| PRIMARY MEDICAL CARE
SERVICES |
| 1. General Primary Medical Care (other
than listed below) |
100.0% |
16.7% |
16.7% |
100.0% |
| 2. Diagnostic Laboratory (technical
component) |
100.0% |
50.0% |
50.0% |
100.0% |
| 3. Diagnostic X-Ray Procedures (technical
component) |
100.0% |
16.7% |
50.0% |
100.0% |
| 4. Diagnostic Tests/Screenings (professional
component) |
100.0% |
33.3% |
33.3% |
100.0% |
| 5. Emergency medical services |
100.0% |
0.0% |
33.3% |
100.0% |
| 6. Urgent medical care |
100.0% |
0.0% |
33.3% |
100.0% |
| 7. 24-hour coverage |
100.0% |
0.0% |
16.7% |
100.0% |
| 8. Family Planning |
100.0% |
0.0% |
33.3% |
100.0% |
| 9. HIV testing and counseling |
83.3% |
16.7% |
66.7% |
100.0% |
| 10. Testing for Blood Lead Levels |
83.3% |
16.7% |
33.3% |
100.0% |
| 11. Immunizations |
100.0% |
0.0% |
16.7% |
100.0% |
| 12. Following hospitalized patients |
66.7% |
16.7% |
50.0% |
83.3% |
| OBSTETRICAL AND GYNECOLOGICAL
CARE |
| 13. Gynecological Care |
100.0% |
16.7% |
33.3% |
100.0% |
| 14. Prenatal care |
66.7% |
0.0% |
66.7% |
100.0% |
| 15. Antepartum fetal assessment |
50.0% |
0.0% |
50.0% |
83.3% |
| 16. Ultrasound |
16.7% |
0.0% |
83.3% |
83.3% |
| 17. Genetic counseling and testing |
33.3% |
0.0% |
83.3% |
83.3% |
| 18. Amniocentesis |
0.0% |
0.0% |
83.3% |
83.3% |
| 19. Labor and delivery professional
care |
16.7% |
0.0% |
83.3% |
83.3% |
| 20. Postpartum care |
83.3% |
0.0% |
50.0% |
100.0% |
| SPECIALTY MEDICAL
CARE |
| 21. Directly observed TB therapy |
33.3% |
0.0% |
83.3% |
83.3% |
| 22. Respite Care |
16.7% |
0.0% |
83.3% |
83.3% |
| 23. Other Specialty Care |
33.3% |
0.0% |
66.7% |
66.7% |
| DENTAL CARE SERVICES |
| 24. Dental Care - Preventive |
50.0% |
16.7% |
66.7% |
100.0% |
| 25. Dental Care - Restorative |
50.0% |
33.3% |
83.3% |
100.0% |
| 26. Dental Care - Emergency |
50.0% |
16.7% |
83.3% |
100.0% |
| 27. Dental Care - Rehabilitative |
50.0% |
0.0% |
66.7% |
83.3% |
| MENTAL HEALTH/SUBSTANCE
ABUSE SERVICES |
| 28. Mental Health Treatment/Counseling |
50.0% |
16.7% |
83.3% |
100.0% |
| 29. Developmental Screening |
83.3% |
0.0% |
16.7% |
83.3% |
| 30. 24-hour Crisis Intervention/Counseling |
16.7% |
16.7% |
83.3% |
83.3% |
| 31. Other Mental Health Services |
50.0% |
16.7% |
66.7% |
83.3% |
| 32. Substance Abuse Treatment/Counseling |
33.3% |
16.7% |
66.7% |
83.3% |
| 33. Other Substance Abuse Services |
50.0% |
16.7% |
66.7% |
83.3% |
| 33a. Comprehensive mental health / Substance
abuse screening |
50.0% |
16.7% |
50.0% |
83.3% |
| OTHER PROFESSIONAL
SERVICES |
| 34. Hearing Screening |
83.3% |
0.0% |
50.0% |
100.0% |
| 35. Nutrition Services Other than WIC |
83.3% |
16.7% |
50.0% |
100.0% |
| 36. Occupational or Vocational Therapy |
16.7% |
0.0% |
83.3% |
83.3% |
| 37. Physical Therapy |
16.7% |
0.0% |
83.3% |
83.3% |
| 38. Pharmacy - Licensed Pharmacy staffed
by Registered Pharmacist |
0.0% |
33.3% |
83.3% |
83.3% |
| 39. Pharmacy - Provider Dispensing |
83.3% |
16.7% |
50.0% |
100.0% |
| Total Pharmacy |
83.3% |
33.3% |
83.3% |
100.0% |
| 40. Vision Screening |
100.0% |
16.7% |
16.7% |
100.0% |
| 41. Podiatry |
16.7% |
0.0% |
83.3% |
83.3% |
| 42. Optometry |
16.7% |
0.0% |
66.7% |
66.7% |
| ENABLING SERVICES |
| 43. Case management |
100.0% |
16.7% |
16.7% |
100.0% |
| 44. Child Care (during visit to center) |
0.0% |
0.0% |
66.7% |
66.7% |
| 45. Discharge Planning |
66.7% |
0.0% |
50.0% |
100.0% |
| 46. Eligibility Assistance |
100.0% |
0.0% |
33.3% |
100.0% |
| 47. Environmental Health Risk Reduction
(via detection and/or alleviation) |
66.7% |
0.0% |
50.0% |
83.3% |
| 48. Health education |
100.0% |
0.0% |
33.3% |
100.0% |
| 49. Interpretation/Translation services |
100.0% |
33.3% |
33.3% |
100.0% |
| 50. Nursing home and assisted-living
placement |
83.3% |
16.7% |
33.3% |
100.0% |
| 51. Outreach |
100.0% |
16.7% |
33.3% |
100.0% |
| 52. Transportation |
66.7% |
33.3% |
33.3% |
100.0% |
| 53. Out Stationed Eligibility Workers |
33.3% |
0.0% |
66.7% |
83.3% |
| 54. Home Visiting |
100.0% |
0.0% |
16.7% |
100.0% |
| 55. Parenting Education |
50.0% |
0.0% |
66.7% |
83.3% |
| 56. Special Education Program |
0.0% |
0.0% |
66.7% |
66.7% |
| 57. Other |
0.0% |
0.0% |
0.0% |
0.0% |
| PREVENTATIVE SERVICES
RELATED TO TARGET CLINICAL AREAS |
| I. Cancer |
| 58. Pap Test |
100.0% |
0.0% |
16.7% |
100.0% |
| 59. Fecal occult blood test |
100.0% |
16.7% |
16.7% |
100.0% |
| 60. Sigmoidoscopy |
33.3% |
0.0% |
66.7% |
100.0% |
| 61. Colonoscopy |
16.7% |
0.0% |
83.3% |
100.0% |
| 62. Mammograms |
16.7% |
0.0% |
100.0% |
100.0% |
| 63. Smoking cessation program |
50.0% |
0.0% |
83.3% |
100.0% |
| II. Diabetes |
| 64. Glycosylated hemoglobin measurement
for people with diabetes |
100.0% |
0.0% |
16.7% |
100.0% |
| 65. Urinary microalbumin measurement
for people with diabetes |
100.0% |
0.0% |
16.7% |
100.0% |
| 66. Foot exam for people with diabetes |
100.0% |
0.0% |
33.3% |
100.0% |
| 67. Dilated eye exam for people with
diabetes |
33.3% |
0.0% |
83.3% |
100.0% |
| III. Cardiovascular
Disease |
| 68. Blood pressure monitoring |
100.0% |
0.0% |
16.7% |
100.0% |
| 69. Weight reduction program |
50.0% |
0.0% |
66.7% |
83.3% |
| 70. Blood cholesterol screening |
100.0% |
0.0% |
16.7% |
100.0% |
| IV. HIV/AIDS (See
line 9. HIV testing and counseling) |
| V. Infant Mortality
(See line 14. Prenatal Care) |
| 71. Follow-up testing and related health
care services for abnormal newborn bloodspot
screening |
33.3% |
0.0% |
83.3% |
83.3% |
| VI. Immunizations
(See line 11. Immunizations) |
| OTHER SERVICES |
| 72. WIC Services |
0.0% |
0.0% |
66.7% |
66.7% |
| 73. Head Start services |
0.0% |
0.0% |
66.7% |
66.7% |
| 74. Food bank/delivered meals |
0.0% |
0.0% |
66.7% |
66.7% |
| 75. Employment/Educational Counseling |
0.0% |
0.0% |
66.7% |
66.7% |
| 76. Assistance in obtaining housing |
0.0% |
0.0% |
66.7% |
66.7% |
