The Resource Group

HOUSTON
REGIONAL
HIV/AIDS
RESOURCE
GROUP, INC.

500 Lovett Blvd.
Suite 100
Houston
Texas
77006

713 526-1016
FAX 713 526-2369

 

 Site Visit Forms
What you need to prepare for our arrival

 
  To save, right click on link and "Save Target As"
We use these forms for all agencies: 
Contract Compliance Evaluation Form
File Size: 148 KB
Data System Evaluation Form
File Size: 22 KB
Governance Evaluation Form
File Size: 140 KB
Personnel Files Evaluation Form
File Size: 42 KB
Personnel Policies & Procedures Evaluation Form
File Size: 166 KB
Rights Protection Evaluation Form
File Size: 153 KB
QM Program Evaluation Form
File Size: 28 KB

 

Agencies who are funded by The Resource Group for
Clinical Services have these forms in addition to those above: 

Clinical Services include: Dental Services, Home Health Care, Hospice, Medical Case Management (DSHS Funding), Adult Daycare, Nutritional Counseling/Supplements Primary Care Services, Psychosocial Case Management (DSHS Funding), Special Needs Case Management (DSHS Funding), and Vision Care
OSHA Walk Through Form
File Size: 109 KB
Clinical Evaluation Form
File Size: 452 KB
Verification of CEU Form
File Size: 99 KB
Verification of Licence & Education Form
File Size: 87 KB
 

Houston - HSDA Evaluation Forms: 


Community Case Management
File Size: 252 KB
Early Medical Intervention
File Size: 47 KB
Food Bank
File Size: 217 KB
Home and Community Based Health Services
File Size: 249 KB
Home Health Care
File Size: 240 KB
Legal Services
File Size: 231 KB
Linguistic Services
File Size: 231 KB
Medical Case Management
File Size: 246KB
Oral Health Care
File Size: 251 KB
Outpatient Ambulatory Medical Care
File Size: 277 KB
Mental Health Services
File Size: 239 KB
 
Rural - Evaluation Forms: 

Rural Medical Case Management
File Size:   96 KB
Rural AIDS Pharm Reimbursement
File Size: 207 KB
Rural Emergency Financial Asstance
File Size: 112 KB
Rural Food Bank
File Size: 210 KB
Rural General Eligibility
File Size: 152 KB
Rural Health Insurance Premium
File Size: 204 KB
Rural Home Health Services
File Size: 233 KB
Rural Oral Health Care
File Size: 203 KB
Rural Outpatient Ambulatory Care
File Size: 209 KB
Rural Mental Health
File Size: 237 KB
Rural Medical Transportation Services
File Size: 227 KB
Rural Outpatient Ambulatory Care-Ophthalmology
File Size: 204 KB

 
HOPWA: 
HOPWA Review Form
File Size: 130 KB
HOPWA File Review Form
File Size: 69 KB
Nutritional Supplements
File Size: 69 KB