Hospitals must use this form only for submitting data for the 2010 Occupational Mix survey. For complete instructions on how to fill out the survey please see the tab titled Form CMS-10079 Instructions							Registered Nurses (RNs)			Licensed Practical Nurses (LPNs) and Surgical Technologists (ST)			"Nursing Aides, Orderlies, & Attendants"			Medical Assistants			Total Nursing			All Other Occupations				Total (Nursing and All Other)	
																											
Provider Number:              (Must be Six Digits- NO DASHES)	Edit Check for Provider Number	Provider Contact Name:	Provider Contact Phone Number:	Reporting Period (From Date): (Must Be Filled Out In The Following Format: MM/DD/YY)	Reporting Period (To Date): (Must Be Filled Out In The Following Format: MM/DD/YY)	Edit Check for Date Range	Paid Salaries Total RNs	Paid Hours Total RNs	Average Hourly Wage (Salaries/Hours) Total RNs	Paid Salaries Total LPNs and STs	Paid Hours Total LPNs and STs	Average Hourly Wage (Salaries/Hours) Total LPNs and STs	"Paid Salaries      Nursing Aides, Orderlies, & Attendants"	"Paid Hours         Nursing Aides, Orderlies, & Attendants"	"Average Hourly Wage (Salaries/Hours) Nursing Aides, Orderlies, & Attendants"	Paid Salaries Medical Assistants	Paid Hours Medical Assistants	Average Hourly Wage (Salaries/Hours) Medical Assistants	Paid Salaries Total Nursing	Paid Hours Total Nursing	Average Hourly Wage (Salaries/Hours) Total Nursing	Paid Salaries All Other Occupations	Paid Hours      All Other Occupations	Average Hourly Wage (Salaries/Hours) All Other Occupations	Paid Salaries         Total (Nursing and All Other)	Paid Hours          Total (Nursing and All Other)	Average Hourly Wage (Salaries/Hours) Total (Nursing and All Other)
							0	0	YOU MUST FILL OUT RN SALARIES AND RN HOURS IN ORDER TO COMPLETE THIS SURVEY	0	0	0.00	0	0	0.00	0	0	0.00	0	0	YOU MUST FILL OUT RN SALARIES AND RN HOURS (COLUMNS H AND I) IN ORDER TO COMPLETE THIS SURVEY	0	0	YOU MUST FILL OUT ALL OTHER SALARIES AND ALL OTHER HOURS IN ORDER TO COMPLETE THIS SURVEY	0	0	THE SURVEY IS INCOMPLETE AS SALARIES OR HOURS FOR NURSING AND ALL OTHER OCCUPATIONS ARE MISSING
							0	0	YOU MUST FILL OUT RN SALARIES AND RN HOURS IN ORDER TO COMPLETE THIS SURVEY	0	0	0.00	0	0	0.00	0	0	0.00	0	0	YOU MUST FILL OUT RN SALARIES AND RN HOURS (COLUMNS H AND I) IN ORDER TO COMPLETE THIS SURVEY	0	0	YOU MUST FILL OUT ALL OTHER SALARIES AND ALL OTHER HOURS IN ORDER TO COMPLETE THIS SURVEY	0	0	THE SURVEY IS INCOMPLETE AS SALARIES OR HOURS FOR NURSING AND ALL OTHER OCCUPATIONS ARE MISSING
							0	0	YOU MUST FILL OUT RN SALARIES AND RN HOURS IN ORDER TO COMPLETE THIS SURVEY	0	0	0.00	0	0	0.00	0	0	0.00	0	0	YOU MUST FILL OUT RN SALARIES AND RN HOURS (COLUMNS H AND I) IN ORDER TO COMPLETE THIS SURVEY	0	0	YOU MUST FILL OUT ALL OTHER SALARIES AND ALL OTHER HOURS IN ORDER TO COMPLETE THIS SURVEY	0	0	THE SURVEY IS INCOMPLETE AS SALARIES OR HOURS FOR NURSING AND ALL OTHER OCCUPATIONS ARE MISSING
							0	0	YOU MUST FILL OUT RN SALARIES AND RN HOURS IN ORDER TO COMPLETE THIS SURVEY	0	0	0.00	0	0	0.00	0	0	0.00	0	0	YOU MUST FILL OUT RN SALARIES AND RN HOURS (COLUMNS H AND I) IN ORDER TO COMPLETE THIS SURVEY	0	0	YOU MUST FILL OUT ALL OTHER SALARIES AND ALL OTHER HOURS IN ORDER TO COMPLETE THIS SURVEY	0	0	THE SURVEY IS INCOMPLETE AS SALARIES OR HOURS FOR NURSING AND ALL OTHER OCCUPATIONS ARE MISSING
							0	0	YOU MUST FILL OUT RN SALARIES AND RN HOURS IN ORDER TO COMPLETE THIS SURVEY	0	0	0.00	0	0	0.00	0	0	0.00	0	0	YOU MUST FILL OUT RN SALARIES AND RN HOURS (COLUMNS H AND I) IN ORDER TO COMPLETE THIS SURVEY	0	0	YOU MUST FILL OUT ALL OTHER SALARIES AND ALL OTHER HOURS IN ORDER TO COMPLETE THIS SURVEY	0	0	THE SURVEY IS INCOMPLETE AS SALARIES OR HOURS FOR NURSING AND ALL OTHER OCCUPATIONS ARE MISSING
							0	0	YOU MUST FILL OUT RN SALARIES AND RN HOURS IN ORDER TO COMPLETE THIS SURVEY	0	0	0.00	0	0	0.00	0	0	0.00	0	0	YOU MUST FILL OUT RN SALARIES AND RN HOURS (COLUMNS H AND I) IN ORDER TO COMPLETE THIS SURVEY	0	0	YOU MUST FILL OUT ALL OTHER SALARIES AND ALL OTHER HOURS IN ORDER TO COMPLETE THIS SURVEY	0	0	THE SURVEY IS INCOMPLETE AS SALARIES OR HOURS FOR NURSING AND ALL OTHER OCCUPATIONS ARE MISSING
							0	0	YOU MUST FILL OUT RN SALARIES AND RN HOURS IN ORDER TO COMPLETE THIS SURVEY	0	0	0.00	0	0	0.00	0	0	0.00	0	0	YOU MUST FILL OUT RN SALARIES AND RN HOURS (COLUMNS H AND I) IN ORDER TO COMPLETE THIS SURVEY	0	0	YOU MUST FILL OUT ALL OTHER SALARIES AND ALL OTHER HOURS IN ORDER TO COMPLETE THIS SURVEY	0	0	THE SURVEY IS INCOMPLETE AS SALARIES OR HOURS FOR NURSING AND ALL OTHER OCCUPATIONS ARE MISSING
							0	0	YOU MUST FILL OUT RN SALARIES AND RN HOURS IN ORDER TO COMPLETE THIS SURVEY	0	0	0.00	0	0	0.00	0	0	0.00	0	0	YOU MUST FILL OUT RN SALARIES AND RN HOURS (COLUMNS H AND I) IN ORDER TO COMPLETE THIS SURVEY	0	0	YOU MUST FILL OUT ALL OTHER SALARIES AND ALL OTHER HOURS IN ORDER TO COMPLETE THIS SURVEY			THE SURVEY IS INCOMPLETE AS SALARIES OR HOURS FOR NURSING AND ALL OTHER OCCUPATIONS ARE MISSING
							0	0	YOU MUST FILL OUT RN SALARIES AND RN HOURS IN ORDER TO COMPLETE THIS SURVEY	0	0	0.00	0	0	0.00	0	0	0.00	0	0	YOU MUST FILL OUT RN SALARIES AND RN HOURS (COLUMNS H AND I) IN ORDER TO COMPLETE THIS SURVEY	0	0	YOU MUST FILL OUT ALL OTHER SALARIES AND ALL OTHER HOURS IN ORDER TO COMPLETE THIS SURVEY			THE SURVEY IS INCOMPLETE AS SALARIES OR HOURS FOR NURSING AND ALL OTHER OCCUPATIONS ARE MISSING
							0	0	YOU MUST FILL OUT RN SALARIES AND RN HOURS IN ORDER TO COMPLETE THIS SURVEY	0	0	0.00	0	0	0.00	0	0	0.00	0	0	YOU MUST FILL OUT RN SALARIES AND RN HOURS (COLUMNS H AND I) IN ORDER TO COMPLETE THIS SURVEY	0	0	YOU MUST FILL OUT ALL OTHER SALARIES AND ALL OTHER HOURS IN ORDER TO COMPLETE THIS SURVEY			THE SURVEY IS INCOMPLETE AS SALARIES OR HOURS FOR NURSING AND ALL OTHER OCCUPATIONS ARE MISSING
							0	0	YOU MUST FILL OUT RN SALARIES AND RN HOURS IN ORDER TO COMPLETE THIS SURVEY	0	0	0.00	0	0	0.00	0	0	0.00	0	0	YOU MUST FILL OUT RN SALARIES AND RN HOURS (COLUMNS H AND I) IN ORDER TO COMPLETE THIS SURVEY	0	0	YOU MUST FILL OUT ALL OTHER SALARIES AND ALL OTHER HOURS IN ORDER TO COMPLETE THIS SURVEY			THE SURVEY IS INCOMPLETE AS SALARIES OR HOURS FOR NURSING AND ALL OTHER OCCUPATIONS ARE MISSING
							0	0	YOU MUST FILL OUT RN SALARIES AND RN HOURS IN ORDER TO COMPLETE THIS SURVEY	0	0	0.00	0	0	0.00	0	0	0.00	0	0	YOU MUST FILL OUT RN SALARIES AND RN HOURS (COLUMNS H AND I) IN ORDER TO COMPLETE THIS SURVEY	0	0	YOU MUST FILL OUT ALL OTHER SALARIES AND ALL OTHER HOURS IN ORDER TO COMPLETE THIS SURVEY			THE SURVEY IS INCOMPLETE AS SALARIES OR HOURS FOR NURSING AND ALL OTHER OCCUPATIONS ARE MISSING
							0	0	YOU MUST FILL OUT RN SALARIES AND RN HOURS IN ORDER TO COMPLETE THIS SURVEY	0	0	0.00	0	0	0.00	0	0	0.00	0	0	YOU MUST FILL OUT RN SALARIES AND RN HOURS (COLUMNS H AND I) IN ORDER TO COMPLETE THIS SURVEY	0	0	YOU MUST FILL OUT ALL OTHER SALARIES AND ALL OTHER HOURS IN ORDER TO COMPLETE THIS SURVEY			THE SURVEY IS INCOMPLETE AS SALARIES OR HOURS FOR NURSING AND ALL OTHER OCCUPATIONS ARE MISSING
							0	0	YOU MUST FILL OUT RN SALARIES AND RN HOURS IN ORDER TO COMPLETE THIS SURVEY	0	0	0.00	0	0	0.00	0	0	0.00	0	0	YOU MUST FILL OUT RN SALARIES AND RN HOURS (COLUMNS H AND I) IN ORDER TO COMPLETE THIS SURVEY	0	0	YOU MUST FILL OUT ALL OTHER SALARIES AND ALL OTHER HOURS IN ORDER TO COMPLETE THIS SURVEY			THE SURVEY IS INCOMPLETE AS SALARIES OR HOURS FOR NURSING AND ALL OTHER OCCUPATIONS ARE MISSING
							0	0	YOU MUST FILL OUT RN SALARIES AND RN HOURS IN ORDER TO COMPLETE THIS SURVEY	0	0	0.00	0	0	0.00	0	0	0.00	0	0	YOU MUST FILL OUT RN SALARIES AND RN HOURS (COLUMNS H AND I) IN ORDER TO COMPLETE THIS SURVEY	0	0	YOU MUST FILL OUT ALL OTHER SALARIES AND ALL OTHER HOURS IN ORDER TO COMPLETE THIS SURVEY			THE SURVEY IS INCOMPLETE AS SALARIES OR HOURS FOR NURSING AND ALL OTHER OCCUPATIONS ARE MISSING
							0	0	YOU MUST FILL OUT RN SALARIES AND RN HOURS IN ORDER TO COMPLETE THIS SURVEY	0	0	0.00	0	0	0.00	0	0	0.00	0	0	YOU MUST FILL OUT RN SALARIES AND RN HOURS (COLUMNS H AND I) IN ORDER TO COMPLETE THIS SURVEY	0	0	YOU MUST FILL OUT ALL OTHER SALARIES AND ALL OTHER HOURS IN ORDER TO COMPLETE THIS SURVEY			THE SURVEY IS INCOMPLETE AS SALARIES OR HOURS FOR NURSING AND ALL OTHER OCCUPATIONS ARE MISSING
							0	0	YOU MUST FILL OUT RN SALARIES AND RN HOURS IN ORDER TO COMPLETE THIS SURVEY	0	0	0.00	0	0	0.00	0	0	0.00	0	0	YOU MUST FILL OUT RN SALARIES AND RN HOURS (COLUMNS H AND I) IN ORDER TO COMPLETE THIS SURVEY	0	0	YOU MUST FILL OUT ALL OTHER SALARIES AND ALL OTHER HOURS IN ORDER TO COMPLETE THIS SURVEY			THE SURVEY IS INCOMPLETE AS SALARIES OR HOURS FOR NURSING AND ALL OTHER OCCUPATIONS ARE MISSING
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
																											
