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In Part A, enter the patient's name, address, and postal code clearly. The physician should provide details about the nature of the disability and answer questions regarding its permanence and available remedial therapy.
The physician must certify their answers by signing and dating the certification section at the bottom of Part A.
In Part B, as a property owner, confirm your relationship to the patient and indicate if you are incurring costs for physical assistance or structural modifications. Provide detailed descriptions where required.
Complete your certification by signing and dating at the end of Part B. Ensure all necessary receipts are attached before submission.
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This transmittal introduces Chapter 40, Hospital and Hospital Health Care Complex Cost Report,. Form CMS-2552-10, which contains instructions for the completion
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