Documenting Scope of Project

A health center documents its approved scope of project in several ways.

Health Center Program Approved Applications
The approved Health Center Program application, such as a New Access Point application or a Look-Alike Initial Designation application, documents health center scope of project.

Form 5A: Services Provided (Form 5A)
A health center records approved services on Form 5A: Services Provided (PDF - 151 KB). The form lists the required and additional health services a health center provides, as well as the service delivery methods for each service. A health center may deliver services directly to patients, through formal contracts and agreements, or through formal written referral arrangements.

Form 5B: Service Sites (Form 5B)
A health center records approved service sites on Form 5B: Service Sites (PDF - 66 KB). The form lists information for each health center site in the scope of project. Site details include information such as service site name, address, operational details, and more.

Form 5C: Other Activities/Locations (Form 5C)
Form 5C: Other Activities/Locations (PDF - 160 KB) lists health center activities that 1) do not meet the service site definition, 2) are conducted on an irregular timeframe or schedule, and 3) offer a limited activity from within the full complement of health center activities within the scope of project. These include, but are not limited to, health fairs, home visits, health education, and immunizations.

Related Resources

Date Last Reviewed:  October 2021