Annual Reporting Template. The following document is the template that must be used for the submission of your Facility's Annual Report. The information requested in the template below pertains only to the insured Services provided in your Facility under contract with AHS for each fiscal year (April 1 to March 31) Name of Facility: Facility Address: Surgical Specialty Number of procedures performed [year], by category Enhanced Medical Goods & Services Please provide a list and statement of revenues for all enhanced medical goods and services provided by your Facility. Annual Reporting Template (Continued) List ALL Staff (related to delivery of insured Services with AHS). Please insert date of issue and re-certification for BCLS/ACLS/PALS. Provide photocopies of updated BCLS/ACLS/PALS certifications and proof of professional registration. *PALS only required if children under ten (10) years of age require recovery room care (as required in Schedule D). Last Name First Name Professional Designation/ Title BCLS Issued BCLS Update ACLS Issued ACLS Update *PALS Issued *PALS Update "Schedule D" of the Agreement states that Medical Staff working in the surgical Facility must have Medical Staff privileges with AHS. Please provide a list of all physicians working in your Facility. Please list your Medical Staff Director first. Medical Staff Director Last Name: Medical Staff Director First Name: Physician Last Names: Physician First Names: Article 10 of the Agreement describes the requirement for teaching and research activities at your Facility. Summarize your Facility's teaching and/or research activity. Annual Reporting Template (Continued) Schedule “D” of the Agreement requests a summary of your Facility's quality assurance and monitoring activities. Summarize your Facility's quality assurance activity.
Annual Reporting Template. The following document is the template that must be used for the submission of your Facility's Annual Report. The information requested in the template below pertains only to the insured Services provided in your Facility under contract with AHS from July 1, 2019 until June 30, 2024. Name of Facility: Facility Address: Surgical Specialty Number of procedures performed [year], by category Enhanced Medical Goods & Services Please provide a list and statement of revenues for all enhanced medical goods and services provided by your Facility.
Annual Reporting Template. Monitoring and reporting are critical components of the climate action planning process. Performing monitoring on a regular basis and reporting the results in a clear manner will allow the City to evaluate progress toward achieving its reduction targets, revise and update reduction measures based on past performance, and regularly reassess emission projections. Ascent will prepare a CAP Update reporting template that will be designed to present information in a concise, graphically interesting format that is easily digested by elected officials and members of the public. The template will include a summary of the monitoring tools/metrics and key considerations in the monitoring of CAP data. These summaries will be formatted to be compatible with the City’s community action toolkit developed under Task 7 Deliverables Reporting template (electronic) Task 9: Staffing Analysis Ascent will conduct an analysis of the staffing needed for each of the GHG reduction and adaptation measures. Staffing will be measured in full-time equivalents. This analysis will be presented in Technical Memorandum #4. Deliverables Included in Technical Memorandum #4 (electronic)
Annual Reporting Template. The following document is the template that must be used for the submission of your Facility's Annual Report. The information requested in the template below pertains only to the insured Services provided in your Facility under contract with AHS from July 1, 2019 until June 30, 2024. Name of Facility: Facility Address: Surgical Specialty Number of procedures performed [year], by category Enhanced Medical Goods & Services Please provide a list and statement of revenues for all enhanced medical goods and services provided by your Facility. List ALL Staff (related to delivery of insured Services with AHS). Please insert date of issue and re-certification for BCLS/ACLS/PALS. Provide photocopies of updated BCLS/ACLS/PALS certifications and proof of professional registration. *PALS only required if children under ten (10) years of age require recovery room care (as required in Schedule D). Last Name First Name Professional Designation/Title BCLS Issued BCLS Update ACLS Issued ACLS Update *PALS Issued *PALS Update
