Table 1 Enrollment tool functionality

➢ Tracking and Documenting: Fillable fields to collect and document insurance enrollment information such as status of insurance application, insurance ID, effective date, eligibility status, number and type of assists provided, total number of individuals assisted, notes, etc.

➢ Panel management function: Allows users to (1) run a report of patients with upcoming appointments within 30 days and identify those without health insurance; and (2) run a daily report of health insurance application assistance in progress.

➢ Retrospective data report: Reports the number of total individuals assisted with each opened form to generate HRSA quarterly reporting of outreach and enrollment assistance provided.