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EXHIBIT "E" <br />Children with Special Health Care Needs Program <br />Quarterly Maternal Child Health Block Grant Reporting Form <br />Replace the box with the following <br />Facility reporting: CHCW-E Quarter period: Click here to enter text. <br />Name of reporter: Date CHIF entry was completed <br />Email report to kasey.knutson a)co.kittitas.wa.us or fax: 933-8246 by the 5th of the month <br />following the end of the quarter. <br />What would you like to share with regional/statewide CYSHCN partners? <br />Highlights, questions, challenges, etc. <br />Local Strategy: Provide Care Coordination for CYSHCN and their families; provide public health <br />nursing services (possible home visiting) when requested by the local birth hospital or physician; and <br />assist parents of CYSHCN with needs associated with transportation, interpretation, housing, durable <br />medical equipment and other basic necessities, as needed. <br />What's new? <br />Factors to success or barriers <br />Professional Services Agreement <br />Page 18 <br />