Attachment 9 Form.xlsx

This is a data collection template for tracking student referrals to primary care and specialist services. The form is designed to capture weekly information about students referred for healthcare services and is part of the Health Services Contract submission requirements, specifically Attachment 9 of the solicitation documentation.

The template requires the collection of the following data elements for each student referral: student name (last name and first name), date of birth, class name and number, the name of the primary care provider or specialist to whom the student was referred, the type of specialist involved, and the reason for referral (diagnosis). This attachment serves as a reporting mechanism for the Enterprise Health Unit Services solicitation (70LGLY26RGLB00005) issued by the Department of Homeland Security Federal Law Enforcement Training Centers (FLETC) to track health services delivery across the four Training Delivery Points located in Glynco, Georgia; Artesia, New Mexico; Charleston, South Carolina; and Cheltenham, Maryland. The form is formatted as an Excel spreadsheet and appears designed to support contract performance monitoring and compliance documentation for the selected contractor.