Appendix 9998. FORMS (12VAC5-216)


Latest version.
  • Hospital Historical Filing, 03-01 (rev. 4/30/96).

    Indicator Definitions – Acute Care Hospitals (rev. 10/15/96).

    Special Services Utilization Calculations

    Ambulatory Surgical Hospital Historical Filing, 03-02 (rev. 4/30/96).

    Indicator Definitions – Ambulatory Surgery Hospitals (rev. 10/15/96).

    Nursing Home Historical Filing, 03-03 (rev. 4/30/96).

    Indicator Definitions – Nursing Homes (rev. 10/15/96).

    Psychiatric Hospital Historical Filing, 03-05 (rev. 4/30/96).

    Indicator Definitions – Psychiatric Hospitals (rev. 10/15/96).

    Rehabilitation Hospital Historical Filing, 03-06 (rev. 4/30/96).

    Indicator Definitions – Rehabilitation Hospitals (rev. 10/15/96).

    Income Statement Reconciliation Worksheet, 04-04 (rev. 4/30/96).