Please provide the requested general information and answer
the lead question below. If your children’s hospital has any residency program
where at least one resident spent greater than or equal to 75% time under
children’s hospital supervision, please answer ‘Yes’ and complete the table
below with hospital-level data. If not, please answer ‘No’, and click ‘Save and
Validate’ to proceed to the next required form. If ‘Yes’ was answered, please
provide the number of hospital discharges for the most recently completed
academic year (July 1 – June 30) for each of the following payment groups.
Include all Medicaid payments including Medicaid managed care and any other
Medicaid payments under the Medicaid and/or CHIP category. Self-pay refers to
patients who have made out-of-pocket payments for services. Uncompensated care
means care for which the hospital receives no payment. Do not include lab
services under Outpatient visits. Please refer to the instruction manual and/or
contact your Government Project Officer if you have any questions about how to
complete this form.