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N.C. Departrnent of Environment,Health and Natural Resources Page 4 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 Planning <br /> Contractor Activity <br /> b. Client received additional information specific to the contraceptive method(s) <br /> to be used. <br /> c. Education in HIV infection and AIDS including counseling on risk assessment, <br /> HIV prevention and how to get tested (on site or referral) was provided. <br /> d. Breast self examination was taught or education reviewed. <br /> e. Required education offered outside the family planning clinic is assessed and <br /> documented and updated as appropriate according to the needs of the individual <br /> family planning patient. <br /> f. There is evidence that significant abnormal clinical and laboratory findings <br /> were discussed with client. <br /> 10. Method specific consent form was reviewed with client, dated, signed by <br /> client, and copy given to client. <br /> a. A new consent form is signed with any change in method. <br /> b. Any individual risk to contraceptive method was identified on the method <br /> specific consent form. <br /> c. Minors under 18 years of age were counseled about the importance of <br /> discussing birth control needs with parent(s) and minor signs form. <br /> d. Information about emergency and after-hour services was provided. <br /> 11. Screening, Diagnosis, Treatment and Follow-up Services <br /> There is evidence in the record that: <br /> a. Significant problems are identified and documented. j <br /> b. Problems, conditions and abnormal findings are appropriately followed. <br /> Reviewed by <br /> DEHNR 3300 (Revised 2/95) r —S �' /3_ �7 3 <br /> General Services Division (Review 9195) Initials Date <br />