The Form 5A service descriptors outline the general elements for all services, both Required and Additional, to assist in accurate recording of the approved Health Center Program scope of project. The descriptors are broadly written to acknowledge the variety of staff and provider types that may deliver any one service and to ensure individual

On Form 5A Service Descriptors (PDF), you will find descriptions of the required and additional services and Form 5A Column Descriptors (PDF) provides descriptions of the three service delivery methods used by health centers.

The Form 5A Self-Assessment Worksheet is a structured document developed by HRSA that corresponds to the sections of Form 5A in the HRSA Electronic Handbooks (EHB) and is designed to guide health centers through the process …

2025年3月5日 · In February 2025, in response to the Trump Administration’s Executive Orders (EOs), HRSA and BPHC made some minor updates to the HRSA Service Descriptors for Form 5A: Services Provided document. Voluntary Family Planning (p. 11):

Purpose: This worksheet is a self-assessment tool for health centers to evaluate the accuracy of their HRSA scope of project, specifically the accuracy of Form 5A: Services Provided (Form 5A). This tool also may be used by health centers to facilitate conversations with their HRSA Health Center Program project officers.

FORM 5A: SERVICES PROVIDED (REQUIRED SERVICES) FOR HRSA USE ONLY. Grant Number. Application Tracking # This form will pre-populate for competing continuation applicants. For more information, refer to the Service Descriptors for Form 5A: Services Provided and the Column Descriptors for Form 5A: Services Provided. Service Type. Service Delivery ...

Form 5A Column Descriptors (PDF) provides descriptions of the three service delivery methods used by health centers. You must propose to make General Primary Medical Care available directly (Column I) and/or

2023年8月10日 · Purpose: This worksheet is a self-assessment tool for health centers to use to evaluate the accuracy of their HRSA scope of project, specifically the accuracy of Form 5A: Services Provided (Form 5A). Locate your Form 5A, all contracts agreements and referral arrangements related to services provided by a contracted or referral provider.

2021年8月4日 · HRSA has provided centers a tool for internal review of their Form 5A Health Center Self-Assessment Worksheet for Form 5A: Services Provided (hrsa.gov). Although this tool is helpful, without the service descriptors, centers remain confused about how to accurately assess their form.

2019年8月7日 · UPDATE (March 3, 2025): HRSA provided guidance that health centers purchasing and providing bus/taxi vouchers/tokens should be documented as a Column I service on the health center’s Form 5A. The FAQ from HRSA states, “If a health center provides its own transportation service or directly pays for transportation that enables patients to ...