CHILDREN WITH SPECIAL HEALTH CARE NEEDS (CSHCN) PROGRAM 2011-2012 QUARTERLY NARRATIVE REPORT Oct 2011 December 2011 CSHCN Program: Quarter(s): – Report Completed By: Jan 2012 March 2012 – E-mail address: April 2012 June 2012 – Telephone Number: July 2012 September 2012 – Instructions: The quarterly narrative is a standardized document that should be used throughout the entire contract year. The format of the forms should not be changed. The narrative and data report should be submitted to the contract manager via secure file transfer of the Health electronically Commerce System no later than 45 days from the end of the quarter for which reimbursement is being claimed. For each quarter, describe in the narrative section, where applicable, steps taken in that period to accomplish planned work plan requirements. If planned activities shift based on unanticipated circumstances, the quarterly report should indicate change and/or modifications. The Summary Page should discuss any changes that occur during the contract period. EXAMPLE Q-1 Q-2 Q-3 Q-4 Work Pan Requirements 10/1/11-12/31/11 1/1/12-3/31/12 4/1/12-6/30/12 7/1/12-9/30/12 LHD shall provide information via Mailed out CSHCN Disseminated brochures Distributed at two area Attended five outreach print or electronic form about the brochures to local school on CSHCNs at two health hospitals Mom” events this quarter. See services of the CSHCN Program, districts, libraries and fairs and one community informational bags that attached list of details. gap-filling programs, insurance, social workers at three event. included CSHCN Resource and state and local programs to area hospitals. Directory, CHP, FHP and health care providers and health medical home brochures. care facilities. NOTE: If a requirement has a checkbox in a column(s) labeled as Q-1, Q-2, Q-3 or Q-4, a narrative response is not required. Indicate the requirement is met by checking the box in the appropriate column. A narrative response is needed for all other requirements.
CHILDREN WITH SPECIAL HEALTH CARE NEEDS (CSHCN) PROGRAM 2011-2012 QUARTERLY NARRATIVE REPORT CSHCN Program: Quarter(s): Oct 2011 – December 2011 Report Completed By: Jan 2012 – March 2012 E-mail address: April 2012 – June 2012 Telephone Number: July 2012 – September 2012 Instructions: The quarterly narrative is a standardized document that should be used throughout the entire contract year. The format of the forms should not be changed. The narrative and data report should be submitted electronically to the contract manager via secure file transfer of the Health Commerce System no later than 45 days from the end of the quarter for which reimbursement is being claimed. For each quarter, describe in the narrative section, where applicable, steps taken in that period to accomplish planned work plan requirements. If planned activities shift based on unanticipated circumstances, the quarterly report should indicate change and/or modifications. The Summary Page should discuss any changes that occur during the contract period. EXAMPLE Work Pan Requirements Q-1 10/1/11-12/31/11 Q-2 1/1/12-3/31/12 Q-3 4/1/12-6/30/12 Q-4 7/1/12-9/30/12 LHD shall provide information via print or electronic form about the services of the CSHCN Program, gap-filling programs, insurance, and state and local programs to health care providers and health care facilities. Mailed out CSHCN brochures to local school districts, libraries and social workers at three area hospitals. Disseminated brochures on CSHCNs at two health fairs and one community event. Distributed at two area hospitals Mom” informational bags that included CSHCN Resource Directory, CHP, FHP and medical home brochures. Attended five outreach events this quarter. See attached list of details. NOTE: If a requirement has a checkbox in a column(s) labeled as Q-1, Q-2, Q-3 or Q-4, a narrative response is not required. Indicate the requirement is met by checking the box in the appropriate column. A narrative response is needed for all other requirements.
Children%20With%20Special%20Health%20Care%20Needs%2012.15.docx