This is your Navigator ID number (ex. MINAVC40000XX)
Please specify in minutes the length of time you spent with the client
Date Format: MM slash DD slash YYYY
Must be healthcare.gov identifier or first name if not applicable
How many people will be enrolling? (ex. 1, 4, 6, etc).
These tend to be general inquiries
Please select one of the following
Please select all services provided during the appointment
Is this a repeat client?
Estimated age of client enrolling in health plan
Did you have a conversation and/or provide tobacco cessation resources during the enrollment process?
This includes testing and locations
Detailed notes of session and final outcomes
How did the client end up at ACCESS (who sent them, where did they see the flyer, etc)