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pdfBureau of Primary Health Care
Uniform Data System
Reporting Tables
1
Table Patients by ZIP Code
Reporting Period: January 1, 2018, through December 31, 2018
ZIP Code
(a)
None/Uninsured
(b)
Medicaid /
CHIP / Other
Public
(c)
Medicare
(d)
Private
(e)
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Other ZIP
Codes
Unknown
Residence
Total
Total
Patients
(f)
Note: This is a representation of the form. The actual online input process looks significantly different, and
the printed output from EHB may be modified
2
Table 3A: Patients by Age and by Sex Assigned at Birth
Reporting Period: January 1, 2018, through December 31, 2018
Line Age Groups
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
Under age 1
Age 1
Age 2
Age 3
Age 4
Age 5
Age 6
Age 7
Age 8
Age 9
Age 10
Age 11
Age 12
Age 13
Age 14
Age 15
Age 16
Age 17
Age 18
Age 19
Age 20
Age 21
Age 22
Age 23
Age 24
Ages 25–29
Ages 30–34
Ages 35–39
Ages 40–44
Ages 45–49
Ages 50–54
Ages 55–59
Ages 60–64
Ages 65–69
Ages 70–74
Ages 75–79
Ages 80–84
Age 85 and over
Total Patients
(Sum Lines 1–38)
Male Patients
(a)
Female Patients
(b)
3
Table 3B: Demographic Characteristics
Reporting Period: January 1, 2018, through December 31, 2018
Line
Patients by Hispanic or Latino Ethnicity
Unreported/
NonRefused to
Hispanic/
Hispanic/
Report
Patients By Race
Latino
Latino
Ethnicity
(a)
(b)
(c)
1.
Asian
2a.
Native Hawaiian
2b.
Other Pacific Islander
2.
Total Native
Hawaiian/Other Pacific
Islander
(Sum Lines 2a + 2b)
3.
Black/African American
4.
American Indian/Alaska
Native
5.
White
6.
More than one race
Unreported/Refused to
report race
Total Patients
(Sum Lines 1+2 + 3 to 7)
7.
8.
Number
(a)
Line Patients by Language
12.
Line
Patients Best Served in a Language Other Than English
Patients by Sexual
Orientation
Total
(d)
(Sum Columns
a+b+c)
Number
(a)
Line
Patients by Gender Identity
13.
Lesbian or Gay
20.
Male
14.
Straight (not lesbian or gay)
21.
Female
15.
Bisexual
22.
16.
Something else
23.
17.
Don’t know
24.
Other
18.
Chose not to disclose
25.
Chose not to disclose
19.
Total Patients
(Sum Lines 13 to 18)
26.
Total Patients
(Sum Lines 20 to 25)
Number
(a)
Transgender Male/ Female-toMale
Transgender Female/ Male-toFemale
4
Table 4: Selected Patient Characteristics
Reporting Period: January 1, 2018, through December 31, 2018
Line
Characteristic
Number of Patients
Line
Income as Percent of Poverty Guideline
Number of Patients
(a)
1.
2.
3.
4
5.
6.
Line
7.
8a.
8b.
8.
9a.
9.
10a.
10b.
10.
11.
12.
100% and below
101–150%
151–200%
Over 200%
Unknown
TOTAL (Sum Lines 1–5)
Principal Third -Party Medical Insurance
Regular Medicaid (Title XIX)
CHIP Medicaid
Total Medicaid (Line 8a + 8b)
Dually Eligible (Medicare and Medicaid)
Medicare (Inclusive of dually eligible and
other Title XVIII beneficiaries)
Other Public Insurance Non-CHIP (specify:)
Other Public Insurance CHIP
Total Public Insurance (Line 10a + 10b)
Private Insurance
TOTAL (Sum Lines 7 + 8 + 9 +10 +11)
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13a.
13b.
Capitated Member months
Fee-for-service Member months
Total Member months
(Sum Lines 13a + 13b)
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
24.
25.
18 and older
(b)
Managed Care Utilization
Payer Category
Line
0-17 years old
(a)
None/Uninsured
Line
13c.
Medicaid
(a)
Medicare
(b)
Other Public
Including NonMedicaid CHIP
(c)
Special Populations
Migratory (330g grantees only)
Seasonal (330g grantees only)
Total Agricultural Workers or Dependents
(All Health Centers Report This Line)
Homeless Shelter (330h grantees only)
Transitional (330h grantees only)
Doubling Up (330h grantees only)
Street (330h grantees only)
Other (330h grantees only)
Unknown (330h grantees only)
Total Homeless (All Health Centers Report This Line)
Total School-Based Health Center Patients
(All Health Centers Report This Line)
Total Veterans (All Health Centers Report This Line)
Private
(d)
TOTAL
(e)
Number of Patients
(a)
5
Line
26.
Special Populations
Number of Patients
(a)
Total Patients Served at a Health Center Located In or
Immediately Accessible to a Public Housing Site
(All Health Centers Report This Line)
Table 5: Staffing and Utilization
Reporting Period: January 1, 2018, through December 31, 2018
Clinic Visits
(b)
Line
Personnel by Major Service Category
FTEs (a)
Patients (c)
1
2
3
4
5
7
8
9a
9b
10
10a
11
12
13
14
15
16
17
17a
18
19
20a
20a1
20a2
20b
20c
20
21
22
22a
22b
22c
22d
23
24
25
26
27
27a
27b
27c
28
29
29a
Family Physicians
General Practitioners
Internists
Obstetrician/Gynecologists
Pediatricians
Other Specialty Physicians
Total Physicians (Lines 1–7)
Nurse Practitioners
Physician Assistants
Certified Nurse Midwives
Total NPs, PAs, and CNMs (Lines 9a–10)
Nurses
Other Medical Personnel
Laboratory Personnel
X-ray Personnel
Total Medical (Lines 8 + 10a through 14)
Dentists
Dental Hygienists
Dental Therapists
Other Dental Personnel
Total Dental Services (Lines 16–18)
Psychiatrists
Licensed Clinical Psychologists
Licensed Clinical Social Workers
Other Licensed Mental Health Providers
Other Mental Health Staff
Total Mental Health (Lines 20a–c)
Substance Abuse Services
Other Professional Services (specify___)
Ophthalmologists
Optometrists
Other Vision Care Staff
Total Vision Services (Lines 22a–c)
Pharmacy Personnel
Case Managers
Patient/Community Education Specialists
Outreach Workers
Transportation Staff
Eligibility Assistance Workers
Interpretation Staff
Community Health Workers
Other Enabling Services (specify___)
Total Enabling Services (Lines 24–28)
Other Programs/Services (specify___)
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