(a) Types of patients served:

1. (1) Outpatients.
2. (2) Inpatients.
3. (3) Both.

(b) Please indicate the following data for inpatient programs:

1. (1) Number of certified beds at the end of the reporting period.
2. (2) Number of admissions during the reporting period.
3. (3) Number of patient days rendered during the reporting period.

(c) Please indicate the following data for outpatient programs:

1. (1) Register of patients on last day of reporting period.
2. (2) Total number of different patients treated during the reporting period.
3. (3) Total number of visits during the reporting period.