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<br />Program information P a g e 1 1 o f 2 2 <br />Program Name: Community Health Center Program <br /> <br />Strategic <br />Objective <br />(please choose one from <br />the Results Framework) <br /> Children improve their educational outcomes <br /> Residents Increase their livelihood security <br /> Residents improve their health outcomes <br /> <br />Intermediate <br />Result <br />(please choose one from <br />the Results Framework) <br />Insert Intermediate Result here. <br /> <br /> <br />3.1: Residents access basic health care services (primary, behavioral, dental). <br /> <br /> <br />RESULTS Actual <br />2018-19 <br />Projected <br />2019-20 <br />Projected <br /> 2020-21 <br />Performance <br />Indicators <br />(Please choose at least <br />one performance <br />indicator to report on <br />from the Results <br />Framework, and add <br />additional performance <br />indicators that you <br />would like to report to <br />the Towns. Please <br />insert additional rows as <br />needed, listing one per <br />row). <br />Insert Performance Indicator here. <br /> <br />Preventive Screening #1 (MEDICAL): <br />#/% Women 23-64 who were <br />appropriately screened for cervical <br />cancer (i.e. pap smear). <br />1,774 (66%) <br /> <br />1,499 (77%) <br />7/1/19 through <br />12/31/19 <br />1,850 (70%) <br /> Preventive Screening #2 <br />(MEDICAL/BEHAVIORAL)): #/% of <br />individuals 18 years and older who <br />were screened for tobacco use one <br />or more times in the last 24 months, <br />and if identified to be a tobacco user, <br />received cessation counseling <br />intervention. <br />3,801 (90%) <br />2,265 (88%) <br />7/1/19 through <br />12/31/19 <br /> 3,800 (90%) <br /> Preventive Screening #3 <br />(MEDICAL/BEHAVIORAL): #/% of <br />individuals 12 years or older who <br />were screened for depression using <br />an age appropriate standardized <br />depression screening tool, and if <br />positive, had a follow-up plan <br />documented. <br />3,411 (66%) <br />2,453 (63%) <br />7/1/19 through <br />12/31/19 <br />3500 (70%) <br /> <br />EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION <br />DocuSign Envelope ID: EEE4BE29-5C31-4220-A7C0-E3D3B4C537B0