Clinic Staff Provision Patient of Loads

Attachment 7c

Clinic Staff - Provision of Patient Loads

Form Approved:

OMB No. 0920-new

Expiration Date: XX/XX/XXXX

SciMetrika Health Survey

In Coordination with CDC and the local Health Department

Clinic Staff – Provision of Patient Loads

WEEKLY E-MAIL SENT BY CLINIC STAFF TO SCIMETRIKA STAFF:

Hello,

For the week of MM/DD to MM/DD:

The total estimated patient load at our clinic will be XX.

We estimate that out of this number, XX clients will be newly diagnosed patients and XX will be individuals who are recently re-engaging in HIV medical care.

These are estimates only.

Thanks.

Clinic Staff – Provision of Patient Loads Page 2