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EXHIBIT "A" <br />SCOPE OF WORK <br />In addition to providing all material and labor, the Contractor shall perform the following: <br />l) Employ a registered nurse, fully licensed within the State of Washington to perform the work <br />described below within the Children with Special Health Care Needs Program , hereinafter <br />"CYSHCN". <br />This work shall include menthly quarterly reporting (Exhibit E) and the following: <br />Task/ Activity/Description <br />Complete Child Health Intake Form (CHIF) using <br />the CHIF Automated System on all infants and <br />children served by the CYSHCN Program as <br />referenced in CYSHCN Program Manual. Ensure <br />client data is collected on all children served by <br />CYSHCN contractors, including <br />neurodevelopmental centers, regional maxillofacial <br />coordinators, and the DOH Newborn Screening <br />Program. <br />Administer requested DOH Diagnostic and <br />Treatment funds for infants and children per <br />CYSHCN Program Manual when funds are used. <br />Professional Services Agreement <br />Page 12 <br />Deliverables/Outcomes Due Date/Time Frame <br />Submit CHIF data into 1/15/19 <br />Secure File Transport 4/15/19 <br />(SFT)website: 7/15/19 h1t ns ;//ifl . ~, (:OV 10/15/19 <br />Submit completed 30 days after forms <br />Health Services completed . <br />Authorization forms <br />and Central <br />Treatment Fund <br />requests directly to <br />theCYSHCN <br />Proe:ram as needed. <br />are