Foundation for Healthy Communities
of the Ohio Hospital Association

Quarterly Grant Report
for Uninsured Pregnant Women and Children

Ohio Public Health Priorities Trust Funds 2007-2008
 

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Reporting Period:         

Submitted By:

Demographic Information (for reporting on direct health care services)
Numbers Served # Served This Report  Grant Year to Date
Unduplicated Pregnant Women

Unduplicated Children (0-11)
Unduplicated Adolescents (12-18)
 

Race/Ethnicity
  # Served This Report Grant Year To Date
White
Black or Afro-American
Hispanics or Latinos
Somalian
Native American
Asian
Other
     
Implementation Information
1) Expenditure Status of the Project
A. Total Original Grant: $

Administrative Fees**
B. Amt spent through 2Q2008: $
C. Amount spent in 3Q2008: $
D. Amount spent in 4Q2008: $
  $
  $
E. Amount Spent to date: $
F. Balance
 (Unspent Funds: A minus I): 		$
 
**Includes what is not covered above; cannot exceed 2% of the grant
 
2) Service Provision Status
Health Care Services Provided (list) # of services this report # of services Grant year-to-date Expenditures ($) this report Expenditures ($) Grant Year-to-date
Direct Health Care Services:        
Exams/Screenings
Labwork/X-Ray
Prescriptions/vaccinations
Counseling (nutr. psych)
Other

Sub-Total:
         
Preventative Education        
Counseling (preventative)
Home Visits
Pre-Natal Care Coord.
Other

Sub-Total:
         
Outreach and Promotion        
Patient Awareness & Recruiting
Promotion (media, mailings, lit)
Transportation
Other

Sub-Total:
         
Total (direct+prev+outreach)
         


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