Agenda - 04-20-1993 - III-A - Laserfiche WebLink

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• N.C. Department of Environment, Health, and Natural Resources page 2 of 2 Division of General Services FY 1993-1994 - CONTRACT ADDENDUM Children and Youth Section 93-5323-068 Office, Section, or Branch Contract Number Orange County Health Department Children's Special Scoliosis Clinic Health Services Contractor Activity CLINICAL SECTION Persons enrolled in a CSHS Clinic will be provided the following services as documented in their medical records and in accordance with CSHS Clinical Guidelines. 1. An estimated * % will receive a health history which includes the following components: present problem, past medical history, developmental history, caregiving history/status, nutrition history and family history. 2a. An estimated * % will receive at each visit a review of systems pertinent to the problem which includes the following components: head, skin, eyes, ears, mouth, throat, neck, respiratory, cardiovascular, gastrointestinal, skeletal and neuromuscular. Applies to Orthopedic, Neurology, Cardiology, Neuromuscular, and Myelodysplasia Clinics. 2b. An estimated N/A % will receive at each visit a review of systems pertinent to the problem which includes the following components: head, ears, mouth, throat and neck. Applies only to Speech and Hearing Clinics. 3. An estimated * % will receive the following health related assessments: behavior, medications, immunization, and nutrition/growth. 4. An estimated 100 % will receive at each visit a pertinent physical examination and blood pressure as indicated. One-time per year year scoliosis clinic, 100% of patients will receive a pertinent examination without blood pressure. 5. An estimated N/A % of children who have special needs related to appliances, equipment and supplies will be assessed and these needs will be addressed in the plan of care. 6. An estimated 100 % will have a written diagnosis. 7. An estimated 100 % will have a plan of care. 8. An estimated N/A % will receive diagnostic tests as indicated in the plan of care. 9. An estimated N/A % will receive treatment services as indicated in the plan of care. All patients are referred for treatment. 10. An estimated 100 % will receive follow-up of missed appointments. 11. An estimated 100 % will receive follow-up of treatment and referral recommendations. 12. An estimated 100 % will have documentation of summary clinic notes sent to referral sources and appropriate providers. 13. An estimated 100 % will have education and counseling provided for each diagnosis and for prescribed treatment. _N/A, one time per year scotinsisclinic. it corthract addendum for Children's Special Health Serivices includes information pertaining to the annual scoliosis clinic. are unable to complete the form in its entirety due to the uniqueness of our one-time per Reviewed by ar clinic and have made notations when necessary. Please callus if you have any questions,,,,yy�l ' DEHNR 3300 (Revised 2/90) on our submitted addendum. It�1 A ��3 General Services Division (Review 1/95) Initials Date