<p> Ryan White Part A Implementation Plan </p><p>Provider: ______Fiscal Year______Page ______of ____ Pages</p><p>Service Priority Total Priority Allocation: Name: Service Priority ☐ ☐ ☐ ☐ Number: n/a Part A Core Medical Part A Support MAI Core Medical MAI Support Service Goal: Reference Current Comprehensive Plan: n/a</p><p>1. Objectives: 3. Quantity 5. Funds: List quantifiable Provide the approximate amount of funds to be time-limited used to provide this service. 2. Service Unit Definition: 3a) Number of objectives related Define the service unit to be provided people to be to the service served priorities listed above Start Date End Date a: b: c: d: e. 6. Select a minimum of two objectives and list planned client level outcomes to be tracked: SAMPLE FORM Ryan White Part A Implementation Plan</p><p>Grantee Name: Big City EMA Fiscal Year: 2013 Page 7 15 Pages</p><p>Service Priority Name: Medical Transportation Services Total Priority Allocation: $35,000</p><p>Service Priority Number: 9 Part A Core Medical ☐ Part A Support ☒ MAI Core Medical ☐ MAI Support ☐ Service Goal: Improve health outcomes by ensuring transportation is available to any Reference Current Comprehensive Plan: client needing assistance with transportation to access medical services. Section G. p. 25</p><p>3. Quantity 4. Time Frame: 5. Funds: 3b) Total Indicate the estimated Provide the 1. Objectives: Number of duration of activity approximate amount List quantifiable time-limited objectives related to the 3a) Number of people to be service relating to the of funds to be used service priorities listed above served units to be objective listed to provide this service. provided Start Date End Date a: By March 1, 2014, 100% of RW funded medical $280 case management service providers will have bus 50 70 $3,520 passes available for distribution to clients requiring 240 440 3/1/2013 2/28/2014 150 600 $16,200 assistance with transportation to medical Total: $20,000 appointments b: By May 1, 2014, 100% of medical case 75 600 5/1/2013 2/28/2014 $15,000 management service providers will have taxi vouchers available for distribution to clients requiring assistance with transportation to medical appointments 6. Select a minimum of two objectives and list planned client level outcomes to be tracked: Decrease in the percentage of clients who identify transportation as a barrier to accessing medical care from 70% to 30%.</p>