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012 Division of Public Health Agreement Addendum FY 16-17 Lee County Health Department Local Health Department Legal Name 101 Maternal Health Activity Number and Description 06/01/2016 — 05/31/2017 Service Period 07/01/2016 — 06/30/2017 Payment Period Page 1 of 1 Women's and Children's Health/ Women's Health Branch DPH Section/Branch Name Phyllis C. Johnson, (919) 707-5715 Phyllis.C.Johnson@dhhs.nc.gov DPH Program Contact (name, telephone number with area code, and email) DPH Program Signature Date (only required for a negotiable agreement addendum) ❑ Original Agreement Addendum ® Agreement Addendum Revision # 1 (Please do not put the Budgetary Estimate revision # here.) I. Background: No change. II. Purpose: This Agreement Addendum Revision #1 provides one-time additional Healthy Mothers, Healthy Children (HMHC) Title V funding to the Local Health Department to assist with the purchase of medical supplies, educational materials, and staff development and training. III. Scope of Work and Deliverables: As of January, 1, 2016, this Agreement Addendum Revision #1 adds Paragraph H as follows: H. The Local Health Department shall purchase with the one-time additional funds, additional medical supplies for the maternity clinic, educational materials for prenatal education for individuals and group formats, and/or expenses for additional staff to participate in staff development and training events. IV. Performance Measures/Reporting Requirements: No change. V. Performance Monitoring and Ouality Assurance: No change. VI. Funding Guidelines or Restrictions: No change. Health Director Signature (use blue ink) Local Health Department to complete: LHD program contact name: (If follow-up information is needed by DPH) Phone number with area code: Email address: Date Sienature on this Paee sienifies you have read and accepted all Pages of this document. Revised July 2015