Enter Facility Daily Composite Rate  

 (facility composite rate should include drug add-back and budget neutrality factor)
  Height (cm) Weight (kg) Age Case-Mix Composite Rate
0
 

Enter Height

Enter Weight

Enter Age

  
Patient BSA Patient BMI BSA Adjust Fact BMI Adjust Fact Age Adjust Fact
0 0 0 0 0
 
Supply Cost Start Date Stop Date Billable Days 100% Profit / -Loss
0 0

Enter Supply Cost

Enter Start Date

Enter Stop Date

  
  80% Profit / -Loss

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0
  Method II
Support Services
0