Navigator Reporting Form 2020 – 2021

Navigator Reporting Form 2020 - 2021

  • 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 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)