08-14 bFORM CMSb-1984-14 4390 Cont Rev 1 43-101 - iahhc-2025

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The document is a detailed cost and data report form (CMS-1984-14) required for hospice providers to submit financial information related to their operations. It includes sections for reporting costs, statistical data, reimbursement questionnaires, balance sheets, and statements of revenues and expenses. The form emphasizes compliance with federal laws and regulations, requiring accurate reporting of financial data, including salaries, expenses, and patient care services. It also outlines the consequences of misrepresentation in the submitted information.

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