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DocuSign Envelope ID:CD6526B8-31F8-4494-98D6-FFE6244E4DOF <br /> Health Department(hereinafter referred to as"OCHD") <br /> Additional Terms and Conditions <br /> These are additional terms and conditions to the Agreement between Orange County and the <br /> (PROVIDER)to the Countywide ASL Interpteter Translator Contract of$15,000 or less The <br /> additional terms and conditions shall supersede any terms in the original contract and are her eby <br /> incorporated as follows: <br /> Add to Section 2 b <br /> vi The Provider is required to sign the OCHD Conditions of Contract <br /> Statement containing the confidentiality, Title X and public health activities <br /> in emergency situations information which is hereby incorporated by <br /> reference <br /> Add to Section 2 di 3 the following sentence: <br /> The Provider should generally instruct clients to call the Health <br /> Department front desk staff or the Spanish voicernail line at 644-3350 <br /> (when language appropriate) to schedule an appointment of to inquire <br /> about services <br /> Add Section 2 e <br /> e Medical Documentation. Prior to beginning work,the Provider is required to: <br /> i Provide proof of immunity to varicella, measles, mumps and rubella Proof <br /> of immunity must be one of the following: medical records diagnosing the <br /> disease, laboratory records confirming the disease, laboratory records <br /> documenting positive disease titers, or medical records documenting receipt <br /> of 2 doses of each vaccine (Exception: If the Provider has documentation <br /> of only one dose of vaccine, the Provider must provide documentation of a <br /> second dose within 60 days of the first day of contract work) <br /> ii Provide proof of a TB screening and results to OCHD The screening can <br /> be one of the following: <br /> 1 Receipt of a TB skin test(ISI)if the Provider has no history of TB <br /> infection/disease or of a positive IS I (Note: If the Provider has not <br /> had an additional IST within the previous 12 months, a second I S I <br /> will be required one week after the first to establish an accurate <br /> baseline) <br /> 2 Completion of a TB Screening Form by a medical provider if the <br /> Provider has a history of TB disease of of having a positive TST. <br /> iii Provide proof of Idap vaccine <br /> iv.Provide proof of current influenza(flu)vaccine <br /> Revised 06115 6 <br />