S02_Attachment_11_-_Annual_Workload_Report.docx
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- Attached to
- Marshall County, MS CBOC Base plus 4 Option years Federal contract opportunity
- Solicitation number
- 36C24919R0003
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36C24919R0003 S02 Attachment 11 - Annual Workload Report.docx
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36C24919R0003 – Marshall County CBOC
Attachment 11 – Annual Workload Report
CBOC WORKLOAD HISTORY ANNUAL REPORT
This report is for the CBOC.
Period of this Report is:
This report is to be generated by the CBOC annually and submitted to the COR and CO within 30-days of the end of each contract performance period.
1. The following is a listing by diagnosis code of the 15 most frequent reasons for visits to this CBOC, based on ICD Diagnosis Codes, during the period _______ to _________:
| DIAGNOSIS CODE |
| DESCRIPTION |
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
2. Laboratory Tests:
a. The following laboratory tests were collected at this CBOC and performed at the VAMC during the period _______ to _________:
| TYPE OF TEST |
| ANNUAL QUANTITY |
Total
b. The following laboratory tests were performed at a Non-VA provider on behalf this CBOC with results uploaded to the patient’s medical record during the period _______ to _________:
TYPE OF TEST
| REASON PERFORMED BY NON-VA PROVIDER |
| ANNUAL QUANTITY |
Total
c. The following laboratory tests were done as Point of Care Testing (POC) at this CBOC as part of the requirement described above during the period _______ to _________:
| POC TESTS PERFORMED |
| ANNUAL QUANTITY |
Total
d. X-Rays / Diagnostic Imaging: The following is a listing of the x-rays / diagnostic imaging procedures, including MRI, CT, and other advance imaging modalities imaging procedures, were requested to be performed by a Non-VA provider on behalf of the CBOC and sent to the VAMC for interpretation during the period _______ to _________:
| TYPE OF IMAGING |
| ANNUAL QUANTITY |
CHEST 2 VIEWS PA&LAT
SHOULDER 2 OR MORE VIEWS
SPINE LUMBOSACRAL MIN 2 VIEWS
FOOT 3 OR MORE VIEWS
MRI: LUMBAR SPINE W/O CONT
KNEE 2 VIEWS
TOE(S) 2 OR MORE VIEWS
HAND 3 OR MORE VIEWS
MAMMOGRAM SCREENING
ANKLE 3 OR MORE VIEWS
ELBOW 2 VIEWS
HIP 2 OR MORE VIEWS
WRIST 3 OR MORE VIEWS
CT HEAD W/O CONT
KNEE FLEX WB ORTHO (3 VIEWS)
SPINE CERVICAL MIN 4 VIEWS
BONE DENSITOMETRY
TIBIA & FIBULA 2 VIEWS
ECHOGRAM ABDOMEN COMPLETE
SPINE THORACIC 2 VIEWS
CT PELVIS W/CONT
CT THORAX W/CONT
MRI: BRAIN [+ BRAIN STEM] W+W/
HUMERUS 2 OR MORE VIEWS
Total
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