| OMB Number: 0915-0285; Expiration Date XX/XX/20XX | ||
| Health Center Controlled Networks (HCCN) PROGRESS REPORT TABLE | ||
| HCCN NAME: 
 Number of Participating Health Centers (Baseline) Number of Participating Health Centers (Current) | APPLICATION TRACKING NUMBER: 
 | GRANT NUMBER: 
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| PARTICIPATING HEALTH CENTER | ||||||
| Participating Health Center Name | 
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| Grant/Look alike Number | 
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| PATIENT DETAILS | ||||||
| Total Patients (UDS Definition) | 
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| Number of Sites (Baseline) | 
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| Number of Sites (Current) | 
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| ENHANCE THE PATIENT AND PROVIDER EXPERIENCE | ||||||
| 
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| 
 | [ ] medical history [ ] lab/test results [ ] shared care plans [ ] education/self-management tools[ ] appointment reminders [ ] appointment scheduling [ ] medication refill [remote monitoring devices] [ ] other (explain) | |||||
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| 
 | [ ] improved CDS [ ] EHR template customization/optimization [ ] telehealth [ ] eConsults [ ] mobile health [ ] dashboards [ ] other reporting tools (please explain) | |||||
| ADVANCE INTEROPERABILITY | ||||||
| 
 | [_] Yes [_] No Previously completed within project period[_] | |||||
| 
 | [_] Yes [_] No Previously completed within project period[_] | |||||
| 
 | [_] Yes [_] No | |||||
| 
 | [_] Yes [_] No | |||||
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| 
 | [_] Yes [_] No | |||||
| USE DATA TO ENHANCE VALUE | ||||||
| 
 | [ ] Busines Intelligence Software s [ ] Data Analytics [ ] Predictive Analytics [ ] SMART Apps [ ] Patient-Centered Tools [ ] other (please explain) | |||||
| 
 | [_] Yes [_] No | |||||
| 
 | [_] Yes [_] No | |||||
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| THE HEALTH CENTER CONTROLLED NETWORK WILL COMPLETE THIS SECTION AT THE END OF THE 3-YEAR PROJECT PERIOD FOR THE ONE-TIME FINAL REPORT | ||||||
| 
 
 
 
 
 
 
 
 
 
 
 
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| 
			 Public Burden Statement: Health centers (section 330 grant funded and Federally Qualified Health Center look-alikes) deliver comprehensive, high quality, cost-effective primary health care to patients regardless of their ability to pay. . paperwork@hrsa.gov HYPERLINK "https://sharepoint.hrsa.gov/sites/bphc/oppd/ED1/OMB%20Forms%20Approval%202020/paperwork@hrsa.gov" 42 U.S.C. 254b HYPERLINK "http://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section254b&num=0&edition=prelim" | ||||||
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document | 
| File Title | HCCN Progress Report Final | 
| Author | Nivedita Nagare | 
| File Modified | 0000-00-00 | 
| File Created | 2021-01-13 |