Inpatient Data Form

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Human Services Block Grant Data Tracking  
Inpatient Data Required  
Provider Name:  
Select Month:  
Select Year:  
Number of Clients that began inpatient treatment
Number of clients that completed inpatient treatment
Percentage of clients that completed treatment
Number of clients that engaged in follow up within (7) days
Percentage of clients that engaged in follow - up treatment within (7) days
Submitter Name
Submitter Email
Submitter Phone
Password
     

Instructions:

 Inpatient Data additional notes

1.  Number of clients that were admitted to and began inpatient treatment.
 
2.  Number of clients that completed inpatient treatment – completed is defined as not
leaving against medical advice or due to program infraction/behavior.
 
3.    Percentage (%) that completed inpatient treatment.  The percentage is calculated by
dividing #2 (number of clients that completed in-patient treatment)
by #1 (number of clients that were admitted to/began inpatient treatment).
 
4. Of # in 2 (clients that completed inpatient treatment), number engaged in follow-up
treatment/after care within seven (7) days.  Follow-up treatment is
defined as engaged in an appropriate of care as assessed via PCPC or a lessor level of care requested
by the client and agreed to by the provider.  If slightly beyond
7 days due to appointment availability this can be included as within seven days.  
 
5.  Percentage (%) that completed inpatient and began follow-up treatment with 7 days
– The percentage is calculated by dividing #2
(number of clients that began follow-up treatment within 7 days by #1 (number of clients that completed inpatient).
follow-up treatment is defined as engaged in an appropriate of care as assessed via PCPC or a lessor level of care requested
by the client and agreed to by the provider.  If slightly beyond 7 days due to appointment availability this can be included as within seven days.
 
It is noted that some individuals may not be able be admitted to outpatient care within 7 days because of lack of
available slots at outpatient provider facilities.  However, 7 days appear to be the standard in which all providers
are required to do a follow-up so it may be best to use that number for this purpose because it is consistent across all providers.
 
Please define unsuccessful vs. successful completion.  In other words, individuals may be discharged for various reasons
(dismissed for program violation, moved, etc…), so indicate those accordingly.
 
Specify service as either short-term (30 or less days) or long-term (more than 30 days).