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HIV/AIDS Bureau - Site Visit Report Template
For HRSA HAB Programs

Site Visit Report General Instructions

Reports for Comprehensive /Technical Assistance Site Visits:

Please ensure all sections and all questions within each section of the online report are completed as applicable:

  1. Health Resources and Services Administration (HRSA)/Consultant Representatives
  2. Recipient Representatives
  3. Site Visit Overview
  4. Findings & Recommendations
    1. Fiscal
    2. Administrative/Programmatic
    3. Clinical Quality Management
    4. AIDS Drug Assistance Program (ADAP)
  5. Technical Assistance Recommendations/Needs
  6. Next Steps
  7. HAB Grant Recipient Innovative Practices
In addition the following Appendices must be completed for DCHAP Site Visits:
  • Appendix A - Agenda
  • Appendix B -List of Site Visit Participants
  • Appendix C - Chart Review
  • Appendix D - Other Materials (if applicable)
  • Appendix E - List of Shared Documents/Reference Materials

Reports for Special Projects:

Please ensure all sections of the special project report are completed.

Contact Information: For assistance with this system, contact MSCG,

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