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<br />Professional Services Agreement <br />Page 13 of 21 <br />EXHIBIT "A" <br /> <br /> SCOPE OF WORK <br /> <br />In addition to providing all material and labor, the Contractor shall perform the following <br />services as detailed below: <br /> <br />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 /> <br />This work shall include quarterly reporting (Exhibit E) due January 10, 2022, annual <br />reporting (Exhibit F) due October 10, 2022, and the following: <br /> <br />Task/Activity/Description Deliverables/Outcomes Due Date/Time <br />Frame <br />Complete Child Health Intake Form <br />(CHIF) using the CHIF Automated <br />System on all infants and children <br />served by the CYSHCN Program as <br />referenced in CYSHCN Program <br />Manual. Ensure client data is <br />collected on all children served by <br />CYSHCN contractors, including <br />neurodevelopmental centers, <br />regional maxillofacial coordinators, <br />and the DOH Newborn Screening <br />Program. <br />Submit CHIF data into Secure <br />File Transport (SFT)website: <br />https://sft.wa.gov <br />1/15/22 <br />4/15/22 <br />7/15/22 <br />10/15/22 <br /> <br />Administer requested DOH <br />Diagnostic and Treatment funds for <br />infants and children per CYSHCN <br />Program Manual when funds are <br />used. <br />Submit completed Health <br />Services Authorization forms <br />and Central Treatment Fund <br />requests directly to the <br />CYSHCN Program as needed. <br />30 days after <br />forms are <br />completed. <br />