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Exhibit “E”Quarterly Reporting Form <br />(CYSHCN Quarterly MCHBG Reporting Form) <br />Email report to: chelsey.loeffers@co.kittitas.wa.us or fax: 933-8246 by the 5th of the month following the end of the quarter. <br />Facility reporting: <br />Quarter period: <br />Name of reporter: <br />Date CHIF entry completed: <br />What would you like to share with regional/statewide CYSHCN partners? Highlights, questions, challenges, etc. <br />What’s new? <br />Factors to success or barriers: