Worksheet S-3 Part I
- Return to Cost Report Summary
- Form S301
- INSTRUCTIONS AS PUBLISHED IN CMS PUB. 15-II, , REV
DRUMRIGHT NURSING HOME
DRUMRIGHT, OK 74030
DRUMRIGHT, OK 74030
Medicare Provider Number: 375466
Cost report status: As Submitted
[Record Code 1356481 - 2010]
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SKILLED NURSING FACILITY AND SKILLED NURSING FACILITY HEALTH CARE COMPLEX STATISTICAL DATA | Provider CCN: 375466 | PERIOD: FROM 01/01/2022 TO 12/31/2022 |
WORKSHEET S-3 PART I | ||||||||||||||||||||||
PART I - STATISTICAL DATA | |||||||||||||||||||||||||
Component | Number of Beds | Bed Days Available | Inpatient Days / Visits | Discharges | Average Length of Stay | Admissions | Full Time Equivalent | ||||||||||||||||||
Title V | Title XVIII | Title XIX | Other | Total | Title V | Title XVIII | Title XIX | Other | Total | Title V | Title XVIII | Title XIX | Total | Title V | Title XVIII | Title XIX | Other | Total | Employees on Payroll | Nonpaid Workers | |||||
1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 | 11 | 12 | 13 | 14 | 15 | 16 | 17 | 18 | 19 | 20 | 21 | 22 | 23 | |||
1 | Skilled Nursing Facility | ### | ### | ### | ### | ### | ### | ### | ### | ### | ### | ### | ### | ### | ### | ### | ### | ### | ### | 1 | |||||
2 | Nursing Facility | 2 | |||||||||||||||||||||||
3 | ICF/IID | 3 | |||||||||||||||||||||||
4 | Home Health Agency | 4 | |||||||||||||||||||||||
5 | Other Long Term Care | 5 | |||||||||||||||||||||||
6 | SNF-Based CMHC | 6 | |||||||||||||||||||||||
7 | Hospice | 7 | |||||||||||||||||||||||
8 | Total (sum of lines 1-7) | ### | ### | ### | ### | ### | ### | ### | ### | ### | ### | ### | ### | ### | ### | ### | ### | ### | ### | 8 | |||||
FORM CMS-2540-10 (08/2016) (INSTRUCTIONS FOR THIS WORKSHEET ARE PUBLISHED IN CMS PUB. 15-2, SECTION 4105) | |||||||||||||||||||||||||
Rev. 7 | 41-307 |