SNFData - 675093 - 12/1997 - Worksheet S-7, Part I

LAKESIDE CARE CENTER
LUBBOCK, TX 79410

Medicare Provider Number: 675093

Cost report status: Reopened

[Record Code 269300 - 1996]

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NHCMQ DEMONSTRATION AND PPS STATISTICAL DATA					PROVIDER NO: 675093	PERIOD: FROM 01/01/1997 TO 12/31/1997	WORKSHEET S-7 Part I
PART I - NHCMQ DEMONSTRATION STATISTICAL DATA FOR COST REPORTING PERIODS BEGINNING PRIOR TO JULY 1, 1998
	GROUP	M3PI REVENUE CODE	SERVICES PRIOR TO JANUARY 1ST (1)		SERVICES ON OR AFTER JANUARY 1ST (1)		TOTAL (See Instructions)
	GROUP	M3PI REVENUE CODE	RATE	DAYS	RATE	DAYS	TOTAL (See Instructions)
	1	2	3	3.01	4	4.01	5
1	RVC	9044			###	###	###	1
2	RVB	9043			###	###	###	2
3	RVA	9042			###	###	###	3
4	RHD	9041			###	###	###	4
5	RHC	9040			###	###	###	5
6	RHB	9039			###	###	###	6
7	RHA	9038			###	###	###	7
8	RMC	9037			###	###	###	8
9	RMB	9036			###	###	###	9
10	RMA	9035			###	###	###	10
11	RLB	9034			###	###	###	11
12	RLA	9033			###	###	###	12
13	SE3	9032			###			13
14	SE2	9031			###	###	###	14
15	SE1	9030			###			15
16	SSC	9029			###	###	###	16
17	SSB	9028			###			17
18	SSA	9027			###	###	###	18
19	CD2	9026			###	###	###	19
20	CD1	9025			###	###	###	20
21	CC2	9024			###			21
22	CC1	9023			###	###	###	22
23	CB2	9022			###			23
24	CB1	9021			###	###	###	24
25	CA2	9020			###	###	###	25
26	CA1	9019			###	###	###	26
27	IB2	9018			###			27
28	IB1	9017			###	###	###	28
29	IA2	9016			###			29
30	IA1	9015			###	###	###	30
31	BB2	9014			###			31
32	BB1	9013			###			32
33	BA2	9012			###			33
34	BA1	9011			###			34
35	PE2	9010			###			35
36	PE1	9009			###	###	###	36
37	PD2	9008			###			37
38	PD1	9007			###	###	###	38
39	PC2	9006			###			39
40	PC1	9005			###	###	###	40
41	PB2	9004			###			41
42	PB1	9003			###	###	###	42
43	PA2	9002			###	###	###	43
44	PA1	9001			###	###	###	44
45	Other Group	9000			###			45
46	TOTAL					###	###	46
(1) Calendar Year Providers: Complete columns 1, 2, 4, 4.01, and 5
Fiscal Year Providers - Rate change as of January 1st: Complete ALL columns.
Fiscal Year Providers - Rate DOES NOT change as of January 1st: Complete columns 1, 2, 3, 3.01, and 5.