Inpatient Rehabilitation Facility-Patient Assessment Instrument {CMS-10036} | Pdf Fpdf Doc Docx | Official Federal Forms

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Inpatient Rehabilitation Facility-Patient Assessment Instrument {CMS-10036} | Pdf Fpdf Doc Docx | Official Federal Forms

Inpatient Rehabilitation Facility-Patient Assessment Instrument {CMS-10036}

This is a Official Federal Forms form that can be used for Centers For Medicare And Medicaid Services.

Alternate TextLast updated: 5/2/2006

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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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