Attachment 8A

Clinical Performance Measures

Use the following required language for inclusion on your DHMH pms4542C, January 2004 form and submit electronically as provided within Local Health Department Funding System. Include only those measures that apply to your program on the DHMH pms4542C. Please do not place information on this template.

Performance Measures

Colorectal Cancer

Number of FOBTs
(if applicable)
Number of sigmoidoscopies
(if applicable)
Number of colonoscopies

Prostate Cancer

Number of DREs
Number of PSAs

Oral Cancer

Number of oral cancer screening examinations
Number of brush biopsies
Breast Cancer
Number of clinical breast exams
Number of mammograms
Cervical Cancer
Number of Pap tests
Skin Cancer
Number of skin cancer screening examinations

Attachment 8B

Educational Performance Measures

Use the following required language for inclusion on your DHMH pms4542C, January 2004 form and submit electronically as provided within Local Health Department Funding System. Include only those measures that apply to your program on the DHMH pms4542C. Please do not place information on this template.

Performance Measures

Colorectal Cancer

Number of individuals in the general public educated about Colorectal Cancer (Form 1)
Number of providers educated about Colorectal Cancer (Form 1)
Number of individuals in the general public targeted/reached for Colorectal Cancer (Form 2)
Number of providers targeted/reached about Colorectal Cancer (Form 2)

Prostate Cancer

Number of individuals in the general public educated about Prostate Cancer (Form 1)
Number of providers educated about Prostate Cancer (Form 1)
Number of individuals in the general public targeted/reached for Prostate Cancer (Form 2)
Number of providers targeted/reached about Prostate Cancer
(Form 2)

Oral Cancer

Number of individuals in the general public educated about Oral Cancer (Form 1)
Number of providers educated about Oral Cancer (Form 1)
Number of individuals in the general public targeted/reached for Oral Cancer (Form 2)
Number of providers targeted/reached about Oral Cancer (Form 2)

Breast Cancer

Number of individuals in the general public educated about Breast Cancer (Form 1)
Number of providers educated about Breast Cancer (Form 1)
Number of individuals in the general public targeted/reached for Breast Cancer (Form 2)
Number of providers targeted/reached about Breast Cancer
(Form 2)

Cervical Cancer

Number of individuals in the general public educated about Cervical Cancer/Screening (Form 1)
Number of providers educated about Cervical Cancer (Form 1)
Number of individuals in the general public targeted/reached for Cervical Cancer (Form 2)
Number of providers targeted/reached about Cervical Cancer
(Form 2)

Skin Cancer

Number of individuals in the general public educated about Skin Cancer (Form 1)
Number of providers educated about Skin Cancer (Form 1)
Number of individuals in the general public targeted/reached for Skin Cancer (Form 2)
Number of providers targeted/reached about Skin Cancer (Form 2)