Specifications include, but are not limited to: Develop a CVR Medical Data Form A. The Contractor must develop a CVR data collection form which will be used by clinics to submit Title X Family Planning medical data. B. The CVR data collection form must include the data elements specified by the Department and must also include the federal data collection requirements, such as, but not be limited to, the following parameters: 1. Women In Need of < one hundred fifty percent (150%) Federal Poverty Level (FPL) 2. Number of Adolescents 3. Number of Annual visits C. The Contractor must supply the blank CVR data collection form to the clinic sites, upon request. 1. Orders for blank CVR data collection forms received from the clinics must be filled within three (3) working days. D. The Contractor must maintain the CVR data collection forms, ensuring they are kept current and consistent with changes in the system. IV. Title X Family Planning Medical Data Collection A. The Contractor must collect Title X Family Planning medical data from up to ten (10) delegates located within Idaho’s seven (7) Health Districts from paper and electronic records for a twelve (12) month period. Data is collected by use of the CVR data collection form (Section III). The completed CVR data collection form will be sent to the Contractor from the clinic sites. A CVR is completed on every Title X client who has a face to face encounter with a program person(s). Upon receipt of the CVR, the Contractor must generate data reports as outlined in Scope of Work V. A-B to include site-specific and state-specific quarterly reports to the Department.
