Medical homes have the Yes Title V 0 None capacity for electronic health 1 Weak (IF YES) How effective are those State Medicaid information and exchange, policies and procedures? CHIP 2 Moderate including maintenance of 1 Not effective Health Plan/Insurer 3 Strong clinical information. 2 Somewhat effective Provider (please specify) 3 Very effective Family/Consumer Other (please specify) OPTIONAL: Why? No for score, above ) (Select “0” Not applicable to my organization Enter Score: Enter Score: Families have easy access to Yes Title V 0 None their electronic health (IF YES) How effective are those State Medicaid 1 Weak information and the opportunity policies and procedures? CHIP 2 Moderate to contribute to the record. 1 Not effective Health Plan/Insurer 3 Strong 2 Somewhat effective Provider (please specify) 3 Very effective Family/Consumer Other (please specify) OPTIONAL: Why? No for score, above ) (Select “0” Not applicable to my organization Enter Score: Enter Score:
Medical homes have the capacity for electronic health information and exchange, including maintenance of clinical information. Yes (IF YES) How effective are those policies and procedures? 1 Not effective 2 Somewhat effective 3 Very effective No (Select “0” for score, above ) Not applicable to my organization Enter Score: Title V State Medicaid CHIP Health Plan/Insurer Provider (please specify) Family/Consumer Other (please specify) 0 None 1 Weak 2 Moderate 3 Strong OPTIONAL: Why? Enter Score: Families have easy access to their electronic health information and the opportunity to contribute to the record. Yes (IF YES) How effective are those policies and procedures? 1 Not effective 2 Somewhat effective 3 Very effective No (Select “0” for score, above ) Not applicable to my organization Enter Score: Title V State Medicaid CHIP Health Plan/Insurer Provider (please specify) Family/Consumer Other (please specify) 0 None 1 Weak 2 Moderate 3 Strong OPTIONAL: Why? Enter Score: