06-01 FORM HCFA-1728-94 3290
EXHIBIT 1 - FORM CMS-1728-94
The following is a listing of the FORM CMS-1728-94 worksheets and the page number location.
Worksheets Page(s)
Wkst. S, Parts I & II 32-303
Wkst. S-2 32-304
Wkst. S-3, Parts I-III 32-305
Wkst. S-3, Part IV 32-305.1
Wkst. S-4 32-305.2
Wkst. S-5 32-306
Wkst. S-6 Parts I & II 32-307
Wkst. A 32-308
Wkst. A-1 32-309
Wkst. A-2 32-310
Wkst. A-3 32-311
Wkst. A-4 32-312
Wkst. A-5 32-313
Wkst. A-6 32-314
Wkst. A-7 32-315
Wkst. A-8-3, Parts I-III 32-316
Wkst. A-8-3, Parts IV & V 32-317
Wkst. B 32-318
Wkst. B-1 32-319
Wkst. C, Parts I & II 32-320
Wkst. C, Parts III, IV & V 32-321
Wkst. D 32-322
Wkst. D-1 32-323
Wkst. F 32-324
Wkst. F-1 32-325
Wkst. F-2 32-326
Wkst. J-1, Parts I & II 32-327
Wkst. J-1, Part III 32-328
Wkst. J-2 32-329
Wkst. J-3 32-330
Wkst. J-4 32-331
Wkst. K 32-331.1
Wkst. K-1 32-331.2
Wkst. K-2 32-331.3
Wkst. K-3 32-331.4
Wkst. K-4, Part I 32-331.5
Wkst. K-4, Part II 32-331.6
Wkst. K-5, Part I 32-331.7
Wkst. K-5, Part II 32-331.8
Wkst. K-5, Part III 32-331.9
Wkst. K-6 32-331.10
Wkst. CM-1, Parts I & II 32-332
Wkst. CM-1, Part III 32-333
Wkst. CM-2 32-334
Wkst. CM-3 32-335
Wkst. CM-4 32-336
Wkst. RH-1, Parts I & II 32-337
Wkst. RH-1, Part III 32-338
Rev. 10 32-301
3290 (Cont.) FORM HCFA-1728-94 06-01
Worksheets Page(s)
Wkst. RH-2 32-339
Wkst. FQ-1, Parts I & II 32-340
Wkst. FQ-1, Part III 32-341
Wkst. FQ-2 32-342
Wkst. RF-1 32-343
Wkst. RF-2 32-344
Wkst. RF-3 32-345
Wkst. RF-4 (Do not complete. See instructions.) 32-346
Wkst. RF-5 32-347
32-302 Rev. 10
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| File Title | 03-97 |
| File Modified | 0000-00-00 |
| File Created | 2021-02-02 |