ANTHC :: CHA Workload Online Form

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Online monthly submission form

Please use the form for online submission of Community Health Aide/Practitioner monthly workload. Only one village at a time may be submitted.

Name of Agency Reporting:
Month & Year:
Village:
# of Pt Encounters:
	List above the # of individual patient encounters (patient seen & SOAP note made) with CHA/P as primary health care provider.
# of Groups:
	List above the # of group health education presentations.
# of Fluoride Tx:
	List above the # of patients treated with fluoride rinses and gels.
# of Visits Assisting:
	List above the # of patients seen by the CHA/P along with another person who is the primary health care provider (e.g., itinerant PHN, physician, dentist, etc.).
Miscellaneous:
	If miscellaneous services are provided, please list the number and a description of services above.
Your Name:
Your E-mail:

The workload weightings vary depending on the type of visit, and are:

Patient encounters (1.0 hour)
Group Education presentations (2.0 hours)
Fluoride tx (.1 hour)
Visits Assisting (.25 hour)

These weightings are based on the general assumptions that a patient encounter is one hour, a group education presentation is two hours, fluoride treatment is six minutes, and that assisting other providers takes fifteen minutes. Weights for other types of visits are variable.