Support Services Consulting

Supply Cost Benchmark Study 

* Denotes a required field.
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 ...............................................................................................