Form C-6 "New Jersey Acute Care Hospitals Cost Reports - Nursing Service Details" - New Jersey

What Is Form C-6?

This is a legal form that was released by the New Jersey Department of Health - a government authority operating within New Jersey. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

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  • Fill out the form in our online filing application.

Download a fillable version of Form C-6 by clicking the link below or browse more documents and templates provided by the New Jersey Department of Health.

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Download Form C-6 "New Jersey Acute Care Hospitals Cost Reports - Nursing Service Details" - New Jersey

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C-6
NEW JERSEY ACUTE CARE HOSPITALS
2020
Hospital: __________________________________________
COST REPORTS
Do not change any preprinted
Hospital Number: |_____|_____|_____|_____|
wording on this form.
NURSING SERVICE DETAILS
Hours (Whole
Costs ($000’s)
Numbers)
A
B
C
D
E
F
G
H
I
Salaries
Employees
Contract
Other
Dep. & Fac.
Lease
Expense
TOTAL
Supplies
(2)
Employees
Services
Expenses
Int.
Cost
Recovery
COST
(2)
1
RNS
Registered Nursing Services
2
LPN
Licensed Practical Nursing
3
ATT
Nursing Attendants
4
CLR
Unit Clerical Services
5
TOTAL Inpatient
(1)
(1) Should agree with Form C, Page 1, MSA, PED, OBS, PSA, ICU, CCU, NNI, NBN.
(2) No physician salaries and fees should be included.
C-6
NEW JERSEY ACUTE CARE HOSPITALS
2020
Hospital: __________________________________________
COST REPORTS
Do not change any preprinted
Hospital Number: |_____|_____|_____|_____|
wording on this form.
NURSING SERVICE DETAILS
Hours (Whole
Costs ($000’s)
Numbers)
A
B
C
D
E
F
G
H
I
Salaries
Employees
Contract
Other
Dep. & Fac.
Lease
Expense
TOTAL
Supplies
(2)
Employees
Services
Expenses
Int.
Cost
Recovery
COST
(2)
1
RNS
Registered Nursing Services
2
LPN
Licensed Practical Nursing
3
ATT
Nursing Attendants
4
CLR
Unit Clerical Services
5
TOTAL Inpatient
(1)
(1) Should agree with Form C, Page 1, MSA, PED, OBS, PSA, ICU, CCU, NNI, NBN.
(2) No physician salaries and fees should be included.