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N.C. Department of Environment,Health and Natural Resources Page 3 of 5 <br /> Division of General Services FY 1995-96 <br /> CONTRACT ADDENDUM <br /> Women's Preventive Health Branch 96 51510 068 <br /> Office, Section, or Branch Contract Number <br /> Orange Family Planninq <br /> Contractor Activity <br /> 7. The following tests will be obtained on all initial or complete visits and <br /> documented in the medical record unless a normal result has been obtained in <br /> the last six months: <br /> a. Hematocrit or hemoglobin <br /> b. Urinalysis for sugar and protein <br /> c. Pap smear <br /> d. Gonorrhea culture <br /> e. Syphilis Serology (required on initial visits, required on complete visits in the <br /> presence of a positive gonorrhea culture or on other visits as indicated by the <br /> clinician). Note: HIV testing is recommended in the presence of a positive <br /> syphilis serology. <br /> 8. Immunity Assessment for Rubella & Tetanus-diphtheria will be documented in <br /> the patient's record on all initial and complete visits: <br /> a. Rubella assessment includes documentation of Rubella vaccine or laboratory <br /> test indicating immunity. Once immunity is documented, no future assessments <br /> are needed. If no documentation of vaccine or immunity, Rubella vaccine is <br /> given to non-pregnant clients (see Medical Guidelines). <br /> b. Tetanus-diphtheria assessment includes documentation of Tetanus-diphtheria <br /> vaccine. Assessment on annual visits is not required if Td vaccine was given <br /> and documented within the last ten years. If no documentation, Td vaccine <br /> should be given (See Medical Guidelines). <br /> 9. Education and Counseling: <br /> a. Client received information on all contraceptive methods and their risks and <br /> benefits (including natural family planning and abstinence for teens). See <br /> Medical Guidelines. <br /> Reviewed by <br /> DEHNR 3300 (Revised 2/95) <br /> General Services Division (Review 9/95) Initials ' Date <br />