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DocuSign Envelope ID: 717C8AE2- 4D6E- 4E46- A9A7- F4213973D039 <br />EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION <br />• Lutheran Family Services — (ACTT) <br />• Referring Organizations and Agencies <br />• Private Psychiatrists <br />• Community Resource Court <br />• Freedom House <br />• Crisis Prevention and Intervention Work - CNCI staff maintain contact with the following <br />agencies when a member is in crisis and needs to be evaluated for harm to self or others <br />and /or checked on if the member has not been seen or heard from in a couple of days. <br />Some of these partners include: <br />• UNC Emergency Department <br />• Freedom House <br />• UNC On -Call Psychiatry <br />• Carrboro and Chapel Hill Police Departments — Wellness Checks are highly effective <br />• County Sheriff's Department <br />• Chapel Hill Police Department Crisis Unit <br />i Lutheran Family Services, XDS and other ACT Teams — intense collaboration <br />especially during crisis. <br />• Primary and Other Health Care - CNCI staff assist members in obtaining quality health care. <br />With the life expectancy of people living with serious mental illness being 25 years shorter <br />than the general population, it is critical that our members receive quality health care. We <br />may help coordinate the care needed and accompany members to medical appointments to <br />provide a support person to help listen, help provide information and ask questions, process <br />the information for decision making, and provide support during the decision making <br />process. Numerous members have faced life threatening diseases and have had to make <br />difficult decisions. Providing emotional support is imperative. Staff will attend appointments <br />and communicate with the providers as needed. Some of these partners include: <br />• Physicians (Primary Care, Specialists) <br />• Piedmont Health Services <br />• UNC Healthcare <br />• <br />Emergency Department <br />• <br />UNC Family Medicine <br />• <br />Cancer Hospital <br />• <br />Department of Psychiatry <br />• <br />UNC Center of Excellence <br />• <br />Neurosciences Hospital <br />• <br />UNC Dental School <br />• <br />SHAC (UNC - Student Health Action Coalition) <br />■ Other <br />Private Providers <br />• Food Access and Healthy Living - The partnerships held by Culinary Program at CNCI <br />highlight the power of community partners: we are able to offer our members nearly 1000 <br />affordable, nutritious, and tasty plates each month through relationships with local food <br />organizations. Some of these partners include: <br />■ Farmer Foodshare Donations Station and POP Market <br />PROGRAM INFORMATION 1/23/2018 1:58:29 PM P a g e 1 5 o f 3 1 <br />