Childhood Lead Poisoning Prevention ProgramMasterpiece on the Mississippi
TO: The Honorable Mayor and City Council Members
FROM: Michael C. Van Milligen, City Manager
DATE: August 31, 2010
Mic ael C. Van Milligen
MCVM:jh
Attachment
cc: Barry Lindahl, City Attorney
Cindy Steinhauser, Assistant City Manager
Mary Rose Corrigan, RN, Public Health Specialist
Dubuque
Iterit
Au Ame tca try
2007
SUBJECT: Iowa Department of Public Health Childhood Lead Poisoning Funding and
Agreement with the Visiting Nurse Association and the Dubuque County
Board of Health
Public Health Specialist Mary Rose Corrigan recommends City Council approval of a
subcontract with the Dubuque County Board of Health and an agreement with the
Dubuque Visiting Nurse Association for additional follow -up of lead poisoned children
through contracted nursing services provided by the Dubuque Visiting Nurse
Association, training for employees, and monies to do outreach and education in
targeted neighborhoods.
I concur with the recommendation and respectfully request Mayor and City Council
approval.
Masterpiece on the Mississippi
TO: Michael C. Van Milligen, City Manager
FROM: Mary-KOs (Corrigan, RN, Public Health Specialist
Dubuque
All- America City
'
e
2007
August 23, 2010
SUBJECT: Iowa Department of Public Health (IDPH) Childhood Lead Poisoning
Funding and Agreement with the Visiting Nurse Association (VNA) and the
Dubuque County Board of Health
INTRODUCTION
This memorandum provides information regarding a contract with the Dubuque County
Board of Health and the Iowa Department of Public Health (IDPH) for continued funding
of the Childhood Lead Poisoning Prevention Program (CLPPP) and a renewed
agreement with the VNA for services related to the CLPPP.
BACKGROUND
In February 1994, the City Council approved a grant agreement authorizing the Health
and Housing Services Departments to contract with the Iowa Department of Public
Health for environmental follow -up and medical case management for children with lead
poisoning according to the Iowa Department of Public Health guidelines. The original
funding contract has been renewed annually. The latest contract ended June 30, 2008.
DISCUSSION
The Iowa Department of Public Health contracts with local Boards of Health for
distribution of their funds. This allows local Boards of Health to monitor public health
funding, avoid duplication of services and assure community health needs are
addressed (see attached contract.)
The subcontracted funds will allow the Health and Housing Services Departments to
provide additional follow -up of lead poisoned children through contracted nursing
services provided by the Dubuque Visiting Nurse Association, training for employees,
and monies to do outreach and education in targeted neighborhoods.
The contract also includes program performance standards, which we currently strive to
achieve through our existing protocols and outreach programs. The grant funds will be
reimbursed based on the specific activities outlined in the budget.
BUDGET IMPACT
The FY11 budget anticipated funding of $15,802. The contract is for $11,835, due to
State budget cuts.
RECOMMENDATION
It is recommended that the City Manager sign the attached subcontract with the
Dubuque County Board of Health and the agreement with the Dubuque Visiting Nurse
Association on behalf of the City of Dubuque.
MRC/cj
cc: David Harris, Housing Services Manager
Robert Boge, Senior Housing Inspector
Nan Colin, VNA, Administrative Director
SUBCONTRACT AGREEMENT FOR CHILDHOOD LEAD POISONING
PREVENTION SERVICES
BETWEEN
DUBUQUE COUNTY BOARD OF HEALTH
AND
THE CITY OF DUBUQUE
WHEREAS, the Dubuque County Board of Health (County Board), as
Contractor, has entered into an Agreement (the Agreement) wit the Iowa Department of
Public Health to perform childhood lead poisoning prevention services as set forth in
the Agreement, a copy of which is attached hereto; and
WHEREAS, County Board desires to enter into a subcontract with the City of
Dubuque (City) to perform the services required by the Agreement and City desires to
provide such services through its Health Services Department.
NOW, THERFORE, IT IS AGREED BY AND BETWEEN THE PARTIES AS
FOLLOWS:
1. City shall perform all of the services required of the Contractor in the
Agreement.
2. County Board shall pay City for its services in the same manner as County
Board as Contractor will be paid for its services under the Agreement.
Signed and dated the day of , 2010.
Pearl Scherrman, Chair
Dubuque County Board of Health
Michael C. Van Milligen
City Manager
SUBCONTRACT AGREEMENT FOR CHILDHOOD LEAD POISONING
PREVENTION SERVICES
BETWEEN
DUBUQUE COUNTY BOARD OF HEALTH
AND
THE CITY OF DUBUQUE
WHEREAS, the Dubuque County Board of Health (County Board), as
Contractor, has entered into an Agreement (the Agreement) wit the Iowa Department of
Public Health to perform childhood lead poisoning prevention services as set forth in
the Agreement, a copy of which is attached hereto; and
WHEREAS, County Board desires to enter into a subcontract with the City of
Dubuque (City) to perform the services required by the Agreement and City desires to
provide such services through its Health Services Department.
NOW, THERFORE, IT IS AGREED BY AND BETWEEN THE PARTIES AS
FOLLOWS:
1. City shall perform all of the services required of the Contractor in the
Agreement.
2. County Board shall pay City for its services in the same manner as County
Board as Contractor will be paid for its services under the Agreement.
Signed and dated the day of , 2010.
4c,47-tz
Pearl Scherrman, Chair
Dubuque County Board of Health
11/1- ael C. Van Milligen
City Manager
SUBCONTRACT
BETWEEN
THE CITY OF DUBUQUE, IOWA,
AND
THE DUBUQUE VISITING NURSE ASSOCIATION
FOR THE
CHILDHOOD LEAD POISONING PREVENTION PROGRAM
This Subcontract between the City of Dubuque, Iowa and The Visiting Nurse Association is dated
for reference purposes the 1 day of July, 2010.
Whereas, Dubuque County, Iowa (Contractor) has entered into Contract 5881L17 with the Iowa
Department of Public Health for Public Health (the Department) for the Childhood Lead Poisoning
Prevention Program (the Contract), a copy of which is attached hereto, pursuant to which Contractor will
provide the work and services described in the Contract in accordance with the Special Conditions
therein, and the General Conditions, a copy of which is attached hereto; and
Whereas, the City of Dubuque, Iowa (City) is the Contract Administrator of the Contract; and
Whereas, it is necessary for City to subcontract for certain work and services; and
Whereas, City now desires to enter into this Subcontract with the Visiting Nurse Association
(VNA) to provide the work and services described herein upon the terms and conditions set forth herein.
NOW, THEREFORE, IT IS AGREED BY AND BETWEEN CITY AND VNA AS FOLLOWS:
SECTION 1. WORK AND SERVICES. City and VNA agree to provide the following work and services
(the Work and Services):
1.1. Citv's Responsibilities. City agrees that it will provide the following services for the CLPPP:
(1) Submit reports /vouchers and other reporting requirements as required by the Iowa
Department of Public Health (IDPH) and the Centers for Disease Control and Prevention (CDC).
(2) Provide for environmental investigations and environmental case management for lead
abatement \lead hazard reduction in housing units in the city of Dubuque, Iowa, and Dubuque
County.
(3) Provide compensation to the VNA during the term of this Agreement not to exceed
$9,000.00 for the performances of VNA's responsibilities as set forth herein.
(4) Oversee and direct medical case management and educational activities through verbal
and written direction.
(5) Shall provide a notification of the results of blood lead testing to the caregivers of all
children in the CLPPP service area who have blood lead levels greater than or equal to 10 pg/dL.
The written notice shall include information regarding the meaning of the blood lead test result,
actions that the parents can take to reduce the child's blood lead level, and the date when the
child should be tested again.
1.2. VNA's Responsibilities. VNA agrees to provide the following services for CLPPP during the term
of this Agreement for the agreed compensation:
(1) Provide written quarterly reports on lead - related activities utilizing the Iowa Quarterly
Report Narrative Outline.
(2) Provide computer documentation of medical case management and related activities into
City's lead database system, STELLAR.
(3) Blood Lead Testing.
(a) VNA shall assure that the State of Iowa Plan for Childhood Blood Lead Testing
(January 2004) is implemented within the CLPPP service area; that medical providers
conduct blood lead testing according to this plan; and may also conduct blood lead testing.
(b) Shall provide a notification of the results of blood lead testing to the caregivers of all
children in the CLPPP service area who have blood lead levels greater than or equal to 10
pg/dL, regardless of whether the VNA did the testing. The written notice shall include
information regarding the meaning of the blood lead test result, actions that the parents
can take to reduce the child's blood lead level, and the date when the child should be
tested again.
(4) Medical Case Management:
(a) Be enrolled as a Medicaid provider for services that can be reimbursed by Medicaid
and shall recover reimbursement from Medicaid for medical case management services
and use the reimbursement as program income.
(b) Follow -up blood lead testing: Assure that providers in Dubuque County that
conduct blood lead testing provide follow -up blood lead testing for children under the age
of six years within the timelines listed below.
1. Confirmatory venous blood lead testing.
• Capillary blood lead level of 15 - 19 pg/dL - within 4 weeks after report
• Capillary blood lead level of 20-44 pg/dL - within 1 week after report
• Capillary blood lead level of 45 - 69 pg /dL - within 48 hours after the report
• Capillary blood lead level greater than or equal to 70 pg/dL — immediately
2. Follow -up testing after an elevated blood lead level for a child who has not
been chelated.
• Capillary or venous blood lead level of 10 - 14 pg/dL - within 3 months. After
two levels less than 10 pg/dL or three levels less than 15 pg/dL, testing
should follow the routine testing schedule for high -risk children
• Venous blood lead level of 15 - 19 pg/dL - within 3 months
• Venous blood lead level of 20 - 44 pg/dL - within 4 to 6 weeks
• Venous blood lead level greater than or equal to 45 pg/dL - immediately.
3. Follow -up testing for a child who has been chelated.
• At the end of chelation
• Depending on the blood lead level, 7 - 21 days after the end of chelation. The
results of this test will determine the need for additional chelation and the
schedule for additional blood lead testing.
(5) Medical evaluations:
(a) Shall assure that providers in Dubuque County provide/conduct medical evaluations
for children under the age of six years within the following timelines:
1. Venous blood lead level of 20 - 44 pg/dL - refer within 48 hours after the report so
that the service is received within 5 days.
2. Venous blood lead level of 45 - 69 pg/dL - refer within 24 hours after the report so
that the service is received within 48 hours
3. Venous blood lead level greater than or equal to 70 pg /dL - refer for emergency
medical evaluation
(6) Home nursing or outreach visits:
(a) Provide home nursing or outreach visits for children under the age of six years
according to the following timelines:
1. Venous blood lead level of 15 - 19 pg/dL - within 4 weeks after the report.
2. Venous blood lead level of 20 - 44 pg/dL - within 2 weeks after the report.
3. Venous blood lead level of 45 - 69 pg/dL - within 1 week after the report.
4. Venous blood lead level greater than or equal to 70 pg/dL - within 2 days after the
report
(7) Chelation:
(a) Assure that children with two venous blood lead levels greater than or equal to 45
pg/dL receive chelation.
(8) Nutrition evaluation:
(9)
(a) Assure that children under the age of six years with a venous blood lead level
greater than or equal to 15 pg /dL receive a nutrition evaluation according to the
following timelines:
1. Venous blood lead level of 15 -19 pg/dL - refer within 4 weeks after the report so that
the service is received within 6 weeks
2. Venous blood lead level of 20 - 44 pg/dL - refer within 2 weeks after the report so that
the service is received within 4 weeks
3. Venous blood lead level of 45 - 69 pg/dL - refer within 1 week after the report so that
the service is received within 2 weeks
4. Venous blood lead level greater than or equal to 70 pg/dL - refer within 2 days after
the report so that the service is received with 1 week.
(b) Shall contact the IDPH for assistance if access to a dietician cannot be assured for
children under the age of six years with a venous blood lead level greater than or equal to
15 pg/dL.
Developmental Assessment:
(a) Shall assure that children under the age of six years with a venous blood lead level
greater than or equal to 20 pg/dL receive a developmental assessment according to the
following timelines:
1. Venous blood lead level of 20 - 44 pg/dL - refer within 2 weeks after the report
2. Venous blood lead level of 45 - 69 pg/dL - refer within 1 week after the report
3. Venous blood lead Level greater than or equal to 70 pg /dL - refer within 2 days after
the report.
(10) Care coordination. Shall provide care coordination.
(11) Assist City with providing public education, lead coalition development and activities, and
outreach to the City of Dubuque residents about childhood lead poisoning.
(12) Provide information about lead poisoning and available services to local pediatric health
care providers.
(13) Participate with City in securing additional funding for childhood lead poisoning prevention
activities.
(14) Provide monthly work activity reports and invoices to the City Health Services Department
outlining services performed, by the 7th day of the month following the previous month.
(15) Assist the City with linkage to the Dubuque County Board of Health for CLPPP planning
and evaluation activities.
SECTION 2. CONTRACT POLICIES AND REQUIREMENTS. In providing the Work and Services,
VNA agrees to comply with the requirements in the Contract, including the Special Conditions, and the
General Conditions, to the extent applicable to the Work and Services described in Section 1.
SECTION 3. ACCESS TO BOOKS AND RECORDS. VNA to provide access, upon reasonable notice,
for the purpose of audit and examination, to its documents, papers, and records, to the extent such
documents, papers, and records are related to the Work and Services, to the Department, Contractor,
City, or any of their duly authorized representatives.
SECTION 4. AMOUNT OF SUBCONTRACT. The amount of the Subcontract is as follows:
SECTION 5. COSTS TO BE REIMBURSED. Attached hereto is a line item budget of specific costs to
be reimbursed under this Subcontract or other cost basis for determining the amount of the Subcontract.
SECTION 6. INCORPORATION OF THE CONTRACT. VNA agrees that all of the provisions of the
Contract, including audit requirements, are incorporated herein by this reference and VNA shall have all
of the same requirements, obligations and conditions as Contractor with respect to VNA's Work and
Services.
SECTION 7. PERIOD OF PERFORMANCE. Unless terminated as provided herein, the Period of
Performance for the Work and Services shall be from the the 1st day of July 2010, through the 30th day
of June, 2011.
SECTION 8. TERMINATION. Either party may terminate this Subcontract for any reason, with or
without cause, upon ten (10) days written notice to the other party. In the event of termination, City shall
compensate VNA for its Work and Services rendered through the date of termination.
SECTION 9. INDEMNIFICATION.
(1) VNA agrees to defend, indemnify, and hold Department, City and Contractor, and their
officers, and employees harmless from and against any and all claims of any kind arising out of or
related to VNA's negligence in the performance of the Work and Services pursuant to this
Subcontract.
(2) City agrees to defend, indemnify, and hold VNA and its officers, and employees harmless
from and against any and all claims of any kind arising out of or related to City's negligence in the
performance of the Work and Services pursuant to this Subcontract.
SECTION 10. INSURANCE. VNA shall at its expense maintain insurance with the same coverage
which Contractor is required to maintain under Par. 13 of the General Conditions.
CITY OF DUBUQUE, IOWA VISITING NURSE ASSOCIATION
By: By:
Michael C. Van Milligen Nan Colin
City Manager Administrative Director
SECTION 8. TERMINATION. Either party may terminate this Subcontract for any reason, with or
without cause, upon ten (10) days written notice to the other party. In the event of termination, City shall
compensate VNA for its Work and Services rendered through the date of termination.
SECTION 9. INDEMNIFICATION.
(1) VNA agrees to defend, indemnify, and hold Department, City and Contractor, and their
officers, and employees harmless from and against any and all claims of any kind arising out of or
related to VNA's negligence in the performance of the Work and Services pursuant to this
Subcontract.
(2) City agrees to defend, indemnify, and hold VNA and its officers, and employees harmless
from and against any and all claims of any kind arising out of or related to City's negligence in the
performance of the Work and Services pursuant to this Subcontract.
SECTION 10. INSURANCE. VNA shall at its expense maintain insurance with the same coverage
which Contractor is required to maintain under Par. 13 of the General Conditions.
CITY OF DUBUQUE, IOWA VISITING NURSE ASSOCIATION
By: By:
Michael C. Van Milligen Nan Colin
City Manager Administrative Director
Thomas Newton, MPP, REHS Chester J. Culver
Director
Iowa Department of Public Health
Promoting and Protecting the Health of Iowans
CONTRACT #: 5881L17
PROJECT TITLE:
Childhood Lead Poisoning Prevention Program
FUNDING SOURCE OF IDPH:
FEDERAL: $0 -- 0.00%
STATE: $11,835 -- 100.00%
OTHER:
FEDERAL CATALOG #: None
MATCH REQUIRED: YES❑ NO NA❑
IOWA CODE CHAPTER 8F DESIGNATION:
Governor
❑ This contract is covered by Iowa Code Chapter 8F.
This contract is NOT covered by Iowa Code Chapter 8F.
❑ At the time of execution, this contract is NOT covered by
Iowa Code Chapter 8F, but if the Contractor executes
additional contracts with the Department, the aggregate of
which exceed $500,000, the contract may be covered.
Patty Judge
Lt. Governor
PROJECT PERIOD: July 1, 2010 to June 30, 2011
CONTRACT PERIOD: July 1 2010 to June 30 2011
CONTRACT AMOUNT: $11,835
FEDERAL TAX ID #: 426004597
CONTRACTOR:
Dubuque County Board of Health
CONTRACT ADMINISTRATOR
NAME: Michael C. Van Milligen, City Manager
AGENCY: City of Dubuque Health Services
Department
City Hall Annex
1300 Main Street
Dubuque IA 52001
PHONE: 563 - 589 - 4181 FAX: 563 - 589 - 4299
E - MAIL: health @cityofdubuque.org
The CONTRACTOR agrees to perform the work and to provide the services described in the Special conditions for the
consideration stated herein. The duties, rights, and obligations of the parties to this contract shall be governed by the
Contract Documents, which include the Special Conditions, General Conditions, Request for Proposal, and Application.
The CONTRACTOR has reviewed and agrees to the General Conditions effective October 1, 2009, as posted on the
Department's web site under Grants, Bids, and Proposals: www.idph.state.ia.us or as available by contacting Rita
Gergely at 515/242 -6340. The contractor specifies no changes have been made to the Special Conditions or General
Conditions.
The parties hereto have
For and on behalf of
the Department
executed this contract on the day and year last specified below.
For and on behalf of
the Contractor
4
By: By: ��t1�c�4
Ken Sharp, Director Pearl Scherrman
Division of Environmental Health Board of Health Chair
Date: Date: ' 3
For and on behalf of
the Designated Agency
By:
Michael C. Van Milligen, City
Manager, Director
City of Dubuque Health Services
Department
Date:
Lucas State Office Building, 321 E. 12th Street, Des Moines, IA 50319 -0075 • 515 - 281 -7689 • www.idph.state.ia.us
DEAF RELAY (Hearing or Speech Impaired) 711 or 1- 800 - 735 -2942
li a Depart ent of Public Health
Promoting and Protecting the He h of Iowans
%-•
Thomas Newton, MPP, REHS
Director
Chester J. Culver
Governor
CONTRACT #: 5881L17
PROJECT TITLE:
Childhood Lead Poisoning Prevention Program
FUNDING SOURCE OF IDPH:
FEDERAL: $0 -- 0.00%
STATE: $11,835 -- 100.00%
OTHER:
FEDERAL CATALOG #: None
MATCH REQUIRED: YESE] NO NAL]
IOWA CODE CHAPTER 8F DESIGNATION:
This contract is covered by Iowa Code Chapter 8F.
This contract is NOT covered by Iowa Code Chapter 8F.
At the time of execution, this contract is NOT covered by
Iowa Code Chapter 8F, but if the Contractor executes
additional contracts with the Department, the aggregate of
which exceed $500,000, the contract may be covered.
Patty Judge
Lt. Governor
PROJECT PERIOD: July 1, 2010 to June 30, 2011
CONTRACT PERIOD: July 1 2010 to June 30 2011
CONTRACT AMOUNT: $11,835
FEDERAL TAX ID#: 426004597
CONTRACTOR:
Dubuque County Board of Health
CONTRACT ADMINISTRATOR
NAME: Michael C. Van Milligen, City Manager
AGENCY: City of Dubuque Health Services
Department
City Hall Annex
1300 Main Street
Dubuque IA 52001
PHONE: 563-589-4181 FAX: 563-589-4299
E-MAIL: health@cityofdubuque.org
The CONTRACTOR agrees to perform the work and to provide the services described in the Special conditions for the
consideration stated herein. The duties, rights, and obligations of the parties to this contract shall be governed by the
Contract Documents, which include the Special Conditions, General Conditions, Request for Proposal, and Application.
The CONTRACTOR has reviewed and agrees to the General Conditions effective October 1, 2009, as posted on the
Department's web site under Grants, Bids, and Proposals: www.idph.stateia.us or as available by contacting Rita
Gergely at 515/242-6340. The contractor specifies no changes have been made to the Special Conditions or General
Conditions.
The parties hereto have executed this contract on the day and year last specified below.
For and on behalf of
the Department
For and on behalf of
the Contractor
For and on behalf of
the Desi ted Agency
By: By4J By:
Ken Sharp, Director Pearl Scherrman Mic ael C. Van Milligen, City
Division of Environmental Health Board of Health Chair
Date: Date:
Manager, Director
City of Dubuque Health Services
Department
Date:
Lucas State Office Building, 321 E. 12th Street, Des Moines, IA 50319-0075 m 515-281-7689 $ www.idph.state.ia.us
DEAF RELAY (Hearing or Speech Impaired) 711 or 1-800-735-2942
Name
Title
Michael C. Van Milligen, City Manager
Agency Director
Mary Rose Corrigan RN,MSN
Program Administrator
Ken TeKippe
Finance Manager
Chris Johnson
Data Entry Clerk
Michelle Zurcher RN (Finley Tri- States Health Group VNS)
Nurse
Mary Rose Corrigan, Tim Link, Richard Miller, Bob Boge,
Kevin Hirsch, Richard Zeller
Certified Elevated Blood Lead (EBL)
Inspector/Risk Assessor
Patrice Lambert
Dubuque County Health Department Director
Bonnie Brimeyer
Dubuque County Health Department Office
Manager
SPECIAL CONDITIONS FOR CONTRACT #5881L17
ARTICLE I — IDENTIFICATION OF PARTIES
Dubuque County Board of Health (CONTRACTOR) has demonstrated through application to the
DEPARTMENT that it is prepared to provide the activities and authority outlined per Iowa Administrative
Code (IAC) 641 Chapter 72. The CONTRACTOR has designated CITY OF DUBUQUE HEALTH
SERVICES DEPARTMENT (hereinafter referred to as the DESIGNATED AGENCY), to carry out the
activities as required in IAC 641- 72.2(3) and described in this contract. The address of the DESIGNATED
AGENCY is:
City Hall Annex
1300 Main Street
Dubuque, IA 52001
ARTICLE II — IDENTIFICATION OF AUTHORIZED STATE OFFICIAL:
Ken Sharp, Director, Division of Environmental Health, is the Authorized State Official for this contract.
Any changes in the terms, conditions, or amounts specified in this contract must be approved by the
Authorized State Official. Negotiations concerning this contract should be referred to Rita Gergely, Chief,
Bureau of Lead Poisoning Prevention, 515/242 -6340
ARTICLE III — DESIGNATION OF AUTHORITY, CONTRACT
ADMINISTRATOR, AND KEY PERSONNEL
The CONTRACTOR, as listed on the contract face sheet, is responsible for financial and administrative
matters of this contract.
The CONTRACTOR has designated the Contract Administrator listed on the contract face sheet the
authority to manage the contract, to assure compliance with all conditions, and to negotiate matters
concerning this project. The Contract Administrator will receive key communications from the
DEPARTMENT and will be responsible for keeping the CONTRACTOR and all authorized agencies
informed.
In addition to the CONTRACTOR and the Contract Administrator, additional individuals(s) as listed below
shall be considered key personnel and may sign claims.
Table A:
ARTICLE IV — STATEMENT OF CONTRACT PURPOSE
The purpose of this contract is to provide funds for the CONTRACTOR to ensure that childhood lead
poisoning prevention activities are conducted as specified in this contract and in compliance IAC 641 —
Chapter 72.
ARTICLE V - DEFINITIONS
DEFINITIONS
"Blood lead testing" means taking a capillary or venous sample of blood and sending it to a laboratory to
determine the level of lead in the blood.
"Capillary" means a blood sample taken from the finger or heel for lead analysis.
"Care coordination" means the process of linking the service system to the recipient and/or family, and
coordination of the various elements in order to achieve a successful outcome.
"CDC" means the Centers for Disease Control and Prevention.
"Certified elevated blood lead (EBL) inspection agency" means an agency that has met the requirements of
641 - 70.5(135) and that has been certified by the department.
"Certified elevated blood lead (EBL) inspector /risk assessor" means a person who has met the requirements
of 641 - 70.5(135) for certification or interim certification and who has been certified by the department.
"Chelation " means the administration of medication that binds lead so that it can be removed from the body.
"Child health contractor" means an agency that has a contract with the Iowa Department of Public Health
for the Title V Child Health program.
"Childhood Lead Poisoning Prevention Program (CLPPP) service area" means the geographic area for
which the CLPPP has agreed to provide CLPPP services.
"CLPPP" means childhood lead poisoning prevention program.
"Complete medical evaluation" means a history, physical examination, and testing for iron status as
described in Chapter 7 of Preventing Lead Poisoning in Young Children, CDC, October 1991.
"Data management" means all actions taken by the CONTRACTOR to manage blood lead data and case
management data. This includes, but is not limited to, entering blood lead test results for all individuals
under the age of 16 years in the CLPPP service area who receive blood lead testing from the CLPPP or any
other provider in the STELLAR database, documenting all case management actions such as contact with the
family or provider, EBL inspection, lead hazard remediation, home nursing or outreach visits, nutrition
evaluations, and developmental assessments in the STELLAR database, and providing all STELLAR reports
required by this contract.
"Developmental testing" means testing done by the local Early Access Program or Area Education Agency
to determine whether a child is developmentally delayed.
"Education and outreach" means seeking out and providing information regarding childhood lead poisoning
to members of populations who are at high risk for lead poisoning and those who work for agencies that
provide service to these high -risk populations; members of the general public, including homeowners,
landlords, Realtors, and members of community organizations, and health professionals and para-
professionals, including physicians, nurses, and laboratory technicians.
"Elevated blood lead (EBL) child" means any child who has had one venous blood lead level greater than or
equal to 20 micrograms per deciliter (µg /dL) or at least two venous blood lead levels of 15 to 19 µg /dL.
"Elevated blood lead (EBL) inspection" means an inspection to determine the sources of lead exposure for
an elevated blood lead (EBL) child and the provision within ten working days of a written report explaining
the results of the investigation to the owner and occupant of the residential dwelling or child - occupied
facility being inspected and to the parents of the elevated blood lead (EBL) child.
"Elevated blood lead (EBL) inspection agency" means an agency that employs or contracts with individuals
who perform elevated blood lead (EBL) inspections. Elevated blood lead (EBL) inspection agencies may
also employ or contract with individuals who perform other lead -based paint activities.
"Environmental case management" means providing elevated blood lead (EBL) inspections in all dwellings
associated with an EBL child and assuring that lead hazards identified at these dwellings.
"Follow -up blood lead testing" means blood lead testing that is conducted after a child has had at least one
capillary or venous blood lead level greater than or equal to 10 µg /dL.
"Home nursing or outreach visit" means a home visit conducted by a nurse or social worker to provide
information to the caregiver of a lead - poisoned child regarding the health effects of lead poisoning, the
importance of good housekeeping and nutrition, and the importance of follow -up blood lead testing and to
assess the overall situation of the child and family to determine whether the child and /or family should be
referred for additional services.
"Laboratory" means a laboratory certified to perform either waived or non - waived blood lead analysis
according to the federal Clinical Laboratory Improvement Act of 1988 (CLIA).
"Lead -based paint hazard" means hazardous lead -based paint, a dust -lead hazard, or a soil -lead hazard as
defined in 641— Chapter 70.
"Lead hazard remediation" means the control of lead hazards identified in the EBL inspection through
interim controls, renovation and remodeling, or lead abatement.
"Local board of health" means a county, district, or city board of health.
"Local coalition" means a group convened by the CONTRACTOR to address the issue of childhood lead
poisoning in the CLPPP service area. The local coalition should be composed of physicians, nurses, housing
officials, parents, contractors, and representatives of neighborhoods where homes are being renovated.
"Medical case management" means all services necessary to evaluate the health and development of a child
with a blood lead level greater than or equal to 10 µg /dL and to treat any conditions identified in the
evaluation. Medical case management includes, but it not limited to, follow -up blood lead testing, medical
evaluation, home nursing or outreach visits, chelation, nutrition evaluation, developmental assessment, and
care coordination.
"Nutrition evaluation" means an evaluation conducted by a dietician to determine whether a child is
receiving a well- balanced and age- appropriate diet, with particular attention to the child intake of Vitamin C,
iron, and calcium.
"Quarterly narrative report" means a report of the contractor's childhood lead poisoning prevention
activities for the quarter that is developed according to guidelines provided by the department and is
provided to the department by the deadlines given in Article VII.
"Referral" means to direct the family of a lead - poisoned to a service for the family or the child and to
follow -up to assure that the family actually received the service.
"STELLAR" means the Systematic Tracking of Elevated Lead Levels and Remediation database, which is
provided by CDC at no charge.
"STELLAR Lab Batch" means the procedure in STELLAR that processes blood lead tests and sets dates for
follow -up blood lead tests, opens medical cases, and opens environmental cases.
"STELLAR quarterly report" means the procedure in STELLAR that compiles the contractor's activities for
the quarter into a data file that is submitted to the department electronically by the deadlines given in Article
VII.
"Venous" means a blood sample taken from a vein in the arm for lead analysis.
ARTICLE VI — DESCRIPTION OF WORK AND SERVICES
The CONTRACTOR shall ensure that childhood lead poisoning prevention services are conducted as
specified in this contract.
CLPPP SERVICE AREA
The CLPPP service area is Dubuque County.
REQUIRED SERVICES
The CONTRACTOR shall ensure that the DESIGNATED AGENCY implements all of the required services
as described below within the CLPPP service area. The required services are blood lead testing, data
management, environmental case management, medical case management, education and outreach, and the
local coalition. The CONTRACTOR shall ensure that the DESIGNATED AGENCY develops written
protocols to describe how each of these services will be provided. Templates provided by the
DEPARTMENT may be used to develop these protocols.
BLOOD LEAD TESTING
The CONTRACTOR shall ensure that the DESIGNATED AGENCY:
• Implements the State of Iowa Plan for Childhood Blood Lead Testing (January 2004) within the
CLPPP service area.
• Conducts blood lead testing or ensures that medical providers conduct blood lead testing according to
this plan.
• Provides a written notice of the results of blood lead testing to the caregivers of all children tested by
the DESIGNATED AGENCY. The written notice shall include information regarding the meaning
of the blood lead test result and the date when the child should be tested again.
• Provides a written notice of the results of blood lead testing to the caregivers of all children in the
CLPPP service area who have blood lead levels greater than or equal to 10 pg/dL, regardless of who
did the testing. The written notice shall include information regarding the meaning of the blood lead
test result, actions that the parents can take to reduce the child's blood lead level, and the date when
the child should be tested again.
DATA MANAGEMENT
The CONTRACTOR shall ensure that the DESIGNATED AGENCY:
• Conducts data management as specified in this contract.
• Notifies the department within 10 working days of assigning STELLAR data entry duties to a new
staff person and ensures that new data entry staff has received appropriate training or works with the
department to assure that new data entry staff receives appropriate training.
• Installs STELLAR on a computer network consisting of at least two computers that are linked to the
same server. The CONTRACTOR shall ensure that the DESIGNATED AGENCY allows the
DEPARTMENT and other agencies providing medical and environmental case management of lead -
poisoned children in the CLPPP service area to access the main STELLAR database via the software,
PC Anywhere, or another software package approved in advance by the DEPARTMENT. This
software shall be installed on a computer that is continuously available for the DEPARTMENT and
other agencies for access. The CONTRACTOR or DESIGNATED AGENCY may request that the
DEPARTMENT waive the requirement that STELLAR be installed on a network and that a computer
be continuously available for the DEPARTMENT and other agencies to access. The
CONTRACTOR shall ensure that the DESIGNATED AGENCY makes this request in writing. The
DEPARTMENT will approve or deny these requests on a case -by -case basis.
• Enters the results of blood lead testing for all individuals under the age of 16 years in the CLPPP
service area who receive blood lead testing from the CLPPP or any other provider in the STELLAR
database.
• Documents all case management actions taken by the DESIGNATED AGENCY such as contact with
the family or provider, EBL inspection, lead hazard remediation, home nursing or outreach visits,
nutrition evaluations, and developmental assessments in the STELLAR database and shall ensure that
all CLPPP subcontractors also document all case management actions that they take in STELLAR.
• Enters blood lead test results and case management actions into STELLAR on at least a weekly basis.
• Runs STELLAR Lab Batch at least every two weeks and forwards case information to other agencies
providing medical and environmental case management in the CLPPP service area at least every two
weeks.
• Provides all STELLAR reports by the deadlines given in this contract. The DEPARTMENT will
periodically review the DESIGNATED AGENCY STELLAR database for errors and notify the
DESIGNATED AGENCY of errors that must be corrected.
• Correct the errors by the date specified in the notification and shall implement quality control
measures to prevent data entry errors.
FILING SYSTEM AND RETENTION OF RECORDS
The DESIGNATED AGENCY shall file paper copies of all blood lead test results entered into STELLAR
alphabetically by the name of the child and shall retain b them until one (1) year after the child attains the
age of majority. The DESIGNATED AGENCY will transfer paper copies of all blood lead test results to the
DEPARTMENT if the subcontract or contract is terminated. The DESIGNATED AGENCY may request
that the DEPARTMENT waive the requirement that the DESIGNATED AGENCY file all blood lead test
results alphabetically by the name of the child. The CONTRACTOR shall ensure that the DESIGNATED
AGENCY makes this request in writing. The DEPARTMENT will approve or deny these requests on a
case -by -case basis.
ENVIRONMENTAL CASE MANAGEMENT
The CONTRACTOR shall ensure that the DESIGNATED AGENCY:
• Maintains certification of individual inspectors as elevated blood lead (EBL) inspector /risk assessors
and agency certification as an elevated blood lead level (EBL) inspection agency. The
CONTRACTOR or DESIGNATED AGENCY and the certified individuals shall comply with the
provisions of Iowa Administrative Code 641- 70.6(3).
• Enrolls as a Medicaid provider for EBL inspection services, recovers reimbursement from Medicaid
for EBL inspections, uses the reimbursement as program income.
• Conducts elevated blood lead (EBL) inspections for any child under the age of six years who has had
one venous blood lead level greater than or equal to 20 .tg/dL or at least two venous blood lead levels
of 15 to 19 µg/dL. EBL inspections shall be conducted for all addresses associated with the child and
for all addresses that the child moves to after the case is initially reported until the child has had one
blood lead level less than 10 µg /dL or three blood lead levels less than 15 µg/dL. EBL inspections
shall be conducted within the following times:
➢ Two venous blood lead levels of 15 to 19 µg /dL – within 4 weeks after the report.
➢ Venous blood lead level of 20 to 44 µg /dL – within 2 weeks after the report
➢ Venous blood lead level of 45 to 69 µg /dL – within 1 week after the report
➢ Venous blood lead level greater than or equal to 70 µg /dL – within 2 days after the report.
• Documents in STELLAR the reason why the DESIGNATED AGENCY was unable to complete any
inspection required by this contract.
• Contacts the occupants and /or owners of dwellings where lead hazards have been identified within 30
days of the initial inspection to check their progress towards making the dwelling lead -safe.
• Contacts the current owners of all dwellings where lead hazards were identified, but lead hazard
remediation has not been completed, at least once every six months until lead hazard remediation is
completed.
• Continues follow up on all of these dwellings until lead hazard remediation is completed, regardless
of whether the dwellings are owner - occupied or rental and regardless of changes in ownership.
• Does not close an address associated with a lead - poisoned child where lead hazards have been
identified unless the lead hazard remediation has been completed unless permission is obtained in
advance from the DEPARTMENT.
• To the extent possible, assists families who have lead - poisoned children in locating resources for lead
hazard remediation and /or alternative housing.
• Conducts clearance testing according to Iowa Administrative Code Chapter 641 -70, Lead
Professional Certification, before verifying that lead hazard remediation has been completed in a
home associated with a lead - poisoned child.
To be eligible for continued funding beginning July 1, 2008, each county in the service area must have
adopted a local board of health regulation or a local board of supervisors ordinance that is at least as
protective as Iowa Administrative Code Chapter 641 -68, Control of Lead -Based Paint Hazards.
MEDICAL CASE MANAGEMENT
The CONTRACTOR shall ensure that the DESIGNATED AGENCY:
• Conducts medical case management as specified in this contract.
• Is enrolled as a Medicaid provider for services that can be reimbursed by Medicaid, recovers
reimbursement from Medicaid for medical case management services, and uses the reimbursement as
program income.
Follow - up blood lead testing
The CONTRACTOR shall ensure that the DESIGNATED AGENCY:
• Assures that providers in the CLPPP service that conduct blood lead testing provide follow -up blood
lead testing for children under the age of six years within the timelines listed below. The
DESIGNATED AGENCY may also provide this follow -up blood lead testing.
Confirmatory venous blood lead testing
➢ Capillary blood lead level of 15 to 19 gg/dL – within 4 weeks after the report.
➢ Capillary blood lead level of 20 to 44 µg /dL – within 1 week after the report
➢ Capillary blood lead level of 45 to 69 µg /dL – within 48 hours after the report
➢ Capillary blood lead level greater than or equal to 70 µg /dL – immediately.
Follow -up testing after an elevated blood lead level for a child who has not been chelated
➢ Capillary or venous blood lead level of 10 to 14 .tg /dL – within 3 months. After two levels
less than 10 µg /dL or three levels less than 15 gg/dL, testing should follow the routine testing
schedule for high -risk children.
➢ Venous blood lead level of 15 to 19 µg/dL – within 3 months.
➢ Venous blood lead level of 20 to 44 gg/dL – within 4 to 6 weeks.
Venous blood lead level greater than or equal to 45 gg/dL – immediately
Follow -up testing for a child who has been chelated
➢ At the end of chelation.
➢ Depending on the blood lead level, 7 to 21 days after the end of chelation. The results of this
test will determine the need for additional chelation and the schedule for additional blood lead
testing.
Medical evaluations
The CONTRACTOR shall ensure that the DESIGNATED AGENCY:
• Assures that providers in the CLPPP conduct medical evaluations for children under the age of six
years within the following timelines:
➢ Venous blood lead level of 20 to 44 µg /dL – Refer within 48 hours after the report so that the
service is received within 5 days.
➢ Venous blood lead level of 45 to 69 µg /dL — Refer within 24 hours after the report so that the
service is received within 48 hours.
➢ Venous blood lead level greater than or equal to 70 µg/dL — Refer for emergency medical
evaluation.
Home nursing or outreach visits
The CONTRACTOR shall ensure that the DESIGNATED AGENCY provides home nursing or outreach
visits for children under the age of six years according to the following timelines:
➢ Venous blood lead level of 15 to 19 µg/dL — within 4 weeks after the report.
➢ Venous blood lead level of 20 to 44 µg /dL — within 2 weeks after the report
➢ Venous blood lead level of 45 to 69 µg/dL — within 1 week after the report
➢ Venous blood lead level greater than or equal to 70 µg/dL — within 2 days after the report.
Chelation
The CONTRACTOR shall ensure that the DESIGNATED AGENCY
• Assures that children with two venous blood lead levels greater than or equal to 45 µg/dL receive
chelation.
Nutrition evaluation
The CONTRACTOR shall ensure that the DESIGNATED AGENCY:
• Assures that children under the age of six years with a venous blood lead level greater than or equal
to 15 µg /dL receive a nutrition evaluation according to the following timelines:
➢ Venous blood lead level of 15 to 19 µg /dL — Refer within 4 weeks after the report so that the
service is received within 6 weeks.
➢ Venous blood lead level of 20 to 44 µg /dL — Refer within 2 weeks after the report so that the
service is received within 4 weeks.
➢ Venous blood lead level of 45 to 69 µg /dL — Refer within 1 week after the report so that the
service is received within 2 weeks.
➢ Venous blood lead level greater than or equal to 70 µg/dL — Refer within 2 days after the
report so that the service is received with 1 week.
• Contacts the DEPARTMENT for assistance if access to a dietitian cannot be assured for children
under the age of six years with a venous blood lead level greater than or equal to 15 4g/dL.
Developmental assessment
The CONTRACTOR shall ensure that the DESIGNATED AGENCY:
• Assures that children under the age of six years with a venous blood lead level greater than or equal
to 20 µg /dL receive a developmental assessment according to the following timelines:
➢ Venous blood lead level of 20 to 44 gg/dL — Refer within 2 weeks after the report.
➢ Venous blood lead level of 45 to 69 µg/dL — Refer within 1 week after the report
➢ Venous blood lead level greater than or equal to 70 µg/dL — Refer within 2 days after the
report.
Care coordination
The CONTRACTOR shall ensure that the DESIGNATED AGENCY provides care coordination or refers the
family to the local child health contractor for this service.
Medical Case Closure Guidelines
Medical cases shall be closed only in the following circumstances:
1. A child has had two consecutive blood lead levels less than 10 µg/dL or three consecutive blood lead
levels less than 15 µg/dL after the initial elevated blood lead level.
2. A child has had a capillary false positive blood lead level; that is, a capillary or venous blood lead
level less than 10 gg/dL immediately after a single capillary blood lead level greater than or equal to
15 .tg/dL.
3. A child has reached the age of six years and has a blood lead level less than 20 µg/dL.
4. A child has moved out of the CLPPP service area. The CONTRACTOR shall ensure that the
DESIGNATED AGENCY immediately notifies the appropriate local CLPPP agency in the area to
which the child has moved and provides copies of all environmental and medical case management
records to the appropriate local CLPPP agency.
CHILDREN OVER THE AGE OF SIX YEARS
The CONTRACTOR shall ensure that the DESIGNATED AGENCY contacts the department for specific
case management guidelines for a child over the age of six years who has a venous blood lead level greater
than or equal to 20 µg/dL.
EDUCATION AND OUTREACH
The CONTRACTOR shall ensure that the DESIGNATED AGENCY provides education and outreach
regarding childhood poisoning in the CLPPP service area.
LOCAL COALITION
The CONTRACTOR shall ensure that the DESIGNATED AGENCY establishes a local coalition for the
CLPPP service area. The coalition may be a subgroup /work group of a larger umbrella coalition. However,
participation in an umbrella coalition does not meet this requirement unless a specific subgroup has been
formed to deal with lead poisoning prevention in the community. The coalition shall include citizens who
are not part of agency (Health, Housing, Human Services, etc.) staff that participate in the CLPPP. The
CONTRACTOR shall ensure that the DESIGNATED AGENCY devotes at least 8 hours of staff time to the
establishment and maintenance of the coalition.
ARTICLE VI — REPORTS
The CONTRACTOR shall ensure that the DESIGNATED AGENCY prepares and submits the following
reports to the DEPARTMENT on forms and /or in the format approved by the DEPARTMENT:
Report Number
Claim Voucher 1 electronic
Expenditure Report 1 electronic
STELLAR Documentation to 1 original
Support Expenditure Report
Date Due
Within 45 days of month of expenditure
Within 45 days of month of expenditure
Within 45 days of month of expenditure
Quarterly Narrative Report 1 Electronic 10 -25 -2010
1 -25 -2011
4 -25 -2011
7 -25 -2011
STELLAR Quarterly Report 1 Electronic 10 -25 -2010
1 -25 -2011
4 -25 -2011
7 -25 -2011
Claim vouchers and expenditure reports shall be filed via SharePoint.
STELLAR documentation to support the expenditure report shall be mailed to:
Rita Gergely, Chief
Bureau of Lead Poisoning Prevention
Division of Environmental Health
Iowa Department of Public Health
321 East 12 Street
Lucas State Office Building
Des Moines, IA 50319 -0075
Quarterly STELLAR and narrative reports shall be emailed to:
Pilar Logsdon: plo2,sdon4iidph.state.ia.us
ARTICLE VII -- BUDGET
The total approved budget for this contract period is detailed in Exhibit 1. Services will be reimbursed at a
flat fee as specified on Exhibit 1 up to the amount of the contract.
The CONTRACTOR or DESIGNATED AGENCY may change the number of any deliverable that the
DEPARTMENT will reimburse under this contract only after filing a written request for the revision and
receiving written approval for this change.
The CONTRACTOR or DESIGNATED AGENCY shall receive written approval from the DEPARTMENT
prior to spending the final three (3) percent of the appropriated state funds awarded.
ARTICLE VI — PAYMENTS
1. Warrants will be made payable to the CONTRACTOR and mailed to the Contract Administrator at
the DESIGNATED AGENCY address. Warrants may be sent to an alternate address if requested in
writing from the CONTRACTOR.
2. Payments shall be made to the CONTRACTOR based on the expenditure reports and claim vouchers
submitted to the DEPARTMENT by the DESIGNATED AGENCY.
3. Final payment may be withheld until all contractually required reports have been received and
accepted by the DEPARTMENT. At the end of the contract period, unobligated contract amount
funds shall revert to the DEPARTMENT.
ARTICLE X — ADDITIONAL CONDITIONS
1. Funds may not be spent for indirect costs, chelation or other medical treatment of lead poisoning, or
lead hazard remediation. Funds may not be spent for blood lead analysis unless this service is listed
as a line item on the expenditure report.
2. On January 1, 2011, April 1, 2011, and June 1, 2011, the DEPARTMENT may amend the contract to
revert funds that are estimated to be unused to the DEPARTMENT and to reallocate the funds to
contractors with demonstrated special needs for childhood lead poisoning prevention services.
3. Payments may be withheld if the DESIGNATED AGENCY or personnel employed by the
DESIGNATED AGENCY are not in compliance with Iowa Administrative Code Chapter 641 -70,
Lead Professional Certification.
4. The CONTRACTOR and /or DESIGNATED AGENCY must check Internet e-mail at least once each
week for lead poisoning prevention updates sent out by the DEPARTMENT.
5. XRF analyzers that were originally purchased, in part or in whole, with Iowa Department of Public
Health grant funds, are to be shared with other elevated blood lead (EBL) inspector /risk assessors that
have a contract with the Childhood Lead Poisoning Prevention program. This sharing is to be at no
cost other than their travel to pick up and deliver the machine. Programs are strongly encouraged to
also share the XRF analyzers with government and private, non - profit housing agencies that employ
appropriately certified inspector /risk assessors. Any fees received for sharing the machine with
government and private, non - profit housing agencies are considered program income that shall be
returned to the lead program and used to enhance lead program efforts.
6. The CONTRACTOR shall comply with Section 5 of the General Conditions for all subcontracts.
7. As a condition of the contract, the CONTRACTOR shall ensure that the DESIGNATED AGENCY
provides linkage with the local board of health in each county where services are provided. The
DESIGNATED AGENCY will ensure that the local board of health has been actively engaged in
planning for and evaluation of services. It will also maintain effective linkages with the local board
of health, including timely and effective communications and ongoing collaboration.
8. All work plan revisions must be approved by the DEPARTMENT prior to implementation.
9. Authorization - Each signatory to this contract or subsequent contract amendments represents and
warrants to the other parties that:
a. The signatory has the right, power, and authority to enter into this agreement and to bind the party
represented by the signatory to this agreement
b. The party has the right, power, and authority to perform its obligations under the agreement; and
c. The party has taken all requisite action (corporate, statutory, or otherwise) to approve execution,
delivery, and performance of this agreement and this agreement constitutes a legal, valid, and
binding obligation upon itself in accordance with its terms.
Reimbursable
Budgeted
Number
Budgeted Rate
(A)
Budgeted
Total (B)
Number
Completed for
Month (C)
Reimbursement
for Month
(A x C)
Number
Completed
to Date
Reimbursement to
Date (D)
Balance
(B — D)
Children Tested for Lead Poisoning (under 6 years) -- pay from
1351
2,850
$1
$2,850
$
$
$
Child CONTC or ACTIO event
403
$10
$4,030
$
$
$
Non - Medicaid Home Nursing Visits
3
$80
$240
$
$
$
Referrals for Nutrition Counseling
3
$10
$30
$
$
$
Referrals for Developmental Testing
2
$10
$20
$
$
$
Non - Medicaid Initial Inspection Events
3
$600
$1,800
$
$
$
EBL Investigation CONTC Events
10
$10
$100
$
$
$
Completed Lead Hazard Remediations -- pay from 1351
1
$10
$10
$
$
$
EBL Investigation INSAB, INSAI, INSAE Events
3
$80
$240
$
$
$
EBL Investigation Properties Passing Clearance Testing -- pay
from 1351
1
$300
$300
$
$
$
Coalition Meeting Hours
6.000
$50
$300.00
$
$
$
Education and Outreach Hours (pay from 1351)
21.5
$50
$1,075.00
$
$
$
Running Lab Batch
24
$10
$240
$
$
$
STELLAR Quarterly Report Submitted on Time
4
$75
$300
$
$
$
Narrative Quarterly Report Submitted on Time
4
$75
$300
$
$
$
XRF Source Replacement
0
$2,000
$0
$
$
$
Blood Lead Sample Collection (pay from 1351)
0
$3
$0
$
$
$
Blood Lead Analysis
0
$11
$0
$
$
$
Initial EBL Inspector Certification
0
$3,000
$0
$
$
$
EBL Inspector Refresher
0
$1,500
$0
$
$
$
TOTAL
NA
NA
$11,835
NA
NA
CONTRACTOR Dubuque County Board of Health
IDPH NOTE: Pay from 1351
DOCUMENTATION OF PROGRAM INCOME
EXHIBIT 1 -- EXPENDITURE REPORT FOR THE MONTH OF
CONTRACT #5881L17 CONTRACT PERIOD: July 1 2010 to June 30 2011 Vendor Code 00002128749
I certify that no funds have been spent on chelation or other medical trea ment of lead poisoning, lead hazard remediation, or blood lead analysis.
SIGNATURE: DATE
Amount for Month
Amount to Date
Program Income Earned
$
$
Program Income Received
$
$
Program Income Expended
$
$
CONTRACTOR Dubuque County Board of Health
IDPH NOTE: Pay from 1351
DOCUMENTATION OF PROGRAM INCOME
EXHIBIT 1 -- EXPENDITURE REPORT FOR THE MONTH OF
CONTRACT #5881L17 CONTRACT PERIOD: July 1 2010 to June 30 2011 Vendor Code 00002128749
I certify that no funds have been spent on chelation or other medical trea ment of lead poisoning, lead hazard remediation, or blood lead analysis.
SIGNATURE: DATE