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DocuSign Envelope ID:E8163127-982F-4CDF-AAFE-9EAE17837984 <br /> • <br /> EXHIBIT' " <br /> Scope of Services—FY 2017-18 <br /> Outside Agency Performance Agreement <br /> Agency Name: Piedmont Health Services,Inc. <br /> Program Name: Carrboro Community Health Center <br /> Funding Award: $16,500 <br /> Outline how the agency will spend Orange County's funding award. <br /> Expense Description Amount <br /> Salary support for a medical provider at Carrboro Community Health Center $10,000 <br /> Interpretation services for refugee population at Carrboro Community Health Center $6,500 <br /> • <br /> P.xogram_Ser.vices <br /> Outline the critical services(activities)the agency will employ to attain the Anticipated Outcomes below,by June 30,2018. <br /> • Refugee health care population health program support <br /> + Affordable medical care for low-income individuals <br /> Anticipated Outcomes <br /> The Anticipated Results column must include quantifiable results in the form of number of persons/units served within Orance <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 Results <br /> Number of refugee health patients served 650 refugees <br /> Number of unique medical patients served(including insurance status, 3,500 Orange County/Town of <br /> income status,Town/County residency)and number of medical visits Chapel Hill/Town of Carrboro <br /> provided residents <br /> • <br /> Certified by: Title: C. E Date. -7 1/ICI /1 <br /> (Provider's ignature) <br />