Louisiana Department of Health & Hospitals | Bruce Greenstein, Secretary

SBHC Documents and Forms

Reporting Forms By Quarter

Reporting Forms by Quarter for Operating SBHCs

Financial

• Reimbursement Guidelines
• Guidelines For Travel Reimbursement
• Reimbursement Form in Word Document
• Reimbursement Form in Excel Spreadsheet
• Request For Reimbursement (Invoice)
• Mileage Reimbursement Log
• Travel Expense Report
• Budget Revision in Word Document
• Budget Revision in Excel Spreadsheet
• Contract Budget Forms
• Inkind Contribution
• Inventory List

Encounter Form

• Instructions For The SBHC Standard Encounter Form
• Standard Medical/Mental Health Encounter Form
• Medical ICD Codes
• Standard Mental Health Encounter Form
• Mental ICD Codes

Quality Assurance

• CQI Policy
• LAPERT I
• Sentinel Conditions
• LAPERT II
• Best Practices For Prevention In SBHCs
  • Screening For Type II Diabetes Mellitus
  • Screening For High Blood Pressure
    • Hypertension Best Practice Training Presentation
    • Hypertension Best Practice Training FAQs
  • Immunization Schedule
  • Screening For Chlamydia/Gonorrhea & Other STDs
  • HIV Prevention
  • Screening For Cervical Cancer
  • Screening For Tobacco Use
• LA SBHCs resource Tool For Comprehensive Physical Exams
• Principles, Standards and Guidelines For SBHCs In Louisiana

Other

• Final School Health Forms
• Adolescent School Health Program Administrative Manual
• Clinical Fusion Instructions
• Sample List of Standard Abbreviations from St. Frances Medical Center
• Sample SBHC Policies
• Sample RN MOU
• Sample SW MOU
• Sample Equipment/Supply List for SBHCs
  Provided by the Tulane Section of Adolescent Medicine