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Information for Health-Care Providers


Table of Contents


Local Health Department Contractor Information

FY2017 Contract Documents

The following documents are for use from September 1, 2016 through August 31, 2017.

  • FY2017 Work Plan (PDF) (rev. 04/2016)
    The work plan contains all the required activities for contracted local health departments.
  • FY2017 Statement of Work (PDF) (rev. 04/2016)
    This document includes performance measures, reports due, schedule, billing instructions, and special provisions that are an essential part of the contract.
  • FY2017 Quarterly Report Form (XLS) (rev. 10/2016)
    Please download and use the most current version of the Quarterly Report Form. Delete older versions of this form previously saved. Outdated versions of the report form will be returned for correction.
  • FY2017 On-Site Evaluation Report Form (DOC) (rev. 09/2016)
    The On-Site Evaluation Report is the tool all reviewers will use to evaluate each standard and activity required by the Work Plan for the current year. Local Health Departments may find it helpful to use this form as a self-assessment tool to prepare for site reviews.
  • FY2017 On-Site Evaluation Report Instructions (DOC) (rev. 09/2016)

FY2016 Contract Documents

The following documents are for use from September 1, 2015 through August 31, 2016.


Other Provider/Physician Resources

Last updated November 30, 2016