Forms, Reports & Program Information

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The following links will take you to either program-specific information or individual program websites. If you have questions about a program not listed here, contact your program staff (see Contact Lists).

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Programs:

CHILD Profile

CSHCN

Drinking Water

EMS & Traffic Safety

Environmental Health

Family Planning

Healthy Child Care Washington

HIV/AIDS Client Services

HIV/AIDS Prevention 

Immunization

Injury Prevention

Local Capacity Development Funds

MCHBG

Oral Health

PHEPR

Preventive Health & Health Services (PHHS) Block Grant

Ryan White HIV Care Services

STD

TB

Tobacco

VISTA

WIC

 

HIV Prevention  

(for additional information see HIV/AIDS Prevention Program)

  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

(for additional information see Immunization Program)

• Vaccine Program State & Federal Requirements updated 3/16/07

• Allowable Expenses

• Immunization Annual Report Form for Accountability Activities  Due Date:  March 1, 2008

• Immunization Annual Report Form for Adult Immunization  Due Date:  March 1, 2008

• Immunization Annual Report Form for Locally Identified Activity  Due Date:  March 1, 2008

LCDF

• 2007 Application and Report Forms

• 2008 Application and Report Forms

MCHBG 

• 2007-2008 LHJ User Guide for MCHBG Activity Plan and Reports 

• MCH Activity Plan & Year End Report   2007 Year-End Report due March 3, 2008

• Matrix of Public Health Standards & Frequently Used MCHBG  Work Activities

Oral Health

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

• Oral Health 2007-2008Activity Plan & Reports 

Preventive Health & Health Services Block Grant (PHHS) 

• Local Support Funds 2007 Report due March 3, 2008

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

Contents and location of this site are subject to change without notice.  Establishing links to this website must be coordinated with the Department of Health Consolidated Contract Office via concon.mail@doh.wa.gov. 

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