N. C. Department of Health and Human Service

Attachment Contract # Contractor Legal Name Page 1 of 1 N. C. Department of Health and Human Service Division of Public Health

SCOPE OF WORK

A. Program Background

The demand measures for this contract are:

The North Carolina Counties served by this Contract are:

The long-term program outcome supported by this Contract is:

B. Contract Purpose

C. Scope of the Contract The Contractor shall:

As a result of this contract, the following outputs shall be attained:

D. Performance Requirements/Standards The Contractor shall:

The short-term and/or interim outcomes of this contract are:

E. Performance Monitoring/Quality Assurance Plan The Contractor shall adhere to the following service quality measures for this contract:

This contract will be monitored according to the following plan:

F. Reimbursement

DHHS 3300 DPH rev7/7/09