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DocuSign Envelope ID: 167F763C-D16E-41D3-B98F-F5E24EE9CC37 <br /> Division of Public Health <br /> Agreement Addendum <br /> FY17-18 <br /> Page 1 of 2 <br /> Women's and Children's Health/ <br /> Orange County Health Department Children and Youth <br /> Local Health Department Legal Name DPH Section /Branch Name <br /> Marcia Fort 919-707-5630 <br /> 324—Speech and Hearing Marcia.Fort@dhhs.nc.gov <br /> Activity Number and Description DPH Program Contact <br /> (name,phone number,and email) <br /> 06/01/2017—05/31/2018 <br /> Service Period DPH Program Signature Date <br /> (only required for a negotiable agreement addendum) <br /> 07/01/2017---06/30/2018 <br /> Payment Period <br /> Original Agreement Addendum <br /> ® Agreement Addendum Revision# 1 <br /> I. Background: <br /> No change. <br /> II. Purpose: <br /> This Agreement Addendum Revision#1 increases funding to increase the FTE for the Child Health <br /> Audiology Consultant(CHAC).Additional funds are provided for maintenance, replacement, or <br /> purchase of equipment used for hearing screening and rescreening and to cover the cost for the CHAC to <br /> attend the National Early Hearing Detection and Intervention Meeting in March 2018 in Denver, <br /> Colorado. <br /> III. Scope of Work and Deliverables: <br /> As of June 1, 2017, this Agreement Addendum Revision #1 adds the following sentence to <br /> Subparagraph 1 of Paragraph A: <br /> With this Agreement Addendum Revision#1, the Local Health Department shall increase by <br /> 0.25 FTE the Child Health Audiology Consultant, to a revised total of 0.75 FTE. <br /> As of June 1, 2017, this Agreement Addendum Revision #1 adds Subparagraphs 12 and 13 to <br /> Paragraph A, as follows: <br /> 12. Serve as purchasing agent for maintenance, replacement or purchase of equipment used for <br /> hearing screening and rescreening to the extent possible with the funds provided with this <br /> Agreement Addendum. <br /> • <br /> Health Director Signature (use blue ink) Date <br /> Local Health Department to complete: LHD program contact name: C..- ,v.,ifL,fc4 <br /> (If follow-up information is needed by DPH) Phone number with area code: Ott 2_ 2_4 v <br /> Email address: (`c.r r yr Oro, ,a r"lt <br /> .J �J <br /> Signature on this page signifies you have read and accepted all pages of this document. Revised June 2016 <br />