Please indicate the start and end dates of the twelve months for which the site is reporting. Scope Of Activity Reported The NHSC Site Data Tables are site specific one per physical address. Who Submits Site Data Tables Department of Health and Human Services to participate as an NHSC member site and which are not currently receiving grant support from the Health Resources and Services Administration s Bureau of Primary Health Care HRSA/BPHC. The NHSC Site Data Tables are to be completed prior to an NHSC Site Visit. All sites meeting the criteria above are to file a complete report except for Federal Bureau of Prison BOP nonfederal prison Indian Health Service IHS Section 638 and Immigration and Naturalization Service INS sites which are only to file the general site information Name of Site through Total Patient Visits and Table 4. Site Data Tables Name of Site Address of Site Date Prepared Prepared By 12 Month Reporting Period Total Annual Patients TABLE 1 PATIENTS OR VISITS BY PRIMA....
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How to fill out the NHSC Site Data Tables online
This guide provides a comprehensive overview of filling out the NHSC Site Data Tables online. It is designed to assist users in accurately completing each section and field of the form, ensuring that all necessary data is reported effectively.
Follow the steps to successfully complete the NHSC Site Data Tables.
- Press the ‘Get Form’ button to access the NHSC Site Data Tables and open the document for completion.
- Enter the site name in the designated field provided at the top of the form. Make sure to include the full legal name of the site.
- Fill in the site address in the spaces provided. Include the street address, city, state, and ZIP code.
- Indicate the date prepared in the designated field. This should reflect the date you are submitting the data.
- Complete the ‘6-Month Reporting Period’ section by entering the start and end dates of the reporting period as MM/YY.
- Input the total number of patients served during the reporting period in the ‘Total Patients’ field.
- Record the total patient visits in the provided space. Ensure accuracy as this affects overall reporting.
- In the first table (‘Patients or Visits by Primary Insurance Type’), provide data for either the number of patients or the number of patient visits categorized by primary insurance type.
- Complete each line in Table 1, including entering the exact number and percentages for categories such as Medicare, Medicaid, other public insurance, and private insurance.
- Proceed to Table 2 and report on patient service charges, collections, and any self-pay adjustments based on your records.
- In Table 3, record the number of sliding fee schedule applications approved and not approved, ensuring that all entries are accurate.
- Finally, complete Table 4 by detailing staffing information, categorizing personnel according to the specified major service categories and reporting their full-time equivalents (FTEs).
- Review all entered information for accuracy and completeness before proceeding to save your changes.
- Once all data is verified, save the completed form. You can also download, print, or share the document as needed.
Complete your NHSC Site Data Tables online today to ensure accurate reporting and compliance.
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