A.1 NOTES: A.2: Participant Demographics during Reporting Period (Newly Enrolled Only) 9. Adult Participants by Age (Newly Enrolled) Adult 18-19 20-21 22-24 25-29 35-44 45-54 55-64 not Total ≤17 ≥65 Participants 34 Report Pregnant Women Female Caregivers Male Caregivers All Adults (Auto Calculate) 10. Participants by Ethnicity (Newly Enrolled) Hispanic Unknown/Did Participants or Not Hispanic or Latino Total not Report Latino Pregnant Women Female Caregivers Male Caregivers All Adults (Auto Calculate) Female Index Children Male Index Children All Index Children (Auto Calculate)
A.1 NOTES: A.2: Participant Demographics during Reporting Period (Newly Enrolled Only) 9. Adult Participants by Age (Newly Enrolled) Adult Participants ≤17 18-19 20-21 22-24 25-29 35-44 45-54 55-64 ≥65 not Report Total Pregnant Women Female Caregivers Male Caregivers All Adults (Auto Calculate) 10. Participants by Ethnicity (Newly Enrolled) Participants Hispanic or Latino Not Hispanic or Latino Unknown/Did not Report Total Pregnant Women Female Caregivers Male Caregivers All Adults (Auto Calculate) Female Index Children Male Index Children All Index Children (Auto Calculate) 34
tribal_miechv_implementation_plan_guidance_and_form_1.docx