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Home My WebLink About1994 S Health - Consolidated Contract between State of North Carolina and OC Health Department for the Purpose of Maintaining and Stimulating the Advancement of Health in NC ,o -l9-QY Page 1 of 11 CONSOLIDATED CONTRACT BETWEEN THE STATE OF NORTH CAROLINA AS REPRESENTED BY THE DEPARTMENT OF ENVIRONMENT, HEALTH, AND NATURAL RESOURCES (Hereinafter called the "State") AND ORANGE COUNTY HEALTH DEPARTMENT (Local Health Department -- Hereinafter called the "Department") FOR THE PURPOSE OF MAINTAINING AND STIMULATING THE ADVANCEMENT OF HEALTH IN NORTH CAROLINA This Contract Shall Cover a Period From July 01, 1994 to June 30, 1995 NOW, THEREFORE, the State and the Department agree that the provisions and clauses herein set forth shall be incorporated in and constitute the terms and conditions applicable for the following activities involving State funding. (State funding or funds means state, federal, and/or special funding or funds throughout this contract.) ACTIVITY ACTIVITY General Immunization Action Plan Communicable Disease Tuberculosis AIDS (Federal) Family Planning Child Service Coordination CSHS Orthopedic MCH Block Grant Nutrition Maternal Health Child Health Adult Health Breast & Cervical Cancer Health Promotion DEHNR 2946(Revised 02/94) Division of General Services (Review 02/95) Page 2 of 11 A. WORK TO BE PERFORMED 1. The Department shall perform activities in compliance with applicable program rules contained in the North Carolina Administrative Code as well as all applicable Federal and State laws and regulations. 2. The Department shall submit for approval the required Program Contract Addenda for State funded budgets. 3. The Department shall submit completed reports as required by budgeted funding criteria and as specified in Listing g_ f Required Fiscal and Statistical Reports (Addenda 1). 4. The Department shall administer and enforce all rules which have been adopted by the Commission for Health Services or approved by the State and adopted by the Local Board of Health. 5. The Department shall provide to the State copies of rules adopted by the Local Board of Health pursuant to G.S. 130A-39 and Public Health Ordinances adopted by the County Commissioners. Copies of existing rules and ordinances shall be submitted to the State Health Director within 45 days. Thereafter, copies of rules adopted shall be submitted within 30 days of adoption. 6. The Department shall provide to the State a Community Diagnosis Prioritization of Problems every biennium. The Department shall also provide a Community Diagnosis- narrative, if completed. B. FUNDING STIPULATIONS 1. Funding for this contract is subject to the availability of State, Federal, and special funds for the purpose set forth in this Contract. 2. During the period of this Contract, the Department shall not use State, Federal or Special Proiect funds received under this Contract to reduce locally appropriated funds as reflected in the Local Health Department Budgets. 3. The Department shall not use personal health program funds to support environmental health personnel nor use environmental health program funds to support personal health programs. Fees generated by the Food and Lodging fees collection program may only be used to support Environmental Health activities. 4. The Department shall comply with Standards for Mandated Public Health Services, 15A NCAC 25, Section .0200; and Administrative Procedures Manual for Federal Block Grant Funds, 1 NCAC 33, Sections .0100 - .1502. 5. The Department shall maintain employee time records for the contract period documenting the portion of time that each employee attributes to each activity when State funds are budgeted for the support of employee salaries and fringe benefits. The percentage of time each employee spends in each activity shall be converted to dollars based upon the employees' salary and benefits. These records will serve to document salary and benefit expenditures reported on Forms DEHNR 2949 and DEHNR 2950, and compliance with Chapter 479, Section 99 of the 1985 Session Laws. Page 3 of 11 6. The Department participating in Medicaid Reimbursement shall: a. Comply with the terms of the Interagency Agreement between the Division of Medical Assistance, Department of Human Resources and the Department of Environment, Health, and Natural Resources and the Provider Participation Agreement effective October 1, 1992 and any subsequent approved addenda or new Agreement approved and established during the period of this contract. b. Make every reasonable effort to collect its cost in providing services, for which Medicaid reimbursement is sought, through public or private third party payors except where prohibited by Federal regulations or State law. No one shall be refused services solely because of an inability to pay. 7. The Department agrees to match the expenditure of Adolescent Pregnancy Prevention Project grant funds with any in-kind source or newly generated funds, public or private available to the project. Payment from the State shall be in accordance with Chapter 689, Section 174 of the 1991 Session Laws. S. Funds budgeted for Adolescent Pregnancy Prevention Activities shall not be expended for dues or out-of-state travel unless prior approval is received from the program. 9. Subject to the approval of the appropriate Division, a local health department may seek reimbursement for services covered by a program operating under 15A NCAC 24A rules when those services are not supported by other state or federal funds. All payment program rules and procedures as specified in the Purchase of Medical Care Services manual must be followed. 10. Subject to the availability of funds and approval of the Office of Public Health Nursing, a local health department may request reimbursement for: a. Nursing service personnel participating in the Introduction to Principles and Practices of Public Health and Public Health Nursing course (2 week course) and the Public Health Nurse Supervisors Training Course (4 week course). Reimbursement is limited to no more than $200.00 per week per participant upon successful completion of the course. b. Community Health Assistants and Staff Nurse attending certain pre-approved Continuing Education courses offered by the Office of Public Health Nursing. Reimbursement is limited to $25.00 per participant per event. 11. The Department shall have an annual audit performed in accordance with The Single Audit Act of 1984 as implemented by OMB Circular A-128. Audit findings and resolution of said findings shall be handled by the Division of Fiscal Management, Budget & Analysis Section. 12. Equipment is a type of fixed asset consisting of specific items of property that: (1) are tangible in nature; (2) have a life longer than one year; and (3) have a significant value. a. For Budgeting and Reporting Purposes 1. Equipment purchases meeting the above definition and having an acquisition cost of $500 or more must be budgeted and reported in Line Item 5000. Page 4 of 11 b. For Inventory Purposes 1. Equipment must be accounted for in accordance with Local Government Accounting System Procedure No. 15. 2. Women, Infants and Children Program All equipment with an acquisition cost of$500.00 or more must be inventoried with the Division of Maternal and Child Health. C. For Prior Approval Purposes I. Equipment purchased or equipment leased where there is an option to purchase with State/Federal funds must receive prior written approval from the appropriate Division, Section, or Branch when the acquisition cost exceeds $500.00. 2. Women, Infants and Children Program All medical equipment and computer equipment, regardless of cost and all other equipment with an acquisition cost of$500.00 or more must receive prior approval from the program office. 3. Equipment purchased with program income generated by the expenditure of Title X Family Planning Funds with an acquisition cost of$500.00 or more must receive prior written approval from the program. C. FISCAL CONTROL 1. The Department shall comply with the Local Government Budget and Fiscal Control Act, North Carolina General Statute Chapter 159, Article 3. a. The Department shall maintain a purchasing and procurement system in accordance with generally accepted accounting practices and procedures set forth by the Local Government Commission. b. The Department shall execute written agreements with all parties who invoice the Department for payment for the provision of services to patients. C. When subcontracting, the following conditions must be met: 1. The Department is not relieved of any of the duties and responsibilities provided in this contract. 2. The subcontractor will agree to abide by the standards contained herein or to provide such information as to allow the Department to comply with these standards. 3. The subcontractor will agree to allow state and federal authorized representatives access to any records pertinent to its role as a subcontractor of the Department. Page 5 of 11 4. The Department will make available to the State upon request a copy of subcontracts supported with State/Federal funds. d. The Department shall receive prior approval from the State when subcontracting for services in the Women, Infants and Children Program. e. The Department shall retain all budgets, budget revisions, contracts, contract addenda, and financial records in-accordance with the current Records Disposition Schedule for County and District Health Departments issued by the Division of Archives and History, Department of Cultural Resources. 2. The Department shall prepare and maintain a budget for each activity covered by this contract in a manner consistent with instructions provided with Forms DEHNR 3370 (Revised 2/93) and DEHNR 2948 (Revised 2/93). a. The Department shall prepare budget revisions for prior approval of the State when those revisions are in the School Health Program (Line Item 6200). b. The Department shall prepare budget revisions for prior approval of the State when State funds will be increased or decreased. C. The Department shall prepare an informational copy for the State of all other budget revisions when proposed expenditures exceed the line amount budgeted. d. The Department shall submit all revisions prior to the end of the term specified in this Contract. Budget revisions received by the State after the end of the contract period will be returned without action. 3. The Department shall observe the following conditions when budgeting and reporting earned revenues: a. All payments from persons, and public or private third party payors, shall be utilized for the activity that generated the revenue and shall not reduce or replace locally appropriated funds during the period of this contract. b. All earned income must be budgeted in the program where earned, except that income earned by a program which has no activity budget can be budgeted in a program approved by the State. C. All fees collected shall be used in the current year or succeeding fiscal years. d. Use of program income generated by the expenditure of Federal categorical funds will be governed by applicable Federal regulations, including but not limited to 45 CFR 74. e. When budgeting: i. Line item 9000 on the program budget must be used to budget the total of line items 101, 102 and 103. ii. Line item 102 on the program budget must be used to budget TXIX earned revenues. Page 6 of I 1 iii. Line item 103 on the program budget must be used to budget other earned revenues. f. When reporting: i. Line item 9000 on the Local Expenditure Report must be used to report the total of line items 101, 102, 103. ii. Line item 102 on the Local Expenditure Report must be used to report TXIX earned revenues that were expended. iii. Line item 103 on the Local Expenditure Report must be used to report other earned revenues that were expended. g. Line Item 6864 in Activity 4125, Transfer of Escrow Funds, shall be used to show anticipated TXIX revenues only. h. A local account shall be maintained for unbudgeted/unreported TXIX fees transferred to the Department. Accounts shall be maintained in sufficient detail to identify the program source generating the fees. i. Title XIX revenues carried forward at the end of fiscal year 1995 may not exceed Title XIX revenues earned during fiscal year 92-93 or $10,000.00 whichever is greater. j. Program budgets that do not include an amount of TXIX funds sufficient to meet the requirements of 3i. will not be approved by the State. 4. The Department shall submit a quarterly report of actual receipts and expenditures of "the Department according to instructions provided with Expenditure Reports, Form DEHNR 2949 (Revised 8/92) and Form DEHNR 2950 (Revised 2/93). a. The Department shall submit quarterly expenditure reports to the State within 45 days from the end of the reporting quarter. b. The Department shall submit the final Expenditure Report to the State within 45 days after the end of the contract period. C. The Department shall submit amended or corrected expenditure reports within six (6) months after the end of the contract period. Any such reports must be prepared for the specific quarter to be amended or corrected. Reports received after December 31 will be returned without action. d. The Department shall refund to the State all State funds not supported by expenditures within 45 days after notification of overpayment. When payment is not received by the State within 45 days, future payments to the Department may be reduced by the amount due or payments may be suspended until the refund is received by the State. e. The Department shall follow Women, Infants and Children Program and other Federal program reporting requirements when they differ from those stated above. Page 7 of I 1 f. The Department shall submit monthly WIC expenditure reports to the State no later than the 8th of the following month. g. Reimbursement of WIC approved expenditures for July, August, and September cannot exceed one-fourth of the total budget for the contract period. h. The Department shall submit monthly Maternal Outreach expenditure reports to the state no later than the 15th of the following month. i. The Department shall submit expenditure reports for Mosquito Control activity in accordance with 15A NCAC 1813, Sections .0104 and .0107. j. The Department shall submit request for payment for services provided under 15A NCAC 24 A rules to the Claims Processing Unit, DEHNR Division of Fiscal Management. k. The Department shall submit request for reimbursement for nurse training to the Office of Public Health Nursing. Form DEHNR 3300 - Public Health Nurse Training Activity must be used as the invoice for payment. 5. The Department shall submit on an annual basis Staff Time Activity Report, DEHNR 3389. The report shall accompany the final expenditure report and must be received by the State within 45 days after the end of the contract period. 6. For Adolescent Pregnancy Prevention Activity, the Department agrees to (1) have responsibility for the immediate direction, supervision and evaluation of the activities supported through the contract, which will be conducted in accordance with the amended plan/update submitted by the Department; (2) submit any media material in writing to the Division of Maternal and Child Health for approval prior to release to the public; (3) submit a mid-year report on progress in meeting project objectives by February 1, 1995; (4) submit an evaluation report demonstrating achievement of stated goals no later than August 16, 1995. D. PERSONNEL POLICIES The Department shall adhere to and fully comply with State personnel policies as found in North Carolina General Statute, Chapter 126, and 1 NCAC 8. Such policies include, but are not limited to, the following: 1. Equal employment opportunity; 2. Affirmative action; 3. Policies for local government employment subject to the State Personnel Act; 4. "Local Classification and Salary Range"; 5. "Compensation Policy for Local Competitive Services Employees"; and 6. "Recruitment and Selection Policy and Procedures"; 7. Environmental Health Specialists employed by the Department shall be delegated authority by the State to administer and enforce State environmental health rules and laws as directed by the Page 8 of 11 State pursuant to G.S. 130A-4(b). This delegation shall be done according to 15A NCAC 18A .2300. a. Local health departments are responsible for sending their newly-employed environmental health specialists (interns) to 40 days (8 weeks) of initial field training/orientation at the training center within 180 days from date of employment. b. Arrangements for initial field training/orientation for newly-employed environmental health specialists will be handled by the Environmental Health Services Section, Division of Environmental Health. E. CONFIDENTIALITY All information as to personal facts and circumstances obtained by Department personnel in connection with the provision of services or other activity under this Contract shall be privileged communication, shall be held confidential, and shall not be divulged without the responsible person's written consent except as may be otherwise required by applicable law or regulation. Such information may be disclosed in summary, statistical, or other form which does not directly or indirectly identify particular individuals. F. CIVIL RIGHTS 1. The Department shall assure that no person, on the grounds of race, color, age, religion, sex, marital status, or national origin (unless otherwise medically indicated) or otherwise qualified handicapped individual solely by reason of his/her handicap be excluded from participation in, be denied the benefits of, or be subjected to discrimination under any program or activity covered by this Contract. 2. The Department shall complete HHS Form 441, Assurance of Compliance with the Department of Health and Welfare regulations, under Title VI of the Civil Rights Act of 1964; for the Women, Infants and Children Program, FNS-64, Assurance of Compliance with the Department of Agriculture Food and Nutrition Service, under Title VI of the civil Rights Act of 1964; and HHS Form 641, Assurance of Compliance with Section 504 of the Rehabilitation Act of 1973. 3. The American with Disabilities Act 1990 (ADA) makes it unlawful to discriminate in employment against a qualified individual with a disability and outlaws discrimination against individuals with disabilities in State and local government services and public accommodations. The Department certifies that it and its principals and subcontractors will comply with regulations in A.D.A. Title I (Employment), Title 11 (Public Services), and Title III (Public Accommodations) in fulfilling the obligations under this agreement. G. RESPONSIBILITIES OF THE STATE 1. The State shall provide to the Department upon request technical assistance in the preparation of the Consolidated Contract/Activity Budgets and Contract Addenda. 2. The State shall specify those administrative forms/reports and their respective revision dates that are required by particular activities pertaining to the Department's budget with the State in Listing of Required Fiscal and Statistical Reports (Addendum 1) for the contract period. New forms/reports not listed in Required Fiscal and Statistical Reports shall be implemented during a contract period only with the approval of the State Health Director. Page 9 of 11 3. The State shall provide to the Department within thirty (30) days after receiving an activity budget from the Department an approved signed copy of the budget. 4. The State shall provide funds to the Department upon approval of the Contract Addenda, activity budgets, and signing of this contract. 5. The State shall assist the Department to comply with all applicable laws, regulations, and standards relating to the activities covered in this contract. 6. The State reserves the right to conduct reviews to determine compliance with the terms of this contract. 7. The State shall be assured that the Department maintains expenditure of locally appropriated funds for maternal health, child health, and family planning activities equal to or greater than that _reported on the Staff Time Activity Report for the period beginning July 1, 1984, and ending June 30, 1985. This maintenance of effort shall be measured by salary equivalencies which are to be maintained in accordance with Section B . 5. of this contract. H. DISBURSEMENT OF FUNDS The State shall disburse funds to the Department as follows: 1. For departments selecting monthly payments through the GMTS option - - - Provided the Consolidated Contract is properly executed and all quarterly expenditure reports are filed within the established time frames, payments equal to 1/12 of the total program approved budget shall be made in the following months: July August September October November January February April May Based on expenditures reported for the first, second, and third quarters, payments shall be adjusted either upward or downward, in payments made in the following months: December March June 2. For Departments selecting monthly payments through the check option - - - Provided the Consolidated Contract is properly executed and all quarterly expenditure reports are filed within the established time frames, payments equal to 1/12 of the total program approved budget shall be made in the following months: July August September October December January March April June Based on expenditures reported for the first, second, and third quarters, payments shall be adjusted either upward or downward, in payments made in the following months: November February May 3. For departments selecting quarterly reimbursement option, payments shall be made when the quarterly expenditure report is received. Page 10 of 11 4. For departments receiving Rural Obstetrical Care Incentive funds, payment of such funds shall be made in one lump sum the month following receipt and approval of the activity budget. 5. For departments receiving Maternal Outreach project funds, payment will be based on actual reported expenditures. Monthly payments will be made provided that expenditure reports are received as required in C. 4. h. 6. Food and lodging fees will be disbursed to the department in one sum the month following receipt and approval of the activity budget and any subsequent budget revisions. 7. Funds for injury prevention projects will be disbursed in one lump sum during the first quarter of the project budget approval. 8. Quarterly payment for reported expenditures in Line Item 1000 shall be limited to one-fourth of the budgeted amount in that line item. 9. Increased or decreased payments necessitated by changes in the total budgeted amount will be reflected in the monthly payments subsequent to approval of the budget revision. 10. Payments shall be suspended when expenditure reports are not received by the time specified in 4 a and f. Payments will resume in the months subsequent to receipt of the expenditure reports. 11. Payment is limited to the total amount of the budget by line item. 12. Final payments will be made based on the 4th quarter expenditure report. Final payments will be equal to the difference between approved reported expenditures and the sum of previous payments. Final payments should be made not later than September provided that an original signed copy of an expenditure report for each quarter has been received by the office of fiscal management. Final payment will be made only after the Staff Time Activity Report, DEHNR 3389, is received by the State. 13. Transfer of Title XIX Fees: a. Title XIX fees received from Medicaid will be transferred to the Department as soon as possible following receipt of payment to the State. b. When fees received exceed the amount shown by program in Activity 4125 an internal adjustment will be made to increase the amount shown. I. AMENDMENT OF CONTRACT Amendments, modifications, or waivers of this contract may be made at any time by mutual agreement of all parties. Amendments shall be in writing and signed by appropriate authorities. J. PROVISION OF TERMINATION This contract may be terminated for reasons other than non-compliance upon sixty (60) days written notice by either party. If termination should occur, the Department shall receive payment only for allowable expenditures. Page 11 of 11 The State may withhold payment to the Department until the State can determine whether the Department is entitled to further payment or whether the State is entitled to a refund. K. COMPLIANCE 1. The State shall assure compliance with all terms of this contract. a. Upon determination of non-compliance, the State shall give the Department sixty (60) days written notice to come into compliance. If the deficiency is corrected, the Department shall submit a written report to the State which sets forth the corrective action taken. b. If the above deficiencies should not be corrected to the satisfaction of the State after the sixty (60) day period, disbursement of funds for the particular activity may be temporarily suspended pending negotiation of a plan of corrective action. C. If the deficiency is still not corrected within the next thirty (30) days following temporary suspension of funding, program funds may be permanently suspended until the Department can provide evidence that the deficiencies have been corrected. d. In the event of the Department's non-compliance with clauses of this contract, the State may cancel, terminate, or suspend this contract in whole or in part and the Department may be declared ineligible for further State contracts or agreements. Such terminations for non-compliance shall not occur until: (1) the provisions of Section K-1 (a-c) have been followed, documented, and have failed to provide a resolution, (2) all other reasonable administrative remedies have been exhausted. 2. If the Department or the State should be determined out of compliance with the provisions of the contract, either party may file a formal appeal with the Office of Administrative Hearings. IN WITNESS WHEREOF, the Department and the State have executed this agreement in duplicate originals, one of which is retained by each of the parties. LOCAL SIGNATURES DEPARTMENT OF ENVERONMENT,HEALTH, AND NATURAL RESOURCES Jonathan B. Howes, Secretary Health Director D to ' Finance Officer Date Department Head's Signature or Authorized Agent Chairman of County ate Commissioners (when required) LOCAL HEALTH DEPARTMENT BUDGET N.C.Department of Environment, Health,and Natural Resources Revision/Number— Division of General Services 4� ��-�✓ SFY Division of General Services I �; P.O.Number 07 / 94 06 / 95 �I 9 5 4 1 1 0 0 0 6 8 Effective Date Termination Date Contract Number Contractor: Orange Co. Health Dept. General Activity: Project Director: Dani P1 R- Reimer Total Budget:$ 569.498 ITEM DESCRIPTION CLASSIFICATION ITEM AMOUNT E STATE EXPENDITURES: X Salaries & Fringe Benefits SA/FR 1000 54,363 Operating Expenses OP EXP 2000 P Purchase of Equipment EQUIP 5000 E General Contracted or Purchased Services GENERAL 6100 N School alth �o. 1 o .� ..................... . Clinician I Laboratory r U Y Pharmacy y Services Transfer .. TXIX x. ............ R Subtotal State Expend. $ 54,363' LOCAL EXPENDITURES: LOCAL EXP 9000 S TOTAL EXPENDITURES—equal to Total Receipts $ 569,498 LOCAL FUNDS: R Appropriation APPROP 101 408,216 E TXIX TXIX 102 37,000 C Other Receipts OTHR REC 103 69,919 E Subtotal Local Funds $ STATE/FEDERAL/SPECIAL FUNDS: I P DEHNR 54,363 T S Subtotal State/Federal/Special $ TOTAL RE PTS—equal to Total Expenditures $ 569,498 L 1 Authorized Official Signatu Date Branch Hod Division/Section Signature Date Init Finance Officer Signature Date Accountant Fiscal Management ature Date tnitW DEHNR 2948(Revised 2/93) General Services Division(Review 2/94) LOCAL HEALTH DEPARTMENT BUDGET N.0 Department of Environment, Health,and Natural Resources Revision Number— Division of General Services � , Division of General Services ———P.O.Number 07/ 94 9 5 4 1 2 5 0 6 8 Effective Date Termination Date Contract Number Contractor: Orange Co. Health Dept, Activity: Transfer of Escrow Project Director: Daniel R. R P.i m P r Total Budget:$ 101,041 ITEM DESCRIPTION CLASSIFICATION nTm AMOUNT XX E ST A TE EXPE NDITURES: NDITURES: y L �y�jj &� Benefits < Salaries Fringe X :<.: �a� Expense ::;:: . . t Purchase of Equipment t en E General Contracted or I Purchased Services ....... N ► < SCIEII.: School Heal th mo Clinician .EII~t "`'<` ``' I Laboratory LAB. .:: :;::.: T Pharmacy Services 5ER U Transfer TXIX 6864 R Subtotal State Expend. 3 30-3,043 E LOCAL EXPENDITURES: LOCAL EXP 9000 $ TOTAL EXPENDITURES—equal to Total Receipts $ 303,043 LOCAL FUNDS: R Appropriation APPROP 101 E TXIX/SSBG Fees TXIX/SSBG 102 Other Receipts OTHR REC 103 C E Subtotal Local Funds $ STATE/FEDERAL/SPECIAL FUNDS: P Transfer TXIX ,)Us,� 303.043 $ Subtotal State/Federal/Special $ TOTAL RECEIPTS—equal to Tool Expenditures $303,043 Authorized Official Signatur Date anwh&Nma 'vision/Section Signature Date Wool Y-:2 z-�y �J'Yl ��'Z� Finance Officer Signature Date Fiscal Management Signature Date DEHNR 2946(Rew 2/92) C—Tal Services N- w—(Review 2/94) Page 1 of 1 N.C. Department of Environment, Health, and Natural Resources FY 95 Division of General Services CONTRACT ADDENDUM Purchase and Contracts 95 4125 068 Office, Section or Branch Contract Number nrangQ Co. Health Dept Transfer of Escrow Contractor Activity 4174 AUDIOMETRY 4125 TB CONTROL –0– 4175 BLOOD CHEM (6) 4126 STD CONTROL 3,047 4176 BLOOD CHEM (12) 4127 ADULT TREATMENT '0_ 4178 NORPLANT 16,674 4131 CARDIOLOGY 4225 MAT CARE HOME VST 4132 NEUROLOGY 4226 POSTPARTUM MAT 4133 SPEECH &-HEARING 4227 POSTPARTUM NEWBRN 4134 ORTHOPEDIC 4228 POSTPARTUM EPSDT 4135 SPEECH THERAPY 4229 PSYCHOSOCIAL COUNS 4136 PHYSICAL THERAPY 4230 NUTRITION COUNSEL 4137 CHILD TREATMENT 8,-272 4231 REFRESHER CHDBIRTH 4138 MATERNAL HEALTH 4232 RHO D IMMUNE GLOB 4139 INTRAPARTUM CARE 4233 PREGNANCY TEST 4140 DENTAL HEALTH 37.000 4234 ORAL GLUCOSE TOL 4141 NON STRESS 4235 MYELODYSPLASIA 4142 REFUGEE HEALTH 4236 DEPO PROVERA 527 4143 PAP SMEAR 4237 CHRONIC DIS MONIT 4144 MAT CARE INITIAL 4238 'COMPREHENSIVE ASSESMNT 4145 MAT CARE SUB 30 812 4239 LIMITED ASSESSMENT 4146 CHILDBIRTH CLASS 4240 COLPOSCOPY W/O BIOPSY 4147 MAT HOME VISIT 4241 COLPOSCOPY W/BIOPSY 4148 PARENTING CLASS 4242 CYROSURGERY 4149 VAG DELIV ONLY 4244 HEMOGLOBIN A1C 4150 TOTAL OBSTET VAG 4245 BLOOD CHOLESTEROL 4151 NEUROMUSCULAR 4246 BLOOD GLUCOSE-SERUM^ 4152 ULTRASOUND 4247 BLOOD GLUCOSE-FINGER 4153 OBSTETRIC CARE 4248 STOOL OCCULT BLOOD 4154 CEASAREAN DELIV 4249 TB SKIN TEST-PPD 4155 HYSTERECTOMY — 4 4250 SERUM CREATININE 4156 CHILD SERV COORD 4251 TRIGLYCERIDES 4157 FAMILY PLANNING 9 000 4252 LIPOPROTEIN 4158 EPSDT 19 884 4253 LIPID PANEL 4159 IMMUN UPDATE –0– 4254 RABIES IMMUNE GLOB 4160 DEC 4255 RABIES VACCINE/UNIT 4161 DEC SPEECH &HEARING 4243 SCREEN MAMMOGRAPHY 235 (� _ 4162 HEPATITIS CHILD ( 4163 HEPATITIS ADULT ' "- '� .s 303,043 4173 GONORRHEA CULT -D IV. (1P FIKALT�' `j JUN U 8 1994 Reviewed by SPECIAL AGUGUNTING _3Q_ — b -0 DEHNR 3300 (revised 9/93) Initials Date General Services Division (Review 1/95) ' LOCAL HEALTH DEPARTMENT BUDGET Department of Environment, italth, and Natural Resources Revision Number .,ision of General Services G 1' Division of Epidemiology a J!' P. O. Number 07 / 94 06 / 95 9 5 4 5 1 0 0 Q 6 8 Effective Date Termination Date Contract Number retractor: Orange Co. Health Dept. Activity: Communicable Disease )ject Director: Daniel B. Reimer Total Budget:$ 178,699 ITEM DESCRIPTION CLASSIFICATION ITEM AMOUNT ? STATE EXPENDITURES: " Salaries & Fringe Benefits SA/FR 1000 A, 13 3 Operating Expenses OP EXP 2000 ? Purchase of Equipment EQUIP 5000 General Contracted or Purchased Services GENERAL_ 6100 School_ 1 0o Health Clinician CLN 6863 PENN Laboratory 6862:..:.:;:.:. Pharmacy Services RX SERV 6865 J Transfer r TXIX Z Subtotal State Expend. $ 4,133 LOCAL EXPENDITURES: LOCAL EXP 9000 3 TOTAL EXPENDITURES—equal to Total Receipts $ 178,699 LOCAL FUNDS: Z Appropriation APPROP 101 156,519 TXIX TXIX 102 3,047 Other Receipts OTHR REC 103 15,000 J Subtotal Local Funds $ 174,566 STATE/FEDERAL/SPECIAL FUNDS: I 5-0— 6100— X510— 0095 i DEHNR 4,133 Subtotal State/Federal/Special $4,133 TOTAL REC IPTS—equal to Total Expenditures $178,699 0 1 Authorized Official Signature Date sue„d,Hnd ivision/Section 9I�ature Date w� inance Officer Signature Date Arco cwt Fiscal Management SignatL6 Date :-IR 2948(Revised 2/93) icral Services Division(Review 2/94) Page of FY -T—_f N.C. Deoartment of Environment, Health, and Natural Resources Division of Eoidemioloav CONTRACT ADDENDUM :ommunicable Disease Control Section 95 45100 068 =ice, Section, or Branch Contract Number Orange Communicable Disease :tractor activity I. Negotiable Objectives: 1) Between April 1, 1994 and March 31, 1995, your health department will administer- 197 DTP #4 doses. 2) By March 30, 1995, the percentage of children who have one or more missed opportunities for immunizations will be no more than 10 percent. (State goal <10%) 3) By June 30, 1995, 9 5 % of household contacts of and infants bom to known chronic hepatitis B carriers complete prophylaxis within 9 months. (State goal=95%) 4) By June 30, 1995, 90% of persons tested for HIV return for results within 3 weeks. (State goal=90%) 5) By June 30, 1995, 100% of staff providing STD service shall be trained to conduct STD evaluations including physical examinations and laboratory work (gram stain, wet prep, urinalysis, stat RPR, and "stat" or "dry" darkfield) and provide treatment under standing orders. (State goal=100%) 6) By June 30, 1995, _U% of persons requiring STD services will be seen within 1 working day of request. (State goal=99%) 7) By June 30, 1995, 90% of TB cases complete treatment within 9 months. (State objective = 90%) 8) By June 30, 1995, 75% of TB cases are on directly-observed therapy. (State goal=90%) 9) By June 30, 1995, 90% of persons eligible for (under American Thoracic Society Guidelines) TB preventive treatment will complete treatment. (State goal=90%) II. Basic Local Communicable Disease Control Services include: 1) Provision of required communicable disease services at no cost to the patient AND regardless of the patient's county of residence. 2) Provision of walk-in immunizations during all hours the health department and satellite locations are open, including lunch time. 3) Make on-site immunization appointment time in all immunization clinic locations and give clients appointment time within one week of their request. 4) Local physician backup, knowledgeable about public health communicable disease control needs for each facet of the communicable disease program. Reviewed by Pace 2 of 2 FY N.C. Department of Environment, Health, and Natural Resources Division of Epidemiology CONTRACT ADDENDUM =unicable Disease Cant=l S,--Lion 95 45100 0 6 8 -ice, Section, or Branch Contract Number Orange Carmmicable Disease ..tractor Activitv 5) Staff with sufficient training to:- a) conduct an investigation to identify the source of infection and those at risk for spread of all reportable communicable diseases. b) conduct screening evaluations and examinations for those who present for service. C) provide appropriate management of cases and contacts to reportable communicable diseases including counseling, treatment, monitoring, and follow- up. d) evaluate and initiate appropriate action on referrals for services unavailable through the health department. e) make appropriate medical and psychosocial referrals for services unavailable through the health department. 6) An Infection Control Policy that addresses: a) management of patients to eliminate airborne disease transmission in the clinic (measles, TB). b) universal blood and body fluid precautions with all patients. C) routine use of aseptic technique to prevent nosocomial infection and infection to staff. d) required measles, mumps, rubella, and influenza immunization for all staff with direct patient contact. e) required hepatitis B immunization of those at high risk and with direct patient contact. f) management of blood exposures for patient or staff. 7) Coordination and consultation with other providers and institutions to assure appropriate screening, diagnosis, treatment, and reporting of communicable disease cases or suspected cases in county jails, nursing homes, rest homes, hospitals, homeless shelters, etc. 8) Reports are submitted within 30 days of initial report of 90% of foodborne and daycare outbreaks describing the steps in the outbreak investigations, results, analysis, conclusions, and interventions to prevent contractors and/or recurrence. 9) Written policies that outline items 1-8 above, as well as: a) outreach activities for groups at high risk for STD, TB, HIV, HBV; b) outreach activities for follow-up of immunization delinquency; C) confidentiality policies for staff including a written agreement and annual training for all staff. Copies of these written policies and activities shall be submitted to the Communicable Disease Control Section by October 1, 1994. Reviewed by _EHNIR 3300 (Revised 2/90) :eneral Services Initials Date LOCAL HEALTH DEPARTMENT BUDGET N.C.Department of Environment, Health,and Natural Resources Revision Number— Division of General Services / (f —Z Z��(� SFY Division of Epidemiology r o 7 1 T.O.Number . 07/ 94 06 / 95 � 4 5 . 2 4 0 () .6,__8__ Effective Date Termination Date Contract Number Contractor: Orange Co. Health Dept. Activity: Immunization Action Plan Project Director: Daniel B. Reimer Total Budget:$ 11 ,861 ITEM DESCRIPTION CLASSIFICATION ITEM AMOUNT E STATE EXPENDITURES: X Salaries & Fringe Benefits SA/FR 1000 110861 Operating Expenses OP EXP 2000 P Purchase of Equipment EQUIP 5000 E General Contracted or Purchased Services GENERAL 6100 School Health ':�:��' '1 ': ;€z� >':.............................. D Clinician <:: : I ................ Laboratory T .:.................. Pharmacy Services ................................................ U Transfer TXIX R Subtotal State Expend. $ 111861 E LOCAL EXPENDITURES: LOCAL EXP 9000 S TOTAL EXPENDITURES—equal to Total Receipts $ 11,861 LOCAL FUNDS: R Appropriation APPROP 101 E TXDC TXIX 102 Other Receipts OTHR REC 103 C E Subtotal Local Funds $ STATE/FEDERAL/SPECIAL FUNDS: I P DEHNR 11,861 T 4- S Subtotal State/Federal/Special $ 11,861 TOTAL CEIPTS—equal to Total Expenditures $ 11,861 tko ZAWut�orizedOfficial Signa Date Branch Hmd Di ' ion/Section Sign tore Date Initial Y-22-41( Finance Officer Signature Date n«o=tant Fiscal Management Signatu Date Initial DEHNR 2948(Revised 2/93) General Services Division(Review 2/94) LOCAL HEALTH DEPARTMENT BUDGET N.C. Department of Environment, Health, and Natural Resources Revision Number Division of General Services 1.,,� � Ste, Division of Epidemiology P.O.Number 07 / g4 ph / g� �(�'� 5 5 4 5 4 50 6 $._ Effective Date Termination Date Contract Number Contractor: Orange Co. Health Dept. Activity: Aids (federal) Project Director: Daniel B. Reimer Total Budger.$ 28,000 ITEM DESCREMON CLASSIFICATION ITEM AMOUNT E STATE EXPENDITURES: X Salaries & Fringe Benefits SA/FR 1000 28,000 Operating Expenses ...OP.EXP 2000 P Purchase of Equipment E General Co ntracted OT Purchased Services "I+1 .......... >} ....... ....... N :<;.: School Health :1 ..!.<'<<>< D Clinician I Laboratory ...................... T . .:.:::.::..::: ... :... ... ....... . Pharmacy Services :;::: : : .>: .:.::;.::; :;:: ::>; U Transfer T?QX ::<:;;::>.: :::.: > R Subtotal State Expend. $ 28,000 E LOCAL EXPENDITURES: LOCAL EXP 9000 S TOTAL EXPENDITURES—equal to Total Receipts $ 28,000 LOCAL FUNDS: R Appropriation APPROP 101 E TXIX/SSBG Fees TXIX/SSBG 102 Other Receipts OTHR REC 103 C Subtotal Local Funds $ E STATE/FEDERAL/SPECIAL FUNDS: I P DEHNR 28,000 Subtotal State/Fe'deral/Special $ 28,000 TOTAL RE —equal to Total Expenditures t(O-2//'!�Y thorized Official Signature Date ri.a �Di ion/Section Signature Date ' Finance Officer Signature Date Fiscal Management i Date DEHNR 2948(Revised 2/92) General SwAm Division(Review 2/94) LOCAL HEALTH DEPARTMENT BUDGET N.C. T)epartment of Environment, Health,and Natural Resources Revision Number Division of General Services SFY Division of Epidemiology 5 P.O.Number 07 / 94 06/ 95 4 _Q 0 Effective Date Termination Date Contract Number Contractor: Orange Co. Health Dent. Activity: Tuberculosis Project Director: Daniel B. Reimer Total Budget:$ 13,218 ITEM DESCRIPTION CLASSIFICATION ITEM AMOUNT E STATE EXPENDITURES: X Salaries & Fringe Benefits SA/FR 1000 13,218 Operating Expenses OP EXP 2000 P Purchase of Equipment EQUIP 5000 E General Contracted or N Purchased Services GENERAL 6100 School Health ........... ............ .......... ......... D Clinician X. T Laboratory Pharmacy Services U Transfer T= R Subtotal State Expend. $ 13,218- E LOCAL EXPENDITURES: LOCAL 'EXP 9000 S . TOTAL EXPENDITURES—equal to Total Receipts $ 13,218 LOCAL FUNDS: R Appropriation APPROP 101 E TXIX TXIX 102 Other Receipts OTHR REC 103 E Subtotal Local Funds $ STATE/FEDERAL/SPECIAL FUNDS: I P A(- 5- �p/0 0— 4 551 a,/) DEHNR 13,218 T S Subtotal State/Federal/Special $ L TOTAL REC S—equal to Total Expenditures $ 13,218 G� 2� qy ,�- �_��-s y Local Authorized Official Signature Date '1�2Initw*H PJvision/Section tgnature Date F—finance Officer Signature Date Accountant Fiscal Management SignAur—e Date Initial DEHNR 2948(Revised 2/93) General Services Division(Review 2/94) Paa_e of F`! �-f5 N.C. Department of Environment, Health, and Natural Resources Division of Epidemiolocv CONTRACT ADDENDUM Communicable Disease Control Section 95 45100 068 =ice, Section, or Branch Contract Number Orange Communicable Disease ,tractor Act_v_ty I. Negotiable Objectives: 1) Between April 1, 1994 and March 31, 1995, your health department will administer- 197 DTP #4 doses. 2) By March 30, 1995, the percentage of children who have one or more missed opportunities for immunizations will be no more than 10 percent. (State goal <10%) 3) By June 30, 1995, 9 5 % of household contacts of and infants born to known chronic hepatitis B carriers complete prophylaxis within 9 months. (State go2l=95°,-.) 4), By June 30, 1995, 90% of persons tested for HIV return for results within 3 weeks. (State goal=90%) 5) By June 30, 1995, 100% of staff providing STD service shall be trained to conduct STD evaluations including physical examinations and laboratory work (gram stain, wet prep, urinalysis, stat RPR, and "stat" or "dry" darkfield) and provide treatment under standing orders. (State goal=100%) 6) By June 30, 1995, _U% of persons requiring STD services will be seen within 1 working day of request. (State goal=99%) 7) By June 30, 1995, 90% of TB cases complete treatment within 9 months. (State objective 90%) 8) By June 30, 1995, 75% of TB cases are on directly-observed therapy. (State goal=90%) 9) By June 30, 1995, 90% of persons eligible for (under American Thoracic Society Guidelines) TB preventive treatment will complete treatment. (State go2l=9001C) H. Basic Local Communicable Disease Control Services include.. 1) Provision of required communicable disease services at no cost to the patient AND regardless of the patient's county of residence. 2) Provision of walk-in immunizations during all hours the health department and satellite locations are open, including lunch time. 3) Make on-site immunization appointment time in all immunization clinic locations and give clients appointment time within one week of their request. 4) Local physician backup, knowledgeable about public health communicable disease control needs for each facet of the communicable disease program. Reviewed by Paae 2 c` L FY hoc/ N.C. Department of Environment, Health, and Natural Resources Division of Epidemioloav CON'T'RACT ADDENDUM xrmmic able Disease Control Sectim 95 45100 0 6 8 f_ce, Section, or Branch Contract Number Orange C muriicable Disease r.tractor Activity 5) Staff with sufficient training to:- a) conduct an investigation to identify the source of infection and those at risk for spread of all reportable communicable diseases. b) conduct screening evaluations and examinations for those who present for service. C) provide appropriate management of cases and contacts to reportable communicable diseases including counseling, treatment, monitoring, and follow- up. d) evaluate and initiate appropriate action on referrals for services unavailable through the health department. e) make appropriate medical and psychosocial referrals for services unavailable through the health department. 6) An Infection Control Policy that addresses: a) management of patients to eliminate airborne disease transmission in the clinic (measles, TB). b) universal blood and body fluid precautions with all patients. C) routine use of aseptic technique to prevent nosocomial infection and infection to staff. d) required measles, mumps, rubella, and influenza immunization for all staff with direct patient contact. e) required hepatitis B immunization of those at high risk and with direct patient contact. f) management of blood exposures for patient or staff. 7) Coordination and consultation with other providers and institutions to assure appropriate screening, diagnosis, treatment, and reporting of communicable disease cases or suspected cases in county jails, nursing homes, rest homes, hospitals, homeless shelters, etc. 8) Reports are submitted within 30 days of initial report of 90% of foodborne and daycare outbreaks describing the steps in the outbreak investigations, results, analysis, conclusions, and interventions to prevent contractors and/or recurrence. 9) Written policies that outline items 1-8 above, as well as: a) outreach activities for groups at high risk for STD, TB, HIV, HBV; b) outreach activities for follow-up of immunization delinquency; C) confidentiality policies for staff including a written agreement and annual training for all staff. Copies of these written policies and activities shall be submitted to the Communicable Disease Control Section by October 1, 1994. Revie y D-7i-?IR 3300 (Revised 2/90) eneral Services Initials at LOCAL HEALTH DEPARTMENT BUDGET N.C.Department of Environment, Health, and Natural Resources Revision Number Division of General Services Division of Maternal and Child Health -`. SFY P.O.Number 07 / 94 06 / 95 9 5 5 1 0 1 0 0 6 8 Effective Date Termination Date pp/� Contract Number Contractor: Orange County Health Dept. Activity: Maternal Health Project Director: Daniel B. Reimer Total Budget: $y4.QR7 ITEM DESCRIPTION CLASSIFICATION ITEM AMOUNT E STATE EXPENDITURES: X Salaries & Fringe Benefits SA/FR 1000 74,483 Operating Expenses OP EXP 2000 P Purchase of Equipment EQUIP — 5000 E General Contracted or Purchased Services GENERAL 6100 .... .< School Health D Clinician CLN 6863 >^hvy .:..:..::,....:.:.`•�`.::`..:r;::,2�,.,,,..:.,...:..:.:,..?:.:...,::;:`. 'isM.:a.:a:x:.<.i:%;:;.:.;:x.;:<3::,':,•.<:.�::.,:::::i.::....:::... ........k:::::>:i:':ti>z:;:`..rs. T Laboratory LAB 6862 Pharmacy Services RX SERV 6865 :s r a din U Transfer TXIX R Subtotal State Expend. s74,483 E LOCAL EXPENDITURES: LOCAL EXP 9000 295,604 S TOTAL EXPENDITURES—equal to Total Receipts $ 370,087 LOCAL FUNDS: R Appropriation APPROP 101 172,296 E TXIX TXIX 102 123,308 Other Receipts OTHR REC 103 C E Subtotal Local Funds -_. $ STATE/FEDERAL/SPECIAL FUNDS: I Prematurity Prevention DEHNR 14,306 P 1510-6100-5101'xXxx 8,435 hen P e nancy 15,784 T �erina a� $74,483 HM/HCBG 35,958 S - 74 483 Subtotal State/Federal/Special $ TOTAL RWEIPTS—equal to Total Expenditures $ 370,087 Y/a POT I 1 ...rte_ o Aut orized Official Signa a Date Hnn Hn Division/Section Signature Date Initw inance Officer Signature Date Accow ,. Fiscal Management Signap6re Date 4,itw DEHNR 2948(Revised 2/93) Gcncral Services Division(Review 2/94) LOCAL HEALTH DEPARTMENT BUDGET N.C.Department of Environment, Health, and Natural Resources Revision Number _ Division of General Services SFY Division of Maternal and Child Health Z-- 07 / 94 06 95 -- P•O.Number / 9 5 5 1 0 1 0 0 6 8 Effective Date Termination Date /�� Contract Number Contractor: Orange County Health Dept. Activity: Maternal Health Project Director: Daniel R. Reimer Total Budget:$ 370.087 ITEM DESCRIPTION CLASSIFICATION ITEM AMOUNT E STATE EXPENDITURES: X Salaries & Fringe Benefits SA/FR 1000 74,483 Operating Expenses OP EXP 2000 P Purchase of Equipment EQUIP — 5000 E General Contracted or N Purchased Services GENERAL 6100 School Health ealth Clinician CLN 6863 I T Laboratory LAB 6862 Pharmacy Services I RX SERV 6865 Transfer TXIX ,<.,.:..:..... R Subtotal State Expend. $ 74,483 LOCAL EXP 9000 295,604 E LOCAL EXPENDITURES: S TOTAL EXPENDITURES—equal to Total Receipts $ 370,087 LOCAL FUNDS: R Appropriation APPROP 101 172,296 E TXIX TXIX 102 123,308 Other Receipts OTHR REC 103 - ` C E Subtotal Local Funds --- $ 295,604 STATE/FEDERAL/SPECIAL FUNDS: I Prematurity Prevention DEHNR 14,306 P I 1510-6100-5101-)CXXx 8,435 I�en PEepancy $74,483 15,784 T S HM erina/HCBG 35,958 Subtotal State/Federal/Special $ 74,483 TOTAL RWEIPTS—equal to Total Expenditures $ 370,087 2/ qi � I -/e MD a o Official Signa a Date sue,xn Division/Section Si aturree — Date -�,i� gn inance Officer Signature Date Arun=z Fiscal Management Si ap re Date Initial DEHNR 2948(Revised 2/93) General Services Division(Review 2/94) LOCAL HEALTH DEPARTMENT BUDGET 1. Department of Environment, -health, and Natural Resources Revision Number ision of General Services Division of Matemal and Child Health S-� P. O.Number 07 / 94 06 / 95 9 5 5 3 1 8 0 0 6 8 Effective Date Termination Date Contract Number ntractor: Orange Co. Health Dept. Activity: Child Service Coordination )jest Director: Daniel B. Reimer Total Budget:$ 213,279 ITEM DESCRIPTION CLASSIFICATION ITEM AMOUNT_ STATE EXPENDITURES: Salaries & Fringe Benefits SA/FR 1000 51;876 Operating Expenses OP EXP 2000 Purchase of Equipment EQUIP 5000 General Contracted or -- Purchased Services GENERAL -6100 School Health SCH HLTH 6200 Clinician CLN 6863 Laboratory LAB 6862 Pharmacy Services RX SERV 6865 l Transfer TXIX ;> >fi8 Subtotal State Expend. $ 51,876 LOCAL EXPENDITURES: LOCAL EX? 9000 TOTAL EXPENDITURES—equal to Total Receipts $ LOCAL FUNDS: Z Appropriation APPROP 101 66,363 TXIX TXIX 102 95,040 Other Receipts - OTHR REC 103 0 Subtotal Local Funds $ STATE/FEDERAL/SPECIAL FUNDS: 1 /Do DEHNR 51,876 r _7 Subtotal State/Federal/Special $ TOTAL RECEIPTS—equal to Total Expenditures $ 211 979 -o 1 Authorized Official Signature Date B,7-ch Division/Sectiofi Signa " Date 2z-9y G� =finance Officer Signature Date A� =t Fiscal Management Si a e Date w� HIR 2948(Rcviscd 2/93) icral Services Division(Review 2/94) LOCAL HEALTH DEPARTMENT BUDGET ;. Department of Environment _ lealth, and Natural Resources ' k `c1�, Revision Number ision of General Services 1 1 ( l Division of Maternal and Child Health –� --L P. O.Number 07 / 94 06/ 95 9 5 3 2 3 0 0 6 8 Effective Date Termination Date Contract Number :itractor: Orange Co. Health Dept. Activity: CSHS Orthopedic - jest Director: Daniel B. Reimer Total Budget:$ -634 ITEM DESCRIPTION CLASSIFICATION ITEM AMOUNT STATE EXPENDITURES: Salaries &. Fringe Benefits SA/FR 1000 634 Operating Expenses OP EXP 2000 ' Purchase of Equipment EQUIP 5000 -- General Contracted or Purchased Services GENERAL 6100 School Health HL. Clinician CLN 6863 ............. Laboratory LAB 6862 Pharmacy Services RX SERV 6865 J Transfer TXIX :fib Subtotal State E ' nd. $ 634 LOCAL EXPENDITURES: LOCAL EXP 9000 TOTAL EXPENDITURES—equal to Total Receipts $ 634 LOCAL FUNDS: Z Appropriation APPROP 101 TXIX TXIX 102 Other Receipts OTHR REC 103 Subtotal Local Funds STATE/FEDERAL/SPECIAL FUNDS: 1 DEHNR 634 C-646:r53o-4�co-v`�3oi-xxK Subtotal State/Federal./Special $ TOTAL REC- S—equal to Total Expenditures $ J_oclut orize Official Signature Date Bench H Division/Section Signature# Date min � 5 =inance Officer Signature Date A�==� Fiscal Management"Signdture Date wit NR 2948(Revised 2/93) Feral servirrs nivkinn(Review 7/04) LOCAL HEALTH DEPARTMENT BUDGET N.C. Department of Environment, `j� Health, and Natural Resources Revision Number_ Division of General Services �� SFY Division of Maternal and Child Health P. O. Number 07 / 94 06 / 95 9 5 5 4 0 2 0 0 6 8 Effective Date Termination Date Contract Number Contractor: Orange Co. Health Dept Activity: MCH Block Grant Nutrition Project Director: naniel B. Reimer Total Budget:$__2,450 ITEM DESCRIPTION CLASSIFICATION ITEM AMOUNT E STATE EXPENDITURES: X Salaries & Fringe Benefits SA/FR 1000 2,450 Operating Expenses OP EXP 2000 P Purchase of Equipment EQUIP 5000 E Contracted General C tract ed or Purchased Services es GENE'; N School Health S : CH TH : D Clinician can I Laboratory ry 5862` T ::,..:.:.:......:.: ..:::::.:. . . m Y Pha r ac Services 5855_:` <::;: ;>:>::<:<::>:<;«»::::»;. ::<:<;°:<;>: ;>::::: :::,..;:;.:;:;:<>:::::.::::::.. U Transfer TXIX R Subtotal State Expend. $ 2,450 E LOCAL EXPENDITURES: LOCAL EXP 9000 S TOTAL EXPENDITURES—equal to Total Receipts $ 2,450 LOCAL FUNDS: R Appropriation APPROP 101 E TXIX TXIX 102 C Other Receipts OTHR REC 103 E Subtotal Local Funds $ STATE/FEDERAL/SPECIAL FUNDS: I P DEHNR 2,450 T S Subtotal State/Federal/Special $ 2,450 TOTAL RECEIPTS—equal to Total Expenditures $ 2P450 004M-M"-� Y a/ q c icial Signature Date B 6 tu H-d Division/Section Signature Date Finance Officer Signature Date Fiscal . agement Signature ate DEHN'R 2948(Revised 2/93) General Services Division(Review 2/94) LOCAL HEALTH DEPARTMENT BUDGET ,I.C.Department of Environment, Health, and Natural Resources Revision Number Division of General Services / SFY Division of Maternal and Child Health P. O.Number 07 /94 9S 5 1 0 Effective Date Termination Date Contract Number Contractor• (lranoa r.n. Naal rh na=r Activity: Child Health Project Director: na ry i a 1 R- R a i ma r Total Budget:$ -196.8 51 ITEM DESCRIPTION CLASSIFICATION ITEM AMOUNT STATE EXPENDITURES: E Salaries & Fringe Benefits SA/FR 1000 39,980 X Operating Expenses OP EXP 2000 P Purchase of Equipment EQUIP 5000 E General Contracted or -- N Purchased Services GENERAL 6100 School Health SCH H]JH 6200 9,725 D Clinician CLN 6863 I Laboratory y ..LAB 6862 Pharmacy Services RX SERV 6865 U Transfer TXIX R Subtotal State Expend. $ 49,705 E LOCAL EXPENDITURES: LOCAL EXP 9000 347,146 S TOTAL EXPENDITURES—equal to Total Receipts $ S LOCAL FUNDS: R Appropriation APPROP 101 315,996 E TXIX TXIX 102 ?'g 1.56 Other Receipts OTHR REC 103 - C E Subtotal Local Funds $ 347,146 I STATE/FEDERAL/SPECIAL FUNDS: — d —S�.S�.—�C1C�CX 9 725 P School Health DEHNR $49,705 35,958 T HM/HCBG 4,022 General yq 7,'s- S Subtotal State/Federal/Special $ 49,705 4b, 0'1-- " / �TOTAL RECEIPTS—equal to Total Expenditures $ 396,851 2/ ql _717.1 1li " V�o- 6 tocal Authorized Official Signatu Date B=6 Had Division/Section Signature Date mitW �titS -7 r_- �'—2 Z 9y / finance Officer Signature Date A�=t f' Fiscal Management 8fgnap6re Dat m;mt DEHNR 2948(Revised 2/93) General Services Division(Review 2/94) LOCAL HEALTH DEPARTMENT BUDGET N.C. Department of Environment, Health, and Natural Resources (�1,� _ Revision Number Division of General Services p SFY Division of Adult Health P. O. Number 07 / 94 06 / 95 9 5 5 4 5 0 0 6 8 Effective Date Termination Date Contract Number Contractor: Orange Co. Health Dept. Activity,: COMP. Breast & Cervical Canc .r f'.nntrpl Project Director: -- Dan;e R_ R Pi mPr Total Budget: $ 25,913 ITEM DESCRIPTION CLASSIFICATION ITEM AMOUNT E STATE EXPENDITURES: X Salaries & Fringe Benefits SA/FR 1000 11,454 Operating Expenses OP EXP 2000 P Purchase of Equipment EQUIP 5000 E -General Contracted or N Purchased Services _GENERAL 6100 11,260 School Health D Clinician CLN 6863 I I Laboratory LAB 6862 Pharmacy Services - .. .....:....... Transfer r e TXIX U T ;s R Subtotal State Expend. S 24,714 E LOCAL EXPENDITURES: LOCAL EXP 9000 1,199 S - TOTAL EXPENDITURES—equal to Total Receipts $ LOCAL FUNDS: R Appropriation APPROP 101 E TXIX TXIX 102 235 C Other Receipts OTHR REC 103 E Subtotal Local Funds $ 1,199 STATE/FEDERAL)/ ECIAL FUNDS: I P �oo �Yfa/a J3 DEHNR 24,714 T S Subtotal State/Federal/Special $ 24,714 TOTAL RWfIPTS —equal to Total Expenditures $ 25,913 c Authorized O icial Signa Date ch Hed Division/Section Signature Date KIZ 4 finance Officer Signature Date A«oununt Fiscal Management Sin re ate W" DEF ,a 2948(Revised 2/93) General Services Division(Review 2/94) LOCAL HEALTH DEPARTMENT BUDGET I .C. Department of Environment, Health, and Natural Resources Revision Number__ Division of General Services SFY Division of Adult Health P. O. Number 07 / 94 06 / 95 9 5 5 5 0 2 0 0 6 8 Effective Date Termination Date Contract Number Contractor: Orange Co. Health Deo t Activity: Adult Health Project Director: Daniel.B. Reimer Total Budget: $ 1099361 ITEM DESCRIPTION CLASSIFICATION ITEM AMOUNT E STATE EXPENDITURES: X Salaries & Fringe Benefits SA/FR 1000 Operating Expenses OP EXP 2000 P Purchase of Equipment EQUIP 5000 E General Contracted or – N Purchased Services GENERAL 6100 50 5_02 School Health D Clinician - CLN 6863 I Laboratory y LAB 6862 Pharmacy Services RX SERV 6865 U Transfer TX IX R Subtotal State Expend. $ 5,502 E LOCAL EXPENDITURES: LOCAL EXP 9000 S TOTAL EXPENDITURES—equal to Total Receipts $ LOCAL FUNDS: R Appropriation APPROP 101 - 9'9,859 E TXIX TXIX 102 Other Receipts OTHR REC --- 103 E Subtotal Local Funds $ 99,859- STATE/FEDERAL/SPECIAL FUNDS: I P DEHNR 5,502 - - .Subtotal State/Federal/Special $ 5,502 TOTAL ECEIPTS —equal to Total Expenditures $105,361 CLoca uthorized icial Sign re Date Branch a Division/S tion Signatare Date tniml finance Officer Signature Date Arco-'r Fiscal Management Si azure Date DEHNR 2948(Revised 2/93) General Services Division(Review 2/94) LOCAL HEALTH DEPARTMENT BUDGET Department of Environment, iealth, and Natural Resources Revision Number_- ,ision of General Services i Division of Adult Health P. O. Number 07/ 94 06 / 95 9 5 5 _0 0 0 6 8 Effective Date Termination Date Contract Number ntractor: Orange Co. Health Dept. Activity: Health Promotion eject Director: Daniel B. Reimer Total Budget:$ 63,033 ITEM DESCRIPTION CLASSIFICATION ITEM _ AMOUNT STATE EXPENDITURES: Salaries & Fringe Benefits SA/FR 1000 22 , 11.6 Operating Expenses OP EXP 2000 Purchase of Equipment EQUIP 5000 General Contracted or Purchased Services GENERAL 6100 School Health ch H . <6 Clinician x Laboratory Pharmacy c y Services Transfer T-XIX >VC7 ...:.....:.. . Subtotal State Expend. S 22,116 LOCAL EXPENDITURES: FLOCAL EXP 9000 40$917 TOTAL EXPENDITURES —equal to Total Receipts S 63,033 - LOCAL FUNDS: - -- -- Appropriation APPROP 101 38,542 TXIX TXIX 102 Other Receipts OTHR REC 103 2,375 Subtotal Local Funds 40,917 STATE/FEDERAL/SPECIAL FUNDS: I DEHNR 22,116 V 1-43D 6/0o- -xXXsC Subtotal State/Federal/St)ecial $ 22,116 TOTAL RECEIPTS —equal to Total Expenditures $ 63,033 it bA to 9- ?Z Loiv AutnorizeJ Official Signature Date B Division/Secti Signatur Date 2 z_yy Finance Officer Signature Date Fiscal Management Si lure Date HWR 2948(Revised 2/93)