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G. Medical Supplies and Expense Schedule <br /> 22 <br /> (1 ) - (2) <br /> Total <br /> Item Cost <br /> - i <br /> Total - Medical Supplies and Expense <br /> H. Cost of Space - Non-Residential Schedule _ <br /> (1 ) (2) <br /> f 'Total <br /> Item L Cost <br /> � f <br /> 1 i <br /> Total Cost of Space - Non-Residential <br /> I. Room and Board Costs - Residential Treatment <br /> (1 ) f (2) • (3) <br /> Total <br /> Item Method of Com.utation Cost <br /> I Total Room 2no Ecarri Costs - Residen'i:l T;eatmen: <br /> 1 <br /> DSS-6844 (2/83) <br /> Family Services , <br />