Contract Support Services - Healthcare Materials Management Consulting

CONTRACT SUPPORT SERVICES

Healthcare Materials Management Consulting

Contract Support Services - Healthcare Materials Management Consulting

Supply Cost Benchmark Study

Contract Support Services
2708 Foothill Blvd., #406
La Crescenta, CA 91214

Phone - 818.957.2649
Fax - 818.957.2790

If you are inquiring about a multiple faclity system, please choose the option to "Add A Facility" at the end of this form. This will allow you to enter information for each of the facilities in your system.
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General Information
*Facility Name:
Facility Address:
*Contact Name:
Contact Title:
*Contact Telephone:
*Email Address:
Facility Information
Licensed Beds ..............................................................................
Total Admissions (Annual) .........................................................
Non Acute or Speciality Admissions (Annual):
Speciality Type: Psych LTC Other
Total Adjusted Patient Days (Annual) ........................................
Non Acute or Speciality Adj. Patient Days (Annual) ................
Optional
Case Mix Index ..............................................................................
Surgical Procedures ....................................................................
  Per Year
Per Month
Financial Information
Total Revenues .............................................................................
Total Operating Expenses ..........................................................
Total Supply Expenses ................................................................
Percent by Category (Optional):
Surgical ..........................................................................................
Medical ...........................................................................................
Ancillary ..........................................................................................
Other ...............................................................................................
Total Purchased Services Expenses .......................................
Percent by Category (Optional):
Surgical ..........................................................................................
Medical ...........................................................................................
Ancillary ..........................................................................................
Other ...............................................................................................