Nhsc site data tables: Fill out & sign online

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Click ‘Get Form’ to open the NHSC Site Data Tables in the editor.
Begin by filling in the 'Name of Site', 'Address of Site', 'Date Prepared', and 'Prepared By' fields. Ensure accuracy as this information is crucial for identification.
For the '12 Month Reporting Period', specify the start and end dates clearly, as this defines the scope of your report.
In Table 1, input data regarding patients or visits by primary insurance type. Use actual numbers where possible, and ensure that totals are calculated correctly.
Proceed to Table 2 to report patient service charges and collections. Enter full charges, amounts collected, and any adjustments accurately.
Complete Table 3 by detailing patient applications for the Sliding Fee Schedule. Record approved and not approved applications separately.
Finally, fill out Table 4 regarding service site staffing. Report FTEs for each category accurately based on your staff's roles.

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