1_29		E00A18A	2900	100
NUMERIC		E_A_HOS_C101_29		E00A18A	2900	101
NUMERIC		E_A_HOS_C1_30		E00A18A	3000	100
NUMERIC		E_A_HOS_C1_31		E00A18A	3100	100
NUMERIC		E_A_HOS_C1_32		E00A18A	3200	100
NUMERIC		E_A_HOS_C1_33		E00A18A	3300	100
NUMERIC		E_A_HOS_C101_33		E00A18A	3300	101
NUMERIC		E_A_HOS_C1_34		E00A18A	3400	100
NUMERIC		E_A_HOS_C101_34		E00A18A	3400	101
NUMERIC		E_A_HOS_C1_35		E00A18A	3500	100
NUMERIC		E_A_HOS_C2_35		E00A18A	3500	200
NUMERIC		E_A_HOS_C1_3501		E00A18A	3501	100
NUMERIC		E_A_HOS_C2_3501		E00A18A	3501	200
NUMERIC		E_A_HOS_C1_3502		E00A18A	3502	100
NUMERIC		E_A_HOS_C2_3502		E00A18A	3502	200
NUMERIC		E_A_HOS_C1_3503		E00A18A	3503	100
NUMERIC		E_A_HOS_C2_3503		E00A18A	3503	200
NUMERIC		E_A_HOS_C1_36		E00A18A	3600	100
NUMERIC		E_A_HOS_C1_37		E00A18A	3700	100
NUMERIC		E_A_HOS_C1_38		E00A18A	3800	100
NUMERIC		E_A_HOS_C1_39		E00A18A	3900	100
NUMERIC		E_A_HOS_C1_40		E00A18A	4000	100
NUMERIC		E_A_HOS_C1_41		E00A18A	4100	100
NUMERIC		E_A_HOS_C101_41		E00A18A	4100	101
NUMERIC		E_A_HOS_C1_4101		E00A18A	4101	100
NUMERIC		E_A_HOS_C1_42		E00A18A	4200	100
NUMERIC		E_A_HOS_C1_43		E00A18A	4300	100
NUMERIC		E_A_HOS_C1_44		E00A18A	4400	100
NUMERIC		E_A_HOS_C1_45		E00A18A	4500	100
NUMERIC		E_A_HOS_C101_45		E00A18A	4500	101
NUMERIC		E_A_HOS_C1_46		E00A18A	4600	100
NUMERIC		E_A_HOS_C1_47		E00A18A	4700	100
NUMERIC		E_A_HOS_C101_47		E00A18A	4700	101
NUMERIC		E_A_HOS_C1_48		E00A18A	4800	100
NUMERIC		E_A_HOS_C101_48		E00A18A	4800	101
NUMERIC		E_A_HOS_C1_49		E00A18A	4900	100
NUMERIC		E_A_HOS_C1_50		E00A18A	5000	100
NUMERIC		E_A_HOS_C1_51		E00A18A	5100	100
NUMERIC		E_A_HOS_C1_52		E00A18A	5200	100
NUMERIC		E_A_HOS_C1_53		E00A18A	5300	100
NUMERIC		E_A_HOS_C1_54		E00A18A	5400	100
NUMERIC		E_A_HOS_C1_55		E00A18A	5500	100
NUMERIC		E_A_HOS_C1_56		E00A18A	5600	100
NUMERIC		E_A_HOS_C1_57		E00A18A	5700	100
NUMERIC		E_A_HOS_C1_58		E00A18A	5800	100
NUMERIC		E_A_HOS_C1_59		E00A18A	5900	100
NUMERIC		E_A_HOS_C1_60		E00A18A	6000	100
NUMERIC		E_A_HOS_C1_61		E00A18A	6100	100
NUMERIC		E_A_HOS_C1_62		E00A18A	6200	100
						
						
						
						
						
						
						
						
NUMERIC		E_A_HOS_C1_63		E00A18A	6300	100
NUMERIC		E_A_HOS_C1_64		E00A18A	6400	100
NUMERIC		E_A_HOS_C1_65		E00A18A	6500	100
NUMERIC		E_A_HOS_C1_66		E00A18A	6600	100
NUMERIC		E_A_HOS_C1_67		E00A18A	6700	100
NUMERIC		E_A_HOS_C1_68		E00A18A	6800	100
NUMERIC		E_A_HOS_C1_69		E00A18A	6900	100
ROLLUP		E_A_HOS_C1_70		E00A18A	7000	100
NUMERIC		E_A_HOS_C1_7092		E00A18A	7092	100
NUMERIC		E_A_HOS_C1_7093		E00A18A	7093	100
NUMERIC		E_A_HOS_C1_7094		E00A18A	7094	100
NUMERIC		E_A_HOS_C1_7095		E00A18A	7095	100
NUMERIC		E_A_HOS_C1_7096		E00A18A	7096	100
NUMERIC		E_A_HOS_C1_7097		E00A18A	7097	100
		 			 	
						
						
						
NUMERIC		E_A_HOS_C1_71		E00A18A	7100	100
NUMERIC		E_A_HOS_C1_7101		E00A18A	7101	100
NUMERIC		E_A_HOS_C1_72		E00A18A	7200	100
NUMERIC		E_A_HOS_C1_73		E00A18A	7300	100
NUMERIC		E_A_HOS_C1_74		E00A18A	7400	100
NUMERIC		E_A_HOS_C1_75		E00A18A	7500	100
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
	CALCULATION OF REIMBURSMENT SETTLEMENT					
	"2552-10 WORKSHEET E, PART B FOR THE HOSPITAL"					
						
DATA TYPE	96 FIELD NAME	10 FIELD NAME	FIELD DESCRIPTION 	WKSHT CD	LINE	COLUMN
						
NUMERIC		E_B_HOS_C1_1		E00A18B	100	100
NUMERIC		E_B_HOS_C1_2		E00A18B	200	100
NUMERIC		E_B_HOS_C101_2		E00A18B	200	101
NUMERIC		E_B_HOS_C1_3		E00A18B	300	100
NUMERIC		E_B_HOS_C101_3		E00A18B	300	101
NUMERIC		E_B_HOS_C1_4		E00A18B	400	100
NUMERIC		E_B_HOS_C101_4		E00A18B	400	101
NUMERIC		E_B_HOS_C1_5		E00A18B	500	100
NUMERIC		E_B_HOS_C101_5		E00A18B	500	101
NUMERIC		E_B_HOS_C1_6		E00A18B	600	100
NUMERIC		E_B_HOS_C101_6		E00A18B	600	101
NUMERIC		E_B_HOS_C1_7		E00A18B	700	100
NUMERIC		E_B_HOS_C101_7		E00A18B	700	101
NUMERIC		E_B_HOS_C1_8		E00A18B	800	100
NUMERIC		E_B_HOS_C101_8		E00A18B	800	101
NUMERIC		E_B_HOS_C1_9		E00A18B	900	100
NUMERIC		E_B_HOS_C1_10		E00A18B	1000	100
NUMERIC		E_B_HOS_C1_11		E00A18B	1100	100
NUMERIC		E_B_HOS_C1_12		E00A18B	1200	100
NUMERIC		E_B_HOS_C1_13		E00A18B	1300	100
NUMERIC		E_B_HOS_C1_14		E00A18B	1400	100
NUMERIC		E_B_HOS_C1_15		E00A18B	1500	100
NUMERIC		E_B_HOS_C1_16		E00A18B	1600	100
NUMERIC		E_B_HOS_C1_17		E00A18B	1700	100
NUMERIC		E_B_HOS_C1_18		E00A18B	1800	100
NUMERIC		E_B_HOS_C1_19		E00A18B	1900	100
NUMERIC		E_B_HOS_C1_20		E00A18B	2000	100
NUMERIC		E_B_HOS_C1_21		E00A18B	2100	100
NUMERIC		E_B_HOS_C1_22		E00A18B	2200	100
NUMERIC		E_B_HOS_C1_23		E00A18B	2300	100
NUMERIC		E_B_HOS_C1_24		E00A18B	2400	100
NUMERIC		E_B_HOS_C1_25		E00A18B	2500	100
NUMERIC		E_B_HOS_C1_26		E00A18B	2600	100
NUMERIC		E_B_HOS_C1_27		E00A18B	2700	100
NUMERIC		E_B_HOS_C1_28		E00A18B	2800	100
NUMERIC		E_B_HOS_C1_29		E00A18B	2900	100
NUMERIC		E_B_HOS_C1_30		E00A18B	3000	100
NUMERIC		E_B_HOS_C1_31		E00A18B	3100	100
NUMERIC		E_B_HOS_C1_32		E00A18B	3200	100
NUMERIC		E_B_HOS_C1_33		E00A18B	3300	100
NUMERIC		E_B_HOS_C1_34		E00A18B	3400	100
NUMERIC		E_B_HOS_C1_35		E00A18B	3500	100
NUMERIC		E_B_HOS_C1_36		E00A18B	3600	100
NUMERIC		E_B_HOS_C1_37		E00A18B	3700	100
NUMERIC		E_B_HOS_C1_38		E00A18B	3800	100
ROLLUP		E_B_HOS_C1_39		E00A18B	3900	100
NUMERIC		E_B_HOS_C1_3998		E00A18B	3998	100
NUMERIC		E_B_HOS_C1_40		E00A18B	4000	100
NUMERIC		E_B_HOS_C1_4001		E00A18B	4001	100
NUMERIC		E_B_HOS_C1_41		E00A18B	4100	100
NUMERIC		E_B_HOS_C1_42		E00A18B	4200	100
NUMERIC		E_B_HOS_C1_43		E00A18B	4300	100
NUMERIC		E_B_HOS_C1_44		E00A18B	4400	100
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
	CALCULATION OF REIMBURSMENT SETTLEMENT					
	"2552-10 WORKSHEET E, PART B FOR THE IPF"					
						
DATA TYPE	96 FIELD NAME	10 FIELD NAME	FIELD DESCRIPTION 	WKSHT CD	LINE	COLUMN
						
NUMERIC		E_B_IPF_C1_1		E00B18B	100	100
NUMERIC		E_B_IPF_C1_2		E00B18B	200	100
NUMERIC		E_B_IPF_C1_3		E00B18B	300	100
NUMERIC		E_B_IPF_C1_4		E00B18B	400	100
NUMERIC		E_B_IPF_C1_5		E00B18B	500	100
NUMERIC		E_B_IPF_C1_6		E00B18B	600	100
NUMERIC		E_B_IPF_C1_7		E00B18B	700	100
NUMERIC		E_B_IPF_C1_8		E00B18B	800	100
NUMERIC		E_B_IPF_C1_9		E00B18B	900	100
NUMERIC		E_B_IPF_C1_10		E00B18B	1000	100
NUMERIC		E_B_IPF_C1_11		E00B18B	1100	100
NUMERIC		E_B_IPF_C1_12		E00B18B	1200	100
NUMERIC		E_B_IPF_C1_13		E00B18B	1300	100
NUMERIC		E_B_IPF_C1_14		E00B18B	1400	100
NUMERIC		E_B_IPF_C1_15		E00B18B	1500	100
NUMERIC		E_B_IPF_C1_16		E00B18B	1600	100
NUMERIC		E_B_IPF_C1_17		E00B18B	1700	100
NUMERIC		E_B_IPF_C1_18		E00B18B	1800	100
NUMERIC		E_B_IPF_C1_19		E00B18B	1900	100
NUMERIC		E_B_IPF_C1_20		E00B18B	2000	100
NUMERIC		E_B_IPF_C1_21		E00B18B	2100	100
NUMERIC		E_B_IPF_C1_22		E00B18B	2200	100
NUMERIC		E_B_IPF_C1_23		E00B18B	2300	100
NUMERIC		E_B_IPF_C1_24		E00B18B	2400	100
NUMERIC		E_B_IPF_C1_25		E00B18B	2500	100
NUMERIC		E_B_IPF_C1_26		E00B18B	2600	100
NUMERIC		E_B_IPF_C1_27		E00B18B	2700	100
NUMERIC		E_B_IPF_C1_28		E00B18B	2800	100
NUMERIC		E_B_IPF_C1_29		E00B18B	2900	100
NUMERIC		E_B_IPF_C1_30		E00B18B	3000	100
NUMERIC		E_B_IPF_C1_31		E00B18B	3100	100
NUMERIC		E_B_IPF_C1_32		E00B18B	3200	100
NUMERIC		E_B_IPF_C1_33		E00B18B	3300	100
NUMERIC		E_B_IPF_C1_34		E00B18B	3400	100
NUMERIC		E_B_IPF_C1_35		E00B18B	3500	100
NUMERIC		E_B_IPF_C1_36		E00B18B	3600	100
NUMERIC		E_B_IPF_C1_37		E00B18B	3700	100
NUMERIC		E_B_IPF_C1_38		E00B18B	3800	100
ROLLUP		E_B_IPF_C1_39		E00B18B	3900	100
NUMERIC		E_B_IPF_C1_40		E00B18B	4000	100
NUMERIC		E_B_IPF_C1_41		E00B18B	4100	100
NUMERIC		E_B_IPF_C1_42		E00B18B	4200	100
NUMERIC		E_B_IPF_C1_43		E00B18B	4300	100
NUMERIC		E_B_IPF_C1_44		E00B18B	4400	100
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
	CALCULATION OF REIMBURSMENT SETTLEMENT					
	"2552-10 WORKSHEET E, PART B FOR THE IRF"					
						
DATA TYPE	96 FIELD NAME	10 FIELD NAME	FIELD DESCRIPTION 	WKSHT CD	LINE	COLUMN
						
NUMERIC		E_B_IRF_C1_1		E00C18B	100	100
NUMERIC		E_B_IRF_C1_2		E00C18B	200	100
NUMERIC		E_B_IRF_C1_3		E00C18B	300	100
NUMERIC		E_B_IRF_C1_4		E00C18B	400	100
NUMERIC		E_B_IRF_C1_5		E00C18B	500	100
NUMERIC		E_B_IRF_C1_6		E00C18B	600	100
NUMERIC		E_B_IRF_C1_7		E00C18B	700	100
NUMERIC		E_B_IRF_C1_8		E00C18B	800	100
NUMERIC		E_B_IRF_C1_9		E00C18B	900	100
NUMERIC		E_B_IRF_C1_10		E00C18B	1000	100
NUMERIC		E_B_IRF_C1_11		E00C18B	1100	100
NUMERIC		E_B_IRF_C1_12		E00C18B	1200	100
NUMERIC		E_B_IRF_C1_13		E00C18B	1300	100
NUMERIC		E_B_IRF_C1_14		E00C18B	1400	100
NUMERIC		E_B_IRF_C1_15		E00C18B	1500	100
NUMERIC		E_B_IRF_C1_16		E00C18B	1600	100
NUMERIC		E_B_IRF_C1_17		E00C18B	1700	100
NUMERIC		E_B_IRF_C1_18		E00C18B	1800	100
NUMERIC		E_B_IRF_C1_19		E00C18B	1900	100
NUMERIC		E_B_IRF_C1_20		E00C18B	2000	100
NUMERIC		E_B_IRF_C1_21		E00C18B	2100	100
NUMERIC		E_B_IRF_C1_22		E00C18B	2200	100
NUMERIC		E_B_IRF_C1_23		E00C18B	2300	100
NUMERIC		E_B_IRF_C1_24		E00C18B	2400	100
NUMERIC		E_B_IRF_C1_25		E00C18B	2500	100
NUMERIC		E_B_IRF_C1_26		E00C18B	2600	100
NUMERIC		E_B_IRF_C1_27		E00C18B	2700	100
NUMERIC		E_B_IRF_C1_28		E00C18B	2800	100
NUMERIC		E_B_IRF_C1_29		E00C18B	2900	100
NUMERIC		E_B_IRF_C1_30		E00C18B	3000	100
NUMERIC		E_B_IRF_C1_31		E00C18B	3100	100
NUMERIC		E_B_IRF_C1_32		E00C18B	3200	100
NUMERIC		E_B_IRF_C1_33		E00C18B	3300	100
NUMERIC		E_B_IRF_C1_34		E00C18B	3400	100
NUMERIC		E_B_IRF_C1_35		E00C18B	3500	100
NUMERIC		E_B_IRF_C1_36		E00C18B	3600	100
NUMERIC		E_B_IRF_C1_37		E00C18B	3700	100
NUMERIC		E_B_IRF_C1_38		E00C18B	3800	100
ROLLUP		E_B_IRF_C1_39		E00C18B	3900	100
NUMERIC		E_B_IRF_C1_40		E00C18B	4000	100
NUMERIC		E_B_IRF_C1_41		E00C18B	4100	100
NUMERIC		E_B_IRF_C1_42		E00C18B	4200	100
NUMERIC		E_B_IRF_C1_43		E00C18B	4300	100
NUMERIC		E_B_IRF_C1_44		E00C18B	4400	100
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
	CALCULATION OF REIMBURSMENT SETTLEMENT					
	"2552-10 WORKSHEET E, PART B FOR THE Other Subprovider I"					
						
DATA TYPE	96 FIELD NAME	10 FIELD NAME	FIELD DESCRIPTION 	WKSHT CD	LINE	COLUMN
						
NUMERIC		E_B_SUB1_C1_1		E01D18B	100	100
NUMERIC		E_B_SUB1_C1_2		E01D18B	200	100
NUMERIC		E_B_SUB1_C1_3		E01D18B	300	100
NUMERIC		E_B_SUB1_C1_4		E01D18B	400	100
NUMERIC		E_B_SUB1_C1_5		E01D18B	500	100
NUMERIC		E_B_SUB1_C1_6		E01D18B	600	100
NUMERIC		E_B_SUB1_C1_7		E01D18B	700	100
NUMERIC		E_B_SUB1_C1_8		E01D18B	800	100
NUMERIC		E_B_SUB1_C1_9		E01D18B	900	100
NUMERIC		E_B_SUB1_C1_10		E01D18B	1000	100
NUMERIC		E_B_SUB1_C1_11		E01D18B	1100	100
NUMERIC		E_B_SUB1_C1_12		E01D18B	1200	100
NUMERIC		E_B_SUB1_C1_13		E01D18B	1300	100
NUMERIC		E_B_SUB1_C1_14		E01D18B	1400	100
NUMERIC		E_B_SUB1_C1_15		E01D18B	1500	100
NUMERIC		E_B_SUB1_C1_16		E01D18B	1600	100
NUMERIC		E_B_SUB1_C1_17		E01D18B	1700	100
NUMERIC		E_B_SUB1_C1_18		E01D18B	1800	100
NUMERIC		E_B_SUB1_C1_19		E01D18B	1900	100
NUMERIC		E_B_SUB1_C1_20		E01D18B	2000	100
NUMERIC		E_B_SUB1_C1_21		E01D18B	2100	100
NUMERIC		E_B_SUB1_C1_22		E01D18B	2200	100
NUMERIC		E_B_SUB1_C1_23		E01D18B	2300	100
NUMERIC		E_B_SUB1_C1_24		E01D18B	2400	100
NUMERIC		E_B_SUB1_C1_25		E01D18B	2500	100
NUMERIC		E_B_SUB1_C1_26		E01D18B	2600	100
NUMERIC		E_B_SUB1_C1_27		E01D18B	2700	100
NUMERIC		E_B_SUB1_C1_28		E01D18B	2800	100
NUMERIC		E_B_SUB1_C1_29		E01D18B	2900	100
NUMERIC		E_B_SUB1_C1_30		E01D18B	3000	100
NUMERIC		E_B_SUB1_C1_31		E01D18B	3100	100
NUMERIC		E_B_SUB1_C1_32		E01D18B	3200	100
NUMERIC		E_B_SUB1_C1_33		E01D18B	3300	100
NUMERIC		E_B_SUB1_C1_34		E01D18B	3400	100
NUMERIC		E_B_SUB1_C1_35		E01D18B	3500	100
NUMERIC		E_B_SUB1_C1_36		E01D18B	3600	100
NUMERIC		E_B_SUB1_C1_37		E01D18B	3700	100
NUMERIC		E_B_SUB1_C1_38		E01D18B	3800	100
ROLLUP		E_B_SUB1_C1_39		E01D18B	3900	100
NUMERIC		E_B_SUB1_C1_40		E01D18B	4000	100
NUMERIC		E_B_SUB1_C1_41		E01D18B	4100	100
NUMERIC		E_B_SUB1_C1_42		E01D18B	4200	100
NUMERIC		E_B_SUB1_C1_43		E01D18B	4300	100
NUMERIC		E_B_SUB1_C1_44		E01D18B	4400	100
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
	CALCULATION OF REIMBURSMENT SETTLEMENT					
	"2552-10 WORKSHEET E, PART B FOR THE Other Subprovider I"					
						
DATA TYPE	96 FIELD NAME	10 FIELD NAME	FIELD DESCRIPTION 	WKSHT CD	LINE	COLUMN
						
NUMERIC		E_B_SUB2_C1_1		E02D18B	100	100
NUMERIC		E_B_SUB2_C1_2		E02D18B	200	100
NUMERIC		E_B_SUB2_C1_3		E02D18B	300	100
NUMERIC		E_B_SUB2_C1_4		E02D18B	400	100
NUMERIC		E_B_SUB2_C1_5		E02D18B	500	100
NUMERIC		E_B_SUB2_C1_6		E02D18B	600	100
NUMERIC		E_B_SUB2_C1_7		E02D18B	700	100
NUMERIC		E_B_SUB2_C1_8		E02D18B	800	100
NUMERIC		E_B_SUB2_C1_9		E02D18B	900	100
NUMERIC		E_B_SUB2_C1_10		E02D18B	1000	100
NUMERIC		E_B_SUB2_C1_11		E02D18B	1100	100
NUMERIC		E_B_SUB2_C1_12		E02D18B	1200	100
NUMERIC		E_B_SUB2_C1_13		E02D18B	1300	100
NUMERIC		E_B_SUB2_C1_14		E02D18B	1400	100
NUMERIC		E_B_SUB2_C1_15		E02D18B	1500	100
NUMERIC		E_B_SUB2_C1_16		E02D18B	1600	100
NUMERIC		E_B_SUB2_C1_17		E02D18B	1700	100
NUMERIC		E_B_SUB2_C1_18		E02D18B	1800	100
NUMERIC		E_B_SUB2_C1_19		E02D18B	1900	100
NUMERIC		E_B_SUB2_C1_20		E02D18B	2000	100
NUMERIC		E_B_SUB2_C1_21		E02D18B	2100	100
NUMERIC		E_B_SUB2_C1_22		E02D18B	2200	100
NUMERIC		E_B_SUB2_C1_23		E02D18B	2300	100
NUMERIC		E_B_SUB2_C1_24		E02D18B	2400	100
NUMERIC		E_B_SUB2_C1_25		E02D18B	2500	100
NUMERIC		E_B_SUB2_C1_26		E02D18B	2600	100
NUMERIC		E_B_SUB2_C1_27		E02D18B	2700	100
NUMERIC		E_B_SUB2_C1_28		E02D18B	2800	100
NUMERIC		E_B_SUB2_C1_29		E02D18B	2900	100
NUMERIC		E_B_SUB2_C1_30		E02D18B	3000	100
NUMERIC		E_B_SUB2_C1_31		E02D18B	3100	100
NUMERIC		E_B_SUB2_C1_32		E02D18B	3200	100
NUMERIC		E_B_SUB2_C1_33		E02D18B	3300	100
NUMERIC		E_B_SUB2_C1_34		E02D18B	3400	100
NUMERIC		E_B_SUB2_C1_35		E02D18B	3500	100
NUMERIC		E_B_SUB2_C1_36		E02D18B	3600	100
NUMERIC		E_B_SUB2_C1_37		E02D18B	3700	100
NUMERIC		E_B_SUB2_C1_38		E02D18B	3800	100
ROLLUP		E_B_SUB2_C1_39		E02D18B	3900	100
NUMERIC		E_B_SUB2_C1_40		E02D18B	4000	100
NUMERIC		E_B_SUB2_C1_41		E02D18B	4100	100
NUMERIC		E_B_SUB2_C1_42		E02D18B	4200	100
NUMERIC		E_B_SUB2_C1_43		E02D18B	4300	100
NUMERIC		E_B_SUB2_C1_44		E02D18B	4400	100
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
	CALCULATION OF REIMBURSMENT SETTLEMENT					
	"2552-10 WORKSHEET E, PART B FOR THE SNF"					
						
DATA TYPE	96 FIELD NAME	10 FIELD NAME	FIELD DESCRIPTION 	WKSHT CD	LINE	COLUMN
						
NUMERIC		E_B_SNF_C1_1		E00E18B	100	100
NUMERIC		E_B_SNF_C1_2		E00E18B	200	100
NUMERIC		E_B_SNF_C1_3		E00E18B	300	100
NUMERIC		E_B_SNF_C1_4		E00E18B	400	100
NUMERIC		E_B_SNF_C1_5		E00E18B	500	100
NUMERIC		E_B_SNF_C1_6		E00E18B	600	100
NUMERIC		E_B_SNF_C1_7		E00E18B	700	100
NUMERIC		E_B_SNF_C1_8		E00E18B	800	100
NUMERIC		E_B_SNF_C1_9		E00E18B	900	100
NUMERIC		E_B_SNF_C1_10		E00E18B	1000	100
NUMERIC		E_B_SNF_C1_11		E00E18B	1100	100
NUMERIC		E_B_SNF_C1_12		E00E18B	1200	100
NUMERIC		E_B_SNF_C1_13		E00E18B	1300	100
NUMERIC		E_B_SNF_C1_14		E00E18B	1400	100
NUMERIC		E_B_SNF_C1_15		E00E18B	1500	100
NUMERIC		E_B_SNF_C1_16		E00E18B	1600	100
NUMERIC		E_B_SNF_C1_17		E00E18B	1700	100
NUMERIC		E_B_SNF_C1_18		E00E18B	1800	100
NUMERIC		E_B_SNF_C1_19		E00E18B	1900	100
NUMERIC		E_B_SNF_C1_20		E00E18B	2000	100
NUMERIC		E_B_SNF_C1_21		E00E18B	2100	100
NUMERIC		E_B_SNF_C1_22		E00E18B	2200	100
NUMERIC		E_B_SNF_C1_23		E00E18B	2300	100
NUMERIC		E_B_SNF_C1_24		E00E18B	2400	100
NUMERIC		E_B_SNF_C1_25		E00E18B	2500	100
NUMERIC		E_B_SNF_C1_26		E00E18B	2600	100
NUMERIC		E_B_SNF_C1_27		E00E18B	2700	100
NUMERIC		E_B_SNF_C1_28		E00E18B	2800	100
NUMERIC		E_B_SNF_C1_29		E00E18B	2900	100
NUMERIC		E_B_SNF_C1_30		E00E18B	3000	100
NUMERIC		E_B_SNF_C1_31		E00E18B	3100	100
NUMERIC		E_B_SNF_C1_32		E00E18B	3200	100
NUMERIC		E_B_SNF_C1_33		E00E18B	3300	100
NUMERIC		E_B_SNF_C1_34		E00E18B	3400	100
NUMERIC		E_B_SNF_C1_35		E00E18B	3500	100
NUMERIC		E_B_SNF_C1_36		E00E18B	3600	100
NUMERIC		E_B_SNF_C1_37		E00E18B	3700	100
NUMERIC		E_B_SNF_C1_38		E00E18B	3800	100
ROLLUP		E_B_SNF_C1_39		E00E18B	3900	100
NUMERIC		E_B_SNF_C1_40		E00E18B	4000	100
NUMERIC		E_B_SNF_C1_41		E00E18B	4100	100
NUMERIC		E_B_SNF_C1_42		E00E18B	4200	100
NUMERIC		E_B_SNF_C1_43		E00E18B	4300	100
NUMERIC		E_B_SNF_C1_44		E00E18B	4400	100
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
	CALCULATION OF REIMBURSMENT SETTLEMENT					
	"2552-10 WORKSHEET E-1, PART II HOSPITAL"					
						
DATA TYPE	96 FIELD NAME	10 FIELD NAME	FIELD DESCRIPTION 	WKSHT CD	LINE	COLUMN
						
NUMERIC		E1_2_HOS_C1_1		E10A182	100	100
NUMERIC		E1_2_HOS_C1_2		E10A182	200	100
NUMERIC		E1_2_HOS_C1_3		E10A182	300	100
NUMERIC		E1_2_HOS_C1_4		E10A182	400	100
NUMERIC		E1_2_HOS_C1_5		E10A182	500	100
NUMERIC		E1_2_HOS_C1_6		E10A182	600	100
NUMERIC		E1_2_HOS_C1_7		E10A182	700	100
NUMERIC		E1_2_HOS_C1_8		E10A182	800	100
NUMERIC		E1_2_HOS_C1_30		E10A182	3000	100
NUMERIC		E1_2_HOS_C1_31		E10A182	3100	100
NUMERIC		E1_2_HOS_C1_32		E10A182	3200	100
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
	CALCULATION OF REIMBURSMENT SETTLEMENT					
	2552-10 WORKSHEET E-2 FOR THE SWING BED SNF					
						
DATA TYPE	96 FIELD NAME	10 FIELD NAME	FIELD DESCRIPTION 	WKSHT CD	LINE	COLUMN
						
NUMERIC		E2_SWSNF_C1_1		E20F180	100	100
NUMERIC		E2_SWSNF_C1_2		E20F180	200	100
NUMERIC		E2_SWSNF_C1_3		E20F180	300	100
NUMERIC		E2_SWSNF_C1_4		E20F180	400	100
NUMERIC		E2_SWSNF_C1_5		E20F180	500	100
NUMERIC		E2_SWSNF_C1_6		E20F180	600	100
NUMERIC		E2_SWSNF_C1_7		E20F180	700	100
NUMERIC		E2_SWSNF_C1_8		E20F180	800	100
NUMERIC		E2_SWSNF_C1_9		E20F180	900	100
NUMERIC		E2_SWSNF_C1_10		E20F180	1000	100
NUMERIC		E2_SWSNF_C1_11		E20F180	1100	100
NUMERIC		E2_SWSNF_C1_12		E20F180	1200	100
NUMERIC		E2_SWSNF_C1_13		E20F180	1300	100
NUMERIC		E2_SWSNF_C1_14		E20F180	1400	100
NUMERIC		E2_SWSNF_C1_15		E20F180	1500	100
ROLLUP		E2_SWSNF_C1_16		E20F180	1600	100
NUMERIC		E2_SWSNF_C1_17		E20F180	1700	100
NUMERIC		E2_SWSNF_C1_18		E20F180	1800	100
NUMERIC		E2_SWSNF_C1_19		E20F180	1900	100
NUMERIC		E2_SWSNF_C1_20		E20F180	2000	100
NUMERIC		E2_SWSNF_C1_21		E20F180	2100	100
NUMERIC		E2_SWSNF_C1_22		E20F180	2200	100
NUMERIC		E2_SWSNF_C1_23		E20F180	2300	100
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
	CALCULATION OF REIMBURSMENT SETTLEMENT (TEFRA)					
	"2552-10 WORKSHEET E-3, PART I FOR THE HOSPITAL"					
						
DATA TYPE	96 FIELD NAME	10 FIELD NAME	FIELD DESCRIPTION 	WKSHT CD	LINE	COLUMN
						
NUMERIC		E3_1_HOS_C1_1		E30A181	100	100
NUMERIC		E3_1_HOS_C1_2		E30A181	200	100
NUMERIC		E3_1_HOS_C1_3		E30A181	300	100
NUMERIC		E3_1_HOS_C1_4		E30A181	400	100
NUMERIC		E3_1_HOS_C1_5		E30A181	500	100
NUMERIC		E3_1_HOS_C1_6		E30A181	600	100
NUMERIC		E3_1_HOS_C1_7		E30A181	700	100
NUMERIC		E3_1_HOS_C1_8		E30A181	800	100
NUMERIC		E3_1_HOS_C1_9		E30A181	900	100
NUMERIC		E3_1_HOS_C1_10		E30A181	1000	100
NUMERIC		E3_1_HOS_C1_11		E30A181	1100	100
NUMERIC		E3_1_HOS_C1_12		E30A181	1200	100
NUMERIC		E3_1_HOS_C1_13		E30A181	1300	100
NUMERIC		E3_1_HOS_C1_14		E30A181	1400	100
NUMERIC		E3_1_HOS_C1_15		E30A181	1500	100
NUMERIC		E3_1_HOS_C1_16		E30A181	1600	100
ROLLUP		E3_1_HOS_C1_17		E30A181	1700	100
NUMERIC		E3_1_HOS_C1_18		E30A181	1800	100
NUMERIC		E3_1_HOS_C1_19		E30A181	1900	100
NUMERIC		E3_1_HOS_C1_20		E30A181	2000	100
NUMERIC		E3_1_HOS_C1_21		E30A181	2100	100
NUMERIC		E3_1_HOS_C1_22		E30A181	2200	100
						
						
						
						
						
						
	CALCULATION OF REIMBURSMENT SETTLEMENT (TEFRA)					
	"2552-10 WORKSHEET E-3, PART I FOR THE IPF "					
						
DATA TYPE	96 FIELD NAME	10 FIELD NAME	FIELD DESCRIPTION 	WKSHT CD	LINE	COLUMN
						
NUMERIC		E3_1_IPF_C1_1		E30B181	100	100
NUMERIC		E3_1_IPF_C1_2		E30B181	200	100
NUMERIC		E3_1_IPF_C1_3		E30B181	300	100
NUMERIC		E3_1_IPF_C1_4		E30B181	400	100
NUMERIC		E3_1_IPF_C1_5		E30B181	500	100
NUMERIC		E3_1_IPF_C1_6		E30B181	600	100
NUMERIC		E3_1_IPF_C1_7		E30B181	700	100
NUMERIC		E3_1_IPF_C1_8		E30B181	800	100
NUMERIC		E3_1_IPF_C1_9		E30B181	900	100
NUMERIC		E3_1_IPF_C1_10		E30B181	1000	100
NUMERIC		E3_1_IPF_C1_11		E30B181	1100	100
NUMERIC		E3_1_IPF_C1_12		E30B181	1200	100
NUMERIC		E3_1_IPF_C1_13		E30B181	1300	100
NUMERIC		E3_1_IPF_C1_14		E30B181	1400	100
NUMERIC		E3_1_IPF_C1_15		E30B181	1500	100
NUMERIC		E3_1_IPF_C1_16		E30B181	1600	100
ROLLUP		E3_1_IPF_C1_17		E30B181	1700	100
NUMERIC		E3_1_IPF_C1_18		E30B181	1800	100
NUMERIC		E3_1_IPF_C1_19		E30B181	1900	100
NUMERIC		E3_1_IPF_C1_20		E30B181	2000	100
NUMERIC		E3_1_IPF_C1_21		E30B181	2100	100
NUMERIC		E3_1_IPF_C1_22		E30B181	2200	100
						
						
						
						
						
						
						
						
						
						
	CALCULATION OF REIMBURSMENT SETTLEMENT (TEFRA)					
	"2552-10 WORKSHEET E-3, PART I FOR THE IRF  "					
						
DATA TYPE	96 FIELD NAME	10 FIELD NAME	FIELD DESCRIPTION 	WKSHT CD	LINE	COLUMN
						
NUMERIC		E3_1_IRF_C1_1		E30C181	100	100
NUMERIC		E3_1_IRF_C1_2		E30C181	200	100
NUMERIC		E3_1_IRF_C1_3		E30C181	300	100
NUMERIC		E3_1_IRF_C1_4		E30C181	400	100
NUMERIC		E3_1_IRF_C1_5		E30C181	500	100
NUMERIC		E3_1_IRF_C1_6		E30C181	600	100
NUMERIC		E3_1_IRF_C1_7		E30C181	700	100
NUMERIC		E3_1_IRF_C1_8		E30C181	800	100
NUMERIC		E3_1_IRF_C1_9		E30C181	900	100
NUMERIC		E3_1_IRF_C1_10		E30C181	1000	100
NUMERIC		E3_1_IRF_C1_11		E30C181	1100	100
NUMERIC		E3_1_IRF_C1_12		E30C181	1200	100
NUMERIC		E3_1_IRF_C1_13		E30C181	1300	100
NUMERIC		E3_1_IRF_C1_14		E30C181	1400	100
NUMERIC		E3_1_IRF_C1_15		E30C181	1500	100
NUMERIC		E3_1_IRF_C1_16		E30C181	1600	100
ROLLUP		E3_1_IRF_C1_17		E30C181	1700	100
NUMERIC		E3_1_IRF_C1_18		E30C181	1800	100
NUMERIC		E3_1_IRF_C1_19		E30C181	1900	100
NUMERIC		E3_1_IRF_C1_20		E30C181	2000	100
NUMERIC		E3_1_IRF_C1_21		E30C181	2100	100
NUMERIC		E3_1_IRF_C1_22		E30C181	2200	100
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
	CALCULATION OF REIMBURSMENT SETTLEMENT (TEFRA)					
	"2552-10 WORKSHEET E-3, PART I FOR SUBPROVIDER I "					
						
DATA TYPE	96 FIELD NAME	10 FIELD NAME	FIELD DESCRIPTION 	WKSHT CD	LINE	COLUMN
						
NUMERIC		E3_1_SUB1_C1_1		E31D181	100	100
NUMERIC		E3_1_SUB1_C1_2		E31D181	200	100
NUMERIC		E3_1_SUB1_C1_3		E31D181	300	100
NUMERIC		E3_1_SUB1_C1_4		E31D181	400	100
NUMERIC		E3_1_SUB1_C1_5		E31D181	500	100
NUMERIC		E3_1_SUB1_C1_6		E31D181	600	100
NUMERIC		E3_1_SUB1_C1_7		E31D181	700	100
NUMERIC		E3_1_SUB1_C1_8		E31D181	800	100
NUMERIC		E3_1_SUB1_C1_9		E31D181	900	100
NUMERIC		E3_1_SUB1_C1_10		E31D181	1000	100
NUMERIC		E3_1_SUB1_C1_11		E31D181	1100	100
NUMERIC		E3_1_SUB1_C1_12		E31D181	1200	100
NUMERIC		E3_1_SUB1_C1_13		E31D181	1300	100
NUMERIC		E3_1_SUB1_C1_14		E31D181	1400	100
NUMERIC		E3_1_SUB1_C1_15		E31D181	1500	100
NUMERIC		E3_1_SUB1_C1_16		E31D181	1600	100
ROLLUP		E3_1_SUB1_C1_17		E31D181	1700	100
NUMERIC		E3_1_SUB1_C1_18		E31D181	1800	100
NUMERIC		E3_1_SUB1_C1_19		E31D181	1900	100
NUMERIC		E3_1_SUB1_C1_20		E31D181	2000	100
NUMERIC		E3_1_SUB1_C1_21		E31D181	2100	100
NUMERIC		E3_1_SUB1_C1_22		E31D181	2200	100
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
	CALCULATION OF REIMBURSMENT SETTLEMENT (TEFRA)					
	"2552-10 WORKSHEET E-3, PART I FOR SUBPROVIDER II"					
						
DATA TYPE	96 FIELD NAME	10 FIELD NAME	FIELD DESCRIPTION 	WKSHT CD	LINE	COLUMN
						
NUMERIC		E3_1_SUB2_C1_1		E32D181	100	100
NUMERIC		E3_1_SUB2_C1_2		E32D181	200	100
NUMERIC		E3_1_SUB2_C1_3		E32D181	300	100
NUMERIC		E3_1_SUB2_C1_4		E32D181	400	100
NUMERIC		E3_1_SUB2_C1_5		E32D181	500	100
NUMERIC		E3_1_SUB2_C1_6		E32D181	600	100
NUMERIC		E3_1_SUB2_C1_7		E32D181	700	100
NUMERIC		E3_1_SUB2_C1_8		E32D181	800	100
NUMERIC		E3_1_SUB2_C1_9		E32D181	900	100
NUMERIC		E3_1_SUB2_C1_10		E32D181	1000	100
NUMERIC		E3_1_SUB2_C1_11		E32D181	1100	100
NUMERIC		E3_1_SUB2_C1_12		E32D181	1200	100
NUMERIC		E3_1_SUB2_C1_13		E32D181	1300	100
NUMERIC		E3_1_SUB2_C1_14		E32D181	1400	100
NUMERIC		E3_1_SUB2_C1_15		E32D181	1500	100
NUMERIC		E3_1_SUB2_C1_16		E32D181	1600	100
ROLLUP		E3_1_SUB2_C1_17		E32D181	1700	100
NUMERIC		E3_1_SUB2_C1_18		E32D181	1800	100
NUMERIC		E3_1_SUB2_C1_19		E32D181	1900	100
NUMERIC		E3_1_SUB2_C1_20		E32D181	2000	100
NUMERIC		E3_1_SUB2_C1_21		E32D181	2100	100
NUMERIC		E3_1_SUB2_C1_22		E32D181	2200	100
						
						
	CALCULATION OF REIMBURSMENT SETTLEMENT (TEFRA)					
	"2552-10 WORKSHEET E-3, PART I FOR THE SNF"					
						
DATA TYPE	96 FIELD NAME	10 FIELD NAME	FIELD DESCRIPTION 	WKSHT CD	LINE	COLUMN
						
NUMERIC		E3_1_SNF_C1_1		E30E181	100	100
NUMERIC		E3_1_SNF_C1_2		E30E181	200	100
NUMERIC		E3_1_SNF_C1_3		E30E181	300	100
NUMERIC		E3_1_SNF_C1_4		E30E181	400	100
NUMERIC		E3_1_SNF_C1_5		E30E181	500	100
NUMERIC		E3_1_SNF_C1_6		E30E181	600	100
NUMERIC		E3_1_SNF_C1_7		E30E181	700	100
NUMERIC		E3_1_SNF_C1_8		E30E181	800	100
NUMERIC		E3_1_SNF_C1_9		E30E181	900	100
NUMERIC		E3_1_SNF_C1_10		E30E181	1000	100
NUMERIC		E3_1_SNF_C1_11		E30E181	1100	100
NUMERIC		E3_1_SNF_C1_12		E30E181	1200	100
NUMERIC		E3_1_SNF_C1_13		E30E181	1300	100
NUMERIC		E3_1_SNF_C1_14		E30E181	1400	100
NUMERIC		E3_1_SNF_C1_15		E30E181	1500	100
NUMERIC		E3_1_SNF_C1_16		E30E181	1600	100
ROLLUP		E3_1_SNF_C1_17		E30E181	1700	100
NUMERIC		E3_1_SNF_C1_18		E30E181	1800	100
NUMERIC		E3_1_SNF_C1_19		E30E181	1900	100
NUMERIC		E3_1_SNF_C1_20		E30E181	2000	100
NUMERIC		E3_1_SNF_C1_21		E30E181	2100	100
NUMERIC		E3_1_SNF_C1_22		E30E181	2200	100
						
						
						
						
						
						
						
						
						
						
						
						
						
						
	CALCULATION OF REIMBURSMENT SETTLEMENT (PPS)					
	"2552-10 WORKSHEET E-3, PART II FOR THE HOSPITAL "					
						
DATA TYPE	96 FIELD NAME	10 FIELD NAME	FIELD DESCRIPTION 	WKSHT CD	LINE	COLUMN
						
NUMERIC		E3_2_HOS_C1_1		E30A182	100	100
NUMERIC		E3_2_HOS_C1_2		E30A182	200	100
NUMERIC		E3_2_HOS_C1_3		E30A182	300	100
NUMERIC		E3_2_HOS_C1_4		E30A182	400	100
NUMERIC		E3_2_HOS_C1_5		E30A182	500	100
NUMERIC		E3_2_HOS_C1_6		E30A182	600	100
NUMERIC		E3_2_HOS_C1_7		E30A182	700	100
NUMERIC		E3_2_HOS_C1_8		E30A182	800	100
NUMERIC		E3_2_HOS_C1_9		E30A182	900	100
NUMERIC		E3_2_HOS_C1_10		E30A182	1000	100
NUMERIC		E3_2_HOS_C1_11		E30A182	1100	100
NUMERIC		E3_2_HOS_C1_12		E30A182	1200	100
NUMERIC		E3_2_HOS_C1_13		E30A182	1300	100
NUMERIC		E3_2_HOS_C1_14		E30A182	1400	100
NUMERIC		E3_2_HOS_C1_15		E30A182	1500	100
NUMERIC		E3_2_HOS_C1_16		E30A182	1600	100
NUMERIC		E3_2_HOS_C1_17		E30A182	1700	100
NUMERIC		E3_2_HOS_C1_18		E30A182	1800	100
NUMERIC		E3_2_HOS_C1_19		E30A182	1900	100
NUMERIC		E3_2_HOS_C1_20		E30A182	2000	100
NUMERIC		E3_2_HOS_C1_21		E30A182	2100	100
NUMERIC		E3_2_HOS_C1_22		E30A182	2200	100
NUMERIC		E3_2_HOS_C1_23		E30A182	2300	100
NUMERIC		E3_2_HOS_C1_24		E30A182	2400	100
NUMERIC		E3_2_HOS_C1_25		E30A182	2500	100
NUMERIC		E3_2_HOS_C1_26		E30A182	2600	100
NUMERIC		E3_2_HOS_C1_27		E30A182	2700	100
NUMERIC		E3_2_HOS_C1_28		E30A182	2800	100
NUMERIC		E3_2_HOS_C1_29		E30A182	2900	100
ROLLUP		E3_2_HOS_C1_30		E30A182	3000	100
NUMERIC		E3_2_HOS_C1_31		E30A182	3100	100
NUMERIC		E3_2_HOS_C1_32		E30A182	3200	100
NUMERIC		E3_2_HOS_C1_33		E30A182	3300	100
NUMERIC		E3_2_HOS_C1_34		E30A182	3400	100
NUMERIC		E3_2_HOS_C1_35		E30A182	3500	100
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
	CALCULATION OF REIMBURSMENT SETTLEMENT (PPS)					
	"2552-10 WORKSHEET E-3, PART II FOR THE IPF"					
						
DATA TYPE	96 FIELD NAME	10 FIELD NAME	FIELD DESCRIPTION 	WKSHT CD	LINE	COLUMN
						
NUMERIC		E3_2_IPF_C1_1		E30B182	100	100
NUMERIC		E3_2_IPF_C1_2		E30B182	200	100
NUMERIC		E3_2_IPF_C1_3		E30B182	300	100
NUMERIC		E3_2_IPF_C1_4		E30B182	400	100
NUMERIC		E3_2_IPF_C1_5		E30B182	500	100
NUMERIC		E3_2_IPF_C1_6		E30B182	600	100
NUMERIC		E3_2_IPF_C1_7		E30B182	700	100
NUMERIC		E3_2_IPF_C1_8		E30B182	800	100
NUMERIC		E3_2_IPF_C1_9		E30B182	900	100
NUMERIC		E3_2_IPF_C1_10		E30B182	1000	100
NUMERIC		E3_2_IPF_C1_11		E30B182	1100	100
NUMERIC		E3_2_IPF_C1_12		E30B182	1200	100
NUMERIC		E3_2_IPF_C1_13		E30B182	1300	100
NUMERIC		E3_2_IPF_C1_14		E30B182	1400	100
NUMERIC		E3_2_IPF_C1_15		E30B182	1500	100
NUMERIC		E3_2_IPF_C1_16		E30B182	1600	100
NUMERIC		E3_2_IPF_C1_17		E30B182	1700	100
NUMERIC		E3_2_IPF_C1_18		E30B182	1800	100
NUMERIC		E3_2_IPF_C1_19		E30B182	1900	100
NUMERIC		E3_2_IPF_C1_20		E30B182	2000	100
NUMERIC		E3_2_IPF_C1_21		E30B182	2100	100
NUMERIC		E3_2_IPF_C1_22		E30B182	2200	100
NUMERIC		E3_2_IPF_C1_23		E30B182	2300	100
NUMERIC		E3_2_IPF_C1_24		E30B182	2400	100
NUMERIC		E3_2_IPF_C1_25		E30B182	2500	100
NUMERIC		E3_2_IPF_C1_26		E30B182	2600	100
NUMERIC		E3_2_IPF_C1_27		E30B182	2700	100
NUMERIC		E3_2_IPF_C1_28		E30B182	2800	100
NUMERIC		E3_2_IPF_C1_29		E30B182	2900	100
ROLLUP		E3_2_IPF_C1_30		E30B182	3000	100
NUMERIC		E3_2_IPF_C1_31		E30B182	3100	100
NUMERIC		E3_2_IPF_C1_32		E30B182	3200	100
NUMERIC		E3_2_IPF_C1_33		E30B182	3300	100
NUMERIC		E3_2_IPF_C1_34		E30B182	3400	100
NUMERIC		E3_2_IPF_C1_35		E30B182	3500	100
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
	CALCULATION OF REIMBURSMENT SETTLEMENT (PPS)					
	"2552-10 WORKSHEET E-3, PART III FOR THE HOSPITAL"					
						
DATA TYPE	96 FIELD NAME	10 FIELD NAME	FIELD DESCRIPTION 	WKSHT CD	LINE	COLUMN
						
						
NUMERIC		E3_3_HOS_C1_1		E30A183	100	100
NUMERIC		E3_3_HOS_C1_2		E30A183	200	100
NUMERIC		E3_3_HOS_C1_3		E30A183	300	100
NUMERIC		E3_3_HOS_C1_4		E30A183	400	100
NUMERIC		E3_3_HOS_C1_5		E30A183	500	100
NUMERIC		E3_3_HOS_C1_6		E30A183	600	100
NUMERIC		E3_3_HOS_C1_7		E30A183	700	100
NUMERIC		E3_3_HOS_C1_8		E30A183	800	100
NUMERIC		E3_3_HOS_C1_9		E30A183	900	100
NUMERIC		E3_3_HOS_C1_10		E30A183	1000	100
NUMERIC		E3_3_HOS_C1_11		E30A183	1100	100
NUMERIC		E3_3_HOS_C1_12		E30A183	1200	100
NUMERIC		E3_3_HOS_C1_13		E30A183	1300	100
NUMERIC		E3_3_HOS_C1_14		E30A183	1400	100
NUMERIC		E3_3_HOS_C1_15		E30A183	1500	100
NUMERIC		E3_3_HOS_C1_16		E30A183	1600	100
NUMERIC		E3_3_HOS_C1_17		E30A183	1700	100
NUMERIC		E3_3_HOS_C1_18		E30A183	1800	100
NUMERIC		E3_3_HOS_C1_19		E30A183	1900	100
NUMERIC		E3_3_HOS_C1_20		E30A183	2000	100
NUMERIC		E3_3_HOS_C1_21		E30A183	2100	100
NUMERIC		E3_3_HOS_C1_22		E30A183	2200	100
NUMERIC		E3_3_HOS_C1_23		E30A183	2300	100
NUMERIC		E3_3_HOS_C1_24		E30A183	2400	100
NUMERIC		E3_3_HOS_C1_25		E30A183	2500	100
NUMERIC		E3_3_HOS_C1_26		E30A183	2600	100
NUMERIC		E3_3_HOS_C1_27		E30A183	2700	100
NUMERIC		E3_3_HOS_C1_28		E30A183	2800	100
NUMERIC		E3_3_HOS_C1_29		E30A183	2900	100
NUMERIC		E3_3_HOS_C1_30		E30A183	3000	100
ROLLUP		E3_3_HOS_C1_31		E30A183	3100	100
NUMERIC		E3_3_HOS_C1_32		E30A183	3200	100
NUMERIC		E3_3_HOS_C1_33		E30A183	3300	100
NUMERIC		E3_3_HOS_C1_34		E30A183	3400	100
NUMERIC		E3_3_HOS_C1_35		E30A183	3500	100
NUMERIC		E3_3_HOS_C1_36		E30A183	3600	100
NUMERIC		E3_3_HOS_C1_50		E30A183	5000	100
NUMERIC		E3_3_HOS_C1_51		E30A183	5100	100
NUMERIC		E3_3_HOS_C1_52		E30A183	5200	100
NUMERIC		E3_3_HOS_C1_53		E30A183	5300	100
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
	CALCULATION OF REIMBURSMENT SETTLEMENT (PPS)					
	"2552-10 WORKSHEET E-3, PART III FOR THE IRF"					
						
DATA TYPE	96 FIELD NAME	10 FIELD NAME	FIELD DESCRIPTION 	WKSHT CD	LINE	COLUMN
						
						
NUMERIC		E3_3_IRF_C1_1		E30C183	100	100
NUMERIC		E3_3_IRF_C1_2		E30C183	200	100
NUMERIC		E3_3_IRF_C1_3		E30C183	300	100
NUMERIC		E3_3_IRF_C1_4		E30C183	400	100
NUMERIC		E3_3_IRF_C1_5		E30C183	500	100
NUMERIC		E3_3_IRF_C1_6		E30C183	600	100
NUMERIC		E3_3_IRF_C1_7		E30C183	700	100
NUMERIC		E3_3_IRF_C1_8		E30C183	800	100
NUMERIC		E3_3_IRF_C1_9		E30C183	900	100
NUMERIC		E3_3_IRF_C1_10		E30C183	1000	100
NUMERIC		E3_3_IRF_C1_11		E30C183	1100	100
NUMERIC		E3_3_IRF_C1_12		E30C183	1200	100
NUMERIC		E3_3_IRF_C1_13		E30C183	1300	100
NUMERIC		E3_3_IRF_C1_14		E30C183	1400	100
NUMERIC		E3_3_IRF_C1_15		E30C183	1500	100
NUMERIC		E3_3_IRF_C1_16		E30C183	1600	100
NUMERIC		E3_3_IRF_C1_17		E30C183	1700	100
NUMERIC		E3_3_IRF_C1_18		E30C183	1800	100
NUMERIC		E3_3_IRF_C1_19		E30C183	1900	100
NUMERIC		E3_3_IRF_C1_20		E30C183	2000	100
NUMERIC		E3_3_IRF_C1_21		E30C183	2100	100
NUMERIC		E3_3_IRF_C1_22		E30C183	2200	100
NUMERIC		E3_3_IRF_C1_23		E30C183	2300	100
NUMERIC		E3_3_IRF_C1_24		E30C183	2400	100
NUMERIC		E3_3_IRF_C1_25		E30C183	2500	100
NUMERIC		E3_3_IRF_C1_26		E30C183	2600	100
NUMERIC		E3_3_IRF_C1_27		E30C183	2700	100
NUMERIC		E3_3_IRF_C1_28		E30C183	2800	100
NUMERIC		E3_3_IRF_C1_29		E30C183	2900	100
NUMERIC		E3_3_IRF_C1_30		E30C183	3000	100
ROLLUP		E3_3_IRF_C1_31		E30C183	3100	100
NUMERIC		E3_3_IRF_C1_32		E30C183	3200	100
NUMERIC		E3_3_IRF_C1_33		E30C183	3300	100
NUMERIC		E3_3_IRF_C1_34		E30C183	3400	100
NUMERIC		E3_3_IRF_C1_35		E30C183	3500	100
NUMERIC		E3_3_IRF_C1_36		E30C183	3600	100
NUMERIC		E3_3_IRF_C1_50		E30C183	5000	100
NUMERIC		E3_3_IRF_C1_51		E30C183	5100	100
NUMERIC		E3_3_IRF_C1_52		E30C183	5200	100
NUMERIC		E3_3_IRF_C1_53		E30C183	5300	100
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
	LTCH PPS					
	"2552-10 WORKSHEET E-3, PART IV-HOSPITAL"					
						
DATA TYPE	96 FIELD NAME	10 FIELD NAME	FIELD DESCRIPTION 	WKSHT CD	LINE	COLUMN
						
						
NUMERIC		E3_4_HOS_C1_1		E30A184	100	100
NUMERIC		E3_4_HOS_C1_2		E30A184	200	100
NUMERIC		E3_4_HOS_C1_3		E30A184	300	100
NUMERIC		E3_4_HOS_C1_4		E30A184	400	100
NUMERIC		E3_4_HOS_C1_5		E30A184	500	100
NUMERIC		E3_4_HOS_C1_6		E30A184	600	100
NUMERIC		E3_4_HOS_C1_7		E30A184	700	100
NUMERIC		E3_4_HOS_C1_8		E30A184	800	100
NUMERIC		E3_4_HOS_C1_9		E30A184	900	100
NUMERIC		E3_4_HOS_C1_10		E30A184	1000	100
NUMERIC		E3_4_HOS_C1_11		E30A184	1100	100
NUMERIC		E3_4_HOS_C1_12		E30A184	1200	100
NUMERIC		E3_4_HOS_C1_13		E30A184	1300	100
NUMERIC		E3_4_HOS_C1_14		E30A184	1400	100
NUMERIC		E3_4_HOS_C1_15		E30A184	1500	100
NUMERIC		E3_4_HOS_C1_16		E30A184	1600	100
NUMERIC		E3_4_HOS_C1_17		E30A184	1700	100
NUMERIC		E3_4_HOS_C1_18		E30A184	1800	100
NUMERIC		E3_4_HOS_C1_19		E30A184	1900	100
NUMERIC		E3_4_HOS_C1_20		E30A184	2000	100
ROLLUP		E3_4_HOS_C1_21		E30A184	2100	100
NUMERIC		E3_4_HOS_C1_22		E30A184	2200	100
NUMERIC		E3_4_HOS_C1_2201		E30A184	2201	100
NUMERIC		E3_4_HOS_C1_23		E30A184	2300	100
NUMERIC		E3_4_HOS_C1_24		E30A184	2400	100
NUMERIC		E3_4_HOS_C1_25		E30A184	2500	100
NUMERIC		E3_4_HOS_C1_26		E30A184	2600	100
NUMERIC		E3_4_HOS_C1_50		E30A184	5000	100
NUMERIC		E3_4_HOS_C1_51		E30A184	5100	100
NUMERIC		E3_4_HOS_C1_52		E30A184	5200	100
NUMERIC		E3_4_HOS_C1_53		E30A184	5300	100
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
	LTCH PPS					
	"2552-10 WORKSHEET E-3, PART IV-SUB1"					
						
DATA TYPE	96 FIELD NAME	10 FIELD NAME	FIELD DESCRIPTION 	WKSHT CD	LINE	COLUMN
						
						
NUMERIC		E3_4_SUB1_C1_1		E31D184	100	100
NUMERIC		E3_4_SUB1_C1_2		E31D184	200	100
NUMERIC		E3_4_SUB1_C1_3		E31D184	300	100
NUMERIC		E3_4_SUB1_C1_4		E31D184	400	100
NUMERIC		E3_4_SUB1_C1_5		E31D184	500	100
NUMERIC		E3_4_SUB1_C1_6		E31D184	600	100
NUMERIC		E3_4_SUB1_C1_7		E31D184	700	100
NUMERIC		E3_4_SUB1_C1_8		E31D184	800	100
NUMERIC		E3_4_SUB1_C1_9		E31D184	900	100
NUMERIC		E3_4_SUB1_C1_10		E31D184	1000	100
NUMERIC		E3_4_SUB1_C1_11		E31D184	1100	100
NUMERIC		E3_4_SUB1_C1_12		E31D184	1200	100
NUMERIC		E3_4_SUB1_C1_13		E31D184	1300	100
NUMERIC		E3_4_SUB1_C1_14		E31D184	1400	100
NUMERIC		E3_4_SUB1_C1_15		E31D184	1500	100
NUMERIC		E3_4_SUB1_C1_16		E31D184	1600	100
NUMERIC		E3_4_SUB1_C1_17		E31D184	1700	100
NUMERIC		E3_4_SUB1_C1_18		E31D184	1800	100
NUMERIC		E3_4_SUB1_C1_19		E31D184	1900	100
NUMERIC		E3_4_SUB1_C1_20		E31D184	2000	100
ROLLUP		E3_4_SUB1_C1_21		E31D184	2100	100
NUMERIC		E3_4_SUB1_C1_22		E31D184	2200	100
NUMERIC		E3_4_SUB1_C1_23		E31D184	2300	100
NUMERIC		E3_4_SUB1_C1_24		E31D184	2400	100
NUMERIC		E3_4_SUB1_C1_25		E31D184	2500	100
NUMERIC		E3_4_SUB1_C1_26		E31D184	2600	100
NUMERIC		E3_4_SUB1_C1_50		E31D184	5000	100
NUMERIC		E3_4_SUB1_C1_51		E31D184	5100	100
NUMERIC		E3_4_SUB1_C1_52		E31D184	5200	100
NUMERIC		E3_4_SUB1_C1_53		E31D184	5300	100
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
	LTCH PPS					
	"2552-10 WORKSHEET E-3, PART IV-SUBII"					
						
DATA TYPE	96 FIELD NAME	10 FIELD NAME	FIELD DESCRIPTION 	WKSHT CD	LINE	COLUMN
						
						
NUMERIC		E3_4_SUB2_C1_1		E32D184	100	100
NUMERIC		E3_4_SUB2_C1_2		E32D184	200	100
NUMERIC		E3_4_SUB2_C1_3		E32D184	300	100
NUMERIC		E3_4_SUB2_C1_4		E32D184	400	100
NUMERIC		E3_4_SUB2_C1_5		E32D184	500	100
NUMERIC		E3_4_SUB2_C1_6		E32D184	600	100
NUMERIC		E3_4_SUB2_C1_7		E32D184	700	100
NUMERIC		E3_4_SUB2_C1_8		E32D184	800	100
NUMERIC		E3_4_SUB2_C1_9		E32D184	900	100
NUMERIC		E3_4_SUB2_C1_10		E32D184	1000	100
NUMERIC		E3_4_SUB2_C1_11		E32D184	1100	100
NUMERIC		E3_4_SUB2_C1_12		E32D184	1200	100
NUMERIC		E3_4_SUB2_C1_13		E32D184	1300	100
NUMERIC		E3_4_SUB2_C1_14		E32D184	1400	100
NUMERIC		E3_4_SUB2_C1_15		E32D184	1500	100
NUMERIC		E3_4_SUB2_C1_16		E32D184	1600	100
NUMERIC		E3_4_SUB2_C1_17		E32D184	1700	100
NUMERIC		E3_4_SUB2_C1_18		E32D184	1800	100
NUMERIC		E3_4_SUB2_C1_19		E32D184	1900	100
NUMERIC		E3_4_SUB2_C1_20		E32D184	2000	100
ROLLUP		E3_4_SUB2_C1_21		E32D184	2100	100
NUMERIC		E3_4_SUB2_C1_22		E32D184	2200	100
NUMERIC		E3_4_SUB2_C1_23		E32D184	2300	100
NUMERIC		E3_4_SUB2_C1_24		E32D184	2400	100
NUMERIC		E3_4_SUB2_C1_25		E32D184	2500	100
NUMERIC		E3_4_SUB2_C1_26		E32D184	2600	100
NUMERIC		E3_4_SUB2_C1_50		E32D184	5000	100
NUMERIC		E3_4_SUB2_C1_51		E32D184	5100	100
NUMERIC		E3_4_SUB2_C1_52		E32D184	5200	100
NUMERIC		E3_4_SUB2_C1_53		E32D184	5300	100
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
	"2552-10 WORKSHEET E-3, PART V "					
						
DATA TYPE	96 FIELD NAME	10 FIELD NAME	FIELD DESCRIPTION 	WKSHT CD	LINE	COLUMN
						
NUMERIC		E3_5_C1_1		E30A185	100	100
NUMERIC		E3_5_C1_2		E30A185	200	100
NUMERIC		E3_5_C1_3		E30A185	300	100
NUMERIC		E3_5_C1_4		E30A185	400	100
NUMERIC		E3_5_C1_5		E30A185	500	100
NUMERIC		E3_5_C1_6		E30A185	600	100
NUMERIC		E3_5_C1_7		E30A185	700	100
NUMERIC		E3_5_C1_8		E30A185	800	100
NUMERIC		E3_5_C1_9		E30A185	900	100
NUMERIC		E3_5_C1_10		E30A185	1000	100
NUMERIC		E3_5_C1_11		E30A185	1100	100
NUMERIC		E3_5_C1_12		E30A185	1200	100
NUMERIC		E3_5_C1_13		E30A185	1300	100
NUMERIC		E3_5_C1_14		E30A185	1400	100
NUMERIC		E3_5_C1_15		E30A185	1500	100
NUMERIC		E3_5_C1_16		E30A185	1600	100
NUMERIC		E3_5_C1_17		E30A185	1700	100
NUMERIC		E3_5_C1_18		E30A185	1800	100
NUMERIC		E3_5_C1_19		E30A185	1900	100
NUMERIC		E3_5_C1_20		E30A185	2000	100
NUMERIC		E3_5_C1_21		E30A185	2100	100
NUMERIC		E3_5_C1_22		E30A185	2200	100
NUMERIC		E3_5_C1_23		E30A185	2300	100
NUMERIC		E3_5_C1_24		E30A185	2400	100
NUMERIC		E3_5_C1_25		E30A185	2500	100
NUMERIC		E3_5_C1_26		E30A185	2600	100
NUMERIC		E3_5_C1_27		E30A185	2700	100
NUMERIC		E3_5_C1_28		E30A185	2800	100
NUMERIC		E3_5_C1_29		E30A185	2900	100
NUMERIC		E3_5_C1_30		E30A185	3000	100
NUMERIC		E3_5_C1_31		E30A185	3100	100
NUMERIC		E3_5_C1_32		E30A185	3200	100
NUMERIC		E3_5_C1_33		E30A185	3300	100
NUMERIC		E3_5_C1_34		E30A185	3400	100
				 		
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
	CALCULATION OF REIMBURSEMENT SETTLEMENT 					
	"2552-10 WORKSHEET E-3, PART VI FOR SNF"					
						
DATA TYPE	96 FIELD NAME	10 FIELD NAME	FIELD DESCRIPTION 	WKSHT CD	LINE	COLUMN
						
NUMERIC		E3_6_SNF_C1_1		E30E186	100	100
NUMERIC		E3_6_SNF_C1_2		E30E186	200	100
NUMERIC		E3_6_SNF_C1_3		E30E186	300	100
NUMERIC		E3_6_SNF_C1_4		E30E186	400	100
NUMERIC		E3_6_SNF_C1_5		E30E186	500	100
NUMERIC		E3_6_SNF_C1_6		E30E186	600	100
NUMERIC		E3_6_SNF_C1_7		E30E186	700	100
NUMERIC		E3_6_SNF_C1_8		E30E186	800	100
NUMERIC		E3_6_SNF_C1_9		E30E186	900	100
NUMERIC		E3_6_SNF_C1_10		E30E186	1000	100
NUMERIC		E3_6_SNF_C1_11		E30E186	1100	100
NUMERIC		E3_6_SNF_C1_12		E30E186	1200	100
NUMERIC		E3_6_SNF_C1_13		E30E186	1300	100
ROLLUP		E3_6_SNF_C1_14		E30E186	1400	100
NUMERIC		E3_6_SNF_C1_15		E30E186	1500	100
NUMERIC		E3_6_SNF_C1_16		E30E186	1600	100
NUMERIC		E3_6_SNF_C1_17		E30E186	1700	100
NUMERIC		E3_6_SNF_C1_18		E30E186	1800	100
NUMERIC		E3_6_SNF_C1_19		E30E186	1900	100
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
	CALCULATION OF DIRECT GME					
	2552-10 WORKSHEET E-4					
						
DATA TYPE	96 FIELD NAME	10 FIELD NAME	FIELD DESCRIPTION 	WKSHT CD	LINE	COLUMN
						
						
NUMERIC		E4_C1_1		E40A180	100	100
NUMERIC		E4_C1_2		E40A180	200	100
NUMERIC		E4_C1_3		E40A180	300	100
NUMERIC		E4_C1_301		E40A180	301	100
NUMERIC		E4_C1_4		E40A180	400	100
NUMERIC		E4_C1_401		E40A180	401	100
NUMERIC		E4_C1_402		E40A180	402	100
NUMERIC		E4_C1_5		E40A180	500	100
NUMERIC		E4_C1_6		E40A180	600	100
NUMERIC		E4_C1_7		E40A180	700	100
NUMERIC		E4_C1_8		E40A180	800	100
NUMERIC		E4_C1_9		E40A180	900	100
NUMERIC		E4_C1_10		E40A180	1000	100
NUMERIC		E4_C1_11		E40A180	1100	100
NUMERIC		E4_C1_12		E40A180	1200	100
NUMERIC		E4_C1_13		E40A180	1300	100
NUMERIC		E4_C1_14		E40A180	1400	100
NUMERIC		E4_C1_15		E40A180	1500	100
NUMERIC		E4_C1_16		E40A180	1600	100
NUMERIC		E4_C1_17		E40A180	1700	100
NUMERIC		E4_C1_18		E40A180	1800	100
NUMERIC		E4_C1_19		E40A180	1900	100
NUMERIC		E4_C1_20		E40A180	2000	100
NUMERIC		E4_C1_21		E40A180	2100	100
NUMERIC		E4_C1_22		E40A180	2200	100
NUMERIC		E4_C1_23		E40A180	2300	100
NUMERIC		E4_C1_24		E40A180	2400	100
NUMERIC		E4_C1_25		E40A180	2500	100
NUMERIC		E4_C1_26		E40A180	2600	100
NUMERIC		E4_C1_27		E40A180	2700	100
NUMERIC		E4_C1_28		E40A180	2800	100
NUMERIC		E4_C1_29		E40A180	2900	100
NUMERIC		E4_C1_30		E40A180	3000	100
NUMERIC		E4_C1_31		E40A180	3100	100
NUMERIC		E4_C1_32		E40A180	3200	100
NUMERIC		E4_C1_33		E40A180	3300	100
NUMERIC		E4_C1_34		E40A180	3400	100
NUMERIC		E4_C1_35		E40A180	3500	100
NUMERIC		E4_C1_36		E40A180	3600	100
NUMERIC		E4_C1_37		E40A180	3700	100
NUMERIC		E4_C1_38		E40A180	3800	100
NUMERIC		E4_C1_39		E40A180	3900	100
NUMERIC		E4_C1_40		E40A180	4000	100
NUMERIC		E4_C1_41		E40A180	4100	100
NUMERIC		E4_C1_42		E40A180	4200	100
NUMERIC		E4_C1_43		E40A180	4300	100
NUMERIC		E4_C1_44		E40A180	4400	100
NUMERIC		E4_C1_45		E40A180	4500	100
NUMERIC		E4_C1_46		E40A180	4600	100
NUMERIC		E4_C1_47		E40A180	4700	100
NUMERIC		E4_C1_48		E40A180	4800	100
NUMERIC		E4_C1_49		E40A180	4900	100
NUMERIC		E4_C1_50		E40A180	5000	100
						
NUMERIC		E4_C2_8		E40A180	800	200
NUMERIC		E4_C2_9		E40A180	900	200
NUMERIC		E4_C2_10		E40A180	1000	200
NUMERIC		E4_C2_11		E40A180	1100	200
NUMERIC		E4_C2_12		E40A180	1200	200
NUMERIC		E4_C2_13		E40A180	1300	200
NUMERIC		E4_C2_14		E40A180	1400	200
NUMERIC		E4_C2_15		E40A180	1500	200
NUMERIC		E4_C2_16		E40A180	1600	200
NUMERIC		E4_C2_17		E40A180	1700	200
NUMERIC		E4_C2_18		E40A180	1800	200
NUMERIC		E4_C2_19		E40A180	1900	200
						
NUMERIC		E4_C2_26		E40A180	2600	200
NUMERIC		E4_C2_27		E40A180	2700	200
NUMERIC		E4_C2_28		E40A180	2800	200
NUMERIC		E4_C2_29		E40A180	2900	200
NUMERIC		E4_C2_30		E40A180	3000	200
						
						
NUMERIC		E4_C3_8		E40A180	800	300
NUMERIC		E4_C3_9		E40A180	900	300
NUMERIC		E4_C3_19		E40A180	1900	300
NUMERIC		E4_C3_20		E40A180	2000	300
NUMERIC		E4_C3_21		E40A180	2100	300
NUMERIC		E4_C3_22		E40A180	2200	300
NUMERIC		E4_C3_23		E40A180	2300	300
NUMERIC		E4_C3_24		E40A180	2400	300
NUMERIC		E4_C3_25		E40A180	2500	300
NUMERIC		E4_C3_31		E40A180	3100	300
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
	BALANCE SHEET					
	2552-10 WORKSHEET G					
						
DATA TYPE	96 FIELD NAME		FIELD DESCRIPTION 	WKSHT CD	LINE	COLUMN
						
ROLLUP		G_C1THRU4_1                   		G000000	100	100
ROLLUP		G_C1THRU4_2                   		G000000	200	100
ROLLUP		G_C1THRU4_3                   		G000000	300	100
ROLLUP		G_C1THRU4_4                   		G000000	400	100
ROLLUP		G_C1THRU4_5                   		G000000	500	100
ROLLUP		G_C1THRU4_6                   		G000000	600	100
ROLLUP		G_C1THRU4_7                   		G000000	700	100
ROLLUP		G_C1THRU4_8                   		G000000	800	100
ROLLUP		G_C1THRU4_9                   		G000000	900	100
ROLLUP		G_C1THRU4_10                  		G000000	1000	100
ROLLUP		G_C1THRU4_11                  		G000000	1100	100
ROLLUP		G_C1THRU4_12                  		G000000	1200	100
ROLLUP		G_C1THRU4_13                  		G000000	1300	100
ROLLUP		G_C1THRU4_14                  		G000000	1400	100
ROLLUP		G_C1THRU4_15                  		G000000	1500	100
ROLLUP		G_C1THRU4_16                  		G000000	1600	100
ROLLUP		G_C1THRU4_17                  		G000000	1700	100
ROLLUP		G_C1THRU4_18                  		G000000	1800	100
ROLLUP		G_C1THRU4_19                  		G000000	1900	100
ROLLUP		G_C1THRU4_20                  		G000000	2000	100
ROLLUP		G_C1THRU4_21                  		G000000	2100	100
ROLLUP		G_C1THRU4_22                  		G000000	2200	100
ROLLUP		G_C1THRU4_23                  		G000000	2300	100
ROLLUP		G_C1THRU4_24                  		G000000	2400	100
ROLLUP		G_C1THRU4_25                  		G000000	2500	100
ROLLUP		G_C1THRU4_26                  		G000000	2600	100
ROLLUP		G_C1THRU4_27                  		G000000	2700	100
ROLLUP		G_C1THRU4_28                  		G000000	2800	100
ROLLUP		G_C1THRU4_29                  		G000000	2900	100
ROLLUP		G_C1THRU4_30                  		G000000	3000	100
ROLLUP		G_C1THRU4_31                  		G000000	3100	100
ROLLUP		G_C1THRU4_32                  		G000000	3200	100
ROLLUP		G_C1THRU4_33                  		G000000	3300	100
ROLLUP		G_C1THRU4_34                  		G000000	3400	100
ROLLUP		G_C1THRU4_35                  		G000000	3500	100
ROLLUP		G_C1THRU4_36                  		G000000	3600	100
ROLLUP		G_C1THRU4_37                  		G000000	3700	100
ROLLUP		G_C1THRU4_38                  		G000000	3800	100
ROLLUP		G_C1THRU4_39                  		G000000	3900	100
ROLLUP		G_C1THRU4_40                  		G000000	4000	100
ROLLUP		G_C1THRU4_41                  		G000000	4100	100
ROLLUP		G_C1THRU4_42                  		G000000	4200	100
ROLLUP		G_C1THRU4_43                  		G000000	4300	100
ROLLUP		G_C1THRU4_44                  		G000000	4400	100
ROLLUP		G_C1THRU4_45                  		G000000	4500	100
ROLLUP		G_C1THRU4_46                  		G000000	4600	100
ROLLUP		G_C1THRU4_47                  		G000000	4700	100
ROLLUP		G_C1THRU4_48                  		G000000	4800	100
ROLLUP		G_C1THRU4_49                  		G000000	4900	100
ROLLUP		G_C1THRU4_50                  		G000000	5000	100
ROLLUP		G_C1THRU4_51                  		G000000	5100	100
ROLLUP		G_C1THRU4_52                  		G000000	5200	100
ROLLUP		G_C1THRU4_53                  		G000000	5300	100
ROLLUP		G_C1THRU4_54                  		G000000	5400	100
ROLLUP		G_C1THRU4_55                  		G000000	5500	100
ROLLUP		G_C1THRU4_56                  		G000000	5600	100
ROLLUP		G_C1THRU4_57                  		G000000	5700	100
ROLLUP		G_C1THRU4_58                  		G000000	5800	100
ROLLUP		G_C1THRU4_59                  		G000000	5900	100
ROLLUP		G_C1THRU4_60                  		G000000	6000	100
						
						
						
						
						
	STATEMENT OF PATIENT REVENUES AND OPERATING EXPENSES					
	2552-10 WORKSHEET G-2					
						
DATA TYPE	96 FIELD NAME	10 FIELD NAME	FIELD DESCRIPTION 	WKSHT CD	LINE	COLUMN
						
						
						
NUMERIC		G2_C1_1		G200000	100	100
NUMERIC		G2_C1_2		G200000	200	100
NUMERIC		G2_C1_3		G200000	300	100
NUMERIC		G2_C1_4		G200000	400	100
NUMERIC		G2_C1_401		G200000	401	100
NUMERIC		G2_C1_5		G200000	500	100
NUMERIC		G2_C1_6		G200000	600	100
NUMERIC		G2_C1_7		G200000	700	100
NUMERIC		G2_C1_8		G200000	800	100
NUMERIC		G2_C1_9		G200000	900	100
NUMERIC		G2_C1_10		G200000	1000	100
ROLLUP		G2_C1_11		G200000	1100	100
ROLLUP		G2_C1_12		G200000	1200	100
ROLLUP		G2_C1_13		G200000	1300	100
ROLLUP		G2_C1_14		G200000	1400	100
ROLLUP		G2_C1_15		G200000	1500	100
NUMERIC		G2_C1_16		G200000	1600	100
NUMERIC		G2_C1_17		G200000	1700	100
NUMERIC		G2_C1_18		G200000	1800	100
NUMERIC		G2_C1_19		G200000	1900	100
ROLLUP		G2_C1_20		G200000	2000	100
ROLLUP		G2_C1_21		G200000	2100	100
ROLLUP		G2_C1_22		G200000	2200	100
NUMERIC		G2_C1_23		G200000	2300	100
ROLLUP		G2_C1_24		G200000	2400	100
NUMERIC		G2_C1_25		G200000	2500	100
ROLLUP		G2_C1_26		G200000	2600	100
ROLLUP		G2_C1_27		G200000	2700	100
NUMERIC		G2_C1_28		G200000	2800	100
						
NUMERIC		G2_C2_18		G200000	1800	200
NUMERIC		G2_C2_19		G200000	1900	200
ROLLUP		G2_C2_20		G200000	2000	200
ROLLUP		G2_C2_21		G200000	2100	200
ROLLUP		G2_C2_22		G200000	2200	200
NUMERIC		G2_C2_23		G200000	2300	200
ROLLUP		G2_C2_24		G200000	2400	200
NUMERIC		G2_C2_25		G200000	2500	200
ROLLUP		G2_C2_26		G200000	2600	200
ROLLUP		G2_C2_27		G200000	2700	200
NUMERIC		G2_C2_28		G200000	2800	200
						
NUMERIC		G2_C1_29		G200000	2900	100
NUMERIC		G2_C1_30		G200000	3000	100
NUMERIC		G2_C1_31		G200000	3100	100
NUMERIC		G2_C1_32		G200000	3200	100
NUMERIC		G2_C1_33		G200000	3300	100
NUMERIC		G2_C1_34		G200000	3400	100
NUMERIC		G2_C1_35		G200000	3500	100
NUMERIC		G2_C1_36		G200000	3600	100
NUMERIC		G2_C1_37		G200000	3700	100
NUMERIC		G2_C1_38		G200000	3800	100
NUMERIC		G2_C1_39		G200000	3900	100
NUMERIC		G2_C1_40		G200000	4000	100
NUMERIC		G2_C1_41		G200000	4100	100
						
NUMERIC		G2_C2_36		G200000	3600	200
NUMERIC		G2_C2_42		G200000	4200	200
NUMERIC		G2_C2_43		G200000	4300	200
						
						
						
						
	STATEMENT OF REVENUES AND EXPENSES					
	2552-10 WORKSHEET G-3					
						
DATA TYPE	96 FIELD NAME	10 FIELD NAME	FIELD DESCRIPTION 	WKSHT CD	LINE	COLUMN
						
						
NUMERIC		G3_C1_1		G300000	100	100
NUMERIC		G3_C1_2		G300000	200	100
NUMERIC		G3_C1_3		G300000	300	100
NUMERIC		G3_C1_4		G300000	400	100
NUMERIC		G3_C1_5		G300000	500	100
NUMERIC		G3_C1_6		G300000	600	100
NUMERIC		G3_C1_7		G300000	700	100
NUMERIC		G3_C1_8		G300000	800	100
NUMERIC		G3_C1_9		G300000	900	100
NUMERIC		G3_C1_10		G300000	1000	100
NUMERIC		G3_C1_11		G300000	1100	100
NUMERIC		G3_C1_12		G300000	1200	100
NUMERIC		G3_C1_13		G300000	1300	100
NUMERIC		G3_C1_14		G300000	1400	100
NUMERIC		G3_C1_15		G300000	1500	100
NUMERIC		G3_C1_16		G300000	1600	100
NUMERIC		G3_C1_17		G300000	1700	100
NUMERIC		G3_C1_18		G300000	1800	100
NUMERIC		G3_C1_19		G300000	1900	100
NUMERIC		G3_C1_20		G300000	2000	100
NUMERIC		G3_C1_21		G300000	2100	100
NUMERIC		G3_C1_22		G300000	2200	100
NUMERIC		G3_C1_23		G300000	2300	100
ROLLUP		G3_C1_24		G300000	2400	100
NUMERIC		G3_C1_25		G300000	2500	100
NUMERIC		G3_C1_26		G300000	2600	100
NUMERIC		G3_C1_27		G300000	2700	100
NUMERIC		G3_C1_28		G300000	2800	100
NUMERIC		G3_C1_29		G300000	2900	100
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
	STATEMENT OF REVENUES AND EXPENSES					
	"2552-10 WORKSHEET H-3, PART I"					
						
DATA TYPE	96 FIELD NAME	10 FIELD NAME	FIELD DESCRIPTION 	WKSHT CD	LINE	COLUMN
						
NUMERIC		H3_1_HHA1_C5_1		H310181	100	500
NUMERIC		H3_1_HHA1_C5_2		H310181	200	500
NUMERIC		H3_1_HHA1_C5_3		H310181	300	500
NUMERIC		H3_1_HHA1_C5_4		H310181	400	500
NUMERIC		H3_1_HHA1_C5_5		H310181	500	500
NUMERIC		H3_1_HHA1_C5_6		H310181	600	500
NUMERIC		H3_1_HHA1_C5_7		H310181	700	500
						
NUMERIC		H3_1_HHA1_C6_1		H310181	100	600
NUMERIC		H3_1_HHA1_C6_2		H310181	200	600
NUMERIC		H3_1_HHA1_C6_3		H310181	300	600
NUMERIC		H3_1_HHA1_C6_4		H310181	400	600
NUMERIC		H3_1_HHA1_C6_5		H310181	500	600
NUMERIC		H3_1_HHA1_C6_6		H310181	600	600
NUMERIC		H3_1_HHA1_C6_7		H310181	700	600
						
						
NUMERIC		H3_1_HHA1_C7_1		H310181	100	700
NUMERIC		H3_1_HHA1_C7_2		H310181	200	700
NUMERIC		H3_1_HHA1_C7_3		H310181	300	700
NUMERIC		H3_1_HHA1_C7_4		H310181	400	700
NUMERIC		H3_1_HHA1_C7_5		H310181	500	700
NUMERIC		H3_1_HHA1_C7_6		H310181	600	700
NUMERIC		H3_1_HHA1_C7_7		H310181	700	700
NUMERIC		H3_1_HHA1_C10_16		H310181	1600	1000
						
NUMERIC		H3_1_HHA2_C5_1		H320181	100	500
NUMERIC		H3_1_HHA2_C5_2		H320181	200	500
NUMERIC		H3_1_HHA2_C5_3		H320181	300	500
NUMERIC		H3_1_HHA2_C5_4		H320181	400	500
NUMERIC		H3_1_HHA2_C5_5		H320181	500	500
NUMERIC		H3_1_HHA2_C5_6		H320181	600	500
NUMERIC		H3_1_HHA2_C5_7		H320181	700	500
						
NUMERIC		H3_1_HHA2_C6_1		H320181	100	600
NUMERIC		H3_1_HHA2_C6_2		H320181	200	600
NUMERIC		H3_1_HHA2_C6_3		H320181	300	600
NUMERIC		H3_1_HHA2_C6_4		H320181	400	600
NUMERIC		H3_1_HHA2_C6_5		H320181	500	600
NUMERIC		H3_1_HHA2_C6_6		H320181	600	600
NUMERIC		H3_1_HHA2_C6_7		H320181	700	600
						
NUMERIC		H3_1_HHA2_C7_1		H320181	100	700
NUMERIC		H3_1_HHA2_C7_2		H320181	200	700
NUMERIC		H3_1_HHA2_C7_3		H320181	300	700
NUMERIC		H3_1_HHA2_C7_4		H320181	400	700
NUMERIC		H3_1_HHA2_C7_5		H320181	500	700
NUMERIC		H3_1_HHA2_C7_6		H320181	600	700
NUMERIC		H3_1_HHA2_C7_7		H320181	700	700
NUMERIC		H3_1_HHA2_C10_16		H320181	1600	1000
						
NUMERIC		H3_1_HHA3_C5_1		H330181	100	500
NUMERIC		H3_1_HHA3_C5_2		H330181	200	500
NUMERIC		H3_1_HHA3_C5_3		H330181	300	500
NUMERIC		H3_1_HHA3_C5_4		H330181	400	500
NUMERIC		H3_1_HHA3_C5_5		H330181	500	500
NUMERIC		H3_1_HHA3_C5_6		H330181	600	500
NUMERIC		H3_1_HHA3_C5_7		H330181	700	500
						
						
						
						
						
						
						
						
						
						
						
						
NUMERIC		H3_1_HHA3_C6_1		H330181	100	600
NUMERIC		H3_1_HHA3_C6_2		H330181	200	600
NUMERIC		H3_1_HHA3_C6_3		H330181	300	600
NUMERIC		H3_1_HHA3_C6_4		H330181	400	600
NUMERIC		H3_1_HHA3_C6_5		H330181	500	600
NUMERIC		H3_1_HHA3_C6_6		H330181	600	600
NUMERIC		H3_1_HHA3_C6_7		H330181	700	600
						
NUMERIC		H3_1_HHA3_C7_1		H330181	100	700
NUMERIC		H3_1_HHA3_C7_2		H330181	200	700
NUMERIC		H3_1_HHA3_C7_3		H330181	300	700
NUMERIC		H3_1_HHA3_C7_4		H330181	400	700
NUMERIC		H3_1_HHA3_C7_5		H330181	500	700
NUMERIC		H3_1_HHA3_C7_6		H330181	600	700
NUMERIC		H3_1_HHA3_C7_7		H330181	700	700
NUMERIC		H3_1_HHA3_C10_16		H330181	1600	1000
						
NUMERIC		H3_1_HHA4_C5_1		H340181	100	500
NUMERIC		H3_1_HHA4_C5_2		H340181	200	500
NUMERIC		H3_1_HHA4_C5_3		H340181	300	500
NUMERIC		H3_1_HHA4_C5_4		H340181	400	500
NUMERIC		H3_1_HHA4_C5_5		H340181	500	500
NUMERIC		H3_1_HHA4_C5_6		H340181	600	500
NUMERIC		H3_1_HHA4_C5_7		H340181	700	500
						
NUMERIC		H3_1_HHA4_C6_1		H340181	100	600
NUMERIC		H3_1_HHA4_C6_2		H340181	200	600
NUMERIC		H3_1_HHA4_C6_3		H340181	300	600
NUMERIC		H3_1_HHA4_C6_4		H340181	400	600
NUMERIC		H3_1_HHA4_C6_5		H340181	500	600
NUMERIC		H3_1_HHA4_C6_6		H340181	600	600
NUMERIC		H3_1_HHA4_C6_7		H340181	700	600
						
NUMERIC		H3_1_HHA4_C7_1		H340181	100	700
NUMERIC		H3_1_HHA4_C7_2		H340181	200	700
NUMERIC		H3_1_HHA4_C7_3		H340181	300	700
NUMERIC		H3_1_HHA4_C7_4		H340181	400	700
NUMERIC		H3_1_HHA4_C7_5		H340181	500	700
NUMERIC		H3_1_HHA4_C7_6		H340181	600	700
NUMERIC		H3_1_HHA4_C7_7		H340181	700	700
NUMERIC		H3_1_HHA4_C10_16		H340181	1600	1000
						
NUMERIC		H3_1_HHA5_C5_1		H350181	100	500
NUMERIC		H3_1_HHA5_C5_2		H350181	200	500
NUMERIC		H3_1_HHA5_C5_3		H350181	300	500
NUMERIC		H3_1_HHA5_C5_4		H350181	400	500
NUMERIC		H3_1_HHA5_C5_5		H350181	500	500
NUMERIC		H3_1_HHA5_C5_6		H350181	600	500
NUMERIC		H3_1_HHA5_C5_7		H350181	700	500
						
NUMERIC		H3_1_HHA5_C6_1		H350181	100	600
NUMERIC		H3_1_HHA5_C6_2		H350181	200	600
NUMERIC		H3_1_HHA5_C6_3		H350181	300	600
NUMERIC		H3_1_HHA5_C6_4		H350181	400	600
NUMERIC		H3_1_HHA5_C6_5		H350181	500	600
NUMERIC		H3_1_HHA5_C6_6		H350181	600	600
NUMERIC		H3_1_HHA5_C6_7		H350181	700	600
						
						
						
						
						
						
						
						
NUMERIC		H3_1_HHA5_C7_1		H350181	100	700
NUMERIC		H3_1_HHA5_C7_2		H350181	200	700
NUMERIC		H3_1_HHA5_C7_3		H350181	300	700
NUMERIC		H3_1_HHA5_C7_4		H350181	400	700
NUMERIC		H3_1_HHA5_C7_5		H350181	500	700
NUMERIC		H3_1_HHA5_C7_6		H350181	600	700
NUMERIC		H3_1_HHA5_C7_7		H350181	700	700
NUMERIC		H3_1_HHA5_C10_16		H350181	1600	1000
						
						
						
						
NUMERIC		H3_1_HHA1_C10_15         		H310181	1500	1000
NUMERIC		H3_1_HHA2_C10_15 		H320181	1500	1000
NUMERIC		H3_1_HHA3_C10_15  		H330181	1500	1000
NUMERIC		H3_1_HHA4_C10_15  		H340181	1500	1000
NUMERIC		H3_1_HHA5_C10_15  		H350181	1500	1000
						
NUMERIC		H3_1_HHA1_C9_15  		H310181	1500	900
NUMERIC		H3_1_HHA2_C9_15 		H320181	1500	900
NUMERIC		H3_1_HHA3_C9_15  		H330181	1500	900
NUMERIC		H3_1_HHA4_C9_15 		H340181	1500	900
NUMERIC		H3_1_HHA5_C9_15  		H350181	1500	900
 						
NUMERIC		H3_1_HHA1_C11_15           		H310181	1500	1100
NUMERIC		H3_1_HHA2_C11_15 		H320181	1500	1100
NUMERIC		H3_1_HHA3_C11_15  		H330181	1500	1100
NUMERIC		H3_1_HHA4_C11_15  		H340181	1500	1100
NUMERIC		H3_1_HHA5_C11_15  		H350181	1500	1100
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
	STATEMENT OF REVENUES AND EXPENSES					
	"2552-10 WORKSHEET H-4, PART II"					
						
DATA TYPE	96 FIELD NAME	10 FIELD NAME	FIELD DESCRIPTION 	WKSHT CD	LINE	COLUMN
						
NUMERIC		H4_2_HHA1_C1_10		H410182	1000	100
NUMERIC		H4_2_HHA1_C1_11		H410182	1100	100
NUMERIC		H4_2_HHA1_C1_12		H410182	1200	100
NUMERIC		H4_2_HHA1_C1_13		H410182	1300	100
NUMERIC		H4_2_HHA1_C1_14		H410182	1400	100
NUMERIC		H4_2_HHA1_C1_15		H410182	1500	100
NUMERIC		H4_2_HHA1_C1_16		H410182	1600	100
NUMERIC		H4_2_HHA1_C1_17		H410182	1700	100
NUMERIC		H4_2_HHA1_C1_18		H410182	1800	100
NUMERIC		H4_2_HHA1_C1_19		H410182	1900	100
NUMERIC		H4_2_HHA1_C1_20		H410182	2000	100
NUMERIC		H4_2_HHA1_C1_21		H410182	2100	100
NUMERIC		H4_2_HHA1_C1_22		H410182	2200	100
NUMERIC		H4_2_HHA1_C1_23		H410182	2300	100
NUMERIC		H4_2_HHA1_C1_24		H410182	2400	100
NUMERIC		H4_2_HHA1_C1_25		H410182	2500	100
NUMERIC		H4_2_HHA1_C1_26		H410182	2600	100
NUMERIC		H4_2_HHA1_C1_27		H410182	2700	100
NUMERIC		H4_2_HHA1_C1_28		H410182	2800	100
NUMERIC		H4_2_HHA1_C1_29		H410182	2900	100
NUMERIC		H4_2_HHA1_C1_30		H410182	3000	100
NUMERIC		H4_2_HHA1_C1_31		H410182	3100	100
NUMERIC		H4_2_HHA1_C1_32		H410182	3200	100
NUMERIC		H4_2_HHA1_C1_33		H410182	3300	100
NUMERIC		H4_2_HHA1_C1_34		H410182	3400	100
NUMERIC		H4_2_HHA1_C1_35		H410182	3500	100
						
NUMERIC		H4_2_HHA1_C2_10		H410182	1000	200
NUMERIC		H4_2_HHA1_C2_11		H410182	1100	200
NUMERIC		H4_2_HHA1_C2_12		H410182	1200	200
NUMERIC		H4_2_HHA1_C2_13		H410182	1300	200
NUMERIC		H4_2_HHA1_C2_14		H410182	1400	200
NUMERIC		H4_2_HHA1_C2_15		H410182	1500	200
NUMERIC		H4_2_HHA1_C2_16		H410182	1600	200
NUMERIC		H4_2_HHA1_C2_17		H410182	1700	200
NUMERIC		H4_2_HHA1_C2_18		H410182	1800	200
NUMERIC		H4_2_HHA1_C2_19		H410182	1900	200
NUMERIC		H4_2_HHA1_C2_20		H410182	2000	200
NUMERIC		H4_2_HHA1_C2_21		H410182	2100	200
NUMERIC		H4_2_HHA1_C2_22		H410182	2200	200
NUMERIC		H4_2_HHA1_C2_23		H410182	2300	200
NUMERIC		H4_2_HHA1_C2_24		H410182	2400	200
NUMERIC		H4_2_HHA1_C2_25		H410182	2500	200
NUMERIC		H4_2_HHA1_C2_26		H410182	2600	200
NUMERIC		H4_2_HHA1_C2_27		H410182	2700	200
NUMERIC		H4_2_HHA1_C2_28		H410182	2800	200
NUMERIC		H4_2_HHA1_C2_29		H410182	2900	200
NUMERIC		H4_2_HHA1_C2_30		H410182	3000	200
NUMERIC		H4_2_HHA1_C2_31		H410182	3100	200
NUMERIC		H4_2_HHA1_C2_32		H410182	3200	200
NUMERIC		H4_2_HHA1_C2_33		H410182	3300	200
NUMERIC		H4_2_HHA1_C2_34		H410182	3400	200
NUMERIC		H4_2_HHA1_C2_35		H410182	3500	200
						
						
						
						
						
						
						
						
						
						
						
						
NUMERIC		H4_2_HHA2_C1_10		H420182	1000	100
NUMERIC		H4_2_HHA2_C1_11		H420182	1100	100
NUMERIC		H4_2_HHA2_C1_12		H420182	1200	100
NUMERIC		H4_2_HHA2_C1_13		H420182	1300	100
NUMERIC		H4_2_HHA2_C1_14		H420182	1400	100
NUMERIC		H4_2_HHA2_C1_15		H420182	1500	100
NUMERIC		H4_2_HHA2_C1_16		H420182	1600	100
NUMERIC		H4_2_HHA2_C1_17		H420182	1700	100
NUMERIC		H4_2_HHA2_C1_18		H420182	1800	100
NUMERIC		H4_2_HHA2_C1_19		H420182	1900	100
NUMERIC		H4_2_HHA2_C1_20		H420182	2000	100
NUMERIC		H4_2_HHA2_C1_21		H420182	2100	100
NUMERIC		H4_2_HHA2_C1_22		H420182	2200	100
NUMERIC		H4_2_HHA2_C1_23		H420182	2300	100
NUMERIC		H4_2_HHA2_C1_24		H420182	2400	100
NUMERIC		H4_2_HHA2_C1_25		H420182	2500	100
NUMERIC		H4_2_HHA2_C1_26		H420182	2600	100
NUMERIC		H4_2_HHA2_C1_27		H420182	2700	100
NUMERIC		H4_2_HHA2_C1_28		H420182	2800	100
NUMERIC		H4_2_HHA2_C1_29		H420182	2900	100
NUMERIC		H4_2_HHA2_C1_30		H420182	3000	100
NUMERIC		H4_2_HHA2_C1_31		H420182	3100	100
NUMERIC		H4_2_HHA2_C1_32		H420182	3200	100
NUMERIC		H4_2_HHA2_C1_33		H420182	3300	100
NUMERIC		H4_2_HHA2_C1_34		H420182	3400	100
NUMERIC		H4_2_HHA2_C1_35		H420182	3500	100
						
NUMERIC		H4_2_HHA2_C2_10		H420182	1000	200
NUMERIC		H4_2_HHA2_C2_11		H420182	1100	200
NUMERIC		H4_2_HHA2_C2_12		H420182	1200	200
NUMERIC		H4_2_HHA2_C2_13		H420182	1300	200
NUMERIC		H4_2_HHA2_C2_14		H420182	1400	200
NUMERIC		H4_2_HHA2_C2_15		H420182	1500	200
NUMERIC		H4_2_HHA2_C2_16		H420182	1600	200
NUMERIC		H4_2_HHA2_C2_17		H420182	1700	200
NUMERIC		H4_2_HHA2_C2_18		H420182	1800	200
NUMERIC		H4_2_HHA2_C2_19		H420182	1900	200
NUMERIC		H4_2_HHA2_C2_20		H420182	2000	200
NUMERIC		H4_2_HHA2_C2_21		H420182	2100	200
NUMERIC		H4_2_HHA2_C2_22		H420182	2200	200
NUMERIC		H4_2_HHA2_C2_23		H420182	2300	200
NUMERIC		H4_2_HHA2_C2_24		H420182	2400	200
NUMERIC		H4_2_HHA2_C2_25		H420182	2500	200
NUMERIC		H4_2_HHA2_C2_26		H420182	2600	200
NUMERIC		H4_2_HHA2_C2_27		H420182	2700	200
NUMERIC		H4_2_HHA2_C2_28		H420182	2800	200
NUMERIC		H4_2_HHA2_C2_29		H420182	2900	200
NUMERIC		H4_2_HHA2_C2_30		H420182	3000	200
NUMERIC		H4_2_HHA2_C2_31		H420182	3100	200
NUMERIC		H4_2_HHA2_C2_32		H420182	3200	200
NUMERIC		H4_2_HHA2_C2_33		H420182	3300	200
NUMERIC		H4_2_HHA2_C2_34		H420182	3400	200
NUMERIC		H4_2_HHA2_C2_35		H420182	3500	200
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
NUMERIC		H4_2_HHA3_C1_10		H430182	1000	100
NUMERIC		H4_2_HHA3_C1_11		H430182	1100	100
NUMERIC		H4_2_HHA3_C1_12		H430182	1200	100
NUMERIC		H4_2_HHA3_C1_13		H430182	1300	100
NUMERIC		H4_2_HHA3_C1_14		H430182	1400	100
NUMERIC		H4_2_HHA3_C1_15		H430182	1500	100
NUMERIC		H4_2_HHA3_C1_16		H430182	1600	100
NUMERIC		H4_2_HHA3_C1_17		H430182	1700	100
NUMERIC		H4_2_HHA3_C1_18		H430182	1800	100
NUMERIC		H4_2_HHA3_C1_19		H430182	1900	100
NUMERIC		H4_2_HHA3_C1_20		H430182	2000	100
NUMERIC		H4_2_HHA3_C1_21		H430182	2100	100
NUMERIC		H4_2_HHA3_C1_22		H430182	2200	100
NUMERIC		H4_2_HHA3_C1_23		H430182	2300	100
NUMERIC		H4_2_HHA3_C1_24		H430182	2400	100
NUMERIC		H4_2_HHA3_C1_25		H430182	2500	100
NUMERIC		H4_2_HHA3_C1_26		H430182	2600	100
NUMERIC		H4_2_HHA3_C1_27		H430182	2700	100
NUMERIC		H4_2_HHA3_C1_28		H430182	2800	100
NUMERIC		H4_2_HHA3_C1_29		H430182	2900	100
NUMERIC		H4_2_HHA3_C1_30		H430182	3000	100
NUMERIC		H4_2_HHA3_C1_31		H430182	3100	100
NUMERIC		H4_2_HHA3_C1_32		H430182	3200	100
NUMERIC		H4_2_HHA3_C1_33		H430182	3300	100
NUMERIC		H4_2_HHA3_C1_34		H430182	3400	100
NUMERIC		H4_2_HHA3_C1_35		H430182	3500	100
						
NUMERIC		H4_2_HHA3_C2_10		H430182	1000	200
NUMERIC		H4_2_HHA3_C2_11		H430182	1100	200
NUMERIC		H4_2_HHA3_C2_12		H430182	1200	200
NUMERIC		H4_2_HHA3_C2_13		H430182	1300	200
NUMERIC		H4_2_HHA3_C2_14		H430182	1400	200
NUMERIC		H4_2_HHA3_C2_15		H430182	1500	200
NUMERIC		H4_2_HHA3_C2_16		H430182	1600	200
NUMERIC		H4_2_HHA3_C2_17		H430182	1700	200
NUMERIC		H4_2_HHA3_C2_18		H430182	1800	200
NUMERIC		H4_2_HHA3_C2_19		H430182	1900	200
NUMERIC		H4_2_HHA3_C2_20		H430182	2000	200
NUMERIC		H4_2_HHA3_C2_21		H430182	2100	200
NUMERIC		H4_2_HHA3_C2_22		H430182	2200	200
NUMERIC		H4_2_HHA3_C2_23		H430182	2300	200
NUMERIC		H4_2_HHA3_C2_24		H430182	2400	200
NUMERIC		H4_2_HHA3_C2_25		H430182	2500	200
NUMERIC		H4_2_HHA3_C2_26		H430182	2600	200
NUMERIC		H4_2_HHA3_C2_27		H430182	2700	200
NUMERIC		H4_2_HHA3_C2_28		H430182	2800	200
NUMERIC		H4_2_HHA3_C2_29		H430182	2900	200
NUMERIC		H4_2_HHA3_C2_30		H430182	3000	200
NUMERIC		H4_2_HHA3_C2_31		H430182	3100	200
NUMERIC		H4_2_HHA3_C2_32		H430182	3200	200
NUMERIC		H4_2_HHA3_C2_33		H430182	3300	200
NUMERIC		H4_2_HHA3_C2_34		H430182	3400	200
NUMERIC		H4_2_HHA3_C2_35		H430182	3500	200
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
NUMERIC		H4_2_HHA4_C1_10		H440182	1000	100
NUMERIC		H4_2_HHA4_C1_11		H440182	1100	100
NUMERIC		H4_2_HHA4_C1_12		H440182	1200	100
NUMERIC		H4_2_HHA4_C1_13		H440182	1300	100
NUMERIC		H4_2_HHA4_C1_14		H440182	1400	100
NUMERIC		H4_2_HHA4_C1_15		H440182	1500	100
NUMERIC		H4_2_HHA4_C1_16		H440182	1600	100
NUMERIC		H4_2_HHA4_C1_17		H440182	1700	100
NUMERIC		H4_2_HHA4_C1_18		H440182	1800	100
NUMERIC		H4_2_HHA4_C1_19		H440182	1900	100
NUMERIC		H4_2_HHA4_C1_20		H440182	2000	100
NUMERIC		H4_2_HHA4_C1_21		H440182	2100	100
NUMERIC		H4_2_HHA4_C1_22		H440182	2200	100
NUMERIC		H4_2_HHA4_C1_23		H440182	2300	100
NUMERIC		H4_2_HHA4_C1_24		H440182	2400	100
NUMERIC		H4_2_HHA4_C1_25		H440182	2500	100
NUMERIC		H4_2_HHA4_C1_26		H440182	2600	100
NUMERIC		H4_2_HHA4_C1_27		H440182	2700	100
NUMERIC		H4_2_HHA4_C1_28		H440182	2800	100
NUMERIC		H4_2_HHA4_C1_29		H440182	2900	100
NUMERIC		H4_2_HHA4_C1_30		H440182	3000	100
NUMERIC		H4_2_HHA4_C1_31		H440182	3100	100
NUMERIC		H4_2_HHA4_C1_32		H440182	3200	100
NUMERIC		H4_2_HHA4_C1_33		H440182	3300	100
NUMERIC		H4_2_HHA4_C1_34		H440182	3400	100
NUMERIC		H4_2_HHA4_C1_35		H440182	3500	100
						
NUMERIC		H4_2_HHA4_C2_10		H440182	1000	200
NUMERIC		H4_2_HHA4_C2_11		H440182	1100	200
NUMERIC		H4_2_HHA4_C2_12		H440182	1200	200
NUMERIC		H4_2_HHA4_C2_13		H440182	1300	200
NUMERIC		H4_2_HHA4_C2_14		H440182	1400	200
NUMERIC		H4_2_HHA4_C2_15		H440182	1500	200
NUMERIC		H4_2_HHA4_C2_16		H440182	1600	200
NUMERIC		H4_2_HHA4_C2_17		H440182	1700	200
NUMERIC		H4_2_HHA4_C2_18		H440182	1800	200
NUMERIC		H4_2_HHA4_C2_19		H440182	1900	200
NUMERIC		H4_2_HHA4_C2_20		H440182	2000	200
NUMERIC		H4_2_HHA4_C2_21		H440182	2100	200
NUMERIC		H4_2_HHA4_C2_22		H440182	2200	200
NUMERIC		H4_2_HHA4_C2_23		H440182	2300	200
NUMERIC		H4_2_HHA4_C2_24		H440182	2400	200
NUMERIC		H4_2_HHA4_C2_25		H440182	2500	200
NUMERIC		H4_2_HHA4_C2_26		H440182	2600	200
NUMERIC		H4_2_HHA4_C2_27		H440182	2700	200
NUMERIC		H4_2_HHA4_C2_28		H440182	2800	200
NUMERIC		H4_2_HHA4_C2_29		H440182	2900	200
NUMERIC		H4_2_HHA4_C2_30		H440182	3000	200
NUMERIC		H4_2_HHA4_C2_31		H440182	3100	200
NUMERIC		H4_2_HHA4_C2_32		H440182	3200	200
NUMERIC		H4_2_HHA4_C2_33		H440182	3300	200
NUMERIC		H4_2_HHA4_C2_34		H440182	3400	200
NUMERIC		H4_2_HHA4_C2_35		H440182	3500	200
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
NUMERIC		H4_2_HHA5_C1_10		H450182	1000	100
NUMERIC		H4_2_HHA5_C1_11		H450182	1100	100
NUMERIC		H4_2_HHA5_C1_12		H450182	1200	100
NUMERIC		H4_2_HHA5_C1_13		H450182	1300	100
NUMERIC		H4_2_HHA5_C1_14		H450182	1400	100
NUMERIC		H4_2_HHA5_C1_15		H450182	1500	100
NUMERIC		H4_2_HHA5_C1_16		H450182	1600	100
NUMERIC		H4_2_HHA5_C1_17		H450182	1700	100
NUMERIC		H4_2_HHA5_C1_18		H450182	1800	100
NUMERIC		H4_2_HHA5_C1_19		H450182	1900	100
NUMERIC		H4_2_HHA5_C1_20		H450182	2000	100
NUMERIC		H4_2_HHA5_C1_21		H450182	2100	100
NUMERIC		H4_2_HHA5_C1_22		H450182	2200	100
NUMERIC		H4_2_HHA5_C1_23		H450182	2300	100
NUMERIC		H4_2_HHA5_C1_24		H450182	2400	100
NUMERIC		H4_2_HHA5_C1_25		H450182	2500	100
NUMERIC		H4_2_HHA5_C1_26		H450182	2600	100
NUMERIC		H4_2_HHA5_C1_27		H450182	2700	100
NUMERIC		H4_2_HHA5_C1_28		H450182	2800	100
NUMERIC		H4_2_HHA5_C1_29		H450182	2900	100
NUMERIC		H4_2_HHA5_C1_30		H450182	3000	100
NUMERIC		H4_2_HHA5_C1_31		H450182	3100	100
NUMERIC		H4_2_HHA5_C1_32		H450182	3200	100
NUMERIC		H4_2_HHA5_C1_33		H450182	3300	100
NUMERIC		H4_2_HHA5_C1_34		H450182	3400	100
NUMERIC		H4_2_HHA5_C1_35		H450182	3500	100
						
NUMERIC		H4_2_HHA5_C2_10		H450182	1000	200
NUMERIC		H4_2_HHA5_C2_11		H450182	1100	200
NUMERIC		H4_2_HHA5_C2_12		H450182	1200	200
NUMERIC		H4_2_HHA5_C2_13		H450182	1300	200
NUMERIC		H4_2_HHA5_C2_14		H450182	1400	200
NUMERIC		H4_2_HHA5_C2_15		H450182	1500	200
NUMERIC		H4_2_HHA5_C2_16		H450182	1600	200
NUMERIC		H4_2_HHA5_C2_17		H450182	1700	200
NUMERIC		H4_2_HHA5_C2_18		H450182	1800	200
NUMERIC		H4_2_HHA5_C2_19		H450182	1900	200
NUMERIC		H4_2_HHA5_C2_20		H450182	2000	200
NUMERIC		H4_2_HHA5_C2_21		H450182	2100	200
NUMERIC		H4_2_HHA5_C2_22		H450182	2200	200
NUMERIC		H4_2_HHA5_C2_23		H450182	2300	200
NUMERIC		H4_2_HHA5_C2_24		H450182	2400	200
NUMERIC		H4_2_HHA5_C2_25		H450182	2500	200
NUMERIC		H4_2_HHA5_C2_26		H450182	2600	200
NUMERIC		H4_2_HHA5_C2_27		H450182	2700	200
NUMERIC		H4_2_HHA5_C2_28		H450182	2800	200
NUMERIC		H4_2_HHA5_C2_29		H450182	2900	200
NUMERIC		H4_2_HHA5_C2_30		H450182	3000	200
NUMERIC		H4_2_HHA5_C2_31		H450182	3100	200
NUMERIC		H4_2_HHA5_C2_32		H450182	3200	200
NUMERIC		H4_2_HHA5_C2_33		H450182	3300	200
NUMERIC		H4_2_HHA5_C2_34		H450182	3400	200
NUMERIC		H4_2_HHA5_C2_35		H450182	3500	200
						
						
						
NUMERIC		L_1_HOS_C1_1		L00A181	100	100
NUMERIC		L_1_HOS_C1_2		L00A181	200	100
NUMERIC		L_1_HOS_C1_3		L00A181	300	100
NUMERIC		L_1_HOS_C1_4		L00A181	400	100
NUMERIC		L_1_HOS_C1_5		L00A181	500	100
NUMERIC		L_1_HOS_C1_6		L00A181	600	100
NUMERIC		L_1_HOS_C1_7		L00A181	700	100
NUMERIC		L_1_HOS_C1_8		L00A181	800	100
NUMERIC		L_1_HOS_C1_9		L00A181	900	100
NUMERIC		L_1_HOS_C1_10		L00A181	1000	100
NUMERIC		L_1_HOS_C1_11		L00A181	1100	100
						
NUMERIC		L_2_HOS_C1_1		L00A182	100	100
NUMERIC		L_2_HOS_C1_2		L00A182	200	100
NUMERIC		L_2_HOS_C1_3		L00A182	300	100
NUMERIC		L_2_HOS_C1_4		L00A182	400	100
NUMERIC		L_2_HOS_C1_5		L00A182	500	100
						
NUMERIC		L_3_HOS_C1_1		L00A183	100	100
NUMERIC		L_3_HOS_C1_2		L00A183	200	100
NUMERIC		L_3_HOS_C1_3		L00A183	300	100
NUMERIC		L_3_HOS_C1_4		L00A183	400	100
NUMERIC		L_3_HOS_C1_5		L00A183	500	100
NUMERIC		L_3_HOS_C1_6		L00A183	600	100
NUMERIC		L_3_HOS_C1_7		L00A183	700	100
NUMERIC		L_3_HOS_C1_8		L00A183	800	100
NUMERIC		L_3_HOS_C1_9		L00A183	900	100
NUMERIC		L_3_HOS_C1_10		L00A183	1000	100
NUMERIC		L_3_HOS_C1_11		L00A183	1100	100
NUMERIC		L_3_HOS_C1_12		L00A183	1200	100
NUMERIC		L_3_HOS_C1_13		L00A183	1300	100
NUMERIC		L_3_HOS_C1_14		L00A183	1400	100
NUMERIC		L_3_HOS_C1_15		L00A183	1500	100
NUMERIC		L_3_HOS_C1_16		L00A183	1600	100
NUMERIC		L_3_HOS_C1_17		L00A183	1700	100
