HCRR Quarterly Report Instructions

Service Area/Quarter/Year

Community/Professional contacts: List contact names/agencies that you have spoken to specifically to discuss the registry or given presentations to in the last quarter. Include contact person’s name and title as well as agency name. This excludes contacts with DDA/HCS/AAAs.

Meetings and Community Events Attended: List any organized meetings (example would community network meeting) or events (example would be health fair or job fairs) that were attended.

Marketing and mailing completed: List number of brochures distributed and to what locations, number of postcards/marketing material mailed out (example postcards to potential providers or consumers).

AAA/HCS/DDD staff contacted: List the staff name/agency of those you had direct contact with in the quarter. (Example: Carla Estes/ DDA)

“Hiring and Supervising Your Home Care Worker” guides distributed: # of guides given out during this quarter to consumers, families or representatives.

“It’s Your Choice” DVDs distributed: # of DVDs given out to consumers, families or representatives during this quarter.

“Becoming a Professional IP” completed: # of providers who confirmed review of “Becoming a Professional IP” this quarter.

Interviews completed: # of applications (that transitioned to interviews) completed during this quarter.

Applications completed: # of interviews (that transitioned to an enrolled and active status) completed during this quarter.

Providers completing Safety & Orientation: # of potential providers that completed safety and orientation during this quarter.

Consumer Applications sent: # of consumer applications given out this quarter.

Additional Comments: Anything special that coordinator wants to add. This is place you would state any attachments (agendas for meetings you attended, spot lights, health fair/job fair flyers that you attended).