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AMENDMENT #4 <br />Pubs/334-383 .pdf <br />Special References (RCWs, WACs, etc) <br />Laboratories are required to report to the Department of Health all Blood Lead test results (WAC 246-101-201). Elevated results (~5 mcg/dL) must be reported within two (2) <br />days; non-elevated results :'.S5 mcg/dL need to be reported within one (1) month . <br />Monitoring Visits (frequency, type) <br />Telephone calls with contract manager at least once every quarter. <br />Definitions <br />BLL-Blood Lead Level <br />EBLL-Elevated Blood Lead Level <br />PEHSU-Pediatric Environmental Health Specialty Units <br />Special Billing Requirements <br />Reimbursement for pre-approved travel expenses including mileage. lodging and meals will be calculated at the current federal General Services Administration (GSA) rates at <br />the time of travel. Current per diem rates by state can be found at: https J/www. gsa , godJravel/vlan-booldper-diem-rate.slper-diem-rates-lookue <br />Special Instructions <br />Payment is contingent upon DOH receipt and approval of all deliverables and an acceptable written report to include a plan of care. Payment to completely expend the "Total <br />Consideration" for a specific funding period will not be processed until all deliverables are accepted and approved by DOH. Invoices ~ may be submitted fHRRihl)' b_r rite JOi/1 -ef <br />eac.~ .went.II fa!lewing tlie memh in whieh-lJ~11di~uN6' ll'e<re me,u-.':ef/ as needed within 60 days after home visit completion and must be based on actual allowahle direct <br />program costs . Billing for services on a monthly fraction of the 'Total Consideration" will not be accepted or approved . If needed, additional funding may be added upon request <br />and DOH approval while funds are available. Contact lead@,doh. iva.gov for additional information. <br />Note: blood lead case management reimbursement excludes indirect costs. <br />DOH Program Contact <br />Araceli Mendez, Health Services Consultant <br />Office of Environmental Public Health Sciences <br />Washington State Department of Health <br />Street Address : 310 Israel Rd SE, Tumwater, WA 98501 <br />Telephone: 360-236-3392 / Fax: 360-236-3059 <br />Email: araceli.mendez@doh.wa.gov <br />DOH Fiscal Contact <br />Victoria Reyes, Management Analyst 1 <br />Assistant Secretary's Office <br />Telephone: 360-236-3071 <br />Exhibit A, Statements of Work <br />Revised as of July 16, 2018 <br />Page 6 of32 Contract Number CLH18249-4