Forms, Reports & Program Information

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These are program-specific forms, reports, and information posted here as a courtesy to Local Health Jurisdictions

 If you have questions about these materials and/or any programs not listed here, contact your program staff (see Contact Lists).

Some files on this page require free readers.  Download a reader.

HIV Prevention  

The two Client Satisfaction Survey forms are to be used by HIV Counseling and Testing programs to conduct a client satisfaction survey at least one time during the year. There are two different surveys:  one for standard testing and one for rapid testing.  The length of time this survey is conducted and number of clients surveyed is up to the funded agency.  A summary report of the aggregate data from these surveys is due 30 days from survey completion and no later than December 31st.

The Observation Report Form is the reporting form agencies should use to report on the observations they do of HIV Testing Counselors.  The report is due 30 days from observation and no later than December 31st.

• HIV Test Counseling Client Satisfaction Survey  (also in Spanish)

• HIV Counseling, Testing and Referral- Staff Observation Report Form

Immunization Program CHILD Profile

• Vaccine Program State & Federal Requirements

• 2007-2009 Allowable Expenses

• 2010 Allowable Expenses

• 2009 Site Visit Requirements

• 2010 Site Visit Requirements

• Annual Provider Agreement Update Schedule

• Immunization Annual Report Form for Accountability Activities  Due Date:  March 1, 2009

• Immunization Annual Report Form for Adult Immunization  Due Date:  March 1, 2009

• Immunization Annual Report Form for Locally Identified Activity  Due Date:  March 1, 2009

LCDF (Local Capacity Development Fund)

• 2010 Application and Report Forms

• 2009 Application and Report Forms

MCHBG  (Maternal Child Health Block Grant)

• MCH User Guide

• MCH Activity Plan & Year End Report  

• MCH 09-10 Funding

Oral Health

•  LHJ Guidance for Completing 2007-2008Activity Plans and Reports

• Oral Health 2007-2008Activity Plan & Reports 

Ryan White HIV Care Services

• WA State Allowable FY 08 Ryan White Part B HIV-related Service Categories

• Quarterly Report Narrative Form

• Quarterly Demographic Form

• Statewide Standards for Medical HIV Case Mgmt

• System Acuity Measurement for HIV Care Case Mgmt

WIC

Attached are the entire WIC Manual chapters which include the two reports that are deliverables for the WIC Program: Expenditure Report and Nutrition Education Plan.

• WIC Program Expenditure Report

• WIC Program Nutrition Education Plan

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