Inpatient Rehabilitation Facility-Patient Assessment Instrument
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Inpatient Rehabilitation Facility-Patient Assessment Instrument Form. This is a Official Federal Forms form and can be use 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
