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16 <br /> meoical supplies anu expense 6 of 7 <br /> (1 ) l (2) <br /> Total <br /> Item Cost <br /> f <br /> Total - Medical Supplies and Expense <br /> H. Cost of Space - Non-Residential Schedule <br /> (1 ) (2) <br /> Total <br /> Item 1 Cost <br /> i <br /> f <br /> Total Cost of Space - Non-Residential <br /> I. Room and Board Costs - Residential Treatment <br /> (1 ) <br /> (2) (3) <br /> Total <br /> Item 1 Method of Computation Cost <br /> 1 <br /> _ I <br /> Total Roo,;, aro 'car Costs - Resid en' , _I r°_atment_ <br /> MS-6844 (2/83) <br /> Family Services <br />