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Individual ACD

Outbreak HCF

Outbreak Non-HCF

STD

Suspect (V) or Case (III)

Contacts

SCF

Lead or NB Screening or SIDS

100%

95%

80%

100%

95%

100%

100%

90%

PHN Standards of Practice Evaluation PHNS Summary of Staff Performance Report

)

PHNS Health Center

PHN Name

Jane Doe

ACD

Oct-March April-Sept

(Due to ANM April 30) (Due to ANM Oct 31)

Year

_________

STD

TB

95%

Other

Total Average %

Overall PHN Compliance %

© 2007 LAC DPH Public Health Nursing

F7

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