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Page 2 of 5 <br />Template rev. July 2020 <br />II. Purpose: <br />This Agreement Addendum provides support for maintaining and improving the EHDI program by <br />identifying and designating no more than 0.75 FTE Audiologist to act as a Child Health Audiology <br />Consultant (CHAC) in the north central part of North Carolina. This CHAC shall act as part of the DPH <br />EHDI Team, with oversight of his or her EHDI program responsibilities carried out by State EHDI <br />Program staff. <br />III. Scope of Work and Deliverables: <br />A. The Local Health Department shall: <br />1. Provide one three-quarter-time (0.75 FTE) audiologist to perform as the Child Health Audiology <br />Consultant (CHAC) on the Division of Public Health (DPH) EHDI team. The CHAC must have <br />a master’s degree in Audiology and must maintain current certification and licensure from the <br />American Speech-Language-Hearing Association and the North Carolina Board of Speech <br />Language Pathologists and Audiologists. <br />2. Collaborate with the DPH Genetics and Newborn Screening Unit Manager to ensure that all <br />responsibilities of the CHAC work plan, as described in Paragraph B below, meets the standards <br />set by the Local Health Department and the EHDI program. The CHAC will be expected to meet <br />the program requirements as determined by the DPH EHDI Program. <br />3. Ensure that the CHAC provides direct and indirect services to identify and assist children with <br />hearing loss in the following counties: Forsyth, Guilford, and Orange. For these counties, the <br />estimated number of births for the state fiscal year 2020-2021 is 12,602. An estimated 24 to 36 <br />(2 to 3 per 1,000 births) of these infants will have some form of hearing loss, and an additional <br />504 infants will need follow-up from newborn hearing screening to determine their hearing <br />status. <br />4. Within five working days, notify the EHDI Program of any staff changes as a result of <br />employment termination of the person designated as the CHAC. <br />5. Agree not to bill families or third parties for services provided under this Agreement Addendum. <br />6. Ensure that the CHAC attends: <br />a. All DPH EHDI Program training events and staff meetings as requested. <br />b. Conferences and workshops as directed by the program and supported by Agreement <br />Addendum funds. <br />c. The National Early Hearing Detection and Intervention Meeting in February/March 2021 in <br />Cincinnati, Ohio. <br />7. Ensure that the CHAC submits the reports and monthly service logs as required by the EHDI <br />Program. <br />8. Provide adequate workspace for the CHAC. <br />9. Serve as the purchasing agent for newborn hearing screening disposable testing supplies used <br />within the catchment area for this Agreement Addendum. <br />10. Serve as purchasing agent for maintenance, replacement or purchase of equipment used for <br />hearing screening and rescreening to the extent possible with the funds provided with this <br />Agreement Addendum. <br />B. The Local Health Department’s Child Health Audiology Consultant (CHAC) shall follow the <br />individual work plan developed annually (SFY) consistent with the plan for all other DPH EHDI <br />Consultants by the DPH Genetics and Newborn Screening Unit Manager which will include, but is <br />not limited to, the following activities: <br />     <br /> <br />DocuSign Envelope ID: 36D07572-B1EC-4E6B-BB09-ECF88788B8AA