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HomeMy WebLinkAboutAgenda - 09-02-2003-9c1ORANGE COUNTY BOARD OF COMMISSIONERS ACTION AGENDA ITEM ABSTRACT Meeting Date: September 2, 2003 ~~ SUBJECT: Board of Health Action Agenda Item No. 9- c -.~ DEPARTMENT: Board of Commissioners PUBLIC HEARING: (YIN) No ATTACHMENT(S): Under Separate Cover Membership Roster Letter of Recommendation Applications/Resumes of Persons Being Recommended Interest List Applications/Resumes of Persons on the Interest List INFORMATION CONTACT: Clerk's Office, ext. 2130, 2125, 2126, 2129 TELEPHONE NUMBERS: Hillsborough 245-2130 Chapel Hill 968-4501 Durham 688-7331 Mebane 336-227-2031 PURPOSE: To consider two appointments to the Orange County Board of Health. BACKGROUND: The Board of Health has two vacancies, one for a Nurse and one for a Physician. Both are unexpired terms, which will expire June 30, 2005 and June 30, 2004 respectively. A recommendation has been made by the Board of Health as follows: For the Nurse position, Ms. Chris Harlan, 109 B Park Road, Chapel Hill, N.C. For the Physician position, Dr. Tim Carey, 201 Westbury, Chapel Hill, N.C. FINANCIAL IMPACT: None. RECOMMENDATION(S): Consider making two appointments to the Board of Health as the Board of Commissioners may decide. a ^v~ ~L~/ 0 ~ .~ O ^~,^ ti VI ~ .~ a O `~J; !"'1 C~ 1M10 bq a a~+ O 0. s A U ~p ~~ 0 ~ ~ 7 .N. v ~ ~ ~ a7 ~ N ~ C p ~ ~ 0~0 ~ O~ ~: y ~ `~ v ~ ~ p w a oN ° ° •^ V U U 0. p C w °q~3 ~ Y _°_ T 'o w° M M ~ O .y ~y H ~ ~ a ~ bq 0.O ~ ~ .x-. f/1 f.. ° Y O .~'. ~ ~ y ~ py v O U C W ° o ~F ~ c 0 ~ ai U a o a. ,~ ~ o ~ V y G W xi LY .C T ~ ~ ~_ N 'cd' '~ H ~ ~ ~+ .~ .~ ~ ,_ t ~ Q a ~ U c M ~° c U ~ w E ~ c ,c a o 'c c ti~^` ° o ~ a `W ~ N y N ~ fd Q^~+~ ^ ~ G `~ F a .o • o. U ~~ ~ O Q O O O O N O O N N N N N m ~ o ^" ~ `c o ^. 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O a w ~ w ~' 0 ~ e ~ v U a i c o o. ~ O Y ~ > W U '~ [O r y w O x a.c o v ~ ~a fd ' fC Vl N N ~ _ C L' ~.~I r ~.~ W . ~ ..Vi ~ ,~ F ~ ~ 0. C F w q U ~ y.~ v L' y O . ~ ~ V"1 Q O '~ O '~ N ~l O U ~ ~ ~ ~ z ~ ~ a o ^' ~ ~~ U ~ ~x ~~ ~'"' ~ ^ ~ N T N ° ~ c ,~ ~ a U ~ ~ 0 ~ ~ y ~ Q ~~1 ! ~ M N 00 a M °o N 00 m B cd C O 5 4°J~ty Hea~f'~ e 'O o~m o ~ 0 m North Carolina Pabllc Nodth ORANGE COUNTY HEALTH DEPARTMENT Rosemary L. Summers, MPH, DrPH Health Director Richard E. Whiffed Human Services Center 300 West Tryon Street Post Office Box 8181 Hillsborough, NC 27278 Phone: (919) 245-2411 Fax: (919) 644-3007 wrvw. co.oranae. nc. us/health BOARD OF HEALTH Melvin S. Hurston, MHSA Chair Alice White, MPH, PhD Vice Chair Moses Carey, Jr. Commissioner Jonathan E. bein, MHS, MD Jessica Y. Lee, DDS, DrPH Alan Rimer, PE Martha J. Stucker, RN, MPH Sharon E. Van Horn, MPH, MD Matthew Vizithum, OD Lee D. Werley, PharmD Edith Kathryn Wilder, DVM To: Board of County Commissioners From: Board of Health Date: August 18, 2003 Re: Recommendations for Appointment ,; i The Orange County Board of Health has considered the current applicants for vacant Board of Health positions and in action at their July 2003 meeting is recommending the following two individuals for your consideration. Ms. Chris Harlan is recommended for your consideration to fill the vacant nurse position on the Board of Health. Ms. Harlan is a registered nurse with a wealth of experience in services to Hispanic populations. In addition, she has expertise in both nursing and public health and is bilingual. Her application is attached for your review. Dr. Timothy Carey is recommended for your consideration to fill the expired physician position on the Board of Health. Dr. Carey is an internist in the UNC Health Care System and is the Director of the Sheps Center for Health Services Research. Dr. Carey is a practicing physician as well as an educator and researcher in public health and health services. Dr. Carey is a volunteer physician who provides services to the residents of the Homeless Shelter in Chapel Hill. He will afford the Board a valuable link with the University community. His application is also attached for your review. These appointments would fill the current vacancies on the Board of Health. It is our understanding that Dr. Carey, if appointed would serve a partial term (one year) and then be eligible for two full terms beginning July 1, 2005. Ms. Harlan, if appointed would also be filling a partial term that ends on June 30, 2005 and then be eligible for one additional term under the current rules that the Commissioners have adopted. Thank you for your consideration of these applicants. run urrlur= u~r: urvL.t raye i vi i i im uarey I / VOLUNTEER APPLICATION ORANGE COUNTY BOARDS AND COMMISSIONS Orange County Commissioners' Office P. O. Box 8181 Hillsborough, NC 27278 ~ Phone (919) 245-2125; FX (919) 644-0246 NAME: Dr. Tim Carey - __ _ HOME ADDRESS: 201 Westbury ` _ CITY: Chapel Hill, NC Zip Code: 27516 TELEPHONE: (H) 919-967-7198 (1N) 919-966-7100_ (Fax) 919-966-8918 EMAIL: tmcareyfc~unc.edu PLACE OF EMPLOYMENT: UNC-CH JOB TITLE: Director, Sheps Center for Health Services Research IN ORDER TO ASSURE COUNTYWIDE REPRESENTATION PLEASE INDICATE YOUR TOWNSHIP OF RESIDENCE: Bingham Cheeks Hillsborough-- Eno_, Chapel Hill XLittle River __ Cedar Grove IN ADDITION, PLEASE INDICATE IF YOU LIVE IN ONE OF THE FOLLOWING AREAS*: NIA JPA (Joint Planning Area) __ EA (Extraterritorial Area) _~ TA (Transition Area) _ WE ASK YOUR HELP IN ASSURING DIVERSITY OF MEMBERSHIP BY AGE, GENDER AND RACE, BY ANSWERING THE FOLLOWING QUESTIONS: Male __X Female _~___ ETHNIC BACKGROUND: African American _~ Hispanic __A_ Caucasian _X_ Native American __ Other DATE OF BIRTH: 01/12/1951__ PLEASE LIST (IN ORDER OF PREFERENCE) THE BOARDS/COMMISSIONS ON WHICH YOU WOULD BE WILLING TO SERVE. 1. --Board of Health_^ 2. __ _ 3. __ Please list work, volunteer and educational experience. WORK EXPERIENCE: For almost 20 years I have been a faculty member in the School of Medicine and School of Public Health at UNC-Chapel Hill. 1 served as Chief of the Division of General Medicine and Clinical Epidemiology for almost 10 years. For the past three years I have been the Director of the Cecil G. Sheps Center for Health Services Research. VOLUNTEER EXPERIENCE: Volunteer physician at the IFC Homeless Shelter Clinic EDUCATIONAL EXPERIENCE: 1972 BA Colby College, Waterville, Maine; 1976 MD University of Vermont School of Medicine; 1985 MPH University of North Carolina OTHER COMMENTS: How did you become aware of orange county volunteer opportunities? (Please specify): Current Orange County Volunteer __X Radio ~ T.V. If appointed, I agree to attend athree-hour orientation which will give an overview of how Orange County Government operates and what its relationship is to other governmental units. Newspaper Other C: \CLERK'zDOCUMENTS-C Drive\A P P L I C A T Z O N S\carey_t. dot Paae 1 of 1 ~ Christina Harlan VOLUNTEER APPLICATION ORANGE COUNTY ADVISORY BOARDS AND COMMISSIONS If you are an Orange County resident, at least 18 years old, and willing to volunteer your time and expertise to your community, please complete and submit this form. Name: Name Called: Home Address: Phone: (Day) Phone: (Evening) Fax: Email: Place of Employment: Job Title: Township of Residence: Zone of Residence: Sex: Ethnic Background: Date of Birth: Ms Christina Harlan 109 B Park Road Chapel Hill, NC 27516 966 9877 942 0587 966 0981 chris_harlan@unc.edu UNC Schools of Public Health and Nursing Instructor Chapel Hill Female Caucasian 11 /29/1950 Please list (in order of preference) the Boards/Commissions on which you would be willing to serve. 1. Board of Health 2. 3. WORK EXPERIENCE: Public Health nurse by background with 30 years experience working in in multiethnic, multilingual, rural and urban in the US, Caribbean and Latin America...in health departments, community health centers and home health agencies. Teach in the School of Public Health and the School of Nursing and work on special projects around public health nursing home visiting (served as a trainer consultant to Families in Focus for instance. Worked for many years with migrant health health centers in NC serving Latino and Haitian farm~vorkers. Currently work on several projects to offer Spanish language and and cultural training to health professionals. Speak Spanish and some Haitian Creole. BSN from American University in Washington DC MA doctoral studies from the New School for Social Research in New York City. Resident of Orange county since 1986. VOLUNTEER EXPERIENCE: Agricultural Worker Safety and Health Committee National Migrant Resource Program NC State Health Dept (Planning committee) Partners of the Americas (Bolivia) TA/C'onsultation in Mexico and `Haiti Peace Corps Volunteer in Brazil. EDUCATIONAL EXPERIENCE: See above: BS in Nursing 1972 American University, Washington DC MA in Medical Anthropology 1982 New School for Social Research, NYC. OTHER COMMENTS: It would be a valuble learning experience for me to serve on the Board of Health. The ability to work closely on the policy and political aspects of public health practice would be a challenge and of great interest. I hope that my diverse background would be a contribution to the work of the Board. How did you become aware of Orange County volunteer opportunities? Current Orange County Volunteer By submitting electronic application, applicant agrees to Ethics Guidelines and agrees to attend three-hour orientation. This form was submitted online, on 6/11/03 11:33:22 AM s Applicant Interest Listing Board of Health Mr. Tim Carey 201 Westbury Chapel Hill NC 27516 Skills: Physician Ms. Vidya Diya Goli 213 Kenan UNC Chapel Hill NC 27514 Skills: Biological Reseazch Skills: Student Ms. Catherine A. Gutmann 117 Weatherhill Pointe Carrboro NC 27510 Skills: Nurse Practioner by Board Name and by Applicant Name Contact Person: Rosemary Summers, Director, Contact Phone: 919-245-2412 Day Phone: 919-966-7100 Sex: Male Evening Phone: 919-967-7198 Race: Caucasian F,4}{; 919-966-8918 Township: Chapel Hill E-mail: tim_carey@unc.edu Date Applied: 07/15/2003 Also Serves On: Day Phone: Sex: Female Evening Phone: 919-914-1246 Race: Asian American FAX: Township: Chapel Hill E-mail: goli@email.unc.edu Date Applied: 01/20/2002 Also Serves On: Also Serves On: Day Phone: 919-286-0411 Sex: Female Evening Phone: 919-967-2990 Race: Caucasian FAX: Township: Chapel Hill E-mail: cgBnP@yahoo.com Date Applied: 06/27/2003 Also Serves On: Ms. Christina Harlan 109 B Park Road Chapel Hill NC 27516 Skills: Public Health Skills: Registered Nurse Ms. Jeanette Holloman 203 Culbreth Park Dr. Chapel Hill NC 27516 Skills: Community Service Volunteer Skills: Customer Service Day Phone: 919-966-9877 Evening Phone: 919-942-0587 Fq}{; 919-966-0981 E-mail: chris_hazlan@unc.edu Also Serves On: Also Serves On: Sex: Female Race: Caucasian Township: Chapel Hil] Date Applied: 06/11/2003 Day Phone: 919-765-1158 Evening Phone: 919-932-5165 FAX: E-mail: J_net69@yahoo.com Also Serves On: Also Serves On: Sex: Female Race: African American Township: Chapel Hill Date Applied: 03/21/2002 Monday, August 18, 2003 Page 1 of 2 q by Board Name and by Applicant Name Applicant Interest Listing Contact Person: Rosemary Summers, Director, BOQYI~ Of HBQrCtIZ Contact Phone: 919-245-2412 Mr. Leslie A. JOhnS Day Phone: 919-942-8700 Sex: Male 106 Blue Granite Ct. Evening Phone: 919-967-3037 Race: Caucasian Chapel Hill NC 27514 FAX: Township: Chapel Hill E-mail: les~ohns@msn.com Date Applied: 01/22/2002 Skills: Advisory Board Experience Also Serves On: Skills: CPA Also Serves On: Ms. Kim Walsh Day Phone: 919-732-460 Sex: Female 3522 Bluestone Court Evening Phone: 919-732-460 Race: Caucasian Chapel Hill NC 27514 FAX: Township: Eno E-mail: kwalsh6@earthlilnk.net Date Applied: 06/11/2003 Skills: Health Department Director Also Serves On: Skills: Medical Doctor Also Serves On: Mr. Glenn W11SOri Day Phone: 919-966-7664 Sex: Male 214 Glandon Dr. Evening Phone: 919-967-3535 Race: Caucasian Chapel Hill NC 27514 FAX: Township: Chapel Hill E-mail: glenn_wilson@unc.edu Date Applied: 03!26/2002 Skills: Associate Dean Also Serves On: Skills: Professor Also Serves On: Skills: UNC-CH School of Medicine Also Serves On: Monday, August 18, 2003 Page 2 of 2 This space for office use only ! O 1/20/02 Page 1 of 1 Vidya (Diya) Goli I VOLUNTEER APPLICATION ORANGE COUNTY BOARDS AND COMMISSIONS If you are an Orange County resident, at least 18 years old, and willing, to volunteer your time and expertise to your community, please complete this application and return to: Orange County Commissioners' Office P.O. Box 8181 Hillsborough, NC 27278 Phone (919) 245-2125; 688-7331; 227-3031 FX (919) 644-0246 NAME: -------------------------------- Vidya (Diya) Goli HOME ADDRESS: ------------------ 213 Kenan, UNC CITY: ----------------------------------- Chapel Hill STATE: -------------------------------- NC ZIP CODE: ---------------------------- 27514 TELEPHONE: (Home) -------------- 914-1246 TELEPHONE: (Work) -------------- TELEPHONE: (FAX) ---------------- EMAIL: --------------------------------- golf@email.unc.edu PLACE OF EMPLOYMENT: ------ UNC JOB TITLE: --------------------------- student TOWNSHIP OF RESIDENCE: ---- Chapel Hill ZONE OF RESIDENCE: ------------ Does not apply SEX: ----------------------------------- Female ETHNIC BACKGROUND: --------- Asian DATE OF BIRTH: -------------------- 01/14/1984 LIST, IN PREFERENCE, THE BOARDS/COMMISSIONS ON WHICH YOU WOULD BE WILLING TO SERVE: 1: ---------------------- Board of Health 2. ------ Human Relations Commission 3. ------ Commission for Women Please list work, volunteer and educational experience. WORK EXPERIENCE: 1. Intern, 6/00-8/00, Southern Testing and Research Labs ('Wilson, NC), liaison between lab technicians and instrument operators and secretaries and group leaders, recording and assessing data, keeping track of new and used chemical reagnets, assisting with lab work, clerical work. VOLUNTEER EXPERIENCE: 1. Member of Youth for Elderly Service, Campus ~' (UNC), 8/O1-present; retirement home companion to elderly people at Carolina House retirement home.2. Carolina Cancer Focus Education and Fundraising Committees, 8/98-present3. AID-UNC (Association for India's Development) Co- Founder and Treasurer, 1/O1-present; organizing projects and upcoming SK race to raise awazeness and contribution to projects against poverty and illiteracy in the poorest parts of India.4. Peer Advisor at UNC, 8/O1- present5. volunteer switchboard operator, NCSSM, 8/99-5/00 communication skills6. Chemistry stockroom/lab assistant, 8/98-12/98; setting up labs and managing lab apparatus(volunteer service required of all students- NCSSM residential school- Durham, NC); organizational and technical skills7. Tour guide, 6/98-8/98, Imagination Station museum (Wilson, NC): clerical, communication skills EDUCATIONAL EXPERIENCE: 1. High School Diploma, North Cazolina School of Science and Math (Durham, NC), 6/5/002. pursuing BS degree in Biology or Biomedical Engineering, UNC-CI:[, 8/00- present, currently in sophomore year OTHER COMMENTS: I have done a lot of service that is non-health related and would really like to do something in the Health field. By submitting electronic application, applicant agrees to Ethics Guidelines and agrees to attend three-hour orientation.This form was submitted online, on Sun Jan 20 17:43:53 2002 Page 1 of 1 Catherine A. Gutmann VOLUNTEER APPLICATION ORANGE COUNTY ADVISORY BOARDS AND COMMISSIONS If you are an Orange County resident, at least 18 years old, and willing to volunteer your time and expertise to your community, please complete and submit this form. Name: Name Called: Home Address: Phone: (Day) Phone: (Evening) Fax: Email: Place of Employment: Job Title: Township of Residence: Zone of Residence: DR. CATHERINE A GUTMANN 117 WEATHERHILL POINTE CARRBORO, NC 27510 919 286 0411 919 967 2990 cggnp@yahoo.com DURHAM VA MEDICAL CENTER NURSE PRACTITIONER Chapel Hill Sex: Female Ethnic Background: Caucasian Date of Birth: 08/10/1940 Please list (in order of preference) the Boards/Commissions on which you would be willing to serve. 1. Board of Health 2. _______~_~_____ 3• WORK EXPERIENCE: MANY YRS TAUGHT COMMUNITY/PUBLIC HEALTH NURING AT THE COLLEGE LEVEL CURRENTLY A GERIATRIC NURSE PRACTITIONER AT THE DURHAM VA FOR THE PAST EIGHT YRS. VOLUNTEER EXPERIENCE: COMPEER PROGRAM-ORANGE COUNTY MENTAL HEALTH ASSOCIATION AIDS CAREGIVING TEAM CHAPEL HILL CARRBORO SCHOOLS MENTORING PROGRAM HABITAT FOR HUMANITY. EDUCATIONAL EXPERIENCE: BSN, MSN, MPH-MEDICAL CARE ORGANIZATION, DRPH-HEALTH POLICY AND ADMINISTRATION. OTHER COMMENTS: None listed. How did you become aware of Orange County volunteer opportunities? Other. If Other, how? BOARD MEMBER. By submitting electronic application, applicant agrees to Ethics Guidelines and agrees to attend three-hour orientation. This form was submitted online, on 6/27/03 12:38:35 p.m. is This space for office use only 3/21/2002 Page 1 of 2 Jeanette Holloman VOLUNTEER APPLICATION ORANGE COUNTY BOARDS AND CONIMISSIONS If you are an Orange County resident, at least 18 years old, and willing to volunteer your time and expertise to your community, please complete this application and return to: Orange County Commissioners' Off ce P.O. Box 8181 Hillsborough, NC 27278 Phone (919) 245-2125; 688-7331; 227-3031 FX (919) 644-0246 NAME: --------~----------------------- Jeanette Holloman HOME ADDRESS: ------------------ 203 Culbreth Park Drive CITY: ----------------------------------- Chapel HIII STATE: -------------------------------- NC ZIP CODE: ------------------------~-- 27516 TELEPHONE: (Home) -------------- 919 932-5165 TELEPHONE: (Work) --------- ------ 919 765-1158 TELEPHONE: (FAX) ---------------- EMAIL: --------------------------------- J_net69@yahoo.com PLACE OF EMPLOYMENT: ------ Blue Cross and Blue Shield of North Carolina JOB TITLE: --------------------------- Claim Specialist TOWNSHIP OF RESIDENCE : ---- Chapel Hill ZONE OF RESIDENCE: ------------ Does not apply SEX: ------------------------------ ------ Female ETHNIC BACKGROUND: --- ------ African American DATE OF BIRTH: -------------------- 12/19/1969 LIST, IN PREFERENCE, THE BOARDS/COMMISSIONS ON WHICH YOU WOULD BE WILLING TO SERVE: 1: ---------------------- Board of Health 2. ---------------------- Human Relations Commission 3. --------------------- Commissions for Women Please list work, volunteer and educational experience. WORK EXPERIENCE: 3 years of Health Insurance Experience in Customer Service and Claims . Educating customers and providers on claim process and insurance benefits. Problem solve difficut claims issue and reviewing grievance issues. Fostering the "teambuilding" philosophy by training new employees on company operations and focusing on customer satisfaction.3 years of providing customer service as a Desk Clerk for Chapel Hill Parks and Recreation. Monitor gym operations and provider information to the public on Chapel Hill Parks and Recreation activities. VOLUNTEER EXPERIENCE: 2 years as an Usher for White Rock Holiness Church. 1 year of volunteering for the BCBCNC Health Fair (proving health information to the community and other employees); 2 years as a SCORE Reprsentative for my department (BCBSNC); A new Member of the Toastmaster Club/New Blue Toastmaster; Volunteering for Girl Scout Troop, (Cookie Booth Sales) l3 EDUCATIONAL EXPERIENCE: North Carolina Central University, Bachelor Degree in Public Administration, December 2002. i 3/21/02 Page 2 of 2 _ :feanette Holloman OTHER COMMENTS: My goal is to better serve the public in health affairs. I would like to extend some of my experience in the health insurance field to better educate the public and come up with solutions to aid the public on their health concerns. How did you become aware of Orange County volunteer opportunities? List all that apply: County Web Site If other, how? By submitting electronic application, applicant agrees to Ethics Guidelines and agrees to attend three-hour orientation.This form was submitted online, on Thu Mar 21 20:51:33 2002 i~ This space for office use only 1/22/02 Page 1 of 1 Leslie A. Johns VOLUNTEER APPLICATI©N ORANGE COUNTY BOARDS AND COMMISSIONS If you are an Orange County resident, at least 18 years old, and willing to volunteer your time and expertise to your community, please complete this application and return to: Orange County Commissioners' Office P.O. Box 8181 Hillsborough, NC 27278 Phone (919) 245-2125; 688-7331; 227-3031 FX (919) 644-0246 NAME: ------------------------------- Leslie A. Johns HOME ADDRESS: ----------------- 106 Blue Granite Court CITY: ----------------------------------- Chapel Hill STATE: ------------------------- ------ NC ZIP CODE: ---------------------------- 27514 TELEPHONE: (Home) -------------- 919-967-3037 TELEPHONE: (Work) --------------- 919-942-8700 TELEPHONE: (FAX) --------- ------- EMAIL: --------------------------------- les,johns@msn.com PLACE OF EMPLOYMENT: ----- Blackman & Sloop, CPAs, P.A. JOB TITLE: --------------------------- CPA TOWNSHIP OF RESIDENCE: ---- Chapel Hill ZONE OF RESIDENCE: ----------- Does not apply SEX: ----------------------------------- Male ETHNIC BACKGROUND: --------- Caucasian DATE OF BIRTH: -------------------- 11251946 LIST, IN PREFERENCE, THE BOARDS/COMMISSIONS ON WHICH YOU WOULD BE WILLING TO SERVE: 1. Economic Development Council...2. Board of Health...3.ABC ....4. OWASA Please list work, volunteer and educational experience. WORK EXPERIENCE: CPA VOLUNTEER EXPERIENCE: Chair Finance Committee, Mercy High School, Burlingame, CA 7 years; Chair Building & Quality Committee, Mills-Peninsula Hospitals, Burlingame, CA, 10 years; Chair, Burlingame Community Education Foundation, Burlingame,CA, 3 years. EDUCATIONAL EXPERIENCE: B.S. Accounting, Long Island University, Brooklyn, NY 1969 OTHER COMMENTS: How did you become aware of Orange County volunteer opportunities? List all that apply: County Web Site If other, how? By submitting electronic application, applicant agrees to Ethics Guidelines and agrees to attend three-hour orientation.This form was submitted online, on Tue Jan 22 11:19:50 2002 !5 Paae 1 of 1 Kim Walsh VOLUNTEER APPLICATION ORANGE COUNTY ADVISORY BOARDS AND COMMISSIONS If you are an Orange County resident, at least 18 years old, and willing to volunteer your time and expertise to your community, please complete and submit this form. Name: Name Called: Home Address: Phone: (Day) Phone: (Evening) Fax: Email: Place of Employment: Job Title: Township of Residence: Zone of Residence: Dr. Kim Walsh 3522 Bluestone Court Chapel Hill, NC 27514 (919) 732-460 (919) 732-460 kwalsh6@earthlink.net Blue Cross and Blue Shield of North Carolina Assistant State Health Plan Medical Director Eno Sex: Female Ethnic Background: Caucasian Date of Birth: 04/16/1960 Please list (in order of preference) the Boards/Commissions on which you would be willing to serve. 1. Board of Health. 2 ........................... 3..................................... WORK EXPERIENCE: 05/27/03-08/31/03 Independent Contractor, writing local public health bioterrorism response plan Alamance County Health Department Burlington, NC. 9/2002-Present Assistant State Health Plan Medical Director Blue Cross and Blue Shield of North Carolina Durham, NC. 8/2002-Present Faculty Member/Small Group Leader,The Practice Course Duke University Medical Center Durham, NC. 3/2001-12/2001 Medical Director Durham County Health Department Durham, NC. 6/1992-2/2001 Medical Director Alamance County Health Department Burlington, NC 6/91- 6/92 Public Health Physician Wake County Department of Health Raleigh, NC. 6/91-9/91 Contract Physician Alamance County Health Department Burlington, NC. 6/91-8/91 Per Diem Physician Kaiser Pennanente Durham, NC. VOLUNTEER EXPERIENCE: Participated in following groups as representative of .Alamance County Health Department: Member, Executive Cancer Committee 5/94-2/01; Alamance Regional Medical Center Member, Advisory Board 5/96-1998; Alamance Minority Cancer Awareness Program Member, Health Advisory Council 1/97-2/01; Alamance-Burlington School System Co-chair, Alamance Child Asthma Coalition 4/99-2/01. EDUCATION: 1988-1991 Family Medicine Residency Training Duke-Watts Family Medicine Program Durham, NC. 1983-1987 Doctor of Medicine (MD 12/87) Duke University School of Medicine Durham, NC. 1985-1986 Masters of Public Health (MPH 09/86) University of North Carolina School of Public Health Department of Maternal and Child Health Chapel Hill, NC. 1978-1982 Bachelor of Arts, English Literature (AB 06/82) Dartmouth College Hanover, NH. OTHER COMMENTS: Full, unrestricted North Carolina Medical license. Diplomate of American Board of Family Practice. Participant at Cunty Board of Health meetings as Health Department representative: Alamance County 1992- 2001 and Durham County 2001. How did you become aware of Orange County volunteer opportunities? Current Orange County Volunteer If Other, how? By submitting electronic application, applicant agrees to Ethics Guidelines and agrees to attend three- hour orientation. This form was submitted online, on 6/11/03 9:45:31 PM FOR OFFICE USE ONLY ~ ~ ~. Glenn u~~ls VOLUNTEER APPLICATION ORANGE COUNTY ADVISORY BOARDS AND COM 1~ i i .., . c... ..~....r----- -'- -+~R ~2 s ~:.: ~ ~. if you are an Orange County resident, at least 18 years old, and willing to volunteer your time and expertise to your community, please complete this application and return to: NAME: U: Orange County Board of Commissioners' Office P.O. Box 8181 Wilisborough, NC 27278 Phone (919) 245.2125; 245-2129; 245-2130; 732-8181 Fax: (1919) 644-0246 • Email: npaciga@co.orange.nc.us vl ~ i ~ S~ v ~1 HOME ADDRESS: ~ ~ ~ v ~a ~ `+~~ ~ ~- ._ .. _ -- ~7 / ..--~ - CITY: ~ Zip Code: ~ / S~f ~ // PHONE: (Day) ~/ V (Evening/late) ~ `S`3t _(Fax) EMAIL: e'~ ~, ` / PLACE EMPLOYMENT: ~1 yG G~r JOB TITLE: iN ORDER TO ASSURE COUNTYWIDE REPRESENTATION PLEASE I KATE YOUR TOWNSHIP OF RESIDENCE: O Bingham O. Cheeks Q i-Bllsborough O Eno- Chapel Hill ~' L~ttle~Ziver ~ O Cedar Grove- ~ -- - ~ ~- IN ADDITION, PLEASE INDICATE IF YOU LIVE IN ONE OF THE FOLLOWING AREAS: ©Joint Planning Area O Extraterritorial Area O Transition Area WE ASK YOUR HELP IN ASSURING DIVERSITY OF_411EMBERSHIP BY AGE, GENDER AND RACE, BY ANSWERING THE FOLLOWING 4UESTIO.NS: (~ Male O Female ETHNIC BACKGROUND: O African American ~aucasian O Hispan c O Native American O Other ATE OP BIRTH: ~ ~ PLEASE LIST (IN ORDER OF PREFERENCE) THE BOARDS/COMMISSIONS ON WHICH YOU WOULD 8E WILLING TO SERVE. /~ ~,~ ~ ._ __..._. _,_. - ~ ~- --_-_- --/ ~~~ VOLUNTEER EXPERIENCE: 17 FOR OFFICE USE ONLY 3-Z~-oZ - P.:~2 oF"2 ~E~nn Wils~ EDUCATION: ~l '~'~ . ~ ~ ~ ETHICS GUIDELINES FOR COUNTY ADVISORY BOARDS AND COMMISSIONS I agree by my signature below that, if appointed, I pledge to comply with the following ethics guidelines for advisory boards and commissions as adopted by the Orange County Board of Commissioners. Members of advisory boards and commissions shall not discuss, advocate, or vote on any matter in which they have a conflict or potential conflict of interest or an interest which reasonably might appear to be in conflict with the concept of fairness in dealing with public business. A conflict of interest or a potential conflict occurs if a member has a separate, private, or monetary interest, either direct or ~~ - ~- ~ - ~~ mai~ec`~; in anyissTfe o~ ~rans~n~ untie~'aCrt~da't~ati-ol~:~~-A~~nsembeTVOtTo~violi~tes-this~provisiorr may ~ -~ - be subject to removal from the board or commission. If.an advisory board or commission member believes he/she has a conflict or potential conflict of interest on a particular Issue, then that member should state this belief to the other members of his/tter respective advisory board or commission during the board or commission's public meeting. The member should state the nature of the conflict, detailing that he/she has a separate, private, or monetary interest, either direct or indirect, in the issue ar transaction under consideration. The member should than excuse himself/herself from considering and voting on the matter. In cases where an advisory board or commission member declares a conflict or potential.eonflict of interest, the member shall excuse himself/herself from the board table/voting area until ail discussion, --- Y . - _J. con'sine`r',~rttfvottng-is-cor~°~pieEed•~#be-r~atteFia quest.~.~__._. .--_---- - --- - __ ,...~. Any advisory board or commission member having questions or needing assistance regarding the interpretation of these ethics guidelines or other conflict of interest matters should contact the administrative staff for the respective board ar commission. Staff will assist the member with questions and interpretations and may provide a recommendation on whether or not the advisory board or commission member should excuse himself/herself from voting. The member may request that the staff respond in writing. Staff may contact the County Manager for any additional assistance. If appointed, I agree to attend athree-hour orientation which will give an overview of how Orange County Government operates and its relationship' to other governmental units. ~ z ~~ Date volAZ5K3:a~r~C7N; H:\_.VOUwPL.ooC How did you become aware of Orange County volunteer opportunltles4 (Please check all that apply): O Newspaper O County Web Page , O Current Oran Coun Voluntee~ O Radio O T.V. Other ~~