Form H-2 "New Jersey Acute Care Hospitals Cost Reports - Summary of Medical Professional Budget Component" - New Jersey

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NEW JERSEY ACUTE CARE HOSPITALS
2020
H-2
COST REPORTS
Page 1 of 2
Hospital: __________________________________________
SUMMARY OF MEDICAL
Do not change any preprinted
Hospital Number: |_____|_____|_____|_____|
PROFESSIONAL
wording on this form.
BUDGET COMPONENT
Affiliation Code:
U=UMDNJ
J=Jefferson
N=NYU
NO=NY College of Osteopathy
C=Columbia Presbyterian
H=Hahnemann
K=Kansas
UP=University of Pennsylvania
P=Phila. College of Osteopathy
For other affiliates, enter 1, 2, etc., under “AFF.” And identify on an attached schedule.
A
B
C
D
E
F
G
H
I
J
K
L
M
N
O
P
Q
R
Accr. (1)
Physicians
Dept. Chiefs / Dir.
R e s i d e n t s
Total
Resident Programs
No.
Sal.&
Sal. &
Number of Trainees (2)
Sal. &
Sal. &
Aff.
Ltr.
Acc.
Hours
Fees (3)
Hours
Fees (3)
Hours
Fees (3)
Hours
Fees (3)
Att.
PGY 1
PGY 2
PGY 3
PGY 4
PGY 5
PGY 6
Total
Agcy.
(000’s)
(000’s)
(000’s)
(000’s)
1
Allergy/Immunology
2
Anesthesiology
3
Colon/Rectal Surgery
4
Dermatology
5
Emergency Medicine
6
Family Practice
7
Geriatrics
8
Internal Medicine
9
Cardiovascular
10
Critical Care
11
Endocrinology/Metabolism
12
Gastroenterology
13
Hematology/Oncology
14
Infectious Diseases
15
Nephrology
16
Pulmonary Disease
17
Rheumatology
18
Combined Med./Pediatrics
19
Neurology
20
Obstetrics/Gynecology
21
Ophthalmology
22
Orthopedics
Footnotes – See Page 2 of 2.
NEW JERSEY ACUTE CARE HOSPITALS
2020
H-2
COST REPORTS
Page 1 of 2
Hospital: __________________________________________
SUMMARY OF MEDICAL
Do not change any preprinted
Hospital Number: |_____|_____|_____|_____|
PROFESSIONAL
wording on this form.
BUDGET COMPONENT
Affiliation Code:
U=UMDNJ
J=Jefferson
N=NYU
NO=NY College of Osteopathy
C=Columbia Presbyterian
H=Hahnemann
K=Kansas
UP=University of Pennsylvania
P=Phila. College of Osteopathy
For other affiliates, enter 1, 2, etc., under “AFF.” And identify on an attached schedule.
A
B
C
D
E
F
G
H
I
J
K
L
M
N
O
P
Q
R
Accr. (1)
Physicians
Dept. Chiefs / Dir.
R e s i d e n t s
Total
Resident Programs
No.
Sal.&
Sal. &
Number of Trainees (2)
Sal. &
Sal. &
Aff.
Ltr.
Acc.
Hours
Fees (3)
Hours
Fees (3)
Hours
Fees (3)
Hours
Fees (3)
Att.
PGY 1
PGY 2
PGY 3
PGY 4
PGY 5
PGY 6
Total
Agcy.
(000’s)
(000’s)
(000’s)
(000’s)
1
Allergy/Immunology
2
Anesthesiology
3
Colon/Rectal Surgery
4
Dermatology
5
Emergency Medicine
6
Family Practice
7
Geriatrics
8
Internal Medicine
9
Cardiovascular
10
Critical Care
11
Endocrinology/Metabolism
12
Gastroenterology
13
Hematology/Oncology
14
Infectious Diseases
15
Nephrology
16
Pulmonary Disease
17
Rheumatology
18
Combined Med./Pediatrics
19
Neurology
20
Obstetrics/Gynecology
21
Ophthalmology
22
Orthopedics
Footnotes – See Page 2 of 2.
NEW JERSEY ACUTE CARE HOSPITALS
2020
COST REPORTS
H-2
Page 2 of 2
Hospital: __________________________________________
SUMMARY OF MEDICAL
Do not change any preprinted
PROFESSIONAL
Hospital Number: |_____|_____|_____|_____|
wording on this form.
BUDGET COMPONENT
A
B
C
D
E
F
G
H
I
J
K
L
M
N
O
P
Q
R
Accr. (1)
Physicians
Dept. Chiefs / Dir.
R e s i d e n t s
Total
Resident Programs
No.
Sal.&
Sal. &
Number of Trainees (2)
Sal. &
Sal. &
Aff.
Ltr.
Acc.
Hours
Fees (3)
Hours
Fees (3)
Hours
Fees (3)
Hours
Fees (3)
Att.
PGY 1
PGY 2
PGY 3
PGY 4
PGY 5
PGY 6
Total
Agcy.
(000’s)
(000’s)
(000’s)
(000’s)
23
Otolaryngology
24
Pathology
25
Pediatrics
26
Neonatal Perinatal Med.
27
Physical Medicine/Rehab.
28
Plastic Surgery
29
Preventive Med./Occ. Med.
30
Psychiatry
31
Diagnostic Radiology
32
Nuclear Radiology
33
Radiation Oncology
34
Surgery
35
Neurosurgery
36
Vascular surgery
37
Thoracic Surgery
38
Urology
39
Transitional
40
Dentistry/General
41
Oral Surgery
42
Podiatry
43
Other
44
TOTAL
(1)
Column A: Letters of affiliation received during the year from ACGME, AOA, or ADA are attached; Column B: No accrediting agency exists.
(2)
In Columns H through M inclusive, please report all GME positions in terms of full-time persons (not equivalents) in-house. Prorate if employed for portion of year. Column N should correspond
with the Total dollars reported on Form C, Columns B and C, Line 33.
(3)
The sum of Columns E, G and P should equal Column R and the sum of Form C, Line 51, Columns E and F.
(4)
The sum of Columns D, F and O should equal Column Q and the sum of Form C, Line 51, Columns B and C.
Page of 2