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Get the free IN LIEU OF FORM CMS-2552-96(04/2005) PREPARED 8/20/2009 11:42 FORM APPROVED OMB NO -...

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Health Financial Systems MCRIF32 FOR PERRY MEMORIAL HOSPITAL THIS REPORT IS REQUIRED BY LAW (42 USC 1395g; 42 CFR 413.20(b)). FAILURE TO REPORT CAN RESULT IN ALL INTERIM PAYMENTS MADE SINCE THE BEGINNING
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In lieu of form refers to an alternative form or document that is submitted instead of a standard form.
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