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Medically Tailored Meals
Fresh Food Farmacy
Produce Prescription
Teaching Kitchen
Nutrition Incentives
Apply to Add Your FIM Program To The Map
Search Area
Filter By Program Type
Show All
Medically Tailored Meals
Fresh Food Farmacy
Produce Prescription
Teaching Kitchen
Nutrition Incentives
Apply to Add Your FIM Program To The Map
Add Your FIM Program To The Map
×
All starred (*) fields are required
Program Type
Medically Tailored Meals
Fresh Food Farmacy
Produce Prescription
Teaching Kitchen
Nutrition Incentives
Organization Name
*
This field is required.
Website
*
This field is required.
Address
*
Enter the location to display on the map
This field is required.
General Organization Contact Email
*
This field is required.
General Organization Contact Phone Number
*
This field is required.
Contact Name
*
This field is required.
Title
*
This field is required.
Phone
*
This field is required.
Email
*
This field is required.
Type Of Organization
*
Select Option
501c3 nonprofit
For profit
Other
This field is required.
Number Of Meals Provided Annually
*
This field is required.
Geographic Area Covered
*
This field is required.
RDN On Staff
*
Yes
No
Choose one option.
Meals Made From Scratch In Your Own Kitchen
*
Yes
No
Choose one option.
Client Referrals Via Medical Referral Form
*
All
Some
No
Choose one option.
Nutritional Assessment By RDN
*
All
Some
No
Choose one option.
Medical diagnoses served
HIV/AIDS
Cancer
Congestive Heart Failure
Hypertension/Stroke
Diabetes
Chronic kidney Disease
Rental Failure
COPD
Other
This field is required.
HIPPA Compliant
*
Yes
No
Choose one option.
Please copy the URL of the image you want to upload and paste it in the URL field.
Here’s how to do it
Your logo (paste image URL)
You can add up to 5 extra photos (paste image URL)
Organization Name
*
This field is required.
Website
*
This field is required.
Address
*
Enter the location to display on the map
This field is required.
General Organization Contact Email
*
This field is required.
General Organization Contact Phone Number
*
This field is required.
Contact Name
*
This field is required.
Title
*
This field is required.
Phone
*
This field is required.
Email
*
This field is required.
Type Of Organization
*
Select Option
501(C)(3) CBO
501(C)(3) intermediary
Healthcare system
Insurance Co
Integrated delivery system
Other
Please select one option.
Implementing Partners
*
FQHC
Community Health Center
Hospital (public/private)
Department of Health
Insurance Co
Retail Food supplier
Non profit food bank/pantry
Schools
Other
Please select at least one option.
Index Patient Screening Questions
*
Food insecurity - please confirm how you are identifying
SDOH Assessment – please confirm the tool you are using
Current Produce consumption
Current assessment of healthy eating (rating scale)
Number of household members
Insurance
SNAP
SSDI
Please select at least one option.
Insurance type(s) accepted
*
Medicare
Medicaid
Commercial/Employer sponsored plan
No insurance
Please select at least one option.
Require established primary care provider
*
Yes
No
Choose one option.
Metrics collected on patient/recipient
*
HbA1c
Height and Weight
BMI
Blood pressure
Blood glucose (ongoing)
Triglycerides
LDL
Tobacco use
Other
Please select at least one option.
Qualitative Metrics collected on patient/recipient(check all that apply)
*
Satisfaction
Fruit and veg consumption
Personal well being
Physical activity
Overall household health
Other
Please select at least one option.
Metrics collected from provider – utilization(check all that apply)
*
Emergency room usage
Admissions/Readmission rates
Care gap compliance (compliance with preventive care exams)
Overall utilization
Other
Please select at least one option.
Program criteria
*
Food insecurity
Established Provider
Income documentation
Established patient
Targeted conditions
Other
Please select at least one option.
Nutrition education
*
Select Option
Offered
Highly encouraged
Mandatory for participation
Please select one option.
Type of education available
*
Meal Planning/Budget planning
Healthy Weight Goals
Cooking demonstrations/classes
Exercise/physical activity
Registered dietician or CDE support
Evidence based chronic condition management programming
Other
Please select at least one option.
Clinical oversight of the program and education
*
Medical provider
RD
RN
Health Coach
Other
Please select at least one option.
Clinical oversight provided on site or in conjunction with a clinical partner
*
Yes
No
Choose one option.
Education Delivery (check all that apply)
*
In person
Virtual
Telephonic
Hybrid
Please select at least one option.
Average length of time people are in the program
*
Select Option
6-month
9-month
12-month
Other
Please select option.
Average number of clinical visits during intervention
*
This field is required.
Food distribution
*
Select Option
Weekly
Biweekly
Monthly
Other
Please select option.
Food provision per distribution (per person in the household)
*
Pounds
OR
Servings
This field is required.
Redemption (Check all)
*
Food Retailer
Farmers Market
CSA
Food Bank
Online Delivery
Other
Please select at least one option.
Food type (check all)
*
Premade meals
Grocery/prep needed
Please select at least one option.
Produce offerings (check all that apply)
*
Fresh
Frozen
Canned-unadulterated
Please select at least one option.
How much produce is provided (Percent of total per person)
*
This field is required.
Additional foods offered
*
This field is required.
If additional foods offered, do you consistently follow ADA/AHA criteria
*
Yes
No
Choose one option.
Documented clinical improvements
*
This field is required.
Publications (max 3)
*
This field is required.
Certifications (max 5)
*
This field is required.
Awards/recognition (max 5)
*
This field is required.
Please copy the URL of the image you want to upload and paste it in the URL field.
Here’s how to do it
Your logo (paste image URL)
You can add up to 5 extra photos (paste image URL)
Organization Name
*
Website
*
Address
*
Enter the location to display on the map
General Organization Contact Email
*
General Organization Contact Phone Number
*
Contact Name
*
Title
*
Phone
*
This field is required.
Email
*
This field is required.
Type Of Organization
*
Select an option
501(C)(3) CBO
501(C)(3) intermediary
Clinic
Other
Please select one option.
Primary Funding Sources(include up to two selections)
*
Large Private Donor
Insurance Company (corporate)
Healthcare provider(corporate)
Municipal
GuSNIP/FINI (Federal)
Other Federal Funding
Crowd-funded from fundraising efforts
Self Sustained / Self Supported
Other
Please select at least one checkbox.
Clinical Implementation Partners (Check all that apply)
*
FQHC
Community Health Center
Hospital (public/private)
Department of Health
Rural Community Health Centers
None
Other
Please select at least one checkbox.
Other Program Partner(s) Types (Check all that apply)
*
Government / Municipal
Health Insurance
Value-based Care / Managed Care (ACO)
Foundation
Corporation
Non-profit or CBO
University
Farmer’s Market
Farm
None
Please select at least one checkbox.
Eligibility (check all that apply)
*
Medicare
Medicaid/MediCal
SNAP
Please select at least one checkbox.
Data Collection Type (check all that apply)
Demographic
Income
Other
Enrollment Data Captured (Check all that apply)
*
HIV/AIDS
Obesity
Cancer
Heart Disease
Pregnancy
Unspecified Diet-Related Chronic Disease
Food insecurity
Produce consumption
Diabetes / Pre-Diabetes
Please select at least one checkbox.
Other social factors (check all that apply)
*
Low Income
Veteran Status
Other
Please select at least one checkbox.
Patient Age Population (Check all that apply)
*
Pediatric (0 - 12)
Adolescent (13 - 17)
Adult (18 - 64)
Older Adult (65+)
Please select at least one checkbox.
Biometrics
Select Option
Yes
None Yet – Need funding
None Yet – Need capacity
None – Not interested
Type of Patient/Recipient Metrics (check all that apply)
HbA1c
Height and Weight/BMI
Blood pressure
Blood glucose (ongoing)
Hypertension
FV consumption
FV knowledge
Type of Provider-Utilization Metrics Collected (check all that apply)
Emergency room usage
Readmittance
Overall utilization
Prescription Amount (dosage)
per day
per month
per patient
Household members included?
Yes
No
Mode of Transaction (Check all that apply)
*
Vouchers/coupons/Tokens
SNAP / EBT Card
Mobile App
Produce Box / CSA subscription
Retailer Loyalty Card
Other
Please select at least one checkbox.
Redemption Site (Check all that apply)
*
Food Retailer
Farmers Market
CSA Box
Food Bank
Online Delivery
On-site produce distribution
Mobile Market
Other
Please select at least one checkbox.
Type of produce
*
Local
Regional
Fresh
Other foods offered
Please select at least one checkbox.
Nutrition/cooking education
Yes
No
Type of Nutrition Education (check all that apply)
Meal planning
Healthy weight goals
Cooking classes, live
Cooking content
Nutrition content
SNAP Ed
Other
Education provider
RDN
CBO
Third party
Duration (select one)
*
6-month
9-month
12-month
Other
Please select one option.
Frequency of biometric data collection / interaction with program operators
Additional Factors to Consider (limit 100 characters)
Please copy the URL of the image you want to upload and paste it in the URL field.
Here’s how to do it
Your logo (paste image URL)
You can add up to 5 extra photos (paste image URL)
Organization Name
*
This field is reqired.
Website Address
*
This field is reqired.
Address
*
Enter the location to display on the map
This field is reqired.
General Organization Contact Email
*
This field is reqired.
General Organization Contact Phone Number
*
This field is reqired.
Contact Name
*
This field is reqired.
Title
*
This field is reqired.
Phone
*
This field is reqired.
Email
*
This field is reqired.
TKC Member?
*
Yes
No
Choose YES or No.
What is the principal purpose of your teaching kitchen (Select up to three)?
*
Student education (i.e. college, university, k-12 schools)
Improving health outcomes
Equity/social justice
Improving culinary skills (teaching cooking/baking)
Generating a profit from products or services sold
Reducing health care costs of trainees/employees
Other
Please check at least one checkbox.
How is your teaching kitchen funded? (select all that apply)
*
Corporate sponsorship
Philanthropy
Volunteer based
Government
In-kind donations
Client paid
Insurance coverage
Other
Please check at least one checkbox.
Type of facility
*
Hospital/medical center
Academic Institution (K-12 school, college, university)
Culinary School
Non-profit, Community-based program
Corporate/ For-profit program
In-home, personal kitchen
Other
Please check at least one checkbox.
Kitchen facilities are
*
Rented
Owned
In-kind space use
Please check at least one checkbox.
Physical Kitchen Structure
*
Pop-up
Mobile
Built in demonstration only
Built in demonstration and hands on stations for participants
Virtual
Please check at least one checkbox.
Licensed Team members include: check all that apply
*
Registered Dietitian
MD
ND
NP/RN
Certified Chef
Chef Educator
Health Coach
Certified Nutritionist
Other licensed team members
Please check at least one checkbox.
Do Participants (Check all that apply)
*
Listen To Lectures
Watch Demos
Cook Along with Instructor
Please check at least one checkbox
Teaching Fundamentals
*
Culinary Education
Nutrition Education
Exercise/Movement Education
Mindfulness Education
Health Coaching/Motivational Interviewing
Other
Please check at least one checkbox
Tell us about your teaching kitchen curriculum: check all that apply
*
We currently use a curriculum that we purchased or license
We developed our own curriculum
Please check at least one checkbox
What is the average number of participants you typically teach in a month?
*
This is field is required
What is the average number of participants you typically teach in a year?
*
This is field is required
Populations Served (Check all that apply)
*
Adults
Children
K12 Students
Culinary Trainees (Chefs)
College or University Students
Persons with Disabilities
Low Income/food insecure
Clients
Patients
Employees
Retirees
Veterans
Active Military (And Families)
Other
Please check at least one checkbox
Please copy the URL of the image you want to upload and paste it in the URL field.
Here’s how to do it
Your logo (paste image URL)
You can add up to 5 extra photos (paste image URL)
Organization Name
*
This field is reqired.
Website Address
*
This field is reqired.
Address
*
Enter the location to display on the map
This field is reqired.
General Organization Contact Email
*
This field is reqired.
General Organization Contact Phone Number
*
This field is reqired.
Contact Name
*
This field is reqired.
Title
*
This field is reqired.
Phone
*
This field is reqired.
Email
*
This field is reqired.
What is the name of the program you offer?
*
This field is reqired.
Is your program associated with a USDA Gus Schumacher Nutrition Incentive Grant Program (GusNIP) and/or Food Insecurity Nutrition Incentive (FINI) award?
Yes
No
Choose one option.
If “Yes”, what is the name of the primary awardee of the GusNIP or FINI award?
*
This field is required.
Would you describe your firm as farm direct (farmers markets, mobile markets, farm/produce stands, CSA's, etc.) or brick and mortar ? (grocery stores, corner stores, etc.)
*
Farm Direct
Brick and Mortar
Choose one option.
Program Operation
Year-round
Seasonal
Choose one option.
If you answered “Seasonal” to the previous question, please check all that apply
*
Winter
Spring
Summer
Fall
Please check at least one checkbox
Allowable SNAP purchases that trigger incentives at your firm? Select the best fit for your program (i.e., What can a customer purchase with their EBT card to earn the incentive?)
*
all SNAP eligible items
all Fruits + Vegetables (FV) (fresh, cut, dried, canned, frozen with no added sugar, salt, oil, etc.)
only fresh FVs
only fresh and frozen FVs
only state and regionally grown FVs
only organic grown FVs
Other
Please check at least one checkbox
Which fruit and vegetable products are eligible for incentives at your fi rm? (e.g., What can a customer purchase with their incentive?) Select all that apply
*
all fresh FVs
canned FVs (no added salt/sugar)
frozen FVs (no added salt/sugar)
dried FVs (no added salt/sugar)
dried herbs and spices
plants that produce herbs and FVs
seeds that produce herbs and FVs
only state and regionally grown FVs
only organic grown FVs
Other
Please check at least one checkbox
In what form(s) are SNAP incentives provided to customers at this firm? Select all that apply
*
coupon
token
frozen FVs (no added salt/sugar)
paper
EBT card
loyalty card – unique ID/phone number
loyalty account – plastic card
loyalty account – mobile application
discount
Other
Please check at least one checkbox
Ratio of SNAP dollars to SNAP incentive. Select all that apply. (Ex: For every $1 spent on SNAP, customer will earn $1 in incentive, up to $20, daily. RATIO is 1:1. A ratio of 2:2 is equivalent to 1:1)
*
1:1
2:1
3:1
4:1
5:2
25% off
50% off
Other
Please check at least one checkbox
Maximum daily incentive amount. (Ex: For every $1 spent on SNAP, customer will earn $1 in incentive, up to $20, daily. Maximum is 20) If your firm does not have cap, enter "0"
*
$
This field is reqired.
Please copy the URL of the image you want to upload and paste it in the URL field.
Here’s how to do it
Your logo (paste image URL)
You can add up to 5 extra photos (paste image URL)
please fill in all the required fields
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