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Quality Life MN Report Link - 2024
Please complete this form every Saturday by 12 midnight. Hours report in this form must match invoice
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Date
MM
/
DD
/
YYYY
Name
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Report Period (Date Range)
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#of
Number hours worked this period
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# of Blood pressure checks performed
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How many people have a doctor?
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How many people are on Blood Pressure medication?
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How many people had insurance?
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How many people did not?
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How many STD/STI screenings?
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How many Gift Cards/CashApps issued?
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How many people signed up for mammograms?
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How many completed mammograms?
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How many names collected?
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How many follow up calls/emails?
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What other services are needed?
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What is the community saying they need?
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What support do you need with the program?
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Other comments
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