Exhibit 15-4

TEST OF CENTER'S OPERATIONAL STAGE

1. Define the elements of primary care you provide now.

   (NOTE: The following questions cover the five basic elements which define good primary care. Answer the questions below using the sub-questions to stimulate your thinking about the services provided by your clinic.)

   Are your services accessible to all members of your community?

   • Is there adequate transportation?
   • Are services affordable?
   • Are you open or do you provide telephone coverage 24 hours/day, 7 days/week?
   • Are providers culturally sensitive to the community?

   Are services comprehensive?

   • Do you provide referrals for specialty care or hospital admission?
   • How do you follow up on referrals?
   • Do you provide preventive services as well as episodic care?
   • Do you provide non-medical supportive services, i.e., counseling, outreach, nutrition?

   How well are your services coordinated?

   • Do you have a method of coordinating patient services?
   • Do you have regular team meetings in which patients are discussed with all members of the health care team?

   Do you provide continuous care?

   • What type of follow-up on individual patients does your clinic provide?
   • Are patients discharged from hospital with follow-up appointments to your clinic?
   • Do specialists refer patients back to their primary care provider after consultation?

2. Does your clinic serve a clearly defined community?

3. Are community members involved in your program? If yes, how? Are they representative of the community you serve?

4. Do you assess community health needs periodically? What are some of the health needs you have identified in the past five years?

5. Have you developed health programs to address these health needs?

6. Do you evaluate your programs and services?

7. Did you change any of your programs or services after evaluations?

DHHS/PHS/HRSA/Bureau of Health Care Delivery and Assistance, Community Oriented Primary Care in Action, Appendix A.