CN-640000-HB395.pdf

DEPARTMENT OF HEALTH - FLORIDA ACCOUNTABILITY CONTRACT TRACKING SYSTEM

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PART I: OVERALL CONTRACT INFORMATION

TOTAL CONTRACT AMOUNT:

A. $485,802.00

MAIN CONTRACT INFORMATION CONTRACT PROCUREMENT INFORMATION

FLAIR CONTRACT ID HB395 ADVANCED AUTHORIZED No

SHORT TITLE BASIC SERVICE COMPETITIVE PROCUREMENT No

LONG TITLE

BASIC SERVICE SCHOOL

HEALTH SERVICE,

HILLSBOROUGH COUNTY

PROCUREMENT CODE Select

AGENCY UNIQUE ID

(ENTER FLAIR

CONTRACT ID)

EXEMPT (if yes, justification required) Yes

ORIGINAL AMOUNT $485,802.00 EXEMPTION CODE L- Other Government Agency

CONTRACT TYPE SC-Standard Agreement STATE TERM ID

CONTRACT STATUS A-Active EXEMPTION JUSTIFICATION

DATE OF EXECUTION 7/1/2022 The Department of Health mandates that School Health Services delivers under this contract to be provided in accordance with s. 381.0056, F.S.,s. 381.0057, F.S., s.

402.3026, F.S, and Chapter 64-6.001-6.006, F.A.C.

BEGINNING DATE 7/1/2022

ORIGINAL END DATE 06/30/2023

NEW ENDING DATE

STATUTORY AUTHORITY

S.381.0056, 381.0057 AND

402.3026, F.S

FINANCIAL ASSISTANCE Yes

CFDA # , ,

AGENCY REFERENCE # -ITB, RFP, ITN,

RFA

CSFA # , , BUSINESS CASE Select

RECIPIENT TYPE District School Board DATE COMPLETED

DO NOT PUBLISH THIS

CONTRACT ON THE FACTS

PUBLIC WEBSITE

(This should always be left blank)

SERVICE AREA 29 LEGAL CHALLENGES TO PROCUREMENT Select

ADMINISTRATIVE COST INFORMATION LEGAL CHALLENGE DESCRIPTION

ADMIN. COST ALLOWED Select

ADMIN.PERCENTAGE 0.00%

ADMIN COST AMOUNT $0.00

PERIODIC INCREASE Select

PERCENTAGE ALLOWED 0.00% OUTSOURCING / CAPITAL IMPROVEMENTS

CONTRACT MANAGER INFORMATION PREVIOUS STATE FUNCTION No

LAST

NAME

Waskovich FIRST NAME Jennifer

INSOURCING CONSIDERED

No

PHONE 813-559-4196 EXTENSION CAPITAL IMPROVEMENT No

DATE OF LAST DOH CERTIFICATION: 4/15/2021 CAPITAL IMPROVEMENT DESCRIPTION

DATE OF ADV. ACCOUNTABILITY or

FCCM

4/6/2022

VENDOR INFORMATION

VENDOR ID VF 596000660-132

VENDOR NAME

HILLSBOROUGH COUNTY PUBLIC

SCHOOLS

VALUE OF IMPROVEMENT $0.00

ADDRESS 901 E. KENNEDY BLVD. UNAMORTIZED VALUE $0.00

CITY/STATE/ZIP TAMPA,FL 33602

FISCAL YEAR END 6/30/2023

CONTACT PERSON Dr. Maria Russ

CONTACT E-MAIL

ADDRESS

maria.russ@hcps.net

PHONE NUMBER 813-273-7020

GENERAL CONTRACT DESCRIPTION (PUBLIC VIEW)

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PART II: CONTRACT ACTIONS

Contract Actions are all actions related to the contract after the initial execution of the agreement with the provider. In addition to amendments, extensions and renewals, these actions include budget, and contract manager changes.

Action Type Agency

Reference # Action

Amount Effective

Date Execution

Date New End Date

Brief Description

NEW $485,802.00 07/01/2022 07/01/2022 06/30/202

NEW CONTRACT

select $0.00 select $0.00 select $0.00 select $0.00 select $0.00 select $0.00 select $0.00 select $0.00 select $0.00 select $0.00 select $0.00 select $0.00 select $0.00 select $0.00 select $0.00 select $0.00 select $0.00 select $0.00 select $0.00 select $0.00 select $0.00 select $0.00 select $0.00 select $0.00 select $0.00 select $0.00 select $0.00 select $0.00 select $0.00 select $0.00 select $0.00 select $0.00 select $0.00 select $0.00 select $0.00 select $0.00 select $0.00 select $0.00 select $0.00 select $0.00 select $0.00 select $0.00 select $0.00 select $0.00 select $0.00 select $0.00 select $0.00

Page | 3 DH 1122, 08/2021 - previous editions may not be used select $0.00 select $0.00 select $0.00

PART III: CONTRACT BUDGET

Fiscal Year 2022-2023

ACCOUNT CODE

AMOUNT TYPE EO VR OCA

OBJECT

CODE

EFF

DATE

AMD

REF L1 GF SF FID BE IBI CAT YR

64 20 2 14101 64200700 29 100777 1 $485,802.00 NEW SG 01 SCHGR 132009 07/01/2022

$0.00 $0.00 $0.00 $0.00

FISCAL YEAR TOTAL AMOUNT $485,802.00

Fiscal Year -

ACCOUNT CODE

AMOUNT TYPE EO VR OCA

OBJECT

CODE

EFF

DATE

AMD

REF L1 GF SF FID BE IBI CAT YR

$0.00 $0.00 $0.00 $0.00

FISCAL YEAR TOTAL AMOUNT $0.00

AMOUNT TYPE EO VR OCA

OBJECT

CODE

EFF

DATE

AMD

REF L1 GF SF FID BE IBI CAT YR

$0.00 $0.00 $0.00

AMOUNT TYPE EO VR OCA

OBJECT

CODE

EFF

DATE

AMD

REF L1 GF SF FID BE IBI CAT YR

$0.00 $0.00 $0.00

AMOUNT TYPE EO VR OCA

OBJECT

CODE

EFF

DATE

AMD

REF L1 GF SF FID BE IBI CAT YR

$0.00 $0.00

GRAND TOTAL $485,802.00

ORGANIZATION EXPENDITURE CODE

PRIMARY ORGANIZATION

EXPENDITURE CODE

L1 L2 L3 L4 L5 L1 L2 L3 L4 L5 64 36 29 85 234

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PART IV: ENCUMBRANCE

This page must reflect the encumbrance needs for the current Fiscal Year action identified on Part II of this DH1122 only. Please do not include historical encumbrance entries or future fiscal year entries.

Contract Number: Current Encumbrance Balance:

Encumbrance Need: Establish Encumbrance for New Contract

CURRENT FISCAL YEAR -

ORGANIZATION CODE

L1 L2 L3 L4 L5 EO VR OBJECT CODE

VENDOR I.D. W/

SEQUENCE # AMOUNT OCA EFFECTIVE DATE

64 36 29 85 234 SG 01 132009 V596000660-125 $485,802.00 SCHGR 07/01/2022

**Signatures are required when the encumbrance change does not involve an amendment or renewal to the contract.

Examples include increasing/reducing/revising an encumbrance, closing an encumbrance, or establishing the encumbrance for a New Fiscal Year of a multi-year contract.

Jennifer Waskovich

Contract Manager Signature Date

Dr. Leslene Gordon

6/7/22

Contract Manager Supervisor Signature Date

Bureau/Program Budget Coordinator Signature Date

Division Budget Administrator Signature Date

Business Office/Central Office Budget Analyst

Signature Date

**An encumbrance change requires submission of Parts I, II, III, and IV of the DH1122.

HB395

$485,802.00

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REQUIREMENTS: This section of the DH1122 is required when someone other than the contract manager is responsible for entering the contract deliverable information into FACTS.

PART V: CONTRACT DELIVERABLES

Deliverable # B.1.a.1) CONTRACT WIDE CONSEQUENCES No

COMMODITY CODE/SERVICE TYPE 85122200

MAJOR DELIVERABLE

DESCRIPTION

Work with the local County Health Department, School district and the county SHAC to develop the biennieal School Health Services Plan in accordance with Florida Administrative Code Rule 64F-6.022

METHOD OF PAYMENT Fixed Fee Lump Sum (Fixed Fee)

MAJOR DELIVERABLE PRICE $0.00

NON-PRICE JUSTIFICATION 1. Price Cannot be determined

PAGE REFERENCE Page 13

PERFORMANCE METRICS

Work with the local County Health Department, School district and the SHAC to develop the School Health Services Plan as specified.

FINANCIAL CONSEQUENCES 1% reduction in that quarter's invoice amount

DELIVERABLE NUMBER B.1.a.1)

Deliverable # B.1.a.2) CONTRACT WIDE CONSEQUENCES No

COMMODITY CODE/SERVICE TYPE 85122200

MAJOR DELIVERABLE

DESCRIPTION

Provide information (written or electronic) to the student's parents or guardians about the school health and healthcare services to be offered by the Provider to students in school, the option to withhold consent or decline specific services. Ensure written parent/guardian consent is obtained for health services as defined by the Provider and in accordance with the School Health Plan.

METHOD OF PAYMENT Fixed Fee Lump Sum (Fixed Fee)

MAJOR DELIVERABLE PRICE $0.00

NON-PRICE JUSTIFICATION 1. Price Cannot be determined

PAGE REFERENCE Page 13

PERFORMANCE METRICS

Parents or guardians must be provided written or electronic information about offered school health and healthcare services.

DELIVERABLE NUMBER B.1.a.2)

Deliverable # B.1.a.3)

COMMODITY CODE/SERVICE TYPE 85122200

MAJOR DELIVERABLE

DESCRIPTION

Send student emergency information cards or forms, in writing or electronically, to parents and guardians throughout the contract term. Collect 45 percent of the completed student emergency information cards or forms by September 30 of each contract year and 95 percent of the completed student emergency information cards or forms by December 31 of each contract year. Ensure that emergency information cards or forms are updated by parents or guardians for each student annually and list the contact person, family physician, allergies, significant health history, and permission for emergency care for the student.

METHOD OF PAYMENT Fixed Fee Lump Sum (Fixed Fee)

MAJOR DELIVERABLE PRICE $121,450.50

NON-PRICE JUSTIFICATION Select

PAGE REFERENCE Page 13-14

PERFORMANCE METRICS Collect student emergency information cards.

FINANCIAL CONSEQUENCES 1% reduction in quarterly invoice, respectively

DELIVERABLE NUMBER B.1.a.3)

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Deliverable # B.1.a.4)

COMMODITY CODE/SERVICE TYPE 85122200

MAJOR DELIVERABLE

DESCRIPTION

Review student health records for a minimum of five percent of students by September 30, a minimum of 45 percent of students by December 31, and a minimum of 90 percent of students by March 31, of each contract year to ensure students have all of their required forms.

METHOD OF PAYMENT Fixed Fee Lump Sum (Fixed Fee)

MAJOR DELIVERABLE PRICE $0.00

NON-PRICE JUSTIFICATION 1. Price Cannot be determined

PAGE REFERENCE Page 15

PERFORMANCE METRICS Student health records must be reviewed

FINANCIAL CONSEQUENCES 1% reduction in final quarter invoice amount

DELIVERABLE NUMBER B.1.a.4)

PART VI: AGENCY CONTRACT REVIEW

By signing this document, the parties certify that the provider selection process, contract negotiation, cost/price analysis, RFP/ITB/ITN and justification of need for advances have been performed and approved for this contract and that documentation supporting these activities is contained in the Contract Manager’s file. This sign-off and approval further attests to the need for the services and signifies that the statement of work is clearly written, and expected results are quantifiable and measurable, and are clearly defined in the contract and meet departmental policy requirements contracting. It also signifies that the contract terms and conditions are in compliance with applicable federal, state, and/or other funding source requirements.

Signature – Contract Manager Date

Signature – Contract Manager Supervisor Date

**Disclaimer:

CONTRACT ADMINISTRATOR

APPROVED DISAPPROVED

Signature – Contract Administrator Date

Comments:

FINANCIAL

Budget sign-off and approval signifies the presence of budget authority to expend monies for services specified in the contract and the correctness of accounting codes.

Signature – Budget Office Date

LEGAL

The subject contract is approved as to form and legality based on the documents provided to the undersigned. The contract is in compliance with applicable Florida law, particularly the provisions governing contracts as outlined in Chapter 287, Florida Statutes.

Signature – General Counsel Date

INFORMATION TECHNOLOGY

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This sign-off and approval is required if the contract involves the acquisition, development or use of hardware, software, telecommunications, network or other IT related items and or services.

OTHER

This sign-off to be used for other approvals as required and/or desired (e.g. Staff Development, etc.)

PART VII: EXTENDED CONTRACT INFORMATION

Deliverable # B.1.a.5)a) CONTRACT WIDE CONSEQUENCES No

COMMODITY CODE/SERVICE TYPE 85122200

MAJOR DELIVERABLE DESCRIPTION

Provide Basic School Health Services at all schools listed in Attachment III in accordance with the current School Health Services Plan; section 381.0056, Florida Statutes; Florida Administrative Code Rules 64F-6.001 through 6.006; and the Department’s School Health Administrative Resource Manual available at, http://www.floridahealth.gov/programs-andservices/childrens-health/school-health/reports-information.html, as revised. At a minimum, provide the following Basic School Health Services, unless the student has a parent or guardian optout form or other written exemption, is not able to be screened due to profound disability, or is currently in treatment for the condition: Perform Vision Screenings for a minimum of 45 percent of non-exempted students in kindergarten, first, third, and sixth grade by December 31 and a minimum of 95 percent by March 31 of each contract year.

METHOD OF PAYMENT Fixed Fee Lump Sum (Fixed Fee)

MAJOR DELIVERABLE PRICE $0.00

NON-PRICE JUSTIFICATION 1. Price Cannot be determined

PAGE REFERENCE Page 17

PERFORMANCE METRICS

Provide vision screenings for mandatory grade levels at all Basic School Health Service Schools

FINANCIAL CONSEQUENCES 3% reduction in that quarter's invoice amount

DELIVERABLE NUMBER B.1.a.5)a)

Deliverable # B.1.a.5)b)

COMMODITY CODE/SERVICE TYPE 85122200

MAJOR DELIVERABLE DESCRIPTION

Provide Basic School Health Services at all schools listed in Attachment III in accordance with the current School Health Services Plan; section 381.0056, Florida Statutes; Florida Administrative Code Rules 64F-6.001 through 6.006; and the Department’s School Health Administrative Resource Manual available at, http://www.floridahealth.gov/programs-andservices/childrens-health/school-health/reports-information.html, as revised. At a minimum, provide the following Basic School Health Services, unless the student has a parent or guardian optout form or other written exemption, is not able to be screened due to profound disability, or is currently in treatment for the condition: Perform Hearing Screenings for a minimum of 45 percent of non-exempted students in kindergarten, first, and sixth grade by December 31 and a minimum of 95 percent by March 31 of each contract year.

METHOD OF PAYMENT Fixed Fee Lump Sum (Fixed Fee)

MAJOR DELIVERABLE PRICE $0.00

NON-PRICE JUSTIFICATION 1. Price Cannot be determined

PAGE REFERENCE page 17 http://www.floridahealth.gov/programs-andservices/childrens-health/school-health/reports-information.html http://www.floridahealth.gov/programs-andservices/childrens-health/school-health/reports-information.html http://www.floridahealth.gov/programs-andservices/childrens-health/school-health/reports-information.html http://www.floridahealth.gov/programs-andservices/childrens-health/school-health/reports-information.html

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PERFORMANCE METRICS

Provide hearing screenings for mandatory grade levels at all Basic School Health Service schools

DELIVERABLE NUMBER B.1.a.5)b)

Deliverable # B.1.a.5)c)

COMMODITY CODE/SERVICE TYPE 8522200

MAJOR DELIVERABLE DESCRIPTION

Provide Basic School Health Services at all schools listed in Attachment III in accordance with the current School Health Services Plan; section 381.0056, Florida Statutes; Florida Administrative Code Rules 64F-6.001 through 6.006; and the Department’s School Health Administrative Resource Manual available at, http://www.floridahealth.gov/programs-andservices/childrens-health/school-health/reports-information.html, as revised. At a minimum, provide the following Basic School Health Services, unless the student has a parent or guardian optout form or other written exemption, is not able to be screened due to profound disability, or is currently in treatment for the condition: Perform Scoliosis Screenings for a minimum of 45 percent of non-exempted students in sixth grade by March 31 and a minimum of 95 percent by June 30 of each contract year.

METHOD OF PAYMENT Fixed Fee Lump Sum (Fixed Fee)

MAJOR DELIVERABLE PRICE $0.00

NON-PRICE JUSTIFICATION 1. Price Cannot be determined

PAGE REFERENCE page 17

PERFORMANCE METRICS

Provide scoliosis screenings for mandatory grade levels at all Basic School Health Service schools

DELIVERABLE NUMBER B.1.a.5)c)

Deliverable # B.1.a.5)d)

COMMODITY CODE/SERVICE TYPE 85122200

MAJOR DELIVERABLE DESCRIPTION

Provide Basic School Health Services at all schools listed in Attachment III in accordance with the current School Health Services Plan; section 381.0056, Florida Statutes; Florida Administrative Code Rules 64F-6.001 through 6.006; and the Department’s School Health Administrative Resource Manual available at, http://www.floridahealth.gov/programs-andservices/childrens-health/school-health/reports-information.html, as revised. At a minimum, provide the following Basic School Health Services, unless the student has a parent or guardian optout form or other written exemption, is not able to be screened due to profound disability, or is currently in treatment for the condition: Perform Growth and Development Screenings for a minimum of 45 percent of non-exempted students in first, third, and sixth grade by March 31 and a minimum of 95 percent by June 30 of each contract year.

METHOD OF PAYMENT Fixed Fee Lump Sum (Fixed Fee)

MAJOR DELIVERABLE PRICE $0.00

NON-PRICE JUSTIFICATION 1. Price Cannot be determined

PAGE REFERENCE page 17

PERFORMANCE METRICS

Provide growth and development screenings for mandatory grade levels at all Basic School Health Service schools

DELIVERABLE NUMBER B.1.a.5)d)

Deliverable # B.1.a.5)e)

COMMODITY CODE/SERVICE TYPE 85122200

MAJOR DELIVERABLE DESCRIPTION

Refer all students with abnormal screening results to the appropriate health care providers for further evaluation and treatment within 45 days of receiving the screening results. Document all referrals made in the student cumulative health record.

METHOD OF PAYMENT Fixed Fee Lump Sum (Fixed Fee)

MAJOR DELIVERABLE PRICE $0.00

http://www.floridahealth.gov/programs-andservices/childrens-health/school-health/reports-information.html http://www.floridahealth.gov/programs-andservices/childrens-health/school-health/reports-information.html http://www.floridahealth.gov/programs-andservices/childrens-health/school-health/reports-information.html http://www.floridahealth.gov/programs-andservices/childrens-health/school-health/reports-information.html

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NON-PRICE JUSTIFICATION 1. Price Cannot be determined

PAGE REFERENCE page 17

PERFORMANCE METRICS

All students with abnormal screening results must be referred to appropriate health care providers for further evaluation and or treatment

DELIVERABLE NUMBER B.1.a.5)e)

Deliverable # B.1.a.5)f)

COMMODITY CODE/SERVICE TYPE 85122200

MAJOR DELIVERABLE DESCRIPTION

Confirm that all students referred to state contracted vision service providers have a signed parent or guardian consent form that includes permission for a Comprehensive Eye Exam, which may involve refraction and dilation.

METHOD OF PAYMENT Fixed Fee Lump Sum (Fixed Fee)

MAJOR DELIVERABLE PRICE $0.00

NON-PRICE JUSTIFICATION 1. Price Cannot be determined

PAGE REFERENCE page 17

PERFORMANCE METRICS

All students referred to State contracted vision service providers must have a signed parental or guardian consent form.

DELIVERABLE NUMBER B.1.a.5)f)

Deliverable # B.1.a.5)g)

COMMODITY CODE/SERVICE TYPE 85122200

MAJOR DELIVERABLE DESCRIPTION

Provide at least one follow-up with the parents or guardians of students referred wtihin 45 days of referrign the student for further evaluation or treatment to ensure the students received the necessary care. Document the attempt(s) to follow-up with the parents or guardians and, if applicable, document any incidence(s) of a parent or guardian being non-responsive to the referral, refusing to follow-up, or a student withdrawing from school in the cumulative health record.

METHOD OF PAYMENT Fixed Fee Lump Sum (Fixed Fee)

MAJOR DELIVERABLE PRICE $0.00

NON-PRICE JUSTIFICATION 1. Price Cannot be determined

PAGE REFERENCE page 17

PERFORMANCE METRICS

At least one follow-up must be provided with the parents or guardians of students referred.

DELIVERABLE NUMBER B.1.a.5)g)

Deliverable # B.1.a.5)h)

COMMODITY CODE/SERVICE TYPE 85122200

MAJOR DELIVERABLE DESCRIPTION

Provide students who are pregnant with information on assistance, counseling, education, prenatal care, and the Healthy Start Program as needed.

METHOD OF PAYMENT Fixed Fee Lump Sum (Fixed Fee)

MAJOR DELIVERABLE PRICE $0.00

NON-PRICE JUSTIFICATION 1. Price Cannot be determined

PAGE REFERENCE page 17

PERFORMANCE METRICS

Additonal Basic Health Services are provided as specified in School Heatlh Services Plan.

DELIVERABLE NUMBER B.1.a.5)h)

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Deliverable # B.1.a.5)i)

COMMODITY CODE/SERVICE TYPE 85122200

MAJOR DELIVERABLE DESCRIPTION

Provide additional Basic School Health Services as specified in the current School Health Services Plan.

METHOD OF PAYMENT Fixed Fee Lump Sum (Fixed Fee)

MAJOR DELIVERABLE PRICE $0.00

NON-PRICE JUSTIFICATION 1. Price Cannot be determined

PAGE REFERENCE page 17

PERFORMANCE METRICS

Additonal Basic Health Services are provided as specified in School Heatlh Services Plan.

DELIVERABLE NUMBER B.1.a.5)i)

Deliverable # B.1.a.6)

COMMODITY CODE/SERVICE TYPE 85122200

MAJOR DELIVERABLE DESCRIPTION

Provide health services for Full-Service Schools, identified in Attachment _III_, in accordance with section 402.3026, Florida Statutes and as specified in the current School Health Services Plan.

METHOD OF PAYMENT Fixed Fee Lump Sum (Fixed Fee)

MAJOR DELIVERABLE PRICE $0.00

NON-PRICE JUSTIFICATION 1. Price Cannot be determined

PAGE REFERENCE page 17

PERFORMANCE METRICS Health services for Full-Service Schools must be provided as specified

DELIVERABLE NUMBER B.1.a.6)

Deliverable # B.1.a.7)a)

COMMODITY CODE/SERVICE TYPE 85122200

MAJOR DELIVERABLE DESCRIPTION

Maintain the following documentation and information, either in written or electronic format, in accordance with section 1002.22, Florida Statutes, Florida Administrative Code Rule 64F-6.005, the Family Educational Rights and Privacy Act, and HIPAA:

Cumulative health record for each student, which contains: Florida Certification of Immunization (Form DH 680) or Part A, Part B, or DH 681 exemptions; School Entry Health Exam form (DH3040-CHP-07/2013) or tother form as specified in section 1003.22, Florida Statutes and Florida Administrative Code Rule 6A-6.024; and documentation of screenings, results, referrals, follow-up attempts, and outcomes as specified in Task 5).

METHOD OF PAYMENT Fixed Fee Lump Sum (Fixed Fee)

MAJOR DELIVERABLE PRICE $0.00

NON-PRICE JUSTIFICATION 1. Price Cannot be determined

PAGE REFERENCE page 17

PERFORMANCE METRICS Maintain documentation and information for health services provided.

DELIVERABLE NUMBER B.1.a.7)a)

Deliverable # B.1.a.7)b)

COMMODITY CODE/SERVICE TYPE 85122200

MAJOR DELIVERABLE DESCRIPTION

Maintain the following documentation and information, either in written or electronic format, in accordance with section 1002.22, Florida Statutes, Florida Administrative Code Rule 64F-6.005, the Family Educational Rights and Privacy Act, and HIPAA: IHPs and Emergency Care Plans for each student as applicable.

METHOD OF PAYMENT Fixed Fee Lump Sum (Fixed Fee)

MAJOR DELIVERABLE PRICE $0.00

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PERFORMANCE METRICS Maintain documentation and information for health services provided.

Deliverable # B.1.a.7)c)

COMMODITY CODE/SERVICE TYPE 85122200

MAJOR DELIVERABLE DESCRIPTION

Maintain the following documentation and information, either in written or electronic format, in accordance with section 1002.22, Florida Statutes, Florida Administrative Code Rule 64F-6.005, the Family Educational Rights and Privacy Act, and HIPAA:

Individualized Medication Administration Records that document medication assistance to students.

METHOD OF PAYMENT Fixed Fee Lump Sum (Fixed Fee)

MAJOR DELIVERABLE PRICE $0.00

NON-PRICE JUSTIFICATION 1. Price Cannot be determined

PAGE REFERENCE page 17

PERFORMANCE METRICS Maintain documentation and information for health services provided.

DELIVERABLE NUMBER B.1.a.7)c)

Deliverable # B.1.a.7)d)

COMMODITY CODE/SERVICE TYPE 85122200

MAJOR DELIVERABLE DESCRIPTION

Maintain the following documentation and information, either in written or electronic format, in accordance with section 1002.22, Florida Statutes, Florida Administrative Code Rule 64F-6.005, the Family Educational Rights and Privacy Act, and HIPAA:

Documentation of medical procedures and treatments.

METHOD OF PAYMENT Fixed Fee Lump Sum (Fixed Fee)

MAJOR DELIVERABLE PRICE $0.00

NON-PRICE JUSTIFICATION 1. Price Cannot be determined

PAGE REFERENCE page 17

PERFORMANCE METRICS Maintain documentation and information for health services provided.

DELIVERABLE NUMBER B.1.a.7)d)

Deliverable # B.1.a.7)e)

COMMODITY CODE/SERVICE TYPE 85122200

MAJOR DELIVERABLE DESCRIPTION

Maintain the following documentation and information, either in written or electronic format, in accordance with section 1002.22, Florida Statutes, Florida Administrative Code Rule 64F-6.005, the Family Educational Rights and Privacy Act, and HIPAA:

Clinic log used daily to record, at a minimum, student identifiers, chief complaints, dates, times of arrival and departure, person on duty, and outcome disposition of the student.

METHOD OF PAYMENT Fixed Fee Lump Sum (Fixed Fee)

MAJOR DELIVERABLE PRICE $0.00

NON-PRICE JUSTIFICATION 1. Price Cannot be determined

PAGE REFERENCE page 17

PERFORMANCE METRICS Maintain documentation and information for health services provided.

DELIVERABLE NUMBER B.1.a.7)e)

Deliverable # B.1.a.7)f)

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COMMODITY CODE/SERVICE TYPE 85122200

MAJOR DELIVERABLE DESCRIPTION

Maintain the following documentation and information, either in written or electronic format, in accordance with section 1002.22, Florida Statutes, Florida Administrative Code Rule 64F-6.005, the Family Educational Rights and Privacy Act, and HIPAA:

Child-specific training and periodic follow-up monitoring of unlicensed assistive personnel as determined by the nursing process as specified in section 1006.062(4), Florida Statutes and Florida Administrative Code, Chapter 64B9-14.

METHOD OF PAYMENT Fixed Fee Lump Sum (Fixed Fee)

MAJOR DELIVERABLE PRICE $0.00

NON-PRICE JUSTIFICATION 1. Price Cannot be determined

PAGE REFERENCE page 17

PERFORMANCE METRICS Maintain documentation and information for health services provided.

DELIVERABLE NUMBER B.1.a.7)f)

Deliverable # B.1.a.8)

COMMODITY CODE/SERVICE TYPE 85122200

MAJOR DELIVERABLE DESCRIPTION

Submit all service and screening data for the services provided in Tasks 5) and 6) to the County Health Department within 15 days following the end of each month in a format compatible with HMS.

METHOD OF PAYMENT Fixed Fee Lump Sum (Fixed Fee)

MAJOR DELIVERABLE PRICE $0.00

NON-PRICE JUSTIFICATION 1. Price Cannot be determined

PAGE REFERENCE page 17

PERFORMANCE METRICS

Service and screening data for the services provided in Tasks 5) and 6) must be submitted to the County Health Department

DELIVERABLE NUMBER B.1.a.8)

Deliverable # B.1.a.9)

COMMODITY CODE/SERVICE TYPE 85122200

MAJOR DELIVERABLE DESCRIPTION

Provide information as specified by the local County Health Department for completion of the Annual School Health Report within 30 days following the end of each contract year.

METHOD OF PAYMENT Fixed Fee Lump Sum (Fixed Fee)

MAJOR DELIVERABLE PRICE $0.00

NON-PRICE JUSTIFICATION 1. Price Cannot be determined

PAGE REFERENCE page 18

PERFORMANCE METRICS

Information as specified by the County Health Department for completion of the Annual School Health Report

DELIVERABLE NUMBER B.1.a.9)

Deliverable # B.1.a.10)a)

COMMODITY CODE/SERVICE TYPE 85122200

MAJOR DELIVERABLE DESCRIPTION

Develop and implement policies and procedures that include measures which prevent the spread of COVID-19 in schools as follows: Provide enclosed isolation room(s) or area(s) in all schools, isolation room monitors (staff), and Department approved disinfection.

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PERFORMANCE METRICS

Policies and procedures that include measures that prevent the spread of COVID-19 in schools must be implemented

FINANCIAL CONSEQUENCES 2% reduction in that quarter's invoice amount

DELIVERABLE NUMBER B.1.a.10)a)

Deliverable # B.1.a.10)b)

COMMODITY CODE/SERVICE TYPE 85122200

MAJOR DELIVERABLE DESCRIPTION

Develop and implement policies and procedures that include measures which prevent the spread of COVID-19 in schools as follows: Ensure that students with possible COVID-19 symptoms or that have tested positive for COVID-19 can wait in supervised isolation room(s)/area(s) until they are picked-up by a parent or guardian.

METHOD OF PAYMENT Fixed Fee Lump Sum (Fixed Fee)

MAJOR DELIVERABLE PRICE $0.00

NON-PRICE JUSTIFICATION 1. Price Cannot be determined

PAGE REFERENCE page 17

PERFORMANCE METRICS

Policies and procedures that include measures that prevent the spread of COVID-19 in schools must be implemented

DELIVERABLE NUMBER B.1.a.10)b)

Deliverable # B.1.a.10)c)

COMMODITY CODE/SERVICE TYPE 85122200

MAJOR DELIVERABLE DESCRIPTION

Develop and implement policies and procedures that include measures which prevent the spread of COVID-19 in schools as follows: Maintain social distancing (as allowed by size of clinic), disinfection, hygiene, and use of PPE at all times in school clinics, except when medication is being administered orally or nasally.

METHOD OF PAYMENT Fixed Fee Lump Sum (Fixed Fee)

MAJOR DELIVERABLE PRICE $0.00

NON-PRICE JUSTIFICATION 1. Price Cannot be determined

PAGE REFERENCE page 17

PERFORMANCE METRICS

Policies and procedures that include measures that prevent the spread of COVID-19 in schools must be implemented

DELIVERABLE NUMBER B.1.a.10)c)

Deliverable # B.1.a.10)d)

COMMODITY CODE/SERVICE TYPE 85122200

MAJOR DELIVERABLE DESCRIPTION

Develop and implement policies and procedures that include measures which prevent the spread of COVID-19 in schools as follows: Develop policy and procedures to screen district school staff and students with temperature checks and questionnaires to prevent spread of COVID-19 in district schools. Use these procedures to screen district school staff and students per school district policy.

METHOD OF PAYMENT Fixed Fee Lump Sum (Fixed Fee)

MAJOR DELIVERABLE PRICE $0.00

NON-PRICE JUSTIFICATION 1. Price Cannot be determined

PAGE REFERENCE page 17

PERFORMANCE METRICS

Policies and procedures that include measures that prevent the spread of COVID-19 in schools must be implemented

DELIVERABLE NUMBER B.1.a.10)d)

Deliverable # B.1.a.10)e)

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MAJOR DELIVERABLE DESCRIPTION

Develop and implement policies and procedures that include measures which prevent the spread of COVID-19 in schools as follows: Maintain a COVID-19 tracking log.

METHOD OF PAYMENT Fixed Fee Lump Sum (Fixed Fee)

MAJOR DELIVERABLE PRICE $0.00

NON-PRICE JUSTIFICATION 1. Price Cannot be determined

PAGE REFERENCE page 17

PERFORMANCE METRICS

Policies and procedures that include measures that prevent the spread of COVID-19 in schools must be implemented

DELIVERABLE NUMBER B.1.a.10)e)

Deliverable # B.1.a.10)f)

COMMODITY CODE/SERVICE TYPE 85122200

MAJOR DELIVERABLE DESCRIPTION

Develop and implement policies and procedures that include measures which prevent the spread of COVID-19 in schools as follows: Maintain running inventory of PPE, hand sanitizer and disinfectants, and ensure supplies are ordered in time to avoid shortages.

METHOD OF PAYMENT Fixed Fee Lump Sum (Fixed Fee)

MAJOR DELIVERABLE PRICE $0.00

NON-PRICE JUSTIFICATION 1. Price Cannot be determined

PAGE REFERENCE page 17

PERFORMANCE METRICS

Policies and procedures that include measures that prevent the spread of COVID-19 in schools must be implemented

DELIVERABLE NUMBER B.1.a.10)f)

Deliverable # B.1.a.10)g)

COMMODITY CODE/SERVICE TYPE 85122200

MAJOR DELIVERABLE DESCRIPTION

Develop and implement policies and procedures that include measures which prevent the spread of COVID-19 in schools as follows: Educate and provide information to school staff, students, and parents and guardians regarding COVID-19 prevention (donning and offing of masks, handwashing and social distancing), hygiene etiquette (not touching face or other students), symptoms of COVID-19, actions to take when COVID-19 symptoms appear, and the quarantine periods recommended by the Department.

METHOD OF PAYMENT Fixed Fee Lump Sum (Fixed Fee)

MAJOR DELIVERABLE PRICE $0.00

NON-PRICE JUSTIFICATION 1. Price Cannot be determined

PAGE REFERENCE page 17

PERFORMANCE METRICS

Policies and procedures that include measures that prevent the spread of COVID-19 in schools must be implemented

DELIVERABLE NUMBER B.1.a.10)g)

Deliverable # B.1.a.10)h)

COMMODITY CODE/SERVICE TYPE 85122200

MAJOR DELIVERABLE DESCRIPTION

Develop and implement policies and procedures that include measures which prevent the spread of COVID-19 in schools as follows: Perform contact tracing in coordination with the County Health Department.

METHOD OF PAYMENT Fixed Fee Lump Sum (Fixed Fee)

MAJOR DELIVERABLE PRICE $0.00

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Policies and procedures that include measures that prevent the spread of COVID-19 in schools must be implemented

DELIVERABLE NUMBER B.1.a.10)h)

Deliverable # B.1.a.10)i)

COMMODITY CODE/SERVICE TYPE 85122200

MAJOR DELIVERABLE DESCRIPTION

Develop and implement policies and procedures that include measures which prevent the spread of COVID-19 in schools as follows: Perform consultations by phone, text, or email with parents or guardians regarding their child’s possible exposure to COVID-19, possible COVID-19 symptoms, and the need to pick-up their child and consult with a health care provider for evaluation and possible COVID-19 testing.

METHOD OF PAYMENT Fixed Fee Lump Sum (Fixed Fee)

MAJOR DELIVERABLE PRICE $0.00

NON-PRICE JUSTIFICATION 1. Price Cannot be determined

PAGE REFERENCE page 17

PERFORMANCE METRICS

Policies and procedures that include measures that prevent the spread of COVID-19 in schools must be implemented

DELIVERABLE NUMBER B.1.a.10)i)

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SHORT TITLE BASIC SERVICE COMPETITIVE PROCUREMENT No

LONG TITLE

BASIC SERVICE SCHOOL

HEALTH SERVICE,

HILLSBOROUGH COUNTY

PROCUREMENT CODE Select

AGENCY UNIQUE ID

(ENTER FLAIR

CONTRACT ID)

EXEMPT (if yes, justification required) Yes

ORIGINAL AMOUNT $485,802.00 EXEMPTION CODE L- Other Government Agency

CONTRACT TYPE SC-Standard Agreement STATE TERM ID

CONTRACT STATUS A-Active EXEMPTION JUSTIFICATION

DATE OF EXECUTION 7/1/2022 The Department of Health mandates that School Health Services delivers under this contract to be provided in accordance with s. 381.0056, F.S.,s. 381.0057, F.S., s.

402.3026, F.S, and Chapter 64-6.001-6.006, F.A.C.

BEGINNING DATE 7/1/2022

ORIGINAL END DATE 06/30/2023

NEW ENDING DATE

STATUTORY AUTHORITY

S.381.0056, 381.0057 AND

402.3026, F.S

FINANCIAL ASSISTANCE Yes

CFDA # , ,

DO NOT PUBLISH THIS

CONTRACT ON THE FACTS

PUBLIC WEBSITE

(This should always be left blank)

SERVICE AREA 29 LEGAL CHALLENGES TO PROCUREMENT Select

ADMINISTRATIVE COST INFORMATION LEGAL CHALLENGE DESCRIPTION

ADMIN. COST ALLOWED Select

ADMIN.PERCENTAGE 0.00%

ADMIN COST AMOUNT $0.00

PERIODIC INCREASE Select

PERCENTAGE ALLOWED 0.00% OUTSOURCING / CAPITAL IMPROVEMENTS

CONTRACT MANAGER INFORMATION PREVIOUS STATE FUNCTION No

LAST

NAME

DATE OF LAST DOH CERTIFICATION: 4/15/2021 CAPITAL IMPROVEMENT DESCRIPTION

DATE OF ADV. ACCOUNTABILITY or

VENDOR NAME

HILLSBOROUGH COUNTY PUBLIC

SCHOOLS

VALUE OF IMPROVEMENT $0.00

ADDRESS 901 E. KENNEDY BLVD. UNAMORTIZED VALUE $0.00

CITY/STATE/ZIP TAMPA,FL 33602

FISCAL YEAR END 6/30/2023

CONTACT PERSON Dr. Maria Russ

CONTACT E-MAIL

Page | 2 DH 1122, 08/2021 - previous editions may not be used

Contract Actions are all actions related to the contract after the initial execution of the agreement with the provider. In addition to amendments, extensions and renewals, these actions include budget, and contract manager changes.

Action Type Agency

Reference # Action

Amount Effective

Date Execution

Date New End Date

Brief Description

NEW $485,802.00 07/01/2022 07/01/2022 06/30/202

NEW CONTRACT

select $0.00 select $0.00 select $0.00 select $0.00 select $0.00 select $0.00 select $0.00 select $0.00 select $0.00 select $0.00 select $0.00 select $0.00 select $0.00 select $0.00 select $0.00 select $0.00 select $0.00 select $0.00 select $0.00 select $0.00 select $0.00 select $0.00 select $0.00 select $0.00 select $0.00 select $0.00 select $0.00 select $0.00 select $0.00 select $0.00 select $0.00 select $0.00 select $0.00 select $0.00 select $0.00 select $0.00 select $0.00 select $0.00 select $0.00 select $0.00 select $0.00 select $0.00 select $0.00 select $0.00 select $0.00 select $0.00

Page | 3 DH 1122, 08/2021 - previous editions may not be used select $0.00 select $0.00 select $0.00

PART III: CONTRACT BUDGET

Fiscal Year 2022-2023

ACCOUNT CODE

AMOUNT TYPE EO VR OCA

OBJECT

CODE

EFF

DATE

AMD

REF L1 GF SF FID BE IBI CAT YR

64 20 2 14101 64200700 29 100777 1 $485,802.00 NEW SG 01 SCHGR 132009 07/01/2022

$0.00 $0.00 $0.00

AMOUNT TYPE EO VR OCA

OBJECT

CODE

EFF

DATE

AMD

REF L1 GF SF FID BE IBI CAT YR

$0.00 $0.00 $0.00 $0.00

AMOUNT TYPE EO VR OCA

OBJECT

CODE

EFF

DATE

AMD

REF L1 GF SF FID BE IBI CAT YR

$0.00 $0.00 $0.00

AMOUNT TYPE EO VR OCA

OBJECT

CODE

EFF

DATE

AMD

REF L1 GF SF FID BE IBI CAT YR

$0.00 $0.00 $0.00

AMOUNT TYPE EO VR OCA

OBJECT

CODE

EFF

DATE

AMD

REF L1 GF SF FID BE IBI CAT YR

$0.00 $0.00

GRAND TOTAL $485,802.00

ORGANIZATION EXPENDITURE CODE

PRIMARY ORGANIZATION

EXPENDITURE CODE

L1 L2 L3 L4 L5 L1 L2 L3 L4 L5 64 36 29 85 234

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PART IV: ENCUMBRANCE

This page must reflect the encumbrance needs for the current Fiscal Year action identified on Part II of this DH1122 only. Please do not include historical encumbrance entries or future fiscal year entries.

Contract Number: Current Encumbrance Balance:

Encumbrance Need: Establish Encumbrance for New Contract

CURRENT FISCAL YEAR -

ORGANIZATION CODE

L1 L2 L3 L4 L5 EO VR OBJECT CODE

VENDOR I.D. W/

SEQUENCE # AMOUNT OCA EFFECTIVE DATE

64 36 29 85 234 SG 01 132009 V596000660-125 $485,802.00 SCHGR 07/01/2022

**Signatures are required when the encumbrance change does not involve an amendment or renewal to the contract.

Examples include increasing/reducing/revising an encumbrance, closing an encumbrance, or establishing the encumbrance for a New Fiscal Year of a multi-year contract.

Jennifer Waskovich

Contract Manager Signature Date

Dr. Leslene Gordon

Contract Manager Supervisor Signature Date

Bureau/Program Budget Coordinator Signature Date

Division Budget Administrator Signature Date

Business Office/Central Office Budget Analyst

**An encumbrance change requires submission of Parts I, II, III, and IV of the DH1122.

HB395

$485,802.00

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REQUIREMENTS: This section of the DH1122 is required when someone other than the contract manager is responsible for entering the contract deliverable information into FACTS.

PART V: CONTRACT DELIVERABLES

Deliverable # B.1.a.1) CONTRACT WIDE CONSEQUENCES No

COMMODITY CODE/SERVICE TYPE 85122200

MAJOR DELIVERABLE

DESCRIPTION

Work with the local County Health Department, School district and the county SHAC to develop the biennieal School Health Services Plan in accordance with Florida Administrative Code Rule 64F-6.022

METHOD OF PAYMENT Fixed Fee Lump Sum (Fixed Fee)

MAJOR DELIVERABLE PRICE $0.00

NON-PRICE JUSTIFICATION 1. Price Cannot be determined

PAGE REFERENCE Page 13

PERFORMANCE METRICS

Work with the local County Health Department, School district and the SHAC to develop the School Health Services Plan as specified.

DELIVERABLE NUMBER B.1.a.1)

Deliverable # B.1.a.2)

COMMODITY CODE/SERVICE TYPE 85122200

MAJOR DELIVERABLE

DESCRIPTION

Provide information (written or electronic) to the student's parents or guardians about the school health and healthcare services to be offered by the Provider to students in school, the option to withhold consent or decline specific services. Ensure written parent/guardian consent is obtained for health services as defined by the Provider and in accordance with the School Health Plan.

METHOD OF PAYMENT Fixed Fee Lump Sum (Fixed Fee)

MAJOR DELIVERABLE PRICE $0.00

NON-PRICE JUSTIFICATION 1. Price Cannot be determined

PAGE REFERENCE Page 13

PERFORMANCE METRICS

Parents or guardians must be provided written or electronic information about offered school health and healthcare services.

DELIVERABLE NUMBER B.1.a.2)

Deliverable # B.1.a.3)

COMMODITY CODE/SERVICE TYPE 85122200

MAJOR DELIVERABLE

DESCRIPTION

Send student emergency information cards or forms, in writing or electronically, to parents and guardians throughout the contract term. Collect 45 percent of the completed student emergency information cards or forms by September 30 of each contract year and 95 percent of the completed student emergency information cards or forms by December 31 of each contract year. Ensure that emergency information cards or forms are updated by parents or guardians for each student annually and list the contact person, family physician, allergies, significant health history, and permission for emergency care for the student.

METHOD OF PAYMENT Fixed Fee Lump Sum (Fixed Fee)

MAJOR DELIVERABLE PRICE $121,450.50

NON-PRICE JUSTIFICATION Select

PAGE REFERENCE Page 13-14

PERFORMANCE METRICS Collect student emergency information cards.

FINANCIAL CONSEQUENCES 1% reduction in quarterly invoice, respectively

DELIVERABLE NUMBER B.1.a.3)

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Deliverable # B.1.a.4)

COMMODITY CODE/SERVICE TYPE 85122200

MAJOR DELIVERABLE

DESCRIPTION

Review student health records for a minimum of five percent of students by September 30, a minimum of 45 percent of students by December 31, and a minimum of 90 percent of students by March 31, of each contract year to ensure students have all of their required forms.

METHOD OF PAYMENT Fixed Fee Lump Sum (Fixed Fee)

MAJOR DELIVERABLE PRICE $0.00

NON-PRICE JUSTIFICATION 1. Price Cannot be determined

PAGE REFERENCE Page 15

PERFORMANCE METRICS Student health records must be reviewed

FINANCIAL CONSEQUENCES 1% reduction in final quarter invoice amount

DELIVERABLE NUMBER B.1.a.4)

PART VI: AGENCY CONTRACT REVIEW

By signing this document, the parties certify that the provider selection process, contract negotiation, cost/price analysis, RFP/ITB/ITN and justification of need for advances have been performed and approved for this contract and that documentation supporting these activities is contained in the Contract Manager’s file. This sign-off and approval further attests to the need for the services and signifies that the statement of work is clearly written, and expected results are quantifiable and measurable, and are clearly defined in the contract and meet departmental policy requirements contracting. It also signifies that the contract terms and conditions are in compliance with applicable federal, state, and/or other funding source requirements.

Signature – Contract Manager Date

Signature – Contract Manager Supervisor Date

**Disclaimer:

CONTRACT ADMINISTRATOR

Signature – Contract Administrator Date

FINANCIAL

Budget sign-off and approval signifies the presence of budget authority to expend monies for services specified in the contract and the correctness of accounting codes.

Signature – Budget Office Date

LEGAL

The subject contract is approved as to form and legality based on the documents provided to the undersigned. The contract is in compliance with applicable Florida law, particularly the provisions governing contracts as outlined in Chapter 287, Florida Statutes.

Signature – General Counsel Date

INFORMATION TECHNOLOGY

Page | 7 DH 1122, 08/2021 - previous editions may not be used

This sign-off and approval is required if the contract involves the acquisition, development or use of hardware, software, telecommunications, network or other IT related items and or services.

OTHER

This sign-off to be used for other approvals as required and/or desired (e.g. Staff Development, etc.)

PART VII: EXTENDED CONTRACT INFORMATION

Deliverable # B.1.a.5)a) CONTRACT WIDE CONSEQUENCES No

COMMODITY CODE/SERVICE TYPE 85122200

MAJOR DELIVERABLE DESCRIPTION

Provide Basic School Health Services at all schools listed in Attachment II in accordance with the current School Health Services Plan; section 381.0056, Florida Statutes; Florida Administrative Code Rules 64F-6.001 through 6.006; and the Department’s School Health Administrative Resource Manual available at, http://www.floridahealth.gov/programs-and-services/childrens-health/school-health/reports-information.html, as revised. At a minimum, provide the following Basic School Health Services, unless the student has a parent or guardian opt- out form or other written exemption, is not able to be screened due to profound disability, or is currently in treatment for the condition: Perform Vision Screenings for a minimum of 45 percent of non-exempted students in kindergarten, first, third, and sixth grade by December 31 and a minimum of 95 percent by March 31 of each contract year.

METHOD OF PAYMENT Fixed Fee Lump Sum (Fixed Fee)

MAJOR DELIVERABLE PRICE $0.00

NON-PRICE JUSTIFICATION 1. Price Cannot be determined

PAGE REFERENCE Page 17

PERFORMANCE METRICS

Provide vision screenings for mandatory grade levels at all Basic School Health Service Schools

DELIVERABLE NUMBER B.1.a.5)a)

Deliverable # B.1.a.5)b)

COMMODITY CODE/SERVICE TYPE 85122200

MAJOR DELIVERABLE DESCRIPTION

Perform Hearing Screenings for a minimum of 45 percent of non-exempted students in kindergarten, first, and sixth grade by December 31 and a minimum of 95 percent by March 31 of each contract year.

METHOD OF PAYMENT Fixed Fee Lump Sum (Fixed Fee)

MAJOR DELIVERABLE PRICE $0.00

NON-PRICE JUSTIFICATION 1. Price Cannot be determined

PAGE REFERENCE page 17

PERFORMANCE METRICS

Provide hearing screenings for mandatory grade levels at all Basic School Health Service schools

DELIVERABLE NUMBER B.1.a.5)b)

Deliverable # B.1.a.5)c) http://www.floridahealth.gov/programs-and-services/childrens-health/school-health/reports-information.html http://www.floridahealth.gov/programs-and-services/childrens-health/school-health/reports-information.html

Page | 8 DH 1122, 08/2021 - previous editions may not be used

COMMODITY CODE/SERVICE TYPE 8522200

Perform Scoliosis Screenings for a minimum of 45 percent of non-exempted students in sixth grade by March 31 and a minimum of 95 percent by June 30 of each contract year.

METHOD OF PAYMENT Fixed Fee Lump Sum (Fixed Fee)

MAJOR DELIVERABLE PRICE $0.00

NON-PRICE JUSTIFICATION 1. Price Cannot be determined

PAGE REFERENCE page 17

PERFORMANCE METRICS

Provide scoliosis screenings for mandatory grade levels at all Basic School Health Service schools

DELIVERABLE NUMBER B.1.a.5)c)

Deliverable # B.1.a.5)d)

COMMODITY CODE/SERVICE TYPE 85122200

MAJOR DELIVERABLE DESCRIPTION

Perform Growth and Development Screenings for a minimum of 45 percent of non-exempted students in first, third, and sixth grade by March 31 and a minimum of 95 percent by June 30 of each contract year.

METHOD OF PAYMENT Fixed Fee Lump Sum (Fixed Fee)

MAJOR DELIVERABLE PRICE $0.00

NON-PRICE JUSTIFICATION 1. Price Cannot be determined

PAGE REFERENCE page 17

PERFORMANCE METRICS

Provide growth and development screenings for mandatory grade levels at all Basic School Health Service schools

DELIVERABLE NUMBER B.1.a.5)d)

Deliverable # B.1.a.5)e)

COMMODITY CODE/SERVICE TYPE 85122200

MAJOR DELIVERABLE DESCRIPTION

Refer all students with abnormal screening results to the appropriate health care providers for further evaluation and treatment within 45 days of receiving the screening results. Document all referrals made in the student cumulative health record.

METHOD OF PAYMENT Fixed Fee Lump Sum (Fixed Fee)

MAJOR DELIVERABLE PRICE $0.00

NON-PRICE JUSTIFICATION 1. Price Cannot be determined

PAGE REFERENCE page 17

PERFORMANCE METRICS

All students with abnormal screening results must be referred to appropriate health care providers for further evaluation and or treatment

DELIVERABLE NUMBER B.1.a.5)e)

Deliverable # B.1.a.5)f)

COMMODITY CODE/SERVICE TYPE 85122200

MAJOR DELIVERABLE DESCRIPTION

Confirm that all students referred to state contracted vision service providers have a signed parent or guardian consent form that includes permission for a Comprehensive Eye Exam, which may involve refraction and dilation.

METHOD OF PAYMENT Fixed Fee Lump Sum (Fixed Fee)

MAJOR DELIVERABLE PRICE $0.00

NON-PRICE JUSTIFICATION 1. Price Cannot be determined

PAGE REFERENCE page 17

PERFORMANCE METRICS

All students referred to State contracted vision service providers must have a signed parental or guardian consent form.

DELIVERABLE NUMBER B.1.a.5)f)

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Deliverable # B.1.a.5)g)

COMMODITY CODE/SERVICE TYPE 85122200

MAJOR DELIVERABLE DESCRIPTION

Provide at least one follow-up with the parents or guardians of students referred wtihin 45 days of referrign the student for further evaluation or treatment to ensure the students received the necessary care. Document the attempt(s) to follow-up with the parents or guardians and, if applicable, document any incidence(s) of a parent or guardian being non-responsive to the referral, refusing to follow-up, or a student withdrawing from school in the cumulative health record.

METHOD OF PAYMENT Fixed Fee Lump Sum (Fixed Fee)

MAJOR DELIVERABLE PRICE $0.00

NON-PRICE JUSTIFICATION 1. Price Cannot be determined

PAGE REFERENCE page 17

PERFORMANCE METRICS

At least one follow-up must be provided with the parents or guardians of students referred.

DELIVERABLE NUMBER B.1.a.5)g)

Deliverable # B.1.a.5)h)

COMMODITY CODE/SERVICE TYPE 85122200

MAJOR DELIVERABLE DESCRIPTION

Provide students who are pregnant with information on assistance, counseling, education, prenatal care, and the Healthy Start Program as needed.

METHOD OF PAYMENT Fixed Fee Lump Sum (Fixed Fee)

MAJOR DELIVERABLE PRICE $0.00

NON-PRICE JUSTIFICATION 1. Price Cannot be determined

PAGE REFERENCE page 17

PERFORMANCE METRICS

Additonal Basic Health Services are provided as specified in School Heatlh Services Plan.

DELIVERABLE NUMBER B.1.a.5)h)

Deliverable # B.1.a.5)i)

COMMODITY CODE/SERVICE TYPE 85122200

MAJOR DELIVERABLE DESCRIPTION

Provide additional Basic School Health Services as specified in the current School Health Services Plan.

METHOD OF PAYMENT Fixed Fee Lump Sum (Fixed Fee)

MAJOR DELIVERABLE PRICE $0.00

NON-PRICE JUSTIFICATION 1. Price Cannot be determined

PAGE REFERENCE page 17

PERFORMANCE METRICS

Additonal Basic Health Services are provided as specified in School Heatlh Services Plan.

DELIVERABLE NUMBER B.1.a.5)i)

Deliverable # B.1.a.6)

COMMODITY CODE/SERVICE TYPE 85122200

MAJOR DELIVERABLE DESCRIPTION

Provide health services for Full-Service Schools, identified in Attachment _III_, in accordance with section 402.3026, Florida Statutes and as specified in the current School Health Services Plan.

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PERFORMANCE METRICS Health services for Full-Service Schools must be provided as specified

DELIVERABLE NUMBER B.1.a.6)

Deliverable # B.1.a.7)a)

COMMODITY CODE/SERVICE TYPE…