Tools and Templates Specifically for our Network Partners

Thank you for partnering with us to provide high-quality sexual and reproductive health services to everyone who wants and needs them with no variation in care regardless of ability to pay. The resources on this page will assist you to meet contract requirements.

Please refer to your contract for required deliverables and due dates. Your contract manager is also available to assist. Please contact them with questions and concerns.

Telehealth Toolkits

Manuals Detailing Network Requirements

  • The Washington State Sexual and Reproductive Health Manual (PDF) summarizes requirements related to providing sexual and reproductive health services supported by funding from the Department of Health.

    This manual includes information on providing non-coercive, inclusive care that is sensitive to clients' culture and linguistic needs. It describes the administrative and financial requirements related to providing services as part of our Network. The manual describes required and optional services, and provides links to clinical best practice documents. It also provides links to federal and state laws related to providing sexual and reproductive health services, including mandatory reporting of abuse of a child or vulnerable adult, unprofessional conduct, and notifiable conditions.
  • The Washington State Clinic Visit Record (CVR) Manual (PDF): The clinics in our Network submit de-identified data about each sexual and reproductive health clinic visit. This manual describes when a CVR should be submitted and when one must not be submitted. It describes each of the data elements we collect and how to submit CVRs to our electronic data system.

Templates for Contract Deliverables

Some deliverables required by your contract must be submitted using templates provided by the department.

  • Part of the required Current Scope Report is to provide organizational contacts and clinic information using this template.
  • The Washington State Sexual and Reproductive Health Network Outreach Action Plan (Word) gathers information on your outreach goals, next steps, resources, responsibilities, and progress.

How we Assess Risk

The department requires that we assess the risk to the department for each contract we enter. For our Network contracts we adapted the Risk Assessment Tool that the department uses to assess federal subrecipient risk. We will publish that tool here as soon as possible.

Tool for Calculating Client Responsibility with Sliding Fee and Third-Party Payer

  • This Excel-based Client Fee Calculator explains how to calculate the client responsibility for clients who have third party payers. It takes your sliding fee schedule, deductibles, copays and coinsurance into account along with your full charge and contracted rate with the third party payer. Your billing and front desk staff might find this useful.

Federal Funding Statements

Documents created with federal funding need to include their funding statement. These statements are below, along with a QR code that links back here. Contact your program consultant if you have any questions about how to use these statements or on what Title X funded materials is produced with your grant funding. 

Please use the statement and QR code that meets your needs. 

This item was developed (in part) with federal funds from the Office of Population Affairs grant FPHPA006560 for Title X family planning services.

This item was developed (in part) with federal funds from the Office of Population Affairs grant FPHPA006613 for telehealth infrastructure enhancement and expansion.