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__ <br />G. Medical Sup lies and Expenses Schedule <br />(1) <br /> <br />Item (2) <br />Total <br />Cost <br /> <br />Total -Medical Su lies and Ex ense <br /> <br />H. Cost of Space -Non-Residential Schedule <br />(1) <br /> <br />Item (2) <br />Total <br />Cost <br /> <br />Total Cost of Space -Non-Residential <br /> <br />I. Room and Board Costs -Residential Treatment <br />~l) <br /> <br />Item ~2) <br /> <br />Method of Computation ~3) <br />Total <br />Cost <br /> <br />Total Room and Board Costs - Residential Treatment <br />