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DocuSign Envelope ID: CCFF6125- AA47- 438A- 98CA- B42519499D42 <br />EXl111Bff "B" <br />Scope of Services — FY 2018 -19 <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 handing award. <br />Expense Description <br />Amount <br />Salary support for a medical provider at Carrboro Community Health Center <br />$10,000 <br />Interpretation services for refugee population at Carrboro Community Health Center <br />;$6,500 <br />Program Services <br />Outline the critical services (activities) the agency will employ to attain the Anticipated Outcomes below, by June 30, 2019. <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 Orange <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 <br />Anticipated Results <br />Number of refugee health patients served <br />650 refugees <br />Number of unique medical patients served (including insurance status, <br />income status, Town/County residency) and number of medical visits <br />rovided <br />3,100 Orange County/Town of <br />Chapel Hill/ Town of Carrboro <br />residents <br />,.p r <br />Certified by: eocuSigned by: <br />1. V (P Oi� T6aA" <br />F8 @8FiBFCBD "ea10 @... <br />Title: iG GGC7 Date: A I � <br />If <br />56 0952737 8/23/2018 <br />