- Draft a 3-5 page change proposal to executive leaders, soliciting their support for a change to the health care system in the community you selected in the previous assessment.
Introduction
To improve health care outcomes within a community, leaders must understand the needs of specific populations. In addition, it is important that leaders are able to gather and present persuasive evidence to decision makers to obtain the necessary funding and establish these needs as priorities for budget and resource planning. Thus, proposed changes should support improved outcomes and align with the current or needed health care policy.
This assessment provides an opportunity to propose a community health care change that is based on the community health assessment you completed in Assessment 2.
Preparation
Your community health assessment was well received by the executives at Vila Health. Consequently, they have asked you to recommend a change in the community that will improve health outcomes. They have also asked you to submit your recommendation in a formal change proposal. You are confident that you can present a strong case for change, including a financial plan, that will ensure the success of this initiative.
In this assessment, you will draft a change proposal to executive leaders to solicit support for a change to the current community health care system. To prepare for the assessment, you are encouraged to begin thinking about your justification for establishing the recommended change as a priority, a strategy for leading change, and how the change will be funded. In addition, you may wish to:Review the assessment requirements and scoring guide to ensure that you understand the work you will be asked to complete.
Review Guiding Questions: Planning for Community and Organizational Change [DOCX], which includes questions to consider and additional guidance on how to successfully complete the assessment.
Note: As you revise your writing, check out the resources listed on the Writing Center’s Writing Supportpage.
The following resource is required to complete the assessment.
Vila Health: Planning for Change.
Vila Health is a virtual environment that simulates a real-world health care system. In the various Vila Health scenarios, you will apply professional strategies, practice skills, and build competencies that you can apply to your coursework and in your career. The information you gather in this scenario will help you to complete the assessment.
TEMPLATES
Use this template for your change proposal.
Change Proposal Template [DOCX].
Requirements
Complete this assessment in two steps:If you have not already done so, complete the Vila Health: Planning for Change simulation.
Draft a change proposal to justify your recommendation for improving the health of the community and establish the change as a priority for the next budget cycle. Consider the feasibility of your proposed change, in terms of overall scope, funding, and timeframe.
The change proposal requirements outlined below, correspond to the grading criteria in the scoring guide, so be sure to address each point. Read the performance-level descriptions for each criterion to see how your work will be assessed. The Guiding Questions: Planning for Community and Organizational Change document provides additional considerations that may be helpful in completing your assessment. In addition, be sure to note the requirements below for document format and length and for citing supporting evidence.Identify the benefits of proposed health care system changes and its implications for a community.
Describe potential barriers to change in an organization or community.
Develop strategies for changing barriers into opportunities and resolving conflict.
Develop a strategy for helping organizational stakeholders understand and evaluate the proposed changes to an existing health care system.
Develop a grant proposal and associated budget for a proposed change to an existing health care system.
clearly and concisely in a logically coherent and appropriate form and style.
Support assertions, arguments, propositions, and conclusions with relevant and credible evidence.
Document Format and Length
Use the Change Proposal Template. can help you in writing and formatting your assessment. If you would like to use a different template or document format for your change proposal, obtain prior approval from faculty.
Your change proposal should be 3–5 pages in length, not including the title page and references page.
Be sure to apply correct APA formatting to all source citations and references.
Supporting Evidence
Cite 3–5 credible sources from peer-reviewed journals or professional industry publications to support your change proposal.
Additional Requirements
Proofread your change proposal before you submit it, to minimize errors that could distract readers and make it more difficult for them to focus on the substance of your analysis.
Portfolio Prompt: You may choose to save your change proposal to your ePortfolio.
Competencies Measured
By successfully completing this assessment, you will demonstrate your proficiency in the following course competencies and assessment criteria:
Competency 1: Identify the challenges and opportunities facing health care.Identify the benefits of proposed health care system changes and its implications for a community.
Competency 2: Compare the effects of different health care finance models and policy frameworks on resources and patient outcomes.
Describe potential barriers to change in an organization or community.
Develop a grant proposal and associated budget for a proposed change to an existing health care system.Competency 4: Develop proactive strategies to change the culture of the organization by incorporating evidence-based practices.
Develop a strategy for helping organizational stakeholders understand and evaluate the proposed changes to an existing health care system.
Develop strategies for changing barriers into opportunities and resolving conflict.Competency 5: Communicate effectively with diverse audiences, in an appropriate form and style consistent with applicable organizational, professional, and scholarly standards. clearly and concisely in a logically coherent and appropriate form and style.
Support assertions, arguments, propositions, and conclusions with relevant and credible evidence.
1
Assessment 3:
Kathy Ergle
Capella University
NURS-FPX 6218: Leading the Future of Health Care
Prof. Donna Ryan
November 23, 2
0
22
2
Change Proposal
A change regarding healthcare is successful when health organizations and professionals
identify the required change and get a chance to influence it. Other significant factors that
contribute to a successful change are the preparedness of professionals, recognizing of the
benefits and value of the change, and knowing its health outcomes (Nilsen et al., 2020). A change
proposal plays a vital role in the identification of change, its value, benefits, and outcomes. In
this assessment, I will draft a change proposal, soliciting the support of executive leaders for
health-related change in the Jordan Community.
Benefits and Implication
The major health issues in the Jordan community were related to imbalanced
socioeconomic status, water contamination, and poor air quality (JordanMN, 2021). Due to
economic differences, several people were included in a low-income
population
. Such a
population has to face several health disparities like difficulty in dealing with the cost of
healthcare services, lack of regular hospital visits due to costly health insurance, and lack of
health access due to expensive management of chronic health conditions (Capella University,
n.d.). Poor economic status is linked with several other aspects of the community such as
education, healthcare access, living standards, and safety (Lago et al., 2018). The poor conditions
of water and air in the community also contribute to several health conditions including cholera,
diarrhea, asthma, respiratory disease, and chronic obstructive pulmonary disorder (Manisalidis et
al., 2020). And such conditions are difficult to manage for people, especially those belonging to
low economic status.
3
Keeping all the issues of the community in view, the proposed change is the use of
telehealth services and the initiative of free medical camps every six months. The goals of the
change include spreading awareness about safety measures, access to affordable healthcare, and
free medical check-ups for the poor population (Haque et al., 2022; Pathak et al., 2019).
Telehealth services have several direct benefits as they will provide the community with easy
access to low-cost healthcare. Low-income people will be able to get affordable healthcare
through online visits (Kichloo et al., 2020). Moreover, the people affected by waterborne health
conditions and air pollution will get treatment and safety awareness through telehealth services.
Free medical camps will be arranged every six months to support the low-income population
who cannot buy costly health insurance. Moreover, they will be directed to get affordable health
insurance under the Affordable Care Act (ACA) (Isola & Reddivari, 2021). The health disparities
in the Jordan community will be addressed by the combination of telehealth and free medical
camps. The change will improve the overall health of the community by improving the existing
health disparities.
Pathak et al., (2019) conducted a study in India, where 60% of the population does not
have access to basic healthcare, to check the effectiveness of the medical camps to address the
health access issue. They found the intervention beneficial for the population’s health and
suggested similar interventions should be followed in the future. Moreover, Haque et al., (2022)
conducted a study based on questionnaires to find the use of telehealth services in different
populations. They found that low-income people were one of the populations who were mostly
associated with the use of telehealth services.
The agreement of all stakeholders is essential for the approval of the proposed change
(Boaz et al., 2018). Making them agree to the change is not an easy job. Stakeholders include
4
patients and funders or payers as well. Patients can feel hesitant to utilize new arrangements due
to misconceptions (Mahmoud et al., 2022). On the other hand, private funders and payers need to
know about the profit and benefits of the change because they have to offer financial support. To
avoid the risk of stakeholders jumping to unfounded conclusions, presentations should be
arranged that will focus on the direct benefits of the proposed change. Moreover, the community
can acknowledge the benefits through pamphlets and awareness campaigns (Seymour, 2018).
Potential Barriers to Change
Although telehealth services are beneficial and easy to access, several barriers can be
faced while the implementation of the change. As the Jordan community contains people from
different ethnicities, cultural and language barriers may affect the services. Moreover, people can
feel hesitant to use online consultations due to misconceptions, privacy issues, or hearing issues
(Mao et al., 2022; Žagar et al., 2019). According to Busso et al. (2022), people can also feel
hesitant to use telehealth services due to a lack of technology knowledge, mistrust of online
services, and behavioral biases. Another barrier that can hinder the proposed change is the
availability of the internet and knowledge of technology for telehealth services at the user level.
The resistance to the use of telehealth services and medical camps can be due to cultural
diversity and privacy-related misconceptions (Žagar et al., 2019; Zhang et al., 2020). A lack of
cultural competence in telehealth providers reduces patient satisfaction and hinders the effective
use of the initiative (Hilty et al., 2020). At the organizational level, the lack of cultural or lingual
competence and technical challenges can create resistance to telehealth change. The study by
Žagar et al., (2019) analyzed the barriers to medical camps and found several factors contributing
to the hindrance. Two of them were cultural diversity and language barriers. Kalicki et al., (2021)
5
presented research that showed two major barriers to telehealth services e.g., video meetings
internet issues, and unavailability to support technology use.
Change Drivers
Drivers of change are factors or people that contribute to the development and
implementation of a change. In this case, the potential drivers of change are health professionals,
volunteers, management, and the involvement of stakeholders in decision-making. My vision for
change is the provision of affordable healthcare and the improvement of health conditions in the
Jordan community by removing health disparities.
Change Model
The change model used here is the Complex Adaptive System (CAS) which takes a
healthcare change as a dynamic system. It integrates agents or changes drivers from different
areas and integrates them under one context where the drivers collaborate by adapting each
other’s actions (Gomersall, 2018). The expected outcomes are a reduction in health disparities,
improved healthcare access, and improvement in cost-related health issues. The time expected
for the change is almost 60 days. The plan will be evaluated every fifteen days through surveys.
The reason behind keeping the evaluation period fifteen days is to get an idea of the early
success of the project. The purpose of the evaluation will be to check the effectiveness and
progress of the proposed change. Approval to change, collection of financial and human
resources, technological arrangements, and preparation of awareness campaigns, presentations,
and medical camps are included in this time framework. Communication with stakeholders
(patients, payers, professionals) is crucial for the successful implementation of the change. It can
be done through presentations for stakeholders, and seminars for the target population focused on
the need and requirement for the mitigation of resistance. The conflict among competing
6
interests will be resolved by training health professionals to get the technological expertise
needed for telehealth. They will be trained to practice cultural and lingual competency. Also,
informing the community about the benefits of telehealth services will reduce the conflict
(Bhaskar et al., 2020).
Stakeholder Communications
Strategies for Stakeholders
The strategies to help stakeholders understand the proposed changes will include
presentations and training sessions. The presentation will be arranged for all the stakeholders,
including payers, nurses, management, and other involved professionals while the training
sessions will be conducted for nurses and the providers who will execute telehealth technology.
For community members, seminars will be arranged to enhance their knowledge of technology
and clear misconceptions about telehealth services. The changes will be evaluated through
surveys and the dissemination of questionnaires among nurses and community members because
it is imperative to know both sides of perceptions for effective evaluation of the project (Gaur et
al., 2020). The key stakeholders for the change will be the hospital management, the target
population of the Jordan Community, health professionals, and financial supporters.
Influence of Stakeholders
The overall influence of the stakeholders on the community is that change cannot be
implemented without their involvement. Health professionals need to be trained in telehealth
services (Haleem et al., 2021). Financial supporters will provide funds to arrange seminars and
medical camps, install telehealth systems, and other campaigns. The management will organize
the system and allocate financial and human resources as per requirements.
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Data for Decision Makers
The data and information provided to the decision makers will include demographic data
of the community, potential benefits and risks of the proposed change, the time required for the
implementation, and expenses needed for the whole change proposal.
Effect of Changes on Organization
The changes will also affect the healthcare organization. For example, the proper
allocation of financial resources will help reduce the financial burden on the hospital related to
the emergency department (Radinmanesh et al., 2021). Moreover, the training of healthcare
providers will help the professionals keep a work-life balance by not wasting time on technical
issues (Haleem et al., 2021).
Buy-In Engagement of Stakeholders
Presentation and training sessions for stakeholders (nurses, payers, and professionals)
will engage them in the project. Moreover, financial incentives for best-performing health
providers can also increase their buy-in (Martin et al., 2020).
A project manager will be leading the budget-related change in the organization. The
major budget will be required for telehealth implementation and salaries. The startup cost will
include software installment and equipment purchase ($50,000). Then, the cost will be required
for its maintenance ($10,000) (Horiachko, 2022). Medical camps in the first year will cost
$12,000 to the hospital. Travel and other costs will add $3,900 to the total expenses of the
proposed change (Guiding Light Orphans, n.d.). The budget information will be provided to the
stakeholders to inform them of the details of the changed proposal and the purpose of the
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required money. Moreover, the documents of the change proposal along with its financial
expenditures will be signed by all major stakeholders involved in funding and decision-making.
The change proposal for improving health disparities in the Jordan Community is crucial
as it affects the community’s overall quality of life. The implementation of telehealth services
and free medical camps will improve the community’s health condition. There might be potential
barriers to the change, but they can be minimized using certain strategies. The involvement of
stakeholders is imperative for the successful implementation of the change.
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Best Places. (n.d.). Health in Jordan, Minnesota. Bestplaces.net.
https://www.bestplaces.net/health/city/minnesota/jordan
Bhaskar, S., Bradley, S., Chattu, V. K., Adisesh, A., Nurtazina, A., Kyrykbayeva, S., Sakhamuri,
S., Moguilner, S., Pandya, S., Schroeder, S., Banach, M., & Ray, D. (2020). Telemedicine
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research: Design principles to support improvement. Health Research Policy and
Systems, 16(1). https://doi.org/10.1186/s12961-018-0337-6
Busso, M., Gonzalez, M. P., & Scartascini, C. (2022). On the demand for telemedicine: Evidence
from the COVID‐19 pandemic. Health Economics, 31(7).
https://doi.org/10.1002/hec.4523
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Capabilities, features, barriers, and applications. Sensors International, 2(2), 100117.
https://doi.org/10.1016/j.sintl.2021.100117
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Shaima, S. N., Chowdhury, S., Matin, K. F., Karim, I. J., Ahmed, M. T., Hossain, S. Z.,
Masud, Md. A. H., Nabi, M. G., Aziz, A. B., Sharif, M., Chowdhury, Md. F. I., Shams, K.
L., Nizam, N. B., & Ananta, T. T. (2022). Perceptions about telemedicine among
populations with chronic diseases amid COVID-19: Data from a cross-sectional survey.
International Journal of Environmental Research and Public Health, 19(7), 4250.
https://doi.org/10.3390/ijerph19074250
Hilty, D. M., Gentry, M. T., McKean, A. J., Cowan, K. E., Lim, R. F., & Lu, F. G. (2020).
Telehealth for rural diverse populations: Telebehavioral and cultural competencies,
clinical outcomes and administrative approaches. MHealth, 20(6), 20–20.
https://doi.org/10.21037/mhealth.2019.10.04
Horiachko, A. (2022, May 4). Cost of telemedicine system: Is it a worthy investment? Softermii.
https://www.softermii.com/blog/cost-of-telemedicine
Isola, S., & Reddivari, A. K. R. (2021). Affordable Care Act. PubMed; StatPearls Publishing.
https://pubmed.ncbi.nlm.nih.gov/31747174/
JordanMN. (2021). Jordan 2021 drinking water report. Jordanmn.gov. https://jordanmn.gov/wp-
content/uploads/2022/04/Jordan-2021-Drinking-Water-Report
Kalicki, A. V., Moody, K. A., Franzosa, E., Gliatto, P. M., & Ornstein, K. A. (2021). Barriers to
telehealth access among homebound older adults. Journal of the American Geriatrics
Society, 69(9). https://doi.org/10.1111/jgs.17163
https://doi.org/10.1111/jgs.17163
https://jordanmn.gov/wp-content/uploads/2022/04/Jordan-2021-Drinking-Water-Report
https://jordanmn.gov/wp-content/uploads/2022/04/Jordan-2021-Drinking-Water-Report
https://pubmed.ncbi.nlm.nih.gov/31747174/
https://www.softermii.com/blog/cost-of-telemedicine
https://doi.org/10.21037/mhealth.2019.10.04
https://doi.org/10.3390/ijerph19074250
https://doi.org/10.1016/j.sintl.2021.100117
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Kichloo, A., Albosta, M., Dettloff, K., Wani, F., El-Amir, Z., Singh, J., Aljadah, M., Chakinala,
R. C., Kanugula, A. K., Solanki, S., & Chugh, S. (2020). Telemedicine, the current
COVID-19 pandemic, and the future: A narrative review and perspectives moving
forward in the USA. Family Medicine and Community Health, 8(3), e0005
30. https://doi.org/10.1136/fmch-2020-000530
Lago, S., Cantarero, D., Rivera, B., Pascual, M., Blázquez-Fernández, C., Casal, B., & Reyes, F.
(2018). Socioeconomic status, health inequalities and non-communicable diseases: A
systematic review. Journal of Public Health, 26(1), 1–14. https://doi.org/10.1007/s10389-
017-0850-z
Mahmoud, K., Jaramillo, C., & Barteit, S. (2022). Telemedicine in low- and middle-income
countries during the COVID-19 pandemic: A scoping review. Frontiers in Public Health,
10(914423). https://doi.org/10.3389/fpubh.2022.914423
Manisalidis, I., Stavropoulou, E., Stavropoulos, A., & Bezirtzoglou, E. (2020). Environmental
and health impacts of air pollution: A review. Frontiers in Public Health, 8(14).
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Mao, A., Tam, L., Xu, A., Osborn, K., Sheffrin, M., Gould, C., Schillinger, E., Martin, M., &
Mesias, M. (2022). Barriers to telemedicine video visits for older adults in independent
living facilities: Mixed methods cross-sectional needs assessment. Journal of Medical
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Nilsen, P., Seing, I., Ericsson, C., Birken, S. A., & Schildmeijer, K. (2020). Characteristics of
successful changes in health care organizations: An interview study with physicians,
registered nurses, and assistant nurses. BMC Health Services Research, 20(1).
https://doi.org/10.1186/s12913-020-4999-8
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camps: A novel approach beckoning. Indian Journal of Community Medicine, 44(3), 233.
https://doi.org/10.4103/ijcm.ijcm_349_18
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review of appropriate indicators for need-based financial resource allocation in health
systems. BMC Health Services Research, 21(1). https://doi.org/10.1186/s12913-021-
06522-0
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at Schengen border. International Journal for Equity in Health, 18(1).
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into the future of healthcare delivery? (Preprint). Journal of Medical Internet Research
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Need Proposal
The main issue identified in the Jordan Community is the existence of socioeconomic
differences, and poor water, and air quality that cause different health conditions in the
community (Best Places, n.d.; JordanMN, 2021). The issue is affecting the Jordan community,
especially the low-income population. The proposed change for the community is aimed at
providing cost-effective healthcare and awareness to the community through telehealth services
and free medical camps. The potential barriers could be a lack of telehealth awareness among the
community, technical issues, misconceptions, and hesitance to the use of telehealth. The need for
change was defined through a windshield survey. Further efforts can be added to the change for
addressing the problem.
Program Description
The reason behind the implementation of telehealth is its economic viability for the
organization and the community. Moreover, the services will help the organization reach more
patients in the community regardless of their cultural and socioeconomic backgrounds. Free
medical camps after six months will provide free check-ups for low-income populations in the
community. The change will involve all the stakeholders like health organizations, professionals,
community members, nurses, project managers, and payers. The project will take 60 days to
implement.
Goals and Objectives
The goals of the proposed initiative are:
Provision of cost-effective healthcare to patients, especially low-income
population
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Free medical checkups for the low-income population
Making healthcare access easy for more patients
Improving cost management for chronic diseases
Program Evaluation
A survey team will be developed to evaluate the program. The team will include members
from Jordan Community for better evaluation. The survey will be conducted every fifteen days,
in the beginning, to check the improvement in the community’s health after the implementation
of the change. After that, the evaluation time will be increased to a period of thirty days. The
survey will be led by disseminating questionnaires and taking interviews with community
members and health providers. The evaluation reports will be presented to the supervisor. Key
stakeholders including funders will be given copies of the reports to inform them about the
progress of the plan.
Summary
The change is important to the community because it will improve the existing health
disparities due to socioeconomic differences and low quality of water and air. The primary
objective of the plan is easy to access to affordable or free healthcare while the funding
organization also aims to improve health coverage at affordable prices. That is why both
objectives are well aligned with each other. The financial support of the funders is essential as
the hospital and Jordan community are not very stable financially. In the end, I would thank the
funding agencies for considering and supporting the initiative financially.
15
16
Categories Startup 1st Year
Other Sources
of Revenue Justification
Salary and Wages $80,000 $100,00
0
Hospital Revenue
and Government
Funds
Salaries will be given
to professionals and
providers for the
change services.
Professionals $47,000 $52,000
Project Manager $7,000 $8,000
Support Staff $26,000 $30,000
Other $10,000
Fringe Benefits These incentives are
significant to raise
the morale of
workers.
Incentives $500 Private Payers
Health Insurance $20,000 $20,000
Telehealth Cost $50,000 $10,000 Funds from
Government and
Private Payers
The initiative of
telehealth needs the
installation of
software equipment,
and maintenance
expenses.
(Software, Equipment)
Medical Camps $6,000 $12,000 Private Payers Free medical camps
will require surgical
supplies, free
medicines, and other
materials.
(Surgical Supplies,
Others)
Travel $200 $400 Hospital Revenue Medical camps have
to be arranged in
different areas of the
community.
(For medical camps)
Miscellaneous $3,500 $3,500 Hospital Revenue Training, awareness
campaigns, and
seminars are essential
for the proposed
change.
(Training, Awareness
Campaigns, Seminars)
Total Expenses $159,700 $146,40
0
-
Change Proposal
Summary
Benefits and Implication
Potential Barriers to Change
Change Drivers
Change Model
Stakeholder Communications
Strategies for Stakeholders
Influence of Stakeholders
Data for Decision Makers
Effect of Changes on Organization
Buy-In Engagement of Stakeholders
Budget Associated with the Proposed Change
Conclusion
References
Appendix A: Grant Proposal
Need Proposal
Program Description
Goals and Objectives
Program Evaluation
Summary
Table
CHANGE PROPOSAL 7
CHANGE PROPOSAL 8
Change Proposal
Your Full Name (no credentials)
School of Nursing and Health Sciences, Capella University
NURS-FPX6
2
18 Leading the Future of Health Care
Planning for Community and Organizational Change
Instructor’s Name
Month, Year
Title of Paper
Note: Delete this note and all instructions from the template before submitting your proposal. Use headings to organize your text, rather than bullets.
Summary
Benefits and Implications
Identify the benefits of proposed health care system changes and its implications for a community.
Consider the goals and potential outcomes of the proposed changes.
What are the direct benefits of your proposed changes?
How will improvements in overall health affect the community?
Potential Barriers to Change
Describe potential barriers to change in an organization or community.
What factors in an organization and community create or contribute to resistance to changes?
What other factors can create barriers to change?
Articulate strategies for changing barriers into opportunities and resolving conflict.
What are the drivers of change in organizations and communities?
How will you communicate with stakeholders and overcome resistance?
How will you resolve conflict among competing interests?
Stakeholder Communications
Articulate a strategy for helping organizational stakeholders understand and evaluate proposed changes to the existing health care system.
Who are the key stakeholders in the organization?
What influence do they have on your proposal?
Consider the effects of these changes on the organization and the specific information needs of decision makers.
References
List your APA-formatted references here.
Appendix A: Grant Proposal
Need Statement
Define the problem that this change is addressing.
Describe the scope of the problem.
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Who is affected? How will you describe this population?
· How many people does this problem affect?
Identify the barriers you are likely to encounter when implementing this change?
Identify the sources of information you used to define the need for change.
Identify any other change initiatives or studies that are addressing this problem.
Program Description
Describe the proposed change initiative and how you plan to implement it. Address the basic questions of who, what, when, where, why, and how.
Goals and Objectives
Describe the goals and objectives of the change initiative.
Program Evaluation
Explain how this change initiative will be evaluated.
· Who will have oversight responsibilities?
· How and how often, will this initiative be evaluated?
· Who is the recipient of the evaluation reports?
· What is the extent of stakeholder involvement in evaluation?
Summary
Explain why this change is important to the community.
Explain how the goals and objectives of this change initiative align with those of the funding organization and why their financial support is vital to the success of this initiative.
Be sure to thank the funding agency for considering and supporting this initiative.
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Appendix B: Project Budget
Table directions:
Add table rows, as needed, for each budget category.
Enter the information (startup, first-year budget figures, other sources of revenue, and justification) for each budget category line item in columns 2–5.
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Categories |
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Startup |
1st Year |
Other Sources |
Justification |
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Salary and Wages |
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· Project Manager |
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· Support Staff |
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· Other |
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Fringe Benefits |
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Consultation or Contract Services |
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Equipment |
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Materials |
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Travel |
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Miscellaneous or Other |
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Total Expenses |
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