Form 0920 RCE Report Card

Form Approved
OMB No. 0920-New
Expiration Date: XX/XX/XXXX

RCE Report Card
[MONTH] 2022
Objectives
Month 2

Month 4

Month 6

70% of RCE Clients attending an RCE Visit
within 72 hours of referral

Process Metrics
Month 2
N

Month 4
%

N

%

N

Month 6
%

N

%

N

TOTAL
%

N

%

N

%

Number of RCE Clients Referred
By internal CTR Counselor
By external CTR Counselor
By self-referral
RCE Client Characteristics
Newly diagnosed with HIV
New to HIV care
Returning to HIV care
Number of RCE Clients Who Received an
RCE Visit Within…
0-24 hours of referral
25-72 hours of referral
RCE Visit Components Received
Introduction with RCE Concierge
Brief intake
Financial assistance/benefits
Discussion
Meeting with an HIV care provider
Laboratory tests
Referral to wraparound services

Evaluation Metrics
Month 2
N

Month 4

Month 6

TOTAL
%

RCE Clients attending second appointment

Public reporting burden of this collection of information is estimated to average 15 minutes per response, including the time for
reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing
the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to a collection of
information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other
aspect of this collection of information, including suggestions for reducing this burden to CDC/ATSDR Reports Clearance Officer;
1600 Clifton Road NE, MS D-74, Atlanta, Georgia 30333; Attn: OMB-PRA (0920-New)
RCE Report Card

Page 1 of 2

Narrative Report
What went well during this reporting period?
RTI Feedback

Internal Feedback

What didn't go well during this reporting period? What improvements could be made?
RTI Feedback

Internal Feedback

What actionable steps can your clinic take in the next 2 months to…
- Increase the number of eligible RCE clients who are reached through the RCE program?
- See more RCE clients within 72 hours of referral?
- Make referrals to wraparound services at the RCE Visit?
- Ensure RCE clients receive a confirmatory viral load test?
- Improve the RCE intake process?
- Improve the client’s overall experience?
RTI Feedback

Internal Feedback

RCE Report Card

Page 2 of 2