HRSA does not require or mandate staffing ratios as this is a health center decision.  HRSA clearly outlines in the Health Center Program Compliance Manual, under “Related Considerations”, that the health center determines its staffing composition.  Each health center is unique with different needs, service areas and populations served.  Remember, no two health centers are alike.  HRSA does evaluate, based on the Health Center Program Site Visit Protocol, Clinical Staffing, Element B, whether the health center is staffed to ensure reasonable patient access.  This means, does the health center, based on their size, complexity and health needs, have enough staff to provide reasonable patient access.  Determining reasonable patient access is completed by a review of Form 5A (Scope of Services), UDS data, the health center’s staffing profile, and interviews with appropriate key members.  For more information, please review these documents: Chapter 5: Clinical Staffing | Bureau of Primary Health Care (hrsa.gov) and Health Center Program Site Visit Protocol: Clinical Staffing (hrsa.gov).