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Name
Title
Agency
Address
City
State
Zip
Web Site
Phone
Fax
Email
About the Agency
Agency Type
Areas Served
-Urban
-Rural
-Suburban
-Tribal
-Statewide
Program Inception Date
Program Location
Coordinating Agency
Funding Source
Service Type
Population Served
Practice Setting
-Hospital-based practice
-Private Physician ∫ Primary Care
-Private Physician ∫ Specialist
-Managed Care Organization/Insurer
-Community Health Center
-Free Clinic
-Public Health Department
-Other State Agency
-School Based Health Clinic
-Community Based Organization
Mission
Has your organization conducted a CLAS audit?
-
Yes
-No
-Do Not Know
-N/A
Are you aware of the following publications:
-Health People 2010
-National Center for Health
-Unequal Treatment
Have you used CLAS standards in your organization?
-
Yes
-No
Do you have a certified transcultural Nurse on staff?
-Yes
-No
Do you use Community Health Workers?
-Yes
-No |
About the Program:
Do you have a certified health education specialist on staff?
Yes
No
Do you collect demographic data and epidemiological data on the population you serve?
Yes
No
Do you use social marketing?
Yes
No
Do you work with community organizations?
Yes
No
Do you have trained certified medical interpreters on staff?
Yes
No
Do you have a consumer advisory board?
Yes
No
What language does this program target?
Chinese
English
Haitian-Creole
Khmer/Cambodian
Laotian
Portuguese
Russian
Spanish
Vietnamese
Not Applicable
Other
Describe how you evaluate the success of this program
How is this program funded?
Does your successful program allow the following processes?
-Building of relationships
-Customized care according to patient needs and values
-Sharing of information freely between organizations
-Use of evidence based decisions or personal evidence
List of Partners:
Future Plans: |
