Although it is technically acceptable for the health center to combine the Quarter 4 (Q4) Risk Management Report and the Annual Risk Management report into the same document, the health center must ensure the combined report fulfills the expectations and requirements of both reports. Additionally, the health center should consider the following, to ensure effectiveness and compliance:

• Regulatory Compliance – The combined report must meet not only the requirements of the Health Resources and Services Administration (HRSA), but also any other federal and state obligations. This includes ensuring the content, format and timelines align with expectations. For example, the Federal Tort Claims Act (FTCA) requires submission of the health center’s Annual Risk Management Report for initial and redeeming applications. The report must include content demonstrating the evaluation and completion risk management activities for the entire calendar year (January 1 through December 31). 
• Clarity and Organization – The combined report must clearly define the difference between quarterly data and activities, as opposed to the annual comprehensive review. The most effective way to accomplish this is to use headings, sections or tables to organize data in a manner that is easy to navigate and understand.  
• Completeness – The combined report must be inclusive of the elements required in the Q4 and annual report. The quarterly report generally addresses specific activities and updates for the fourth quarter, while the annual report provides a broader analysis of trends, accomplishments, corrective plans of action and subsequent plans.
• Stakeholder Expectations – The health center should confirm with both internal and external stakeholders that a combined report will be acceptable, meet their expectations, and allow them to fulfill their roles and responsibilities effectively. 
• Timeliness – The combined report must be delivered in a timeline that satisfies the requirements of quarterly reporting, as well as those for annual reporting. Typically, the Q4 Risk Management Report is delivered in January, with the Annual Risk Management Report being delivered no later than February. 

Industry standard best practices demonstrate high performing health centers provide a separate Q4 Risk Management Report and an Annual Risk Management Report. By consolidating the two reports, the health center has the ability to minimize duplicated efforts, improve the clarity of reporting, and present a comprehensive view of risk management activities over the year; however, the health center must ensure that all regulatory requirements are met, stakeholder expectations are addressed, and the individual purposes of reports are preserved within the collective document.