CHT Staffing

CHT Staffing Report

Date
Health Service Area (e.g. – Newport, Springfield)
CHT Administrative Entity (e.g. – hospital or FQHC name)
Current Total # CHT Staff supported by Blueprint payer funding (in FTEs)
Current # CHT Managers supported by Blueprint payer funding (in FTEs)
Current # CHT Managers Vacancies supported by Blueprint payer funding (in FTEs)
Current # CHT Admin Support supported by Blueprint payer funding (in FTEs)
Current # CHT Admin Support Vacancies supported by Blueprint payer funding (in FTEs)
Current # CHT Care Coordinators supported by Blueprint payer funding (in FTEs)
Current # CHT Care Coordinators Vacancies supported by Blueprint payer funding (in FTEs)
Current # CHT Social Workers supported by Blueprint payer funding (in FTEs)
Current # CHT Social Workers Vacancies supported by Blueprint payer funding (in FTEs)
Current # CHT Mental Health/Substance Abuse Clinicians supported by Blueprint payer funding (in FTEs)
Current # CHT MH/SA Clinician Vacancies supported by Blueprint payer funding (in FTEs)
Current # CHT Health Educators supported by Blueprint payer funding (in FTEs)
Current # CHT Health Educators Vacancies supported by Blueprint payer funding (in FTEs)
Current # CHT Certified Diabetes Educators supported by Blueprint payer funding (in FTEs)
Current # CHT Certified Diabetes Educators Vacancies supported by Blueprint payer funding (in FTEs)
Current # CHT Pharmacists supported by Blueprint payer funding (in FTEs)
Current # CHT Pharmacists Vacancies supported by Blueprint payer funding (in FTEs)
Current # CHT Nutrition Specialists supported by Blueprint payer funding (in FTEs)
Current # CHT Nutrition Specialists Vacancies supported by Blueprint payer funding (in FTEs)
Current # Other CHT Staff supported by Blueprint payer funding (in FTEs)
Current # Other CHT Staff Vacancies supported by Blueprint payer funding (in FTEs)

Note: Express all FTEs in numbers rounded to two decimal places – e.g. – 1.25

CHT Staff List

Date / CHT Administrative Entity (e.g. – hospital or FQHC name) / CHT Staff Member First Name / CHT Staff Member Last Name / CHT Staff Member Title* / CHT Staff Member Credentials (e.g. – RN, LSW, RD, CDE) / CHT Staff Member FTE (express FTEs in numbers rounded to two decimal places – e.g. 1.25) / CHT Staff Member Start Date (mm-dd-yyyy) / CHT Staff Member Termination Date (mm-dd-yyyy) / CHT Staff Member Funding Source (e.g. – Blueprint Payer Funding, Blueprint HSA Grant Funding, CHT Administrative Entity Funding)

*Please choose from the following titles: CHT Manager, CHT Admin Support, Care Coordinator, Social Worker, Mental Health/Substance Abuse Clinician, Health Educator, Certified Diabetes Educator, Pharmacist, Nutrition Specialist, Other