PARD Forms

This form needs to be submitted by a critical access hospital when it is requesting the initiation of an interim rate request.

This form needs to be submitted by a distinct partial unit when it is requesting the initiation of an interim rate request.

This form needs to be submitted by a hospital when it is requesting the initiation of an interim rate request.

This form needs to be submitted by a rural health clinic when it is requesting the initiation of an interim rate request.

This form needs to be submitted by a swing bed facility when it is requesting the initiation of an interim rate request.

This form needs to be submitted by a distinct partial unit when it is requesting the initiation of a periodic interim payment (PIP) request.

This form needs to be submitted by a hospital when it is requesting the initiation of a periodic interim payment (PIP) request.

This form needs to be submitted by an inpatient rehabilitation facility (IRF) when it is requesting the initiation of a periodic interim payment (PIP) request.

Providers should use this submittal sheet when they are faxing their statistical and reimbursement reports.