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How to use or fill out Diabetes Awareness Month, Funding Status Update, and More! with our platform
- Click ‘Get Form’ to open it in the editor.
- Begin by entering your Health Center Name, Street Address, City, State, and Zip Code in the designated fields.
- Fill out the required sections for Prescribing Provider and Behavioral Health Provider. Ensure you include their names, job titles, credentials, work phone numbers, and emails.
- If applicable, add details for any Other Staff Member in the optional section provided.
- Answer the eligibility questions regarding your health center's status as a community health center or FQHC and provide information on adolescent patient visits.
- Complete the open-ended questions about your health center’s priority adolescent health issues and expectations from participating in the program.
- Ensure all applicants sign where indicated and that supervisors acknowledge their support for participation.
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| Versions | Form popularity | Fillable & printable |
|---|---|---|
| 2024 | 4.7 Satisfied (24 Votes) | |
| 2023 | 4.3 Satisfied (27 Votes) | |
| 2023 | 4.1 Satisfied (45 Votes) | |
| 2023 | 4.1 Satisfied (46 Votes) | |
| 2023 | 4.4 Satisfied (35 Votes) | |
| 2022 | 4.8 Satisfied (52 Votes) | |
| 2022 | 4.6 Satisfied (28 Votes) | |
| 2021 | 4.8 Satisfied (61 Votes) | |
| 2021 | 4.8 Satisfied (31 Votes) | |
| 2021 | 4.7 Satisfied (124 Votes) | |
| 2021 | 4.8 Satisfied (145 Votes) | |
| 2021 | 4.8 Satisfied (89 Votes) | |
| 2021 | 4.8 Satisfied (49 Votes) | |
| 2021 | 4.5 Satisfied (36 Votes) | |
| 2021 | 4.2 Satisfied (40 Votes) |
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