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Description of Organization Core Business Mission  Values/Philosophy Objectives Reason for Developing Briefly explain why your organization wants

Description of Organization

Core Business

Mission 

Values/Philosophy

Objectives

Reason for Developing

Briefly explain why your organization wants to develop a new ADHC/CBAS center and how developing and operating an ADHC/CBAS center fits with your organization’s core business, mission, values/philosophy, objectives and population(s) served.

Identified Need 

Briefly explain the need for a CBAS center in the proposed geographic location for the proposed target population to be served. Provide supporting evidence, including data that identify problems with access to CBAS services, high rates of hospital admissions/readmissions, nursing home admissions, population statistics, etc. List other CBAS centers in the area and include utilization rates to explain the need for a new CBAS center in the proposed location.

Participant Needs

Provide a general description of the anticipated medical, mental health, social, personal care, activity and problems/conditions/needs of your center’s target population

Medical-

Mental Health-

Social-

Personal Care-

CBAS- Community Base Adult Sevices

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