Worksheet S-3, Part I
- Return to Cost Report Summary
- Form S301
- INSTRUCTIONS AS PUBLISHED IN CMS PUB. 15-II, 3509, REV 16
HILLCREST LIVING CENTER
MOORE, OK 73160-
MOORE, OK 73160-
Medicare Provider Number: 375331
Cost report status: Settled Without Audit
[Record Code 192550 - 1996]
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SKILLED NURSING FACILITY AND SKILLED NURSING FACILITY HEALTH CARE COMPLEX STATISTICAL DATA | PROVIDER NO: 375331 |
PERIOD: FROM 01/01/2003 TO 12/31/2003 |
WORKSHEET S-3 Part I |
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Component | Number of Beds |
Bed Days Available |
Inpatient Days | Discharges | Average Length of Stay | Admissions | Full Time Equivalent |
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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 |
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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 | 2 | ||||||||||||||||||||||||
3 | Nursing Facility | 3 | |||||||||||||||||||||||
3.01 | ICF/MR | 3.01 | |||||||||||||||||||||||
4 | Other Long Term Care | 4 | |||||||||||||||||||||||
5 | Home Health Agency | 5 | |||||||||||||||||||||||
6 | 6 | ||||||||||||||||||||||||
7 | SNF-Based Outpatient Rehabilitation Providers | 7 | |||||||||||||||||||||||
8 | Hospice | 8 | |||||||||||||||||||||||
9 | Total (Sum of lines 1-8) | ### | ### | ### | ### | ### | ### | ### | ### | ### | ### | ### | ### | ### | ### | ### | ### | ### | ### | 9 | |||||
10 | Ambulance Trips | 10 |