Official Federal Forms
Centers For Medicare And Medicaid Services
Last updated: 5/2/2006
Inpatient Rehabilitation Facility-Patient Assessment Instrument {CMS-10036}
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Description
DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES Form Approved OMB No. 0938-0842 INPATIENT REHABILITATION FACILITY PATIENT ASSESSMENT INSTRUMENT Form CMS-10036 (01/06) American LegalNet, Inc. www.USCourtForms.com 1 DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES INPATIENT REHABILITATION FACILITY PATIENT ASSESSMENT INSTRUMENT Form CMS-10036 (01/06) American LegalNet, Inc. www.USCourtForms.com 2 DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES INPATIENT REHABILITATION FACILITY PATIENT ASSESSMENT INSTRUMENT Form CMS-10036 (01/06) American LegalNet, Inc. www.USCourtForms.com 3
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