Operational Site Visit (OSV) Training - Resources*

HRSA Resource Center

Management and Finance

NHSC Sliding Scale Fee Info Packet (See page 10 & 11 for sample fee schedule) (pdf) - This is a guide to preparing a successful Sliding Scale Fee Policy

Sample Sliding Scale Fee Policy (secure access only) - To access Policy template you must sign in to secure Members portal. 

MOU - Referral Services (secure access only) 

Primary Care and/or Hospitalist Agreement (secure access only)

Procurement Policy (secure access only)

Sliding Scale Fee Schedule Sample (secure access only - Excel)

2017 Federal Poverty Guidelines

Federal Register FPL Text

Clinical

5B Referral and Tracking Table (doc)

5B Referral and Tracking Table Example

Credentialing Checklist (pdf)

Credentialing Policy (secure access only) - To access Policy template you must sign in to secure Members portal. 

Governance 

Checklist for Health Center Bylaws (pdf)

Bylaws Template (doc - secure access only) - To access Policy template you must sign in to secure Members portal.

Sample Succession Plan Work Plan (doc)

Succession Policy (secure access only)- To access Policy template you must sign in to secure Members portal. 

Annual Disclosure and Conflict of Interest Form (doc)

Operational Site Visit (OSV) Resources

*Disclaimers

  • All non-Federal documents provided by MPHCA are only aids to grantees. Any "sample" documents downloaded from the MPHCA website must be tailored to the health center's unique circumstances and needs and should be reviewed by the health center's own counsel for legal sufficiency and applicability.