Critical MASS

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
About the Program
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
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:

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