2011-262 Health - Wake Radiology Diagnostic Imaging, Inc. - Agreement for X-Ray Services for OCHD patients

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STATE OF NORTH CAROLINA ORANGE COUNTY July 1, 2011—June 30,2012 AGREEMENT FOR X-RAY SERVICES FOR ORANGE COUNTY HEALTH DEPARTMENT (OCHD) PATIENTS The following are procedures to be used in providing x-ray services to Orange County Health Department referrals: 1. Wake Radiology Diagnostic Imaging, Inc.will provide a PA chest x-ray and written interpretation for OCHD referred patients without active TB symptoms. a. The patient does not need an appointment, but needs to present to Wake Radiology during regular business hours. b. The patient must bring a current completed chest x-ray voucher from OCHD. c. A PA chest x-ray will be taken, developed, and read. d. A two view chest x-ray if ordered will be taken, developed, and read. e. A written interpretation of the chest x-ray will be mailed to: Orange County Health Department 2501 Homestead Road Chapel Hill, NC 27516 Attn: Sue Rankin, R.N. f. The x-ray and voucher will be maintained in the office of Wake Radiology. g. The patient will not be charged for the x-ray. OCHD will be billed at a fee of$62.00 per single view chest x-ray(71010) and $80.00 for a two view chest x-ray(71020). The bill will be sent to: Orange County Health Department P. O. Box 8181 Hillsborough, NC 27278 Attn: Sue Rankin, R.N. This agreement is to be in effect from July 1, 2011 through June 30, 2012 and is renewable annually. 7 � Dorothy Cilenti, Dr H, Interim Health Director Dat Orange County Health Department `"7 �;L!be Roberf E. Schaaf, MD(, President Date Wake Radiology Diagnostic Imaging, Inc. Clarence Grier Date Orange County Finance Director Orange County Finance Director "This instrument has been pre-audited in the manner required by the Local Government Budget and Fiscal Control Act."