COVID-19 Member of Congress Report Form

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First Name

Member of Congress State/Territory

Member's Name

Date of Meeting

YYYY

Type of Meeting

Phone Call

Virtual Meeting

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Who attended the meeting?

Was the Member of Congress present?

What key issues were discussed?

Did you ask your Member of Congress to reach out to HHS Secretary Azar regarding the Provider Relief Fund allocation?

Yes

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Did you ask your Member of Congress about supporting $77B for Community Health Centers?

Yes - asked for the full $77B

No - asked for emergency funding only

No - asked for long-term funding only

No - did not ask about funding

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What are the key takeaways from the meeting?

Is any follow-up needed by NACHC staff?

Yes

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Additional comments?

Advocate Name

Advocate Title

Advocate's Organization Name

Advocate's Organization Type

NACHC

PCA

Community Health Center

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Advocate's Email

Advocate's Phone Number

Envoyer

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