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PHN Standards of Practice Evaluation Area Nurse Manager Summary of Staff Performance

)

ANM

Oct-March April-Sept

(Due to ND May 15) (Due to ND Nov 15)

Year

________

SPA

Health Center/s

PHNS Name

Jane Doe

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%

ACD

STD

TB

95%

Other

Total Average %

Compliance % for all PHNs

© 2007 LAC DPH Public Health Nursing

F8

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