Exhibit 9-4

HEALTH CENTERSPACE PROGRAMMING ILLUSTRATION

In this illustration, the health center being planned will house a new project. Therefore, no project-specific historical data are available to use in the planning process. The planning assumptions are based on general health care utilization, productivity and capacity characteristics. For projects that have been in operation prior to facility planning, historical data should be the first source of planning information. Centers funded through the Bureau of Community Health Services can use some of the data reported in the Uniform Data System (UDS) as planning information (e.g., the ratio of medical and dental encounters per user).

Before using historical operating data as the basis for planning a new facility, a comparison should be made with data from other sources. In some situations, utilization, productivity and/or capacity may have been constrained by some feature(s) of the existing facility. If this is found to be the case, the use of other planning data should be considered, at least when the new facility is likely to eliminate the constraints imposed by the old facility.

* Facility Planning Guideline for Ambulatory Health Centers, DHHS, PHS, HRSA, Bureau of Community Health Services. (This is the predecessor agency to the Bureau of Primary Health Care.)

Planning Assumptions

  1. The project will have 10,000 active medical users. (Note: This is not the same as serving a catchment area with a population of 10,000 or having 10,000 registrants.
  2. The project will have 4,000 active dental users.
  3. The following services will be offered by the center:
    1. Primary medical care: all services except specialty referral services (e.g. dermatology, nephrology and pediatric cardiology).
    2. Dental services including treatment and prophylaxis.
    3. Radiology: plates of chest, back, skull and extremities; no fluoroscopy or other special services.
    4. Laboratory: basic chemistry, hematology, microbiology and urinalysis. Samples will be taken for outside lab analysis for other services.
    5. Pharmacy
    6. Social services
    7. Health education
  4. Each active medical user will have an average of 3.5 medical encounters per year in the center.
  5. Each active dental user will have an average of 2.5 dental encounters per year in the center.
  6. Ten percent of the medical encounters delivered in the center require x-rays in the center.
  7. Each medical examination/treatment room has an annual capacity of 2,500 encounters.
  8. Each dental operatory has an annual capacity of 2,000 encounters.
  9. Each x-ray procedure room has an annual capacity of 8,750 procedures.

Space Programming for Basic Center Components

Medical

10,000 users x 3.5 encounters/year/user = 35,000 encounters/year.

35,000 encounters/year ÷ 2,500 encounters/year/room = 14 rooms.

A total of 14 exam/treatment rooms will be provided, with one of them large enough to accommodate minor surgery. Consultation rooms will be provided on the basis of one for every two exam/treatment room. Seven consultation rooms will be provided here. The information in Chapter III can be used to make a preliminary determination of the necessary support space in the medical area. The rooms to be included other than the exam rooms, and the amount of space in each room, are determined on a rather subjective basis. For large health centers, areas like general storage will have to be larger than the 50 square feet suggested here. The preliminary medical space program is as follows:

Room Number Total Square Feet
Examination 13 1,300
Treatment 1 180
Consultation 7 700
Nurses' Office 1 80
Sterile Storage 1 50
Soiled Workroom 1 80
Reception 1 100
Waiting Area - 360
Toilets 2 60
General Storage 1 50
________
MEDICAL TOTAL 2,960

Dental

4,000 users x 2.5 encounters/year/user = 10,000 encounters/year

10,000 encounters/year ÷ 2,000 encounters/year/operatory = 5 operatories.

At this stage in planning there will be no differentiation made between operatories to be used by dentists and those to be used by hygienists. The preliminary space program for the dental area is as follows:

Room Number Total Square Feet
Operatory 5 500
X-ray, including panorex 1 140
Darkroom 1 30
Soiled Workroom 1 30
Sterilizing Alcove 1 30
Recovery Room 1 60
Consultation 1 100
Reception 1 100
Waiting - 150
Toilets 1 60
General Storage 1 50
________
DENTAL TOTAL 1,250

Note: An alternative method for relating expected utilization to medical and dental facility needs is to base the process on staff productivity. That is, the number of expected encounters is divided by anticipated provider productivity, resulting in a projected staffing level. Facilities are then planned on the basis of a certain number of rooms or operatories per provider.

Radiology

35,000 medical encounters/year x .1 x-ray procedures/medical encounter = 3,500 x-ray procedures/year.

The expected activity in x-ray at the center is much less than the capacity for a single room. One room will be provided. The preliminary space program for radiology is as follows:

Room Number Total Square Feet
X-ray 1 220
Control 1 30
Dressing Booth 2 30
Darkroom 1 100
Viewing 1 120
Film Filing 1 200
Storage 1 40
Waiting - 100
________
RADIOLOGY TOTAL 840

Laboratory and Pharmacy

The preliminary space programs for laboratory and pharmacy are based on the space figures from Chapter IV. They are as follows:

Room Number Total Square Feet
Lab, except microbiology 1 240
Microbiology 1 80
Venipuncture 1 30
Toilet 1 30
EKG 1 80
________
LABORATORY TOTAL 460

(Note: In many centers the EKG room is included in the medical area.)

Room Number Total Square Feet
Storage, Compounding,
Dispensing 		1 400
Office/Records 1 100
________
PHARMACY TOTAL 500

Medical Records

Room Number Total Square Feet
Office 1 120
Interview 2 160
Identification Plate 1 80
Filing Area - 400
________
MEDICAL RECORDS TOTAL 760

Social, Community, and Education Services

Room Number Total Square Feet
Social Service Director 1 120
Social Worker 1 120
Health Educator 1 120
Conference/Classroom 1 400
Library 1 240
________
RECORDS TOTAL 1,000

Administration

Room Number Total Square Feet
Executive Director 1 150
Assistant Director 1 120
Medical Director 1 150
Dental Director 1 150
Secretarial Area 1 120
Personnel 1 120
Purchasing 1 120
Finance Director 1 120
Financial Staff 1 240
Mail and Duplicating 1 180
Conference 1 240
Reception and Waiting 1 120
________
ADMINISTRATION TOTAL 1,830

Staff Facilities

Room Number Total Square Feet
Male Locker/Toilet 1 200
Female Locker/Toilet 1 200
Staff Dining 1 180
________
STAFF FACILITIES TOTAL 580

Public Facilities

Room Number Total Square Feet
Lobby 1 400
Information 1 80
Toilets 2 60
Pediatric Waiting (Playroom) 1 180
Switchboard 1 100
________
PUBLIC FACILITIES FACILITIES TOTAL 820

Room Number Total Square Feet
Sterilizing 1 120
Maintenance 1 180
General Storage 1 500
Phone Equipment 1 100
Janitor's Closet 2 80
________
SUPPORT FACILITIES FACILITIES TOTAL 980

Space Program Summary

Area Square Feet
Medical 2,960
Dental 1,250
Radiology 840
Laboratory 460
Pharmacy 500
Medical Records 760
Social, Community and Education 1,000
Administration 1,830
Staff Facilities 580
Public Facilities 820
Support Facilities 980
TOTAL 11,980

The 11,980 figure represents the number of net square feet that would be required in the new facility. In order to convert this into an estimate of the required gross square feet, a net-to-gross conversion factor must be applied. The conversion factor is discussed in Chapter X.

Total Net Square Feet 11,980
Net-to-Gross Conversion Factor 1.5
________
Total Gross Square Feet 17,970