Nhsc site data tables 2025

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The document outlines the NHSC Site Data Tables, which are used for reporting patient and service data at specific healthcare sites. It includes sections for site identification, patient demographics by insurance type, service charges and collections, sliding fee schedule applications, and staffing details. The tables aim to capture comprehensive data on patient visits, financial transactions, and personnel involved in providing medical, dental, and mental health services over a six-month reporting period.

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Click ‘Get Form’ to open the NHSC Site Data Tables in the editor.
Begin by filling in the Site Name and Site Address fields. Ensure that all information is accurate and up-to-date.
Enter the Date Prepared and Prepared By details. This helps maintain a clear record of who completed the form.
For the 6-Month Reporting Period, specify the start and end dates in mm/yy format. Then, input the Total Patients and Total Patient Visits based on your records.
Proceed to Table 1: Fill in the Number of Patients and Patient Visits for each Primary Insurance Type. Make sure to calculate percentages accurately.
Continue with Table 2 by reporting Full Charges, Amount Collected, and Adjustments for each Payment Source.
In Table 3, document SFS Applications Approved, Not Approved, and Total Applications Received during the reporting period.
Finally, complete Table 4 by entering FTEs for various personnel categories. Ensure that you classify staff correctly based on their roles.

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Versions	Form popularity	Fillable & printable
2021	4.8 Satisfied (145 Votes)
2020	4.3 Satisfied (211 Votes)
2018	4.1 Satisfied (47 Votes)
2013	4.4 Satisfied (552 Votes)

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