2006 S Health - Renewal with Chapel Hill Training & Outreach, Inc. & Health Department for Dental Services for Head Start

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5. OCHD will complete the CAP-H.S.S.-30 forms pertaining to dental health and return the forms to OCHS/EHS to be made a part of the child's permanent Head Start record. 6. OCHD will file for Medicaid/other third party insurance plans for reimbursement when necessary (OCHS/EHS is not a health provider, therefore cannot file). 7. OCHD will submit a bill to Angela Wilcox, Director, OCHS/EHS, in the amount of $10,000 on an annual basis. OCHS/EHS agrees to pay the OCHD in two installments, $5,000 by December 31, 2006 and the remaining $5,000 by June 30, 2007, upon receipt of OCHD original invoice. The check should be made payable to Orange County Health Department and mailed to Letitia Burns, Central Administrative Services Director, PO Box 8181, Hillsborough, NC. 8. OCHS/EHS agrees as follows: a. To transport no more than 5-10 children to be scheduled at least every other week on a block basis and to provide adequate supervision in the waiting room. OCHS/EHS shall be responsible for obtaining and maintaining adequate automobile liability insurance as required by law and if requested will furnish to the County certificates of such insurance. b. To arrive for the scheduled appointments on-time with all children scheduled for that day. OCHS/EHS shall be responsible for re-scheduling any appointments unable to be met at least 24 hours in advance. b. To provide necessary parental permissions, information for the Eligibility Determination forms, and the Medical and Dental Histories for each child prior to that child undergoing treatment. OCHS/EHS will bring all signed forms on the day of service. c. To provide CAP-H.S.S.-30 forms pertaining to dental health and will make the completed form a part of the child's permanent OCHS/EHS record. d. To obtain a copy of each child's Medicaid card or other dental insurance and bring a copy to the OCHD on the scheduled day of service. 9. In the event that enrollment in OCHS/EHS program ceases or is significantly reduced during the term of this agreement, OCHS/EHS may terminate this agreement upon 30 days notice and OCHD will return a pro rata share of the payment for services not provided (approximately $100 per enrolled child for those children whose dental work has not been started). 10. The parties agree that there shall be no unlawful discrimination based upon race, color, ancestry, religion, sex, age, disability or veteran status. 11. The parties agree to abide by HIPAA regulations in the sharing of protected health information. 12. The term of this initial Agreement is for a period of one year commencing on the 1st day of July, 2006 and terminating on the 30th day of June, 2007. This agreement shall be renewable by written agreement signed by the official representatives of the parties. Either party may terminate this Agreement after providing thirty (30) days notice. 13. The parties agree to the full and complete performance of the mutual covenants contained herein and that this Agreement constitutes the sole, full and complete agreement by and between the parties; and no amendments, changes, additions, deletions or modifications to or of this Agreement shall be valid unless reduced to writing, signed by the parties and attached hereto. 14. This agreement shall be governed by the laws of the State of North Carolina.