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DocuSign Envelope ID: 167F763C-D16E-41D3-B98F-F5E24EE9CC37 <br /> Page 2 of 4 <br /> IL Purpose: <br /> The purpose of this Agreement Addendum is to identify and designate no more than 0.5 FTE <br /> Audiologist to act as a Child Health Audiology Consultant (CHAC) in the north central part of North <br /> Carolina to provide support for maintaining and improving the EHDI program. This person shall act as <br /> part of the EHDI Team. Oversight of his or her EHDI program responsibilities will be carried out by <br /> State EHDI Program staff. <br /> III. Scope of Work and Deliverables: <br /> In the counties the Local Health Department shall serve, the estimated number ofbirths for the state <br /> fiscal year 2017-2018 is 19,800. An estimated 39 to 59°(2 to 3 per 1,000 births) of these infants will <br /> have some form of hearing loss, and an additional 240 infants will need follow-up from newborn <br /> hearing screening to determine their hearing status. <br /> A. The Local Health Department shall: <br /> 1. Provide no more than one half-time (0.5 FTE) Audiologist to perform as the Division of Public <br /> Health (DPH) Child Health Audiology Consultant (CHAC) on the EHDI team. This CHAC will <br /> be expected to meet the program requirements as determined by the DPH, Children and Youth <br /> (C&Y) Branch, EHDI program. The CHAC shall provide direct and indirect services to identify <br /> and assist children with hearing loss in the following counties: Alamance, Caswell, Davidson, <br /> Davie, Forsyth, Guilford, Orange, Randolph, Rockingham, Stokes, Surry, and Yadkin. <br /> 2. Assure that this CHAC has a master's degree in Audiology and current certification/licensure <br /> from the American Speech-Language-Hearing Association and the North Carolina Board of <br /> Speech Language Pathologists and Audiologists. <br /> 3. Collaborate with State EHDI Program staff to ensure that all responsibilities of the CHAC work <br /> plan meet the standards set by the Local Health Department and the DPH, C&Y Branch EHDI <br /> program. <br /> 4. Within five working days, notify the DPH, C&Y Branch EHDI program of any staff changes as a <br /> result of employment termination of the person designated as the CHAC. <br /> 5. Agree not to bill families or third parties for services provided under this Agreement Addendum. <br /> 6. Ensure that the Audiologist serving as the CHAC attends all DPH, C&Y Branch EHDI program <br /> training events and staff meetings. <br /> 7. Ensure that the designated CHAC submits the reports and monthly service logs as required by <br /> the DPH, C&Y Branch, EHDI program, <br /> 8. Assure that the work performed by the CHAC is overseen by State EHDI Program staff. <br /> 9. Ensure that the CHAC attends conferences and workshops as directed by the DPH C&Y Branch <br /> EHDI program and supported by Agreement Addendum funds. <br /> 10. Provide adequate workspace for the CHAC. <br /> 11. Serve as the purchasing agent for newborn hearing screening disposable testing supplies used <br /> within the catchment area for this agreement addendum. <br /> B. The Local Health Department's Audiologist shall follow the work plan developed by State EHDI <br /> Program staff which will include, but is not limited to, the following activities: <br /> 1. Provide technical assistance to birthing facilities for hearing screening,rescreening and tracking <br /> of infants born at each facility. <br /> Revised June 2016 <br />