2021-336-Health-Piedmont Health Services-Outside Agency

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Certified by:________________________ Title: ____________________ Date: ____________ (Provider’s Electronic Signature) **You will sign this document electronically with your performance agreement. EXHIBIT “B” Scope of Services – FY 2020-21 Outside Agency Performance Agreement Agency Name: Program Name: Funding Award: Outline how the agency will spend Orange County’s funding award. Program Services Outline the critical services (activities) the agency will employ to attain the Anticipated Outcomes below, by June 30, 2021. x x x Anticipated Outcomes The Anticipated Results column must include quantifiable results in the form of number of persons/units served within Orange County, only (all Towns and municipalities). If you use percentages, you must also provide the total number of participants within that measure’s description or for an earlier performance measure. Performance Measures Anticipated Results Expense Description Amount Primary medical care for low-income, uninsured patients at PHS's three Orange County health centers $5,500 Interpretation costs for services to large immigrant and refugee populations $5,500 Primary medical care for patients experiencing homelessness at PHS IFC Community Health Center $5,500 PHS Community Health Center program will be a primary care home for over 3,700 low-income, uninsured patients in the 2020-2021 grant period. 3,700 PHS Community Health Center program will be a primary care home for 650 unduplicated refugee patients over the 2020-2021 grant period. 650 PHS Community Health Center program will care for 180 people experiencing homelessness during the 2020-2021 grant period. 180 Piedmont Health Services Inc. PHS Community Health Centers $16,500 primary medical care for low-income, uninsured patients primary medical care for immigrant and refugee popluations primary medical care for people experiencing homelessness DocuSign Envelope ID: EEE4BE29-5C31-4220-A7C0-E3D3B4C537B0 CEO 6/28/2021