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Lee Werley made reference to the primary care services. It is identified in the community assessment. The services will start with people the Health Department is already dealing with in the clinics. It will be mainly at the Whitted Building. The proposal is very conservative and the majority of the cost will be lab work and pharmaceuticals. The investment would be approximately $44,000 the first year. The community has asked for this and he thinks the staff can take it on initially and work on it the first year. They would like to have this approved and started by January 1, 2005. The services could be expanded in time. Tim Carey said that he thought this was a great idea because the risk is very limited and they would be working with existing patients. Lee Werley said that he thinks this will improve the health outcomes of the vulnerable population. John Link made reference to the nurse practitioner position and asked, when it comes to primary care, how far a nurse practitioner can go and at what point the patient has to be referred to a physician. Tim Carey said that all nurse practitioners in the state work under a joint board and there are explicit conditions. His guess is that 95% can be managed by nurse practitioners. Wayne Sherman said that there is a medical director on staff, who would be consulting with the nurse practitioners on a regular basis. Commissioner Halkiotis asked far someone to speak to the increase in cost of pharmaceuticals. Lee Werley said that the cost would be around $17,000. They will be able to get special federal health pricing because it is the Health Department. They will still use the sliding scale for patients to pay for the drugs. Most of the people are on the lower end of the scale. Health Director Rosemary Summers said that the committee and staff developed a basic set of drugs that would be offered in-house. She said that 90-95°~ were all generic drugs. Commissioner Carey asked how they would charge for the prescriptions. Wayne Sherman said that there would be a minimum $3 fee for in-stock medications and then there is the sliding scale. This is the same as the Medicaid minimum charge. Rosemary Summers said that they have heard from the community that they would prefer to have these services at the Health Department. Commissioner Brown said that she does not understand specifically what medical services will be provided. She asked for more specific information. Healthy Carolinians Coordinator Maria Hitt said that they get calls all the time for mammograms and pap smears. Wayne Sherman said that in primary care, a patient would have to be enrolled and it would not be a drop-in service. Commissioner Brown asked about a sliding scale and haw they get payment.