Monthly Data Reporting for Bridge Clinics

By the 10th of each month, Bridge Clinics participating in the California Bridge Program must submit the required data from their patient contacts for the reporting period (monthly) to the Bridge team at the Public Health Institute.  We can only accept aggregate data for patient totals that are specified in the contracts with each site. We cannot accept individual patient level data at this time. Please anticipate an updated system in the coming months.

Please submit all data using the form below. Any questions may be addressed via email to



Please use this form to enter your totals for the required contracted monthly reporting. These totals are for patients that are actually seen at the clinic and do not include patients that only call or contact the clinic without being treated. Please send any questions to

Note: If any patient was served twice in the reporting period, please only count that patient ONCE per reporting period.

  • Enter numbers only; a field at the bottom of this page is available for comments or explanations.

  • Please do not leave any fields blank. Enter ‘0’ for zero or none, and enter ‘unknown’ if the response is not known.

* Indicates required field.


Additional tools to support data collection

These tools can help with site-level data collection. Please remember to send only aggregate total numbers to the Bridge Program via the online form.