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HomeMy WebLinkAboutC03-143 Colorado Department of Public Health and Environment~ ~03 -i~3 -~~t DEPARTMENT OR AGENCY NAME COLORADO DEPARTMENT OF PUBLIC HEALTH AND ENVIItONMENT DEPARTMENT OR AGENCY NUMBER FHA CONTRACT ROUTING NUMBER 04-00007 CONTRACT This CONTRACT is made this 1st day of July , 2003, by and between: the state of Colorado, acting by and through the DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT, whose address or principal place of business is 4300 Cherry Creek Drive South. Denver, Colorado 80246, hereinafter referred to as "the State"; and, BOARD OF COUNTY COMMISSIONERS OF EAGLE COUNTY, whose address or principal place of business is PO Boz 850 , Eaale , CO, 81631, hereinafter referred to as "the Contractor". WHEREAS, pursuant to 25-4-501, 8 C.RS., as amended, the General..("lssembly has dectare~i: that tuberculosis is an infectious and communicable disease, that it endangers the population of this state, and that the treatment and control of said disease is a state responsibility; , . WHEREAS, pursuant to 25-4-511, 8 C.R.S., assistance under section 25-4-501 shall be given to any applicant who is suffering from tuberculosis in any form requiring treatment and is without sufficient means to obtain such treatment; WHEREAS, the General Assembly of the State of Colorado has, for the fiscal year beginning July 1, 2003, (SFY03-04 Long Appropriations Bill) appropriated fimding for Tuberculosis control; WHEREAS, as of the made date of this Contract, the State has a currently valid Group II purchasing delegation agreement with the division of finance and procurement within the Colorado Department of Persomiel and Administration; WHEREAS, section 29-1-201, C.RS., as amended, encourages governments to make the most efficient and effective use of their powers and responsibilities by cooperating and contracting, with each other to the fullest extent possible to provide any function, service, or facility lawfully authorized to each' of the cooperating or contracting entities, and to this end all state of Colorado contracts with its political subdivisions are exempt from the state of Colorado's personnel rules and procurement code; WHEREAS, as to the State, authority exists in the Law and Funds have been budgeted; appropriated, and otherwise made available, and a sufficient uncommitted balance thereof remains available for subsequent encumbering and payment in Fund Number(s)100, Organizational Unit Code(s) 4644, 4648. and 4645. Appropriation Code(s) 386 Program Code(s) 9012, and Object Code(s) 5420.2710, under Contract Encumbrance Number PO FHA EPI04000001: and Encumbrance Number PO FHA EPI0400007. " WHEREAS, all required approvals, clearances, and coordination have-been accomplished from and with all appropriate agencies. Page 1 of 15 H:\Contracts\TBContracts04\.StateFundingOnlyEag1e04.DOC Created by Marti Wood Created on 4/21J2003 11:15 AM ~, NOW THEREFORE, inconsideration of their mutual promises to each, stated below, the parties hereto agree as follows: A. EFFECTIVE DATE AND TERM. The proposed effective date of this Contract is July 1.2003. However, in accordance with section 2430-202(1), C.RS., as amended, this Contract is not valid until it has been approved by the State Controller, or an authorized designee thereof. The Contractor is not authorized to, and shall not, commence performance under this Contract until this Contract has been approved by the State Controller. The State shall have no financial obligation to the Contractor whatsoever for any work or services or, any costs or expenses, incurred by the Contractor prior to the effective date of this Contract. If the State Controller approves this Contract on or before its proposed effective date, then the Contractor shall commence performance under this Contract on the proposed effective date. If the State Controller approves this Contract after its proposed effective date, then the Contractor shall only commence performance under this Contract on that later date. The initial term of this Contract shall commence on the effective date of this Contract and continue through and including June 30.2004 unless sooner terminated by the parties pursuant to the terms and conditions of this Contract. In accordance with section 24103- 503, C.RS., as amended, and Colorado Procurement Rule R-24103-503, the total term of this Contract, including any renewals or extensions hereof, may not exceed five (5) years. B. DUTIES AND OBLIGATIONS OF THE CONTRACTOR The Contractor shall provide or coordinate the following services for all individuals within its service azea according to the State's Tuberculosis Manual; Section, 25-4-501, et se9.8 C.R.S; and Rules and Regulations Pertaining to Epidemic and Communicable Disease Control (6-CCR- 1009-1, Regulation 4). Services should be prioritized as follows: finding all patients with active TB and ensuring completion of therapy, finding and evaluating contacts of TB patients and ensuring co~letion of appropriate treatment, and targeted testing of high-risk groups and ensuring co~letion of treatment for latent TB infection. A. Provide active TB treatment, including directly observed therapy as required by reference above, and ensure adherence to the completion of therapy for all reported cases; B. Ensure contacts to all newly identified infectious TB cases aze identified, investigated, and receive appropriate evaluation; C. Provide treatment, including directly observed therapy when appropriate, and ensure completion of therapy for infected contacts; D. Collect specimens for mycobacteriologytwting on all persons suspected of having TB. Assure that rapid identification and susceptt'bilities (isoniazid, rifampin, ethambutol, streptomycin, and pyrazinamide) aze conducted on cultures positive for Mycobacterium tuberculosis complex; E. Order TB medications through the State contract pharmacy. Drugs other than first line drugs and pyridoxine require prior approval from the State TB Program F. Provide, or arrange for, chest x-rays and the interpretation; G. Provide, or arrange for, laboratory testing and other necessary medical evaluation services; Page 2 of 15 H:\Contracts\TBContracts04\StateFundingOnlyEag1e04.)~C Created by Marti Wood Created on 4/22/21m3 11:15 AM r , H. Periodically monitor and evaluate those persons with active and suspected active TB, latent TB infection, and all other persons as necessary to protect the public health; I. Provide treatment for latent TB infection, and ensure adherence to and completion of th~PY~ J. Provide culturally appropriate patient education and information pertaining to TB treatment and/or follow-up plan; K. In conjunction with the CDPHE TB Program, set agency specific goals based on National TB Objectives which is incorporated herein by this reference, made a part hereof, and attached hereto as "Attachment A". 2. Tuberculin skin testing, chest x-rays, and chest x-ray interpretations are not eligible for reimbursement under this Task Order for the following: Correctional facility inmates; Persons undergoing immigration medical examinations; Paid or volunteer employees of health care facilities, long-term care facilities, drug treatment centers, correctional facilities, shelters, schools, or child care facilities. 3. The Contractor shall recommend and offer an HIV antibody test to: All persons diagnosed with TB disease, regazdless of their age or the apparent absence of risk factors for HIV infection; All persons with positive tuberculin skin tests with HIV risk factors; Foreign-bom persons from HIV endemic azeas. In accordance with section 25-4-1401, et sea.• C.RS., as amended, the Contractor shall report all known HIV antibody test results to the State. Individuals who refuse testing shall be informed . regazding the risks associated with HIV/TB co-infection. 4. The Contractor shall supply the State, with complete patient data for all persons with infection and disease for integration into the TB records system. Data will include: A. Known TB Contacts/latent TB infection--initial report of patient name, birth date, demographic and other patient information, risk factors as identified on the Tuberculosis Surveillance and Case Management Report (TB 1'n (attached hereto as "Attachment B"), treatment start date, drug regimen, and dosages. Follow-up report including length of treatment, treatment completion date, and other case management/follow-up information via a Patient Follow-up Information and Transfer form (TB 10) (attached hereto as "Attachment C"). B. Suspect/Known Active TB cases- initial report of patient name, birth date, demographic and other patient information, risk factors as identified on the Tuberculosis Surveillance and Case Management Report, treatment start date, drug regimen, dosages, how treatment was administered (e.g. direct observed therapy), number of doses given, bacteriological results including drug susceptibility results, changes inpatients' status, diagnosis, or any other information as appropriate. A Patient Follow-up Information and Transfer form will also be used by the Contractor to report when a TB patient completes treatment, moves, or transfers out of the county. The State shall provide format and instructions for any additional data transfer required. Page 3 of 15 H:\Contracts\TBContracts(}4\StateFundingOnlyEagle04.DOC Created by Marti Wood Created on 4/22/2003 11:15 AM ~ • C. The Contractor shall provide other statistical information regazding number and status of patients served to the State upon request. 5. The State shall immediately notify the Contractor of all newly arrived Class A or B TB immigrants to the county via a CDC 75.17 fom~, which is incorporated herein by this reference, made a part hereof, and attached hereto as "Attachment D". Within thirty (30) calendaz days of the Contractor's receipt of written notification from the State of the arrival of a Class A or B immigrant, the Contractor shall contact that immigrant and conduct a TB screening including a PPD skin test and chest x-ray. The Contractor shall also obtain sputum cultures x 3 if a clinical evaluation by a qualified medical provider or chest x-ray interpretation indicates an active disease in an immigrant. The Contractor shall provide appropriate follow-up for an identified immigrant and, complete and return the CDC 75.17 form for an identified immigrant to the State. 6. The Contractor shall, through the services of a nurse or outreach worker, conduct an outreach program to ensure that patients receive appropriate information and education and assist with follow-up needed to fulfill requirements as listed above. Services provided by these workers shall include, but aze not limited to, ensure adherence to and the co~letion of therapy for TB patients and implement outreach and contact follow-up activities for all newly reported cases and suspected cases of TB. 7. The Contractor agrees to provide the State a narrative report for the calendaz yeaz by Mazch 1 of the following calendaz year which includes: A. Progress in implementing outreach activities, results of the evaluation of those activities, and whether the county TB Program objectives were met. B. A statement of any difficulties or special problems encountered in meeting the agreement objectives. C. A statement of action plans designed to overcome or address difficulties and problems. D. A statement of population served and the special needs of those populations that have been met through the agreement. E. A statement of time spent by the outreach workers in TB prevention and follow-up activities. 8. The Contractor shall submit preliminary Contact Investigation Reports (copies attached and made apart hereof as "Attachment E") to the State after initiation of contact investigation. A final report should be submitted when the contact investigation is complete. The Contractor and the State agree to collaborate in automating data collection and transfer of these reports. The Contractor shall provide, or arrange for, quarantine services for patients requiring isolation. 10. The Contractor shall provide consultation to other providers in the service azea regarding TB reporting, screening, treatment, and follow up as needed 11. The Contractor will be responsible for monitoring all sub-contracts and for payment of services rendered. Copies of approved agreements with sub-contractors will be forwazded to the State TB Program. 12. The Contractor acknowledges that the payment for those TB control services provided pursuant to section 25-4-513, C.R.S., as amended, aze paid at 80% from state fimding sources and 20% from Page 4 of 15 H:\ConUacts\TBContracts04\StateFundingOnlyEag1e04.DOC Created by Marti Wood Created on 4/2TJ2003 11:15 AM • • the county fimding sources in which the recipient resides. The Contractor shall be responsible for the rema;ping 20%, which may be contributed in the form of an in-kind agency match. C. DUTIES AND OBLIGATIONS OF THE STATE. 1. In consideration of the Tuberculosis Control services satisfactorily and timely performed by the Contractor under this Contract, the State shall cause to be paid to the Contractor a sum not to exceed THREE THOUSAND NINE HUNDRED FIVE DOLLARS, 905.00 for the initial term of this Contract. Of the total financial obligation of the State referenced above, 9$3 05.00 aze identified as attributable to a fimdmg source of the state of Colorado. Payment pursuant to this contract shall be made as earned, in whole or in part, from available State funds encumbered in an amount not to exceed TWENTY THOUSAND DOLLARS ($20,000.00) Statewide for Tuberculosis Direct Observed Therapv for State Fiscal Year 2004. Of the total financial obligation of the State referenced above, one hundred percent is derived from the State General Fund. The liability of the State, at anytime, for such payments shall be limited to the unencumbered remaining balance of such fiords. If there is a reduction in the total funds appropriated for the purposes of this Contract, then the State, in its sole discretion, may proportionately reduce the fimding for this Contract or terminate this Contract in its entirety. The State shall reimburse the Contractor for expenditures in accordance with the budget below. The Contractor's transfer of fiords from one line item to another must have prior, written approval of the State: Description Funding Source Amount Tuberculosis Control and Outreach State $ 3568.00 Diagnostic Services State $ 337.00 Direct Observed Therapy @ $12.50 per visit State As Administered Total $ 3905.00 2. To receive compensation under this Contract, the Contractor shall submit a signed monthly "Cost Reimbursement Statement". A sample Cost Reimbursement Statement is incorporated herein by this reference, made a part hereof, and attached hereto as "Attachment F". A Cost Reimbursement Statement must be submitted within sixty (60) calendaz days of the end of the billing period for which services were rendered. Cost Reimbursement Statements shall: reference this Contract by its contract routing number, which number is located on page one of this Contract; state the applicable performance dates, the names of payees; a brief description of the services performed during the relevant performance dates; the incurred expenditures; and, the total requested reimbursement.; and reflect the total program cost as the sum of the "Local Agency Match" and "Amount Requested for Reimbursement" on the monthly billing statement (Attachment F). The "Local Agency Match" shall document the Contractor's 20% contribution of program costs.Reimbursement during the initial, and any renewal or extension, tenor of this Contract shall be conditioned upon affirmation by the State that all services were rendered by the Contractor in accordance with the terms of this Contract. Cost Reimbursement Statements shall be sent to: Page 5 of 15 H:\Contracts\TBContract504\.StateFundmgOnlyEagleo4.DOC Created by Marti Wood Created an 4/27J21b3 11:15 AM • • Colorado Department of Public Health and Environment, Marti Wood, DCEED-A3, 4300 Cherry Creek Drive South, Denver, CO 80246. 4. The State may prospectively increase or decrease the amount payable under this Contract through a "Contract Change Order Letter". A sample Contract Change Order Letter is incorporated herein by this reference, made a part hereof, and attached hereto as "Attachment G". To be effective, the Contract Change Order Letter must be: signed by the State and the Contractor; and, approved by the State Controller or an authorized designee thereof. Additionally, the Contract Change Order Letter shall include the following information: A. Identification of this Contract by its contract routing number and affected paragraph number(s); B. The type(s) of service(s) or program(s) increased or decreased and the new level of each service or program; C. The amount of the increase or decrease in the level of funding for each service or program and the new total financial obligation of the State; D. A provision stating that the Contract Change Order Letter shall not be deemed valid until it has been approved by the State Controller or such assistant as he may designate. Upon proper execution and approval, the Contract Change Order Letter shall become an amendment to this Contract. Except for the General and Special Provisions of this Contract, the Contract Change Order Letter shall supersede this Contract in the event of a conflict between the two. It is expressly understood and agreed to by the parties that the contract change order letter process may be used only for increased or decreased levels of funding, corresponding adjustments to service or program levels, and any related budget line items. Any other changes to this Contract, other than those authorized by the contract renewal letter process described below, shall be made by a formal amendment to this Contract executed in accordance with the Fiscal Rules of the state of Colorado. If the Contractor agrees to and accepts the proposed Contract Change Order Letter, then the Contractor shall execute and return the Contract Change Order Letter to the State by the date indicated in the Contract Change Order Letter. If the Contractor does not agree to and accept the proposed Contract Change Order Letter, or fails to timely return the partially executed Contract Change Order Letter by the date indicated in the Contract Change Order Letter, then the State may, upon written notice to the Contractor, terminate this Contract thirty (30) calendar days after the return date indicated in the Contract Change Order Letter has passed. The written notice shall specify the effective date of termination of this Contract. In the event of termination under this clause, the parties shall not be relieved of their respective duties and obligations under this Contract until the effective date of termination has occurred. Increases or decreases in the level of contractual funding made through this contract change order letter process during the initial, renewal, or extension terms of this Contract may be made under the following circumstances: Page 6 of 15 H:\Contracts\TBContracts04lStateFundmgOnIyEagle04.DOC Created by Marti Wood Created on M22/2003 11:15 AM ~ i E. If necessary to fully utilize appropriations of the state of Colorado and/or non- appropriated federal grant awazds; F. Adjustments to reflect current yeaz expenditures; G. Supplemental appropriations, or non-appropriated federal funding changes resulting in an increase or decrease in the amounts originally budgeted and available for the purposes of this Contract; H. Closure of programs and/or termination of related contracts; Delay or difficulty in implementing new programs or services; and, Other special circumstances as deemed appropriate by the State. 5. The State may renew this Contract through a "Contract Renewal Letter". A sample Contract Renewal Letter is incorporated herein by this reference, made a part hereof, and attached hereto as "Attachment H". To be effective, the Contract Renewal better must be: signed by the State and the Contractor, and, approved by the State Controller or an authorized designee thereof. Additionally, the Contract Renewal Letter shall include the following information: A. Identification of this Contract by its contract routing number and affected paragraph number(s); B. The type(s) of service(s) or program(s), to be renewed and the new level of each service or program for the renewal term; C. The amount of the increase or decrease, if any, in the level of funding for each renewed service or program and the new total financial obligation of the State; D. A provision stating that the Contract Renewal Letter shall not be deemed valid until it has been approved by the State Controller or such assistant as he may designate. Upon proper execution and approval, the Contract Renewal Letter shall become an amendment to this Contract. Except for the General and Special Provisions of this Contract, the Contract Renewal Letter shall supersede this Contract in the event of a conflict between the two. It is expressly understood and agreed to by the parties that the contract renewal letter process maybe used only to: renew this Contract; increase or decrease levels of funding related to that renewal; make corresponding adjustments to service or program levels, and, adjust any related budget line items. Any other changes to this Contract, other than those authorized by the contract change order letter process described above, shall be made by a formal amendment to this Contract executed in accordance with the Fiscal Rules of the state of Colorado. If the Contractor agrees to and accepts the proposed Contract Renewal Letter, then the Contractor shall execute and return the Contract Renewal Letter to the State by the date indicated in the Contract Renewal Letter. If the Contractor does not agree to and accept the proposed Contract Renewal Letter, or fails to timely return the partially executed Contract Renewal Letter by the date indicated in the Contract Renewal Letter, then the State may, upon written notice to the Contractor, terminate this Contract thirty (30) calendaz days after the return date indicated in the Contract Renewal Letter has passed The written notice shall specify the effective date of termination of this Contract. In the event of termination under this clause, the parties shall not be relieved of their respective duties and obligations under this Contract until the effective date of termination has occurred. Page 7 of 15 H:\Contcacts\TBContracts04\StateFundingOnlyEagle04.DOC Created by Marti Wood Created on M22/2~3 11:15 AM • • D. GENERAL PROVISIONS. Because this Contract involves the expenditure of federal, state, or private funds, this Contract is subject to, and contingent upon, the continued availability of those funds for payment pursuant to the terms and conditions of this Contract. If those funds, or any part thereof, become unavailable as determined by the State, then the State may immediately terminate this Contract. 2. The parties warrant that each possesses actual, legal authority to enter into this Contract. The parties further warrant that each has taken all actions required by its applicable law, procedures, rules, or bylaw to exercise that authority, and to lawfully authorize its undersigned signatory to execute this Contract and bind that party to its terms. The person or persons signing this Contract, or any attachments or amendments hereto, also warrant(s) that such person(s) possess(es) actual, legal authority to execute this Contract, and any attachments or amendments hereto, on behalf of that party. 3. The Contractor is a `public entity" within the meaning of the Colorado Governmental Immunity Act (CGIA), section 2410-101, et sea.. C.RS., as amended. Therefore, the Contractor shall at all times during the initial term of this Contract, and any renewals or extensions hereof, maintain such liability insurance, by commercial policy orself-insurance, as is necessary to meet its liabilities under the CGIA. On or before the effective date of this Contract, the Contractor must provide the State with written proof of such insurance coverage. 4. The Contractor certifies that, as of the effective date of this Contract, it has currently in effect all required licenses, certifications, approvals, insurance, permits, etc., if any, that aze necessary to properly perform the services and/or deliver the products specified in this Contract. The Contractor also warrants that it shall maintain all required licenses, certifications, approvals, insurance, permits, etc., if any, that aze necessary to properly perform this Contract, without reimbursement by the State or other adjustment in the Contract price. Additionally, all employees or subcontractors of the Contractor performing services under this Contract shall hold, and maintain in effect, all required licenses, certifications, approvals, insurance, permits, etc., if any, that aze necessary to perform their duties and obligations under this Contract. Any revocation, withdrawal or nonrenewal of any required licenses, certifications, approvals, insurance, permits, etc., if any, that aze necessazy for the Contractor, or its employees and subcontractors, to properly perform its duties and obligations under this Contract shall be grounds for termination of this Contract by the State for default without fiuther liability to the State. 5. To be considered for payment, billings for payments pursuant to this Contract must be received within a reasonable time after the period for which payment is requested; but in no event no later than sixty (60) calendar days after the relevant performance period has passed. Final billings under this Contract must be received by the State within a reasonable time after the expiration or termination of this Contract; but in no event no later than sixty (60) calendaz days from the effective expiration or termination date of this Contract. Page 8 of I S H:\Contracts\TBContracts04\StateFundingOnlyEagle04.DOC Created by Marti Wood Created on 4/22/2003 11:15 AM • • 6. Unless otherwise provided for in this Contract, "Local Match" shall be included on all billing statements, in the column provided therefore, as required by the funding source. 7. The Contractor shall grant to the State, or its authorized agents, access to the records and financial statements of the Contractor that directly relate to its performance under this Contract. The Contractor shall retain all such records and financial statements for a period of six (6) years after the date of issuance of a final audit report. This requirement is in addition to any other audit requirements contained in other paragraphs of this Contract. 8. Unless otherwise provided for in this Contract, for all contracts with terms longer than three (3) months, the Contractor shall submit a written progress report specifying the progress made for each activity identified in this Contract. These progress reports shall be submitted in accordance with any applicable procedures developed and prescnbed by the State. The preparation of progress reports in a timely manner is the responsibility of the Contractor. If the Contractor fails to comply with this provision, then the failure: may result in a delay of payment of funds; or, termination of this Contract. 9. The Contractor shall maintain a complete file of all records, documents, communications, and other materials that directly relate to this Contract. These materials shall be sufficient to properly reflect all direct and indirect costs of labor, materials, equipment, supplies, and services, and other costs of whatever nature for which a contract payment was made. These records shall be maintained according to generally accepted accounting principles and shall be easily separable from other records of the Contractor. Copies of all such records, documents, communications, and other materials shall be the property of the State and shall be maintained by the Contractor, in a central location as custodian for the State, on behalf of the State, for a period of six (6) years from the date of final payment under this Contract, or for such further period as maybe necessary to resolve any pending matters, including, but not limited to, audits performed by the federal government. 10. The Contractor authorizes the State, or its authorized agents or designees, to perform audits or make inspections of those records that directly relate to its performance under this Contract. Audits and inspections maybe made at any reasonable time during the term of this Contract and for a period of three (3) after the termination or expiration date of this Contract. The Contractor shall permit the State, or any other duly authorized governmental agent or agency, to monitor all activities conducted by the Contractor pursuant to the terms of this Contract. Monitoring may include, but is not limited to: internal evaluation procedures, examination of program data, special analyses, on-site checks, formal audit examinations, or any other reasonable procedures. All monitoring shall be performed by the State in a manner that does not unduly interfere with the work of the Contractor. 11. Subject to the Public (Open) Records Act, section 2472-101, et sea.. C.RS., as amended, if the Contractor obtains access to any records, files, or other information of the State in connection with, or during the performance of, this Contract, then the Contractor shall keep all such records, files, or other information confidential and shall comply with all laws and regulations concerning the confidentiality of all such records, files, or information to the same extent as such laws and regulations apply to the State. Any breach of confidentiality by the Contractor, or third party agents of the Contractor, shall constitute good cause for the State to cancel this Contract, without liability to the State. Any State waiver of an alleged breach of confidentiality by the Contractor, Page 9 of 15 H:\Contracts\TBContracts04\StateFundingOnlyEag1e04.DOC Created by Marti Wood Created on 4/27J211a3 11:15 AM • • or third party agents of the Contractor, does not constitute a waiver of any subsequent breach by the Contractor, or third party agents of the Contractor. 12. Unless otherwise provided for in this Contract, or in a written amendment executed and approved pursuant to the Fiscal Rules of the state of Colorado, all material, information, data, computer softwaze, documentation, studies, and evaluations produced in the performance of this Contract for which the State has made a payment under this Contract are the sole property of the State. 13. If any copyrightable material is produced under this Contract, then the State shall have a paid in full, irrevocable, royalty free, and non-exclusive license to reproduce, publish, or otherwise use, and authorize others to use, the copyrightable material for any purpose authorized by the Copyright I.aw of the United States as now or hereinafter enacted. Upon the written request of the State, the Contractor shall provide the State with three (3) copies of all such copyrightable material. 14. If required by the terms and conditions of a state grant, the Contractor shall obtain the prior approval of the State and all necessary third parties prior to publishing any materials produced under this Contract. If required by the terms and conditions of a state grant, the Contractor shall also credit the State and all necessary third parties with assisting in the publication of any materials produced under this Contract. 15. If this Contract is in the nature of personal/purchased services, then the State reserves the right to inspect services provided under this Contract at all reasonable times and places during the term of this Contract. "Services", as used in this clause, includes services performed or written work performed in the performance of services. ff any of the services do not conform with the terms of this Contract, then the State may require the Contractor to perform the services again in conformity with the tenors of this Contract, with no additional compensation to the Contractor for the reperformed services. When defects in the quality or quantity of the services cannot be connected by reperfonmance, then the State may: require the Contractor to take all necessary action(s) to ensure that the future performance conforms to the terms of the Contract; and, equitably reduce the payments due to the Contractor under this Contract to reflect the reduced value of the services performed by the Contractor. These remedies in no way limit the other remedies available to the State as set forth in this Contract. 16. If, through any cause attributable to the action(s) or inactions) of the Contractor, the Contractor: fails to fulfill, in a timely and proper manner, its duties and obligations under this Contract; or, violates any of the agreements, covenants, provisions, stipulations, or terms of this Contract, then the State shall thereupon have the right to terminate this Contract for cause by giving written notice thereof to the Contractor. The written notice shall be given to the Contractor no less than thirty (30) calendar days before the proposed termination date and shall afford the Contractor the opportunity to cure the default or state why termination is otherwise inappropriate. If this Contract is terminated for default, then all finished or unfinished data, documents, drawings, evaluations, hardware, maps, models, negatives, photographs, reports, software, studies, surveys, or any other material, medium or information, however constituted, which has been or is to be produced or prepazed by the Contractor under this Contract shall, at the option of the State, become the property of the State. The Contractor shall be entitled to receive just and equitable compensation for any services or supplies delivered to, and accepted by, the State. If applicable, the Contractor shall return any unearned advance payment it received under this Contract to the State. Notwithstanding the above, the Contractor is not relieved of liability to the State for any damages sustained by the State because of the breach of this Contract by the Contractor. The State Page 10 of 15 H:\Contracts\TBContractc04\StateFundingonlyEag1e04.DOC Created by Marti Wood Created on 4/22/2003 11:15 AM • • may withhold any payment due to the Contractor under this Contract to mitigate the damages of the State until such time as the exact amount of those damages is determined. If, after terminating this Contract for default, it is determined for any reason that the Contractor was not in default, or that the action(s) or inactions) of the Contractor was excusable, then such termination shall be treated as a termination for convenience, and the respective rights and obligations of the parties shall be the same as if this Contract had been terminated for convenience as descn'bed in paragraph 21. below 17. The State may, when the interests of the State so require, terminate this Contract, in whole or in part, for the convenience of the State. The State shall give written notice of termination to the Contractor. The written notice shall specify the part(s) of the Contract terminated. The written notice shall be given to the Contractor no less than thirty (30) calendaz days before the effective date of termination. If this Contract is terminated for convenience, then all finished or unfinished data, documents, drawings, evaluations, hazdwaze, maps, models, negatives, photographs, reports, soflwaze, studies, surveys, or any other material, medium or information, however constituted, which has been or is to be produced or prepazed by the Contractor under this Contract shall, at the option of the State, become the property of the State. The Contractor shall be entitled to receive just and equitable compensation for any services or supplies delivered to, and accepted by, the State. If applicable, the Contractor shall return any uneazned advance payment it received under this Contract to the State. This paragraph in no way implies that a party has breached this Contract by the exercise of this paragraph. If this Contract is terminated by the State as provided for herein, then the Contractor shall be paid an amount equal to the percentage of services actually performed for, or goods actually delivered to, the State, less any payments ah-eady made by the State to the Contractor for those services or goods. However, if less than sixty percent (60%) of the services or goods covered by this Contract have been performed or delivered as of the effective date of termination, then the Contractor shall also be reimbursed (in addition to the above payment) for that portion of those actual "out-of-pocket" expenses (not otherwise reimbursed under this Contract) incurred by the Contractor during the term of this Contract that aze directly attnbutable to the uncompleted portion of the services, or the undelivered portion of the goods, covered by this Contract. In no event shall reimbursement under this clause exceed the total financial obligation of the State to the Contractor under this Contract. If this Contract is terminated for default because of this Contract by the Contractor, then the provisions of paragraph 20, above shall apply. 1 S. Neither the Contractor nor the State shall be liable to the other for any delay in, or failure of performance of, any covenant or promise contained in this Contract to the extent that the delay or failure is caused by a supervening cause. As used in this Contract, "supervening cause" is defined to mean: an act of God, fire, explosion, action of the elements, strike, intemiption of transportation, rationing, court action, illegality, unusually severe weather, waz, or any other cause which is beyond the control of the affected party and which, by the exercise of reasonable diligence, could not have been prevented by the affected party. A delay or failure to perform that is caused by a supervening cause shall not constitute a material breach of this Contract or give rise to any liability for damages therefor under this ContracK. 19. The enforcement of the terms and conditions of this Contract, and all rights of action related to that enforcement, shall be strictly reserved to the State and the Contractor. Nothing contained in this Contract shall give rise to, or allow, any claim or right of action whatsoever to or by any third person. Nothing contained in this Contract shall be construed as a waiver of any provision of the Colorado Governmental Immunity Act, section 2410-101 et sea•. C.RS., as amended. Any person or entity, other than the State or the Contractor, who may receive services or benefits under this Contract shall be deemed an incidental beneficiary only. Page 1 I of 15 H:\Contracts\TBContractso4\StateFundingOnlyEag1e04.DOC Created by Marti Wood Created on 4/22/2003 11:15 AM • 20. To the extent that this Contract maybe executed and performance of the obligations of the parties maybe accomplished within the intent of this Contract, the terms of this Contract are severable. If any term or provision of this Contract is declared invalid by a court of competent jurisdiction, or becomes inoperative for any other reason, then that invalidity or failure shall not affect the validity of any other term or provision of this Contract. 21. The waiver of a breach of a term or provision of this Contract shall not be construed as a waiver of a breach of any other term or provision of this Contract or, as a waiver of a breach of the same term or provision upon subsequent breach. 22. If this Contract is in the nature of personal/purchased services, then, except for accounts receivable, the rights, duties, and obligations of the Contractor shall not be assigned, delegated, or otherwise transferred, except with the prior, express, written consent of the State. 23. Unless otherwise provided for in this Contract, this Contract shall inure to the benefit of, and be binding upon, the parties hereto and their respective successors and assigns. 24. Unless otherwise provided for in this Contract, the Contractor shall notify the State, within five (5) working days after being served with a summons, complaint, or other pleading in any case that involves any services provided under this Contract and which has been filed in any federal or state court or administrative agency. The Contractor shall deliver copies of any documents that it was served with to the State within five working (5) days of the date of service. 25. This Contract is subject to such modifications as may be required by changes in applicable law, or the implementing rules, regulations, or procedures of that law. Any required modification(s) shall be automatically incorporated into, and be made a part of, this Contract as of the effective date of the change as if that change was fully set forth herein. Except as provided above, no modification of this Contract shall be effective unless that modification is agreed to in writing by both parties in the form of a written amendment to this Contract that has been previously executed and approved in accordance with the Fiscal Rules of the state of Colorado. 26. Unless otherwise provided for in this Contract, all terms and conditions of this Contract, and the attachments or exhibits hereto, that may require continued performance or compliance beyond the termination or expiration date of this Contract shall survive that termination or expiration date and shall be enforceable as provided for herein. 27. Unless otherwise provided for in this Contract, no term or condition of this Contract shall be construed or interpreted as a waiver, express or implied, of any of the immunities, rights, benefits, protections, or other provisions of the Colorado Governmental Immunity Act (CGIA), section 24 10-101, et sea•. C.RS., as amended. Liability for claims for injuries to persons or property arising out of the alleged negligence of the State or the Contractor, their departments, institutions, agencies, boards, officials, and employees is controlled and limited by the provisions of section 24-10-101 et sea., C.RS., as amended. Page 12 of 15 H:\Contracts\TBContracts04\StateFundingOnlyEagle04.DOC Created by Marti Wood Created on M22/2003 11:15 AM • ~ 28. The captions and headings used in this Contract aze for identification only, and shall be disregazded in any construction of the terms, provisions, and conditions of this Contract. 29. Venue for any action related to this Contract shall be in the City and County of Denver, Colorado. 30. All attachments or exhibits to this Contract aze incorporated herein by this reference and made a part hereof as if fully set forth herein. In the event of any conflict or inconsistency between the terms of this Contract and those of any attachment or exhibit to this Contract, the terms and conditions of this Contract shall control. 31. No state or private funds payable under this Contract shall be used for the acquisition, operation, or maintenance of computer softwaze in violation of United States copyright laws or applicable licensing restrictions. The Contractor hereby certifies that, for the term of this Contract, and any renewals or extensions hereof, the Contractor has in place appropriate systems and controls to prevent such improper use of public fiords. If the State determines that the Contractor is in violation of this paragraph, then the State may exercise any remedy available to the State at law, equity, or under this Contract, including, without limitation, immediate termination of this Contract and any other remedy consistent with United States copyright laws or applicable licensing restrictions. 32. This Contract is the complete integration of all understandings between the parries. 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 amendment to this Contract executed and approved in accordance with applicable law. E. SPECIAL PROVISIONS. 1. CONTROLLER'S APPROVAL. CRS 2430-202 (1) This contract shall not be deemed valid until it has been approved by the Controller of the State of Colorado or such assistant as he may designate. 2. FUND AVAILABILITY. CRS 24-30-202 (5.5) Financial obligations of the State of Colorado payable after the current fiscal yeaz are contingent upon funds for that purpose being appropriated, budgeted, and otherwise made available. 3. INDEMNIFICATION. The Contractor shall indemnify, save, and hold harmless the State against any and all claims, damages, liability and court awazds including costs, expenses, and attorney fees incurred as a result of any actor omission by the Contractor, or its employees, agents, subcontractors, or assignees pursuant to the terms of this contract. Page 13 of 15 H:\Contracts\TBContracts04\StateFundingOnlyEag1e04.DOC Creaked by Marti Wood Created on 4/22/2003 11:15 AM ~ ~ No term or condition of this contract shall be construed or interpreted as a waiver, express or implied, of any of the immunities, rights, benefits, protection, or other provisions for the parties, of the Colorado Governmental Immunity Act, CRS 2410-101, et seq., or the federal tort claims act, 28 U.S.C. 2671 et seq., as applicable as now or hereafter amended. 4. INDEPENDENT CONTRACTOR 4 CCR 801-2 THE CONTRACTOR SHALL PERFORM TTS 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 AND LOCAL HEAD TAX ON ANY MONIES PAID BY THE STATE PURSUANT TO THIS CONTRACT. CONTRACTOR ACKNOWLEDGES THAT THE CONTRACTOR AND TTS EMPLOYEES ARE NOT ENTITLED TO UNEMPLOYMENT INSURANCE BENEFTTS UNLESS THE CONTRACTOR OR THIItD PARTY PROVIDES SUCH COVERAGE AND THAT THE STATE DOES NOT PAY FOR OR OTHERWISE PROVIDE SUCH COVERAGE. CONTRACTOR SHALL HAVE NO AUTHORIZATION, EXPRESS OR IMPLIED, TO BIND THE STATE TO ANY AGREEMENTS, LIABILITY, OR UNDERSTANDING EXCEPT AS EXPRESSLY SET FORTH HEREIN. CONTRACTOR SHALL PROVIDE AND KEEP IN FORCE WORKERS' COMPENSATION (AND PROVIDE PROOF OF SUCH INSURANCE WHEN REQUESTED BY THE STATE) AND UNEMPLOYMENT COMPENSATION INSURANCE IN THE AMOUNTS REQUIRED BY LAW, AND SHALL BE SOLELY RESPONSIBLE FOR THE ACTS OF THE CONTRACTOR, TTS EMPLOYEES AND AGENTS. 5. NON-DISCRINIINATION. The contractor agrees to comply with the letter and the spirit of all applicable state and federal laws respecting discrimination and unfair employment practices. 6. CHOICE OF LAW. 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 azbitration by any extra judicial body or person or which is otherwise in conflict with said laws, rules, and regulations shall be considered null and void. Nothing contained in any provision incorporated herein by reference which purports to negate this or any other 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, or otherwise. 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 hereafter be established. 7. EMPLOYEE FINANCIAL INTEREST. CRS 2418-201 & CRS 2450-507 The signatories aver that to their ]mowledge, no employee of the State of Colorado has any personal or beneficial interest whatsoever in the service or property described herein. Page 14 of 15 H:\Contracts\TBContracts04SStateFundingOnlyEag1e04.DOC Created by Marti Wood Created on 4/22/21M13 11:15 AM • ~ IN WITNESS WHEREOF, the parties hereto have executed this Contract on the day first above written. EAGLE COUNTY ~ iv1~li un~aie~ (apolitical subdi on of the f Color do) By: Name: `_ Title: ~' _ ~ FEIN: 846000762 ATTEST (Atl3x d~ By: Coi -~fslrie~-er-Yawn Clerk or COLORADO DEPARTMENT OF LAW OFFICE OF THE ATTORNEY GENERAL Ken Salazar, Attorney General By: ~ (~ STATE OF COLORADO Bill Owens, Governor ®~ rr~o~.~c® }~ ~ OGRAM APPROVAL: :~, .~ * ,~ °o osA~° ~ By: APPROVALS: ALL CONTRACTS MUST BE APPROVED BY THE STATE CONTROLLER CRS 24-30-202 requires that the State Controller approve all state contracts. This contract is not valid until the State Controller, or such assistant as he may delegate, has signed it. The contractor is not authorized to begin performance until the contract is signed and dated below. If performance begins prior to the date below, the State of Colorado may not be obligated to pay for the goods and/or services provided. STATE CONTROLLER: Arthur L. Barnhart By: ~--r~._C~ or~ Date: `~ I c~ I ~~ By: ~ or the Ez utive Director DEPAR NT OF PUBLIC HEALTH AND ENVIRONMENT Page 15 of 15 H:\Contracts\TBContracts04~StateFundingOnlyEagle04.DQC Created by Marti Wood Created on 4/22!200311:15 AM • Attachment A National TB Objectives Comaletion of therapy • At least 90 percent of patients with newly diagnosed TB, for whom therapy for one year or less is indicated;, will complete therapy within 12 months. ("Please refer to the definitions in "Reported Tuberculosis in the United States 1997 for more information.) Contact investigation • Contacts will be ident~ied for at least 90 percent of newly reported sputum AFB-smear positive TB cases. • At least 95 percent of contacts to sputum AFB-smear positive TB cases will be evaluated for infection and disease. • At least 85 percent of infected contacts that are started on treatment for latent TB infection will complete therapy. Reoorting • All new cases of TB disease will be reported using the electronic reporting system developed by CDC. There will be at least 95 percent completeness' for the following variables (question number) in the expanded Report of Verified Case of Tuberculosis (RVCT): in RVCT, Date of Birth (7), Sex (8), Race (9) or Ethnic origin (10), Country of Origin (11), Month-Year Arrived in U.S. (12), Status at Diagnosis of TB (13), Previous Diagnosis of Tuberculosis (14), Major Site of Disease (15), Sputum Smear (17), Sputum Culture (18), Microscopic Exam of Tissue and Other Body Fluids (19), Culture of Tissue and Other Body Fluids (20), Chest X-Ray (21), Tuberculin Skin Test at Diagnosis (22), Resident of Correctional Facility at Time of Diagnosis (25), Resident of Long-Term Care Facility at Time of Diagnosis (26), Initial Drug Regimen (27), Date Therapy Started (28), Occupation (32); in Follow Up Report-1, Initial Drug Susceptibility Results (33), Susceptibility Results (34); in Follow Up Report-2, Sputum Culture Conversion Documented (35), Date Therapy Stopped (36), Reason Therapy Stopped (37), Directly Observed Therapy (39). '"Unknown" and "missing" responses are considered not complete. A response of "not done" is considered complete. • Drug susceptibility results will be reported for at least 90 percent of all new, culture-positive TB cases. • HN status will be reported for at least 75 percent of all newly reported TB cases age 25-44. Laboratory testing • For at least 80% of initial diagnostic specimens received by the public health laboratory for TB diagnosis, the following laboratory turnaround times will be met: reporting of smear-positive or smear- negative results of acid-fast examination of specimens within 24 hours of specimen receipt; for culture-positive specimens, reporting of MTB or not MTB within 14-21 days from specimen receipt; and reporting of drug susceptibility tests for first-line drugs within 15 to 35 days from specimen receipt. • For at least 80% of isolates of mycobacteria referred to the public health laboratory for additional TB diagnostic testing, the following laboratory turn-around times will be met: reporting of isolates as MTB or not MTB within 7 days of isolate receipt, and reporting of first-line drug susceptibility tests within 10-14 days from isolate receipt. Targeted testina and treatment of latent TB infection: • At least 75% of persons with latent TB infection found through targeted skin testing activities and started on treatment for TB infection will complete therapy. . • ..... .... .. Attachment B TUBERCULOSIS SURVEILLANCE AND CASE N~GEMENT REPORT Colora~ Department of Pubes Flealn, and Environment DCEED-TB-A3 Trber~xibsis Canbol 4300 Cherry Creek Drive Siwlh Demrer, Colorado 80246-1 S30 (303) 692 267J Phone (30Ci) 691 x749 Fax .~ ~. i ~ Name: Date of Bi<tb Corrrriry of B"ufh _ ~ - Morrth Year Address: ~ ~ p USA Arrived in USA ~Y• ~A= Nom Courtly of Work Phone: Residence Sex: Race ^ Mai ^ YVh>te Ethnic Origrr Female ^ Black _ p p Am~itan Ir,diaro Alaskan Native p Non-Hispar~ twla;~l sates p Asian+Pacific !slab ^ unkravrn p statrrs X-ray aken try: (Agency's Name): / / Refugee: p Yes p No p thrlaroavn Awn Number# otn.sider~e in Colorado - - •.- - _ Agenq's Name: ~ A,gency County Agengls Addn qty: Zip: Phone: Name of Patients Primary Care Physician: Addn~ ~: Phone: ~. _ ., MOST RECENT SKIN TEST ~ "` ~' Type: p MarRacc Tubersot ^ ~ p me p ~ci-) Re5111ts: p Postive ^ Negatnre p Not Done p unlcwwn O o~ c~ bnduratian nrn Date PPD Given i r Date PPD Read ^ Stable ^ Wotsenin9 ^ ~Pro~9 p tkriv>aarrn X-RAY FINDINGS 3" ~' " Date of X-ray: Previous / / Abnomral X-ray: / / X~ay results: Abnormality ^ Normal ^ Cavday Abnom~al ^ Werrcavitary Cow w/TB ^ Not Done ^ Nbncavr7ary Nat Cor~tent w/TB Unkrxarm ^ Other(Spea'fy) p Canada, .span, Western Europe. Austrdiia, Nee- Zealand Mexico. Central or South America Africa. M~dle Easy China, ItxSa, Central or Sout1>east Asia, Indonesia, p Eastern Europe, Russia, tJlaiaine o ~~ Previous ff positive, is this a skin test Positive PPD conversion negative to positive Yes within Z years: p ~ ^ Yes ~~~ ^No ~ test: ^ Unknown Return X~ay to: ~.+ Note: CaPIiE ~ s~aDely attadr x-ray ;~ _ CLINICAL ~... symptoms: None ^ Productive Catrgh ^~ Weight CASs Fever ^ Night Sweats ^ Other(sPe~Y) Date of Onset of special Cow ~ p Pregnant EDC: / / ~ ~ p Postpartum Breast Feed'ng ^ Other (SP~y)= Name of Person ~ Date: TB-17 o?J99 Pabterrls Name: ~ ~ Oa1e of B~ O~pation Yes No ^ Health rare worker ^ ^ Homeless wtitdn past year ^ corre<~o~, ^ ^ ltesid~c of Correction Faa7dy ^ M~gratorlt Ariad~al worker ~ at time of Diagnosis ^ Nat Employed wtit-6i past 24 months a Yes, ^ Unlmown ^ ^ Federal Prison ^ og~ O (may) ^ ^ State Prison ^ ^ L.oeal.hdr7 IioM- many other persons in household ^ ^ Juvenile bes~es palie+~t? ^ D other ^ 0 ^ 1 ~ ^ 4.+ ^ ^ UNmown On lfAedir~ions thad may have ~ Yes No interactions with anti-TB drugs? ^ ^ Resident of long Term Care ^ Yes ^ No Speal~- Fari6tj+ at time of Diagnosis? ltYes, ^ ^ Nursing name Yes No ^ ^ Hosptial ^ ^ ~1~9 ~J Lie ^ ^ Residential ^ ^ Excessive Alcohol Abuse ^ ^ McNal HeaHh ^ ^ ~~~9 ~ ~ llse ! or Drtrg Trearne~nt• ^ ^ Other ^ ^ Corntnned diagnosis of TS? ^ Yes ^ No ^ Suspect tt tonterned Est primary site- Secondarysite: Hospiaal Adrrrissioa: Adrrd~ssion Diagnoses: - Date: / / StiAEAR CIJLTi1RE Pos Neg Not Done Pos Neg Not Done ^ Sputum ^ ^ ^ ^ ^ ^ ^ Utine ^ •..^ ^ ' ^ ^ ^ ^ Other ., ^ ^ ^ - ^ ^ ^ ^ Current ^ Past'-~ ^ Completedfup eatuse I ^ Started but did not complete tuq cause I ^ Unlatown. it completed tact course N treated in the past was this for. ^ Active Disease ^ Preventive Therapy DOT By. Drug Regimen: (Mark ad than apply) .: Date Started lsoniazid mg / /. B-s mg / / Ritampin mg _ / / - Pyra¢inamide mg / / Efhamnbutoi mg / / Streptomydn mg / / Ethionam~e mg / / Otherf~N) - Attachment B pg 2. Yes No -- ^ ^ D ^ ^ sfioosis ^ ^ 6 ^ ^ ln~e Thera~- O D ^ ^ Kidney Far'tme Yes No ^ ^ ~~ ^ ^ Pnev~rs Diagrx~ of TB . Date: ~~( ^~ ^ BCG 1/accirration •: Date• / / Yes No ^ ^ Prior HlY Test Date: /~ HYes. dYYe"' ~SitelProvider) Pos Neg .. ^ ^ Is patient in it~alatiian or in need of isolat~rdne? ^ Yes ^ No It yes. Was a contact inveon initiated: ^ Yes ^ No If yes, is a Corded Investiigation tour needed? ^ Yes ^ Na Date serrt /_/ By when?: Gate: / / Date: / / oar Date: L.aboratmy Submitted to ^ Cobrddo Departrr~ertt of Pubie Health and Envirome ^ other laboratory (~Y) Date: / Person YVbo Exposed thPs Patient Name: Address: City: State: Zqr - Phone: / / dosreress of Sormce to Case: Sauce Spntum resuit.~ ^ Household ^ 6ATB CufNre Positive ^ Workplace ^ AFB Smear Positive ^ Other ^ Smear and CuRure Negative ^ Unknovm ^ unknown Laboratory . • PATIENT FOLLOW=uP INFORMATION AND TRANSF~FOR~A (T8-10) - ( I ~ hour idbnr~lion ( ) ttepijr rsqus~ed To: ~;Za~~, Attachment C Pat~nCs Name: SEx Matr~l status q~ress: M F S M W D Sep CCityy. Stale. Tp Birtlldabe,_ / / ~ Rxe Ptrone Numt~er: Cainty: ' ACTfVE CASE< YES NO CoM~rrred by Labor PCP ?: YES NO Ryes„ date of : I Date of Tt3C.sidn teat. / / ReauR to MM: Farr Pulmonary E~ Ptdrrror~- (specNy sbe) Suspea,__ LATEST t3P-GTE RivLt~Git~AL s ~ A ~ us: nroc rraewe.kam..-a..raow. r~roa a.oraow~..a..wuo.r. oa r..a.ePo.r~. ~ tabowtogr.irw. ~p.an~i «i. ufi. aw csp.Mr slay ~ - oRUCS: H patient on ~ tt~rapy Date started: / / Data stopped: ~L Number of weeks on DOT: H patient NOT on drug therapy. give reason: Most reo~t X-ray res~ltsldate(s) Prevbua Hospitaliza~on for TB: When Where: primary Care Provider: Phone is REd,~ T01~ YES NO ~ Me~tiorrs ~d dosage Date of ~ test: / / Date started:.~1_ Date slopped : _[~_ Reason Medkation given by whom . • pate of won: / / ff patient has moved or r~elo~. tdamcaaona and dosage Colorado [~partmertt of Public Hearth and Environment Name of Person ®onng the tome Date 4300 Cherry Creek Drive South. DCEED-TB-A3 Denver. Colorado 8022'21530 303-692 2679 Ts.~o~e,-~ Attachment D 1 ~s~~~~ ~~ s ~r8 ~d .g ~ ~ ~ O ~~~ E .~.~ ~'~ p~ C 3 a. g r9 a ~~~~3a~ 3~£ ~~ ~ ~ .. ~~s~~ `-~~o~ r Y L• r ~ ~ ~ o ~ ~ : e ~ ~ Y g 2 ~. C w` ~~ e~ 3 o E .~i ~ E a ~ gc ~g~'~ ~ E ~ ,. ~ •~ 3 H Y c 7 Z Z I C ~" w ~. Q C. p0 O .~ ~"1 h M r Y 0 u w 0 t~ A r N O Y °e O C .'sue 0 .O <r N A S V 9 `o 0 e M 0 ~~ Q .. V 0 ~~ $~~w w ~~ ~v~ Z ^_~ ~rr >> ~~a ~3 03p ~ o<Z<F"gg A~~~' o~_ =~~~~g }~~~~~ZZ (r.-.-±-.-~+~ a 'o 0 'O~~OM v OQ>MM ~-O~ O C L'Z<Z~ i! U a w ~~ ~~ ~a Y ~~s ~ Li ~ a`~ O v 3'~ a~< e Q OG ~~_ ~~ 0 ~~ E ~, e ~ ~g 0 E' E Y w z=~ M O v ..°. M ~ ~ C S ~~ = `~ S Y _»~ cg gg•~; 5~ ~~ -: .. ~ ~ Y > O _ a ~ O _ p Y O ..~azz ~Od O ~z<z ~Q,..,.._, - - x~..__, ~< q 0 U A a c~ ~~ L~/1 T~ V Y a a u C. ~~~ ~- ~ ~~- z~ STATE OF COLORADO Bill CMrens, Governor Douglas H. Benevento, Executive Director Dedicated to protecting and improving the health and environment of the people of Colorado 4300 Cherry Creek Dr. S. Laboratory and Radiation Services Division Denver, Colorado 80246-1530 8100 Lowry Blvd. Phone (303) 692-2000 Denver, Colorado 80230-6928 TDD Line (303) 691-7700 (303) 692-3090 Located in Glendale, Colorado http://www.cdphe.state.co.us ~~ `\~~ July 10, 2003 Kathleen Fotinash Eagle County Public Health & Hutnan Service P.O. Box 660 Eagle, CO 81631 Dear Ms. Kathleen Forinash; ~UL ~ 7 2003 .',OMAN S~~VtCE~ 1,_ _ - of • Coto ,~ti - e y 0 'F 1876 '~ Colorado Department of Public Health and Environment Enclosed please find a fully approved contract for Tuberculosis Control, contract routing number 04-00007 for the period July 1, 2003 through June 30, 2004 with the Colorado Department of Public Health and Environment, Disease Control and Environmental Epidemiology Division Control. Please keep the original document in your contract files. On June 3, 2003, the TB Program sent out an E-mail to County Directors of Health Departments. I would like to emphasize the following points within that E-mail: • With prior CDPHE approval, funds can be moved from one contract line to another as needed for your TB activities. (This can be done simply with a memo or by an E-mail to me.) • If you experience increased or unusual TB activity and are running short of funds, please notify the CDPHE TB program and we will make every effort to provide additional funds. • If resources allow and the top priorities of treatment of active TB and contract investigations are being met, please do not hesitate to screen and treat high-risk patients with latent TB infection. Also I would like to bring your attention to Attachment F of this contract. Please use this billing form when seeking reimbursement for your contract. While a signature is required, this form may be faxed if you prefer. We appreciate all your efforts to reduce tuberculosis in Colorado and to protect the public health and we look forward to working in collaboration with you during the following fiscal year. If you have any questions or require any further information, please feel free to contact me. Sincerely, Marti Wood TBiRefugee Contract Administrator Disease Control and Environmental Epidemiology Phone: (303) 692-2754 Fax: (303) 691-7749 E-mail: marti.wood(u~state.co.us