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b. To provide necessary parental permissions, information for the Eligibility Determination <br />forms, and the Medical and Dental Histories for each child prior to that child undergoing <br />treatment. OCHS/EHS will bring all signed forms on the day of service. <br />c. To provide CAP-H.S.S.-30 forms pertaining to dental health and will make the completed <br />form a part of the child's permanent OCHS/EHS record. <br />d. To obtain a copy of each child's Medicaid card or other dental insurance and bring a copy to <br />the OCHD on the scheduled day of service. <br />9. In the event that enrollment in OCHS/EHS program ceases or is significantly reduced during the <br />term of this agreement, OCHS/EHS may terminate this agreement upon 30 days notice and OCHD <br />will return a pro rata share of the payment for services not provided (approximately $100 per enrolled <br />child for those children whose dental work has not been started). <br />10. The parties agree that there shall be no unlawful discrimination based upon race, color, ancestry, <br />religion, sex, age, disability or veteran status. <br />11. The parties agree to abide by HIPAA regulations in the sharing of protected health information. <br />12. The term of this initial Agreement is for a period of one year commencing on the 1st day of July, <br />2004 and terminating on the 30th day of June, 2005. This agreement shall be renewable by written <br />agreement signed by the official representatives of the parties. Either party may terminate this <br />Agreement after providing thirty (30) days notice. <br />13. The parties agree to the full and complete performance of the mutual covenants contained herein <br />and that this Agreement constitutes the sole, full and complete agreement by and between the <br />parties; and no amendments, changes, additions, deletions or modifications to or of this Agreement <br />shall be valid unless reduced to writing, signed by the parties and attached hereto. <br />14. This agreement shall be governed by the laws of the State of North Carolina. <br />