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America's Health Care Hereos

Site Development Manual: Chapter 5

Exhibit 5-4: COMMUNITY CHARACTERISTICS PROFILE*

  CHARACTERISTIC COMMUNITY WIDE DATA
# %
TARGET POPULATION DATA
# %
RACE/ETHNICITY White (non-Hispanic)        
Black or African-American (non-Hispanic)        
Hispanic        
American Indian or Alaskan Native        
Asian        
Native Hawaiian or Other Pacific Islander        
Other        
Total Population        
INCOME AS A
PERCENT OF
POVERTY LEVEL
Below 100%        
100-199 percent        
200 percent and above        
Unknown        
PRIMARY THIRD
PARTY PAYMENT
SOURCE
Medicaid/Capitated        
Medicaid/Not Capitated        
Medicare        
Other Public Insurance        
Private Insurance, including capitation        
None/Uninsured        
SPECIAL
POPULATIONS
Migrant/Agricultural worker        
Seasonal Agricultural worker        
Homeless People        
People with AIDS        
HIV-infected        
Substance Abuse        
Public Housing Residents        
Low Income School Children/Adolescents        
Other        

*Source: Bureau of Primary Health Care Program Information Notice (PIN 2004-02).

Health Resources and Services Administration U.S. Department of Health and Human Services