HomeMy WebLinkAboutInter-Dept DPH DSS-Provide Immunization Status Information Services to DSS_D-19-786.pdf1 INTERDEPARTMENTAL AGREEMENT
2 THIS INTERDEPARTMENTAL AGREEMENT is made and entered into this 1stday of July,
3 2019,by andbetweenthe DEPARTMENT OF SOCIAL SERVICES,hereinafterreferredto as "DSS"
4 and the DEPARTMENT OF PUBLIC HEALTH,hereinafter referred to as "DPH,"both separate
5 departments of the COUNTY OF FRESNO.
6 WIT N E SSE T H:
7 WHEREAS,pursuant to the California Work Opportunity and Responsibility to Kids Act
8 (Welfare and Ir-stitutionsCode sections 11200 et seq.hereinafter called "CaIWORKs") and 42 United
9 States Code sections 601 et seq.(Temporary Assistance for Needy Families (TANF) Block Grant),
1_0 COUNTYis mandated and funded to serve CalWORKsparticipants;and
:~1 WHEREAS,pursuant to Welfare and Institutions Code section 11265.8,COUNTY is mandated
:_2 to verify the immunization status of children under six years of age for CalWORKs participants;and
3_3 WHEREAS,DSS has need of providing education and outreach regarding the importance of
.L4 childhood immunizations,the CalWORKs and Medi-Cal programs,and the benefits of the online
'~5 California Immunization Registry (CAIR) to both CalWORKs and Medi-Cal applicants and recipients;
',_6 and
'_7 WHEREAS,DPH has access to and participates in the online CAIR and is qualified,willing and
~8 ableto provide immunization status,information,and servicesto DSS: and
"_9 WHEREAS,DPH is qualified, willing and able to provide training,education,and support to
20 DSS staffregarding accessing and utilizing CAIR; and
:21 WHEREAS,DPH is qualified,willing and able to provide education and outreach regarding the
:.~2 Medi-Cal Program,the importance of childhood immunizations,and the benefits of the online CAIR;
:>.3 NOW,THEREFORE,in consideration of their mutual covenants and conditions,the parties
24 hereto agree as follows:
.25 1.SERVICES AND SUPPLIES
A.DPH and DSS shallperform all services and fulfill all responsibilities as
:,;7 identified in Ex hibitA, incorporated herein by reference and made part of this Agreement.
B.DSS agrees to dedicate funds to DPH for the services and supplies identified in
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M-19-0007
1 Exhibit B,incorporated herein by reference and made part of this Agreement.
2 C.DPH shall provide all services in accordance with the State of Cali fomi a's Social
3 Services Manual of Policies and Procedures,Eligibility and Assistance Standards,incorporated herein
4 by reference .
.5 2.TERM
6 A.This Agreement shall become effective on the l "day of July 2019 and shall
7 terminate on the 30th day of June 2020.
8 B.This Agreement shall automatically be extended for two (2)additional twelve
9 (12)month periods upon the same terms and conditions set forth,unless written notice of non-renewal
lOis given by either party no later than thirty (30)days prior to the renewal period.
11 3.TERMINATION
12 A.Non-Allocation of Funds -The terms of this Agreement,and the services to be
13 provided thereunder,are contingent on the approval of funds by the appropriating government agency.
~_4 Should sufficient funds not be allocated,the services provided may be modified or this Agreement
15 terminated at any time by DSS providing DPH thirty (30)days advance written notice.
16 B.Breach of Contract -DSS may immediately suspend or terminate this
17 Agreement in whole or in part,wherein the determination of DSS there is:
18 1)An illegal or improper use of funds:
19 2)
3)
A failure to comply with any term of this Agreement;
A substantially incorrect or incomplete report submitted to DSS;or20
21 4)Improperly performed services.
22 In no event shall any payment by DSS constitute a waiver by DSS of any breach of this
:n Agreement or any default that may then exist on the part ofDPH.Neither shall such payment impair
24 or prejudice any remedy available to DSS with respect to the breach or default.DSS shall have the
25 right to demand of DPH the repayment to DSS of any funds disbursed to DPH under this Agreement,
::6 which in the judgment of DSS were not expended in accordance with the terms of this Agreement.
27 DPH shall promptly refund any such funds upon demand or,at DSS's option,such repayment shall be
::~8 deducted from future payments owing to DPH under this Agreement.
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1 Without Cause -Under circumstances other than those set forth above,thisC.
2 Agreement may be terminated by either party upon the giving of thirty (30)days advance written
3 notice of an intention to terminate.However,termination of this Agreement shall not affect any active
4 cases or services pursuant to this Agreement,which shall be handled to their conclusion by DPH.
5 4.COMPENSATION
6 DSS agrees to pay DPH and DPH agrees to receive compensation as follows:
7 Payment shall be made upon certification or other proof satisfactory to DSS that services have been
8 performed by DPH as specified in this Agreement.Allowable expenditures under this Agreement are
9 specifically established and identified in Exhibit B.In no event shall payment for services performed
10 under this Agreement be in excess of Two Hundred Seventy Five Thousand Nine Hundred Thirty Four
11 and Noll 00 Dollars ($275,934.00)for each twelve (12)month period of this Agreement.It is
12 understood that all expenses incidental to DPH's performance of services under this Agreement shall
13 be borne by DPH.The total cost of services under this Agreement shall not exceed Eight Hundred
14 Twenty Seven Thousand Eight Hundred Two and No/lOO Dollars ($827,802.00).
15 Payments by DSS shall be in arrears for services provided during the preceding month,
J.6 within forty-five (45)days after receipt and verification ofDPH's monthly invoices by DSS.If DPH
:.7 should fail to comply with any provision of this Agreement,DSS shall be relieved of its obligation for
18 further compensation to DPH.All final claims shall be submitted by DPH within sixty (60)days
19 following the final month of service for which payment is claimed.No action shall be taken by DSS
2:0 on claims submitted beyond the sixty (60)day closeout period.Any compensation that is not
21 expended by DPH pursuant to the terms and conditions of this Agreement shall automatically revert to
~22 DSS.
23 In the event that the State of California is unable to meet its financial obligations and
24 payment to Counties for social services is delayed,DSS may delay or defer payment to DPH until
25 such time as the State budget issues are resolved.DPH must accept delayed or deferred payment for
26 services in such instances.
27 5.INVOICE AND SUPPORTING DOCUMENTATION
28 A.DPH shall request reimbursement from DSS based on actual expenditures,and
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1 submit an invoice monthly via email to:DSSInvoices@fresnocountyca.gov by the 20th of each month
2 for the prior month's expenditures.Prior to submission to DSS,the invoice shall be reviewed,
3 approved and signed by a representative ofDPH who is authorized to certify services were performed
4 and reimbursement requests represent actual costs.Requests for payment shall include a monthly
5 activity report (Exhibit C),supporting program and financial documentation including but not limited
6 to a year-to-date statement and back-up documentation,a summary of charges for each DSS program
7 from which DPH is seeking reimbursement,relevant labor documentation,and any additional
8 supporting documentation justifying expenditures for the period(s)during which costs were incurred.
9 B.Reimbursement for services rendered under this Agreement shall not be made
10 until said invoices and supporting documentation,as identified hereinabove,are received and reviewed
11 by DSS.If said invoices are incorrect or otherwise not in proper form or substance,DSS shall have the
12 right to withhold payment as to only that portion of the invoice that is incorrect or improper.DSS
13 agrees to reimburse DPH monthly in arrears,within forty-five (45)days after receipt and verification of
14 DPH's invoice.
15 Once the invoice has been approved for payment by DSS,the Fiscal Divisionc.
16 staff shall prepare an Inter-Department Journal Voucher to reimburse DPH for their expenditures.The
].7 Inter-Departmental Journal Vouchers shall be subject to County,State and Federal audits.
18 All costs shall be supported by properly executed payrolls,time records,D.
19 invoices,vouchers,orders or other accounting documents pertaining in whole or in part to this
20 Agreement,and they shall be clearly identified and readily accessible.The support documentation must
21 indicate the line item budget account to which the cost is charged,if applicable.
22 Invoices and all supporting documentation shall be sent to DSS,Attention:DSSE.
23 Staff Analyst (Stop No.109 in the County of Fresno Messenger System),or forwarded via email to
24 DS SInvoices@fresnocountyca.gov.
25 6.MODIFICATION
26 Any matters of this Agreement may be modified from time to time by the writtenA.
27 consent of all the parties without,in any way,affecting the remainder.
28 DPH hereby agrees to any amendments in funding resulting from a reduction inB.
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1 funds from State and Federal sources.In addition,this Agreement is subject to any restrictions,
2 limitations,or enactments of all legislative bodies which affect the provisions,term or funding of this
3 Agreement in any manner.
4 7.AUDITS AND INSPECTION
5 DPH shall at any time during business hours,and as often as DSS may deem necessary,
6 make available to DSS for examination all of its records and data with respect to the matters covered
.7 by this Agreement.DPH shall,upon request by DSS,permit DSS to audit and inspect all such records
8 and data necessary to ensure DPH's compliance with the terms of this Agreement.
'9 8.NON-ASSIGNMENT
10 N either party shall assign,transfer or subcontract this Agreement nor their rights or
11 duties under this Agreement without the prior written consent of the other party.
12 9.RECORDS
13 DPH shall assume responsibility for maintaining detailed records to support its invoices
14 to DSS for services provided under this Agreement.DPH shall provide DSS with access to said
15 records for audit purposes.Furthermore,DPH shall retain said records for a minimum of five (5)years
1.6 following the expiration of this Agreement.In the event of any outstanding State of California or
t_7 Federal audits or exceptions,DPH agrees to retain its records until such audits and exceptions are
18 finalized.
19 10.RELATIONSHIP OF PARTIES
:2 0 It is understood that this is an Interdepartmental Agreement by and between two (2)
21 separate departments within the County of Fresno and is not intended to and shall not be construed to
22 create a relationship of agent,servant,employee,partnership,joint venture,or association.
23
24
11.NONDISCRIMINATION
A.DPH hereby agrees that in the performance of the Agreement,it will comply
25 with Title VI and VII of the Civil Rights Act of 1964 as amended;Section 504 of the Rehabilitation
26 Act of 1973 as amended;the Age Discrimination Act of 1975 as amended;the Food Stamp Act of
27 1977,as amended and in particular section 272.6;Title II of the Americans with Disabilities Act of
28 1990;California Civil Code Section 51 et seq.,as amended;California Government Code section
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15
DPH agrees to compile data,maintain records and submit reports as required,to
1 11135-11139.5,as amended;California Government Code section 12940 (c),(h),(1),(i),and (j);
2 California Government Code section 4450;Title 22,California Code of Regulations section 98000-
3 98413;Title 24 of the California Code of Regulations,Section 3105A(e);the Dymally-Alatorre
4 Bilingual Services Act (California Government Code Section 7290-7299.8);Section 1808 of the
5 Removal of Barriers to Interethnic Adoption Act of 1996;and other applicable federal and state laws,
'6 as well as their implementing regulations [including 45 Code of Federal Regulations (CFR)Parts 80,
7 84,and 91,7 CFR Part 15,and 28 CFR Part 42],by ensuring that employment practices and the
8 administration of public assistance and social services programs are nondiscriminatory,to the effect
9 that no person shall because of ethnic group identification,age,sex,color,disability,medical
10 condition,national origin,race,ancestry,marital status,religion,religious creed,sexual union or
11 political belief be excluded from participation in or be denied the benefits of,or be otherwise subject
12 to discrimination under any program or activity receiving federal or state financial assistance.DPH
13 agrees that it will immediately take any measures necessary to effectuate the terms of this Non-
14 Discrimination Agreement.
B.DPH gives the above agreement in consideration of and for the purpose of
]6 obtaining any and all federal and state assistance.DPH hereby agrees that administrative
1 7 methods/procedures which have the effect of subjecting individuals to discrimination or defeating the
18 objectives of the California Department of Social Services (CDSS)Manual of Policies and Procedures
19 (MPP)Chapter 21 will be prohibited.
C.20
21 permit effective enforcement of the aforementioned laws,rules and regulations,and permit authorized
22 DSS,CDSS and/or federal government personnel,during normal working hours,to review such
23 records,books and accounts as needed to ascertain compliance.If there are any violations of the Non-
24 Discrimination section,CDSS shall have the right to invoke fiscal sanctions or other legal remedies in
25 accordance with Welfare and Institutions Code section 10605,or Government Code section 11135-
26 11139.5,or any other laws,or the issue may be referred to the appropriate federal agency for further
27 compliance action and enforcement of this section.Furthermore,if an allegation of discrimination
28 occurs,DSS may withhold all further funds until DPH can show clear and convincing evidence to the
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1 satisfaction ofDSS that funds provided under this Agreement were not used in connection with the
2 alleged discrimination.
3 D.The requirements stated above are binding on DPH directly or through contract,
4 license,or other provider services,as long as it receives federal or state assistance.
5 12.CONFIDENTIALITY AND MEDI-CAL PRIVACY
6 All services performed by DPH under this Agreement shall be in strict conformance with
7 all applicable federal,state,and/or local laws and regulations relating to confidentiality including,but
8 not limited to:California Welfare and Institutions Code Sections 10850 and 14100.2;the CDSS Manual
9 of Policies and Procedures,Division 19-0000;and the California Department of Health Care Services
10 (DHCS)Medi-Cal Eligibility Procedures Manual,Section 2H.In addition,all services performed by
11 DPH under this Agreement shall also be in conformance with the Medi-Cal Data Privacy and Security
12 Agreement between the California DHCS and the County of Fresno (hereinafter referred to as the
13 "Medi-Cal Data Agreement")that is then in effect,which is by this reference incorporated herein.The
14 current Medi-Cal Data Agreement is available upon request or can be viewed at:
15 http://www.fresnocountyca.gov/MediCalPrivacy/.The purpose of this section is to assure that all
16 applications and records concerning program recipients shall be kept confidential and shall not be
1 7 opened to examination,publicized,disclosed,or used for any purpose not directly connected with the
18 administration of the program.DPH shall inform all of its employees,agents,officers,and
19 subcontractors of this provision;and that any person knowingly and intentionally violating this
20 provision is guilty of a misdemeanor.
21 13.DATA SECURITY
22 For the purpose of preventing the potential loss,misappropriation or inadvertent
23 disclosure of DSS's data including sensitive or personal client information;abuse of County resources;
24 and/or disruption to County operations,DPH must employ adequate data security measures to protect
25 the confidential information provided to DPH by DSS,for the purpose of providing services under this
26 Agreement as required by the County Administrative Office Management Directives,Chapter 1300,
27 Information Services.
28 Confidential client information transmitted to one party by the other by means of
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10
7
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1 electronic transmissions must be encrypted according to Advanced Encryption Standards (AES)of 128
2 BIT or higher.Additionally,a password or pass phrase must be utilized.
3 DPH is responsible to immediately notify DSS of any breaches or potential breaches of
4 security related to DSS's confidential information,data maintained in computer files,program
5 documentation,data processing systems,data files and data processing equipment which stores or
6 processes DSS data,internally or externally.
14.GOVERNING LAW
8 The rights and obligations of the parties and all interpretation and performance of this
9 Agreement shall be governed in all respects by all federal,state and local statutes and regulations.
15.ENTIRE AGREEMENT
11 This Agreement,including all Exhibits,constitutes the entire Interdepartmental
12 Agreement between DSS and DPH with respect to the subject matter hereof and supersedes all
13 previous agreements,negotiations,proposals,commitments,writings,advertisements,publications,
14 and understandings of any nature whatsoever unless expressly included in this Inter-Departmental
15 Agreement.
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1 IN WITNESS WHEREOF,the parties hereto have caused this Interdepartmental Agreement to be
2 executed by their signatures below.
4
5 DEPARTMENT OF SOCIAL SERVICES DEPARTMENT OF PUBLIC HEALTH
6
By:M{2g:
David Pomaville,Director pu...
7
8
9
Department of Social Services
Fund/Subclass:
Organization:
Account/Program:
0001/10000
56107001
7295/0
Department of Public Health
Fund/Subclass:
Organization:
Revenue Account:
0001110000
56201654
599010
Exhibit A
Page 1of4
SUMMARY OF SERVICES
ORGANIZATION:Department of Public Health
ADDRESS:1221 Fulton Street,Fresno,CA 93775
SERVICES:Online Immunization Registry Services
PROJECT DIRECTOR:Ge Vue,Supervising Public Health Nurse,(559)600-3475
CONTRACT PERIODS:July 1,2019 -June 30,2020
July 1,2020 -June 30,2021
July 1,2021 -June 30,2022
CONTRACT AMOUNT:$275,934 per each Contract Period
PROJECT DESCRIPTION:
The Department of Public Health (DPH)provides immunization information,status
updates,and services to the Department of Social Services (DSS)and ~s clients.Per
Welfare and Institutions Code 11265.8,CalWORKs recipients must provide proof of
immunization for children less than six (6)years of age in order to receive benefits.
Verification and tracking of immunizations are accomplished through the utilization of the
California Immunization Registry (CAIR),also known as the "Immunization Registry."DSS
Eligibility Workers have the ability to view the registry but are not authorized to make new
entries or updates into the registry.DPH staff fulfill this role.In addtlon to facilitating
immunization record entry into CAIR,DPH staff participate in outreach activities educating
parents about required immunizations,promoting use of the registry,and the availability of
health programs such as Medi-Cal and the Affordable Care Act.CAIR benefits CalWORKs
and Medi-Cal clients by ensuring that a child's immunization record is legible and easily
located at the time of application and subsequent renewals.
DPH STAFFING:
•1.0 FTE Office Assistants (OAs)to input and update immunization records in CAIR
and assist with outreach and education.
•1.0 FTE Health Education Specialist (HES)to conduct outreach and education
activlies targeted to CalWORKs and Medi-Cal applicants and recipients informing
them of the importance of immunizations and the immunization registry and provide
ongoing training,education,and support to Eligibility Workers regarding the
utilization of CAIR as needed.
ExhibitA
Page 2 of4
•0.3 FTE Supervising Public Health Nurse (PHN)to provide oversight of the OAs and
HES,attend meetings with DSS staff,and ensure the accuracy of the Monthly
Activity Reports and invoicing.
OUTCOMES:
•Conduct a minimum of four CAIR trainings during each 12-month contract period for
all appropriate DSS staff.
•Enter 100%of new or updated immunization information received from DSS or DPH
outreach,into CAIR,within 45 days of receipt.
DPH SHALL BE RESPONSIBLE FOR THE FOLLOWING:
1.Provide read-only CAIR access to DSS Eligibility Workers.
2.Provide,in conjunction with DSS Staff Development,new and ongoing CAIR education
and training for DSS Eligibility Workers,including the following activities:
•Conduct training needs assessment upon request;including pre-and post-tests.
•Provide test results to DSS Supervisor and to staff monitoring the Immunization
Registry Interdepartmental Agreement.
•Present CAIR PowerPoint and training materials to staff or management upon
request.
•Contact CalWORKs Eligibility Supervisors to address their Immunization Registry
training needs for their respective units.
•Provide ongoing assistance to DSS Staff Development for CAIRI training,as
needed.
3.Provide DSS Staff Analyst with a monthly CAIR Activity Report.
4.Input and update CalWORKs and non-CaiWORKs children's immunization records
into CAIR,as received from DSS staff.
5.Submit to the DSS Staff Analyst,along with the monthly invoice and activity report,a
narrative of the activities of the Health Education Specialist funded through the
Immunization Registry Interdepartmental Agreement.
6.Provide Information Technology support for CAIR,as needed,such as processing
requests to add new users and password renewals,at no additional cost.
7.Participate in a minimum of 8 CalWORKs and Medi-Cal outreach activities per 12-
month contract period,both independently and with DSS staff.As part of outreach,
discuss program availability.If requested,refer children for CHDP or CHDP Gateway
temporary Medi-Cal and obtain parent permission to enter children into the
immunization registry.
Exhibit A
Page 30f4
8.Meet with DSS staff as often as needed to exchange pertinent information,resolve
problems,and work together to effectively coordinate services.At minimum,meetings
shall be held twice per fiscal year.
9.Use local radio or television media outlets to promote use of the registry and to
promote immunizations in general.When possible,donated air time should be used.
Purchase of air time is budgeted under Professionaland Specialized Services.
10.Submit to the DSS CAIR Liaison a monthly CAIR Article for publishing in the DSS PS
Newsletter.
DSS SHALL BE RESPONSIBLE FOR THE FOLLOWING:
1.Allow the DPH Health Education Specialist to share and promote CAIR to DSS staff
and CaIWORKs/Medi-Cal clients throughout the term of the Interdepartmental
Agreement.This may include annual HES visits to DSS lobbies,recognizing DSS
staff who facilitate entry of immunization records into CAIR,and posting monthly
immunization news and reminders in the DSS PS Newsletter.
2.Identify both a DSS CAIR Liaison and a DSS Staff Analyst who can respond to
questions from DPH.The DSS CAIR Liaison shall:
a.Respond to DSS staff requests for password resets,account reactivation
and other appropriate system needs.
b.Send emails to DSS CalWORKs Program Managers and DSS CalWORKs
Lobby Supervisors in advance of scheduled lobby visits to promote CAIR;
providing information regarding the purpose and the potential date/time of
the visits as well as coordinating the scheduling of the visits.
3.Provide DPH with a completed Form 2310 -CAIR Immunization Registry Notice to
Patients and Parents (Exhibit D),attached hereto and by this reference incorporated
herein);including written consent from the parent or legal guardian,copies of the
child(ren)'s immunization records,and required demographic information of any
child for whom DSS requests immunization records to be entered into CAIR.
4.Provide DPH with name(s)of staff and logon 10 information to request User Access
Login to CAIR via email.Requests to change user status or account updates will also
be completed via email.The DSS Staff Developmenttrainer will follow the procedure
above to obtain CAIR access for trainees.DPH will submit the online CAIR registration
to obtain User 10 and passwords to the CAIR Regional Help Desk for processing.
5.Facilitate DSS staff assessments,trainings,and evaluations in conjunction with DPH
staff.
6.Meet with DPH staff as often as needed to exchange pertinent information,resolve
problems,and work together to effectively coordinate services.At minimum,meetings
shall be held twice per fiscal year.
Exhibit A
Page4of4
7.Publish a monthly CAl R Article on behalf of DPH in the DSS PS Newsletter.
8.Provide DPH with a current contact list of all DSS CalWORKs Eligibility Supervisors at
least twice during each 12-month contract period.This list will be utilized by DPH to
contact program supervisors to address the training needs for their respective units.
Exhibit B
Budget Summary FY 2019-20
Department of Public Health California Immunization Registry (CAIR)Services
July 1,2019 -June 30,2020
$275,934
Salaries and Benefits
Percent 6100 6250 Total 6350 6400 6500 6600 6650 Benefits Total Total
Position Time Salary Bi-ling Pay Salary Unemp.Retirement OASDI Health Ins.Life Ins.Admin.Benefits S&B
OA III (Xiong)100%$39,385 $1,300 $40,685 $72 $26,364 $3,112 $8,643 $0 $109 $38,300 $78,985
H.E.S.(Tello)100%$55,985 $1,300 $57,285 $101 $37,121 $4,382 $11,641 $0 $109 $53,354 $110,639
S.P.H.N.(Vue)30%$114,631 $0 $34,389 $61 $22,284 $2,631 $2,593 $0 $33 $27,602 $61,991
TOTAL $210,001 $2,600 $132,359 $234 $85,769 $10,125 $22,877 $0 $251 $119,256 $251,616
Services and Supplies
Professional &Specialized Services-7295
Travel -7412
Office Supplies -7265
Total S&S
$20,218
$3,100
$1,000
TOTAL T $24,318
ITOTAL S&B and S&S $275,9341
TOTAL FY 2019-20 Allocation:$275,934
Total Cal WORKs Allocation (35%,based on MAR actions taken):
Total Medi-Cal Allocation (65%,based on MAR actions taken):
$96,577
$179,357
Interdepartmental Agreement
Monthly Activity Report
ORGANIZATION:
SERVICES:
CONTRACT PERIOD:
REPORT MONTH:
Fresno County Department of Public Health
Immunization Registry &Outreach
July 1,2019 --June 30,2022
July-19
MONTH
1.Number of New CalWORKs Referrals
2.Number of New FCDPH Referrals (Resulting from outreach/other activities)
3.Existing CalWORKs Registry Clients
a.No Action Taken (No Updates Required)
b.Action Taken (Updates Required)
4.Existing FCDPH Registry Clients
a.No Action Taken (No Updates Required)
b.Action Taken (Updates Required)
5.Number of Registry Inputs (New CW &FCDPH Referrals +Action Taken)
6.Number of Times DSS staff accessed the Registry (Duplicated)
7.Number of Times DSS staff accessed the Registry (Unduplicated/Unique)
8.Number of CAIR Trainings
9.Number of Outreach Activities
ADDITIONAL COMMENTS:
o
o
o
I certify that this report is correct and complete to the best of my knowledge.
SIGNATURE DATE
DATEApprovedby:
Legend:
New Referrals:Enter the number of children referred to the Department of Public Health Immunization Registry Program
from either CalWORKs or FCDPH that are new to the registry.
Existing Registry Clients:Enter the number of children from CalWORKs or FCDPH that are already known (have their
vaccination information record)to the Registry (CAIR)program.
No Action Taken:Number of children referred to the Registry with "Existing"CAIR records whose records did not require
an update (vaccination information on yellow card matches CAIR record).
Action Taken:Number of children referred to the Registry with "Existing"CAIR records whose records required an
update (vaccination information on yellow card did not match CAIR record).
Number of Registry Inputs:Total number of CAIR data entries resulting from New Referrals and Action Taken (updates
required);Calculation:1+2+3b+4b.
Duplicated =The total number of times the registry was accessed by DSS staff during the month.
Unduplicated =A unique count of the total DSS individuals that accessed the registry during the month.
YTD
o
o
o
o
o
o
o
o
o
o
o
o
o