Laserfiche WebLink
Division of Public Health <br />010 <br />Agreement Addendum <br />FY 16-17 <br />Page 1 of 2 <br />Lee County Health Department Epidemiology / Communicable Disease Branch <br />Local Health Department Legal Name DPH Section/Branch Name <br />610 STD Prevention <br />Activity Number and Description <br />06/01/2016 — 05/31/2017 <br />Service Period <br />07/01/2016 — 06/30/2017 <br />Payment Period <br />Vivian Mears, 252-341-3487 <br />vivian.mears@dhhs.nc.gov <br />DPH Program Contact <br />(name, telephone number with area code, and email) <br />DPH Program Signature Date <br />(only required for a negotiable agreement addendum) <br />❑ Original Agreement Addendum <br />® Agreement Addendum Revision # 1 (Please do not put the Budgetary Estimate revision # here.) <br />I. Background: <br />This Agreement Addendum Revision #1 adds the following paragraph: <br />Chlamydia trachomatis is the most frequently observed bacterial sexually transmitted infection in <br />the U.S. and in North Carolina. Although Chlamydia trachomatis (CT) is a reportable condition <br />in North Carolina, the initial funding for this Agreement Addendum had not supported testing for <br />men evaluated in local health department STD clinics. <br />II. Purpose: <br />This Agreement Addendum Revision #1 provides additional funding to assist the Local Health <br />Department with their identifying, treating, and reporting Chlamydia trachomatis. <br />III. Scope of Work and Deliverables: <br />As of October 1, 2016, this Agreement Addendum Revision #1 adds the following: <br />In addition to performing one or more of the deliverables listed in Paragraphs 1, 2, and 3, the Local <br />Health Department shall: <br />4. Provide urine Nucleic Acid Amplification Testing (HAAT) for Chlamydia trachomatis (CT) <br />when a male STD patient may have had urethral exposure to CT within 60 days of the test and <br />there are no clinical findings on exam or complaint of urethral symptoms. <br />Health Director Signature (use blue ink) <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 />Date <br />Nignature on this page signifies you have read and accepted all pages of this document <br />Revised July 2015 <br />