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See instructions Inpatient Rehabilitation Facility PPS subprovider Enter Y for yes and N for no. no. 40 f 1 ii Enter Y for yes and N for no. XIX Title V and XIX Services yes or N for no in the applicable column. 91. S-3 Pt. I line 2 col. 6 Enter Y for yes and N for no. General Instruction Enter Y for all YES responses. 85 Enter Y for yes or N for no. see instructions IME Direct GME 61. 00 Did your hospital receive FTE slots under ACA section 5503 Enter Y for yes or N for no in column 1. D-2...
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Step 1: Obtain the necessary forms from the registration desk or download them from the hospital's website.
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Step 2: Fill out your personal information such as name, date of birth, address, and contact details.
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Step 3: Provide your insurance information, including policy number and details of coverage.
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Step 4: Specify the reason for your visit or the medical services you require.
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Step 5: If applicable, provide any relevant medical history or previous treatment information.
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Step 6: Review the completed form for accuracy and sign it.
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Step 7: Submit the filled-out form to the registration desk or the designated department at Kosciusko Community Hospital.
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Anyone in need of medical care or treatment in the Kosciusko County area can benefit from Kosciusko Community Hospital.
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Residents of Kosciusko County, as well as visitors or tourists in need of medical attention, can utilize the services provided by the hospital.
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