SMORES HEALTH. CHW OUTCOMES AND REPORTING WORKSHEET
Reviewed October 9, 2026

Original planning worksheet. Example measures are not required by CDC or a payer. Confirm funder definitions and organizational disclosure rules separately. Use aggregate or fictional information here during evaluation.

REPORT PURPOSE
Decision this report will support:
Audience:
Program(s):
Reporting period and time zone:
Date rule (service, entry, review, or other):
Extraction date:
Owner:

COPY THIS METRIC CARD FOR EACH MEASURE
Name:
Question answered:
Unit (people, encounters, activities, referrals, or other):
Numerator:
Denominator, if applicable:
Included/excluded records:
Cohort and follow-up window:
Evidence/source field:
Handling of duplicates, corrections, and missing data:
Known limitations:
Definition version and owner:

REFERRAL RECONCILIATION EXAMPLE (FICTIONAL)
20 sent; 8 confirmed received; 4 scheduled; 3 declined; 5 unknown.
Confirmed receipt among all referrals: 8 / 20 = 40%.
Confirmed receipt among known results: 8 / 15 = about 53%.
These answer different questions. Label the denominator and unknown results.

MONTHLY REVIEW
[ ] Count people separately from encounters and activities.
[ ] Do not count note versions as additional delivered services.
[ ] Reconcile a sample of records to the report.
[ ] Show missing data and unknown outcomes.
[ ] Check that claims do not exceed the evaluation design.
[ ] Review small groups and unnecessary identifying details.
[ ] Record definition changes and corrections.

Finding:
Evidence and limitation:
Action to take:
Owner and review date:

Guide: https://smoreshealth.com/peer-support-software/community-health-worker-outcomes-reporting
Demo: https://cal.com/team/smoreshealth/demo