From FQHC LAL ID pre-application planning (service area needs assessment) to the actual application process, FQHC Pro is here to help your CHC become a Federally Qualified Health Center Look-Alike. We will lead in expertly developing application documents:
1. Project Abstract
2. Project Narrative:
Need; Response; Collaboration; Evaluative Measures; Resources/Capabilities; and Governance
3. Attachments:
a) Patient Origin and Utilization Information
b) Service Area Map and Table
c) Medicare and Medicaid Documentation
d) Bylaws
e) Governing Board Meeting Minutes
f) Co-Applicant Agreement for Public Entities
g) Contracts and Referral Arrangements
h) Articles of incorporation
i) Evidence of Nonprofit or Public Center Status
j) Financial Statements
k) Organizational Chart
l) Position Descriptions of Key Personnel
m) Biographical Sketches of Key Personnel
n) Sliding Fee Discount Schedule
o) Collaboration Documentation
p) Floor Plans
q) Budget Narrative
r) Health Center Program Requirements Compliance
4. Program Specific Forms:
Form 1A: General Information Worksheet
Form 1C: Documents on File
Form 2: Staffing Profile
Form 3: Income Analysis
Form 3A: Look-Alike Budget Information
Form 4: Community Characteristics
Form 5A: Services Provided
Form 5B: Service Sites
Form 5C: Other Activities/Locations
Form 6A: Current Board Member Characteristics
Form 6B: Request for Waiver of Board Member Requirement
Form 8: Health Center Agreements
Form 12: Organization Contacts
Clinical and Financial Performance Measures
5. Operational Site Visit preparation
Interested, right? Let's discuss.
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Industry
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Health and Human Services
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Company size
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2-10 employees
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Headquarters
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New York, New York
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Type
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Partnership
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Founded
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2018
