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U.S. Department of Health and Human Services
Indian Health Manual

Part 3, Chapter 12: Manual Exhibit 3-12.8B

Community Health Educator Quarterly Report Form


TO: Area or Program Director, Indian Health Service
Attention:  Area or Program Office Public Health Educator
THROUGH:  Immediate Supervisor, (Name of Facility)

FROM: Service Unit Public Health Educator, Community Health Educator, Community Health Education Assistant
SUBJECT: Quarterly Report for (Location)________________(Date) __________
  1. Community/Tribal Health Developments
  2. School
  3. Patient Services
  4. Staff Support Services
  5. Special Events
  6. Projected Activities
  7. Attachments
    1. Projects written up or project reports.
    2. Materials developed or adapted.
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