Mobile Health Unit Assessment

Organization Name

Question 2*

Are you a 2021 Mobile Health Unit Enhancement Program applicant?

Please enter the project name as listed on your application.

If you are interested in learning more, please click the link below to learn about resources and support to increase mobile health unit service delivery. https://sccrph.submittable.com/submit/202207/2021-mobile-healthcare-unit-enhancement-program

Question 3*

What is the number of Mobile Health Units owned by your organization?

Mobile Health Unit 1

Please select the appropriate characteristics for your organization's Mobile Health Unit.

Unit Type

Please describe the type of mobile health unit.

How long has the unit been in operation?
Service Area(s)

Please list other areas of service.

Frequency of Service

How often is the mobile health unit(s) deployed to a service location?

Please specify other services provided by the mobile health unit.

Please specify other target populations.

Mobile Health Unit 2

Please select the appropriate characteristics for the 2nd Mobile Health Unit.

Unit Type - Mobile Health Unit 2

Please describe the type of mobile health unit.

How long has unit 2 been in operation?
Service Area(s) - Mobile Health Unit 2

Please list other areas of service.

Frequency of Service - Mobile Health Unit 2

How often is the mobile health unit(s) deployed to a service location?

Please specify other services provided by the mobile unit.

Please specify other target populations.

Mobile Health Unit 3

Please select the appropriate characteristics for the 3rd Mobile Health Unit.

Unit Type - Mobile Health Unit 3

Please describe the type of mobile health unit.

How long has unit 3 been in operation?
Services Area(s) - Mobile Health Unit 3

Please list other areas of service.

Frequency of Service - Mobile Health Unit 3

How often is the mobile health unit(s) deployed to a service location?

Please specify other services provided.

Please specify other target populations.

Mobile Health Unit 4

Please select the appropriate characteristics for the 4th Mobile Health Unit.

Unit Type - Mobile Health Unit 4

Please describe the type of mobile health unit.

How long has unit 4 been in operation?
Services Area(s) - Mobile Health Unit 4

Please list other areas of service.

Frequency of Service - Mobile Health Unit 4

How often is the mobile health unit(s) deployed to a service location?

Please specify other services provided.

Please specify other target populations.

Mobile Health Unit 5

Please select the appropriate characteristics for the 5th Mobile Health Unit.

Unit Type - Mobile Health Unit 5

Please describe the type of mobile health unit.

How long has unit 5 been in operation?
Service Areas - Mobile Health Unit 5

Please list other areas of service.

Frequency of Service - Mobile Health Unit 5

How often is the mobile health unit(s) deployed to a service location?

Please specify other services provided.

Please specify other target populations.

Mobile Health Unit 6

Please select the appropriate characteristics for the 6th Mobile Health Unit.

Unit Type - Mobile Health Unit 6

Please describe the type of mobile health unit.

How long has unit 6 been in operation?
Service Areas - Mobile Health Unit 6

Please list other areas of service.

Frequency of Service - Mobile Health Unit 6

How often is the mobile health unit(s) deployed to a service location?

Please specify other services provided.

Please specify other services provided.

Please specify other target populations.

Mobile Health Unit 7

Please select the appropriate characteristics for the 7th Mobile Health Unit.

Unit Type - Mobile Health Unit 7

Please describe the type of mobile health unit.

How long has unit 7 been in operation?
Service Area(s) - Mobile Health Unit 7

Please list other areas of service.

Frequency of Service - Mobile Health Unit 7

How often is the mobile health unit(s) deployed to a service location?

Please specify other services provided by the mobile unit.

Please specify other target populations.

Funding

How is funding provided for the mobile health unit(s)?

Please specify other funding sources.

Question 5*

Do you receive reoccurring funds from your sponsor organization?

Question 6*

Are fundraising activities conducted to raise money for the mobile health unit(s)?

If you currently seek reimbursement for mobile health unit services, please indicate the payers from which you receive reimbursement:

Please specify other commercial payers.

Question 8*

Is sustainability an issue for your mobile health unit(s)?

If you currently seek reimbursement for mobile unit services, please indicate the place of service used when billing for those services:

Please specify other places of services used when billing.

If you are NOT currently seeking reimbursement for mobile health unit service, please indicate any barriers to billing for those services:

Please specify any other barriers to billing for services.

Coverage

Where does the mobile health unit(s) set up/park when it goes to areas of service?

Please specify other places the mobile health unit(s) set up/park.

What are some of the challenges the mobile health unit(s) face or have previously faced?

Please specify other challenges.

Interested in participating in an interview?*

We are interested in learning about the future goals of your mobile health unit(s). In addition to this survey, we will potentially be extending an invitation to participate in a brief interview. This will serve as an opportunity to dive into challenges, impact and outcomes, community partnerships, and strategic vision for mobile health unit services.

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