Colorado Physician Health Program Annual Report July 2005 - June 2006

1. Colorado Physician Health ProgramAnnual Report July 2005 - June 2006 Executive Director: Sarah R. Early, PsyD Medical Director: Michael H. Gendel, MD The mission of Colorado Physician Health Program is to assist physicians, residents, medical students, physician assistants and physician assistant students who may have health problems which if left untreated, could adversely effect their ability to practice medicine safely.

2. Table of ContentsAnnual ReportJuly 2005 - June 2006 • Referral Summary Page 3 • Number of New Referrals - Program History Page 4 • Source of New Referrals - Year-to-Date Page 5 • Primary Presenting Problem -Year-to-Date Page 6 • Specialty of New Referrals - Year-to-Date Page 7 • License Status of New Referrals - Year-to-Date Page 8 • New Referrals – Geographical Area - Year-to-Date Page 9 • Referrals & Reactivations 1993 - 2006 Page 10 • Reactivations - Year-to-Date Page 11 • Inactivations (Reasons/Outcome) - Year-to-Date Page 12 • Participants Documentation Requests Page 13 • Program Highlights Page 14 • Community Outreach Page 15 • Services Provided by CPHP Page 16 • CPHP Board of Directors and Staff Page 17 APPENDIX • Definition of Terms Page 19

3. Referral Summary July 2005 - June 2006 • New Referrals: Fiscal Year 2005-2006 represents the highest number of New Referrals in CPHP history. While CPHP projected an increase number of referrals due to the fact that 2005 was a Colorado Board of Medical Examiners (BME) renewal year, the referrals exceeded the expectations. When compared to the 2004-05 Fiscal Year CPHP realized a 34% increase in referrals. This is an actual growth of 74 cases. • Caseload:The average active caseload at any given period during Fiscal Year 2005-06 was 403 clients. This represents an increase of 8% compared to Fiscal Year 2004-05 (373 active client caseload). • Overview: Significantly, 52% of New Referrals came to CPHP voluntarily. 48% were mandatory referrals. This is a slight increase (5%) of voluntary New Referrals when compared to Fiscal Year 2004-05 (with 47% voluntary New Referrals). Of the total New Referrals this year, 64% had an active Colorado license, 11% had a Colorado Training License and 5% held Physician Assistant licenses. 19% did not hold any license which includes 10% Applicants, 6% students and 3% out-of-state clients. CPHP served New Referral clients from 24 counties of residence throughout Colorado during Fiscal Year 2005-06. • Referral Source: The highest single source of New Referrals was Self referrals, representing 32% of New Referrals. The second highest source of New Referrals was the BME (24%). Administration (12%) was the third highest category of referral source. • Primary Presenting Problem of New Referrals: The three most common primary presenting problems were: Psychiatric at 26%, followed by Legal at17% and lastly tied were Substance Abuse and Behavioral each at 14%. • Specialty of New Referrals: For Fiscal Year 2005-06 Family Practice (16%) is the most frequent specialty of New Referrals, followed by Internal Medicine (14%) and Anesthesiology (10%). • Reactivations: Of the 290 New Referrals, 56 were Reactivations. This represents 19% of the total New Referrals. • Outcome: For Fiscal Year 2005-06, CPHP inactivated 243 participants and opened 290 new cases, resulting in a net gain of 47 cases. Of 243 inactivations, 61 (25%) Declined Evaluation, 9 Relocated, 1 was Referred in Error and 1 was incarcerated; therefore, 171 clients were evaluated. Of the 171 evaluated, 160 (94%) were inactivated with an outcome considered successful and/or satisfactory. CPHP is pleased with our continued high rate of satisfactory outcomes! • Documentation Requests: CPHP processed 1170 report requests during Fiscal Year 2005-06. • Total Participants in CPHP History: Since the inception of the program in 1986, CPHP has served 2,496 participants.

4. Annual Number of New Referrals Program History 1986 - Present • This graph shows the continued overall growth of New Referrals in the history of the program. Fiscal Year 2005-2006 represents the highest number of New Referrals in CPHP history. While CPHP projected an increase number of referrals due to the fact that 2005 was a Colorado Board of Medical Examiners (BME) renewal year, the referrals exceeded the expectations. When compared to the 2004-05 Fiscal Year CPHP realized a 34% increase in referrals. This is an actual growth of 74 cases. • When compared to Fiscal Year 2003-04 (the last fiscal year that was a BME license renewal year), CPHP experienced an actual growth of 68 cases, an increase of 31%. • The average active caseload at any given period during Fiscal Year 2005-06 was 403 clients. This represents an increase of 8% compared to Fiscal Year 2004-05 (373 active client caseload). • * = BME License Renewal Years

5. Source of New Referrals July 2005 - June 2006 Continued High Self & Voluntary Referrals Client Medical Profession Other = DPM, PhD N=290 Other= Attorney, PHP • During Fiscal Year 2005-06, the highest single source of New Referrals was Self referrals, representing 32% of New Referrals. This is a decrease (7%) when compared to last year (39%). CPHP continues to be proud of the number of Self Referrals to the program demonstrating trust and confidence in CPHP. This decrease in self referrals appears to correlate with the addition of the referral source category Proactive which encompassed 10% of the New Referrals. CPHP created this referral source category to more accurately reflect client circumstances. • Significantly, 52% of New Referrals came to CPHP voluntarily. 48% were mandatory referrals. This is a slight increase (5%) of voluntary New Referrals when compared to Fiscal Year 2004-05 (with 47% voluntary New Referrals). CPHP is proud of the high percentage of referrals that are voluntary, as this reflects the respect for the program among physicians within the state and medical community. CPHP attributes this high level of voluntary referrals to the relationship building efforts made in the community, the positive and caring approach of CPHP’s staff and provision of educational materials that normalizes physician experiences and illness. • The second highest source of New Referrals was the BME (24%). Administration (12%) was the third highest category of referral source. This is consistent with 2004-05 percentage of BME New Referrals also at 24% and Administrative New Referrals at 13%. CPHP appreciates the referrals received from the BME to assist physicians in evaluating potential health issues that may effect their ability to practice medicine safely. The other significant change in New Referral source this Fiscal Year was the addition of the referral source category Proactive which encompassed 10% of the New Referrals. • Please note updated definitions in referral source categories. See page 19. • The pie chart on the right reflects the medical profession of CPHP clients. The majority of clients are Physicians without a resident status (67%). Residents (16%) comprise the second largest group served and Physician Assistants (7%) comprise the third largest group.

6. Primary Presenting Problem of New Referrals July 2005 - June 2006 Other= Career, Emotional N=208 • In an effort to better understand the relevancy of the primary presenting problem data, CPHP has removed cases that are “in process” or have not yet been assigned a primary presenting problem. Of the 290 New Referrals received during Fiscal Year 2005-06, 82 were in process at the time of this report, thus 208 were assigned a primary presenting problem. • A primary presenting problem area which best represents the participant is identified by the clinical team following the completion of the initial intake interview. This does not mean that other problem areas are not present or being addressed with the participant at CPHP. Rather, the primary presenting problem is identified for data collection and reporting purposes. • The three most common primary presenting problems among the 208 New Referrals were: Psychiatric at 26%, followed by Legal at 17% and lastly tied were Substance Abuse and Behavioral each at 14%. • Using the same methodology of data collection, this representation has varied from Fiscal Year 2004-05 with the top three categories of Psychiatric (21%), Substance Abuse (21%) and Behavioral (20%). When compared to last fiscal year, the primary presenting problem of Psychiatric increased 5%, Substance Abuse decreased 7% and Behavioral decreased 6%. Legal issues, which was not in the top three primary presenting problems last fiscal year, increased 10%. There was a significant increase in clients seeking assistance for legal problems which included a variety of issues, with a predominance of Driving Under the Influence and Domestic Violence charges.

7. Specialty of New Referrals July 2005 – June 2006 Other = Dermatology, Gastroenterology, Pathology, Podiatry, Radiation/Oncology, Urology, None N/A = Student N=208 • In an effort to reflect the true representation of specialties served, CPHP is reporting on cases where specialty information has been collected. The data on specialty is collected at the time of intake. Of the 290 New Referrals received during Fiscal Year 2005-05, 82 had not completed an initial intake session at the time of this report, thus for 208 New Referrals, specialty information had been collected. • For Fiscal Year 2005-06 Family Practice (16%) is the most frequent specialty of New Referrals, followed by Internal Medicine (14%) and Anesthesiology (10%). • This representation is similar to Fiscal Year 2004-05 with the same three most frequent specialties of Family Practice (21%), Internal Medicine (14%) and Anesthesiology (15%). However, when compared to last fiscal year, this fiscal year CPHP had an decrease of Family Practice physicians by 5%, the same percentage of Internal Medicine physicians and a decrease of Anesthesiologists by 5%. • The specialty statistics among CPHP participants are only meaningful if there is a deviation from the specialty populations of practicing physicians in Colorado. CPHP does not posses current information to determine the significance of this data.

8. License Type of New Referrals July 2005 - June 2006 Other = DPM, PhD N=290 • This pie chart shows the medical license type of each New Referral to CPHP at the time of referral. • Of the total New Referrals this year, 64% had an active Colorado license, 11% had a Colorado Training License and 5% held Physician Assistant licenses. 19% did not hold any Colorado license which includes 10% Applicants, 6% students and 3% out-of-state clients.

9. Colorado Counties Served by CPHP July 2005 - June 2006 * ^ ^ * * ^ * N * * * ^ * * * * * * * * * * ^ ^ * * * ^ ^ * ^ ^ ^ ^ ^ * ^ * ^ ^ * ^ ^ = Other Other includes counties that contain less than 10 physicians, based on a BME listing (obtained in September 2005) of Colorado licensed physicians. These counties are grouped into one category (Other) to protect the confidentiality of clients residing in those counties. Counties in this category include: Baca, Cheyenne, Conejos, Crowley, Custer, Dolores, Hinsdale, Jackson, Kiowa, Mineral, Park, Phillips, Rio Blanco, Saguache, San Juan and Sedgwick. ^ = County Served * • CPHP served New Referral clients from 24 counties of residence throughout Colorado during the Fiscal Year 2005-06. • The most frequent county of residence among New Referrals was Denver Countyat26%.

10. Referrals & Reactivations1993 - 2006 • Of the 290 New Referrals, 56 were Reactivations. This represents 19% of the total New Referrals. This is a slight decrease (2%) when compared to Fiscal Year 2004-05 at 21%.

11. ReactivationsJuly 2005 - June 2006 Referral Source Primary Presenting Problem N=56 • “Reactivation” refers to when a participant returns to CPHP after having been inactivated. • Referral sources of reactivated clients are depicted on the left pie chart. Of 56 participants who were reactivated, 28% Self Referred. This represents a decrease when compared to Fiscal Year 2004-05 when 34% of Reactivations Self Referred. • The second most frequent referral source among reactivated clients was the BME (23%). This is a decrease of 7% when compared to last fiscal year in which BME Referrals comprised 30% of the Reactivation sample. • 55% of Reactivations voluntarily returned to CPHP during Fiscal Year 2005-06. There is a increase of 18% when compared to Fiscal Year 2005-06 which had 37% voluntary Reactivations. CPHP is pleased with the increase in voluntary referrals as this demonstrates trust and confidence in CPHP services. • Primary presenting problems of reactivated clients are illustrated on the right pie chart. These statistics reflect that Reactivations most commonly present with Psychiatric issues (27%), followed by Behavioral problems (22%) and Legal (16%) issues. • This distribution is similar to the Annual New Referrals (three largest categories: Psychiatric, Legal, and Substance Abuse and Behavioral). The primary presenting problem of Psychiatric was similar for Reactivations (27%) compared to Annual New Referrals (26%). The primary presenting problem of Behavioral was 8% higher for Reactivations (22%) compared to Annual New Referrals (14%). The primary presenting problem of Legal was similar for Reactivations (16%) compared to Annual New Referrals (17%).

12. 243 Participants Inactivated (Reasons/Outcome)July 2005 - June 2006 Length of Active Status at CPHP N=243 Other = Incarcerated, Referred in Error • “Inactivation” refers to when a case is closed at CPHP. Definitions of inactivation reasons are on page 19. • For Fiscal Year 2005-06, CPHP inactivated 243 participants and opened 290 new cases, resulting in a net gain of 47 cases. • Of 243 inactivations, 61 (25%) Declined Evaluation, 9 Relocated, 1 was Referred in Error and 1 was incarcerated; therefore, 171 clients were evaluated. Of the 171 evaluated, 160 (94%) were inactivated with an outcome considered successful and/or satisfactory. CPHP is pleased with our continued high rate of satisfactory outcomes! • Length of Active Status at CPHP is depicted on the right pie chart. The majority of participants (57%) completed the necessary involvement with CPHP in one year or less.

13. Participants Documentation Requests July 2005 - June 2006 N= 1170 • CPHP processed 1170 report requests during Fiscal Year 2005-06. This is an increase of 25% compared to Fiscal Year 2004-05 at 939 report requests!

14. Program HighlightsJuly 2005 - June 2006 • CPHP Honors 20 Years of Service!: 2006 is CPHP’s 20th anniversary year! CPHP is proud of our tradition of peer assistance and this year we are taking the time to reflect on our history and celebrate our achievements. We look forward to honoring our anniversary year through several venues including a CPHP newsletter tribute, distribution of commemorative mementos state-wide and hosting a tribute event for our medical community colleagues and supporters. Thank you to all, past and present, who have promoted CPHP’s mission! • CPHP Welcomed New CPHP Board Director:Alfred Gilchrist, Executive Director of Colorado Medical Society, began his three year term on May 16, 2006 as a CPHP Board Director. CPHP appreciated the caliber of experience and expertise that Mr. Gilchrist brings to CPHP. Welcome! • Workplace Violence Prevention: CPHP believes in the utmost safety and protection of both its employees and clients. Often, CPHP clients have difficult and complex problems that occasionally result in unfavorable behaviors. In an effort to prevent or minimize volatile situations, it was determined essential to develop workplace violence prevention procedures. CPHP had previously established workplace violence policies yet recently expanded on these guidelines with step-by-step procedures to follow in the event of an emergency. CPHP Associate Medical Directors who also are violence prevention experts, Doris C. Gundersen, MD, and David A. Iverson, MD, led an internal staff committee to create procedures that are readily accessible and specific. All CPHP staff are trained on these procedures to best serve clients in a safe environment. • Federation of State Physician Health Programs (FSPHP): CPHP continued active national involvement with the FSPHP during Fiscal Year 2005-06 with CPHP Medical Director, Michael H. Gendel, MD, serving as Immediate Past President of this organization. As always, CPHP welcomes FSPHP meetings as a forum for education and exchange of information among state physician health programs. • Western Region of the Federation of State Physician Health Programs (FSPHP) Annual Meeting: CPHP Medical Director, Executive Director, and Associate Medical Directors attended the Western Region of the FSPHP Annual Meeting in Honolulu, Hawaii October 7-9, 2005. CPHP representatives welcomed the opportunity to network with colleagues from other Physician Health Programs and gain valuable information about physician health related issues. • Federation of State Physician Health Programs (FSPHP) Annual Meeting: The CPHP Executive Director and Associate Medical Director attended the FSPHP Annual Meeting in Boston, Massachusetts April 21-24, 2006. Dr. Gundersen presented in a joint panel session to both the FSPHP and the Federation of State Medical Boards on Physician Depression and Suicide. Sarah R. Early, PsyD participated in a panel discussing the topic of Gaining and Sustaining Funding. • Spirit of Medicine Fundraising Campaign: CPHP completed the annual Spirit of Medicine fundraising campaign with successful results! CPHP utilizes fundraising efforts to supplement expenses that exceed the Peer Assistance Budget. CPHP Board of Directors along with the Development Specialist and Staff work together to cultivate and extend fundraising efforts throughout the Colorado medical community. We appreciate all of our generous contributors. • Availability of Services: In addition to CPHP providing services to Colorado licensed physicians and physician assistants, contracts exist to provide services for residents, medical students and physician assistant students enrolled at University of Colorado Health Sciences Center Residency Program, Medical School, and Physician Assistant Program, St. Joseph’s Residency Training Program, St. Anthony’s Residency Training Program, Red Rocks Community College Physician Assistant Program and Southern Colorado Family Residency Training Program for the 2005-06 academic year. • Finance and Peer Assistance Budget: CPHP finished the fourth quarter and fiscal year with a Year-to-Date Peer Assistance Net Loss of $40,863.31. Year-to-Date Revenue was higher mainly due to an unanticipated increase in the Peer Assistance Contract as approved beginning in March, 2006. Year-to-Date expenses were largely on target with Year-to-Date budget with the exception of increased expense in physician hours to meet clinical demands. The Net Loss was supplemented with cash reserves from the annual Spirit of Medicine campaign.

15. Community Outreach Highlights July 2005 - June 2006 • Copic/CPHP Educational Seminars:CPHP and Copic successfully completed the fourth series of educational seminars to educate physicians about the importance of maintaining a healthy lifestyle. These seminars were met with overwhelming success throughout Colorado. Locations of the fourth series of presentations included: Metro Denver, Boulder, Steamboat Springs, Pueblo, Durango, Colorado Springs and Fort Collins. The presentation topics for this series included: Work Stress Among Physicians, Professional Boundaries, and Physicians in Relationships and Families. The fifth series is underway for 2006-07! • Targeted Community Outreach Initiatives: • Colorado Permanente Medical Group (CPMG) Collaboration:Sarah R. Early, PsyD joined various CPMG representatives to explore the issue of physician wellness and the relation to patient safety. Issues of prevention, early intervention, and methods of assistance have been explored. CPHP is pleased to collaborate with this large Health Maintenance Organization to proactively support their clinical staff. • UCHSC Medical School Outreach:On August 9-10, 2005, Sarah R. Early, PsyD and Mary Ellen Caiati, MD, CPHP Associate Medical Director, were invited by Maureen Garrity, PhD, to attend the orientation for the UCHSC Medical School students in Winter Park. Dr. Early presented on health issues that physicians face throughout their medical career and utilization of CPHP as a resource. In addition, she co-facilitated two voluntary discussion groups on the topic of life balance. During the academic year, Dr. Early collaborated with the Medical School Alliance to address challenges faced during a physician’s career and preventative measures to promote a healthy, balanced lifestyle. Lastly, during an annual meeting with the Dean of the School of Medicine, Michael Gendel, MD and Dr. Early collaborated on student wellness issues and future organizational areas of interest. CPHP appreciates the opportunity to collaborate with the future physicians of Colorado. • Anesthesiology Outreach:On January 19, 2006, CPHP representatives met with the Human Resources Director of South Denver Anesthesiology to discuss the best avenues to proactively serve their physician staff. On January 23, 2006, Dr. Early, and Ms. Carol Goddard, CPHP Board Director, met with the President of the Colorado Society of Anesthesiology to collaborate on mutual issues of concern; namely, providing education of the risk factors specific to Anesthesiologists and useful resources. Future joint ventures were discussed. • Physician Assistant Outreach: CPHP provided targeted education and outreach to physician assistants this year. CPHP exhibited at the Colorado Academy of Physician Assistant Regional Meeting at St. Joseph’s Hospital on August 26, 2005 and on January 14-16, 2006, at the Mid-Winter conference at Copper Mountain. In addition, Elizabeth “Libby” Stuyt, MD, CPHP Associate Medical Director presented to the Advanced Practice Nurses & Physician Assistant Alliance of Southern Colorado on Healthcare Provider Stress Management on September 24, 2005 in Pueblo. CPHP was delighted with the opportunity to outreach and inform the physician assistant population. • Additional Community Presentations: In addition to the presentations on Work Stress Among Physicians,CPHP conducted presentations and exhibits about CPHP and related physician health topics. Audiences included Residency Programs, Medical and Physician Assistant Programs, Medical and Professional Societies, Spouse Alliance Groups, Medical Staff Offices, Group Practices and Treatment Providers. CPHP was pleased to exhibit at the annual meetings/conferences for Colorado Medical Society, Colorado Society of Osteopathic Medicine, Colorado Health and Hospital Association, and Colorado Rural Health. • Community Meetings: Referral source meetings were held with community entities including hospital administration and medical staff offices; medical and physician assistant training programs; residency programs; and affiliate organizations. Issues addressed included: how CPHP and the organization may work best together, building relationships with referral sources and improving CPHP services. Workplace consultation continues to be an important element of CPHP services. CPHP participants’ and/or participants’ potential workplaces seek assistance from CPHP on identifying problems, intervention strategies, how to make referrals, and documentation. • Participant Monitoring Visits: CPHP Medical Director and Associate Medical Directors traveled to various areas in the state for client appointments outside of Metro Denver including Boulder, Fort Collins, Grand Junction, Durango and Pueblo.

16. Services Provided by CPHP • Client Services: • Assessment • Treatment referral • Monitoring and support • Family support • Documentation • Workplace and Referral Source Services: • Consultation on identifying physicians who need assistance • Consultation on making referrals • Workplace consultations • Educational presentations • Medical Community Services: • Promote physician health awareness • Educational presentations • Partnership with organizations to meet special needs • Develop meaningful research on physician health • Presentation Topics: • Colorado Physician Health Program services • Physician stress and stress management • Substance abuse, addiction • Professional boundaries • Self-care and physician health issues • Disruptive physician management • Women in medicine • Physicians in relationships and families

17. CPHP Board of Directors and Staff Board of DirectorsBoard of Directors- continuedMedical Director and Associate Medical Directors Officers:Board Directors: Chair James Borgstede, MDGeorge Dikeou, EsqMichael H. Gendel, MD Penrad Imaging Executive Vice President Medical Director Radiology Copic Companies Colorado Springs Denver Mary Ellen Caiati, MD Associate Medical Director Vice ChairAlfred Gilchrist Stephen Dilts, MD Executive Director Doris C. Gundersen, MD RetiredColorado Medical Society Associate Medical Director CPHP Medical Director Emeritus Denver Denver David A. Iverson, MD Carol Goddard Associate Medical Director Immediate-Past ChairOwner and CEO Bruce Wilson, MDGoddard Associates Jay H. Shore, MD RetiredEnglewood Associate Medical Director Grand Junction Warren Johnson, MDMichael S. Sturges, MD Secretary Private Practice Associate Medical Director Caroline Gellrick, MD Family Practice Exempla Occupational Medicine Brighton Elizabeth “Libby” B. Stuyt, MD Wheat Ridge Associate Medical Director Debbie Lazarus Treasurer Colo. Medical Society Alliance Theodore Zerwin, MSW Greenwood Village Professional and Administrative Staff Retired, President Arthritis Foundation Michael Michalek, MD Westminster RetiredSarah R. Early, PsyD LakewoodExecutive Director Director-at-Large Maureen Garrity, PhDDennis O’Malley Cae Allison, LCSW Associate Dean, Student Affairs President Director of Clinical Services Univ. of Colo Health Science Ctr Craig Hospital Denver Englewood Teresa Bajorek, CPCS Executive Assistant/Office Administrator Director-at-LargeLawrence Varner, DO Larry Schafer, MDPrivate Practice Karen Chipley, MBA Private Practice Orthopedic Surgery Director of Finance Oncology/Hematology Aurora Wheat Ridge Brian Ellis Receptionist/Program Assistant Lynne Klaus, LCSW Clinician Shari Lewinski, LPC Clinician Sally Moody, MSW Clinician Naomi Richards, LCSW Clinician Jill Sample, BS Clinical Coordinator Todd Weiss, BA Development Specialist

18. APPENDIX

19. Definition of Terms REFERRAL SOURCES: For the purpose of this report, the following definitions are applied: Self: Voluntary referrals who request services on their own and there are not consequences with other entities or organizations if they do not follow through. Proactive: Self referral who request services who will have or would likely have consequences with other entities or organizations if they do not follow through. Board of Medical Examiners (BME): Any written referral made by the BME or required evaluations as part of the application or renewal process to Colorado Administrative (Admin): Dept. Heads, Directors, Partners, Presidents, CEO’s (which are not part of a hospital system). For example, Vail Clinic, CFO of a Radiology group, managed care such as Kaiser Permanente Hospital: MEC, Medical Staff Offices, Quality Management, Chief of Staff, Credentialing Committees Resident Program (Res Prog) : Any referrals made by Residency Directors and personnel Peer: Any MD, DO, or PA that does not fit into another category Treatment Provider (Tx Prov): Professionals in community that provide treatment to CPHP participants Malpractice: A malpractice company Attorney: Referrals made by a physician’s attorney Medical School: Any referrals made by the Medical School Faculty, administration and personnel Physician Assistant Program: Any referrals made by a Physician Assistant School Faculty, administration and personnel REASONS FOR INACTIVATION: Monitoring Completed (Mon Comp): Client has followed CPHP recommendations for treatment, and/or monitoring. Monitoring no longer warranted. Evaluation Completed (Eval Comp): Client completed evaluation, no treatment or monitoring recommended. Also used for out of state clients that will follow-up with treatment and/or monitoring in own state. Evaluation Declined (Eval Declined): Client referred for evaluation. Refused or declined to have evaluation or cannot be located. No patient safety issues identified. Relocated: Client relocated after evaluation completed. No patient safety issues identified. Monitoring Declined (Mon Declined): Client completed evaluation. Client declined CPHP recommendations for treatment and/or monitoring. No patient safety issues identified. Other: Any reason that does not fit another category. Non-Compliance: Client did not comply with the completion of CPHP evaluation and/or did not comply with CPHP treatment and/or monitoring recommendations. Potential safety or patient safety issues identified. Deceased: Client deceased.