Annual Report

 

VHCPP ANNUAL REPORTING FORM

(July 1, 2015 – June 30, 2016)

Clinic/Organization: Space Coast Volunteers in Medicine

1. Total Number of Medical Patient Visits: _______4,332

(A patient visit is a face-to-face meeting between a patient and a

health care professional in order to receive medical services.)

2. Total Number of Dental Patient Visits _419

(A patient visit is a face-to-face meeting between a patient and a

health care professional in order to receive dental services.)

3. Total Number of Patient Visits __4751

4.   Total Number of Active Licensed Health Care Providers Participating in you organization__ Volunteer (If hours are documented.): ________81

(Total number of 766 and non-766 providers that are actively

participating in your clinic.)

 

5.   Total Number of Licensed Healthcare Provider Volunteer Hours__7,781.00

 

6.   Total Dollar Value of Services for Licensed Healthcare Providers______$945,202 (To be determined by: (1) An hourly rate based on the

figures below; (2) Actual cost of services; or (3) Value based on visits

or referrals.)

7.   Total Dollar Value of Donations: ____$1,207,268.77 _____

(Donations include items such as: monies, pharmaceuticals, eyeglasses,

labs, x-rays, equipment, etc., do not include grants.)

8.   Total Number of General Staff Volunteers :                                   _______38

(Volunteers performing general duties, answer the phone, medical

records, make copies, repairs, etc.)

9. Total Number of General Staff Volunteer Hours: ______5,927
10. Total Value of Services for General Staff Volunteers: _____$136,735.89

11. Total Value of Service: _____$2,289,206.66
(Add lines 4, 5, and 8 together.)
12. Total Number of Active DOH 110 Volunteers: __________26

(Include only the DOH 110 volunteers that have applications on file who

complete the eligibility and referral process for DOH.)

13. Total Number of DOH 110 Volunteer Hours: ________1858.75

(110 volunteers hours doing patient eligibility and referrals only.)

14. Total Dollar Value of Services for DOH 110 Volunteers: ______$42,881.36

(Multiply line 11 by $21.79) This value will be reported under the CHD.

The following values per hour are offered as a suggested guideline for your use in estimating the value of your volunteer services.

Physician:         $250/Hour         Optometrist:             $50/Hour           LPN:                                  $25/Hour

Dentist:             $200/Hour         ARNP/PA:                   $75/Hour           Respiratory Therpt:        $40/Hour

Chiropractor:     $ 90/Hour         Registered Nurse:   $35/Hour           Dental Hygienist:           $25/Hour

Pharmacist:       $ 75/Hour         Physical Therapist:  $60/Hour           Support Staff:                  $21.79/Hour

Social Worker:   $ 50/Hour

rev. 8/22/2016

TOTAL VALUE OF SERVICES PROVIDED BY SCVIM: $2,289,206.66

______________________________________________________

VHCPP ANNUAL REPORTING FORM

(July 1, 2014 – June 30, 2015)

Clinic/Organization: Space Coast Volunteers in Medicine

1. Total Number of Patient Visits: _______1,556

(A patient visit is a face-to-face meeting between a patient and a

health care professional in order to receive medical services.)

2. Total Number of Active Licensed Health Care Providers

Participating in Your Organization: ________70

(Total number of 766 and non-766 providers that are actively

participating in your clinic.)

3.   Total Number of Licensed Health Care Provider Volunteer

Hours: (If hours are documented.)

4.   Total Dollar Value of Services for Licensed Health Care ______$463,143

Providers: (To be determined by: (1) An hourly rate based on the

figures below; (2) Actual cost of services; or (3) Value based on visits

or referrals.)

5.   Total Dollar Value of Donations: ____$219,623 _____

(Donations include items such as: monies, pharmaceuticals, eyeglasses,

labs, x-rays, equipment, etc., do not include grants.)

6.   Total Number of General Staff Volunteers :                                   _______34

(Volunteers performing general duties, answer the phone, medical

records, make copies, repairs, etc.)

7. Total Number of General Staff Volunteer Hours: ______6068
8. Total Value of Services for General Staff Volunteers: _____$139,988

9. Total Value of Service: _____$822,754
(Add lines 4, 5, and 8 together.)
10. Total Number of Active DOH 110 Volunteers: __________25

(Include only the DOH 110 volunteers that have applications on file who

complete the eligibility and referral process for DOH.)

11. Total Number of DOH 110 Volunteer Hours: ________854

(110 volunteers hours doing patient eligibility and referrals only.)

12. Total Dollar Value of Services for DOH 110 Volunteers: ______$19,702

(Multiply line 11 by $21.79) This value will be reported under the CHD.

The following values per hour are offered as a suggested guideline for your use in estimating the value of your volunteer services.

Physician:         $250/Hour         Optometrist:             $50/Hour           LPN:                                  $25/Hour

Dentist:             $200/Hour         ARNP/PA:                   $75/Hour           Respiratory Therpt:        $40/Hour

Chiropractor:     $ 90/Hour         Registered Nurse:   $35/Hour           Dental Hygienist:           $25/Hour

Pharmacist:       $ 75/Hour         Physical Therapist:  $60/Hour           Support Staff:                  $21.79/Hour

Social Worker:   $ 50/Hour

rev. 08/22/16

TOTAL VALUE OF SERVICES PROVIDED BY SCVIM: $822,754

‘(July 1, 2013 – June 30, 2014)

Clinic/Organization: Space Coast Volunteers in Medicine

1. Total Number of Patient Visits: _______2,047

(A patient visit is a face-to-face meeting between a patient and a

health care professional in order to receive medical services.)

2. Total Number of Active Licensed Health Care Providers

Participating in Your Organization: ________81

(Total number of 766 and non-766 providers that are actively

participating in your clinic.)

3.   Total Number of Licensed Health Care Provider Volunteer

Hours: (If hours are documented.)

4.   Total Dollar Value of Services for Licensed Health Care ______$472,519

Providers: (To be determined by: (1) An hourly rate based on the

figures below; (2) Actual cost of services; or (3) Value based on visits

or referrals.)

5.   Total Dollar Value of Donations: ____$121,973 _____

(Donations include items such as: monies, pharmaceuticals, eyeglasses,

labs, x-rays, equipment, etc., do not include grants.)

6.   Total Number of General Staff Volunteers :                                   _______44

(Volunteers performing general duties, answer the phone, medical

records, make copies, repairs, etc.)

7. Total Number of General Staff Volunteer Hours: ______6,861
8. Total Value of Services for General Staff Volunteers: _____$151,902.54

9. Total Value of Service: _____$746,394.54
(Add lines 4, 5, and 8 together.)
10. Total Number of Active DOH 110 Volunteers: __________21

(Include only the DOH 110 volunteers that have applications on file who

complete the eligibility and referral process for DOH.)

11. Total Number of DOH 110 Volunteer Hours: ________682

(110 volunteers hours doing patient eligibility and referrals only.)

12. Total Dollar Value of Services for DOH 110 Volunteers: ______$15,099.48

(Multiply line 11 by $21.79) This value will be reported under the CHD.

The following values per hour are offered as a suggested guideline for your use in estimating the value of your volunteer services.

Physician:         $250/Hour         Optometrist:             $50/Hour           LPN:                                  $25/Hour

Dentist:             $200/Hour         ARNP/PA:                   $75/Hour           Respiratory Therpt:        $40/Hour

Chiropractor:     $ 90/Hour         Registered Nurse:   $35/Hour           Dental Hygienist:           $25/Hour

Pharmacist:       $ 75/Hour         Physical Therapist:  $60/Hour           Support Staff:                  $21.79/Hour

Social Worker:   $ 50/Hour

rev. 08/22/16

TOTAL VALUE OF SERVICES PROVIDED BY SCVIM: $746,394.54

_______________________________________________________________________________________

VHCPP ANNUAL REPORTING FORM

(July 1, 2012 – June 30, 2013)

Clinic/Organization: Space Coast Volunteers in Medicine

1. Total Number of Patient Visits: _______2,811

(A patient visit is a face-to-face meeting between a patient and a

health care professional in order to receive medical services.)

2. Total Number of Active Licensed Health Care Providers

Participating in Your Organization: ________85

(Total number of 766 and non-766 providers that are actively

participating in your clinic.)

 

3.   Total Number of Licensed Health Care Provider Volunteer

Hours: (If hours are documented.)

 

4.   Total Dollar Value of Services for Licensed Health Care ______$583,165

Providers: (To be determined by: (1) An hourly rate based on the

figures below; (2) Actual cost of services; or (3) Value based on visits

or referrals.)

5.   Total Dollar Value of Donations: ____$183,702 _____

(Donations include items such as: monies, pharmaceuticals, eyeglasses,

labs, x-rays, equipment, etc., do not include grants.)

6.   Total Number of General Staff Volunteers :                                   _______49

(Volunteers performing general duties, answer the phone, medical

records, make copies, repairs, etc.)

7. Total Number of General Staff Volunteer Hours: ______8,179
8. Total Value of Services for General Staff Volunteers: _____$178,220
(Multiple line 7 by $21.79)
9. Total Value of Service: _____$945,087
(Add lines 4, 5, and 8 together.)
10. Total Number of Active DOH 110 Volunteers: __________22

(Include only the DOH 110 volunteers that have applications on file who

complete the eligibility and referral process for DOH.)

11. Total Number of DOH 110 Volunteer Hours: ________1,155

(110 volunteers hours doing patient eligibility and referrals only.)

12. Total Dollar Value of Services for DOH 110 Volunteers: ______$25,167

(Multiply line 11 by $21.79) This value will be reported under the CHD.

The following values per hour are offered as a suggested guideline for your use in estimating the value of your volunteer services.

Physician:         $250/Hour         Optometrist:             $50/Hour           LPN:                                  $25/Hour

Dentist:             $200/Hour         ARNP/PA:                   $75/Hour           Respiratory Therpt:        $40/Hour

Chiropractor:     $ 90/Hour         Registered Nurse:   $35/Hour           Dental Hygienist:           $25/Hour

Pharmacist:       $ 75/Hour         Physical Therapist:  $60/Hour           Support Staff:                  $21.79/Hour

Social Worker:   $ 50/Hour

rev. 8/22/2016

TOTAL VALUE OF SERVICES PROVIDED BY SCVIM: $945,087

_______________________________________________________________________________________

VHCPP ANNUAL REPORTING FORM

REPORTING PERIOD:   July 1, 2011 TO:  June 30, 2012

(To be submitted to the Regional Coordinator by the July 30, 2012)

 

Clinic/Organization: Space Coast Volunteers in Medicine

 

1. Total Number of Patient Visits: 3006

(A patient visit is a face-to-face meeting between a patient and a

health care professional in order to receive medical services.)

2. Total Number of Licensed Health Care Providers

Participating in Your Organization: 91

(Total number of 766 and non-766 providers that are actively

participating in your clinic.)

3. Total Number of Licensed Health Care Provider Volunteer Hours: 5141

(If hours are documented.)

4. Total Dollar Value of Services for Licensed Health Care Providers: $ 604,694

(To be determined by: (1) An hourly rate based on the figures

below; (2) Actual cost of services; or (3) Value based on visits

or referrals.)

 

 

5. Total Dollar Value of Donations: $ 141,337

(Donations include items such as: monies, pharmaceuticals, eyeglasses,

labs, x-rays, equipment, etc., do not include grants.)

6. Total Number of General Volunteers : 138

(Volunteers performing general duties, answer the phone, medical

records, make copies, repairs, etc.)

 

 

7. Total Number of General Volunteer Hours: 11,136

8. Total Value of Services for General Volunteers: $ 237,870

(Multiple line 7 by $21.36)

9. Total Value of Service: $ 983,901

 (Add lines 4, 5, and 8 together.)

10. Total Number of  E&R SPECIALISTS/110 Volunteers: 36

(Include only the DOH 110 volunteers that have applications on file who

have completed the ELIGIBILITY AND REFERRAL process for DOH.)

11. Total Number of E&R SPECIALISTS/110 Volunteer Hours: 2,946

(110 volunteers hours doing patient eligibility and referrals only.)

12. Total Dollar Value of Services for E&R SPECIALISTS/110 Volunteers: $ 62,927

 (Multiply line 11 by $21.36)  This value will be reported under the CHD.

 

The following values per hour are offered as a suggested guideline for your use in estimating the value of your volunteer services.

 

Physician:             $250/Hour             Optometrist:             $50/Hour            LPN:                                       $25/Hour

Dentist:                  $200/Hour             ARNP/PA:                 $75/Hour            Respiratory Therpt.              $40/Hour

Chiropractor:        $  90/Hour             Registered Nurse:   $35/Hour           Dental Hygienist:               $25/Hour

Pharmacist:          $  75/Hour             Physical Therapist  $60/Hour            Support Staff                        $21.36/Hour

Social Worker       $  50/Hour

rev. 08/22/16  TOTAL PROGRAM VALUE of SERVICES FOR SCVIM CLINIC: $983,901

 

VHCPP ANNUAL REPORTING FORM

REPORTING PERIOD:  July 1, 2010  TO:  June 30, 2011 (Clinic Opened April 2011)

(To be submitted to the Regional Coordinator by the July 30, 2011)

Clinic/Organization: Space Coast Volunteers in Medicine

1. Total Number of Patient Visits: 293

(A patient visit is a face-to-face meeting between a patient and a

health care professional in order to receive medical services.)

2. Total Number of Licensed Health Care Providers

Participating in Your Organization: 10

(Total number of 766 and non-766 providers that are actively

participating in your clinic.)

3. Total Number of Licensed Health Care Provider Volunteer Hours: 376

(If hours are documented.)

4. Total Dollar Value of Services for Licensed Health Care Providers: $62,100

(To be determined by: (1) An hourly rate based on the figures

below; (2) Actual cost of services; or (3) Value based on visits

or referrals.)

5. Total Dollar Value of Donations: $ 198,550

(Donations include items such as: monies, pharmaceuticals, eyeglasses,

labs, x-rays, equipment, etc., do not include grants.)

6. Total Number of General Volunteers : 119

(Volunteers performing general duties, answer the phone, medical

records, make copies, repairs, etc.)

7. Total Number of General Volunteer Hours: 3,110.50

8. Total Value of Services for General Volunteers: $ 66,440.72

(Multiple line 7 by $21.36)

9. Total Value of Service: $ 327,090.72

 (Add lines 4, 5, and 8 together.)

10. Total Number of  E&R SPECIALISTS/110 Volunteers: 33

(Include only the DOH 110 volunteers that have applications on file who

have completed the ELIGIBILITY AND REFERRAL process for DOH.)

11. Total Number of E&R SPECIALISTS/110 Volunteer Hours: 1,205.25

(110 volunteers hours doing patient eligibility and referrals only.)

12. Total Dollar Value of Services for E&R SPECIALISTS/110 Volunteers: $ 25,744.14

 (Multiply line 11 by $21.36)  This value will be reported under the CHD.

The following values per hour are offered as a suggested guideline for your use in estimating the value of your volunteer services.

Physician:             $250/Hour             Optometrist:             $50/Hour            LPN:                                       $25/Hour

Dentist:                  $200/Hour             ARNP/PA:                 $75/Hour            Respiratory Therpt.              $40/Hour

Chiropractor:        $  90/Hour             Registered Nurse:   $35/Hour           Dental Hygienist:               $25/Hour

Pharmacist:          $  75/Hour             Physical Therapist  $60/Hour            Support Staff                        $21.36/Hour

Social Worker       $  50/Hour

rev. 08/22/16  TOTAL PROGRAM VALUE of SERVICES FOR SCVIM CLINIC: $25,744.14

 

 

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