2017-2018 School Health Services Program Annual Report

Form Login Account:
New Users / Returning Users CLICK HERE to setup or return to your account for this form. Creating an account enables you to return to this form and your submitted results. An account will also enable you to partially complete this form and return later to finish the form. The account you establish is only for this form. Enter numbers only in fields requesting a number, do not type words. Use tab key or mouse to move to next box. If no funds were spent on a category, leave blank. No need to enter zeros.
 

SUMMARY OF EXPENDITURES

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

Total of funds
 Expended for (2017-2018)
$0.00

ADMINISTRATIVE EXPENDITURE REPORT

Total Administrative Expenditures (2017-2018):
$0.00

HEALTH SERVICES EXPENDITURES (by CDE Category)

Assistance/Emergency Funds (Vouchers)

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

Audiology (numbers only)

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)

Materials/Equipment/Supplies (List number of pieces)

Mental Health (numbers ONLY)

Motor Therapy (numbers ONLY)

Nursing Services (numbers ONLY)

Nutrition (list number of classes)

Occupational Therapy OT (#s ONLY)

Orientation and Mobility O/M (#s only)

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

Physical Therapy PT (#s Only, no words)

Physician Services (list number of visits)

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

Speech Language SLP (#s ONLY)

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

Transportation (list number of items purchased) #s ONLY

Vision (list number of items purchased)

Total # piece of Equipment
0.00
Total Equipment Expenditure
0.00
Total # FTE
0.00
Total FTE Expenditure
0.00
Total Health Services Expenditures (2017-2018):
$0.00
Total Health Service # of Unduplicated Students (2017-2018):
0.00

SUBCONTRACTOR REPORT

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:
$0.00
Current Total:
0.00
Current Total:
0.00
Current Total:
0.00