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07-99
ICR 201107-0938-006 · OMB 0938-0463 · Object 26209201.
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Document Metadata
| File Type | application/msword |
|---|---|
| File Title | 07-99 |
| Author | * |
| Last Modified By | Writer |
| File Modified | 2011-07-14 |
| File Created | 2026-11-15 |
| Conversion State | complete |
Extracted Text
CROSSWALK SECTION 4195
ELECTRONIC REPORTING SPECIFICATIONS FOR FORM CMS-2540-10
(1) Text regarding “S-3, Part V” added to Table 2 - Worksheet Indicators
Worksheets That Apply to the SNF Cost Report
Worksheet
Worksheet Indicator -
S-3, Part V
S300005
(2) Text regarding “WORKSHEET S-3, PART V” added to Table 3 - List of Data Elements with Worksheet, Line, and Column Designations
WORKSHEET S-3, PART V
LINE(S)
COLUMN(S)
FIELD
SIZE
USAGE
Registered Nurses (RN)
1
1-3
9
9
Licenses Practical Nurses (LPN)
2
1-3
9
9
Nursing Assistants/Aids
3
1-3
9
9
Physical Therapists
4
1-3
9
9
Physical Therapy Assistants
5
1-3
9
9
Physical Therapy Aids
6
1-3
9
9
Occupational Therapists
7
1-3
9
9
Occupational Therapy Assistants
8
1-3
9
9
Occupational Therapy Aids
9
1-3
9
9
Speech Therapists
10
1-3
9
9
Respiratory Therapists
11
1-3
9
9
Other Medical Staff
12
1-3
9
9
Registered Nurses (RN)
13
1
9
9
Licenses Practical Nurses (LPN)
14
1
9
9
Nursing Assistants/Aids
15
1
9
9
Physical Therapists
16
1
9
9
Physical Therapy Assistants
17
1
9
9
Physical Therapy Aids
18
1
9
9
Occupational Therapists
19
1
9
9
Occupational Therapy Assistants
20
1
9
9
Occupational Therapy Aids
21
1
9
9
Speech Therapists
22
1
9
9
Respiratory Therapists
23
1
9
9
Other Medical Staff
24
1
9
9
(3) Text regarding Worksheet S-3 revised to include Part “V” in Table 3C ‑ Lines That Cannot be Subscripted (Beyond Those Preprinted)
Worksheet
Lines
S-3, Parts II III IV&V
All