HomeMy WebLinkAboutAgenda - 12-12-2006-5fORANGE COUNTY
BOARD OF COMMISSIONERS
ACTION AGENDA ITEM ABSTRACT
Meeting Date: December 12, 2006
Action Agenda
Item No. ~ ' -F
SUBJECT: Primary Care Funds Acceptance
DEPARTMENT: Health PUBLIC HEARING: (Y/N) No
ATTACHMENT(S): INFORMATION CONTACT:
Grant Proposal Rosemary Summers, 245-2411
PURPOSE: To accept start-up funding to provide primary care services to traditional Health
Department clients at Southern Human Services Center (SHSC).
BACKGROUND: In the 2003 Orange County Community Health Assessment, access to health
care was the number one health issue identified by the community. Concurrently, the Orange
County Health Department undertook a comprehensive need and feasibility study regarding
access to primary care services. A strong recommendation from that report was for the Health
Department to begin the provision of primary care services to its traditionally served clients,
initially in Hillsborough with eventual expansion to Chapel Hill. Doing so strengthened the
community safety net for low-income, uninsured residents and increased the availability of
access to primary care.
In January 2005, the Health Department received its first grant ($86,460) to begin primary care
services in the Hillsborough clinic. These funds were used to provide temporary personnel and
purchase needed primary care supplies, pharmaceuticals and equipment.' In the first 6 months
of operations, the County provided 196 encounters to 128 clients of which 50% had Medicaid
and 47% were on the sliding scale. Of those served based on the sliding scale, 91 % were in the
0% - 20% self-pay category. The focus was truly on reaching the uninsured and medically
indigent with .quality primary care services.
In December 2005, the Health Department received a continuation of the primary care grant in
the amount of $43,346 to continue primary care services in the Hillsborough clinic. In FY 05-06,
278 clients were served with 540 primary care encounters. Based on these successful efforts,
the Department was awarded a continuation primary care grant in the amount of $43,346 for FY
06- 07. From the period January 2005 through October 2006, the Department provided 910
primary care services to 411 Health Department clients in the Hillsborough Clinic. Fifty-six
percent of the clients have had Medicaid and 42% have received services based on sliding
scale fees, with the vast majority in the 0-20% income range. Eleven percent of the population
the Department has served with primary care services were Hispanic.
In late summer 2006, an opportunity arose to apply for primary care expansion grant funds.
There were numerous reports that low income clients were experiencing long waiting times for
appointments at UNC Clinics and periods of time when the Carrboro Community Health Center
was not accepting new appointments. Since expansion of primary care to the Chapel Hill Clinic
at Southern Human Services Center was recommended in the 2003 Primary Care .Needs and
Feasibility Study and was also in the approved 2006-11 Healfih Department Strategic Plan, a
grant application was completed and submitted in the amount of $70,370. On November 20,
2006 staff received notification that the Department had been awarded the full amount. The
funds are to be expended from December 1, 2006 through May 31, 2007. Staff projects to
serve 80 clients with 128 primary care encounters within this start-up period, of which 45% of
clients will be self-pay on the sliding fee scale.
FINANCIAL. IMPACT: A total of $70,370 will be added as primary care revenue to the Health
Department FY 06-07 budget. Of this amount, $35,454 will be used for temporary personnel
and $9,315 will be used for operating expenses including office and medical supplies,
pharmaceuticals, lab services and interpreter costs. A total of $25,601 is available for new
equipment, office furniture, and minor renovations to the SHSC facility. It is anticipated that
continuation funds will be available next fiscal year for both this site and for the current site at
Whitted.
RECOMMENDATION(S): The Manager recommends that the Board accept the funding to
expand primary care services to Southern Human Services Center.
Orange County Health Department 3
FY 2007 Community Health Center Grants
ORGANIZATIONAL INFORMATION & SIGNATURE SHEET
Organization Name: Orange County Health Department
Organization EIN: # 56-6000327
Mailing; Address: 300 West Tryon Street, PO Box 8181, Hillsborough, NC 27278
Organization Type (check one)
^ FQHC ^ Free Clinic ^ Free Pharmacy
X Health Department ^ Hospital ^ Rural Health Clinic
^ AI~C Program ^ Other (specify)
Organization Fiscal Year: FY 06-07
Contact Person: Wayne Sherman, Personal Health Services Director
Email Address: wsherman@co.orange.nc.us
Phone Number: (919) 245-2402
Grant Request: Category I -Program Grant $44,769
Category II -Capital Grant $25,601
Total Request (cannot exceed $75,000) $70,370
Grant Application Submitted By:
Signature:
Name: Rosemary Summers
Organization Name: Orange County Health Department
Date:
Title: Health Director
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Orange County Health Department
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FY 2007 Community Health Center Grants
ST:~'VI:MAItY OF EVALUATION CRITERIA & BASELINE DATA
Instructions: This form must be completed and submitted with your grant application to be considered
for community health grant funding. IF THIS FORM IS NOT COMPLETED YOUR REQUEST
WILL NOT BE CONSIDERED FOR FUNDING.
Patients Served by Project
Report the current number of patients or users served by the project (this number will be 0 for the
creation of new services) and the anticipated number of patients or users who will be served by the
proposed project through June 30, 2007. Patients/Users are the number of unduplicated patients for all
project initiatives funded by the Community Health grant.
Baseline as of
1/1/2007 date Target to be Served
b 6/30/07
Total Unduplicated Patients /Users 0 80
Evaluation Criteria
Summarize the evaluation criteria from your application in the table below. You need to complete both
this table and the evaluation section in the grant application.
Evaluation Criteria Baseline Values/Measures Target to Be Reached
as of 1/1/2007 date b 6/30/07
Example:
To increase behavioral health cap°e 3 encounters/month 17 encounters/month
encounters for uninsured patients from 3
to 17 encounters per month
1. Recruit and employ temporary No temporary primary care .4 FTE FNP
personnel to begin Primary Care services personnel at SHSC .5 FTE Lab Tech
at SHSC .5 FTE PHN
.4 FTE Nursing Assistant
.5 FTE Management
Support
2. Increase primary care clients at SHSC 0 patients 80 patients
from 0 to 80
3. Increase primary care encounters to 0 encounters 128
SHSC clients from 0 to 128
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Orange County Health Department
4. 45% of primary care encounters are to 0% 45%
uninsured clients (self-pay, sliding scale)
Orange County Health Department 6
FY 2007 Community Health Center Grants
CATEGORY I -PROGRAM GRANTS
I Overview of Organization (1-2 paragraphs)
The Orange County Health Department (OCHD) mission is to enhance the quality of life, promote the
health, and preserve the environment for the nearly 130,000 residents living in Orange County. It does
so through an array of public health services including clinical, dental, health education, home visiting,
communicable disease, environmental health, and administrative services. Clinically, the health
department has historically focused on preventive health services for women and children such as family
planning, prenatal and well child services. Services are provided through two fully functioning Health
Department clinics: one in Hillsborough with 2 full-time FNPs and one in Chapel Hill with 1 full-time
F'NP. The 50 % Medical Director provides consultation and services in each site. In January 2005,
OCHD began to provide primary care services for clients enrolled in preventive services in the
Hillsborough clinic.
In the start-up first 6 months of operation (January =June 2005), 196 primary care services were
provided to 128 unduplicated clients. 50% of clients were Medicaid. Of the 47% on sliding fee scale,
91% were in the 0% - 20% self-pay category. In FY OS-06 (July 2005 -June 2006), the Hillsborough
clinic provided 544 primary care services to 279 unduplicated clients. 57% of services were to Medicaid
clients and 1 % were to privately insured clients. 42% were to uninsured, self-pay clients, of which 81
were to clients at the 0-20% pay level. Our efforts have been truly focused on reaching the uninsured
and medically indigent with quality primary care services.
II Community Need (1 page) 15 points
With t7NC Hospitals and UNC Physicians and Associates, the number of physicians in Orange County
is quite high, yet some residents still face difficulties in health care access due to barriers of cost,
language and transportation. A significant portion of Orange County residents lack health insurance
which contributes to the ongoing health disparities seen within the population. Minority. groups have
lower rates of insurance and higher rates of poverty as well as disease burden than do white residents. In
the 2005 BRFSS, 14.8% of Orange County residents stated they had no health insurance, but 42.6% of
minority respondents stated that they had no health insurance versus only 7.1 % of white respondents.
Also 28.5% of minority respondents stated there had been a time in the past year that they could not
access health care due to cost versus only 7.6% of white respondents. At the time of the 2000 census,
14.1% of Orange County residents were living.in poverty; of that number 12.4% were white and 19.5%
were black. Among Hispanic households at that time, 30% had a household income of less than
$20,000. A growing population of Hispanics has made their home in Carrboro and the surrounding area
in the past decade. In addition, a substantial number of Burmese refugees have resettled in the Chapel
Hill area and have sought services through the Health Department.
An extensive primary care needs assessment was undertaken in the Sulnmer/Fall of 2003 indicating a
need for increased access to affordable primary care, most notably in Northern Orange County. Orange
County Health Department clients expressed interest in receiving such services through the Health
Department. Community physicians supported the concept and the Executive Director (at the time) of
Piedmont Health Services, a community health center based in Chapel Hill, who serves as both a Board
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Orange County Health Department
7
of Health member and a County Commissioner, voted in favor of it. The Orange Community Health
Assessment completed in December 2003 further substantiated this need. The number one issue
identified by the community was `Barriers to receiving services:. cost of healthcare, lack of insurance,
and geographic availability of services'. Since January 2005, primary care services have been offered to
clients enrolled in our traditional prevention programs -Family Plaauling, Prenatal, and Well Child
Services - in our Hillsborough clinic. Primary care services include diagnosis and treatment of acute
health conditions as well as monitoring and care of chronic diseases.
Since the advent of primary care services at the Hillsborough clinic, clients accessing preventive
services at our Southern Human Services Clinic in Chapel Hili have also requested the provision of
primary care. Currently they must either travel to the Hillsborough clinic for such services or be referred
elsewhere. Carrboro Community Health Center, a Federally Qualified Health Center serving low-
income clients, has had a 3-month waiting period during the summer of 2006 for new patients. Many
new prenatal patients who could, not be seen there have been referred to OCHD for services. In addition,
iTNC Hospitals recently discontinued their Urgent Care Clinic associated with the Emergency
Department. This further limited accessibility for clients without a medical home. In the recently
completed 2006-11 OCHD Strategic Plan adopted by the Board of Health, expansion of primary care
services to Southern Human Services Center was identified as an implementation strategy in FY 06-07.
III Project Description (2 pages) 25 points
OCHD initiated primary care services in its Hillsborough clinic on January 4, 2005. The goal was to
provide a medical home for the growing uninsured and medically indigent population in the rural
northern and central parts of the county. Additionally, to improve access to care, OCHD initiated
evening clinic hours (9:30 AM - 6:30 PM) one day per week at each site (Hillsborough -Tuesday and
Chapel Hill -Thursday). Open access scheduling (same day appointments) was instituted while services
were offered in an integrated fashion (any type of service any day of the week, much like a family
practice). The addition of primary care services increased the volume and complexity of health care
visits to the health department clinics. Acute and chronic health conditions were now being addressed in
addition to psychosocial, nutritional and preventive health needs. Additional lab services were offered as
well as provision of limited pharmaceuticals to 0-20% self-pay clients. Referrals to UNC Physicians
have been arranged for assessments and/or treatment of complicated conditions. Admissions to UNC
Hospitals have been through our Medical Director, affiliated with UNC Family Practice.
Based on a growing need for access to care for uninsured and medically indigent populations in Chapel
Hill, Carrboro and rural southern Orange County, we propose to expand primary care services to the
Chapel Hili office of the Orange County Health Department located in the Southern Human Services
Center. This clinic is on the free bus route in Chapel Hill-Carrboro, thus reducing transportation as a
barrier to care. As in the Hillsborough primary care program, we anticipate offering primary care
services to clients enrolled in our traditional prevention services: Maternity, Family Planning and Well
Child Services. We seek to provide a medical home and continuity of care for individuals/families we
serve. Services will be provided on a sliding fee scale that slides to $15. Low-cost stock pharmaceuticals
will be available at $3/prescription for 0-20% clients with acute needs. A reduced cost pharmacy
program for individuals with chronic diseases will be offered in coordination with pharmaceutical
companies.
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Orange County Health Department 8
With funding received in December 2006, we anticipate, following recruitment of personnel, to start
primary care services in January 2007. We will market the service through brochures, word of mouth,
and possibly print media. We will expend the funds from January through May 2007. The program will
undoubtedly start modestly but continue to grow, such that by June 30, 2007, we will have served 80
clients with 128 primary care services. In FY 07-08, we anticipate the program will grow such that we.
will serve 176 clients with 282 primary care encounters.
IV Sustainability (1 page) 10 points
With the success of the expansion of primary care services to Southern Human Services Center, we
would hope to have the opportunity to apply for continuation grant funds, if available. We also will be
seeking support from our Board of Health and Board of County Commissioners for the cost of a full
year of primary care services in Chapel Hill. This will include personnel costs {.5 FNP, .5 Lab Tech, 1.0
PHN, .5 NA, and .5 Management Support position), operating costs (medical supplies, pharmaceuticals,
lab services, office supplies, interpreters, and training) and equipment costs. A budget with offsetting
earned revenue will be developed and presented.
V Collaboration (1 page) 25 points
UNC Health Care has worked in conjunction with OCHD in the development of primary care services in
Orange County. LJNC HealthLink has entered into acost-effective contract with OCHD to provide after
hours coverage for providers. LJNC Family Practice, with whom OCHD has a contract for Medical
Director services, has agreed to admit OCHD primary care clients to UNC Hospitals for care. In
addition, OCHD is working with UNC Healthcare, Piedmont Health Services, private medical providers
and other agencies to implement the Central Carolina Health Network (a Community Care Network) to
provide cost-effective and efficient case management of the Medicaid population. Additionally, efforts
are underway through this Network to develop the community infrastructure to manage and coordinate
services to the uninsured population. OCHD's primary care services are a vital safety net link in a
community effort to increase access to health services and to address the growing indigent population.
VI After-Hours Patient Care (1-2 paragraphs) OS points
As noted above, OCHD has entered into. a contract with UNC Health Link to provide after-hours
consultation and triage of patient concerns. Primary Care clients are advised to call HealthLink with
after-hours concerns and to follow the guidance provided, which may range from implementing home
remedies to seeing their medical provider the following day, or going immediately to the Hospital ED in
emergent situations. OCHD practitioners are on second call and available.to HealthLink nurses should
patient consultation be necessary. Admissions to IJNC Hospitals are arranged through L1NC Family
Practice.
VII Project Evaluation (1 page) 10 points
We will use 4 measures to evaluate the expansion of primary care services to the Chapel Hill clinic:
1) Recruit and employ temporary personnel to begin primary care services at SHSC: Baseline = no
temporary personnel; Target by 6-30-07 = .4 FNP, .5 PHN, .5 Lab Tech, .4 NA, .5 Mngmt Supt.
2) Increase Primary Care clients at SHSC from 0 to 80: Baseline = 0; Target by 6-30-07 = 80
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Orange County Health Department
9
3) Increase Primary Care encounters to SHSC clients from 0 to 128: Baseline = 0;
. Target by 6-30-07 = 128
4) 45% of Primary Care encounters are to uninsured patients: Baseline = 0%;
Target by 6-30-07 = 45%
VIII Project Budget (1 page) 10 points
Program Budget: (December 2006 -June 30, 2007)
PERSONNEL:
Temporary Personnel - (1/1 - 5/31/07)
.4 FTE Family Nurse Practitioner (16 hrs/wk X 22 wks X $25.63/hr) $9,022
5 FTE Public Health Nurse (20 hrs/wk X 22 wks X $21.75/hr) $9,570
5 FTE Laboratory Technician (20 hrs/wk X 22 wks X $15.45/hr) $6,798
.4 FTE Nursing Assistant (16 hrs/wk X 22 wks X $13.59/hr) $4,784
.5 FTE Management Support (20 hrs/wk X 22 wks X $12/hr) $5,280
SUBTOTAL PERSONNEL $35,454
OPERATING:
Medical Supplies $1,500
Pharmacy Supplies $3,500
Lab Services $1,000
Training $300
Duplicating. $250
Printing $250
Advertising $400
Telephone (Purchase/Installation/Maintenance of 3 new phones for staff) $715
Office Supplies $250
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Orange County Health Department
Dept. Supplies (Primary Care Reference Books) $350
Interpreter Costs (Contract, AT&T Language Line) ~ $800
SUBTOTAL OPERATING $9,315
TOTAL PROGRAM BUDGET $44,769
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Orange County Health Department 11
FY 2007 Community Health Center Grants
CATEGORY II -CAPITAL GRANT APPLICATION
I Overview of Organization (1-2 paragraphs)
The Orange County Health Department (OCHD) mission is to enhance the quality of life, promote the
health, and preserve the environment for the nearly 130,000 residents living in Orange County. It does
so through an array of public health services including clinical, dental, health education, home visiting,
communicable disease, environmental health, and administrative services. Clinically, the health
department has historically focused on preventive health services for women and children such as family
planning, prenatal and well child services. Services are provided through two fully functioning Health
Department clinics: one in Hillsborough with 2 full-time FNPs and one in Chapel Hill with 1 full-time
FNP. The 50 % Medical Director provides consultation and services in each site. In January 2005,
OCHD began to provide primary care services for clients enrolled in preventive services in the
Hillsborough clinic.
In the start-up first 6 months of operation (January -June 2005), 196 primary care services were
provided to 128 unduplicated clients. 50% of clients were Medicaid. Of the 47% on sliding fee scale,
91 % were in the 0% - 20% self-pay category. In FY OS-06 (July 2005 -June 2006), the Hillsborough
clinic provided 544 primary care services to 279 unduplicated clients. 57% of services were to Medicaid
clients and 1% were to privately insured clients. 42% were to uninsured, self-pay clients, of which 81%
were to clients at the 0-20% pay level. Our efforts have been truly focused on reaching the uninsured
and medically indigent with quality primary care services.
II Community Need (1 page) 15 points
With LTNC Hospitals and UNC Physicians and Associates, the number. of physicians in Orange County
is quite high, yet some residents still face difficulties in health care access due to barriers of cost,
language and transportation. A significant portion of Orange County residents lack.health insurance
which contributes to the ongoing health disparities seen within the population. Minority groups have
lower rates of insurance and higher rates of poverty as well as disease burden than do white residents. In
the 2005 BRFSS, 14.8% of Orange County residents stated they. had no health insurance, but 42.6% of
minority respondents stated that they had no health insurance versus only 7.1 % of white respondents.
Also 28.5% of minority respondents stated there had been a time in the past year that they could not
access health care due to cost versus only 7.6% of white respondents. At the time of the 2000 census,
14.1 % of Orange County residents were living in poverty; of that number 12.4% were white and 19.5%
were black. Among Hispanic households at that time, 30% had a household income of less than
$20,000. A growing population of Hispanics has made their home in Carrboro and the surrounding area
in the past decade. In addition, a substantial number of Burmese refugees have resettled in the Chapel
Hill area and have sought services through the Health Department.
An extensive primary care needs assessment was undertaken in the Summer/Fall of 2003 indicating a
need for increased access to affordable primary care, most notably in Northern Orange County. Orange
County Health Department clients expressed interest in receiving such services through the Health
Department. Community physicians supported the concept and the Executive Director (at the time) of
Piedmont Health Services, a community health center based in Chapel Hili, who serves as both a Board
11
Orange County Health Department
12
of Health member and a County Commissioner, voted in favor of it. The Orange Community Health
Assessment completed in December 2003 further substantiated this need. The number one issue
identified by the community was `Barriers to receiving services: cost of healthcare, lack of insurance,
and geographic availability of services'. Since January 2005, primary care services have been offered to
clients enrolled in our traditional prevention programs -Family Planning, Prenatal, and Well Child
Services - in our Hillsborough clinic. Primary care services include diagnosis and treatment of acute
health conditions as well as monitoring and care of chronic diseases.
Since the advent of primary care services at the Hillsborough clinic, clients accessing preventive
services at our Southern Human Services Clinic in Chapel Hill have also requested the provision of
primary care. Currently they must either travel to the Hillsborough clinic for such services or be referred
elsewhere. Carrboro Community Health Center, a Federally Qualified Health Center serving low-
income clients, has had a 3-month waiting period during the suzlluzer of 2006 for new patients. Many
new prenatal patients who could not be seen there have been referred to OCHD for services. In addition,
UNC Hospitals recently discontinued their Urgent Care Clinic associated with the Emergency
Department. This further limited accessibility for clients without a medical home. In the recently
completed 2006-11 OCHD Strategic Plan adopted by the Board of Health, expansion of primary care
services to Southern Human Services Center was identified as an implementation strategy in FY 06-07.
III Description of Capital Need (1 page) 20 points
With the proposed expansion of primary care services to the Southern Human Services Center, we will
have additional equipment and space needs. An EKG machine will be needed to assess the cardiac status
of primary care patients, especially those presenting with symptoms. A handicapped accessible Lift
Exam Table will be necessary to be ADA-compliant. A replacement copier machine is needed to make
clear copies of primary care schedules, records, forms, brochures, and educational materials. The
addition of 5 part-time personnel will require adequate office space to accommodate staff accessing e-
mails, working on the computer, and completing record keeping. We anticipate renovating a current
small office used for storage of equipment/supplies/educational materials into an office space with two
office modules and chairs. Two additional office modules and chairs will be centrally located near the
medical records/reception area. Modules will be equipped with a desktop computer and phone.
A small alcove will be enclosed to serve as a new storage area for equipment, supplies and patient
literature.
IV Relationship between Community Need & Capital Request (2 pages) 25 points
This capital request is in conjunction with a program grant application to expand primary care services
to Southern Human Services Center. To increase access to care for uninsured and medically indigent
persons, we will be adding additional temporary personnel. The personnel will need office space to
coordinate referral and follow-up services for clients by phone, to provide appointment reminder calls,
to research medicaUpsychosocial treatment options available in the community, and to complete their
administrative responsibilities. EKG equipment will assure primary care clients are receiving timely and
specified cardiac assessments to protect health. A Lift Exam Table will assure we are providing services
to all county residents, including those with physical disabilities. We anticipate that once funding is
awarded, we will proceed with renovations and purchase of equipment to assure start up of primary care
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Orange County Health Deparhnent 13
in January 2007. Renovations may not be completed in January but we will work to get them done
ASAP.
V Collaboration (1 page) 20 points
LTNC Health Care has worked in conjunction with OCHD in the development of primary care services in
Orange County. UNC HealthLink has entered into acost-effective contract with OCHD to provide after
hours coverage for providers. UNC Family Practice, with whom OCHD has a contract for Medical
Director services, has agreed to admit OCHD primary care clients to UNC Hospitals for care. In
addition; OCHD is working with UNC Healthcare, Piedmont Health Services, private medical providers
and other agencies to implement the Central Carolina Health Network (a Community Care Network) to
provide cost-effective and efficient case management of the Medicaid population. Additionally, efforts
are underway through this Network to develop the community infrastructure to manage and coordinate
services to the uninsured population. OCHD's primary care services are a vital safety net link in a
community effort to increase access to health services and to address the growing indigent population.
VI Project Evaluation (l .page) 10 points
We will use 4 measures to evaluate the expansion of primary care services to the Chapel Hill clinic:
1) Recruit and employ temporary personnel to begin primary care services at SHSC: Baseline = no
temporary personnel; Target by 6-30-07 = .4 FNP, .5 PHN, .5 Lab Tech, .4 CHA, .5 Mngmt Supt
2) Increase Primary Care clients at SHSC from 0 to 80: Baseline = 0; Target by 6-30-07 = 80
3} Increase Primary Care encounters to SHSC clients from 0 to 128: Baseline = 0;
Target by 6-30-07 = 128
4) 45% of Primary Care encounters are to uninsured patients: Baseline = 0%;
Target by 6-30-07. = 45%
VII Project Budget (1 page) 10 points
Capital Budget (December 2006 -June 30, 2007)
EQUIPMENT:
EKG Machine $4000
Copier Machine $5000
Lift Exam Table (Handicap accessible) $3990
IT EQUIPMENT:
Desktop Computers X 3 ($1300/ea) $3900
OFFICE FURNITURE:
Office Modules X 4 ($900/ea) $3600
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Orange County Health Department
Office Chairs X 4 ($90/ea)
OFFICE RENOVATIONS:
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$360
Reconfiguring office/storage space to accommodate additional personnel $4,751
TOTAL CAPITAL BUDGET
$25,601
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