5. Sample log template _Patient Tutoring Services Feb 6 2023.xlsx

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Patient Tutoring Services
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RFQ-23-004845
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teaching hours

DatePay Period End DateTeacherICBranchInpatient/OutpatientBehavioral/Non BehavioralStudentLocationAttendedTeaching Start TimeTeaching End TimeTeaching TimeActual Teaching ValueConferencePreparationInterdisc.Complete Research ReportsTotal
9/1/129/12/12Teacher ANCICHDOutpatientBehavioralBrilliant StudentClassroomYes9:00 AM10:00 AM1:001.001.000.102.10
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substitute home school info

Last Name StudentFirst Name StudentDate Enrolled in ProgramDate Finished ProgramActive/ InactiveGrade Level/NeedGenderParent/Guardian NameParent/Guardian Phone #Home School NameHome School ContactHome School PhoneHome School AddressSchool SystemCityStateCountry
Active

DropDown

TeachersInstitutesGrade Level/NeedStateCountry
Teacher ANCIKAlabamaUSA
Teacher BNEI1stAlaskaAntigua
Teacher CNHLBI2ndArizonaAustralia
Teacher DNHGRI3rdArkansasBahamas
Teacher ENIA4thCaliforniaBrazil
NIAAA5thColoradoChili
BehavioralNIAID6thConnecticutDominican Republic
BehavioralNIAMS7thDelawareHonduras
Non-BehavioralNIBIB8thFloridaIsrael
NICHD9thGeorgiaJamaica
LocationNIDCD10thHawaiiKuwait
BedsideNIDCR11thIdahoPeru
ClassroomNIDDK12thIllinoisPuerto Rico
OtherNIDAGEDIndiana
NIEHSESOLIowa
School YearNIGMSKansas
2012-2013NIMHGenderKentucky
FemaleLouisiana
Patient TypeNIMHDMaleMaine
InpatientNINDSMaryland
OutpatientNINRStatusMassachusetts
NLMActiveMichigan
AttendedNCCAMInactiveMinnesota
NoNCATSMississippi
YesCCMissouri
ODMontana
Active/InactiveNebraska
ActiveNevada
InactiveNew Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
StatesOregon
Pennsylvania
Rhode Island
South Carolina
CountrySouth Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming

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