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<br />Outside Agencies/Human Services Outside Agencies/Human Services Outside Agencies/Human Services Outside Agencies/Human Services <br /> <br />Program information P a g e 1 2 o f 2 2 <br />Please use the drop down menu below to select which function area best aligns with your agency <br />and program(s) in which you are requesting funding. Please select only one from the drop down <br />menu below. <br />Public Health and Health Education <br />If you selected other, please tell us what function area best aligns with your organization: <br /> <br /> <br /> <br />Please indicate three program goals/performance measures below. <br />A few notes: <br />• If you use percentages, please put the actual number equivalence. <br />• Please ensure your performance measures are outcome based and not outputs. <br /> <br />Program Goal # 1 Refugee Health Care <br />Performance Measure <br />(How will you accomplish your goal?) <br />PHS Community Health Center Program will be a primary care <br />home for 650 unduplicated refugee patients over the 2020-2021 <br />grant year. <br />Actual Results <br />(Outcome) <br />Ending FY18-19 <br />801 refugees <br /> Projected Results <br />(Outcome) <br />Ending FY2020 <br />600 refugees thus far served between 7/1/19 – 12/31/19 (goal of <br />650) <br />Projected Results <br />(Outcome) <br />Ending FY2021 <br />650 <br /> <br />Program Goal # 2 Primary Care for Low-Income, Uninsured Patients <br />Performance Measure <br />(How will you accomplish your goal?) <br /> PHS Community Health Center program will be a primary care <br />home for over 3,700 low income uninsured patients in the 2020- <br />2021 grant period. <br />Actual Results <br />(Outcome) <br />Ending FY18-19 <br />3,691 <br />Primary Care (medical, dental, behavioral) for low-income and <br />other medically vulnerable groups <br />EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION <br />DocuSign Envelope ID: EEE4BE29-5C31-4220-A7C0-E3D3B4C537B0