MMP Facility Survey Minimal Dataset

Medical Monitoring Project Facility Survey

Minimal Dataset Elements

Facility ID:________________________

Facility Street Address 1:__________________________________

Facility Street Address 2:__________________________________

City and State:_________________________

Zip Code:________________

State and County FIPS Code, Primary Care Health Professional Shortage Area (HPSA) designation, and Medically Underserved Area/Population (MUA/P) designation:

Find the FIPS Code, HPSA designation, and MUA/P designation using the following address look-up website: https://data.hrsa.gov/tools/shortage-area/by-address

11-digit FIPS Code:

Is the facility located in a HPSA?

₁ No

Yes ₂ Yes

Is the facility located in a MUA/P?

₁ No

Yes ₂ Yes

Urbanicity:

Using the first 5 digits of the 11-digit FIPS Code from above, find the Rural-Urban Continuum Code using the 2013 Rural-Urban Continuum Code (RUCC) spreadsheet located here: https://www.ers.usda.gov/data-products/rural-urban-continuum-codes.aspx

RUCC code for this facility:

RUCC Code
Metro counties:
1	Counties in metro areas of 1 million population or more
2	Counties in metro areas of 250,000 to 1 million population
3	Counties in metro areas of fewer than 250,000 population
Nonmetro counties:
4	Urban population of 20,000 or more, adjacent to a metro area
5	Urban population of 20,000 or more, not adjacent to a metro area
6	Urban population of 2,500 to 19,999, adjacent to a metro area
7	Urban population of 2,500 to 19,999, not adjacent to a metro area
8	Completely rural or less than 2,500 urban population, adjacent to a metro area
9	Completely rural or less than 2,500 urban population, not adjacent to a metro area

Ryan White HIV/AIDS Program funding:

Find the facility’s Ryan White HIV/AIDS Program funding status using the following on-line address lookup tool: https://findhivcare.hrsa.gov/

Does the facility receive Ryan White HIV/AIDS Program funding?

₁ No

Yes ₂ Yes, choose all that apply below

₁ Part A

₂ Part B

₃ Part C

₄ Part D

₅ Part F (if not checked, skip to next question)

₁ SPNS

₂ AETC

₃ Dental

₄ MAI

Proxy for HIV Patient Load:

How many MMP respondents had medical records abstracted at this facility during the 2019 cycle?