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AMENDMENT #4 Task *May Support PHAB Due Date/Time Payment Task/Activity/Description Deliverables/Outcomes Information and/or Number Standards/Measures Frame Amount Developmental Screening Questionnaire online a) Completion date and results of within 60 days visits per child not to ht!Q://www.Qarenthe1Q123 .org/. The LHJ must the online WithinReach after completion. exceed total funding provide a hard copy of the developmental Developmental Screening consideration. screening in case it cannot be submitted online. In Questionnaire unusual, and DOH approved cases, in which the b) If blood lead testing of at-risk Note: this excludes WithinReach assessment cannot be performed, family members was indirect costs. the LHJ may refer the family to the child 's recommended, list the physician or to another entity that is trained to individuals administer developmental screening tests c) The referral date and provider of b) Encourage blood lead testing of other children the nutritional assessment, less than 72 months of age and pregnant or include all other referrals nursing caregivers in the home d) The members of the case c) If appropriate, refer the child's caregivers to the management team, their Women, Infants, and Children (WIC) program or involvement, and the case a Registered Dietitian Nutritionist (RON) for a information provided to them nutritional assessment and to other service providers as appropriate d) Coordinate services and communicate regularly with members of the case management team 3 DOH will reimburse LHJ staff for DOH-approved case Attend approved training and submit As needed Reimbursement for management related training opportunities and travel training invoices and receipts to DOH-approved including training fees if applicable and mileage, DOH trainingfees, mileage lodging and meals at the current federal GSA rates at and per diem not to the time of travel. exceed total funding consideration. (See Special Billing Requirements below.) *For Information Only: Funding is not tied to the revised Standards/Measures listed here. This information may be helpful in discussions of how program activities might contribute to meeting a Standard/Measure. More detail on these and/or other Public Health Accreditation Board (PHAB) Standards/Measures that may apply can be found at: http ://www .phaboard .org/wp -conten t/up loads/PHA.13 -Standards-and -Measures-Version • l . 0. odf Program Specific Reg uirements/N arrative Program Manual, Handbook, Policy References Guide for Public Health Case Management of Children with Elevated Blood Lead Levels https://www. doh. wa. gov/Portals/ 1 /Documents/4000/334-414.pdf A Targeted Approach to Blood Lead Screening in Children, Washington State Exhibit A , Statements of Work Revised as of July 16 , 2018 Page 5 of32 Contract Number CLH18249-4