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DocuSign Envelope ID:3104DB10-5BE2-4447-B27F-DB78763E6E88 <br /> iii,Provide proof of Tdap vaccine. <br /> iv.Provide proof of current influenza(flu) vaccine. <br /> v. Unless otherwise provided, proof of immunization must take the form of <br /> one of the following: Provider's immunization record or medical record <br /> signed by a representative of the Provider's healthcare practice. In either <br /> case both the Provider's name and the date of immunization must be present. <br /> Only vaccines approved by the Centers for Disease Control and Prevention <br /> (www.ede.gov/flu/proteettvaceine/vaccines.litm) will be accepted. The <br /> provider is responsible for the costs associated with acquiring the <br /> vaccination. <br /> Replace Section 3 with the following paragraphi: <br /> 3, County's Responsibilities. Exception: "Family" Refugee Health Assessment <br /> (communicable disease and/or physical exam) appointments with 3 or more family <br /> members will only be reimbursed for a total of two (2) hours in the case of same day <br /> cancelled appointments. MID will not reimburse the Provider if an appointment is <br /> cancelled with more than 24 hour notice. <br /> Replace Section 4.b.iii the following paragraph:. <br /> iii. In the event of a cancelled appointment,the Provider is required to stay until <br /> relieved of duty by the nurse supervisor or the individual in charge of <br /> clinical operations. OCHD staff may require other interpreter-related <br /> services in place of the scheduled appointment. As stated above, the <br /> Provider may submit an invoice in the event of a broken appointment (with <br /> less than 24 hour notice). <br /> 1 <br /> a <br /> S <br /> t <br /> 7 <br /> Revised 06/16 4 <br />