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G. Medical Supplies and Expenses Schedule <br /> {1} (2) <br /> Total <br /> Item Cost <br /> N/A <br /> Total - Medical Supplies and Expense <br /> H. Cost of Space - Non-Residential Schedule <br /> {1) (2) <br /> Total <br /> Item Cost <br /> N/A <br /> Total Cost of Space - Non-Residential <br /> I. Room and Board Costs - Residential Treatment <br /> {1} (2) (3) <br /> Total <br /> Item Method of Computation Cost <br /> N/A <br /> Total Room and Board Costs- Residential Treatment <br />