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61 0 <br />Division of Public Health <br />Agreement Addendum <br />FY 14-15 <br />Lee County Health Department <br />Local Health Department Legal Name <br />Page 1 of 1 <br />Women's and Children's Health/Women's Health <br />DPH Section/Branch Name <br />Tricia Parish, (919) 707 -5696 <br />151 Family Planning tricia.parish @dhhs.nc.gov <br />Activity Number and Description DPH Program Contact <br />(name, telephone number with area code, and email) <br />06/01/2014 — 05/31/2015 <br />Service Period <br />07/01/2014 — 06/30/2015 <br />DPH Program Signature Date <br />(only required for a negotiable agreement addendum) <br />Payment Period <br />❑ Original Agreement Addendum <br />® Agreement Addendum Revision # 1 (Please do not put the Budgetary Estimate revision # here.) <br />I. Background No change. <br />II. Purpose <br />This Revision #1 to the Agreement Addendum provides an additional $2,678 as a result of recently <br />received carry forward Title X funds. Some local health departments are also receiving additional <br />performance -based amounts based on increases in the number of family planning clients seen in recent <br />years by those local health departments. The additional funds are to be used as described below, in <br />section III Scope of Work and Deliverables, during the period June 1 -29, 2014 only. <br />III. Scope of Work and Deliverables <br />These carry forward funds are to be used to support additional clinical services during the period <br />June 1 -29, 2014 only. Those local health departments receiving additional performance -based funds <br />shall purchase birth control supplies with those funds, and are strongly encouraged to purchase long - <br />acting contraceptive devices. <br />IV. Performance Measures/Reportin2 Requirements No change. <br />V. Performance Monitoring and Quality Assurance No change. <br />VI. Funding Guidelines or Restrictions (if applicable) No change. <br />Health Director Signature (use blue ink) Date <br />Local Health Department to complete: LHD program contact name: <br />(If follow up information is needed by DPH) Phone number with area code: <br />Email address: <br />ruuwrc uu LUIS page slgmnes you have read and accepted all pages of this document <br />Revised 8/12/13 <br />