Form 1 Implementation Plan

The Health Center Program Application Forms

implementation plan

Implementation Plan

OMB: 0915-0285

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NAP Implementation Plan


The Implementation Plan outlines the applicant’s planned activities required to bring the organization into operational readiness and compliance with all 19 Health Center Program requirements within 120 days of the Notice of Award (NoA). See Appendix C of the FOA for instructions. Applicants may choose focus areas based on the list in Appendix C or provide different focus areas based on the action steps necessary to achieve the required operational and compliance status. Goals must be specific to the proposed NAP.


Goal

On separate rows, identify the goals for each focus area. Goals should describe measureable results.

Key Action Steps

Identify the action steps that must occur to accomplish each goal.

Person/Area Responsible

Identify who will be responsible and accountable for carrying out each action step.

Time Frame

Identify the expected time frames for carrying out each action step.

Comments

As desired, provide supplementary information.

Focus Area: Operational Service Delivery Program

Goal A1

  1. Action Step

  1. Person Responsible

  1. Time Frame



  1. Action Step

  1. Person Responsible

  1. Time Frame


Goal A2

  1. Action Step

  1. Person Responsible

  1. Time Frame



  1. Action Step

  1. Person Responsible

  1. Time Frame


Goal A3

  1. Action Step

  1. Person Responsible

  1. Time Frame



  1. Action Step

  1. Person Responsible

  1. Time Frame


Focus Area: Key Management Staff/Systems/Arrangements

Goal B1

  1. Action Step

  1. Person Responsible

  1. Time Frame



  1. Action Step

  1. Person Responsible

  1. Time Frame


Goal B2

  1. Action Step

  1. Person Responsible

  1. Time Frame



  1. Action Step

  1. Person Responsible

  1. Time Frame


Goal B3

  1. Action Step

  1. Person Responsible

  1. Time Frame



  1. Action Step

  1. Person Responsible

  1. Time Frame


Focus Area: Operational NAP Site(s) within 120 Days

Goal C1

  1. Action Step

  1. Person Responsible

  1. Time Frame



  1. Action Step

  1. Person Responsible

  1. Time Frame


Goal C2

  1. Action Step

  1. Person Responsible

  1. Time Frame



  1. Action Step

  1. Person Responsible

  1. Time Frame


Goal C3

  1. Action Step

  1. Person Responsible

  1. Time Frame



  1. Action Step

  1. Person Responsible

  1. Time Frame


Focus Area: Implementation of Sliding Fee Discount Program and Billing and Collections System

Goal D1

  1. Action Step

  1. Person Responsible

  1. Time Frame



  1. Action Step

  1. Person Responsible

  1. Time Frame


Goal D2

  1. Action Step

  1. Person Responsible

  1. Time Frame



  1. Action Step

  1. Person Responsible

  1. Time Frame


Goal D3

  1. Action Step

  1. Person Responsible

  1. Time Frame



  1. Action Step

  1. Person Responsible

  1. Time Frame


Focus Area: Quality Improvement/Quality Assurance (QI/QA) Program

Goal E1

  1. Action Step

  1. Person Responsible

  1. Time Frame



  1. Action Step

  1. Person Responsible

  1. Time Frame


Goal E2

  1. Action Step

  1. Person Responsible

  1. Time Frame



  1. Action Step

  1. Person Responsible

  1. Time Frame


Goal E3

  1. Action Step

  1. Person Responsible

  1. Time Frame



  1. Action Step

  1. Person Responsible

  1. Time Frame


Focus Area: Governing Board

Goal F1

  1. Action Step

  1. Person Responsible

  1. Time Frame



  1. Action Step

  1. Person Responsible

  1. Time Frame


Goal F2

  1. Action Step

  1. Person Responsible

  1. Time Frame



  1. Action Step

  1. Person Responsible

  1. Time Frame


Goal F3

  1. Action Step

  1. Person Responsible

  1. Time Frame



  1. Action Step

  1. Person Responsible

  1. Time Frame


Focus Area: Other

Goal G1

  1. Action Step

  1. Person Responsible

  1. Time Frame



  1. Action Step

  1. Person Responsible

  1. Time Frame


Goal G2

  1. Action Step

  1. Person Responsible

  1. Time Frame



  1. Action Step

  1. Person Responsible

  1. Time Frame


Goal G3

  1. Action Step

  1. Person Responsible

  1. Time Frame



  1. Action Step

  1. Person Responsible

  1. Time Frame




File Typeapplication/msword
File TitleNAP Implementation Plan
SubjectNAP Implementation Plan
AuthorHRSA
Last Modified ByHRSA
File Modified2013-01-25
File Created2013-01-25
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