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Fees Eligible for Sliding Fee Scale <br />Fees NOT Eligible for Sliding Fee Scale <br />Vaccine Administration Fee (except for <br />travel vaccines) <br />Vaccine Administration Fee for travel <br />vaccines <br />Blood draw <br />Travel Consultations <br />Tuberculosis services <br />Environmental Health <br />HIV/Hepatitis C services <br />Hourly rates <br />75% <br />Vital Records <br />100% <br />Lab and Ship in (external labs) <br />Ed ucati on/c I asses <br />Adult Influenza (when purchased, not <br />free) <br />Adult vaccines <br />The scale shall be divided into four increments and correlate to a percentage of the <br />federal p . verty level as seen in the table below. <br />Sliding Fee Scale Formula <br />Federal Poverty Level <br />Sliding Fee <br />0-133% <br />0% <br />133-155%% <br />25% <br />155-177% <br />50% <br />177-200% <br />75% <br />200% <br />100% <br />G. Inability to Pay: Individuals having indicated an inability to pay shall not be refused <br />services that are considered important to prevent the spread of communicable diseases <br />amongst the general public, such as tuberculin skin testing, HIV and hepatitis C testing, <br />and syphilis testing for high-risk clients; and the vaccine administration fee. <br />H. Fee Collection: Fees for most services at KCPHD shall be collected at the time of service <br />provision, application for services, or permit/license issuance, unless other billing <br />arrangements have been made prior. <br />I . Payment shall be in the form of cash, credit card, money order, cashier check, or <br />personal check for almost all services. For Vital Records and Food Worker Cards, <br />personal checks are not accepted, with the exception of business checks from <br />organizations that have established a working relationship with and received pre- <br />authorization from KCPHD. Money orders, cashiers checks, and personal checks <br />shall be made out to Kittitas County Public Health Department or KCPHD. Two- <br />party checks shall not be accepted for payment. <br />2. Checks returned for insufficient funds shall be assessed the Kittitas County <br />insufficient fund fee and follow up actions shall follow Kittitas County Cash <br />Handling Policy and Procedures. <br />3. Clinic services will be billed to contracted private or public insurance when possible <br />and as indicated in the table in Attachment B. If services are billed, but not covered <br />by health insurance the patient will be billed for the cost of the service. <br />4. In the case of a lab test that needs to be sent to the Public Health Seattle and King <br />County (PHSKC) laboratory, customers will be asked to write a personal check made <br />out to PHSKC to be sent with the lab request. The payment will be logged in a <br />database at the front desk and a tracking number will be requested when it is sent. <br />2 <br />