Leave of Absence, Bed Hold, and Room and Board (leave)
(Boxes 12 and 13), and the recipient’s status is noted as “00” (still under care) in the Patient Status field (Box 14). Also, since the initial billing period is for nine days at the San Francisco County NF-B per . diem rate of $137.95, the gross amount $1241.55 is entered in the . Gross Amount field (Box 17). ................
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