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Table 1 - Services Offered and Delivery Method

 
Service Type Provided by Site (a) By Referral or Contract Site Pays* (b) By Referral or Contract No Pymt (c) Not Provided (d) Service Type Provided by Site (a) By Referral or Contract Site Pays * (b) By Referral or Contract No Pymt (c) Not Provided (d)
Medical Care Services Mental Health / Substance Abuse Services
1.) General Primary Medical Care (other than below)         25.) Mental Health Treatment/Counseling        
2.) Diagnostic Laboratory (technical component)         26.) Developmental Screening        
3.) Diagnostic X-Ray (technical component)         27.) 24-hour Crisis Intervention/Counseling        
4.) Diagnostic Tests/Screenings (professional comp.)         28.) Other Mental Health Services        
5.) Emergency Medical Services         29.) Substance Abuse Treatment/Counseling        
6.) Urgent Medical Care         30.) Other Substance Abuse Services        
7.) 24-hour Coverage         Other Professional Services
8.) Family Planning         31.) Hearing Screening        
9.) HIV Testing         32.) Nutrition Services other than WIC        
10.) Immunizations         33.) Occupational or Vocational Therapy        
11.) Following Hospitalized Patients         34.) Physical Therapy        
          35.) Pharmacy        
Obstetrical and Gynecological Care         36.) Vision Screening        
12.) Gynecological Care         37.) WIC Services        
13.) Prenatal Care         Other Services
14.) Antepartum Fetal Assessment         38.) Case Management        
15.) Ultrasound         39.) Child Care (during visit to Site)        
16.) Genetic Counseling and Testing         40.) Discharge Planning        
17.) Amniocentesis         41.) Eligibility Assistance        
18.) Labor and Delivery Professional Care         42.) Employment/Educational Counseling        
19.) Postpartum Care         43.) Environmental Hlth Risk Redctn (via Detectn)        
          44.) Food Bank / Delivered Meals        
Specialty Medical Care 45.) Health Education        
20.) Directly Observed TB Therapy         46.) Housing Assistance        
21.) Other Specialty Care         47.) Interpretation/Translation Services        
          48.) Nursing Home & Assisted Living Placement        
Dental Care Services 49.) Outreach        
22.) Dental Care – Preventive         50.) Transportation        
23.) Dental Care – Restorative         51.) Home Visiting        
24.) Dental Care – Emergency         52.) Parenting Education        
          53.) Other (Specify: )