Navigator Reporting Form 2020 – 2021

Navigator Reporting Form 2020 - 2021

  • This is your Navigator ID number (ex. MINAVC40000XX)
  • Please specify in minutes the length of time you spent with the client
  • MM slash DD slash YYYY
  • Must be identifier or first name if not applicable
  • How many people will be enrolling? (ex. 1, 4, 6, etc).
  • How many people request general inquires
    These tend to be general inquiries
    Please select one of the following
    Please select all services provided during the appointment
    Is this a repeat client?
    Estimated age of client enrolling in health plan
    Did you have a conversation and/or provide tobacco cessation resources during the enrollment process?
    This includes testing and locations
  • Detailed notes of session and final outcomes
  • How did the client end up at ACCESS (who sent them, where did they see the flyer, etc)