Attachment A Hospital Sitting Services - Service Delivery Area Name of Applicant: _____________________________ Date: _____________________ Region(s) to be Served: Applicant must mark with a next to the Region(s), and Catchment Area “√” (where applicable) to be served. Region Catchment Area √ Region One (1) Area 1 Area 2 Region Two (2) Region Three (3) Region (4) Four Area 1 Area 2 Region Five (5) Region Six (6) Region Seven (7) Region Eight (8) Region Nine (9) Region Ten (10) Region Eleven (11) Region 1 Catchment Area 1: The following Counties in Region 1 Armstrong, – – Carson, Collingsworth, Dallam, Deaf Smith, Donley, Gray, Hansford, Hartley, Hemphill, Hutchinson, Lipscomb, Moore, Ochiltree, Oldham, Potter, Randall, Roberts, Sherman, and Wheeler; Region 1 - Catchment Area 2: The following Counties in Region1 Bailey, – Briscoe, Castro, Childress, Cochran, Crosby, Dickens, Garza, Hale, Hall, Hockley, King, Lamb, Lubbock, Lynn, Motley, Parmer, Swisher, Terry, and Yoakum; Region 2 All Counties in Region 2 – Region 3 All Counties in Region 3 – Region 4 Catchment Area 1: All Counties in Region 4 – All Counties in Region 4, but only for children Region 4 - Catchment Area 2: hospitalized in the states of Arkansas or Louisiana Region 5 All Counties in Region 5 –
Attachment A Hospital Sitting Services - Service Delivery Area Name of Applicant: _____________________________ Date: _____________________ Region(s) to be Served: Applicant must mark with a “√” next to the Region(s), and Catchment Area (where applicable) to be served. Region √ Catchment Area Region One (1) Area 1 Area 2 Region Two (2) Region Three (3) Region Four (4) Area 1 Area 2 Region Five (5) Region Six (6) Region Seven (7) Region Eight (8) Region Nine (9) Region Ten (10) Region Eleven (11) Region 1 – Catchment Area 1: The following Counties in Region 1 – Armstrong, Carson, Collingsworth, Dallam, Deaf Smith, Donley, Gray, Hansford, Hartley, Hemphill, Hutchinson, Lipscomb, Moore, Ochiltree, Oldham, Potter, Randall, Roberts, Sherman, and Wheeler; Region 1 - Catchment Area 2: The following Counties in Region1 – Bailey, Briscoe, Castro, Childress, Cochran, Crosby, Dickens, Garza, Hale, Hall, Hockley, King, Lamb, Lubbock, Lynn, Motley, Parmer, Swisher, Terry, and Yoakum; Region 2 – All Counties in Region 2 Region 3 – All Counties in Region 3 Region 4 – Catchment Area 1: All Counties in Region 4 Region 4 - Catchment Area 2: All Counties in Region 4, but only for children hospitalized in the states of Arkansas or Louisiana Region 5 – All Counties in Region 5