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.

Documents posted in .pdf version will be made available in an alternative format on request to users who are unable to download or view .pdf files on the Web. To request alternative format, contact the specific program.  (see Contact Lists)

Children With Special Health Care Needs (CSHCN) Manual (rev #26 - Nov 2009)

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 and Child Profile Office

• 2011 Allowable Expenses

• 2012 Allowable Expenses

Local Capacity Development Funds (LCDF)

• Appendix A to 2012 Statement of Work

• Supporting Document for 2012 Statement of Work

MCHBG  (Maternal Child Health Block Grant)

• MCH User Guide 09-10

• MCH User Guide 11-12

• MCH Activity Plan & Year End Report  

• MCH 11-12 Funding

Oral Health

• Oral Health Allocation Revision (July 2010 Reduction)

• Oral Health 2011-2012Activity Plan and Sealant Report

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

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