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