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INDIAN RIVER COUNTY HEALTH DEPARTMENT FEE SCHEDULE --Effective Nov.01, 2006 Florida Administrative Code,Chapter 10D-121 For the purpose of family planning, sexually transmitted disease, or HIV/AIDS services only, minors seeking those services shall be considered a separate family for income eligibility determination purposes and shall be assessed fees for those services based upon their own personal gross income. Any client who elects to waive the eligibility determination process shall be assigned to the full fee category. If there is no fee for a service, income eligibility does not need to be determined, except for WIC. The self-declaration statement shall include a signed acknowledgment that the statement is true at the time it is made, and that the person making the statement understands that the provider shall attempt to verify the statement. Verification can be secured by telephone, in written form, or by face-to-face contact, verification does not require a written document to confirm an applicant's or client's statement. If the provider is unable to verify wages paid or an employer will not verify wages paid,the self-declaratory statement provided by the applicant must be accepted as accurate. Clients served by CHD's and their subcontractors shall not be denied services for tuberculosis,sexually transmitted disease,or HIV/AIDS communicable disease control because of failure or inability to pay a prescribed fee, regardless of their income. Clients interviewed, examined,or tested at IRCHD's initiative because they are a contact to a case of communicable disease or because they are a member of a group at risk that is being investigated by the IRCHD shall not be charged a fee for the interview, examination, or testing;these clients may be charged on a sliding fee scale for any treatment indicated, but they cannot be denied services based on inability to pay. Clients served by IRCHD and their subcontractors shall not be denied family planning services for failure or inability to pay a prescribed fee, regardless of their income; however,the family planning services of inserting Norplant, and male and female sterilization, shall be limited depending on the availability of funds to pay for these services. Clients shall not be denied pregnancy testing for failure or inability to pay. Clients may request a review of their fee charge on the basis that they have severe, unusual, and unavoidable expenses or obligations that substantially reduce their ability to pay and which warrant special consideration. 10/23/2006CLFEE2006-07 Page 8 of 11