Official Federal Forms > Centers For Medicare And Medicaid Services
Inpatient Rehabilitation Facility-Patient Assessment Instrument CMS-10036 - Official Federal Forms
| Inpatient Rehabilitation Facility-Patient Assessment Instrument Form. This is a national form and can be used in Centers For Medicare And Medicaid Services . |
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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) American LegalNet, Inc. www.USCourtForms.com 1 DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES INPATIENT REHABILITATION FACILITY PATIENT ASSESSMENT INSTRUMENT Form CMS-10036 (01/06) American LegalNet, Inc. www.USCourtForms.com 2 DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES INPATIENT REHABILITATION FACILITY PATIENT ASSESSMENT INSTRUMENT Form CMS-10036 (01/06) American LegalNet, Inc. www.USCourtForms.com 3
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