Dow, John Reason for Assessment:Start of Care

Clincal Answers
M0230=       599
M0250 Box 4
M0390 Box 1
M0420  2
M0460   
M0476   
M0488   
M0490  2
M0530  2
M0540  0
M0550  Box 0
M0610  Box 1
Functional Answers
M0650  Box 2
M0660  Box 2
M0670  Box 3
M0680  Box 1
M0690  Box 1
M0700  Box 1
Utilization Answers
M0170  Box NA
CS=         29    FS=        21    SU=         1
MSA =       7160
HHRG Grouper C3F2S0
Wage Index:0.93980000
PPS rate = $   2242.77


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Clinton, Bill Reason for Assessment:Start of Care

Clincal Answers
M0230=       879
M0250 Box 4
M0390 Box 0
M0420  0
M0460   
M0476   
M0488   
M0490  1
M0530  2
M0540  0
M0550  Box 0
Functional Answers
M0650  Box 0
M0660  Box 0
M0670  Box 2
M0680  Box 0
M0690  Box 0
M0700  Box 0
Utilization Answers
M0170  Box NA
CS=          8    FS=         8    SU=         1
MSA =       7160
HHRG Grouper C1F1S0
Wage Index:0.93980000
PPS rate = $   1334.01


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Barymore, Mike Reason for Assessment:Start of Care

Clincal Answers
M0230=       820    Orthopedic
M0250 Box 4
M0390 Box 1
M0420  2
M0460   
M0476   
M0488   
M0490  2
M0530   
M0540  0
M0550  Box 0
Functional Answers
M0650  Box 1
M0660  Box 2
M0670  Box 2
M0680  Box 1
M0690  Box 2
M0700  Box 1
Utilization Answers
M0170  Box 1
CS=         28    FS=        26    SU=         0
MSA =       7160
HHRG Grouper C3F3S0
Wage Index:0.93980000
PPS rate = $   2332.68


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Smith, Mary Reason for Assessment:Start of Care

Clincal Answers
M0230=        81
M0250 Box 4
M0390 Box 0
M0420  2
M0460   
M0476   
M0488   
M0490  4
M0530   
M0540  0
M0550  Box 0
M0610  Box 1
Functional Answers
M0650  Box 1
M0660  Box 2
M0670  Box 2
M0680  Box 1
M0690  Box 1
M0700  Box 2
Utilization Answers
M0170  Box 1
8 or more hours of therapy
CS=         14    FS=        21    SU=         4
MSA =       7160
HHRG Grouper C1F2S2
Wage Index:0.93980000
PPS rate = $   3342.61