0604 - Oklahoma · 2016. 7. 19. · 0604 02/12/2010 [email protected] (405) 271-9202...
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OMB No.: 0990-0221 FPAR Number: Date Submitted: Reporting Period: Expires: through See Notes Check One: Revision Initial Submission 10/31/2010 Grantee Legal Name OK (405) 271-6761 (405) 271-2994 OKLAHOMA CITY OKLAHOMA STATE DEPARTMENT OF HEALTH 1000 Northeast 10th Street Maternal and Child Health Service/MCH Assessment 12/31/2009 (405) 271-4476 Mrs. Jill Nobles-Botkin, MSN, CNM OKLAHOMA STATE DEPARTMENT OF HEALTH 1000 NE 10th St OK Title X Project Director 0604 02/12/2010 [email protected] (405) 271-9202 [email protected] ✔ Title X Project Director OKLAHOMA CITY State 73117-1299 OK E-Mail E-Mail No. of Family Planning Service Sites Supported by the Title X Grant Oklahoma State Department of Health Oklahoma City No. of Delegates/Subcontractors Supported by the Title X Grant Grantee Contact Person (Person Completing FPAR) City City City 73117 Name (Month/day/year) (Month/day/year) ✔ Title X Family Planning Annual Report Perinatal and Reproductive Health Epidemiologist Address of Grantee Administrative Offices Fax Fax Dana Coles 73117-1207 Address Grant Profile Cover Sheet 01/01/2009 OKLAHOMA STATE DEPARTMENT OF HEALTH 1000 Northeast 10th Street Women's Health Division Address Phone Phone 99 State State ✔ 4
Transcript of 0604 - Oklahoma · 2016. 7. 19. · 0604 02/12/2010 [email protected] (405) 271-9202...
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OMB No.: 0990-0221
FPAR Number:
Date Submitted:
Reporting Period:
Expires: 04/30/07
through
See NotesCheck One:
Revision
Initial Submission
10/31/2010
Check if total number of sites is different from application
Grantee Legal Name
OK
(405) 271-6761
(405) 271-2994
OKLAHOMA CITY
Zip Code
Zip Code
Zip Code
OKLAHOMA STATE DEPARTMENT OF HEALTH 1000 Northeast 10th Street Maternal and Child Health Service/MCH Assessment
12/31/2009
(405) 271-4476
Mrs. Jill Nobles-Botkin, MSN, CNM
OKLAHOMA STATE DEPARTMENT OF HEALTH 1000 NE 10th St
OK
Title X Project Director
0604
02/12/2010
(405) 271-9202
✔
Title X Project Director
OKLAHOMA CITY
State
73117-1299
OK
E-Mail
E-Mail
No. of Family Planning Service Sites Supported
by the Title X Grant
Oklahoma State Department of Health
Oklahoma City
No. of Delegates/Subcontractors Supported by the Title X Grant
Grantee Contact Person (Person Completing FPAR)
City
City
City
73117
Name
Name
(Month/day/year) (Month/day/year)
✔
Title X Family Planning Annual Report
Title Perinatal and Reproductive Health Epidemiologist
Address of Grantee Administrative Offices
Fax
Fax
Dana Coles
73117-1207
Address
Address
Grant Profile Cover Sheet
01/01/2009
OKLAHOMA STATE DEPARTMENT OF HEALTH 1000 Northeast 10th Street Women's Health Division
Address
Phone
Phone
99
State
State
✔
4
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OMB No.: 0990-0221
FPAR Number:
Date Submitted:
Reporting Period:
Expires: 04/30/07
through
See NotesCheck One:
Revision
Initial Submission
10/31/2010
3
2
1
7
6
5
4
9
8
Age Group (Years)
3818
1154
22715
8173
Total Users (Sum Rows 1 to 9)
12/31/2009
Male Users (B)
29
10290
1951
69996
65
1315
1980
13850
8293
235
0604
02/12/2010
25 - 29
22950
✔
7133
3883
40 - 44
18 - 19
147
Under 15 1183
79
20 - 24
✔
1264Over 44
(Month/day/year) (Month/day/year)
881
126
Title X Family Planning Report
30 - 34
Table 1 Unduplicated Number of Family Planning Users by Age and Gender
7054
70877
01/01/2009
10
10164
35 - 39
Total Users (Sum Cols A+B)
(C)
29
Female Users (A)
120
13703
51
15 - 17
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OMB No.: 0990-0221
FPAR Number:
Date Submitted:
Reporting Period:
Expires: 04/30/07
through
See NotesCheck One:
Revision
Initial Submission
10/31/2010
551
3
2
1
7
6
5
4
8
0
42365
Asian
✔
4873
0
White
Unknown/ Not Reported
12/31/2009
Race
111
0 0
Table 2Unduplicated Number of Female Family Planning Users by Ethnicity and Race
69996
184
1
0604
02/12/2010
0
0
Native Hawaiian or other Pacific Islander
Black or African American
1 57362
More than one race 1700
5170
4374
177
5281
(Month/day/year) (Month/day/year)
0
0
American Indian or Alaska Native
Unknown/ Not
Reported (C)
Total Female Users
(Sum Cols A + B + C) (D)
Total Female Users (sum rows 1 to 7)
Title X Family Planning Annual Report
01/01/2009
Not Hispanic or Latino
(B)
0
Hispanic or Latino
(A)
18
15860
1516
54135
52 229
14996
499
533
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OMB No.: 0990-0221
FPAR Number:
Date Submitted:
Reporting Period:
Expires: 04/30/07
through
See NotesCheck One:
Revision
Initial Submission
10/31/2010
597
62
3
2
1
7
6
0
5
187
4
8
4
137
129
Black or African American
More than one race
0
0
468
0
0
12/31/2009
2
0
Unknown/ Not Reported
American Indian or Alaska Native
Unknown/ Not
Reported (C)
Total Male Users
(Sum Cols A + B + C) (D)
Total Male Users (Sum Rows 1 to 7)
0604
White
Native Hawaiian or other Pacific Islander
02/12/2010
Hispanic or Latino
(A)
0
0
183
0
Not Hispanic or Latino
(B)
2927
Title X Family Planning Annual Report
✔
3
Table 3 Unduplicated Number of Male Family Planning Users by Ethnicity and Race
64
0
(Month/day/year) (Month/day/year)
Asian 3
2
Race
1
881
01/01/2009
0
0
0
1
744
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OMB No.: 0990-0221
FPAR Number:
Date Submitted:
Reporting Period:
Expires: 04/30/07
through
See NotesCheck One:
Revision
Initial Submission
Over 250%
10/31/2010
3
2
1
7
6
5
4
Income as Percent of the HHS Poverty Guidelines
940
50516
Unknown/not reported
12/31/2009
101% - 150%
201% - 250%
0604
02/12/2010
70877
Title X Family Planning Annual Report
Table 4 Unduplicated Number of Family Planning Users by Income Level
Total Users (Sum Rows 1 to 6)
0
Number of Users (A)
(Month/day/year) (Month/day/year)
4199
01/01/2009
✔
1181
14041
151% - 200%
100% and below
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OMB No.: 0990-0221
FPAR Number:
Date Submitted:
Reporting Period:
Expires: 04/30/07
through
See NotesCheck One:
Revision
Initial Submission
10/31/2010
3
2
1
5
4
46746
12/31/2009
13517
✔
Total Users (Sum Rows 1 to 4)
Number of Users
(A)
0604
Public health insurance covering primary medical care
02/12/2010
Table 5 Unduplicated Number of Family Planning Users by Principal Health Insurance Coverage Status
Unknown/not reported
10614(Optional) Coverage unknown for family planning services
0
Uninsured (no public or private health insurance)
(Optional) Coverage for all or some family planning services 0
(Month/day/year) (Month/day/year)
Principal Health Insurance Covering Primary Medical Care
Title X Family Planning Annual Report
2a
2c
2b
01/01/2009
10614
0
70877
(Optional) Coverage for no family planning services
Private health insurance covering primary medical care (Sum Rows 2a to 2c)
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OMB No.: 0990-0221
FPAR Number:
Date Submitted:
Reporting Period:
Expires: 04/30/07
through
See NotesCheck One:
Revision
Initial Submission
10/31/2010
1
12/31/2009
0604
02/12/2010
Number of Users
(A)
✔
Table 6 Unduplicated Number of Family Planning Users with Limited English Proficiency (LEP)
(Month/day/year) (Month/day/year)
11068
Title X Family Planning Annual Report
01/01/2009
Number of users with limited English proficiency (LEP)
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OMB No.: 0990-0221
FPAR Number:
Date Submitted:
Reporting Period:
Expires: 04/30/07
through
See NotesCheck One:
Revision
Initial Submission
10/31/2010
2897
Contraceptive sponge
56
18-19 (C)
3
2
1
7
6
5
4
9
8
284
1154
151
0
Rely on male method
84
1
92
0
✔
0
2
1
8
387
281
521
0
35-39 (G)
Total Female Users (Sum Rows 1 to 20)
7
Male Condom
Spermicide (used alone)
525
9844
Table 7Unduplicated Number of Female Family Planning Users by Primary Method and Age
Unduplicated Number of Female Users by Age
0
509 28376
Abstinence
3-Month hormonal injection
40-44 (H)
1043
1536
25-29 (E)
3
0
12/31/2009
3
69996
Hormonal/contraceptive patch
1
0
Other reason
13
1
Oral contraceptive
85
31
157
963
175
10066
2105
Primary Method
Intrauterine device (IUD)
105
179
201
0
Vaginal ring 53
16
3 273
2
Title X Family Planning Annual Report
21
0604
134
71
66
37
02/12/2010
0
531
64
294
93
4701028
0
0
0
359
0
25
0
963
690 2320
0
3155
0
15126
67
8
753 1443
559
0
71
1
1
20-24 (D)
30-34 (F)
254336
121
587
Female sterilization
1044
908
1478
Hormonal implant 20
3675
186 250
31
42
20
61
3249
0
29
3
34
2
0
9417
411
32
15-17 (B)
49
82
280
18
2504
15
1319
No method
734
0
18
448
9
3841 5030
60
(Month/day/year) (Month/day/year)
< 15 (A)
0
800
294
3239
4574
1414
5
Fertility awareness method (FAM)
0 0
Female condom
1067
0
> 44 (I)
00 0
16
0
79
3
0
1069
Vasectomy
0
269
3242
10164
19
2
17
18
15
16
13
14
11
12
21
20
3
Total FemaleUsers
(Sum Cols A to I)(J)
52
01/01/2009
✔
0
10
1
Method unknown
34 11
7054
40
330
3818
115
1951 1264
Pregnant or seeking pregnancy
120
4
0
137038173
15
76
61
496
00
36
248
66109
00
0
1-Month hormonal injection
22715
1415
643475
00
7431
947
18
0
0
582
2017 63
Other method
1564 1832
19
206342
150
Cervical cap/diaphragm
1450
28
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OMB No.: 0990-0221
FPAR Number:
Date Submitted:
Reporting Period:
Expires: 04/30/07
through
See NotesCheck One:
Revision
Initial Submission
10/31/2010
✔
3
15-17 (B)
3
Method unknown
42
Total Male Users (Sum Rows 1 to 9)
30-34 (F)
18-19 (C)
716
5
6
3
4
9
7
8
1
2
0
Other method
Rely on female method(s)
12/31/2009
Title X Family Planning Annual Report
Fertility awareness method (FAM)
0 3 2 122
0
2
5
Other reason
0604
0
02/12/2010
4
20 2 1
58
1
3
30
12
35-39 (G)
50
Vasectomy
87
0
1
Table 8 Unduplicated Number of Male Family Planning Users by Primary Method and Age
Male condom0 2
13
18
0
0
147
> 44 (I)
29 51
40-44 (H)
12029
0
6579
7
< 15 (A)
27
235
(Month/day/year) (Month/day/year)
0 0 00
1
881
Partner pregnant or seeking pregnancy
0
0
0
1
10
3
10
10
01/01/2009
0
112113
No method
2
1 10
112
0
Total Male Users
(Sum Cols A to I) (J)
0
0 0
3 3
25-29 (E)
0 0
0 11
60
1 5
46
Unduplicated Number of Male Users by Age
2
20
20-24 (D)
2
37
Primary Method
16
44
Abstinence
1
321
126
189
25
6
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OMB No.: 0990-0221
FPAR Number:
Date Submitted:
Reporting Period:
Expires: 04/30/07
through
See NotesCheck One:
Revision
Initial Submission
10/31/2010
3
2
1
4 261
12/31/2009
Number of Pap tests with an HSIL or higher result
3029
0604
02/12/2010
34102
Number of Users or Number of Tests
(A)
Number of Pap tests performed
(Month/day/year) (Month/day/year)
✔
Table 9Cervical Cancer Screening Activities
01/01/2009
34045
Number of Pap tests with an ASC or higher result
Screening Activity
Unduplicated number of users who obtained a Pap test
Title X Family Planning Annual Report
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OMB No.: 0990-0221
FPAR Number:
Date Submitted:
Reporting Period:
Expires: 04/30/07
through
See NotesCheck One:
Revision
Initial Submission
10/31/2010
2
1 44238
12/31/2009
Title X Family Planning Annual Report
Number of Users
(A)
0604
02/12/2010
Screening Activity
Table 10Clinical Breast Exams and Referrals
Unduplicated number of users referred for further evaluation based on their CBE 377
(Month/day/year) (Month/day/year)
Unduplicated number of users who received a clinical breast exam (CBE)
✔
01/01/2009
-
OMB No.: 0990-0221
FPAR Number:
Date Submitted:
Reporting Period:
Expires: 04/30/07
through
See NotesCheck One:
Revision
Initial Submission
10/31/2010
3
2
1
6
5
4
Female Users (A)
15 - 17
5572
Title X Family Planning Annual Report
12/31/2009
376
0604
02/12/2010
✔
Male Users (B)
18 - 19
164
Under 15
50
8981
656
20 - 24
5
33047
(Month/day/year) (Month/day/year)
Age Group(Years)
35
25 and over
4691
Total Users(Sum Rows 1 to 5)
Table 11Unduplicated Number of Family Planning Users Tested for Chlamydia by Age and Gender
01/01/2009
13147
Number of Users
122
-
OMB No.: 0990-0221
FPAR Number:
Date Submitted:
Reporting Period:
Expires: 04/30/07
through
See NotesCheck One:
Revision
Initial Submission
10/31/2010
Number of Tests
3
2
1
5
4
✔
Test Type
34545
3
Total Tests
(Sum Cols A + B) (C)
253
12/31/2009
Male (B)
Syphilis
0604
02/12/2010
Title X Family Planning Annual Report
9114
34161
0
(Month/day/year) (Month/day/year)
Table 12Number of Gonorrhea, Syphillis, and HIV Tests
✔
Female (A)
7973
HIV - Anonymous tests
HIV - Positive confidential tests
01/01/2009
Gonorrhea
8226
261 9375 HIV - All confidential tests
384
-
OMB No.: 0990-0221
FPAR Number:
Date Submitted:
Reporting Period:
Expires: 04/30/07
through
See NotesCheck One:
Revision
Initial Submission
10/31/2010
3
2
1
✔
0
4.46
34.31
150850
12/31/2009
62444
Title X Family Planning Annual Report
Table 13 Number of Family Planning Encounters by Type of Provider
✔
0604
Total Family Planning Encounters (Sum rows 1 + 2)
Number of
FTEs (A)
02/12/2010
Number of Family Planning
Encounters (B)
88406
Provider Type
Physicians
Other clinical services providers (e.g., registered nurses)
Clinical Services Providers
(Month/day/year) (Month/day/year)
1b
1a
1c
Non-clinical Services Providers
01/01/2009
Physician assistants/nurse practitioners/ certified nurse midwives
-
OMB No.: 0990-0221
FPAR Number:
Date Submitted:
Reporting Period:
Expires: 04/30/07
through
See NotesCheck One:
Revision
Initial Submission
10/31/2010
14076096
0
0
12623824
0
0
0
0
Amount
0
$
$
$
$
$
Title X Family Planning Annual Report
)
)
)
)
)
0
Bureau of Primary Health Care (BPHC)
12/31/2009
432442
2666455
Total Revenue (sum rows 5 + 9 + 18)
Total - Other Revenue (sum rows 10 to 17)
Federal Grants
Other public health insurance
✔
7d
7e
7a
7b
7c 0
0604
02/12/2010
✔
0
0
0
0
0
Prepaid (A)
Temporary Assistance for Needy Families (TANF)
0
3098897
0 2666455
Title XX (Social Services Block Grant)
0
0
State government revenue
Other (Specify:
Other (Specify:
Other (Specify:
Third-party payers
(Month/day/year) (Month/day/year)
21540127
Title X (family planning services)
Title V (MCH Block Grant)
0
4365134
Table 14 Revenue Report
3
4
5
6
1
2
4365134
7
8
9
Private health insurance
State Children's Health Insurance Program (state CHIP)
19
17
18
15
16
13
14
11
12
01/01/2009
10
Medicare (Title XVIII)
Payment for Services
Other federal grant (Specify:
Other federal grant (Specify:
Not Pre-paid (B)
Medicaid (Title XIX)
Total - Third-Party Payers (sum rows 7a to 7e)
Total client collections/self-pay
Total-Federal Grants (sum rows 1 to 4)
Total - Payment for Services (sum row 6 + cell 8a + cell 8b)
1452272 Local government revenue
Other Revenue
-
Grantee Profile: Two additional sites reported are from Tulsa City County Health Department and
Oklahoma City County Health Department. Each opened an additional site to target the African
American population with support of additional Federal Title X funds.
Table 1: The reduction in numbers served was primarily related to the county health department
system where there was a decrease of provider coverage and a public health priority for providing
services for H1N1 prevention. In addition to the decrease in providers, the OSDH made some
slight changes in our data collection system to assure more accurate reporting of services.
Added by the Regional Office: the changes to the data collection system included eliminating
those women visiting a health clinic only for a confirmatory pregnancy test required by other
programs.
Table 2: N/A
Table 3: N/A
Table 4: N/A
Table 5: N/A
Table 6: N/A
Table 7: The IUD in the
-
Grant funds, respectively.
Added by Regional Office: The decrease in clinical encounters and the increase in non-clinical
encounters (compared to the previous year) reflect the clarification of the "other clinical services
provider" definition and shifting their encounters with clients to "non-clinical" encounters.
Table 14: Added by the Regional Office: The Medicaid revenue listed on line 7a includes revenue
received through the Medicaid family planning waiver.
