HomeMy WebLinkAbout670179.tiff1967 DENTAL SERVICES CONTRACT
FOR WELFARE RECIPIENTS
WELD COUNTY DENTAL SOCIETY:
WHEREAS, the Weld County Dental Society has submitted a contract
to the Board of County Commissioners for the year 1967, copy of which is hereto
attached and made a part of this resolution, and
WHEREAS, after careful review and consideration, the Board believes
it to be in the best interests of the County to accept said contract.
NOW, THEREFORE, BE IT RESOLVED, by the Board of County Commissioners
of Weld County, Colorado that the 1967 Dental Services contract for Welfare
recipients as submitted by the Weld County Dental Society be and the same is
hereby accepted and signed.
The above and foregoing resolution was, on motion duly made and
seconded, adopted by the following vote: 7
DATED: FEBRUARY 1, 1967
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THE BOARD OF COUNTY COMMISSIONERS
WELD COUNTY, COLORADO
670179
WELD COUNTY DENTAL CONTRACT
This contract executed at Greeley, Colorado this first day of January, 1967
by and between the Board of County Commissioners of Weld County, Colorado, here-
inafter called the County, and the Weld County Dental Society, hereinafter cal-
led the Society:
Witnesseth:
That in consideration of the mutual promises and obligations and other con-
siderations herein expressed, it is mutually agreed until December 31, 1967:
1. The Society shall render or cause to be rendered by members of the Weld
County Dental Society dental services as outlined in the fee schedule
for the county indigents who are in need of this service fox the sum of
Two Thousand Eight Hundred Twenty -Four Dollars and Ninety -Eight cents
($2,824.98) per quarter. Payment is to be made as soon as possible aft-
er the close of each calendar quarter to the Weld County Dental Society.
2. The Society will appoint an Administrative Committee to assist incheck-
ing bills for services rendered.
3. The Society will appoint its own committee, which shall be empowered 'to
make all other needed arrangements to properly administer and fairly
divide the funds among all participating members rendering service, and
conduct the business of the Society under this contract. The decision of
this committee shall be final and binding to all doctors participating
in this'contract. It is expressly understood, however, that any mem-
ber of the Weld County Dental Society may be present at any meeting of
such committee and have full opportunity to examine the books to see
that the funds are divided fairly and without prejudice among all par-
ticipating doctors who have performed services during the preceding
month. The members of the committee act only as agent for the Society
and in no case shall they be held liable.
je 2
Weld County Dental Contract
4. Any participating doctor suspected of irregular bills or falsification of
his records may be disqualified from participating in the contract by the
Administrative Committee.
5. The Society will, so far as it lies within the power of its members, see
that proper dental care and service is rendered to all indigents of Weld
* County.
In A'itness Thereof, said parties have subscribed and executed these presents,
the County in its proper name and by its proper authorized officers, attested by
its Clerk and Seal, and said Society by its proper name and proper officers there-
unto duly authorized by it, the date first shown mentioned.
The Board of County Commissioners
Weed County, .Colorado
Attest:
By:
County Cler
Deputy County Clerk
, Chairman
Member
Member
The Weld County Dental Society
AdmluisLtative Committee
I
Weld County Department of
Public Welfare
President
Chairman
Director
6. Any unexpended funds at the end of the year 1967 shall revert back to
Weld County, Colorado.
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1967 FEE SCHEDULE FOR PUBLIC WELFARE AND INDIGENT DENTAL CASES,
WELD COUNTY, COLORADO
Dental Services Authorized as Follows:
I. Emergency and Restorative Services for the Following:
A. Aid to Dependent Children to age 21 if regularly attending school
B. Aid to Dependent Children - Unemployed Parents to age 21 if regularly attend-
ing school
C. Title V children (children whose parents are on the Work Training Program,
Title V) - to age 21 if regularly attending school
D. Foster home children placed in the custody of the welfare department only
E. Children of General Assistance families when parents are Weld County resi-
dents and in need of dental services.
II. Emergency Services Only for All Other Children to Age 16 If Not in Regular At-
tendance at School and to Age 18 If Child Is in Regular School Attendance
III. Blue Cards Issued by the Weld County Department of Public Welfare for Aid to De-
pendent Children and Aid to Dependent Children - Unemployed Parents for Ages
Stated Above. ADC or ADC -U are indicated near the household number. White Cards
for Foster Children with CWS Written Near the Household Number.
Cards Indicate Children of Title V Recipients - Ages as Given above Apply to This
Category Also. These Cards Are Also Marked EOA Near the Household Number. Please
Note Carefully the Category Designation on Each Card.
Procedure to Be Followed:
I. Record the Following Information from Welfare Records:
A. Name - Mary Doe; parents - John and Doris Doe
B. Address
C. Birthdate
D. Household Number
rdge 2
1967 Fee Schedule for Public
Welfare and Indigent Dental
Cases, Weld County, Colorado
II. Please Ascertain If Applicant Has a Current Card Issued from Our Office
III. Give Emergency Services and/or Examination for Eligible Children
IV. If Additional Services Are Required for Eligible Children, Please Comple Author-
ization Slips as Follows:
A. Name - child's name and parents' names
B. Birthdate (child's)
C. Household Number
D. Fee for emergency service and/or examination
E. Give fee estimate for remaining services
F. Sign your name
G. Authorization slips are sent to the welfare department and are signed by the
Business Office supervisor, Miss Verda Meineke.
H. No additional services other than emergencies should be started until the pa-
tient returns the Authorization Slip to their dentist.
I. There will be a mandatory charge of $1.00 for every patient for emergency
treatment or examination. All CWS (foster children) cards are exempt of any
cash charges by patients, which is assumed by the county welfare department.
The total remaining fee estimate as a result of examination must be handled
as follows: patient to pay 10% to the nearest dollar of the remaining
charges. This must be paid by the patient before any further work is started.
V. Record Information on Yellow Record Cards as Follows:
A. Name of patient, household number, and age on lower right of record.
B. Name of doctor in upper left of record
VI. Submit Completed Records not Later than March 31, 1967, June 30, 1967, September
30, 1967, and not later than November 30, 1967 to the Chairman of the Welfare
Committee, Dr. Dodd. Records Should Include:
iage 3
1967 Fee Schedule for Public
Welfare and Indigent Dental
Cases, Weld County, Colorado
A. Authorization Slip
B. Pre and post -operative x-rays; no charge for post -operative x-rays
C. Statement showing
1. Name of patient
2. Age
3. Household number
4. Total charges (Not to include fees paid by patient)
VII. Fee Schedule for Aid to Dependent Children, Aid to Deptndent Children Unemploy-
ed Parents, Title V, and Foster Children, and General Assistance Children with
Verified Residence:
A. Examination and Bite Wing x-ray $ 5.00
B. Each additional x-ray 1.00 Each
C. Extractions
1. Deciduous 5.00
2. Permanent 7.00
D. No gold
E. Amalgams
1. Deciduous
a. One surface 5.00
b. Two surface 8.00
c. Three surface 11.00
2. Permanent
a. One surface 6.00
b. Two surface 10.00
c. Three surface 14.00
F. Silicates or Resin 8.00
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1967 Fee Schedule for Public
Welfare and Indigent Dental
Cases, Weld County, Colorado
G. Pulpotomy including restoration $14.00
H. Any other procedures must be approved by Welfare Committee
Chairman, Dr. Dodd.
VIII. Other Services in Emergency Cases Only
A. Fees - Adults and children not qualified for restorative services, which will
include: (1) Aid to Dependent Children parents, (2) Aid to Dependent Chil-
dren - Unemployed Parents, (3) EOA (Title V) parents, (4) Aid to the Needy
Disabled, (5) General Assistance adults:
1. Emergency treatment or single extraction (including x-ray) $ 7.00
2. Vincent's or acute gingival infection 7.00
3. Two additional extractions allowed without authorization 5.00 each
4. No additional x-ray or examination fee allowed
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