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N.C. Department of Environment, Health and Natural Resources PageLof 5 <br /> Division of General Services FY 1994-95 <br /> CONTRACT ADDENDUM <br /> Women's Preventive Health Branch 95 51510 068 <br /> Office, Section, or Branch Contract Number <br /> Orange .Family Planning ' <br /> Contractor Activity <br /> (c) Limited revisits include reason for visit, method specific history, <br /> weight, blood pressure and education and counseling if indicated. <br /> 8. The following tests will be obtained on all initial or complete visits and <br /> documented in the medical record: <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 <br /> complete visits in the presence of a positive gonorrhea culture <br /> or on other visits as indicated by the clinician). Note: HIV <br /> testing is recommended in the presence of a positive syphilis <br /> serology. <br /> 9. Immunity Assessment for Rubella & Tetanus-diphtheria will be <br /> documented in the patient's record on all initial and complete visits: <br /> (a) Rubella assessment`includes documentation of Rubella vaccine or <br /> laboratory test indicating immunity. Once immune, no future <br /> assessments are needed. If no documentation of vaccine or <br /> immunity, Rubella vaccine is given to non-pregnant clients (see <br /> Medical Guidelines). <br /> (b) Tetanus-diphtheria assessment includes documentation of Tetanus- <br /> diphtheria vaccine. <br /> Assessment on complete visits is not required if TD vaccine was given and <br /> documented within the last ten years. If no documentation, Td vaccine <br /> should be given (See Medical Guidelines). <br /> Reviewed by <br /> DEHNR 3300 (Revised 2/'94) A<-5 _ � ?--cj <br /> General Services Division(Review 1/95) Initials Date <br />