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Data Input Sheet
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Organization NameTCHF School Test
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SBHC TypeUrban Non-FQHC
Click in cell to select from list
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UtilizationYear 1Year 2Year 3Year 4
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# of Students 800 800 800 800
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# of users 400 480 520 560
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# of visits/yr 1,240 1,488 1,612 1,736
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Utilization50%60%65%70%
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Mix of CareYear 1Year 2Year 3Year 4
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Medical, Immunization, Other79%79%79%79%
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Dental3%3%3%3%
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Mental Health18%18%18%18%
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Total100%100%100%100%
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Types of Insurance CoverageYear 1Year 2Year 3Year 4
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Medicaid28%28%28%28%
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CHP+6%6%6%6%
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Private Insurance11%11%11%11%
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Other/Gov't5%5%5%5%
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Uninsured50%50%50%50%
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Total100%100%100%100%
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Avg Billable Amt per VisitYear 1Year 2Year 3Year 4
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Medical $ 100 $ 100 $ 100 $ 100
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Dental $ 85 $ 85 $ 85 $ 85
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Mental Health $ 120 $ 120 $ 120 $ 120
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Reimbursement Rates %Year 1Year 2Year 3Year 4
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Medicaid30%40%45%50%
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CHP+30%40%45%50%
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Private Insurance0%0%0%0%
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Other/Gov't33%33%33%33%
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Uninsured0%0%0%0%
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Other Revenue Sources (annual amt)
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Grants & Contrib. (exc. TCHF funds) 26,180 40,430 48,682 57,684 38% of total revenue CASBHC 07-08
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Gov't/Other 17,224 26,599 32,027 37,950 25% of total revenue CASBHC 07-08
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19% In-Kind revenue
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18% Patient Revenue
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Column1
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Urban Non-FQHC
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Rural Non-FQHC
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Urban FQHC
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Rural FQHC
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Column1
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Select position from pull-down list
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Nurse Practitioner
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Psychiatrist
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Medical Assistant
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Mental Health Coordinator
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Administrator
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Pediatrician
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Health Care Partner
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Social Worker
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Physician Assistant
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Health Educator
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Director/Grant Writer
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Counselors
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Dental Hygenist
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