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DocuSign Envelope ID: B8F76F11-8DOD-43D5-8654-06F0031808EC <br /> EXHIBIT "A" <br /> Scope of Services--FY 2015-16 <br /> Outside Agency Performance Agreement <br /> Agency Name: Piedmont Health Services,Inc. <br /> Program Name: Carrboro Community Health Center Patient-Centered Primary Care Home <br /> Funding Award: $10,000 <br /> Outline how the agency will spend Orange County's funding award. <br /> Expense Description Amount <br /> Provider salary support for uncompensated medical and dental care at the Carrboro $10,000 <br /> Community Health Center. <br /> Program Services <br /> For assistance with this or the following section, please reference the Exhibit A instructions and example, located within the <br /> contract and reporting memorandum, Outline the major activities the agency will employ to attain the Anticipated Outcomes <br /> below,by June 30,2016. <br /> • The HRSA Bureau of Primary Health Care defines a health center patient as an individual who <br /> receives a visit from a licensed independent provider. In the case of PHS, this includes <br /> individuals making a medical and/or dental primary care visit at one of our health center sites. <br /> Our other services (e.g. case management, pharmacy, nutrition) are provided as an enhancement <br /> to the provider visit. Thus, the primary care visit (medical or dental) is the appropriate unit of <br /> service for Carrboro Community Health Center. <br /> • i <br /> Anticipated Outcomes <br /> The Anticipated Results column must include quantifiable results in the form of number of persons/units served within Oranize <br /> County, only (all Towns and municipalities), if you use percentages, you must also provide the total number of participants <br /> within that measure's description or for an earlier performance measure. <br /> Performance Measures Anticipated <br /> Results <br /> Residents of Chapel Hill/Carrboro/Orange County will receive primary care services 3,400 <br /> (medical and dental) at the Carrboro Community Health Center unuplicated <br /> patients <br /> DocuSigned by: <br /> a aSbin, CFO /24/2015 <br /> 1246181904C145A... <br /> i <br /> Certified by: Title: -� Date: <br /> �..� <br /> rovider's Signature) <br />