32 Miss. Code. R. 1-22.5
Facility/Agency Furnishing Services - This item involves identifying sources that actually delivered rehabilitation/independent living services to the client not the source paying for the service.
Services Furnishing - Public and Private Sources - Select the choice if the client received some services in a public rehabilitation facility and some in a private rehabilitation facility or if a client attended both public and private clinic during the rehabilitation process.
Educational Institutions (except Business/Vocational Schools) -Includes colleges, universities, junior colleges, elementary or high schools and schools for the mentally and physically disabled.
Business/Vocational Schools - Includes business, commercial, vocational, technical or trade schools.
Hospitals and Sanatoriums - Includes hospitals, mental hospitals, other chronic condition or specialized hospitals.
Health Organization and Agencies (except Rehabilitation Facilities) Includes community mental health centers, State Children's Agencies and any other public and private health organizations and agencies.
Community Rehabilitation Facilities - Includes any location at which a variety of services are provided to help individuals overcome their functional limitations in reference to their disabilities.
Welfare Agencies Includes State and local Welfare agencies, labor unions, civic and community welfare organizations.
Other Public Organizations and Agencies (not specifically education, health or welfare) Includes State employment agency, State Vocational Rehabilitation Agency, Social Security, etc. Since this pertains to only public sources, legitimate selections would be "services furnished public sources."
Other Private Organizations and Agencies (not specifically education, health or welfare) Includes employee, prosthetic and orthotic companies, etc. Since this pertains to only private sources, legitimate selections would be "services furnished private sources"
Individual (Private) - Includes physicians and other persons providing services who cannot be classified with an organization or agency. Since this pertains to only private sources, legitimate codes would be "services furnished private sources."
Donations - Cash Donated: enter the amount that the client has received from any outside resource to help purchase planned services.
Estimated Value of Goods and Services Estimate the value of goods and services purchased with the cash donation.
32 Miss. Code. R. 1-22.5