the
university of texas at brownsville
BSN DEGREE COMPLETION PROGRAM
To:
Dean, school of health sciences
course:
**date:
faculty: ___________________________________
|
$50/Hour
Health Education (HE) Consultation Services
(CS) Physical Assessments
(PA) |
$65/Hour Home Visit (HV) |
$25/Test TB Tests (TB) DDST Immunizations |
$20/Test Accucheck (AC) |
$15/Screening Blood Pressure (B/P) Hearing (HS) Vision (VS) Scoliosis (SS) Acanthosis Nigricans
(AN) Cholesterol (CL) Lower Extremity
Amputation Prevention (LEAP) |
|
$50/hr |
$65/HV # |
$25/hr |
$20/AC # |
$15/hr |
TOPIC/TYPE
CONSULTATION (HE)
& LOCATION |
DOLLAR VALUE
TO COMMUNITY |
||||||||||
|
HE # |
PA # |
CS # |
|
TB # |
DDST # |
IM # |
|
B/P # |
HS # |
VS # |
SS # |
AN # |
CL # |
LP # |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
*Please
write title.
Total Dollar Value:
**Please return by the last
work day of the semester.
# NUMBER OF CLIENTS SEEN
X COST
= DOLLAR VALUE TO COMMUNITY