NH May CDC Monthly Reporting Form
- Naomi Smith (Deactivated)
Original form
Pre- Report Details
1. What national-level organization is working with you on this award?
National Association of Community Health Centers |
2. What is the name of the organization that carried out the activities included in this report.
Neighborhood Health |
3. What month did your organization implement the activities shared in this report.
May |
4. What year did your organization implemented the activities shared in this report.
2022 |
5. What was the date this report was submitted to CDC.
5/31/2022 |
6. Is this your first time ever completing a state-, local- and community-level report for the P4VE program
Yes |
SECTION 3: Increasing Vaccination Opportunities and Enhancing Provider Partnerships
15. Total number of new partnerships established with vaccine administrators (e.g., provider groups, health clinics, health departments) to increase vaccination opportunities.
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Is your organization a health center or other vaccine-administering health entity?
16. Number of new vaccination sites established, by partnership.
Separate (by column) COVID-19 vaccination sites and influenza vaccination sites.
Questions | COVID-19 ONLY # | INFLUENZA ONLY # | COVID-19 AND INFLUENZA # |
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16.1. Provider groups or clinics, only |
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16.2. State health departments, only |
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16.3. Local health departments, only |
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16.4. 2 or more partnerships listed above helped establish vaccination site (e.g., provider groups or clinics, state health departments, local health departments) |
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17. If known, estimate the total number of people who received a vaccine at any new or existing temporary and/or mobile vaccination site established due to any partnership. If not known, leave blank.
Separate COVID-19 vaccines administered, and influenza vaccines administered.
COVID-19 ONLY |
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INFLUENZA ONLY |
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18. If known, estimate how many of the total number of people who received a vaccine represent members of racial and ethnic population(s) of focus. If not known, leave blank.
Separate COVID-19 vaccines administered, and influenza vaccines administered.
COVID-19 ONLY |
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INFLUENZA ONLY |
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19. At how many unique street addresses did your organization establish a temporary and/or mobile COVID-19 or influenza vaccination site, due to any partnership?
Please use the fields that appear below to add additional information about each unique address at which a vaccination site was established. Be sure to include each unique address at which a mobile vaccination unit established a vaccination site.
Move to question 20 if your organization did not establish any vaccination sites during this reporting period.
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20. If applicable, describe any new educational campaigns conducted for healthcare providers or healthcare professionals, including topics covered and types of providers and professionals reached.
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THIS IS THE FINAL SECTION OF THE REPORT - IF POSSIBLE, PLEASE LIMIT ALL RESPONSES TO 5 SENTENCES OR LESS.
SECTION 4: Successes, Challenges and Additional Information
21. If the program were to feature your organization in an upcoming webinar or program-wide communication, what new, major successes would you like to share?
If applicable, include the web addresses related to the new, major successes mentioned in your response.
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22. What new, major challenges would your organization like to discuss during future program check-ins?
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23. What additional information would you like to share about any partnerships with local organizations, coalitions, community projects, vaccination providers, or health departments? List the names of new partners and their contributions to program activities when possible.
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24. What additional context would you like to share about any of the answers provided in this report?
Leave the spaces below blank if you have no additional context to share.
24a. What would you like to share about equipping influential messengers?
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24b. What would you like to share about vaccination opportunities and provider partnerships?
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24c. What would you like to share about barriers to vaccine uptake?
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Thank you! You've reached the end of the report.
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