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N.C. Department of Environment, Health, and Natural Resources Page 4 of 4 <br /> Division of General Services FY 1993-94 <br /> CONTRACT ADDENDUM <br /> Women's Preventive Health Branch 94-5155-068 <br /> Office, Section, or Branch Contract Number <br /> Orange Co. Health Department Family Planning <br /> Contractor Activity <br /> (d) Breast self examination was taught or education reviewed. <br /> (e) Minors under 18 years of age were counseled about the <br /> importance of discussing birth control needs with parent(s) <br /> and minor signs foul'. <br /> (f) Information about emergency and after-hour services was provided. <br /> 13. Method specific consent form was reviewed with client, dated, signed by <br /> client, and copy given to client. <br /> (a) Consent forms are updated and resigned with any change in <br /> method, or change in prescription of same method. <br /> (b) Any individual risk to contraceptive method was identified on <br /> the method specific consent form. <br /> 14. Screening, Diagnosis, Treatment and Follow-up Services <br /> There is evidence in the record that: <br /> (a) Significant problems are identified and documented. <br /> (b) Problems, conditions and abnormal findings are appropriately <br /> followed. <br /> (c) There is evidence that clinical and laboratory findings were <br /> discussed with client. <br /> 15. The highest level provider of care on all Initial and Complete Visits for <br /> oral contraceptive, IUD, NorpIant and Depo Provera users was a physician <br /> or physician extender (nurse practitioner, CNM or physician assistant). <br /> Reviewed by <br /> DEHNR 3300 (Revised 2/93) C7 4---)3/ .3 <br />