Spreadsheet: 07e8f140-3ff0-4144-8504-e406f875aee0
Sheet: Sheet1

Unnamed: 0 | Provider Name: | Unnamed: 2 | Unnamed: 3
 | Contact Person:
 | Phone:
 | E-Mail:
 | Date of Service July 1, 2010 - September 30, 2010 (Due October 31, 2010)
 | Total Charges |  | Entry Notes
 | Total Charges | 0
 | 3rd party payments | 0
 | Patient Liability | 0
 | Write-Off Amount | 0
 | Charges
 | Outpatient Urgent & Emergency | 0
 | Outpatient Non-Urgent & Non-Emergency | 0
 | Inpatient Urgent & Emergency | 0
 | Inpatient Non-Urgent & Non-Emergency | 0
 | Total Charges | 0 | Entry Does Match Cell C9
 | Inpatient Admits
 | Total Number of Admissions | 0
 | Total Number of Days | 0
 | Number of Admissions by CICP Rating
 | A | 0
 | B | 0
 | C | 0
 | D | 0
 | E | 0
 | F | 0
 | G | 0
 | N | 0
 | H | 0
 | I | 0
 | Z | 0
 | Unknown | 0
 | Total | 0 | Entry Does Match Cell C24
 | Number of Days by CICP Rating
 | A | 0
 | B | 0
 | C | 0
 | D | 0
 | E | 0
 | F | 0
 | G | 0
 | N | 0
 | H | 0
 | I | 0
 | Z | 0
 | Unknown | 0
 | Total | 0 | Entry Does Match Cell C25
 | Number of Admits by Age & Sex
 | Male
 | 0-5 | 0
 | 6-17 | 0
 | 18-24 | 0
 | 25-54 | 0
 | 55-64 | 0
 | 65+ | 0
 | Total | 0
 | Female
 | 0-5 | 0
 | 6-17 | 0
 | 18-24 | 0
 | 25-54 | 0
 | 55-64 | 0
 | 65+ | 0
 | Total | 0
 | Total | 0 | Entry Does Match Cell C24
 | Inpatient Charges by Age & Sex
 | Male
 | 0-5 | 0
 | 6-17 | 0
 | 18-24 | 0
 | 25-54 | 0
 | 55-64 | 0
 | 65+ | 0
 | Total | 0
 | Female
 | 0-5 | 0
 | 6-17 | 0
 | 18-24 | 0
 | 25-54 | 0
 | 55-64 | 0
 | 65+ | 0
 | Total | 0
 | Total | 0 | Entry Does [NAME] C18+C19
 | Outpatient Visits
 | Total Number of Visits | 0
 | Number of Visits by CICP Rating
 | A | 0
 | B | 0
 | C | 0
 | D | 0
 | E | 0
 | F | 0
 | G | 0
 | N | 0
 | H | 0
 | I | 0
 | Z | 0
 | Unknown | 0
 | Total | 0 | Entry Does Match Cell C99
 | Number of Visits by Age & Sex
 | Male
 | 0-5 | 0
 | 6-17 | 0
 | 18-24 | 0
 | 25-54 | 0
 | 55-64 | 0
 | 65+ | 0
 | Total | 0
 | Female
 | 0-5 | 0
 | 6-17 | 0
 | 18-24 | 0
 | 25-54 | 0
 | 55-64 | 0
 | 65+ | 0
 | Total | 0
 | Total | 0 | Entry Does Match Cell C99
 | Outpatient Charges by Age & Sex
 | Male
 | 0-5 | 0
 | 6-17 | 0
 | 18-24 | 0
 | 25-54 | 0
 | 55-64 | 0
 | 65+ | 0
 | Total | 0
 | Female
 | 0-5 | 0
 | 6-17 | 0
 | 18-24 | 0
 | 25-54 | 0
 | 55-64 | 0
 | 65+ | 0
 | Total | 0
 | Total | 0 | Entry Does Match Cell C17+C16
 | Unduplicated Patient Count
 | Total Number of Unique Clients Served (not claims) by Age
 | 0-5 | 0
 | 6-18 | 0
 | 19+ | 0
 | Total | 0
 | Total Number of Unique Inpatient Clients Served (not claims) by Age
 | 0-5 | 0
 | 6-18 | 0
 | 19+ | 0
 | Total | 0
 | Total Number of Unique Outpatient Clients Served (not claims) by Age
 | 0-5 | 0
 | 6-18 | 0
 | 19+ | 0
 | Total | 0
 | County Utilization
 | Admits & Visits by County (County code)
 | 01  Adams | 0
 | 02  [NAME] | 0
 | 03  Arapahoe | 0
 | 04  Archuleta | 0
 | 05  Baca | 0
 | 06  Bent | 0
 | 07  Boulder | 0
 | 08  Chaffee | 0
 | 09  Cheyenne | 0
 | 10  Clear Creek | 0
 | 11  Conejos | 0
 | 12  Costilla | 0
 | 13  Crowley | 0
 | 14  Custer | 0
 | 15  Delta | 0
 | 16  Denver | 0
 | 17  Dolores | 0
 | 18  [NAME] | 0
 | 19  Eagle | 0
 | 20  Elbert | 0
 | 21  El Paso | 0
 | 22  Fremont | 0
 | 23  [NAME] | 0
 | 24  [NAME] | 0
 | 25  Grand | 0
 | 26  Gunnison | 0
 | 27  Hindsdale | 0
 | 28  Huerfano | 0
 | 29  Jackson | 0
 | 30  Jefferson | 0
 | 31  [NAME] | 0
 | 32  [NAME] | 0
 | 33  Lake | 0
 | 34  La Plata | 0
 | 35  Larimer | 0
 | 36  [NAME] | 0
 | 37  Lincoln | 0
 | 38  Logan | 0
 | 39  Mesa | 0
 | 40  Mineral | 0
 | 41  [NAME] | 0
 | 42  Montezuma | 0
 | 43  Montrose | 0
 | 44  Morgan | 0
 | 45  Otero | 0
 | 46  Ouray | 0
 | 47  Park | 0
 | 48  Phillips | 0
 | 49  [NAME] | 0
 | 50  Prowers | 0
 | 51  Pueblo | 0
 | 52  Rio Blanco | 0
 | 53  Rio Grande | 0
 | 54  Routt | 0
 | 55  Saguache | 0
 | 56  San Juan | 0
 | 57  San Miguel | 0
 | 58  Sedgwick | 0
 | 59  Summit | 0
 | 60  Teller | 0
 | 61  Washington | 0
 | 62  Weld | 0
 | 63  Yuma | 0
 | 64  Broomfield | 0
 | Unknown | 0
 | Total | 0 | Entry Does Match Cell C99+C24