Resident Name: Enter Resident Roll

Pay Status: M = Medicaid E = Medicare V = Veteran's Administration P = Private Pay O = Other Third Party

Census Codes: LEVEL OF CARE

S = Skilled A = Intermediate I B = Intermediate II C = Intermediate III D = ICF/IID

Present = Identify the RESIDENT as being present by placing the appropriate level of care designation for each day on the census roll sheet.

H = Paid Hospital Leave, Bed Reserved. Place an H for each day on the census roll sheet in addition to the level of care when a resident is in the hospital and the day is a paid day.

T = Paid Therapeutic Home Leave, Bed Reserved. Place a T for each day on the census roll sheet in addition to the level of care when a resident is on Therapeutic Home Leave and the day is a paid day.

_ Deceased _

_ Transferred _

_ Discharged _

X = Non-Paid Leave