Questions
for Deletion of Service(s)
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In
this CIS request, you have marked the following services for
deletion:
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Service has not been selected.
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*1.
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Describe
the reason for the deletion of the service and how it
will impact your health center and the patients you
serve. Include the number of patients that will be
affected by the deletion of the service. (Provide
a summary of one page or less.)
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(Maximum
3,000 Characters)
Maximum
paragraph(s) allowed approximately: 3 (3000 character(s)
remaining)
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*2.
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Was
the service to be deleted added through the below?
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a
change in scope within the last 36 months or;
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a
funded application within the last 36 months or;
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other
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*2a.
When
will you stop providing the service?
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Date
of stopping service (mm/dd/yyyy):
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*3.
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Provide
the name, city, state, and zip code of the nearest
location(s) where patients can receive this service
following the deletion of the service from your scope of
project.
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3a.
Name
and Address of nearest services
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(Maximum
3,000 Characters)
Maximum
paragraph(s) allowed approximately: 3 (3000 character(s)
remaining)
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3b.
Average
travel time for patients to service location
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Currently:
hrs
mins (Format:
99)
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Following
Deletion:
hrs
mins (Format:
99)
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3c.
Average
miles traveled by patients to service location
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Currently:
miles (Format:
9 or 9.99)
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Following
Deletion:
miles (Format:
9 or 9.99)
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