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["Hospital Name","Medicare ID#","Medicaid ID#","Medicaid ID#","Distinct Part Psych?","Freestanding Psych?"]
["Ochsner Medical Center - Baton Rouge",190202,1700797,70079,"No","No"]
["Northoaks Rehab Hospital",193044,1702871,70287,"No","No"]
["Ochsner Medical Center - Kenner",190274,1704385,70438,"No","No"]
["Serenity Springs Speciality Hospital",194074,1704865,70486]
["Community Care Hospital      ",194056,1709204,70920,"No","Yes"]
["Longleaf Hospital            ",194022,1709417,70941]
["Liberty Healthcare Systems   ",194083,1709581,70958,"No","Yes"]
["Acadia Vermillion            ",194044,1709981,70998]
["East LA State Hospital",194008,1710016,71001,"Yes","Yes"]
["Central LA State Hospital",194025,1710555,71055,"No","Yes"]
["Baton Rouge General Medical Center",190065,1720020,72002]
["Lane Regional Medical Center ",190020,1720101,72010,"No","No"]
["Opelousas General Health System",190017,1720151,72015,"Yes","No"]
["Christus St Frances Cabrini Hospital",190019,1720208,72020,"No","No"]
["St Tammany Parish Hospital   ",190045,1720259,72025,"No","No"]
["North Oaks Medical Center",190015,1720267,72026,"No","No"]
["Terrebonne General Medical Center",190008,1720275,72027,"No","No"]
["Slidell Memorial Hospital    ",190040,1720313,72031,"No","No"]
["Iberia General Hospital",190054,1720330,72033,"No","No"]
["University Health Conway     ",190011,1720372,72037,"Yes","No"]
["Lallie Kemp Regional Medical Center",191321,1720411,72041,"No","No"]
["University Hospitals & Clinic",190006,1720429,72042,"No","No"]
["Lake Charles Memorial Hospital",190060,1720461,72046,"Yes","No"]
["Rapides Regional Medical Center  ",190026,1730106,73010,"No","No"]
["Ochsner Clinic Foundation",190036,1730351,73035,"Yes","No"]
["West Calcasieu Cameron Hospital ",190013,1730483,73048,"No","No"]
["East Jefferson General Hospital",190146,1735183,73518,"Yes","No"]
["Thibodaux Regional Medical Center",190004,1736848,73684]
["University Health Shreveport ",190098,1737712,73771,"Yes","No"]
["Leonard J Chabert Medical Center",190183,1739227,73922,"Yes"]
["Christus Health Shreveport   ",190041,1744379,74437,"No","No"]
["Ochsner Medical Center - North Shore",190204,1744611,74461,"No","No"]
["River Oaks Hospital          ",194031,1761672,76167,"No","Yes"]
["Tulane University Hospital & Clinic",190176,1763799,76379,"No","No"]
["The Regional Medical Center of Acadiana",190205,1764981,76498,"No","No"]
["Northern Louisiana Medical Center",190086,1765627,76562,"No","No"]
["Medical Center of LA - New Orleans",190005,1765651,76565,"Yes","No"]
["Savoy Medical Center         ",190025,1766062,76606,"No","No"]
["Lakeview Regional Medical Center",190177,1766836,76683,"Yes","No"]
["Lake Area Medical Center     ",190201,1767671,76767,"No","No"]
["Shriners Hospitals For Children",193301,2700031,170003,"No","No"]
["Northlake Behavioral Health System",null,null,170011]
["Our Lady Of The Angels Hospital",null,null,170014]
["New Orleans East Hospital    ",null,null,170018]

{"sheet":"Instructions","index":1,"n_rows":80,"n_cols":3,"rows_kept":80,"cut":false,"hidden":false,"merged":[[1,1,1,2]],"flags":["formulas_cached_only"]}
[]
[null,"Survey is Due:  Monday, December 19, 2016"]
[]
["Section A"]
[]
["1.",null,"The requested data should be provided for the period from July 01, 2015 to June 30, 2016."]
[]
["Section B"]
[]
["1.",null,"Begin by completing the general information section.  All boxes outlined in BLUE need to be completed.  All boxes outlined in RED will need to be completed if the pre-populated information is incorrect."]
[null,null,"a.  Select your hospital's name from the drop down list.  "]
[null,null,"b.  Certain cells will pre-populate based on prior year information.  Review the pre-populated information.  If it is incorrect, please provide the correct information in the space provided."]
[null,null,"i.  Pre-populated data includes Medicare / Medicaid #, type of ownership, and whether your hospital is a free-standing psychiatric hospital, or has a distinct part psych unit."]
[null,null,"c.  Not all cells will pre-populate.  Please complete any data that does not pre-populate."]
[null,null,"i.  Please provide your hospital's fiscal year end, parish, whether your hospital's distinct part psych unit is accredited by the Joint Commission on the Accreditation of Healthcare Organizations, and the answers to all three OB questions."]
[]
["2.",null,"Detailed supporting documentation for all data elements reported in the survey must be maintained for a minimum of 5 years.  "]
[]
["Section C"]
[]
["1.",null,"Section C of the survey is to collect information on services provided to Medicare, Medicaid, Medicaid Managed Care and other third party insured patients, and the uninsured for the SFY 2017 DSH UCC calculation."]
[null,null,"Uninsured claims are defined below:"]
[null,null,"To the extent hospital charges pertain to services that are medically necessary under applicable Medicaid standards and the services are defined as inpatient or outpatient hospital services under the Medicaid state plan the following charges are generally considered to be \"uninsured\":"]
[]
[null,null,"Hospital inpatient and outpatient charges for services to patients who have no source of third party coverage for a specific inpatient hospital or outpatient hospital service (reported based on date of service). (42 CFR 447.295 (b))"]
[]
["2.",null,"Reconciliation of  uninsured charges on Section C to Section E and Exhibit A and uninsured payments on Section C to Section E and Exhibit B for the period from July 01, 2015 to June 30, 2016."]
[]
["Section D"]
[]
["1.",null,"Section D of the survey is to collect information for uninsured charges in order to be in compliance with Act 540."]
[]
["2.",null,"This section of the survey is used to collect information to calculate the hospital's uninsured cost.  By federal Medicaid regulations, the uninsured cost must be calculated using cost report costing methodologies."]
[]
["3.",null,"Record the routine per diem cost per day for each hospital routine cost center present on your Medicare cost report.  These amounts are calculated on Worksheet D-1 of the cost report.  Record each ancillary cost-to-charge ratio for each ancillary cost center on your cost report.  These amounts are calculated on Worksheet C, Part 1 of the Medicare cost report.  Teaching Hospitals: Use the Medicaid version of the Worksheet C, Part 1 so your Direct Medical Education costs are included in the cost report per diems and ancillary cost-to-charge ratios."]
[]
["4.",null,"Record your routine days of care, routine charges and I/P and O/P ancillary charges in the next column.  This information, when combined with cost information from the cost report, will calculate the total cost of hospital services provided to uninsured individuals."]
[]
["5.",null,"Federal requirements mandate the uninsured services must be costed using Medicare cost reporting methodologies.  As such, a hospital will need to report the uninsured days of care they provided each survey period, by routine cost center, as well as inpatient and outpatient ancillary service revenue by cost report cost center.  Exhibit A has been prepared to assist hospitals develop the data needed to support responses on the survey.  This data must be maintained in an auditable format.  It must also only include charges for inpatient and outpatient hospital services, excluding physician charges and other non-hospital charges.  Per federal guidelines uninsured patients are individuals with no source of third party healthcare coverage (insurance).  If the patient had health insurance, even if the third party insurer did not pay, those services are insured and cannot be reported as uninsured on the survey."]
[]
["6.",null,"Federal requirements mandate the hospital cost of providing services to the uninsured during the data collection period must be reduced by uninsured payments received during the data collection period.  Exhibit B will assist hospitals in developing the data necessary to support uninsured payments received during the data collection period.  The data must be maintained in an auditable format and made available upon request.  Uninsured payments must include all 1011 Undocumented Alien payments."]
["7.",null,"Reconciliation of total uninsured charges on Section E to Exhibit A and total uninsured payments on Section E to Exhibit B for the period from July 01, 2015 to June 30, 2016."]
[]
["Section F"]
[]
["1.",null,"Section F of the survey is to collect the obstetrician information per question."]
[]
["Exhibit A"]
["1.",null,"See Exhibit A for an example format of the information that needs to be available to support the data reported in Section A and Section B.  This was prepared to share with hospitals an acceptable format for the information that should be maintained to support answers provided in Section A and Section B of the hospital DSH survey.  This information should be maintained by the facility in accordance with the documentation retention requirements outlined above.  "]
["2.",null,"We prefer you complete Exhibit A based on your individual state Medicaid hospital reimbursement methodology (if your state reimburses based on discharge date then only include the claims that were discharged during the cost reporting period covered by Exhibit A).  However, if the uninsured data cannot be easily reported using the Medicaid methodology, report it based on your own methodology in a consistent manner from year to year (e.g., discharge, admit, or dates of service)."]
[]
["Exhibit B - Support for Uninsured I/P and O/P Hospital Payments Received: "]
[]
["1.",null,"See Exhibit B for an example format of the information that needs to be available to support the data reported in Section E of the survey related to payments received from ALL uninsured during the survey period regardless of their dates of service.  This information must be maintained by the facility in accordance with the documentation retention requirements outlined in the general instructions section."]
[]
["Please direct any questions regarding the completion of the survey to the following individuals:"]
[null,null,"Jana Miller or Lesley Howard, Myers & Stauffer LC"]
[null,null,"Phone:  1-800-374-6858"]
[null,null,"Email:   ladsh@mslc.com"]
[null,null,"                   OR"]
[null,null,"Tizi Robinson, Louisiana Department of Health"]
[null,null,"Phone:  225-219-4285"]
[null,null,"Email:  Tizi.Robinson@la.gov"]
[]
["File Submission "]
["Files must be compressed (zipped) using any of the following compression utility programs:"]
[null,"▪","PKZip for Windows version 8.0 or later (from PKWare Corporation, www.pkzip.com)"]
[null,"▪","WinZip 9.0 or later version (from Nico Mak Computing, www.winzip.com)"]
[null,"▪","PKZip for zSeries version 5.6 or later (from PKWare Corporation, www.pkzip.com)"]
["NOTE: Compressed (zipped) files must be password-protected using AES 256-bit encryption.  Passwords must be at least"]
["12 alphabetic and numeric characters in length."]
[]
["Files should be submitted using the Myers and Stauffer Web Portal"]
[null,"▪","3.5 inch floppy diskette (MS-DOS HD format, 1.4 Mbytes);"]
[null,"▪","CD-ROM disk (Windows 9x/2000/XP formats);"]
[null,"▪","DVD (Windows 9x/2000/XP formats)"]
[null,"▪","Myers and Stauffer Web Portal"]
[]
[]
["See the \"Checklist\" tab for a list of items required for submission and mailing information."]

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["DSH Survey Submission Checklist"]
[null,"Please indicate with an \"X\" each item included or a \"N/A\" if not included.  Consider a separate cover letter to explain any \"N/A\" answers to avoid additional documentation requests."]
[null,null,null,"1.","Electronic copy of the DSH Survey (sections A-F completed)"]
[null,null,null,"2.","Signed and dated copy of DSH Survey Section A, B, C, D"]
[null,null,null,"3.","Electronic copy of Exhibit A - Uninsured Charges / Days"]
[{"$nulls":5},"- Must be in Excel (.xls or .xlsx) or CSV (.csv) using either a TAB or | (pipe symbol above the ENTER key)"]
[null,null,null,"4.","Electronic copy of Exhibit B - Self-Pay Payments"]
[{"$nulls":5},"- Must be in Excel (.xls or .xlsx) or CSV (.csv) using either a TAB or | (pipe symbol above the ENTER key)"]
[null,null,null,"5.","Latest electronic cost report"]
[null,null,null,"6.","Latest fiscal year consolidated financial statements "]
[null,null,null,"7.","Revenue code cross-walk used to prepare cost report"]
[]
[]
[null,null,null,"Upload survey and other data to:"]
[{"$nulls":6},"https://dsh.mslc.com"]
[]
[null,null,null,"Submit questions to:"]
[]
[]
[{"$nulls":6},"Phone:  (800) 374-6858"]
[{"$nulls":6},"E-Mail:  ladsh@mslc.com"]
[]
[null,null,null,"Please Call Myers and Stauffer if you have any questions on completing the survey."]

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["A.  The Reporting Period Covered by this Survey Includes:"]
[]
["Reporting Period Begin Date:",null,"2015-07-01"]
["Reporting Period End Date:",null,"2016-06-30"]
[{"$nulls":28},0]
[]
["B.  General Information",{"$nulls":27},"Yes"]
[{"$nulls":28},"No"]
["Select Your Facility from the Drop-Down Menu Provided:",null,"DATA",{"$nulls":5},"CORRECT?",null,"IF INCORRECT, PROPER INFORMATION"]
["1.","Hospital Name",{"$nulls":26},"Public"]
["2.","Medicare Provider ID Number: ","",{"$nulls":25},"Private"]
["3.","Medicaid Provider ID Number:  ","",{"$nulls":25},"State"]
["4.","Type of Ownership:  (Public, Private, State)"]
[]
["Please provide the following information.",{"$nulls":27},"Acadia Vermillion            "]
["5.","Hospital Fiscal Year:",{"$nulls":26},"Baton Rouge General Medical Center"]
["6.","Parish:",{"$nulls":26},"Central LA State Hospital"]
[{"$nulls":28},"Christus Health Shreveport   "]
["Psychiatric Information:",{"$nulls":9},"DATA (based on prior year)",null,"If incorrect, please provide explanation here",{"$nulls":15},"Christus St Frances Cabrini Hospital"]
["7.","Does the hospital have a distinct part psychiatric unit?",{"$nulls":8},"",{"$nulls":17},"Community Care Hospital      "]
["8.","Is the hospital a freestanding psychiatric hospital?",{"$nulls":8},"",{"$nulls":17},"East Jefferson General Hospital"]
["8a.","If yes, is hospital accredited by the Joint Commission on the Accreditation of Healthcare Organizations?",{"$nulls":26},"East LA State Hospital"]
[{"$nulls":28},"Iberia General Hospital"]
["In accordance with Section 1923(d) of the Social Security Act in order to qualify for Medicaid DSH payments for SFY 2017 we must verify that your facility meets",{"$nulls":27},"Lake Area Medical Center     "]
["the requirement related to the provision of obstetric services.  Hospitals opening after December 22, 1987, must either meet criteria #9 or #11.",{"$nulls":27},"Lake Charles Memorial Hospital"]
["Obstetrician Information:",{"$nulls":27},"Lakeview Regional Medical Center"]
["9.","Does the hospital have at least two obstetricians who have staff privileges at the hospital and have agreed to provide",{"$nulls":10},"Please list the names, medical license numbers, and ",{"$nulls":15},"Lallie Kemp Regional Medical Center"]
[null,"non-emergent obstetric services to Medicaid-eligible individuals?",{"$nulls":10},"Medicaid provider numbers of the obstetricians on staff",{"$nulls":15},"Lane Regional Medical Center "]
[null,"In the case of a hospital located in a rural area, the term obstetrician includes any physician with staff privileges at the",{"$nulls":10},"who agree to provide OB services to Medicaid eligibles.",{"$nulls":15},"Leonard J Chabert Medical Center"]
[null,"hospital to perform non-emergency obstetric procedures. ",{"$nulls":10},"Please Input the Data in the Sec. F Obstetrician Data tab.",{"$nulls":15},"Liberty Healthcare Systems   "]
[{"$nulls":28},"Longleaf Hospital            "]
["10.","Hospital is exempt from the requirement in #8 above because it did not offer non-emergency obstetric services to the general population",{"$nulls":26},"Medical Center of LA - New Orleans"]
[null,"when federal Medicaid DSH regulations were enacted on December 22, 1987.",{"$nulls":26},"North Oaks Medical Center"]
[{"$nulls":28},"Northern Louisiana Medical Center"]
["11.","Hospital treats patients who are predominantly individuals under 18 years of age.",{"$nulls":26},"Northlake Behavioral Health System"]
[{"$nulls":28},"Northoaks Rehab Hospital"]
[{"$nulls":28},"Ochsner Clinic Foundation"]
["C.  Charges and Payments Received by Payer Source:   July 01, 2015 to June 30, 2016",{"$nulls":27},"Ochsner Medical Center - Baton Rouge"]
[{"$nulls":28},"Ochsner Medical Center - Kenner"]
[null,"Hospital Name",0,{"$nulls":25},"Ochsner Medical Center - North Shore"]
[null,"Medicaid Provider ID Number:","",{"$nulls":25},"Opelousas General Health System"]
[{"$nulls":4},"Charges",null,"Charges",null,"Charges",null,"Charges",null,"Charges",null,"Payments Received",{"$nulls":13},"Our Lady Of The Angels Hospital"]
[{"$nulls":4},"Attributable to",null,"Attributable to",null,"Attributable to",null,"Attributable to",null,"Attributable to",null,"(Cash Basis)",{"$nulls":13},"Rapides Regional Medical Center  "]
["Hospital Charges (July 01, 2015 to June 30, 2016)",null,null,null,"Medicare Program",null,"Medicaid Program",null,"Medicaid Managed Care",null,"Other 3rd Parties",null,"Uninsured Patients",null,"Uninsured Payments",{"$nulls":13},"River Oaks Hospital          "]
[null,null,"Inpatient Hospital Charges (Excluding Physician Charges)",{"$nulls":25},"Savoy Medical Center         "]
[null,null,"Outpatient Hospital Charges (Excluding Physician Charges)",{"$nulls":25},"Serenity Springs Speciality Hospital"]
[null,null,"Hosp-Based Physician Charges I/P & O/P Hosp.",{"$nulls":25},"Shriners Hospitals For Children"]
[null,null,"Inpatient Psychiatric Hospital Services",{"$nulls":25},"Slidell Memorial Hospital    "]
[null,null,"Outpatient Psychiatric Hospital Services",{"$nulls":25},"St Tammany Parish Hospital   "]
[null,null,"Inpatient Rehabilitation Hospital Services",{"$nulls":25},"Terrebonne General Medical Center"]
[null,null,"Outpatient Rehabilitation Hospital Services",{"$nulls":25},"The Regional Medical Center of Acadiana"]
[{"$nulls":28},"Thibodaux Regional Medical Center"]
[null,"Total Hospital Charges by Payer Source & \nTotal Uninsured Payments",null,null,0,null,0,null,0,null,0,null,0,null,0,{"$nulls":13},"Tulane University Hospital & Clinic"]
[{"$nulls":28},"University Health Conway     "]
[null,"Total Hospital Charges by Payer Source & Total Uninsured Payments (Excluding Physician Charges)",null,null,0,null,0,null,0,null,0,null,0,null,0,{"$nulls":13},"University Health Shreveport "]
[{"$nulls":12},"(Agrees to Total Charges on Section B and Exhibit A)",null,"(Agrees to Total Payments on Section B and Exhibit B)",{"$nulls":13},"University Hospitals & Clinic"]
[{"$nulls":10},"     ",null,null,null,"ERROR--DOES NOT AGREE TO SECTION E",{"$nulls":13},"West Calcasieu Cameron Hospital "]
[{"$nulls":28},"New Orleans East Hospital    "]
[]
[{"$nulls":4},"Totals\n (All Payer Sources)"]
[null,null,"Total Hospital Charges",null,0]
[]
[null,null,"Total Hospital Charges (Excluding Physician Charges)",null,0]
[]
["Non-Hospital Charges (July 01, 2015 to June 30, 2016)"]
[null,null,"Hospital Swing Bed SNF/NF"]
[null,null,"Skilled Nursing Facility / Nursing Facility"]
[null,null,"Hospital-Based Rural Health Clinic"]
[null,null,"Hospital-Based FQHC"]
[null,null,"Hospital-Based Home Health Agency"]
[null,null,"Other Non-Hospital Services"]
[]
[null,null,"Total Non-Hospital Charges",null,0]
[]
[null,null,"Total Hospital and Non-Hospital Charges",null,0,null,"Note:  Amount must reconcile to facility wide charges July 01, 2015 to June 30, 2016"]
[]
[null,"Hospital Name",0]
[null,"Medicaid Provider ID Number :",""]
[]
[]
["D.  Certification"]
[]
[]
[]
[null,"The following certification is to be completed by the hospital's CEO or CFO:"]
[]
[null,"I hereby certify that the above information in the Louisiana DSH Survey is true and accurate to the best of our ability, and supported by financial and other records maintained by this entity.  I understand that this information will be used to determine Medicaid Disproportionate Share Hospital (DSH) eligibility and payments.  Detailed support exists for all amounts reported in this survey.  These records will be retained for a period of not less than 5 years following the due date of the survey.  "]
[]
[]
[null,"Hospital CEO or CFO Signature",null,null,"Date"]
[]
[]
[null,"Printed Name and Title"]
[]
[]
[]
[]
[null,"Contact Name"]
[null,"Title"]
[null,"Mailing Street Address"]
[null,"City, State, Zip"]
[null,"Telephone Number"]
[null,"E-Mail Address"]

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["Section E.  Calculation of Uninsured Inpatient and Outpatient Hospital Costs:",{"$nulls":56},0]
[]
[]
[{"$nulls":6},"7/1/2015 - 6/30/2016",{"$nulls":5},"7/1/2015 - 6/30/2016"]
[{"$nulls":6},"Uninsured Charges and Days",{"$nulls":5},"Uninsured Cost"]
["Line #","Cost Center Description","Per Diem Cost for Routine Cost Centers",null,"Cost to Charge Ratio for Ancillary Cost Centers",null,"Inpatient Days and Charges              (See Exhibit A)",null,"Outpatient Charges                 (See Exhibit A)",null,null,null,"Inpatient Cost",null,"Outpatient Cost",null,"Total"]
[]
["Data Sources:",null,"Cost Report Worksheet D-1,       Part II",null,"Cost Report Worksheet C        Part 1",null,"From Hospital's Own Internal Analysis",null,"From Hospital's Own Internal Analysis",null,null,null,"Calculated",null,"Calculated",null,"Calculated"]
[]
["Routine Cost Centers (list below):",{"$nulls":5},"Days"]
[30,"Adults & Pediatrics",{"$nulls":10},0,null,null,null,0]
[31,"Intensive Care Unit",{"$nulls":10},0,null,null,null,0]
[32,"Coronary Care Unit",{"$nulls":10},0,null,null,null,0]
[33,"Burn Intensive Care Unit",{"$nulls":10},0,null,null,null,0]
[34,"Surgical Intensive Care Unit",{"$nulls":10},0,null,null,null,0]
[null,"Neonatal Intensive Care Unit",{"$nulls":10},0,null,null,null,0]
[40,"Subprovider (Psychiatry)",{"$nulls":10},0,null,null,null,0]
[41,"Subprovider (Rehabilitation)",{"$nulls":10},0,null,null,null,0]
[43,"Nursery",{"$nulls":10},0,null,null,null,0]
[null,"Other (Please List)",{"$nulls":10},0,null,null,null,0]
[null,"Other (Please List)",{"$nulls":10},0,null,null,null,0]
[null,"Other (Please List)",{"$nulls":10},0,null,null,null,0]
[{"$nulls":4},"Total Days",null,0]
[]
[{"$nulls":6},"Routine Charges",{"$nulls":5},"Routine Costs"]
[null,"Routine Charges",{"$nulls":10},0]
[null,"Calculated Routine Charge Per Diem",{"$nulls":4},0]
[]
["Ancillary Cost Centers (list below):",{"$nulls":5},"Ancillary Charges",null,"Ancillary Charges",null,null,null,"Ancillary Cost",null,"Ancillary Cost",null,"Ancillary Cost"]
[50,"Operating Room",{"$nulls":10},0,null,0,null,0]
[53,"Anesthesiology",{"$nulls":10},0,null,0,null,0]
[54,"Radiology-Diagnostic",{"$nulls":10},0,null,0,null,0]
[60,"Laboratory",{"$nulls":10},0,null,0,null,0]
[62,"Whole Blood & Packed Red BL",{"$nulls":10},0,null,0,null,0]
[65,"Respiratory Therapy",{"$nulls":10},0,null,0,null,0]
[66,"Physical Therapy",{"$nulls":10},0,null,0,null,0]
[67,"Occupational Therapy",{"$nulls":10},0,null,0,null,0]
[69,"Electrocardiology",{"$nulls":10},0,null,0,null,0]
[71,"Medical Supplies Charged ",{"$nulls":10},0,null,0,null,0]
[73,"Drugs Charged to Patients",{"$nulls":10},0,null,0,null,0]
[91,"Emergency",{"$nulls":10},0,null,0,null,0]
[92,"Observation",{"$nulls":10},0,null,0,null,0]
[{"$nulls":12},0,null,0,null,0]
[{"$nulls":12},0,null,0,null,0]
[{"$nulls":12},0,null,0,null,0]
[{"$nulls":12},0,null,0,null,0]
[{"$nulls":12},0,null,0,null,0]
[{"$nulls":12},0,null,0,null,0]
[{"$nulls":12},0,null,0,null,0]
[{"$nulls":12},0,null,0,null,0]
[{"$nulls":12},0,null,0,null,0]
[{"$nulls":12},0,null,0,null,0]
[{"$nulls":12},0,null,0,null,0]
[{"$nulls":12},0,null,0,null,0]
[{"$nulls":12},0,null,0,null,0]
[{"$nulls":12},0,null,0,null,0]
[{"$nulls":12},0,null,0,null,0]
[{"$nulls":12},0,null,0,null,0]
[{"$nulls":12},0,null,0,null,0]
[{"$nulls":12},0,null,0,null,0]
[{"$nulls":12},0,null,0,null,0]
[{"$nulls":12},0,null,0,null,0]
[{"$nulls":12},0,null,0,null,0]
[{"$nulls":12},0,null,0,null,0]
[{"$nulls":12},0,null,0,null,0]
[{"$nulls":12},0,null,0,null,0]
[{"$nulls":12},0,null,0,null,0]
[{"$nulls":12},0,null,0,null,0]
[{"$nulls":12},0,null,0,null,0]
[{"$nulls":12},0,null,0,null,0]
[{"$nulls":12},0,null,0,null,0]
[{"$nulls":12},0,null,0,null,0]
[{"$nulls":12},0,null,0,null,0]
[{"$nulls":12},0,null,0,null,0]
[{"$nulls":12},0,null,0,null,0]
[{"$nulls":12},0,null,0,null,0]
[{"$nulls":12},0,null,0,null,0]
[{"$nulls":12},0,null,0,null,0]
[{"$nulls":12},0,null,0,null,0]
[{"$nulls":12},0,null,0,null,0]
[{"$nulls":12},0,null,0,null,0]
[{"$nulls":12},0,null,0,null,0]
[{"$nulls":4},"Total Charges",null,0,null,0]
[]
[{"$nulls":6},"Total IP and OP Charges",null,0,null,null,null,"ERROR - TOTAL CHARGES DO NOT AGREE TO SECTION C"]
[{"$nulls":8},"(Section A & Exhibit A)"]
[]
[{"$nulls":10},"Total Ancillary Costs",null,0,null,0,null,0]
[]
[{"$nulls":10},"Total Routine and Ancillary Costs",null,0,null,0,null,0]
[]
[{"$nulls":10},"Payments from Uninsured During Survey Period (Cash Basis)",{"$nulls":5},0]
[{"$nulls":12},"(Exhibit B)",null,"(Exhibit B)"]
[]
[{"$nulls":10},"Net Uninsured Cost",null,0,null,0,null,0]

{"sheet":"Sec. F Obstetrician Data","index":5,"n_rows":4,"n_cols":3,"rows_kept":4,"cut":false,"hidden":false,"merged":[],"flags":["formulas_cached_only"]}
["Section F.  Obstetrician Information:"]
[]
[]
["Obstetrician Name","Medical License Number","Medicaid Provider #"]

{"sheet":"ADJ Sec. A, B, C, D Hosp Data","index":6,"n_rows":103,"n_cols":29,"rows_kept":103,"cut":false,"hidden":true,"merged":[[19,12,19,14],[20,12,20,14],[8,2,8,6],[8,10,8,14],[9,2,9,6],[9,10,9,14],[10,2,10,6],[10,10,10,14],[100,2,100,4],[101,2,101,4],[39,2,39,8],[11,2,11,6],[11,10,11,14],[12,2,12,6],[12,10,12,14],[15,2,15,6],[16,2,16,6],[18,12,18,14],[102,2,102,4],[40,2,40,8],[52,1,52,2],[54,1,54,2],[76,2,76,8],[77,2,77,8],[86,1,86,8],[97,2,97,4],[98,2,98,4],[99,2,99,4]],"flags":["formulas_cached_only"]}
["A.  The Reporting Period Covered by this Survey Includes:"]
[]
["Reporting Period Begin Date:",null,"2015-07-01"]
["Reporting Period End Date:",null,"2016-06-30"]
[]
[{"$nulls":28},0]
["B.  General Information",{"$nulls":27},"Yes"]
[{"$nulls":28},"No"]
["Select Your Facility from the Drop-Down Menu Provided:",null,"DATA",{"$nulls":5},"CORRECT?",null,"IF INCORRECT, PROPER INFORMATION"]
["1.","Hospital Name",0,{"$nulls":5},0,null,0,{"$nulls":17},"Public"]
["2.","Medicare Provider ID Number: ","",{"$nulls":5},0,null,0,{"$nulls":17},"Private"]
["3.","Medicaid Provider ID Number:  ","",{"$nulls":5},0,null,0,{"$nulls":17},"State"]
["4.","Type of Ownership:  (Public, Private, State)",0,{"$nulls":5},0,null,0]
[]
["Please provide the following information."]
["5.","Hospital Fiscal Year:","00:00:00"]
["6.","Parish:",""]
[]
["Psychiatric Information:",{"$nulls":9},"DATA (based on prior year)",null,"If incorrect, please provide explanation here"]
["7.","Does the hospital have a distinct part psychiatric unit?",{"$nulls":8},"",null,0]
["8.","Is the hospital a freestanding psychiatric hospital?",{"$nulls":8},"",null,0]
[null,"If yes, is hospital accredited by the Joint Commission on the Accreditation of Healthcare Organizations?",{"$nulls":8},0]
[]
["In accordance with Section 1923(d) of the Social Security Act in order to qualify for Medicaid DSH payments for SFY 2017 we must verify that your facility meets"]
["the requirement related to the provision of obstetric services.  Hospitals opening after December 22, 1987, must either meet criteria #9 or #11."]
["Obstetrician Information:"]
["9.","Does the hospital have at least two obstetricians who have staff privileges at the hospital and have agreed to provide",{"$nulls":8},0,null,"Please list the names, medical license numbers, and "]
[null,"non-emergent obstetric services to Medicaid-eligible individuals?",{"$nulls":10},"Medicaid provider numbers of the obstetricians on staff"]
[null,"In the case of a hospital located in a rural area, the term obstetrician includes any physician with staff privileges at the",{"$nulls":10},"who agree to provide OB services to Medicaid eligibles."]
[null,"hospital to perform non-emergency obstetric procedures. ",{"$nulls":10},"Please Input the Data in the Sec. F Obstetrician Data tab."]
[]
["10.","Hospital is exempt from the requirement in #8 above because it did not offer non-emergency obstetric services to the general population",{"$nulls":8},0]
[null,"when federal Medicaid DSH regulations were enacted on December 22, 1987."]
[]
["11.","Hospital treats patients who are predominantly individuals under 18 years of age.",{"$nulls":8},0]
[]
[]
["C.  Charges and Payments Received by Payer Source:   July 01, 2015 to June 30, 2016"]
[]
[null,"Hospital Name",0]
[null,"Medicaid Provider ID Number:",""]
[{"$nulls":4},"Charges",null,"Charges",null,"Charges",null,"Charges",null,"Charges",null,"Payments Received"]
[{"$nulls":4},"Attributable to",null,"Attributable to",null,"Attributable to",null,"Attributable to",null,"Attributable to",null,"(Cash Basis)"]
["Hospital Charges (July 01, 2015 to June 30, 2016)",null,null,null,"Medicare Program",null,"Medicaid Program",null,"Medicaid Managed Care",null,"Other 3rd Parties",null,"Uninsured Patients",null,"Uninsured Payments"]
[null,null,"Inpatient Hospital Charges (Excluding Physician Charges)",null,0,null,0,null,0,null,0,null,0,null,0]
[null,null,"Outpatient Hospital Charges (Excluding Physician Charges)",null,0,null,0,null,0,null,0,null,0,null,0]
[null,null,"Hosp-Based Physician Charges I/P & O/P Hosp.",null,0,null,0,null,0,null,0,null,0,null,0]
[null,null,"Inpatient Psychiatric Hospital Services",null,0,null,0,null,0,null,0,null,0,null,0]
[null,null,"Outpatient Psychiatric Hospital Services",null,0,null,0,null,0,null,0,null,0,null,0]
[null,null,"Inpatient Rehabilitation Hospital Services",null,0,null,0,null,0,null,0,null,0,null,0]
[null,null,"Outpatient Rehabilitation Hospital Services",null,0,null,0,null,0,null,0,null,0,null,0]
[]
[null,"Total Hospital Charges by Payer Source & \nTotal Uninsured Payments",null,null,0,null,0,null,0,null,0,null,0,null,0]
[]
[null,"Total Hospital Charges by Payer Source & Total Uninsured Payments (Excluding Physician Charges)",null,null,0,null,0,null,0,null,0,null,0,null,0]
[{"$nulls":12},"(Agrees to Total Charges on Section B and Exhibit A)",null,"(Agrees to Total Payments on Section B and Exhibit B)"]
[{"$nulls":10},"     ",null,null,null,"ERROR--DOES NOT AGREE TO SECTION E"]
[]
[]
[{"$nulls":4},"Totals\n (All Payer Sources)"]
[null,null,"Total Hospital Charges",null,0]
[]
[null,null,"Total Hospital Charges (Excluding Physician Charges)",null,0]
[]
["Non-Hospital Charges (July 01, 2015 to June 30, 2016)"]
[null,null,"Hospital Swing Bed SNF/NF",null,0]
[null,null,"Skilled Nursing Facility / Nursing Facility",null,0]
[null,null,"Hospital-Based Rural Health Clinic",null,0]
[null,null,"Hospital-Based FQHC",null,0]
[null,null,"Hospital-Based Home Health Agency",null,0]
[null,null,"Other Non-Hospital Services",null,0]
[]
[null,null,"Total Non-Hospital Charges",null,0]
[]
[null,null,"Total Hospital and Non-Hospital Charges",null,0,null,"Note:  Amount must reconcile to facility wide charges July 01, 2015 to June 30, 2016"]
[]
[null,"Hospital Name",0]
[null,"Medicaid Provider ID Number :",""]
[]
[]
["D.  Certification"]
[]
[]
[]
[null,"The following certification is to be completed by the hospital's CEO or CFO:"]
[]
[null,"I hereby certify that the above information in the Louisiana DSH Survey is true and accurate to the best of our ability, and supported by financial and other records maintained by this entity.  I understand that this information will be used to determine Medicaid Disproportionate Share Hospital (DSH) eligibility and payments.  Detailed support exists for all amounts reported in this survey.  These records will be retained for a period of not less than 5 years following the due date of the survey.  "]
[]
[]
[null,"Hospital CEO or CFO Signature",null,null,"Date"]
[]
[]
[null,"Printed Name and Title"]
[]
[]
[]
[]
[null,"Contact Name",""]
[null,"Title",""]
[null,"Mailing Street Address",""]
[null,"City, State, Zip",""]
[null,"Telephone Number",""]
[null,"E-Mail Address",""]

{"sheet":"ADJ Sec. E Uninsured Data","index":7,"n_rows":95,"n_cols":58,"rows_kept":95,"cut":false,"hidden":true,"merged":[[3,6,3,8],[3,12,3,16]],"flags":["formulas_cached_only"]}
["Section E.  Calculation of Uninsured Inpatient and Outpatient Hospital Costs:",{"$nulls":56},0]
[]
[]
[{"$nulls":6},"7/1/2015 - 6/30/2016",{"$nulls":5},"7/1/2015 - 6/30/2016"]
[{"$nulls":6},"Uninsured Charges and Days",{"$nulls":5},"Uninsured Cost"]
["Line #","Cost Center Description","Per Diem Cost for Routine Cost Centers",null,"Cost to Charge Ratio for Ancillary Cost Centers",null,"Inpatient Days and Charges              (See Exhibit A)",null,"Outpatient Charges                 (See Exhibit A)",null,null,null,"Inpatient Cost",null,"Outpatient Cost",null,"Total"]
[]
["Data Sources:",null,"Cost Report Worksheet D-1,       Part II",null,"Cost Report Worksheet C        Part 1",null,"From Hospital's Own Internal Analysis",null,"From Hospital's Own Internal Analysis",null,null,null,"Calculated",null,"Calculated",null,"Calculated"]
[]
["Routine Cost Centers (list below):",{"$nulls":5},"Days"]
[30,"Adults & Pediatrics",0,null,null,null,0,{"$nulls":5},0,null,null,null,0]
[31,"Intensive Care Unit",0,null,null,null,0,{"$nulls":5},0,null,null,null,0]
[32,"Coronary Care Unit",0,null,null,null,0,{"$nulls":5},0,null,null,null,0]
[33,"Burn Intensive Care Unit",0,null,null,null,0,{"$nulls":5},0,null,null,null,0]
[34,"Surgical Intensive Care Unit",0,null,null,null,0,{"$nulls":5},0,null,null,null,0]
[0,"Neonatal Intensive Care Unit",0,null,null,null,0,{"$nulls":5},0,null,null,null,0]
[40,"Subprovider (Psychiatry)",0,null,null,null,0,{"$nulls":5},0,null,null,null,0]
[41,"Subprovider (Rehabilitation)",0,null,null,null,0,{"$nulls":5},0,null,null,null,0]
[43,"Nursery",0,null,null,null,0,{"$nulls":5},0,null,null,null,0]
[0,"Other (Please List)",0,null,null,null,0,{"$nulls":5},0,null,null,null,0]
[0,"Other (Please List)",0,null,null,null,0,{"$nulls":5},0,null,null,null,0]
[0,"Other (Please List)",0,null,null,null,0,{"$nulls":5},0,null,null,null,0]
[{"$nulls":4},"Total Days",null,0]
[]
[{"$nulls":6},"Routine Charges",{"$nulls":5},"Routine Costs"]
[null,"Routine Charges",{"$nulls":4},0,{"$nulls":5},0]
[null,"Calculated Routine Charge Per Diem",{"$nulls":4},0]
[]
["Ancillary Cost Centers (list below):",{"$nulls":5},"Ancillary Charges",null,"Ancillary Charges",null,null,null,"Ancillary Cost",null,"Ancillary Cost",null,"Ancillary Cost"]
[50,"Operating Room",null,null,0,null,0,null,0,null,null,null,0,null,0,null,0]
[53,"Anesthesiology",null,null,0,null,0,null,0,null,null,null,0,null,0,null,0]
[54,"Radiology-Diagnostic",null,null,0,null,0,null,0,null,null,null,0,null,0,null,0]
[60,"Laboratory",null,null,0,null,0,null,0,null,null,null,0,null,0,null,0]
[62,"Whole Blood & Packed Red BL",null,null,0,null,0,null,0,null,null,null,0,null,0,null,0]
[65,"Respiratory Therapy",null,null,0,null,0,null,0,null,null,null,0,null,0,null,0]
[66,"Physical Therapy",null,null,0,null,0,null,0,null,null,null,0,null,0,null,0]
[67,"Occupational Therapy",null,null,0,null,0,null,0,null,null,null,0,null,0,null,0]
[69,"Electrocardiology",null,null,0,null,0,null,0,null,null,null,0,null,0,null,0]
[71,"Medical Supplies Charged ",null,null,0,null,0,null,0,null,null,null,0,null,0,null,0]
[73,"Drugs Charged to Patients",null,null,0,null,0,null,0,null,null,null,0,null,0,null,0]
[91,"Emergency",null,null,0,null,0,null,0,null,null,null,0,null,0,null,0]
[92,"Observation",null,null,0,null,0,null,0,null,null,null,0,null,0,null,0]
[0,0,null,null,0,null,0,null,0,null,null,null,0,null,0,null,0]
[0,0,null,null,0,null,0,null,0,null,null,null,0,null,0,null,0]
[0,0,null,null,0,null,0,null,0,null,null,null,0,null,0,null,0]
[0,0,null,null,0,null,0,null,0,null,null,null,0,null,0,null,0]
[0,0,null,null,0,null,0,null,0,null,null,null,0,null,0,null,0]
[0,0,null,null,0,null,0,null,0,null,null,null,0,null,0,null,0]
[0,0,null,null,0,null,0,null,0,null,null,null,0,null,0,null,0]
[0,0,null,null,0,null,0,null,0,null,null,null,0,null,0,null,0]
[0,0,null,null,0,null,0,null,0,null,null,null,0,null,0,null,0]
[0,0,null,null,0,null,0,null,0,null,null,null,0,null,0,null,0]
[0,0,null,null,0,null,0,null,0,null,null,null,0,null,0,null,0]
[0,0,null,null,0,null,0,null,0,null,null,null,0,null,0,null,0]
[0,0,null,null,0,null,0,null,0,null,null,null,0,null,0,null,0]
[0,0,null,null,0,null,0,null,0,null,null,null,0,null,0,null,0]
[0,0,null,null,0,null,0,null,0,null,null,null,0,null,0,null,0]
[0,0,null,null,0,null,0,null,0,null,null,null,0,null,0,null,0]
[0,0,null,null,0,null,0,null,0,null,null,null,0,null,0,null,0]
[0,0,null,null,0,null,0,null,0,null,null,null,0,null,0,null,0]
[0,0,null,null,0,null,0,null,0,null,null,null,0,null,0,null,0]
[0,0,null,null,0,null,0,null,0,null,null,null,0,null,0,null,0]
[0,0,null,null,0,null,0,null,0,null,null,null,0,null,0,null,0]
[0,0,null,null,0,null,0,null,0,null,null,null,0,null,0,null,0]
[0,0,null,null,0,null,0,null,0,null,null,null,0,null,0,null,0]
[0,0,null,null,0,null,0,null,0,null,null,null,0,null,0,null,0]
[0,0,null,null,0,null,0,null,0,null,null,null,0,null,0,null,0]
[0,0,null,null,0,null,0,null,0,null,null,null,0,null,0,null,0]
[0,0,null,null,0,null,0,null,0,null,null,null,0,null,0,null,0]
[0,0,null,null,0,null,0,null,0,null,null,null,0,null,0,null,0]
[0,0,null,null,0,null,0,null,0,null,null,null,0,null,0,null,0]
[0,0,null,null,0,null,0,null,0,null,null,null,0,null,0,null,0]
[0,0,null,null,0,null,0,null,0,null,null,null,0,null,0,null,0]
[0,0,null,null,0,null,0,null,0,null,null,null,0,null,0,null,0]
[0,0,null,null,0,null,0,null,0,null,null,null,0,null,0,null,0]
[0,0,null,null,0,null,0,null,0,null,null,null,0,null,0,null,0]
[0,0,null,null,0,null,0,null,0,null,null,null,0,null,0,null,0]
[0,0,null,null,0,null,0,null,0,null,null,null,0,null,0,null,0]
[0,0,null,null,0,null,0,null,0,null,null,null,0,null,0,null,0]
[0,0,null,null,0,null,0,null,0,null,null,null,0,null,0,null,0]
[0,0,null,null,0,null,0,null,0,null,null,null,0,null,0,null,0]
[0,0,null,null,0,null,0,null,0,null,null,null,0,null,0,null,0]
[{"$nulls":4},"Total Charges",null,0,null,0]
[]
[{"$nulls":6},"Total IP and OP Charges",null,0,null,null,null,"ERROR - TOTAL CHARGES DO NOT AGREE TO SECTION C"]
[null,0,"Total Charges Prior to Match",{"$nulls":5},"(Section A & Exhibit A)"]
[null,0,"Total Charges After Match"]
[null,0,"Charges Removed for Match",{"$nulls":7},"Total Ancillary Costs",null,0,null,0,null,0]
[]
[{"$nulls":10},"Total Routine and Ancillary Costs",null,0,null,0,null,0]
[]
[{"$nulls":10},"Payments from Uninsured During Survey Period (Cash Basis)",null,0,null,0,null,0]
[{"$nulls":12},"(Exhibit B)",null,"(Exhibit B)"]
[]
[{"$nulls":10},"Net Uninsured Cost",null,0,null,0,null,0]

{"sheet":"Exhibit A - Patient Information","index":8,"n_rows":18,"n_cols":16,"rows_kept":18,"cut":false,"hidden":false,"merged":[[0,0,0,15],[5,9,5,10],[1,0,1,15],[5,6,5,8]],"flags":["formulas_cached_only"]}
["Summary of Uninsured Patient Services During the Survey Period"]
["7/1/2015 - 6/30/2016"]
[]
[]
[{"$nulls":13},"Cost","Total Charges","Routine"]
["Patient",{"$nulls":5},"Residency Information",null,null,"Date(s) of Service",null,"Service","Revenue","Report","for Services","Days of"]
["Identifier Code","Last Name","First Name","Social Security Number","Date of Birth","Gender","City","Parish/County","State","From","To","Indicator","Code","Line #","Provided","Care"]
[]
[{"$nulls":11},"Inpatient Hospital"]
[{"$nulls":11},"Outpatient Hospital"]
[{"$nulls":11},"Physician I/P & O/P Hospital"]
[{"$nulls":11},"Hospital-Based Pharmacy *"]
[{"$nulls":11},"Hospital-Based RHC"]
[{"$nulls":11},"Hospital-Based FQHC"]
[]
[]
[]
[{"$nulls":11},"* - For services not incidental to inpatient or outpatient hospital services."]

{"sheet":"Exhibit B - Uninsd Pmt (Cash)","index":9,"n_rows":15,"n_cols":12,"rows_kept":15,"cut":false,"hidden":false,"merged":[[6,0,6,1],[7,2,7,3],[7,8,7,10]],"flags":["formulas_cached_only"]}
["Summary of Uninsured Cash Collections Received in the Survey Period"]
["7/1/2015 - 6/30/2016"]
[]
[]
[]
[]
["Patient Identifier",{"$nulls":4},"Amount of","Indicate if",{"$nulls":4},"Calculated Hospital"]
["Patient",null,"Date(s) of Service",null,"Date of ","Cash","Collection is a","Service","Total Charges for Services Provided*",null,null,"Uninsured"]
["Identifier Code","Name","From","To","Cash Collection","Collections","1011 Payment***","Indicator","Hospital I/P & O/P","Physician I/P & O/P","Other Non-Hospital**","Collections"]
[]
[9999999,"Doe, John","2003-05-12","2003-05-25","2011-03-01",50,"Yes",null,50000,1000,0,49]
[9999999,"Doe, John","2003-05-12","2003-05-25","2011-04-01",75,"No",null,50000,1000,0,74]
[9999999,"Doe, John","2003-05-12","2003-05-25","2011-05-01",25,"No",null,50000,1000,0,25]
[9999999,"Doe, John","2003-05-12","2003-05-25","2011-06-01",45,"No",null,50000,1000,0,44]
[null,null,null,"Sub-Total",null,195,{"$nulls":5},192]

{"sheet":"Workbook Config","index":10,"n_rows":15,"n_cols":15,"rows_kept":15,"cut":false,"hidden":true,"merged":[],"flags":["formulas_cached_only"]}
[]
[]
["Workbook/Worksheet",null,"Is TRUE/FALSE",null,"Visible: -1/Hidden: 0/VeryHidden: 2","TRUE/FALSE","TRUE/FALSE","TRUE/FALSE",null,"TRUE/FALSE","Range","R1C1","Row# List","Col# List","Protection Schemes"]
["ObjectType","ObjectName","Protection","Password","Visibility","FormulaBar","Gridlines","Headings","CodeName","SelectedSheet","SelectedCell","ReferenceStyle","HiddenRows","HiddenColumns","Protections"]
["Workbook","Community Hospital and Act 540 DSH Survey SFY 2017.xls",true,"M&SDSH11",null,true,{"$nulls":5},1]
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["Worksheet","Checklist",false,null,-1,null,false,true,"Sheet6",false,"$E$24",null,"18:19",null,"EnableSelection:= 0, DrawingObjects:= False, Contents:= False, Scenarios:= False, UserInterfaceOnly:= False, AllowFormattingCells:= False, AllowFormattingColumns:= False, AllowFormattingRows:= False, AllowInsertingColumns:= False, AllowInsertingRows:= False, AllowInsertingHyperlinks:= False, AllowDeletingColumns:= False, AllowDeletingRows:= False, AllowSorting:= False, AllowFiltering:= False, AllowUsingPivotTables:= False"]
["Worksheet","Sec. A, B, C, D Hospital Data",false,null,-1,null,false,true,"Sheet1",false,"$C$5",null,null,"S:AO","EnableSelection:= 0, DrawingObjects:= False, Contents:= False, Scenarios:= False, UserInterfaceOnly:= False, AllowFormattingCells:= True, AllowFormattingColumns:= False, AllowFormattingRows:= False, AllowInsertingColumns:= False, AllowInsertingRows:= False, AllowInsertingHyperlinks:= False, AllowDeletingColumns:= False, AllowDeletingRows:= False, AllowSorting:= False, AllowFiltering:= False, AllowUsingPivotTables:= False"]
["Worksheet","Sec. E Uninsured Data",false,null,-1,null,false,true,"Sheet4",false,"$M$5",null,null,"S:BF","EnableSelection:= 0, DrawingObjects:= False, Contents:= False, Scenarios:= False, UserInterfaceOnly:= False, AllowFormattingCells:= False, AllowFormattingColumns:= False, AllowFormattingRows:= False, AllowInsertingColumns:= False, AllowInsertingRows:= False, AllowInsertingHyperlinks:= False, AllowDeletingColumns:= False, AllowDeletingRows:= False, AllowSorting:= False, AllowFiltering:= False, AllowUsingPivotTables:= False"]
["Worksheet","Sec. F Obstetrician Data",true,null,-1,null,false,true,"Sheet7",false,"$O$54",null,null,null,"EnableSelection:= 0, DrawingObjects:= True, Contents:= True, Scenarios:= True, UserInterfaceOnly:= False, AllowFormattingCells:= False, AllowFormattingColumns:= False, AllowFormattingRows:= False, AllowInsertingColumns:= False, AllowInsertingRows:= False, AllowInsertingHyperlinks:= False, AllowDeletingColumns:= False, AllowDeletingRows:= False, AllowSorting:= False, AllowFiltering:= False, AllowUsingPivotTables:= False"]
["Worksheet","ADJ Sec. A, B, C, D Hosp Data",false,null,0,null,false,true,"Sheet8",false,"$O$54",null,null,"Q:AP","EnableSelection:= 0, DrawingObjects:= False, Contents:= False, Scenarios:= False, UserInterfaceOnly:= False, AllowFormattingCells:= False, AllowFormattingColumns:= False, AllowFormattingRows:= False, AllowInsertingColumns:= False, AllowInsertingRows:= False, AllowInsertingHyperlinks:= False, AllowDeletingColumns:= False, AllowDeletingRows:= False, AllowSorting:= False, AllowFiltering:= False, AllowUsingPivotTables:= False"]
["Worksheet","ADJ Sec. E Uninsured Data",false,null,0,null,false,true,"Sheet9",false,"$O$54",null,null,"T:BF","EnableSelection:= 0, DrawingObjects:= False, Contents:= False, Scenarios:= False, UserInterfaceOnly:= False, AllowFormattingCells:= False, AllowFormattingColumns:= False, AllowFormattingRows:= False, AllowInsertingColumns:= False, AllowInsertingRows:= False, AllowInsertingHyperlinks:= False, AllowDeletingColumns:= False, AllowDeletingRows:= False, AllowSorting:= False, AllowFiltering:= False, AllowUsingPivotTables:= False"]
["Worksheet","Exhibit A - Patient Information",false,null,-1,null,false,true,"Sheet3",false,"$A$7",null,null,null,"EnableSelection:= 0, DrawingObjects:= False, Contents:= False, Scenarios:= False, UserInterfaceOnly:= False, AllowFormattingCells:= False, AllowFormattingColumns:= False, AllowFormattingRows:= False, AllowInsertingColumns:= False, AllowInsertingRows:= False, AllowInsertingHyperlinks:= False, AllowDeletingColumns:= False, AllowDeletingRows:= False, AllowSorting:= False, AllowFiltering:= False, AllowUsingPivotTables:= False"]
["Worksheet","Exhibit B - Uninsd Pmt (Cash)",false,null,-1,null,false,true,"Sheet10",true,"$L$23",null,null,null,"EnableSelection:= 0, DrawingObjects:= False, Contents:= False, Scenarios:= False, UserInterfaceOnly:= False, AllowFormattingCells:= False, AllowFormattingColumns:= False, AllowFormattingRows:= False, AllowInsertingColumns:= False, AllowInsertingRows:= False, AllowInsertingHyperlinks:= False, AllowDeletingColumns:= False, AllowDeletingRows:= False, AllowSorting:= False, AllowFiltering:= False, AllowUsingPivotTables:= False"]