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DocuSign Envelope ID:5F2A6749-5668-4688-B470-4D344E4C961 F <br /> iv Provide proof of current influenza(flu)vaccine-. <br /> v. Unless otherwise provided, proof of immunization must take the form <br /> of one of the following: Provider's immunization record or medical <br /> record signed by a representative of the Provider's healthcare practice In <br /> either case both the Provider's name and the date of immunization must <br /> be present Only vaccines approved by the Centers for Disease Control <br /> and Prevention (www,ede.gov/flu/protect/vaccine/vaccines htrn) will be <br /> accepted The provider is responsible far the costs associated with <br /> acquiring the vaccination. <br /> Add sentence to end of 5 2 ii. <br /> Exception: "Family" Refugee Health Assessment (communicable disease and/or <br /> physical exam) appointments with 3 or more family members will only be <br /> reimbursed for a total of two (2) hours in the case of same day cancelled <br /> appointments OCHD will not reimburse the Provider if an appointment is <br /> cancelled with more than 24 hour notice <br /> Replace 5 b iii with the following <br /> Cancelled Appointments. In the event of a cancelled appointment,the Interpreter is <br /> required to stay until relieved of duty by the nurse supervisor or the individual in <br /> charge of clinical operations. OCHD staff may require other interpreter-related <br /> services in place of the scheduled appointment As stated above, the Provider may <br /> submit an invoice in the event of a cancelled appointment (with less than 24 hour <br /> notice) <br /> Revised 06115 <br /> 12 <br />