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
The NHSC Site Data Tables are essential for reporting site-specific data related to patient care and service delivery. This guide will provide you with clear instructions for completing the form online, ensuring that you accurately document the required information.
Follow the steps to successfully complete the NHSC Site Data Tables online.
- Press the ‘Get Form’ button to access the NHSC Site Data Tables and open the form in the editing interface.
- Begin by entering the 'Site Name' and 'Site Address' in the designated fields. Ensure you provide the complete name and address of your site.
- Fill in the 'Date Prepared' field with the current date or the date you are completing the form.
- Specify the '6-Month Reporting Period' by entering the start and end dates in the mm/yy format.
- Complete the fields for 'Total Patients' and 'Total Patient Visits' using the actual data from the reporting period.
- In Table 1, provide the number of patients and patient visits categorized by primary insurance type. Ensure to fill out the 'Number of Patients' and 'Number of Patient Visits' for each insurance type.
- Continue to Table 2, and report the full charges, amounts collected, and adjustments for various payment sources, making sure to report in whole dollars.
- For Table 3, record the 'Number of Applications' for the Sliding Fee Schedule, ensuring to distinguish between approved and not approved applications.
- In Table 4, document the staffing levels by entering the Full-Time Equivalents for each category of personnel involved in service delivery at the site.
- After completing all sections, review the entries for accuracy. Once verified, you may opt to save changes, download, print, or share the completed form as needed.
Start filling out your NHSC Site Data Tables online today to ensure compliance and accurate reporting.
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