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1 5 <br /> How many employees does your organization have in the North Sound region? <br /> ❑ 1-25 Employees <br /> �] 26-99 Employees • .. . .............•_. - . <br /> ❑ 100-999 Employees <br /> El1000 or more Employees <br /> Which North Sound ACH project area(s)is your organization prepared to work on (refer to Attachment A for more <br /> information about each project area before responding): <br /> 0 Community Based Care Coordination 0 Diversion Interventions <br /> 0 Care Coordination During Care Transitions 0 Chronic Disease Prevention and Management <br /> ❑ Reproductive/Maternal Child Health [] Access to Oral Health Services <br /> ❑ Addressing the Opioid Crisis 0 Bi-Directional integration of Physical and Behavioral <br /> Health <br /> Does your organization provide care and/or services to people who are eligible for/enrolled in Medicaid(Apple <br /> Health)? Ekes ❑No <br /> Does your organization track the Medicaid status of your patients or clients? 0 Yes ❑No <br /> If yes,for the calendar year 2017,how many Medicaid enrollees(unduplicated)did your organization serve? <br /> -4,826(EMS) <br /> North Sound ACH will be facilitating trainings on evidence-Based Models for the initiatives.Some may be in-person <br /> while others will be web-based.Partnering providers must commit that staff will learn about models and best <br /> practices for any initiative area the organization commits to. How many employees does your organization anticipate <br /> taking part in trainings in each of the in€tiative areas below? <br /> 5-6 Community Based Care Coordination 5-6 Diversion Interventions <br /> Care Coordination During Care Transitions Chronic Disease Prevention and Management <br /> Reproductive/Maternal Child Health Access to Oral Health Services <br /> 5-6 Addressing the Opioid Crisis• • Bi=Directional integration of Physical and Behavioral <br /> Health <br /> Does your organization enter data in WA's immunization registry(WAlIS)? OYes ElNo <br /> Does your organization enter data in WA's Prescription Monitoring Program(PMP)? ❑Yes ❑✓ No <br /> Does your organization use an electronic health/service record(EHR)?(Check only one) <br /> ❑✓ Yes,ail charts are electronic;no paper charts <br /> 0 Yes,although we still have some paper charts <br /> No,but we plan to implement <br /> 0 No,and we have no plan to implement <br /> North Sound ACH May 2018 Call for Partners Application 2 <br /> 129 <br />