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Contract#68-2004 <br /> Personalized Patient Home Assistance,Inc. <br /> ATTACHMENT B <br /> SCOPE OF WORK <br /> Orange County Department of Social Services County Department on Aging <br /> Federal Tax Id. or SSN 56-1629016 <br /> Contract# 68-2004 <br /> A. CONTRACTOR INFORMATION <br /> 1. Contractor Agency Name:Personalized Patient Home Assistance, Inc. <br /> 2. If different from Contract Administrator Information in General Contract: <br /> Address <br /> Telephone Number: Fax Number: Email: <br /> 3. Name of Program(s): In-Home Services <br /> 4. Status: ( ) Public ( )Private,Not for Profit (X)Private,For Profit <br /> 5. Contractor's Financial Reporting Year July 1, 2010 through June 30, 2011 <br /> B. Explanation of Services to be provided and to whom(include SIS Service Code): <br /> The Contractor will provide employees to perform in-home services for the <br /> Department of Social Services' clients and the Department on Aging's clients, at the <br /> level amount and frequency specified by the social worker in the In-Home Aide Services <br /> Plan (SIS Code 042) The Contractor will provide Level 1I Home Management and <br /> Level III Personal Care The Contractor is required to meet all goals and outcomes listed <br /> in Attachment N. <br /> C. Rate per unit of Service (define the unit): <br /> 1. If Standard Fixed Rate, Maximum Allowable, (See Rates for Services Chart) <br /> $14.40/hour <br /> 2. Negotiated County Rate. <br /> D.Number of units to be provided: <br /> E. Details of Billing process and Time Frames; The County will reimburse the Contractor <br /> for services described in this contract up to the budgetary limits of the contract allotment. <br /> The County will reimburse the Contractor at a rate of$14.40/hour for approved services <br /> provided For reimbursement the Contractor must submit an original and two copies of <br /> an invoice by the fifth of the month for the receding month's expenditures to the <br /> designated County Administrator. All invoices for the provision of services to the <br /> Contract-Scope of Work(06/04) Page lof 2 <br />