HomeMy WebLinkAbout921079.tiff RESOLUTION
RE: APPROVE PRENATAL PROGRAM CONTRACT WITH THE COLORADO DEPARTMENT OF HEALTH
AND AUTHORIZE CHAIRMAN TO SIGN
WHEREAS, the Board of County Commissioners of Weld County, Colorado,
pursuant to Colorado statute and the Weld County Home Rule Charter, is vested
with the authority of administering the affairs of Weld County, Colorado, and
WHEREAS, the Board has been presented with a Prenatal Program Contract
between the Weld County Health Department and the Colorado Department of Health,
commencing October 1, 1992, and ending September 30, 1994, with the further terms
and conditions being as stated in said contract, and
WHEREAS, after review, the Board deems it advisable to approve said
contract, a copy of which is attached hereto and incorporated herein by
reference.
NOW, THEREFORE, BE IT RESOLVED by the Board of County Commissioners of Weld
County, Colorado, that the Prenatal Program Contract between the Weld County
Health Department and the Colorado Department of Health be, and hereby is,
approved.
BE IT FURTHER RESOLVED by the Board that the Chairman be, and hereby is,
authorized to sign said contract.
The above and foregoing Resolution was, on motion duly made and seconded,
adopted by the following vote on the 9th day of November, A.D. , 1992, nunc pro
tunc October 1, 1992.
�Q BOARD OF COUNTY COMMISSIONERS
ATTEST. /ili �GG24^��l WELD COUNTY, COLORADO
Weld County Clerk to the Board
� — Ger e Ke edy, Chairman
/
BY: 6 _
Deputy Clerk o the Board Constance L. Harb�o�e' t, Pro-Tem
APPROVED AS TO ORM: � ,
C. W. Kir y/
/"J.
��yv yp
Co my Attorney Gor a �/ ^
b 1/O-
W. H. Webster
921079
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FORM 6-ACOZ1(R5B5)
DEPARTMENT OR AGENCY NUMBER
260000 -- FAA
CONTRACT ROUTING NUMBER
930564
CONTRACT
THIS CONTRACT, made this 1st day of October 1992, by and between the State
of Colorado for the use and benefit of the Department of 1 HEALTH . 4300 Cherry
Creek Drive South. Denver. Colorado. 80222,
hereinafter referred to as the State, and 4 WELD COUNTY HEALTH DEPARTMENT. 1517
16th Avenue Ct. . Greeley. CO 80631 hereinafter referred to as the contractor.
WHEREAS, authority exists in the Law and Funds have been budgeted,
appropriated and otherwise made available and a sufficient unencumbered balance
thereof remains available for payment in Fund Number 100 , APPR code 585 ,
Contract Encumbrance Number FAA PRN93O564; and
WHEREAS, required approval, clearance and coordination has been
accomplished from and with appropriate agencies; and
WHEREAS, the State has formulated a comprehensive State plan relative to
the Maternal and Child Health Division, Prenatal Program; and
WHEREAS, said comprehensive State plan and federal budget allocates funds
to other agencies in order to provide these health care services to the people
of Colorado; and
WHEREAS, the Contractor is considered by the State to be an appropriate
agency to fulfill the requirements of the program as herein set forth.
NOW THEREFORE, it is hereby agreed that for and in consideration of their
mutual promises to each other, hereinafter stated, the parties hereto agree as
follows:
1. The Contractor will provide prenatal and postpartum care, including
education and counseling, in accordance with the "Prenatal Care
Guidelines", a copy of which has been made available to the
Contractor; and through the use of written protocols. The
Contractor will be reimbursed $400 for each patient with no other
payor source, who has completed at least one visit that included
medical care and the required laboratory work.
2. The Contractor will offer the following program components to
pregnant women:
a) Coordinated care between medical providers and the local health
agency including assistance in securing delivery services.
b) Referrals and assistance in seeking continuous infant and child
health care.
c) Up to two home visits per woman, one of which must be a postpartum
assessment of mother and newborn within 48 hours of hospital
discharge. The second home visit may be postpartum or during the
prenatal period. Reimbursement to the Contractor is $75.00 per
visit.
d) Diagnostic tests.
e) Free pregnancy testing at a reimbursement to the Contractor of $8.00
per test. The Contractor agrees to provide referrals for women with
Page 1 of 7
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positive tests; and contraceptive education, referral, and if
appropriate non-prescriptive contraceptives to women with negative
pregnancy tests.
3. Individual records on each maternity patient will be maintained by
the Contractor and are subject to audits, either self or
independent, to be determined by the State. Data on each prenatal
patient will be submitted on forms supplied by the State (Attachment
A) .
4. Payment for patients who transfer from one Contractor to another
will be negotiated between the two Contractors, with assistance from
the State.
5. If funds are available, the State will pay the Contractor $50 for
every additional patient in FY93 who enters prenatal care in the
first 12 weeks gestation and/or for every woman age 17 or younger
who enters care. Payment will be for the number of patients that
exceeded FY92 and will be added to the September payment.
6. The Contractor agrees to maintain at least the same level of
local/county funding for the Prenatal Program as in FY92, as
reported on the final expenditure/revenue report.
7. Program income generated from patient fee collections and donations
must be used by the program only for prenatal services which further
the objectives of the legislation under which this contract is made.
In accordance with Title V, Section 501 (b) (2) and Section 505 (2)
(d) no charges shall be made for services provided to patients at or
below 100% of the poverty level. Federal poverty guidelines have
been provided to the Contractor. Patients between 100% and 185% of
poverty may be charged on a sliding fee scale. Patients at or below
133% of poverty must be instructed to apply for Medicaid.
8. In accordance with Title V, Section 504 (b) (6) Title V funds may
not be used to pay for any item or service (other than an emergency
item or service) furnished by an individual or entity convicted of
a criminal offense under the Medicare or any State health care
program (i.e. Medicaid, Maternal and Child Health, or Social
Services Block Grant programs) .
9. The Contractor agrees to provide services to all program
participants and employees in a smoke-free environment. Smoking may
not be permitted in waiting areas, examination rooms, formal
sessions providing education, therapy, or similar services.
Designated smokin5 areas may be established for staff, program
participants, family members,and visitors. These designated areas
should be well ventilated in order that the waiting area and the
service delivery environment remains smoke free.
Page 2 of 7
10. The State will pay Sixteen thousand eight hundred ($16.800)
Dollars to administer the program, purchase medical supplies
and pharmaceuticals, and to provide medical, laboratory,
education and counseling to 42 patients; Fifteen thousand
(315 .000) Dollars for 200 home visits; Five thousand (S5.000)
Dollars for diagnostic tests; Eight thousand (S8.000) Dollars
for pregnancy tests for 1000 patients; and -0- Dollars for
annual meeting expenses (for fiscal year 1993) . Dollar
amounts and patient numbers for fiscal year 1994 are subject
to change based on differences between estimated and actual
funding appropriations and legislative approval and will be
set forth in a letter in accordance with the form attached
hereto as Attachment B. In consideration of said services by
the Contractor and conditioned upon affirmation by the Women's
Health Section Prenatal Program that services were rendered in
accordance with this contract, the State will cause to be paid
to the Contractor a sum not to exceed Forty-four thousand
eight hundred ($44.800) Dollars as follows:
a) Contractor will request reimbursement on a signed Contract
Reimbursement Statement (Attachment C) .
b) The Contractor will submit to the State a semi-annual report of
total expenses and revenues by April 30, 1993, and November 15, 1993
(Attachment D) .
11. Payment pursuant to this Contract will be made as earned, in whole
or in part, from available funds encumbered in an amount not to
EXLEVEN ((91.4244511) DOLLARS foION FOUR r the E purchase ofOUSAND prenatalVcarre HUNDRED
is further understood and agreed that the maximum amount of State
funds available for fiscal year 1992-93 for the purchase of prenatal
care is in THOUSAND FIVE the
LEVEN(S1.42NE 4.511) DOLLARS.LION FOUR � D The liabilityRED 1i of
the State, at any time, for such payments shall be limited to the
unencumbered amount remaining of such funds. This contract is
subject to and contingent upon the continuing availability of
federal funds for the purposes hereof.
12. Changes in total reimbursement amounts for the above named services
in consideration of increased or decreased levels of utilization in
the approval snal AttachmenttE)hall whiche made by a shall include s hely follooned w letter of
following:
a. Identification of Contract by Contract number and number of
affected paragraph;
b. Amount of increase or decrease in funding;
Amount of increase or decrease in utilization;
d. Effective date of the funding change;
e. Authorized signatures of the State, the Contractor and the
State Controller. It is understood that no change except
funding amounts and resulting changes in utilization shall be
made through the letter of approval.
13. The term of this Contract is October 1, 1992, through September 30,
1994.
Page 3 of 7
COLORADO DEPARTMENT OF HEALTH - hereinafter, under the General Provisions referred to as
"Health" .
GENERAL PROVISIONS -- page 1 of 2 pages
I. The contractor shall perform its duties hereunder as an independent contractor and
not as an employee. Neither the contractor nor any agent or employee of the contractor
shall be or shall be deemed to be an agent or employee of the state. Contractor shall
pay when due all required employment taxes and income tax withholdine. shall provide and
keep in force worker's compensation (and show proof of such Insurance) and unemployment
compensation insurance in the amounts required by law. Contractor will be solely
responsible for its acts and the acts of its agents, employees, servants and
subcontractors during the performance of this contract. •
2. Contractor authorises Health, or its agents, to perform audits and to make
inspections for the purpose of evaluating performance under this contract.
•
3. Either party shall have the right to terminate this agreement by giving the other
party thirty days notice by registered mail, return receipt requested. If notice is so
given, this agreement shall terminate on the expiration of the thirty days, and the
liability of the parties hereunder for the further performance of the terms of this
agreement shall thereupon cease, but the parties shall not be relieved of the duty to
perform their obligations up to the date of termination.
4. This agreement is intended as the complete integration of all understandings
between the parties. No prior or contemporaneous addition, deletion, or other amendment
hereto shall have any force or effect whatsoever, unless embodied herein in writing. No
subsequent novation, renewal, addition, deletion, or other amendment hereto shall have
any force or effect unless embodied in a written contract executed and approved pursuant
to the State Fiscal Rules.
5. If this contract involves the expenditure of federal funds, this contract is
contingent upon continued availability of federal funds for payment pursuant to the
terms of this agreement. Contractor also agrees to fulfill the requirements of:
a) Office of Management and Budget Circulars A-87, A-21 or A-122, and A-102 or
A-110, whichever is applicable;
b) the Hatch Act (5 USC 1501-1508) and Public Law 95-454 Section 4728. These
statutes state that federal funds cannot be used for partisan political purposes of any
kind by any person or organization involved in the administration of federally-assisted
programs;
c) the Davis-Bacon Act (40 Stat. 1494, Mar. 3, 1921, Chap. 411, 40 USC
276A-276A-5) . This act requires that all laborers and and mechanics employed by
contractors or sub-contractors to work on construction projects financed by federal
assistance must be paid wages not less than those established for the locality of the
project by the Secretary of Labor;
d) 42 USC 6101 et seq, 42 USC 2000d, 29 USC 794. These acts require that no
person shall, on the grounds of race, color, national origin, age, or handicap, be
excluded from participation in or be subjected to discrimination in any program or
activity funded, in whole or in part, by federal funds; and
Page 4 of Pages
Rev. 06/01/92
" "
GENERAL PROVISIONS--Page 2 a' pages
e) the Americans with Disabilities Act (Public Law 101-336; 42 USC 12101, 12102,
12111 - 12117, 12131 - 12134, 12141 - 12150, 12161 - 12165, 12181 - 12189, 12201 - 12213
and 47 USC 225 and 47 USC 611.
f) if the contractor is acquiring real property and displacing households or
businesses in the performance of this contract, the contractor is in compliance with the
Uniform Relocation Assistance and Real Property Acquisition Policies Act, as amended
(Public Law 91-646, as amended and Public Law 100-17, 101 Stat. 246 - 256) ;
g) when applicable, the contractor is in compliance with the provisions of the
"Uniform Administrative Requirements for Grants and Cooperative Agreements to State and
Local Governments (Common Rule) .
6. By signing and submitting this contract the contractor states that:
a) the contractor is in compliance with the requirements of the Drug-Free
Workplace Act (Public Law 100-690 Title V, Subtitle D, 41 USC 701 et seq. ) ;
b) the contractor is not presently debarred, suspended, proposed for debarment,
declared ineligible, or voluntarily excluded from covered transactions by any federal
department or agency; and
7. To be considered for payment, billings for payment pursuant to this contract must
be received within 60 days after the period for which payment is being requested and
final billings on the contract must be received by Health within 60 days after the end
of the contract term.
8. If applicable, Local Match is to be submitted on the monthly payment statements, in
the column provided, as required by the funding source.
9. If Contractor receives $25,000.00 or more per year in federal funds in the
aggregate from Health, Contractor agrees to have an annual audit, by an independent
certified public accountant, which meets the requirements of Office of Management and
Budget Circular A-128 or A-133, whichever applies. If Contractor is required to submit
an annual indirect cost proposal to Health for review and approval, Contractor's auditor
will audit the proposal in accordance with the requirements of OMB Circular A-87, A-21
or A-122. Contractor agrees to furnish one copy of the audit reports to the Health
Department Accounting Office within 30 days of their issuance, but not later than nine
months after the end of Contractor's fiscal year. Contractor agrees to take appropriate
corrective action within six months of the report's issuance in instances of
noncompliance with federal laws and regulations. Contractor agrees to permit Health or
its agents to have access to its records and financial statements as necessary, and
further agrees to retain such records and financial statements for a period of three
years after the date of issuance of the audit report. This contract does
contain federal funds as of the date it is signed. This requirement is in addition to
any other audit requirements contained in other paragraphs within this contract.
10. Contractor agrees to not use federal funds to satisfy federal cost sharing and
matching requirements unless approved in writing by the appropriate federal agency.
Page S of 7 Pages
Rev. 06/01/92 ncla
Form 6-AC-028
SPECIAL PROVISIONS
CONTROLLER'S APPROVAL
1. This contract shall not be deemed valid until it shall have been approved by the Controller of the State a Colorado or such assistant as he may designate.This
provision is applicable to any contract involving the payment of money by the State.
FUND AVAILABILITY
2. Financial obligations of the State payable alter the current fiscal year are contingent upon funds for that purpose being appropriated.budgeted and otherwise
made available. •
BOND REQUIREMENT
3. If this contract involves the payment of more than fifty thousand dollars for the construction,erection,repair,maintenance,or improvement of any building.
road,bridge,viaduct,tune.excavation or odor public works for this State.the contractor shall.before entering the performance of any sues work included in this
contract,duly execute and deliver to and file with die official whose signature appears below for the State.a good and sufficient bond or other acceptable surety to be
approved by said official in a penal stun not less than one-half of the total amount payable by the terms of this contact Such bond shall be duly executed by a
qualifiedcorporate surety.conditioned(or the due and faithful performance of die contract and in addition,shall provide that if the contractor or his subcontractors
fail to duly pay for any labor.materials,team hire.sustenance.provision.provendor or other supplies used or consumed by sucheoewaetoror his subcontractor in
performance of the work contracted to be done.the surety will pay the same in an amount not exceeding the sum specified in the bond,together with interest at the
rate of eight per cent per amnun.Unless such bond,when so required,is executed,delivered and filed,=claim in favor of the contractor arising under this contract
shall be audited,allowed or paid.A certified or cashier's check or a bank money order payable to the Treasurer of the State of Colorado may be accepted in lieu of a
bond This provision 4 in compliance with 38.26-106 CRS.as amended.
DYDEMNIFICATION
4. To the extent authorized by law.the contractor shall indemnify.save and hold harmless the State,its employees and agents.against any and all claims.
damages,liability and court awards including oasts.expenses.and attorney fees incurred'sneak result of any act or omission by the contractor,or its employees.
agents.subcontractors.or assignees pursuant to the terms of this contract
DISCRIMINATION AND AFFIRMATIVE ACTION
5. The contractor agree to amply with the later and spirit of the Colorado Mridisaimimarim Act of 1957,as amended,and other applicable law respecting
distsinination and unfaireupieymeat practices(24.34(02.CRS 1982 Replacement Vol.).and as required by Executive Order,Equal Opportunity and Mfinna'
Uve Action.dated April 16. 1975.tunuant thereto. the following provision shall be contained in all Stare contracts or subcontracts
During the performance of this contract the contractor agrees as follows: •
(1) Ilse contractor will not discriminate against any employee or applicant for employment because dram creed,color,national origin.sex.marital status.
religion.ancestry.mental or physical handicap.or age.The contractor will take affirmative an to insure that applicants are employed.and that employees are
treated during emplo inert without regard to the above mandated ddtaraeraisties.Such=doe shall iodide,but not be limited to the following employment
upgrading.demotion.or wander.rearniment or mania advertising layer orterm/natio=rases of pay or other forms ofcoropanation:and selection for
training,inehdtmgappmwceship.The contractor agrees to poet in conspicuous places,available to employees and applicants(or eniploymast.notices to be Pro-
vided by the contracting officer setting forth provisions of this nondnaimiaation done.
(2) The contractor wilt in all solicitations or advertisemaws for employees peanut by oroe helot ofthe contractor.state that all qualified applicants will receive
consideration for employment without regard to race,creed color-national origin,sex,marital status,raisin,ancestry,mental or physical handicap.or
>rde—
(3) The contracorwill sand to each labor union or representative of workers with which he has collective bargaining apeman orothercosuract or understand-
ing,notice to be provided by the contracting officer,advising the labor union or workers'representative of the contractor's commitment under the Executive
Order, Equal Opportunity and Affirmative Acton,dated April 16. 1975.and of the rules-regulations.and relevant Orders'Oche Governor.
(4) The contractor and labor union will furnish all information and reports required by Executive Order,Equal Opportunity and Affirmative Action of April 16.
1975,and by the rules,regulations and Orders of the Governor,or pursuant thereto-and will permit access to his books,records-and accounts by the contracting
agency and the office of the Governor or his designee for purposes of investigation to ascertain compliance with such rules, regulations and orders.
(5) A labor organization will not exclude any individual otherwise qualified from full membership rights in such labor organization.or expel any such individual
front membership in such labor organization or discriminate against any of its members in the full enjoyment of work opportunity.because of race.creed.color.
sex, national origin,or ancestry.
(6) A labor organization,or the employees or members thereof will not aid,abet,incite,compel or coerce the doing of any act defined in this contract to be dis-
criminatory or obstruct or prevent any person from complying with the provisions of this contact or any order issued thereunder:or attempt either directly or
indirectly, to commit any act defined in this contract to be discriminatory.
395-53-01-1022
Revised 1/88 page _f? of 7 pages u I„:.Oran...
;9 .379
Form 6-AC-02C w
(7) In the event of the contractors non-compliance with the non-discrimination clauses of this contractor or with any of such rules,regulations,or orders,this
contract may be cancelled,terminated or suspended in whole or in part and the contractor may be declared ineligible for further State contracts in accordance
with procedures,authorized in Executive Order.Equal Opportunity and Affirmative Action of April 16,1975 and the rules,regulations,oronders promulgated
in accordance therewith,and such other sanctions as may be imposed and remedies as may be invoked as provided in Executive Order,Equal Opportunity and
Affirmative Action of April 16, 1975, or by rules,regulations,or orders promulgated in accordance therewith,or as otherwise provided by law.
(8) The contractor will include the provisions of paragraph(1)through(8)in every sub-contract and subcontractor purchase order unless exempted by rules,
regulations,or orders issued pursuant to Executive Order,Equal Opportunity and Affirmative Action of April 16,1975,so that such provisions will be binding
upon each subcontractor or vendor.The contractor will take such action with respect to any sub-contracting or purchase order as the contracting agency may
direct,as a means of enforcing such provisions,including sanctions for non-compliance;provided,however,that in the event the contractor becomes involved
in,or is threatened with,litigation with the subcontractor or vendor as a result of such direction by the contracting agency,the contractor may request the State
of Colorado to enter into such litigation to protect the interest of the State of Colorado.
COLORADO LABOR PREFERENCE
6a, Provisions of 8-17-101&102,CRS for preference of Colorado labor are applicable to this contract if public works within the State are undertaken hereun-
der and are financed in whole or in part by State funds.
b. When construction contract for a public project is to be awarded to a bidder,a resident bidder shall be allowed a preference against a non-resident bidder
from a state or foreign country equal to the preference given or required by the state or foreign country in which the non-resident bidder is a resident.If it is deter-
mined by the officer responsible for awarding the bid that compliance with this subsection.06 may cause denial of federal funds which would otherwise be avail-
able or would otherwise be inconsistent with requirements of federal law,this subsection shall be suspended,but only to the extent necessary to prevent denial of
the moneys or to eliminate the inconsistency with federal requirements(section 8-19401 and 102, CRS).
GENERAL
7. The laws of the State of Colorado and rules and regulations issued pursuant thereto shall be applied in the interpretation,execution and enforcement of this
• contract.Any provision of this contract whether or not incorporated herein by reference which provides for arbitration by any extra-judicial body or person or
which is otherwise in conflict with said laws,mks and regulations shall be considered null and void_Nothing contained in any provision incorporated herein by
reference which purports to negate this or any ether special provision in whole or in part shall be valid or enforceable or available in any action at law whether by
way of complaint,defense orotherwise.Any provision rendered null and void by the operation of this provision will not invalidate the remainder of this contract to
the extent that the contract is capable of execution.
& At all times during the performance of this Contract,the Contractor shall strictly adhere to all applicable federal and state laws,rules and regulations that
have been or may beret be established.
9. The signatories hereto aver that they are familiar with 18.8.301,et.seq.,(Bribery and Corrupt Influences)and 18-8-401,et seq..(Abuse ofPublic Office),
CRS 1978 Replacement Vol,and that no violation of such provisions is present.
10. The signatories aver that to their knowledge, no state employee has a personal or beneficial interest whatsoever in the service or property
described herein:
IN WITNESS WHEREOF,the parties hereto have executed this Contract on the day first above written.
Contractor
(Full Legal Name) WP 1 rl f it m tp STATE OF COLORADO
ROY ROMER, GOVERNOR
yan7th D�partman*
B for the
i • ti ,� •S EXECUTIVE DIRECTOR.
Position(Tide) IL!! I-,^(uri n
846000813
Soar Sway NSrr or For lD.Meals DEPARTMENT
OF HEALTH
(If Corporation.) s7.t '/ t_yf
Attest(Seal) �Si WELD COUNTii HEALTH DEPARTMENT
By ,� � 11�,..-C,o 6.�
Ca n r9ar.re Seaton.or Dqui..laa,Ter-a/CIa/Ca,+y Clerk By: ; e w.,- ., .
Randolph Cordon, M.D. , M.P.B.
• APPROVALS Director
ATTORNEY GENERAL CONTROLLER
By By
PROGRAM APPROVALC'A
1 /
Page 7 winch is the Lao or pages
395.51OL1030(Ree.sad I/881 'Sec instructions ea meat side. OCd04305a-81
frnig n•sfl
i a.J IQJ�.cy
ATTACHMENT "A"
Document RBFBE 1
Roy 9/92 COLORADO DEPARTMENT OF HEALTH
PRENATAL MONTHLY REPORT
PATIENTS WHO DELIVERED OR TERMINATED
Deliverer U1
Terminator 02
Clinic Cade Patient tuber Used by Clinic Trans. Code Patient Ma< -
-
• ai5mlal tecvrity5Mu ne�i (',ye; :a�. Annual In. 'Count,' tae Or)s Rate -'�:vrlor. Ate
sa, :,a•A-,�: .. .•^;cd Medtwl 7+eg Rcgi Preg•liedlul
S.oting i rAlracrol Drugs ••x Kutr,tioa Pa d.unocial At 4llvti tar ..< +`<
41
rTt rro '-' '‘,:26‘6 6 . 2 _s . „•�„ +.. `L 6,,,„ ,Pan.
Rist .26-20 �tRl"ak 26r2D gX's'4R/*a .Z6.2R 36 RI* 26-20 'X RIB 26-20 +;'X< aEduutlal' *+<"� F"
;Ls
C.� w Mint
676 n k L4U"' CatdaP Dal �-c '"grew b 'y`•' �' �IrthrNeiy12F "•Ge U�� wstlw°>t der•
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648.8 . 3••,.
(c.-act) (mlt_fsstl2(Abn_i1u:I -
• Deliverers Only <--------- - Deliverers Only---- > <—Terminaters Only -->
•• Terminators Only
Ooeument RBFBE 1 -
Rev. 9/92
COLORADO DEPARTMENT OF HEALTH
PRENATAL MONTHLY REPORT
PATIENTS WHO DEUVERED OR TERMINATED
Deliverer 01
Terminator 02
a.
91nic Cade Patient Number Used-by Cl laic -Traits.-Trans.Code • Patient Rase
x x x ) x .
y-•.,r•,k' ....' -r.".e �,lr nn --1, 'aa'*.t -stn 4 cw?wrs*
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•
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,A R1* „26-26 6 j* 6.20 r36 Risk '26-20 36 - 'Risk 26-26 6 ?tit, Z6de 't36 �`Edaattan �� AgeU , • •sine
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ilm d) (Intraut d)t(I4t deathly ann Prenatil .-.. .:: :: ',Age ac yy,'^+,• �r��.-s'r Rea-
6
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6N_7:""' 651 d - •6t6.e"•
'C-Beet) (Kult_Gest)(Atn.61..1-
• Gel iverers Only < Gel inners Only > <--- Terminators Only >
•• terminators Only
(1 n -N.-,n0.,-
ROY ROMP- Tel . -Numbers:
M ATTACHMENT "B"
uldincnver
Governor (Jb.,R2-9076
Ptarmigan Place,Denver
PATRICIA A. NOLAN, MD, MPH (303)320.1529
Executive Director First National Bank Building.Denver
(303)3554559
k�l 4210 East 11th Avenue Grand Junction Office
COLORADO
(303)268-7198
Denver, Colorado 80220-3716
DEPARTMENT Phone (303)320-8333 Pueblo Office
(719)563A641
OFAHEALTH
Date
Agency Name
Agency Address
City, State Zip
Dear
The Colorado Department of Health hereby notifies that
the contract amount from the Prenatal Program, Contract # will
be for the period
October 1, 1993 through September 30, 1994. $
shall be used to provide basic services to patients;
$ shall be used to provide home visits;
$ shall be for diagnostic tests,
$ shall be for prenancy testing;
$ shall be for annual meeting travel expenses and
$ shall be to provide enhanced services
to patients.
This notification shall not be deemed valid until it is approved by the
controller of the State of Colorado or his designee. Please sign and return
all copies of this notification to the Prenatal Program. A fully executed
copy will be returned to you.
Sincerely,
Lee Thielen
Assistant Director
Colorado Department of Health
Contractor
Title
Program Approval Date
State Controller
CDHFPP 7/92 r. a .�
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APPLICANT:
PROJECT:
ACTUAL EXPENDITURES
FOR THE PERIOD:
Annual Number Total Source of Funds
salary Months Amount *Applicant Requested 'S
Rate Budget Required and Other :> from CDH
PERSONAL SERVICES:
Contractual/Fee for Service:
Supervising Personnel:
Fringe Benefits: Rate =
Sub total Personal Services
OPERATING EXPENSES:
(includes Building/Facility
Cost not part of Indirect)
Sub total Operating
TRAVEL:
Sub total Travel
EQUIPMENT:
Sub Total Eqiupment
Administrative/Indirect Cost
TOTAL PROJECT'.COST *
*Source of Funding for'Applicant and Other'
Local:** $ **
Medicaid: $
Patient Fees: $
Other: $
Total Applicant and Other $
**Are these local funds used to match any other grant? Yes No
Signature of Director or Authorized Representative
rw[rxd' :'t-s3
ROY ROMER nisp..N.,.a,.,:
f. Mdn aii°'" Da' ATTACHMENT E 6
Governor (303)322"998
Pt.,nd pa Place,Denver
PATRICIA A.NOLAN,MD,MPH (303) 1529
Executive Director Fm Malawi wl Bank Bolding.Denver
(303)355-6559
'kill Grand 3,mcace Office
COLORADO
�P�yO� 4210 East 11th Avenue (303)24a•n98
Vl lJl�tiil�J Denver,Colorado 80220-3716 Pubes Office
DEPARTMENT Phone(303)32O-8333 (719)543-8441
OFAHEALTH
Date
Agency Name
Agency Address
City, State Zip
Dear •
The Colorado Department of Health hereby notifies that
the maximum amount of reimbursement from the Prenatal Program, Contract
No. , covering the period October 1, 1992 to September 30, 1993, is
hereby increased/decreased by Dollars IS ) to a new total
of Dollars (S ) . The number of
prenatal patients to be served is to be increased/decreased by
patients to a new total of patients; home visits are to
be increased/decreased by to a new total of
diagnostic service dollars are to be increased/decreased by to a
new total of (Page 3, Paragraph 11).
This notifiation shall not be deemed valid until it is approved by the
controller of the State of Colorado or his designee. Please sign and return
all copies of this notification to the Family Planning Program A fully
executed copy will be returned to you.
Sincerely,
Lee Thielen
Assistant Director
Colorado Department of Health
Contractor
Title
Date
Program Approval
State Controller
CDH FPP 7/92
4.+rrhi P..n.•
m�mORAnDUm{
WilDe George Kennedy, Chairman
Board of County Commissioners October 30,(;��R di
To Date .fr
COLORADO Jeannie K. Tacker, Business Manager, Weld County Health Dept
From
Prenatal Program Contract
Subject:
Enclosed for Board approval is a contract between the Weld County Health
Department and Colorado Department of Health for the Prenatal Program.
The Health Department will receive $44,800 to provide prenatal care for 42 non-
Medicaid patients, 200 home visits, diagnostic tests and pregnancy testing
services. This contract is an increase of $7,682 over the prior year's contract.
The term of the contract shall be from October 1, 1992 through September 30,
1994.
If you have any questions, please feel free to contact me.
921079
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