2016-2017 School Health Services Program Annual Report

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SUMMARY OF EXPENDITURES Enter totals here after all amounts have been entered and totaled in report.

Total of funds
 Expended for (2016-17)


Total Administrative Expenditures (2016-17):


Assistance/Emergency Funds (Vouchers)

Assistive Technology (Pieces of Equipment) numbers only, do not type words


Case Management/Care Coordination (List FTE # ONLY - do not list hours)

Dental (list number of visits)

Health Assistant/Clinic Aide (list number of FTEs only, do not enter words)

Health Education (list number of FTEs only, do not enter words)

Intensive Health Tech (Delegated Services, list FTEs, do not enter words)

Insurance Outreach - CHP+ and Medicaid (list number of FTEs only, do not enter words)

Materials/Equipment/Supplies (List number of pieces, do not enter words)

Mental Health

Motor Therapy


Nutrition (list number of classes)

Occupational Therapy

Orientation and Mobility

Parent/Family Support Services (list FTEs only, do not enter words)

Physical Therapy

Physician Services (list number of visits)

Screenings and Assessments (list number of screenings and assessments performed) do not type words

Speech Language

Training/Professional Development (list number of trainings or PD classes paid for with Medicaid funds)

Transportation (list number of items purchased)

Vision (list number of items purchased)

Total Health Services Expenditures (2016-17):
Total Health Service # of Unduplicated Students (2016-17):


Please describe below how the subcontractor was chosen, the services contracted, and how the subcontractor's performance was monitored. Describe any problems, corrective actions taken and results of those actions. List billing agents here.

Subcontractor Total: