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<br />,^." <br /> <br />" <br /> <br />DOCUMENT NO. 7560022067-97 <br />ATTACHMENT NO. 05 <br /> <br />PERFORMING AGENCY: PARIS-LAMAR COUNTY HEALTH DEPARTMENT <br /> <br />RECEIVING AGENCY PROGRAM: BUREAU OF LABORATORIES <br /> <br />TERM: September 0 I, 1996 IHRU: August 31, 1997 <br />SECTION I. SCOPE OF WORK: <br /> <br />PERFORMING AGENCY laboratory agrees to provide testing services on specimens received in <br />support of the following statewide programs: <br /> <br />Milk and Dairy Products Division (Milk Bacteriology and Chemistry) <br />Bureau ofHIV/SID Prevention (Syphilis, Gonorrhea, and/or Chlamydia) <br />TB Elimination Division (Tuberculosis Testing) <br />Infectious Disease, Epidemiology & Surveillance Division (Outbreak Investigations) <br />Women's Health Division (Health Screening) <br />Seafood Safety Division (Shellfish Testing) <br /> <br />PERFORMING AGENCY will provide a monthly activity report according to the attached format <br />within ten days of the end of the reporting month. <br /> <br />PERFORMING AGENCY agrees to meet standards for such analyses as set forth by RECEIVING <br />AGENCY, Bureau of Laboratories, the Clinical Laboratory Improvement Act, the Safe Drinking <br />Water Act, the National Conference ofInterstate Milk Shippers, and/or the 1993 U. S. Public Health <br />Service Grade "A" Pasteurized Milk Ordinance, 25 T AC, Chapter 217. <br /> <br />PERFORMING AGENCY will provide specimens/samples in or benefiting the geographic area <br />defined as <br /> <br />SECTION II. SPECIAL PROVISIONS: <br /> <br />General Provisions, PROGRAM INCOME Article, paragraph two, is not applicable to this <br />Attachment. However, additional instructions regarding program income follow in the next three <br />paragraphs. <br /> <br />PERFORMING AGENCY is required to bill Medicaid for the following laboratory tests performed <br />for Medicaid eligible patients: syphilis serology screening, syphilis serology confirmation, and <br />gonorrhea and chlamydia diagnosis. PERFORMING AGENCY will use their own billing system <br />or may use the automated system provided by NHIC, the Medicaid fiscal intermediary. <br /> <br />..~. <br /> <br />ATTACHMENT - Page I <br />