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Coniract ?! L8607fi- I Oh <br />North Carolina Baptist (iospihtl <br />Federal Tax Id. <br />Contract # 68-1015 <br />ATTACHMENT B -Scope of Work <br />A. CONTRACTOR INFORMATION <br />1. Contractor Agency Name: North Carolina Baptist Hospital <br />2. If different from Contract Administrator Information in General Contract: <br />Address <br />Telephone Number: 336-716-8404 Fax Number: 336-716-8401 Email: ifrye(a;wjuh~ne.edu <br />3. Name of Program (s): Quantitative Interdisciplinary Evaluations (QIE) <br />4. Status: ( )Public (X) Private, Not for Profit OPrivate, For Profit <br />5. Contractor's Financial Reporting Year: July -June <br />B. Explanation of Services to be provided and to whom (include SIS Service Code): <br />Provider shall provide services to Contracting Agency in the following manner: <br />Quantitative Interdisciplinary Evaluations (QIE) up to five (5) per month. <br />Contractor will notify the County immediately of any no show and will consult with the Community <br />Employment Case Manager andlor the Human Resource Placement Specialist in preparation for the <br />QIE. There will be no no-show fee for not keeping an appointment. No appointments will be <br />rescheduled for a patient who cancels within 24 hours more than 2 times, or for a patient that is a no <br />show more than 1 time. <br />Contractor will document the outcome of the QIE in a format acceptable to the Social Security <br />Administration and /or other Service/Medical agency. Said documentation will be forwarded to the <br />County within 5 business days of the QIE. <br />Contractor agrees to meet with the participant and Community Employment Case Manager/Human <br />Resource Placement Specialist at the end of the QIE to discuss findings and recommendations. <br />County agrees to notify Contractor if patient agrees to follow-up appointments. <br />Compensation: County agrees to compensate Contractor at the rate of $300.50 per hour. Total cost of <br />this agreement shall not exceed fifteen thousand ninety-six dollars ($15,096.00). County agrees to give <br />a 24-hour prior notification of any known cancellations. <br />Invoice/Payment: Contractor shall submit an invoice to County by the fifth (5`h) business day of the <br />month following provisions of the services. County shall provide payment to Contractor within two (2) <br />weeks of receipt of the invoice. <br />Contract-General (06/04) Page 9 of 19 <br />