Form 1 OVC Grant Monthly Progress Report Updated

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Overview

Instructions
Terms and Definitions
Cover Page
Key Activity 1
Key Activity 2
Key Activity 3
Key Activity 4
Key Activity 5
A. Access
B. Quality
C. Care Coordination
D. Health Equity
Share Additional Information

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Sheet 1: Instructions

Grant Recipient Monthly Progress Report (MPR) – Optimizing Virtual Care (OVC)
Version 3.5 Last Updated: 4/1/22
I. Introduction
This document is a suggested Monthly Progress Report (MPR) template for Optimizing Virtual Care (OVC) grant recipients to report project activities. We encourage you to use the Grant Recipient MPR to report information related to overall program implementation and the following OVC project objectives: A. Increase Access to Care and Information, B. Improve Clinical Quality and Health Outcomes, C. Enhance Patient Care Coordination, D. Promote Health Equity
Please Note: Some questions included this document may not be relevant for all grant program’s activities. Grant recipients may choose to share additional information above and beyond the data requested in the "Share Additional Information" tab.
II. Grant Recipient MPR Overview
The Grant Recipient MPR template is organized into three sections and contains a total of 13 tabs, as described below.
Section 1. Information and Instructions - Tabs in this section provide resources to support grant recipients in filling out the MPR Template sheets
Introduction Tab	Provides an overview of the Grant Recipient MPR template and guidance for completing the form
Terms and Definitions Tab	Provides definitions for key terms used throughout the Grant Recipient MPR template
Section 2. Monthly Updates - This section of the Grant Recipient MPR Template provides table templates to support health centers with submitting MONTHLY progress report data and includes questions about A. Key Activity Implementation Tables and B. OVC Project Objective Updates, as listed below.
Cover Page Tab	Enter grant recipient name, OVC grant number, BCHMIS ID and reporting month
Key Activity 1 Tab Key Activity 2 Tab Key Activity 3 Tab Key Activity 4 Tab Key Activity 5 Tab	Use the five activity tabs' tables to describe your health center’s experience implementing five key OVC project-related activities during the reporting month. Grant recipients are encouraged to list "activities" from their OVC Application Logic Model and Project Work Plan submissions. See “Attachment 2” in the OVC grant application for reference. Please enter only one activity per tab.
Section 3. Project Objective Updates and Additional Information- Tabs include reporting on OVC's four project objectives, and sharing information not otherwise reported.
A. Access Tab B. Quality Tab C. Care Coordination Tab D. Health Equity Tab	Describe your health center's progress implementing key ctivities related to the indicated OVC project objectives (A) Increasing Access to Patient Care and Information, B) Improving Clinical Quality and Health Outcomes, C) Enhancing Care Coordination, or D) Promoting Health Equity). Specific instructions are included on each tab.
Share Additional Information Tab	Grant recipients may use this tab to submit any additional information, comments, or data findings not requested in other areas of the template. For example, if your Health Center has a definable program for a specific patient population through the OVC grant, please report related data for OVC-specific telehealth visits and any other relevant information in the Share Additional Information tab.
III. Additional Guidance for Completing the Grant Recipient MPR Template
Reporting Period: Monthly
Submission Deadline: Monthly. Due to HRSA on the 5th of every month (Or the next regular business day if the 5th day falls on a Saturday, Sunday or federal holiday)
Naming Convention: Rename this file using the following format before uploading to the EHB: OVC Grant Number_Reporting Month (example: X1XYZ10101_March 2022)

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Sheet 2: Terms and Definitions

Key Term	Definition
Appointment Wait Time	This is the time (in hours or days) patients must wait before they can see a health care provider for an appointment.
Ethnicity	Self-reported patient ethnicity (Hispanic or Latina/o or Not Hispanic/Latina/o)
Face-to-Face (In-Person) Health Visit	Documented, in-person, face-to-face contact between a patient and a provider who exercises objective judgment in the provision of services to the patient. To be included as a visit, services rendered must be documented in the patient’s record
Limited English Proficient (LEP)	Describes individuals who do not speak English as their primary language and who have a limited ability to read, speak, write, or understand English.
Medical Insurance	Patient's primary medical insurance (Medicare, Medicaid/Childrens Health Insurance Program (CHIP)/other public insurance, private insurance)
Patient	Patient: A person who has at least one countable visit in one or more categories of services
Race	Self-reported patient race (Asian, Native Hawaiian, Black, African American, White, More than one race)
Service Category	Includes medical care, dental, mental health, substance use disorder, vision, other professional, enabling
Special Populations	Migratory and seasonal agricultural workers, homeless populations, residents of public housing, patients from school-based health centers, veterans, populations with limited English proficiency,
Telehealth	The use of electronic information and telecommunications technologies to support and promote long-distance clinical health care, patient and professional health-related education, public health, and health administration.
Telemedicine	Telemedicine is a subset of telehealth services referring to remote clinical services.
UDS Service Categories	Medical, dental, mental health, substance use disorder, other professional, vision, pharmacy, other programs and services, quality improvement, total facility and non-clinical support personnel,enabling services. See the 2021 Uniform Data System Reporting Manual.
Virtual Care Type: Asynchronous Store and Forward	Asynchronous Store and forward: Electronic transmission of medical information for remote evaluation, such as x-rays, sonograms, other digital images, documents, and pre-recorded audio and/or videos that are not real-time interactions.
Virtual Care Type: Mobile Health (mHealth)	Patient technologies, like smartphone and tablet apps, that enable patients to capture personal health data independent of an interaction with a clinician.
Virtual Care Type: Other Asynchronous Technologies	Email, fax, internet/online questionnaires, prescribing, or other transmissions.
Virtual Care Type: Remote Monitoring	Patient technologies, like smartphone and tablet apps, that enable patients to capture personal health data independent of an interaction with a clinician.
Virtual Care Type: Synchronous Audio-Only	Use of a telephone or audio-only technology to conduct a “live” or real-time interactive visit between a patient and provider.
Virtual Care Type: Synchronous Video	Use of a two-way video technology or other HIPAA compliant video connection to conduct a “live” or real-time interactive visit between a patient and provider
Virtual Care Types	1. Synchronous Live Audio Only 2. Synchronous Live Video 3. Asynchronous Store and Forward 4. Remote monitoring 5. Mobile health(mHealth) 6. Other Asynchronous technologies
Virtual visit	Virtual (telemedicine/telehealth) contact between a patient and a licensed or credentialed provider who exercises his/her independent, professional judgment in the provision of services to the patient. Virtual visits must be provided using interactive, synchronous audio and/or video telecommunication systems that permit real-time communication between the provider and a patient • Virtual visits should use telemedicine- specific CPT or HCPCS codes with: • GT – Via interactive audio and video telecommunications systems • .95 – Synchronous telemedicine service rendered via a real-time interactive audio and video telecommunications system
Visit	A documented contact between a patient and a licensed or credentialed provider who exercises his/her independent, professional judgment in the provision of services to the patient. Virtual visits are allowable for each of the service categories. This is the only change to the definition of a visit. All other criteria remain the same)

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Sheet 3: Cover Page

Grant Recipient Monthly Progress Report (MPR) – Optimizing Virtual Care (OVC)
Grant Recipient Information (Please complete below)
Grant Recipient Organization Name	OVC Grant Number	BCHMIS ID	Reporting Month/Year]
Public Burden Statement: Data collection for the Optimizing Virtual Care (OVC) Grant program will provide HRSA with information to guide future program and policy decisions regarding virtual care. 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. The OMB control number for this information collection is 0906 -XXXX and it is valid until XX/XX/202X. This information collection is required for HRSA-funded health centers to obtain or retain OVC grant funding. Public reporting burden for this collection of information is estimated to average 2 hours per response, including the time for reviewing instructions, searching existing data sources, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to HRSA Reports Clearance Officer, 5600 Fishers Lane, Room 14N136B, Rockville, Maryland, 20857 or [email protected].

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Sheet 4: Key Activity 1

Instructions: Please complete the "Key Activity 1" table each month to describe your health center’s engagement in one of at least five program-related activities identified in the “Optimizing Virtual Care Work Plan." See “Attachment 2” in the OVC grant application for reference. Please submit only one activity per table. In the Monthly Key Activity Table below, list 1) one key program-related activity reported in your health center’s "Optimizing Virtual Care Work Plan”. For the activity listed, identify the OVC project (2) objective(s) the activity addresses, (3) changes to the activity work plan (4) activity status, (5) challenges/obstacles, (6) successes, (7) lessons learned, and (8) additional comments.
	1) Key Activity 1: (Write In) Example: "Recruit, hire, and train new staff; integrate existing teams into the project”
(Select (X) all that apply)	2) Objective: What OVC objective(s) does this activity address?
	A. Increase Access to Care and Information
	B. Improve Clinical Quality and Health Outcomes
	C. Enhance Patient Care Coordination
	D. Promote Health Equity
(Select (X) One)	3) Did you change the work plan for this activity during the reporting period?
	No
	Yes
	3a) [If yes] Please describe the change and the reasons for the change (100 Words Max):
(Select (X) all that apply)	4) Activity Status: This activity…
	Is not started
	Is completed
	Is in progress and on schedule
	Is in progress and timing is delayed
	Is started but will not be completed in the grant period
(Select (X) all that apply)	5) Challenges: What challenges impacted your health center's ability to implement this activity during the reporting month? Challenges related to….
	Patient adoption
	Staff adoption
	Community engagement
	Telehealth technology or vendor issues
	Health center logistical space or workflow challenges
	Organizational structure (e.g., policies, processes, or governance)
	Cost and/or service reimbursements
	Information security, privacy, and confidentiality
	Technology infrastructure (e.g., broadband and/or telecommunication services)
	Local, state, and/or federal policies
	Other (Write in): ____________________________
	5a) How did challenges impact the activity? (Please consider impacts related to achieving OVC project objectives) (300 Word Max)
	6) Success: What activity-related achievements did the health center make during this reporting month? (i.e., Organizational benchmarks reached, community recognitions earned)  Please list achievements below (300 Words Max)
	6a) What factors contributed to these achievements?  (300 Word Max)
	7) Lessons Learned: What lessons did the health center learn during the reporting month?  (300 Word Max)
	8) Additional comments about this activity

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Sheet 5: Key Activity 2

Instructions: Please complete the "Key Activity 2" table each month to describe your health center’s engagement in one of at least five program-related activities identified in the “Optimizing Virtual Care Work Plan." See “Attachment 2” in the OVC grant application for reference. Please submit only one activity per table. In the Monthly Key Activity Table below, list 1) one key program-related activity reported in your health center’s "Optimizing Virtual Care Work Plan”. For the activity listed, identify the OVC project (2) objective(s) the activity addresses, (3) changes to the activity work plan (4) activity status, (5) challenges/obstacles, (6) successes, (7) lessons learned, and (8) additional comments.
	1) Key Activity 2: (Write In) Example:“Develop a standardized workflows for telehealth visits and virtual care patient training and support."
(Select (X) all that apply)	2) Objective: What OVC objective(s) does this activity address?
	A. Increase Access to Care and Information
	B. Improve Clinical Quality and Health Outcomes
	C. Enhance Patient Care Coordination
	D. Promote Health Equity
(Select (X) One)	3) Did you change the work plan for this activity during the reporting period?
	No
	Yes
	3a) [If yes] Please describe the change and the reasons for the change (100 Words Max):
(Select (X) all that apply)	4) Activity Status: This activity…
	Is not started
	Is completed
	Is in progress and on schedule
	Is in progress and timing is delayed
	Is started but will not be completed in the grant period
(Select (X) all that apply)	5) Challenges: What challenges impacted your health center's ability to implement this activity during the reporting month? Challenges related to….
	Patient adoption
	Staff adoption
	Community engagement
	Telehealth technology or vendor issues
	Health center logistical space or workflow challenges
	Organizational structure (e.g., policies, processes, or governance)
	Cost and/or service reimbursements
	Information security, privacy, and confidentiality
	Technology infrastructure (e.g., broadband and/or telecommunication services)
	Local, state, and/or federal policies
	Other (Write in): ____________________________
	5a) How did challenges impact the activity? (Please consider impacts related to achieving OVC project objectives) (300 Word Max)
	6) Success: What activity-related achievements did the health center make during this reporting month? (i.e., Organizational benchmarks reached, community recognitions earned)  Please list achievements below (300 Word Max)
	6a) What factors contributed to these achievements?  (300 Word Max)
	7) Lessons Learned: What lessons did the health center learn during the reporting month? (300 Word Max)
	8) Additional comments about this activity

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Sheet 6: Key Activity 3

Instructions: Please complete the "Key Activity 3" table each month to describe your health center’s engagement in one of at least five program-related activities identified in the “Optimizing Virtual Care Work Plan." See “Attachment 2” in the OVC grant application for reference. Please submit only one activity per table. In the Monthly Key Activity Table below, list 1) one key program-related activity reported in your health center’s "Optimizing Virtual Care Work Plan”. For the activity listed, identify the OVC project (2) objective(s) the activity addresses, (3) changes to the activity work plan (4) activity status, (5) challenges/obstacles, (6) successes, (7) lessons learned, and (8) additional comments.
	1) Key Activity 3: (Write In) Example:“Purchase and install new cameras and speakers for exam rooms and to optimize telehealth visits."
(Select (X) all that apply)	2) Objective: What OVC objective(s) does this activity address?
	A. Increase Access to Care and Information
	B. Improve Clinical Quality and Health Outcomes
	C. Enhance Patient Care Coordination
	D. Promote Health Equity
(Select (X) One)	3) Did you change the work plan for this activity during the reporting period?
	No
	Yes
	3a) [If yes] Please describe the change and the reasons for the change (100 Words Max):
(Select (X) all that apply)	4) Activity Status: This activity…
	Is not started
	Is completed
	Is in progress and on schedule
	Is in progress and timing is delayed
	Is started but will not be completed in the grant period
(Select (X) all that apply)	5) Challenges: What challenges impacted your health center's ability to implement this activity during the reporting month? Challenges related to….
	Patient adoption
	Staff adoption
	Community engagement
	Telehealth technology or vendor issues
	Health center logistical space or workflow challenges
	Organizational structure (e.g., policies, processes, or governance)
	Cost and/or service reimbursements
	Information security, privacy, and confidentiality
	Technology infrastructure (e.g., broadband and/or telecommunication services)
	Local, state, and/or federal policies
	Other (Write in): ____________________________
	5a) How did challenges impact the activity? (Please consider impacts related to achieving OVC project objectives) (300 Word Max)
	6) Success: What activity-related achievements did the health center make during this reporting month? (i.e., Organizational benchmarks reached, community recognitions earned)  Please list achievements below (300 Word Max)
	6a) What factors contributed to these achievements?  (300 Word Max)
	7) Lessons Learned: What lessons did the health center learn during the reporting month?  (300 Word Max)
	8) Additional comments about this activity

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Sheet 7: Key Activity 4

Instructions: Please complete the "Key Activity 4" table each month to describe your health center’s engagement in one of at least five program-related activities identified in the “Optimizing Virtual Care Work Plan." See “Attachment 2” in the OVC grant application for reference. Please submit only one activity per table. In the Monthly Key Activity Table below, list 1) one key program-related activity reported in your health center’s "Optimizing Virtual Care Work Plan”. For the activity listed, identify the OVC project (2) objective(s) the activity addresses, (3) changes to the activity work plan (4) activity status, (5) challenges/obstacles, (6) successes, (7) lessons learned, and (8) additional comments.
	1) Key Activity 4: (Write In) Example: "Purchase remote monitoring devices (pulse oximeters and RPM scales) and distribute to eligible patients."
(Select (X) all that apply)	2) Objective: What OVC objective(s) does this activity address?
	A. Increase Access to Care and Information
	B. Improve Clinical Quality and Health Outcomes
	C. Enhance Patient Care Coordination
	D. Promote Health Equity
(Select (X) One)	3) Did you change the work plan for this activity during the reporting period?
	No
	Yes
	3a) [If yes] Please describe the change and the reasons for the change (100 Words Max):
(Select (X) all that apply)	4) Activity Status: This activity…
	Is not started
	Is completed
	Is in progress and on schedule
	Is in progress and timing is delayed
	Is started but will not be completed in the grant period
(Select (X) all that apply)	5) Challenges: What challenges impacted your health center's ability to implement this activity during the reporting month? Challenges related to….
	Patient adoption
	Staff adoption
	Community engagement
	Telehealth technology or vendor issues
	Health center logistical space or workflow challenges
	Organizational structure (e.g., policies, processes, or governance)
	Cost and/or service reimbursements
	Information security, privacy, and confidentiality
	Technology infrastructure (e.g., broadband and/or telecommunication services)
	Local, state, and/or federal policies
	Other (Write in): ____________________________
	5a) How did challenges impact the activity? (Please consider impacts related to achieving OVC project objectives) (300 Word Max)
	6) Success: What activity-related achievements did the health center make during this reporting month? (i.e., Organizational benchmarks reached, community recognitions earned)  Please list achievements below (300 Word Max)
	6a) What factors contributed to these achievements?  (300 Word Max)
	7) Lessons Learned: What lessons did the health center learn during the reporting month? (300 Word Max)
	8) Additional comments about this activity

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Sheet 8: Key Activity 5

Instructions: Please complete the "Key Activity 5" table each month to describe your health center’s engagement in one of at least five program-related activities identified in the “Optimizing Virtual Care Work Plan." See “Attachment 2” in the OVC grant application for reference. Please submit only one activity per table. In the Monthly Key Activity Table below, list 1) one key program-related activity reported in your health center’s "Optimizing Virtual Care Work Plan”. For the activity listed, identify the OVC project (2) objective(s) the activity addresses, (3) changes to the activity work plan (4) activity status, (5) challenges/obstacles, (6) successes, (7) lessons learned, and (8) additional comments.
	1) Key Activity 5: (Write In) Example: "Collaborate with community organization partners to enhance remote monitoring patient experience and utilization"
(Select (X) all that apply)	2) Objective: What OVC objective(s) does this activity address?
	A. Increase Access to Care and Information
	B. Improve Clinical Quality and Health Outcomes
	C. Enhance Patient Care Coordination
	D. Promote Health Equity
(Select (X) One)	3) Did you change the work plan for this activity during the reporting period?
	No
	Yes
	3a) [If yes] Please describe the change and the reasons for the change (100 Word Max):
(Select (X) all that apply)	4) Activity Status: This activity…
	Is not started
	Is completed
	Is in progress and on schedule
	Is in progress and timing is delayed
	Is started but will not be completed in the grant period
(Select (X) all that apply)	5) Challenges: What challenges impacted your health center's ability to implement this activity during the reporting month? Challenges related to….
	Patient adoption
	Staff adoption
	Community engagement
	Telehealth technology or vendor issues
	Health center logistical space or workflow challenges
	Organizational structure (e.g., policies, processes, or governance)
	Cost and/or service reimbursements
	Information security, privacy, and confidentiality
	Technology infrastructure (e.g., broadband and/or telecommunication services)
	Local, state, and/or federal policies
	Other (Write in): ____________________________
	5a) How did challenges impact the activity? (Please consider impacts related to achieving OVC project objectives) (300 Word Max)
	6) Success: What activity-related achievements did the health center make during this reporting month? (i.e., Organizational benchmarks reached, community recognitions earned)  Please list achievements below (300 Word Max)
	6a) What factors contributed to these achievements?  (300 Word Max)
	7) Lessons Learned: What lessons did the health center learn during the reporting month? (300 Word Max)
	8) Additional comments about this activity

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Sheet 9: A. Access

Instructions: Please complete the "A. Access" table below to describe your health center's efforts related to: A) Increasing Patient Access to Care and Information
A. Access: Increase Patient Access to Care and Information
A.1. What types of virtual care did your a) overall health center and b) Specific OVC grant-funded project* use during the reporting month? (See Terms and Defininitions tab for descriptions of virtual care types) (Select (X) below for all that apply)
a) Overall Health Center	b) Specific OVC project (optional*)	Virtual Care Type
		Face-to-Face (In-Person) Visits
		Synchronous – Live Audio Only
		Synchronous – Live Video
		Asynchronous Store and Forward
		Remote Monitoring
		Mobile Health (mHealth)
		Other Asynchronous Technology: (Write In)  ____________________
*If applicable, for health centers that have different data for OVC-specific activities to report in a given month

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Sheet 10: B. Quality

Instructions: Please complete the "B.Quality" table below to describe your health center's efforts related to: B) Improving Clinical Quality and Health Outcomes
B. Quality: Improve Clinical Quality and Health Outcomes
B.1. Which of the following clinical activities, from the 2022 UDS Clinical Quality Measures, did your a) overall health center and b) specific OVC grant-funded project* implement using virtual care during the reporting month? (Select (X) all that apply)
a) Overall Health Center	b) Specific OVC project (optional*)	Clinical Activities
		None of These or Technology Not Offered
		Breast Care Screening
		Cervical Care Screening
		Childhood Immunization Status
		Colorectal Cancer Screening
		Depression Screening and Follow-Up Plan
		Diabetes Eye Exam**
		HIV Screening
		Diabetes Control (Hemoglobin A1C)
		High Blood Pressure Control
		Depression Remission, 12 months
		Other: (Write In)_____________________________________
		Other: (Write In)_____________________________________
		Other: (Write In)_____________________________________
*If applicable, for health centers that have different data for OVC-specific activities to report in a given month
** 'Diabetes Eye Exam' is a CMS electronic clinical quality measure (eCQM CMS131V10), not a 2022 UDS Measure

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Sheet 11: C. Care Coordination

Instructions: Please complete the "C. Care Coordination" tables below to describe your health center's efforts related to: C) Enhancing Care Coordination
C. Care Coordination: Enhance Patient Care Coordination
C.1a. Based on staffing for your overall health center during the reporting period, For each service category; Report in Column A, the total number of full-time equivalent staff (FTE) during the reporting month. Report in Column B, the total number of FTE staff hired during the reporting month. Report in Column C the total number of FTE staff who completed virtual care training. Report in Column D the total number of FTE staff who used virtual care.
UDS Service Categories*	A. Total FTEs	B. FTEs Hired	C. FTEs Completed Virtual Care Training	D. FTEs Used Virtual Care
Medical
Dental
Mental Health
Substance Use Disorder
Other Professional Services
Vision
Pharmacy
Enabling Services
Other Programs and Services
Quality Improvement Personnel
Total Facility and Non-Clinical Support Personnel
C.1b. Based on staffing for your specific OVC grant-funded project during the reporting period, For each service category; Report in Column A, the total number of full-time equivalent staff (FTE) during the reporting month. Report in Column B, the total number of FTE staff hired during the reporting month. Report in Column C the total number of FTE staff who completed virtual care training. Report in Column D the total number of FTE staff who used virtual care.
UDS Service Categories	A. Total FTEs	B. FTEs Hired	C. FTEs Completed Virtual Care Training	D. FTEs Used Virtual Care
Medical
Dental
Mental Health
Substance Use Disorder
Other Professional Services
Vision
Pharmacy
Enabling Services
Other Programs and Services
Quality Improvement Personnel
Total Facility and Non-Clinical Support Personnel
C.2. [If Table C.1. Column C indicates, FTEs completed virtual care training] Who provided virtual care training to FTEs?  (Select (X) all that apply)
Training Resources	a) Overall Health Center	b) Specific OVC project (optional*)
Virtual care training(s) provided by internal health center staff
Virtual care training(s) provided by external entities (e.g., other organizations, vendors, contractors)
C.2.a. [If provided by external entity] List names of external entities, separated by commas, that provided training to the right:
*If applicable, for health centers that have different data for OVC-specific activities to report in a given month
C.3. Please describe your health centers OVC-grant fund spending on clinical and non-clinical equipment during the reporting month. Use Column A to record the total amount spent and Column B to describe purchases made during the reporting month.
Equipment Type	A. Total Amount	B. Description
Clinical Equipment
Non-Clinical Equipment

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Sheet 12: D. Health Equity

Instructions: Please complete the "C. Health Equity" tables below to describe your health center's efforts related to: D) Promoting Health Equity
D. Promote Health Equity
D.1. List and describe the community organizations your health center partnered with to support virtual care.  Please list one organization per row and add additional rows if needed.
Community Organization Name (City, State)	Describe partnership activity
D.2. Which standardized screener(s) for social risk factors, if any, did your health center use during the reporting month?
Select (X) all that apply	Standardized screeners (Click embedded link for more information)
	Accountable Health Communities Screening Tool
	Upstream Risks Screening Tool and Guide
	iHELP/ HELLP (Income, Housing, Education, Legal Status, Literacy, Personal, Safety Questionnaire)
	Recommend Social and Behavioral Domains for EHRs
	(PRAPARE) Protocol for Responding to and Assessing Patients’ Assets, Risks, and Experiences
	(WE CARE) Well Child Care, Evaluation, Community Resources, Advocacy, Referral, Education
	WellRx
	Health Leads Screening Toolkit
	Other: (Please describe): _______________________________________
	We DO NOT use a standardized screener
D.3. List and describe the processes, events, and materials your health center used to educate staff about disparities in access to virtual care among patients served during the reporting month.
Process/Event/Material Name	Description (50 Word Max each)
D.4. What did you hear from providers about virtual care use during the reporting month? (Consider challenges, successes, and lessons shared formally and/or informally) (300 Word max)	.
D.5. What did you hear from patients about virtual care use during the reporting month? (Consider challenges, successes, and lessons shared formally and/or informally) (300 Word max)
D.6. Additional Comments: (300 Word max)

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Sheet 13: Share Additional Information

[Grant recipients may use this tab to submit any additional information, comments, or data findings not requested in other areas of the template]

For example, if your Health Center has a definable program for a specific patient population through the OVC grant,

please report related data for OVC-specific telehealth visits and any other relevant information in this tab.