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Contract # (Contractor) ATTACIIMENT B - Scope of Work Federal Tax Id. or, SSN_,_,K1303 Contract # A. CONTRACTOR INFORMATION 1. Contractor Agency Name: ^°-°'~°^^ *'rndinnl !'°n4nr_NnCFhFi aat - 2. If ca'fferent from Contract Administrator Information in General Contract; Address TelephoneNumber;~04.783-3000 Fax Number: __Etnail• 3, Name of Program (s): ~11~Y~Y ("enter 4; Status: (X) Public ()Private, Not for Profit ()Private, For Profit 5. Contractor's Financial Reporting Year ,[O,ly 1, 2007 through 1 ne 0 008 B. Explanation of Services to be provided and to whom (include SIS Service Codo): Program Coda 212 is to be used, CPS-Medical, Psychological, and Medico-legal Diagnostic Services. The purpose of this service. is to provide multidisciplinary assessmerns and production of related reports and evidence at the Child Advocacy Center at Carolinas Medical Center-NorthEast. Children referred to the program are alleged victims of child abuse and/or neglect. Tho Contractor: • The Contractor agrees to provide, through the Child Advocacy Center (CAC), multidisciplinary assessments of children who have bean referred by the Cabarrus County Department of Social Services. It is'understood that costs for physician services required for the Child Medical Examination (CME) component of the . multidisciplinary aeaessment, where completed, may be met through the CME Progratn, and that the reimbursement provided under this contract supports other Child Advocacy Center costs for facilities, equipm~t, supplies, and staff required for completion of the multidisaiplinary asaeasment. The unit cost is based upon costs calculated and documented by Carolinas Medical Cantor-NorthEast, and is exclusive of other hospital overhead costs. • The Contractor agrees to maintain records to document the provision of services for three years or until audits are completed, whichever occurs later. • The Contractor will furnish a monthly report (D5S 1571, part IV) to the Department in order that the Department's request for federaUstate reimbursement may be submitted no later than the 5'" working day of the month following provision of service. • Activities required for the multidisciplinary evaluation to be performed by CAC staff include, but are not limited to, coordination of assessments, completion of medical exam; interviews, and other components of the complete forensic rnultidisciplinary assessment; production of reports and evidence; provision of evidence in court as required; and connection of families with needed services as appropriate. Contract-Scope of Work (06104) F-1 I Page lof 4