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DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES

Form Approved OMB No. 0938-0842

INPATIENT REHABILITATION FACILITY – PATIENT ASSESSMENT INSTRUMENT

Form CMS-10036 (01/06)

1


DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES

INPATIENT REHABILITATION FACILITY – PATIENT ASSESSMENT INSTRUMENT

Form CMS-10036 (01/06)

2


DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES

INPATIENT REHABILITATION FACILITY – PATIENT ASSESSMENT INSTRUMENT

Form CMS-10036 (01/06)

3


CMS10036