Outpatient Rehabilitation Cost Report and Supporting Regulations in 42 CFR 413.20 and 413.24

03-01 FORM CMS-2088-92 1890

EXHIBIT 1 - Form CMS-2088-92

The following is a listing of the Form CMS-2088-92 worksheets and the page number location.

Worksheets Page(s)

W kst. S, Parts I-III 18-303

Wkst. S, Part IV 18-304

Wkst. S-1 18-305

Wkst. A 18-306 - 18-307

Wkst. A-1 18-308

Wkst. A-3 18-309

Wkst. A-3-1 18-310

Wkst. B 18-311 - 18-313

Wkst. B-1 18-314 - 18-316

W kst. C 18-317 - 18-318

W kst. D 18-319

Wkst. G 18-320

Wkst. A-8-2 18-321

Wkst. A-8-3, Parts I-III 18-322

Wkst. A-8-3, Parts IV-VI 18-323

Wkst. A-8-4, Parts I & II 18-324

Wkst. A-8-4, Parts III-V 18-325

Wkst. A-8-5, Parts I & II 18-326

Wkst. A-8-5, Parts III & IV 18-327

Wkst. A-8-5, Parts V & VI 18-328

Rev. 4

18-301