SAMPLE AGREEMENT - Aphasia Institute
SAMPLE AGREEMENT - Aphasia Institute
SAMPLE AGREEMENT - Aphasia Institute
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Form Act3a Activity Summary<br />
Healthcare Service Provider:<br />
The <strong>Aphasia</strong> Intstitute<br />
Schedule B2<br />
Budget 2011/13<br />
Service Category 2011-2012 Budget<br />
OHRS<br />
Framework<br />
Level 3<br />
Allocated Total<br />
Cost for<br />
Functional Centre<br />
Full-time<br />
equivalents (FTE)<br />
Visits Face-toface,<br />
Telephone In-<br />
House, Contracted<br />
Out<br />
Not Uniquely<br />
Identified Service<br />
Recipient<br />
Interactions<br />
Hours of Care In-<br />
House and<br />
Contracted Out<br />
Inpatient /<br />
Resident Days<br />
Individuals Served<br />
by Functional<br />
Centre or as<br />
appropriate<br />
Individuals Served<br />
by Organization<br />
Attendance Days<br />
Face-to-Face<br />
Group Sessions<br />
(# of sessions)<br />
Meal Delivered-<br />
Combined<br />
Total In-Home Care 72 5 30 $57,658 1.00 130 0 0 0 28 0 0 0<br />
Total CSS In-Home and Community Services (CSS IH COM) 72 5 82 $93,120 1.50 2,800 0 0 0 219 0 0 0<br />
Total CSS-ABI Services 72 5 83 $210,168 2.20 0 0 0 0 200 7,300 0 0<br />
Total CSS Community Support Initiatives 72 5 84 $192,070 2.00 3,900 0 0 0 400 0 0 0<br />
Total Activity- LHIN Managed 2011-2012 $553,016 6.70 6,830 0 0 0 847 7,300 0 0<br />
Service Category<br />
2012-2013 Budget<br />
OHRS<br />
Framework<br />
Level 3<br />
Allocated Total<br />
Cost for<br />
Functional Centre<br />
Full-time<br />
equivalents (FTE)<br />
Visits Face-toface,<br />
Telephone In-<br />
House, Contracted<br />
Out<br />
Not Uniquely<br />
Identified Service<br />
Recipient<br />
Interactions<br />
Hours of Care In-<br />
House and<br />
Contracted Out<br />
Inpatient /<br />
Resident Days<br />
Individuals Served<br />
by Functional<br />
Centre or as<br />
appropriate<br />
Individuals Served<br />
by Organization<br />
Attendance Days<br />
Face-to-Face<br />
Group Sessions<br />
(# of sessions)<br />
Meal Delivered-<br />
Combined<br />
Total In-Home Care 72 5 30 $57,658 1.00 130 0 0 0 28 0 0 0<br />
Total CSS In-Home and Community Services (CSS IH COM) 72 5 82 $93,120 1.50 2,800 0 0 0 219 0 0 0<br />
Total CSS-ABI Services 72 5 83 $210,168 2.20 0 0 0 0 200 7,300 0 0<br />
Total CSS Community Support Initiatives 72 5 84 $192,070 2.00 3,900 0 0 0 400 0 0 0<br />
Total Activity- LHIN Managed 2012-2013 $553,016 6.70 6,830 0 0 0 847 7,300 0 0<br />
The <strong>Aphasia</strong> <strong>Institute</strong> Page 29 of 43
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