PRIMARY MEDICAL CARE
SERVICES |
1. General Primary Medical Care (other
than listed below) |
100.0% |
25.0% |
25.0% |
100.0% |
2. Diagnostic Laboratory (technical
component) |
100.0% |
75.0% |
75.0% |
100.0% |
3. Diagnostic X-Ray Procedures (technical
component) |
0.0% |
50.0% |
100.0% |
100.0% |
4. Diagnostic Tests/Screenings (professional
component) |
100.0% |
50.0% |
100.0% |
100.0% |
5. Emergency medical services |
25.0% |
0.0% |
100.0% |
100.0% |
6. Urgent medical care |
100.0% |
25.0% |
50.0% |
100.0% |
7. 24-hour coverage |
100.0% |
0.0% |
50.0% |
100.0% |
8. Family Planning |
100.0% |
0.0% |
25.0% |
100.0% |
9. HIV testing and counseling |
100.0% |
0.0% |
75.0% |
100.0% |
10. Testing for Blood Lead Levels |
75.0% |
25.0% |
75.0% |
100.0% |
11. Immunizations |
100.0% |
0.0% |
0.0% |
100.0% |
12. Following hospitalized patients |
100.0% |
0.0% |
50.0% |
100.0% |
OBSTETRICAL AND GYNECOLOGICAL
CARE |
13. Gynecological Care |
100.0% |
25.0% |
50.0% |
100.0% |
14. Prenatal care |
100.0% |
25.0% |
75.0% |
100.0% |
15. Antepartum fetal assessment |
50.0% |
0.0% |
75.0% |
100.0% |
16. Ultrasound |
50.0% |
0.0% |
100.0% |
100.0% |
17. Genetic counseling and testing |
50.0% |
0.0% |
100.0% |
100.0% |
18. Amniocentesis |
0.0% |
0.0% |
100.0% |
100.0% |
19. Labor and delivery professional
care |
75.0% |
0.0% |
50.0% |
100.0% |
20. Postpartum care |
100.0% |
0.0% |
25.0% |
100.0% |
SPECIALTY MEDICAL
CARE |
21. Directly observed TB therapy |
0.0% |
0.0% |
100.0% |
100.0% |
22. Respite Care |
0.0% |
0.0% |
100.0% |
100.0% |
23. Other Specialty Care |
0.0% |
25.0% |
75.0% |
75.0% |
DENTAL CARE SERVICES |
24. Dental Care - Preventive |
75.0% |
0.0% |
50.0% |
100.0% |
25. Dental Care - Restorative |
75.0% |
0.0% |
50.0% |
100.0% |
26. Dental Care - Emergency |
75.0% |
0.0% |
50.0% |
100.0% |
27. Dental Care - Rehabilitative |
75.0% |
0.0% |
50.0% |
100.0% |
MENTAL HEALTH/SUBSTANCE
ABUSE SERVICES |
28. Mental Health Treatment/Counseling |
100.0% |
50.0% |
100.0% |
100.0% |
29. Developmental Screening |
100.0% |
25.0% |
75.0% |
100.0% |
30. 24-hour Crisis Intervention/Counseling |
0.0% |
0.0% |
100.0% |
100.0% |
31. Other Mental Health Services |
0.0% |
0.0% |
100.0% |
100.0% |
32. Substance Abuse Treatment/Counseling |
50.0% |
0.0% |
100.0% |
100.0% |
33. Other Substance Abuse Services |
25.0% |
25.0% |
100.0% |
100.0% |
33a. Comprehensive mental health / Substance
abuse screening |
50.0% |
0.0% |
100.0% |
100.0% |
OTHER PROFESSIONAL
SERVICES |
34. Hearing Screening |
100.0% |
0.0% |
50.0% |
100.0% |
35. Nutrition Services Other than WIC |
100.0% |
0.0% |
100.0% |
100.0% |
36. Occupational or Vocational Therapy |
0.0% |
0.0% |
100.0% |
100.0% |
37. Physical Therapy |
0.0% |
25.0% |
100.0% |
100.0% |
38. Pharmacy - Licensed Pharmacy staffed
by Registered Pharmacist |
0.0% |
50.0% |
75.0% |
75.0% |
39. Pharmacy - Provider Dispensing |
75.0% |
0.0% |
25.0% |
75.0% |
Total Pharmacy |
75.0% |
50.0% |
75.0% |
75.0% |
40. Vision Screening |
100.0% |
25.0% |
25.0% |
100.0% |
41. Podiatry |
50.0% |
0.0% |
50.0% |
100.0% |
42. Optometry |
0.0% |
25.0% |
100.0% |
100.0% |
ENABLING SERVICES |
43. Case management |
100.0% |
0.0% |
100.0% |
100.0% |
44. Child Care (during visit to center) |
0.0% |
0.0% |
75.0% |
75.0% |
45. Discharge Planning |
75.0% |
0.0% |
100.0% |
100.0% |
46. Eligibility Assistance |
100.0% |
0.0% |
75.0% |
100.0% |
47. Environmental Health Risk Reduction
(via detection and/or alleviation) |
100.0% |
0.0% |
75.0% |
100.0% |
48. Health education |
100.0% |
0.0% |
75.0% |
100.0% |
49. Interpretation/Translation services |
100.0% |
25.0% |
25.0% |
100.0% |
50. Nursing home and assisted-living
placement |
0.0% |
0.0% |
75.0% |
75.0% |
51. Outreach |
100.0% |
0.0% |
25.0% |
100.0% |
52. Transportation |
50.0% |
25.0% |
75.0% |
100.0% |
53. Out Stationed Eligibility Workers |
25.0% |
0.0% |
75.0% |
100.0% |
54. Home Visiting |
50.0% |
0.0% |
50.0% |
75.0% |
55. Parenting Education |
50.0% |
0.0% |
75.0% |
75.0% |
56. Special Education Program |
0.0% |
0.0% |
50.0% |
50.0% |
57. Other |
25.0% |
0.0% |
0.0% |
25.0% |
PREVENTATIVE SERVICES
RELATED TO TARGET CLINICAL AREAS |
I. Cancer |
58. Pap Test |
100.0% |
0.0% |
50.0% |
100.0% |
59. Fecal occult blood test |
100.0% |
0.0% |
50.0% |
100.0% |
60. Sigmoidoscopy |
0.0% |
0.0% |
100.0% |
100.0% |
61. Colonoscopy |
0.0% |
0.0% |
100.0% |
100.0% |
62. Mammograms |
25.0% |
0.0% |
75.0% |
100.0% |
63. Smoking cessation program |
75.0% |
0.0% |
75.0% |
100.0% |
II. Diabetes |
64. Glycosylated hemoglobin measurement
for people with diabetes |
100.0% |
25.0% |
50.0% |
100.0% |
65. Urinary microalbumin measurement
for people with diabetes |
100.0% |
25.0% |
75.0% |
100.0% |
66. Foot exam for people with diabetes |
100.0% |
25.0% |
50.0% |
100.0% |
67. Dilated eye exam for people with
diabetes |
0.0% |
0.0% |
100.0% |
100.0% |
III. Cardiovascular
Disease |
68. Blood pressure monitoring |
100.0% |
0.0% |
25.0% |
100.0% |
69. Weight reduction program |
75.0% |
0.0% |
50.0% |
100.0% |
70. Blood cholesterol screening |
100.0% |
0.0% |
50.0% |
100.0% |
IV. HIV/AIDS (See
line 9. HIV testing and counseling) |
V. Infant Mortality
(See line 14. Prenatal Care) |
71. Follow-up testing and related health
care services for abnormal newborn bloodspot
screening |
0.0% |
0.0% |
100.0% |
100.0% |
VI. Immunizations
(See line 11. Immunizations) |
OTHER SERVICES |
72. WIC Services |
0.0% |
0.0% |
100.0% |
100.0% |
73. Head Start services |
0.0% |
0.0% |
100.0% |
100.0% |
74. Food bank/delivered meals |
25.0% |
0.0% |
50.0% |
75.0% |
75. Employment/Educational Counseling |
0.0% |
0.0% |
75.0% |
75.0% |
76. Assistance in obtaining housing |
25.0% |
0.0% |
75.0% |
75.0% |