Home Care Entities Accountability Tracking

SENIOR CITIZENS' SERVICES FUND BOARD

QUARTERLY ACCOUNTABILITY TRACKING

Home Care/Hospice

Grant Recipient Name:

Date:

Provide total number of Camden County Seniors Utilizing Services (enter number of individual Camden Seniors you provided service to):

Contact Email:

Month	Current Year Number Served	Prior Year Number Served
January (Report Due)
February
March
April (Report Due)
May
June
July (Report Due)
August
September
October (Report Due)
November
December

Identify the Services you provided breaking down in units of service by each type where Camden County Funds were used to cover the costs or monthly Billing for each client. Rate Utilize Medicaid Fee for Service for HCBS

Service	Jan	Feb	March	April	May	June	July	Aug	Sept	Oct	Nov	Dec
Chore services ($5.02)
Homemaker ($5.02)
Authorized Nurse Visit ($4.35)
Basic Personal Care ($5.02)
Advanced Personal Care ($5.69)
Other