Agenda - 04-16-1991 - Laserfiche WebLink

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N.C. Deparanent of Environment, Health, and Natural Resources Page 2 of 3 Division of General Services CONTRACT ADDENDUM 1Y 1991 -92 Children and Youth Section 5323 Office, Section, or Branch 9268 Orange County Orthopedic (Scoliosis) Clinic Contract Number Contractor Children's Special Health *See attached narrative on Activity Services contract addendum page, — ADMINISTRATIVE SECT ION 1. An estimated 45 (number) new clients will be admitted to this clinic.* 2. An estimated 50 (number) client visits will be made to this clinic. (This is a one -time only clinic.) 3. An estimated 50 (number) of CSHS- eligible clients will receive assessments manual for definition). (see HSIS 4. An estimated N/A (number) of CSHS -- eligible clients will receive treatment manual for definition). (All patients referred for treatment,) (see HSIS 5. An estimated N/A (number) of CSHS - eligible clients will receive therapy. (All patients referred for therapy.) 6. What counties are served by this clinic? 1. Orange 3. 5. 2. 4. 6. 7. List laboratory and diagnostic services funded by this contract. 1. X:` s . 3. - 5. 2. 4 • 6. 8. List other services funded by this clinic, e.g., casting, therapy, etc. 1. N/A 3. 5. 2. 4. 6. 9. Please attach current eligibility criteria and fee schedule used in this clinic. CSHS criteria. 10. Describe on a separate sheet methods for billing for third -party payers, e.g., insurance, Medicaid, etc. Medicaid billing is processed by the HSIS system. 11. Who is the clinic coordinator or contact person? Name: Leigh McFalls, RN Phone: (919) 732--8181, ext. 2400 12. List on a separate sheet subcontractors for services by name, address, and discipline. Dr. Stephen Grubb, 101 Cornier Drive, Suite 200, Chapel Hill, NC 27514 *Refer to HSIS Output Reports: Children's Special Health Services for service objectives 461 -4. DEHNR 3300 (Revised 2190) General Services Division (Review 1/95) Reviewed by Inid _f T Date