Form Aaa-1240a Forff - Disease Prevention And Health Promotion Services Quarterly Summary Report

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ARIZONA DEPARTMENT OF ECONOMIC SECURITY
AAA-1240A FORFF (12-16) - Page 1
Division of Aging and Adult Services
DISEASE PREVENTION AND HEALTH PROMOTION SERVICES
QUARTERLY SUMMARY REPORT
AREA AGENCY ON AGING REGION:
REPORT PERIOD:
REPORT PREPARED BY:
DATE
AGENCY DIRECTOR’S SIGNATURE
DATE
1. Major activities and accomplishments during this period
2. Problems/Barriers and how it was addressed
3. Dissemination activities (Outreach)
4. Best practices or program Innovations
5. Technical Assistance or support needed from the Division of Aging and Adult Services
6. Vignettes
See page 3 for EOE/ADA/LEP/GINA disclosures

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