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6 <br /> establish a fee of $20 per vaccine which associated covers excluding the administration <br /> fee. <br /> I-693 Form Completion: <br /> Immigrants who are attempting to adjust their immigration status must have a Report of <br /> Medical Examination and Vaccination Record Form (1693) completed as required by the <br /> U.S. Citizenship and Immigration Services Agency of the Department of Homeland <br /> Security. <br /> This form can only be completed by medical providers who have been approved to do <br /> so. The form serves as verification of required vaccines needed for the adjustment of <br /> immigration status, and takes an additional 25-30 minutes to complete. <br /> HIB Vaccine & Kinrix Vaccine: <br /> These vaccines were provided at no charge by the state in the past. Subsequently, the <br /> Health Department never purchased them, and thus did not have a need to establish a <br /> charge. However due to vaccine shortages and projected changes in the availability of <br /> free vaccine from the state, we anticipate the need to purchase these vaccines beginning <br /> this fiscal year. We are requesting to establish a charge in order to cover our costs <br /> associated with the provision of the vaccines. <br /> Tobacco Use Cessation Counselinq: <br /> Tobacco use cessation counseling is currently being provided by nursing staff during <br /> scheduled office visits. In order to cover costs associated with the counseling sessions <br /> we are requesting to charge the maximum Medicaid allowable reimbursement rate. <br /> The Board of County Commissioners amends the FY 2012-13 County Fee Schedule to <br /> include the above mentioned new fees in the Health Department. <br /> Efland Volunteer Fire Company, Inc. <br /> 11.At its September 18, 2012 meeting, the Board of County Commissioners approved the <br /> Financing Arrangement for Efland Volunteer Fire Company, Inc. to purchase a Fire <br /> Engine truck, as well as an appropriation of $45,000 from the department's unassigned <br /> fund balance to help with the purchase of the truck. With this appropriation, <br /> approximately $5,000 remains in their County-held fund balance. This budget <br /> amendment provides for the budgeting of this $45,000 appropriation within the Fire <br /> District Fund. (See Attachment 1, column 7) <br /> FINANCIAL IMPACT: Financial impacts are included in the background information above. <br /> RECOMMENDATION(S): The Manager recommends the Board of County Commissioners <br /> approve budget, grant, and capital project ordinance amendments for fiscal year 2012-13. <br />