Schedule A-7 Center Name: NEW JERSEY DEPARTMENT OF HUMAN SERVICES Page 2 of 2 PEDIATRIC MEDICAL DAY CARE CENTER COST REPORT DHS License Number: Molina Number: DO NOT change any preprinted ITEMIZED SALARY SCHEDULE Cost Report F.Y.E.: wording on this schedule. Sch.A Clinical Work Schedule Function Total Hours Full Time Line Name Position Hours Per Annual Salary Days and Hours of the Code * Per Week Equivalent No. Week Day *Codes: A-Administration C-Clinical Staff D–Dietary Staff S-Support Staff T-Transportation Note: Administrator and Assistant Administrator are reported under “A”, Administration.
Center Name: DHS License Number: Molina Number: Cost Report F.Y.E.: NEW JERSEY DEPARTMENT OF HUMAN SERVICES PEDIATRIC MEDICAL DAY CARE CENTER COST REPORT ITEMIZED SALARY SCHEDULE Schedule A-7 Page 2 of 2 DO NOT change any preprinted wording on this schedule. Sch.A Line No. Name Position Function Code * Total Hours Per Week Clinical Hours Per Week Annual Salary Full Time Equivalent Work Schedule Days and Hours of the Day *Codes: A-Administration C-Clinical Staff D–Dietary Staff S-Support Staff T-Transportation Note: Administrator and Assistant Administrator are reported under “A”, Administration.
(F)%20PRN%202016-209%20(DHS-DAS%2010_166).docx