"Supplementary Exhibit 3A.  Beneficiaries Attributed to Your TIN for the Cost Measures (excluding MSPB) and Claims-Based Quality Outcome Measures: Hospital Admissions for Any Cause


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"Supplementary Exhibit 3 provides details about each beneficiarys hospitalizations in 2014, for those beneficiaries attributed to your TIN based on the two-step attribution rule."																
																
																
Attributed Beneficiaries Admitted to the Hospital				Characteristics of Hospital Admission										Discharge Disposition		
HIC	Gender	DOB	 Index	Date of Admission	"Admitting Hospital
(Name, CCN, City, State)"				"Principal Diagnosis
(Code, Description)"		Admission Via the ED	ACSC Admission	Followed by Unplanned All-Cause Readmission within 30 Days of Discharge	Date of Discharge	"Discharge Status
(Code, Description)"	
#	F	04/01/1939	#	06/12/14	Name 	CMS Certification Number	City 	State	481	Pneumococcal Pneumonia	X	PNEU	?	06/19/14	3	Disch to SNF
-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-
																
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