HomeMy WebLinkAbout2025-732-E-Health Dept-Piedmont Health Services-Registered Dietician ServicesRevised 11/25
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[Departmental Use Only]
TITLE PHS - Dietitian
FY 2025-2026
NORTH CAROLINA
REGISTERED DIETITIAN SERVICES
AGREEMENT
ORANGE COUNTY
This Services Agreement (hereinafter “Agreement”), made and entered into this first day of
July, 2025, (“Effective Date”) by and between Orange County, North Carolina a body politic and
corporate of the State of North Carolina (hereinafter, the "County") through their Department of
Health (hereinafter, the “OCHD”) and Piedmont Health Services, Inc, (hereinafter, the "PHS").
WITNESSETH:
That the County and PHS, for the consideration herein named, do hereby agree as follows:
1. Services
a. Scope of Work.
i) This Agreement is for services to be rendered by the County to PHS with respect
to: Twenty hours (20) per week services of a North Carolina licensed Registered
Dietitian (“RD”), as provided in the attached Exhibit 1, PHS Job Description (WIC
Nutritionist) and Section 3 below, Basic Services.
ii) By executing this Agreement, the County represents and agrees that OCHD is
qualified to perform and fully capable of performing and providing the services
required or necessary under this Agreement in a fully competent, professional and
timely manner. County will not have any individual perform services under this
Agreement who has been excluded from participation in any federal or state health
care programs, or who have been convicted of criminal offenses related to their
involvement in Medicaid, Medicare or other health insurance or health care
programs, or social service programs. Each person providing services under this
agreement must be legally authorized (current licensed or, if applicable, certified
or registered) to provide the applicable services in North Carolina and only act
within the scope of his or her authority to provide such services.
iii) Time is of the essence with respect to this Agreement.
iv) The services to be performed under this Agreement consist of Basic Services, as
described and designated in Section 3 hereof and as provided in Exhibit 1, PHS Job
Description. Compensation to the County for Basic Services under this Agreement
shall be as set forth herein.
2. Responsibilities of PHS
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a. Services to be provided. The County shall provide PHS with all services required in
Section 3 to satisfactorily complete the Project within the time limitations set forth herein
and in accordance with the highest professional standards.
b. Standard of Care.
i) The County shall exercise reasonable care and diligence in performing services
under this Agreement in accordance with the highest generally accepted standards
of this type of practice throughout the United States and in accordance with
applicable federal, state and local laws and regulations applicable to the
performance of these services. County is solely responsible for the professional
quality, accuracy and timely completion and/or submission of all work related to
the Basic Services.
ii) The County shall be responsible for all errors or omissions, in the performance of
the Agreement. The County shall correct any and all errors, omissions,
discrepancies, ambiguities, mistakes or conflicts at no additional cost to the PHS.
iii) The County shall not, except as otherwise provided for in this Agreement,
subcontract the performance of any work under this Agreement without prior
written permission of PHS. No permission for subcontracting shall create, between
the PHS and the subcontractor, any contract or any other relationship.
iv) The County is an independent contractor of PHS. Any and all employees of the
County engaged by the County in the performance of any work or services required
of the County under this Agreement, shall be considered employees or agents of
the County only and not of PHS, and any and all claims that may or might arise
under any workers compensation or other law or contract on behalf of said
employees while so engaged shall be the sole obligation and responsibility of the
County.
v) The County agrees that its employees, agents and its subcontractors, if any, shall
be required to comply with all federal, state and local antidiscrimination laws,
regulations and policies that relate to the performance of County’s services under
this Agreement.
vi) If activities related to the performance of this Agreement require specific licenses,
certifications, or related credentials County represents that it and/or its employees,
agents and subcontractors engaged in such activities possess such licenses,
certifications, or credentials and that such licenses certifications, or credentials are
current, active, and not in a state of suspension or revocation.
3. Basic Services
a. Basic Services. The Services to be rendered pursuant to this Agreement are as follows
(fully describe services to be provided): Twenty hours per week services of a Registered
Dietitian as provided in accordance with the attached Exhibit 1 PHS Job Description, WIC
Nutritionist, and this Section of the Agreement as provided below:
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i) Hiring Responsibility:
(a) OCHD will conduct the recruitment process; however, the PHS shall review
and contribute to the job posting;
(b) All job applications must follow the Orange County and OCHD hiring and
recruitment policies;
(c) The position will be posted on the Orange County job vacancy website. PHS
may create a link to the Orange County vacancy website to advertise the
position;
(d) PHS will collaborate with OCHD in the selection process by helping to
develop interview questions and serving on the interview and selection panel.
ii) Job Description: The person in the position will follow the duties described within
the Orange County job description when working with OCHD. While working at
PHS, the person will follow the job duties as described in the PHS job description for
WIC Nutritionist (Exhibit 1). Job duties will be consistent with the scope of practice
for dietitians registered and licensed to practice in North Carolina.
iii) Supervision: OCHD Nutrition Program Manager is the primary supervisor of the RD.
However, PHS will provide on-site supervision of the dietitian for the 20 hours per
week the person works at PHS. PHS will report any practice infractions to OCHD
within twenty-four hours. PHS will work with OCHD to create WPPR performance
measures and consult with OCHD on the annual performance review. Supervisors
will communicate monthly to monitor the performance of the services under this
agreement.
iv) Orientation/Training: The RD must attend any County, OCHD and PHS required
orientation and training. OCHD and PHS will discuss training needs and requirements
and develop a mutually agreed upon schedule to meet the requirements. The
contracted dietitian will be trained and proficient in the WIC Nutritionist role in
Crossroads. Training and Orientation may cause the normal work schedule to vary.
v) Policies/Procedures: The RD shall abide by the rules, policies, and procedures of PHS
in the performance of all services provided under this Agreement (which shall
include, but not be limited to, clinical policies, procedures, and protocols; HIPAA
privacy and security policies; quality assurance standards; standards of conduct; and
grievance and complaint resolution procedures, as amended from time to time) and
shall fully cooperate with PHS, as reasonably requested in PHS’ quality improvement
processes, as well as implementing PHS’ corporate compliance program or other
regulatory certification or accreditation program. PHS shall provide the RD a copy of
all PHS rules, policies, and procedures the RD is expected to abide prior to the RD
commencing performance of the services provided under this Agreement.
vi) Probationary Period: OCHD has a statutorily required 12 month probationary period
to assess if the employee can perform proficiently. During this period of time, the
Orange County Health Director has the right to terminate the employment due to
unsatisfactory performance. Since this employee will be employed by OCHD, this
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would supersede the 90-day probationary period normally applied to PHS employees.
Termination of the RD employment will terminate this Agreement.
vii) Any revenue generated by the RD at PHS while providing the twenty hours of service
shall be the property of PHS.
viii) PHS assumes responsibility for setting fees, billing, collections and dispute
resolutions for RD services provided at the PHS site consistent with PHS’s customary
billing and collection policies and procedures, including but not limited to PHS’s
sliding scale fee discount program.
4. Duration of Services
a. Term. The term of this Agreement shall be from July 1, 2025 to June 30, 2026.
b. Scheduling of Services.
i) Regular Schedule. The RD shall work at OCHD on Tuesday and Thursday (8am to
4:30pm) and Fridays (all day). The RD shall work at PHS on Mondays (8am to 5pm)
and Wednesdays (8am to 5pm) and Thursday (5pm to 8pm), any changes to regular
schedule or location of the RD will be made by the PHS Supervisor and the OCHD
Nutrition Program Manager. Schedule or location changes must be mutually agreed
upon by both parties in writing.
ii) Excess Time Worked. Any time worked over the twenty hours per week required
under this Agreement shall be paid by PHS.
iii) Holiday Schedule. The RD will follow the holiday schedule adopted by the Orange
County Board of County Commissioners for County employees. If PHS requires the
RD to work during a scheduled holiday, PHS will be responsible for any overtime or
holiday pay.
iv) Leave. The RD will be provided with vacation and sick leave as an Orange County
employee. When the employee is on scheduled leave from Orange County and PHS,
PHS will be required to pay for services when the RD is on approved leave. The
OCHD Nutrition Program Manager will consult with the PHS Supervisor prior to
approving employee requests for vacation and sick leave.
v) The Commencement Date for Basic Services shall be July 1, 2025.
5. Compensation
a. Compensation for Basic Services. Compensation for Basic Services shall include all
compensation due to the County from PHS for all services under this Agreement. The
maximum amount payable for Basic Services shall not exceed a total of Forty Nine
Thousand Three Hundred Eighty Nine Dollars ($49,389.00) exclusive of any overtime or
holiday pay. Mileage reimbursement shall only be paid when the RD is working at a
location that is not part of the regularly assigned schedule. Mileage will be reimbursed at
the then-current IRS rate (currently .70 cents) per mile for a maximum of 100 miles
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($70.00). Payment for Basic Services shall become due and payable within thirty (30) days
of the County properly invoicing PHS. The County shall invoice PHS monthly. Payment
shall be subject to provisions of Section 5(b). Payment will begin only after the employee
has been hired to the position and has begun receiving compensation from the County.
b. Disputes. In the event the amount stated on an invoice is disputed by the PHS, PHS may
withhold payment of all or a portion of the amount stated on an invoice until the parties
resolve the dispute. Should the County fail to perform its duties under the terms of this
Agreement, PHS may, without fault or penalty, withhold any payment associated with the
work to be performed until such time as said work is completed.
c. Additional Services. PHS shall not be responsible for costs related to any services in
addition to the Basic Services performed by County unless County requests such
additional services in writing and such additional services are evidenced by a written
amendment to this Agreement.
6. Responsibilities of the County
a. Cooperation and Coordination. The County has designated Amber Benner to act as the
County's representative with respect to Agreement and shall have the authority to render
decisions within guidelines established by the Health Director and/or the County Board of
Health and shall be available during working hours as often as may be reasonably required
to render decisions and to furnish information.
7. Insurance
a. General Requirements. PHS shall purchase and maintain and shall cause each of his
subcontractors to purchase and maintain, during the period of performance of this
Agreement:
i) Comprehensive General Liability Insurance covering claims arising out of or
relating to bodily injury, including bodily injury, sickness, disease or death of any
of the PHS's employees or any other person and to real and personal property
including loss of use resulting thereof in the amount of at least $ 1,000,000 for each
occurrence and $2,000,00 in the aggregate;
b. Additional Insured. All insurance policies required under this Agreement shall name the
County as an additional insured party. Evidence of such insurance shall be furnished to
the County, together with evidence that each policy provides the County with not less than
thirty (30) days prior written notice of any cancellation, non-renewal or reduction of
coverage.
c. Insurance. The County shall secure and maintain occurrence-based professional liability
insurance of at least $2,000,000 per occurrence and $4,000,000 aggregate for any
individual providing Basic Services under the Agreement. PHS employees have been
deemed to be federal employees and as such are covered for medical liability protection
under the Federal Tort Claims Act (“FTCA”), but contracted providers employed by
another agency or entity are not covered under the FTCA.
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Evidence of Insurance. The County shall provide PHS with certificates of insurance
evidencing the coverage required in the section above.
8. Liability
Each party shall be responsible for its own acts and omissions and those of its employees and
agents. Nothing in this Agreement shall be construed to create any obligation for either party
to indemnify, defend, or hold harmless the other. Nothing herein shall be construed as a waiver
of any governmental immunities or defenses available under North Carolina law.
9. Amendments to the Agreement
a. Changes in Basic Services. Changes in the Basic Services and entitlement to additional
compensation or a change in duration of this Agreement shall be made by a written
Amendment to this Agreement executed by the County and the PHS. The County shall
proceed to perform the Services required by the Amendment only after receiving a fully
executed Amendment from PHS.
10. Termination
a. Termination for Convenience of the County. This Agreement may be terminated without
cause by PHS or the County and for convenience upon seven (7) days’ prior written notice
to the other party.
b. Compensation After Termination.
i) In the event of termination, the County shall be paid that portion of the fees and
expenses that the employee has earned to the date of termination.
ii) Should this Agreement be terminated, the County shall deliver to PHS within thirty
(30) days, at no additional cost, all deliverables including any electronic data or files
relating to this Agreement.
c. Waiver. The continuation of services by the County under this Agreement or the failure
of the County to require compliance by PHS with any provisions of this Agreement or the
waiver by the County of any breach of this Agreement shall not constitute a waiver of any
claim for damages by the County for any breach of this Agreement or a waiver of any
other required compliance with this Agreement.
d. Suspension. County may suspend the Basic Services and this Agreement at any time for
County’s convenience and without penalty to County upon three (3) days’ notice to PHS.
Upon any suspension by County, PHS shall discontinue work on the Basic Services and
shall not resume the Basic Services until notified to proceed by County.
11. Additional Provisions
a. Limitation and Assignment. The County and PHS each bind themselves, their successors,
assigns and legal representatives to the terms of this Agreement. Neither the County nor
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the PHS shall assign or transfer its interest in this Agreement without the written consent
of the other.
b. Governing Law. This Agreement and the duties, responsibilities, obligations and rights of
respective parties hereunder shall be governed by the laws of the State of North Carolina.
Provider shall at all times remain in compliance with all applicable local, state, and federal
laws, rules, and regulations and the Orange County Non -Discrimination Policy and
Orange County Living Wage Policy (each policy is incorporated herein by reference an d
may be viewed at,
http://www.orangecountync.gov/departments/purchasing_division/contracts.php). Any
violation of this requirement is a breach of this Agreement and County may immediately
terminate this Agreement without further obligation on the part of the County. This
paragraph is not intended to limit and does not limit the definition of breach to
discrimination. By executing this Agreement PHS affirms that PHS and any
subcontractors of PHS are and shall remain in compliance with Article 2 of Chapter 64 of
the North Carolina General Statutes. By executing this Agreement PHS certifies that PHS
has not been identified, and has not utilized the services of any agent or subcontractor, on
the list created by the State Treasurer pursuant to G.S. 147-86.58. By executing this
Agreement Provider certifies that PHS has not been identified, and has not utilized the
services of any agent or subcontractor identified, on the list created by the State Treasurer
pursuant to G.S. 147-86.81. County certifies that no person providing Basic Services will
be listed on the government wide exclusions System for Awards Management (SAM) or
barred from providing services under any federal or state healthcare program.
c. Confidentiality of Patient Records. All parties agree to abide by all laws and regulations
governing the confidentiality of patient information, including HIPAA privacy rules and
further agree to vigorously safeguard privileged information. The parties agree to comply
with the Business Associate Agreement attached hereto as Exhibit 2.
d. Dispute Resolution. Any and all suits or actions to enforce, interpret or seek damages with
respect to any provision of, or the performance or non-performance of, this Agreement
shall be brought in the General Court of Justice of North Carolina sitting in Orange
County, North Carolina. It is agreed by the parties that no other court shall have
jurisdiction or venue with respect to such suits or actions. The Parties may agree to
nonbinding mediation of any dispute prior to the bringing of such suit or action.
e. Entire Agreement. This Agreement represents the entire and integrated agreement
between the County and the PHS and supersedes all prior negotiations, representations or
agreements, either written or oral. This Agreement may be amended only by written
instrument signed by both parties. Modifications may be evidenced by facsimile
signatures.
f. Severability. If any provision of this Agreement is held as a matter of law to be
unenforceable, the remainder of this Agreement shall be valid and binding upon the
Parties.
g. Non-Appropriation. PHS acknowledges that County is a governmental entity, and the
validity of this Agreement is based upon the availability of public funding under the
authority of its statutory mandate. County acknowledges that PHS receives some of its
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funding from governmental entities as well, and the validity of this Agreement is based
upon the availability of public funding.
In the event that public funds are unavailable and not appropriated for the performance of
County or PHS’s obligations under this Agreement, then this Agreement shall
automatically expire without penalty to County or PHS immediately upon written notice
to the other of the unavailability and non-appropriation of public funds. It is expressly
agreed that neither PHS nor County shall activate this non-appropriation provision for its
convenience or to circumvent the requirements of this Agreement, but only as an
emergency fiscal measure during a substantial fiscal crisis.
In the event of a change in the County’s statutory authority, mandate and/or mandated
functions, by state and/or federal legislative or regulatory action, which adversely affects
County’s authority to continue its obligations under this Agreement, then this Agreement
shall automatically terminate without penalty to County upon written notice to PHS of such
limitation or change in County’s legal authority.
h. Notices. Any notice required by this Agreement shall be in writing and delivered by
certified or registered mail, return receipt requested to the following:
Orange County Piedmont Health Services, Inc.
Attention: Kimberlee Quatrone Attention: Daniella Jaimes-Colina
P.O. Box 8181 88 Vilcom Cntr. Dr., Suite 110
Hillsborough, NC 27278 Chapel Hill, NC 27514
i. Signatures. This Agreement together with any amendments or modifications may be
executed electronically. All electronic signatures affixed hereto evidence the intent of the
Parties to comply with Article 11A and Article 40 of North Carolina General Statute
Chapter 66.
j. Priority: In determining the basic services to be provided, should any documents be
referenced in this Agreement, the terms herein shall have priority in any conflict between
the terms of referenced documents and the terms of this Agreement, except the Business
Associate Agreement.
k. Records Access and Retention. The County will retain records related to this Agreement
and provide information to PHS and authorized federal officials upon request. The County
will retain such records for no less than three (3) years. PHS and the County agree that the
state, USDA, the Comptroller General of the United States, or any of their duly authorized
representatives, shall have access to any books documents, papers, and records of the
contractor which are directly pertinent to that specific contract, for the purpose of making
audit, examination, excerpts, and transcriptions. PHS and the County shall maintain all
required records for the period specified in the North Carolina Department of Health and
Human Resources Records Retention and Disposition Schedule for Local Health
Departments,
http://www.records.ncdcr.gov/local/county_health/health_Department_2007.pdf.
l. Title VI and WIC Policy. All activities under this contract will be conducted in accordance
with Title VI of the Civil Rights Act of 1964 (42 U.S.C.2000d et seq.), Title IX of the
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Education Amendments of 1972 (20 U.S.C. 1681 et seq.), Section 504 of the
Rehabilitation Act of 1973 (29 U.S.C.794), Age Discrimination Act of 1975 (42 U.S.C.
6101 et seq.); Title II and Title III of the Americans with Disabilities Act (ADA) of 1990
as amended by the ADA Amendment Act of 2008 (42 U.S.C. 12131-12189) as
implemented by Department of Justice regulations at (28 CFR Parts 35 and 36); Executive
Order 13166, "Improving Access to Services for Persons with Limited English
Proficiency." (August 11, 2000), all provisions required by the implementing regulations
of the U.S. Department of Agriculture (7 CFR Part 15 et seq); and FNS directives and
guidelines to the effect that no person shall, on the ground of race, color, national origin,
age, sex (including gender identity and sexual orientation), or disability, be excluded from
participation in, be denied the benefits of, or otherwise be subjected to discrimination
under any program or activity for which Federal financial assistance is received for the
administration of the WIC Program; and hereby gives assurances that it will immediately
take measures necessary to effectuate this agreement. By providing this assurance, the
PHS agrees to compile data, maintain records and submit records and reports as requested
by the Community Nutrition Services Section to permit effective enforcement of the
nondiscrimination laws, and to permit the Community Nutrition Services Section
personnel during normal working hours to review and copy such records, books and
accounts, access such facilities, and interview such personnel as needed to ascertain
compliance with the non-discrimination laws. If there are any violations of this assurance,
the Community Nutrition Services Section shall have the right to seek judicial
enforcement of this assurance. This assurance is given in consideration of and for the
purpose of obtaining any and all Federal financial assistance, grants, and loans of Federal
funds, reimbursable expenditures, grant, or donation of Federal property and interest in
property, the detail of Federal personnel, the sale and lease of, and the permissi on to use
Federal property or interest in such property or the furnishing of services without
consideration, or at a consideration that is reduced for the purpose of assisting the
recipient, or any improvements made with Federal financial assistance extended to the
Program applicant by USDA. This includes any Federal agreement, arrangement, or other
contract that has as one of its purposes the provision of cash assistance for the purchase of
food, and cash assistance for the purchase or rental of food service equipment or any other
financial assistance extended in reliance on the representations and agreement made in
this assurance.
m. Property Acquisition. To the extent that PHS acquires, leases, modernizes or otherwise
alters property, equipment and/or supplies under this Agreement using Federal grant
funds, in whole or in part, the parties recognize that such property, equipment, and or
supplies, will be managed and disposed consistent with the requirements of 45 CFR
section 75.316, et seq, and 2 CFR section 200.310 et seq.
[SIGNATURE PAGE TO FOLLOW]
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IN WITNESS WHEREOF, the Parties, by and through their authorized agents, have
hereunder set their hands and seal, all as of the day and year first above written.
ORANGE COUNTY: PHS:
By: _________________________________
Travis Myren, County Manager
By: __________________________________
Daniella Jaimes-Colina, PhD,
Chief Executive Director
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ORANGE COUNTY—INTERNAL USE ONLY
______________________________________________________________________________
Finance Information
Vendor Name: Piedmont Health Services Vendor Contact Person: Ashley Brewer Phone: 336-382-0242 Address:
88 Vilcom Center Drive., Ste. 110 City Chapel Hill State: NC Zip: 27514 Department: Health Amount: $49,459
Purpose: Registered Dietician Services Budget Code(s): 10414005-443110-71411 – This is a contract for Piedmont
to pay us. Vendor # 27898
Vendor Status with NCSOS: Current-Active Vendor is a BOCC consultant: Yes No
Contract Details
Contract Type: New Amendment (Original Contract: ) (Most Recent Amendment )
Effective Date 7-1-2025 End Date 6-30-2026 Notice Date (Notice Purpose )
Award
Approved by Board (Agenda Date: 6-17-25); Made or Administered by
Signature Authority
- BOCC Express Delegation (Agenda Date: )
- Policy 9.4: Under $5,000; Service Under $90,000; Construction Under $250,000
- Budget Policy Section XV (Capital Improvement Project: )
Bidding
Informal Bidding ($30k-$90k); Formal RFP ($90k+); Other (<$30k); Exception(# )
Department Affirmation
This agreement is approved as to technical form and content and I as Department Director affirmatively state work
on this project has not been initiated prior to execution of the agreement.
Services related to this agreement have already begun or been completed. Description of the nature of the
emergency condition that was addressed:
Department Director’s Signature ________________________________________ Date: ________
Information Technologies
This agreement has been reviewed and is approved as to information technology content and specifications:
Office of the Chief Information Officer___________________________________ Date: ________
Inapplicable because no hardware/software purchases or related services
Risk Management
This agreement is approved for sufficiency of insurance standards, specifications, and requirements:
Office of the Risk Management Officer___________________________________ Date: _________
Financial Services
This instrument has been pre-audited in the manner required by the Local Government Budget and Fiscal Control Act:
Office of the Chief Financial Officer ____________________________________ Date: _________
Legal Services
This agreement is approved as to legal form and sufficiency:
Office of the County Attorney __________________________________________Date: ________
Clerk to the Board
All Docusign contracts must be copied to the Clerk upon completion: occlerkdocs@orangecountync.gov
The following signature block is for hard copies only and is not required for Docusign contracts:
Received for record retention:
Office of the Clerk to the Board __________________________________________Date:_________
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12/5/2025
12/8/2025
12/8/2025
12/8/2025
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Piedmont Health Services
Performance Evaluation/Job Description
Name: WIC Nutritionist Reports to: Lead Nutritionist
FLSA Status: OSHA Category:
Review Period:_______________________ Type of Evaluation: ___________________
JOB SUMMARY
Performs a variety of responsible tasks involving counseling of individuals and families in nutrition principals, diet, food selection,
and economics for the WIC Program.
MINIMUM QUALIFICATIONS
Education: Bachelors degree from an accredited college or university in Nutrition, Public Health Nutrition or Dietetics
Current/valid License: N/A
Experience: One year of public health experience or similar preferred.
PATIENT POPULATION SERVED
Ethnically and racially diverse population of pregnant, breastfeeding, postpartum women, infants and young children and all f amily members involved.
PHYSICAL DEMANDS/ WORKING CONDITIONS
Requires frequent sitting for long periods, operation of standard office machines and computer. May require lifting of up to 25
pounds. Requires hand-eye coordination and manual dexterity. Requires use of office equipment, such as computer terminals,
telephones or copiers. Requires normal vision range. Work is performed in an office environment. Contact with staff and ex ternal
clients and vendors.
Revised: September 2014
Exhibit 1
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RESPONSIBILITIES AND DUTIES
Below Standard Needs Improvement Meets Expectations Exceeds Expectations 1. Patient Care:
Determine WIC Program eligibility based on the medical and nutrition risk identified. Determines risk codes, based on assessment and information presented. Provides individualized counseling in nutrition and breastfeeding based on needs and resources identified above.
Consults with medical providers, social work and other healthcare providers as needed to provide optimal care. Conducts counseling in culturally appropriate way to meet the needs of the patients. Screens immunization records of clients and makes referral as appropriate. Based on professional discretion determines follow schedule for patient Communicates with medical providers as needed Defers to lead nutritionist or RD for additional guidance with patients Demonstrates the ability to work with diverse patient populations served Competency Validation: 1 2 3 4 Comments:
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RESPONSIBILITIES AND DUTIES
Below Standard Needs Improvement Meets Expectations Exceeds Expectations 2. Quality Control/Safety: Prescribes or reviews food package to determine adequacy. Completes WIC certifications Evaluates all prescriptions for special and therapeutic formula Helps to ensure a safe environment in clinic with staff and clients. Competency Validation: 1 2 3 4 Comments:
3. Patient Education:
Asks open-ended questions to obtain additional information. Provides thorough assessment of each patient and determine appropriate risk code Based on client centered approach, determines educations topic. Effectively presents education topic with appropriate handouts. Determines correct follow-up visit based on risk code. Documents nutrition education contacts. Interprets, evaluates, and utilizes pertinent current research relating to nutrition care. Assists in the development and selection nutrition education materials for use by clients. Assists in outreach activities.
Competency Validation: 1 2 3 4 Docusign Envelope ID: D0D199CE-4413-4A0E-9DDE-C5FF6975DC6E
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Comments: Nasim is eager about increasing ca
RESPONSIBILITIES AND DUTIES
Below Standard Needs Improvement Meets Expectations Exceeds Expectations 4. Procedure Execution:
Reviews chart notes, past visits prior to meeting with patient Performs anthropometric measurements as needed per standards in the WIC Local Policy and Procedures Manual
and State WIC Policy and Procedures Manual Follows all procedures and policies as outlined by the WIC local and state Policy and Procedure Manuals Competency Validation: 1 2 3 4 Comments:
5. Administrative Duties
Assists in ordering of supplies such as State WIC, and free materials. Assists in problem solving and making recommendations concerning issues pertinent to the WIC Program guidelines
within local agency. Assists in training of new staff members and interns Assists in the performance of other administrative duties in relationship to the WIC Program. In the absence of the lead nutritionist, functions as supervisor on a interim basis Competency Validation: 1 2 3 4 Docusign Envelope ID: D0D199CE-4413-4A0E-9DDE-C5FF6975DC6E
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Comments:
UNIVERSAL PERFORMANCE STANDARDS
Below Standard Needs Improvement Meets Expectations Exceeds Expectations 6. Customer Service (Internal and External Customers) Demonstrates concern for the rights, privacy and confidentiality of patients and others Understands the urgency of customer needs and responds quickly Treats all patients in accordance with the Patient’s Bill of Rights Considers the impact on patients, visitors and peers when taking action and carrying out one’s own job tasks Anticipates the needs of patients, visitors, providers and peers and assists them in a helpful, positive manner Seeks to solve problems for patients and their families and offers assistance and encouragement to others Communicates with patients/families, visitors and coworkers in a courteous and respectful manner Demonstrates effective communication recognizing diversity among age groups, cultures, and educational levels Competency Validation: 1 2 3 4 Comments:
7. Teamwork Consistently works in a positive and cooperative manner with other employees in and outside of departmental unit Values and incorporates the contributions of people from diverse backgrounds; demonstrates respect for the
opinions and ideas of others Assist in training and orientation of new staff
Shares information and own expertise with others to enable them to accomplish goals and objectives Seeks out opportunities to help rather than waiting to be asked Assist other team members in the performance of their assignment Docusign Envelope ID: D0D199CE-4413-4A0E-9DDE-C5FF6975DC6E
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Competency Validation: 1 2 3 4 Comments:
UNIVERSAL PERFORMANCE STANDARDS Below Standard Needs Improvement Meets Expectations Exceeds Expectations 8. Professional Conduct Maintains professional demeanor in all interactions with patients and staff Functions independently and completes assignments with minimal supervision Adapts to changes in the work environment Maintains acceptable attendance record Observes work schedule by being punctual for shift, observing designated break schedule, and not leaving work area
while on duty Adheres to all applicable Center and department rules, policies and procedures Participates in continuing education , in-services, staff development and meetings Has completed annual retraining Responds positively to constructive criticism from peers and supervisors Competency Validation: 1 2 3 4 Comments:
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UNIVERSAL PERFORMANCE STANDARDS Below Standard Needs Improvement Meets Expectations Exceeds Expectations 9. Efficiency
Completes work in an organized and timely manner Prioritizes and plans work activities to achieve maximum efficiency Meets productivity standards Strives to improve productivity Minimize non-productive time by filling slow periods with activities such as assisting others, professional
development and education, organization of work area, housekeeping, etc. Organize job functions and work area to effectively complete assignments Manage resources efficiently and works to reduce costs and improve quality Competency Validation: 1 2 3 4 Comments:
10. Quality of Work /Problem Solving
Demonstrates commitment to excellence by consistently looking for ways to improve and promote quality Identifies problems in a timely manner and develops alternative solutions to problems Contribute to Continuous Quality Improvement activities Reports to appropriate person any conflicting cultural values, ethics, or religious beliefs that may impact patient care Consistently evaluates work and evaluate if further steps are needed to meet customer/patient/management
expectations Demonstrates sound judgment by taking appropriate actions regarding questionable findings or concerns Competency Validation: 1 2 3 4 Docusign Envelope ID: D0D199CE-4413-4A0E-9DDE-C5FF6975DC6E
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Comments:
Performance Category
Overall Performance Category for this review period:
____________Exceeds Expectation (An employee consistently exceeds all performance expectations for this period.)
____________Meets Expectations (An employee in this category has met all areas of expectations and effectively demonstrated
relevant competencies.)
____________Needs Improvement (Performance that is acceptable is some, but not all aspects of the job and does not consistently meet basic position
requirements.)
Next Review will be conducted on _____________
Summary / Areas for Improvement
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Signature Page
Employee Comments:
Employee Signature
I have received a written and verbal Performance Review. My signature does not indicate agreement or disagreement with this
review.
Employee Signature________________________________Department________________________ Date _____
Supervisor Signature
I have written and delivered a performance Review for this employee:
Supervisor Signature________________________________ Position_________________________ Date____________________
Executive Director Signature________________________________ Date _____
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Exhibit 2
THIS BUSINESS ASSOCIATE AGREEMENT (this “Agreement”) is made as of the 1st
day of July, 2025 (the “Effective Date”), by and between Piedmont Health Services, Inc.
(“Covered Entity”) and Orange County Health Department (“Business Associate”), each
individually a “Party” and together the “Parties.”
BACKGROUND STATEMENTS
A. Purpose. The purpose of this Agreement is to comply with the requirements of the
Health Insurance Portability and Accountability Act of 1996 and the associated regulations
(45 C.F.R. parts 160-164, as may be amended, including the “Privacy Rule” and the “Security
Rule”) (“HIPAA”) and the Health Information Technology for Economic and Clinical Health
Act and the associated regulations, as may be amended (“HITECH”). “HIPAA” and “HITECH”
are collectively referred to in this Agreement as “HIPAA.” Unless otherwise defined in this
Agreement, capitalized terms have the meanings given in HIPAA, as applicable. HIPAA
requires Business Associate to provide reasonable assurances to Covered Entity that the
Business Associate will appropriately safeguard Protected Health Information (“PHI”).
B. Relationship. Covered Entity and Business Associate have entered into an
agreement (the “Services Agreement”) pursuant to which Business Associate may receive,
use, obtain, access, maintain, transmit, and/or create PHI from or on behalf of Covered
Entity in the course of providing certain services (the “Services”) for Covered Entity.
AGREEMENT
The Parties hereby agree as follows:
Section 1. Permitted Uses and Disclosures.
Business Associate may use and/or disclose PHI only as permitted or required
by this Agreement or as otherwise required by Law. Business Associate may disclose PHI to,
and permit the use of PHI by, its employees, contractors, agents, or other representatives
only to the extent directly related to and necessary for the performance of the Services.
Business Associate will request from Covered Entity no more than the minimum PHI
necessary to perform the Services. Business Associate will request, use and disclose only
PHI that constitutes a Limited Data Set, if practicable, and will otherwise limit any request,
use or disclosure of PHI to the minimum necessary for the intended purpose of the request,
use or disclosure. Business Associate will not use or disclose PHI in a manner (i) inconsistent
with Covered Entity’s obligations under HIPAA, or (ii) that would violate HIPAA if disclosed
or used in such a manner by Covered Entity.
Business Associate will comply with the Privacy Rule requirements applicable to
Covered Entity if and to the extent Business Associate’s performance of the Services involves
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carrying out Covered Entity’s Privacy Rule obligations. Business Associate will also comply
with its own direct obligations under HIPAA. Business Associate will not engage in
marketing or fundraising that involves the use or disclosure of PHI and will not otherwise
receive direct or indirect remuneration for PHI, except as expressly permitted in writing by
Covered Entity in connection with the provision of the Services.
Section 2. Safeguards for the Protection of PHI.
Business Associate will implement and maintain commercially appropriate
administrative, physical, and technical security safeguards to ensure that PHI obtained by or
on behalf of Covered Entity is not used or disclosed by Business Associate in violation of this
Agreement. Such safeguards will be designed to protect the confidentiality and integrity of
such PHI obtained, accessed, created, maintained, or transmitted from or on behalf of
Covered Entity. Business Associate will comply with the applicable req uirements of the
Security Rule. Upon request by Covered Entity, Business Associate will provide a written
description of such safeguards.
Section 3. Reporting and Mitigating the Effect of Unauthorized Uses and
Disclosures.
Business Associate will report without unreasonable delay and in no case later
than sixty (60) calendar days, upon discovery, in writing and in accordance with Section 10.6,
any Security Incident or Breach (as defined below) by it or any of its employees, directors,
officers, agents, subcontractors or representatives concerning the use or disclosure of PHI.
For purposes of this Agreement, “Breach” means any acquisition, access, use or disclosure of
PHI under this Agreement that is (a) in violation of HIPAA or (b) not permitted under this
Agreement. Business Associate will be deemed to have discovered a Breach as of the first
day on which the Breach is, or should reasonably have been, known to (a) Business Associate
or (b) any employee, officer, or other agent of Business Associate other than the individual
committing the Breach. Business Associate further will investigate the Breach and provide
to Covered Entity, as soon as possible all information Covered Entity may require to make
notifications of the Breach to Individuals and/or other persons or entities (“Notifications”).
Business Associate will cooperate with Covered Entity in addressing the Breach. Business
Associate will not notify Individuals or other persons or entities of the Breach without the
express written consent of Covered Entity, unless required by applicable law. Covered Entity
may direct Business Associate to make the Notifications and implement other mitigation
steps, in a reasonable form and manner, and within reasonable timeframes directed by
Covered Entity, consistent with Covered Entity’s legal obligations. Business Associate will
be responsible for the reasonable costs of required notifications and mitigation directly
resulting from such Breach to the extent the Breach is determined to have resulted from the
negligence, wrongful acts, or omissions of Business Associate or its employees or agents.
Nothing in this Agreement shall be construed to waive Business Associate’s governmental
immunities or defenses under North Carolina law
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Business Associate will establish and implement procedures and other
reasonable efforts for mitigating, to the greatest extent possible, any harmful effects arising
from any improper use and/or disclosure of PHI.
Section 4. Use and Disclosure of PHI by Subcontractors, Agents, and
Representatives.
Business Associate will require any subcontractor, agent, or other
representative that is authorized to receive, use, maintain, transmit, or have access to PHI
obtained or created under the Agreement, to agree, in writing, to (1) adhere to the same
restrictions, conditions and requirements regarding the use and/or disclosure of PHI and
safeguarding of PHI that apply to Business Associate under this Agreement; and (2) comply
with the applicable requirements of the Security Rule.
Section 5. Individual Rights.
Business Associate will comply with the following Individual rights
requirements as applicable to PHI used or maintained by Business Associate:
5.1 Right of Access. Business Associate agrees to provide access to PHI, at
the request of Covered Entity, as necessary to satisfy Covered Entity’s obligations with
regard to the individual access requirements under the Privacy Rule. Business Associate will
otherwise comply with its obligations regarding an Individual’s right of access to PHI under
HIPAA.
5.2 Right of Amendment. Business Associate agrees to make any
amendment(s) to PHI as necessary to meet the amendment requirements under HIPAA.
5.3 Right to Accounting of Disclosures. Business Associate agrees to
document such disclosures of PHI as would be required for Covered Entity to respond to a
request by an Individual for an accounting of disclosures of PHI in accordance with HIPAA,
and to provide all such documentation to Covered Entity or, to an Individual, as necessary to
satisfy Covered Entity’s obligations with regard to an Individual’s right to an accounting of
disclosures. Business Associate will otherwise comply with its obligations regarding an
Individual’s right to an accounting of disclosures under HIPAA.
Section 6. Use and Disclosure for Business Associate’s Purposes.
6.1 Use. Except as otherwise limited in this Agreement, Business Associate
may use PHI for the proper management and administration of Business Associate or to
carry out the legal responsibilities of Business Associate.
6.2 Disclosure. Except as otherwise limited in this Agreement, Business
Associate may disclose PHI for the proper management and administration of Business
Associate, provided the disclosures are Required by Law, or Business Associate obtains
reasonable assurances from the person to whom the PHI is disclosed that the PHI will remain
confidential and be used or further disclosed only as Required by Law or for the purpose for
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which it was disclosed to the person, and the person notifies Business Associate immediately
upon discovery of any instances in which the confidentiality of the PHI has been Breached,
as defined and described in Section 3 of this Agreement.
Section 7. Audit and Inspection.
With reasonable notice, Covered Entity may audit Business Associate to monitor
compliance with this Agreement. Business Associate will promptly correct any violation of
this Agreement found by Covered Entity and will certify in writing that the correction has
been made. Covered Entity’s failure to conduct an audit or, if an audit is conducted, to detect
any unsatisfactory practice, does not constitute acceptance of the practice or a waiver of
Covered Entity’s rights under this Agreement.
Business Associate will make its internal practices, books, records, and policies and
procedures relating to the use and disclosure of PHI received from, or created or received by
Business Associate on behalf of Covered Entity, available to the federal Department of Health
and Human Services (“HHS”), the Office for Civil Rights (“OCR”), or their agents and to
Covered Entity for purposes of monitoring compliance with HIPAA.
Section 8. Term and Termination
8.1 Term. This Agreement will become effective on the Effective Date.
Unless terminated sooner pursuant to Section 8.2, this Agreement will remain in effect for
the duration of all Services provided by Business Associate and for so long as Business
Associate will remain in possession of any PHI received from, or created or received by
Business Associate on behalf of Covered Entity.
8.2 Termination. In the event of a material breach of this Agreement, the
non-breaching Party may immediately terminate the Services Agreement and this
Agreement. Alternatively, in the non-breaching Party’s sole discretion, the non-breaching
Party may provide the breaching Party with written notice of the existence of the material
breach and afford the breaching Party thirty (30) days to cure the material breach. In the
event the breaching Party fails to cure the material breach within such time period, the non-
breaching Party may immediately terminate the Services Agreement and this Agreement.
8.3 Effect of Termination. Upon termination of the Services Agreement and
this Agreement, Business Associate will recover any PHI relating to this Agreement in the
possession of its subcontractors, agents or representatives. Business Associate will return
to Covered Entity or destroy all such PHI plus all other PHI relating to this Agreement in its
possession, and will retain no copies. If Business Associate cannot feasibly return or destroy
the PHI, Business Associate will ensure that any and all protections, requirement s and
restrictions contained in this Agreement will be extended to any PHI retained after the
termination of this Agreement, and that any further uses and/or disclosures will be limited
to the purposes that make the return or destruction of the PHI infeasible.
Section 9. [Intentionally Omitted]
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9.1 .
Section 10. Miscellaneous.
10.1 Survival. The respective rights and obligations of the Parties under
Sections 7 (Audit and Inspection), 8.3 (Effect of Termination), 9 (Indemnification) and 10
(Miscellaneous) will survive termination of this Agreement indefinitely.
10.2 Amendments. This Agreement constitutes the entire agreement
between the Parties with respect to its subject matter. It may not be modified, nor will any
provision be waived or amended, except in a writing duly signed by authorized
representatives of the Parties. Notwithstanding the foregoing, Covered Entity may amend
this Agreement upon written notice to Business Associate if the amendment is necessary to
comply with a statutory or regulatory requirement.
10.3 Waiver. A waiver with respect to one event will not be construed as
continuing, or as a bar to or waiver of any right or remedy as to subsequent events.
10.4 Compliance with HIPAA. Any ambiguity in this Agreement will be
resolved in favor of a meaning that permits the Parties to comply with HIPAA. The Part ies
agree to amend this Agreement from time to time as necessary for the Parties to comply with
the requirements of HIPAA.
10.5 No Third-Party Beneficiaries. Nothing express or implied in this
Agreement is intended to confer, nor will anything herein confer, upon any person other than
the Parties and their respective successors and permitted assigns, any rights, remedies,
obligations or liabilities whatsoever.
10.6 Notices. Any notice to be given under this Agreement to a Party will be
made via U.S. Mail, commercial courier or hand delivery to such Party at its address given
below, and/or via facsimile to the facsimile telephone number listed below, or to such other
address or facsimile number as will hereafter be specified by notice from the Party. Any such
notice will be deemed given when so delivered to or received at the proper address.
If to Business Associate, to: If to Covered Entity to:
Orange County Health Dept. Piedmont Health Service, Corporate Office
PO Box 8181, 300 W. Tryon St. 88 Vilcom Center Dr., Ste 110
Hillsborough, NC 27278 Chapel Hill, NC 27514
Attention: Ashley Rawlinson Attention: Daniella Jaimes-Colina, PhD
10.7
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10.8 Relationship between Parties: The relationship of the Parties is that of
independent contractors, and nothing in this Agreement will be construed to render either
Party a partner, employee or agent of the other, nor will either Party have authority to bind
the other in any respect, it being intended that each Party will remain solely responsible for
its own actions. No employee or agent of one Party to this Agreement will be conside red an
employee or agent of the other Party.
IN WITNESS WHEREOF, each of the Parties has caused this Agreement to be
executed in its name and on its behalf as of the Effective Date.
COVERED ENTITY BUSINESS ASSOCIATE
Sign: ______________________________ Sign: _____________________________
Piedmont Health Services, Inc. Orange County Health Department
Print Name: __Daniella Jaimes-Colina, PhD Print Name: Quintana Stewart__
Title: _Chief Executive Director__________ Title: Health Director_____________
Date: ______________________________ Date: ____________________________
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