HomeMy WebLinkAbout2004-277 CONTRACT BETWEEN
INDIAN RIVER COUNTY BOARD OF COUNTY COMMISSIONERS
AND
STATE OF FLORIDA DEPARTMENT OF HEALTH
FOR OPERATION OF
( INDIAN RIVER COUNTY HEALTH DEPARTMENT
CONTRACT YEAR 2004=2005
This agreement ( "Agreement" ) is made and entered into between the State of Florida ,
Department of Health ("State" ) and the Indian River County Board of County
Commissioners (" County" ) , through their undersigned authorities , effective October 1 ,
2004 ,
RECITALS
A . Pursuant to Chapter 154 , F . S . , the intent of the legislature is to " promote ,
protect , maintain , and improve the health and safety of all citizens and visitors of this state
through a system of coordinated county health department services . "
B . County Health Departments were created throughout Florida to satisfy this
legislative intent through " promotion of the public' s health , the control and eradication of
preventable diseases , and the provision of primary health care for special populations . "
C . India River County Health Department ( "CHD " ) is one of the County Health
Departments created throughout Florida . It is necessary for the parties hereto to enter into
this Agreement in order to assure coordination between the State and the County in the
operation of the CHD .
NOW THEREFORE , in consideration of the mutual promises set forth herein , the
sufficiency of which are hereby acknowledged , the parties hereto agree as follows :
1 . RECITALS . The parties mutually agree that the forgoing recitals are true and
correct and incorporated herein by reference .
2 . TERM . The parties mutually agree that this Agreement shall be effective from
October 1 , 2004 , through September 30 , 2005 , or until a written agreement replacing this
Agreement is entered into between the parties , whichever is later, unless this Agreement
is otherwise terminated pursuant to the termination provisions set forth in paragraph 8 ,
below .
3 . SERVICES MAINTAINED BY THE CHD . The parties mutually agree that the CHD
shall provide those services as set forth on Part III of Attachment II hereof, in order to
maintain the following three levels of service pursuant to Section 154 . 01 (2 ) , Florida
Statutes , as defined below :
a . " Environmental health services" are those services which are organized and
operated to protect the health of the general public by monitoring and regulating activities
in the environment which may contribute to the occurrence or transmission of disease .
I
Environmental health services shall be supported by available federal , state and local
funds and shall include those services mandated on a state or federal level . Examples of
environmental health services include , but are not limited to , food hygiene , safe drinking
water supply , sewage and solid waste disposal , swimming pools , group care facilities ,
migrant labor camps , toxic material control , radiological health , occupational health .
b . "Communicable disease control services " are those services which protect the
health of the general public through the detection , control , and eradication of diseases
which are transmitted primarily by human beings . Communicable disease services shall
be supported by available federal , state , and local funds and shall include those services
mandated on a state or federal level . Such services include , but are not limited to ,
epidemiology , sexually transmissible disease detection and control , HIV/AIDS ,
immunization , tuberculosis control and maintenance of vital statistics .
C . " Primary care services " are acute care and preventive services that are made
available to well and sick persons who are unable to obtain such services due to lack of
income or other barriers beyond their control . These services are provided to benefit
individuals , improve the collective health of the public , and prevent and control the spread
of disease . Primary health care services are provided at home , in group settings , or in
clinics . These services shall be supported by available federal , state , and local funds and
shall include services mandated on a state or federal level . Examples of primary health
care services include , but are not limited to : first contact acute care services ; chronic
disease detection and treatment ; maternal and child health services ; family planning ;
nutrition ; school health ; supplemental food assistance for women , infants , and children ;
home health ; and dental services .
4 . FUNDING . The parties further agree that funding for the CHD will be handled as
follows :
a . The funding to be provided by the parties and any other sources are set forth in Part
II of Attachment II hereof. This funding will be used as shown in Part I of Attachment II .
i. The State's appropriated responsibility (direct contribution excluding any state fees,
Medicaid contributions or any other funds not listed on the Schedule C) as provided in
Attachment ll , Part II is an amount not to exceed $ 3 , 130 , 757 (State General
Revenue, Other State Funds and Federal Funds listed on the Schedule C) . The State's
obligation to pay under this contract is contingent upon an annual appropriation
by the Legislature .
ii. The County' s appropriated responsibility (direct contribution excluding any fees,
other cash or local contributions) as provided in Attachment I I , Part I I is an amount not
to exceed $ 810 , 115 (amount listed under the `Board of County Commissioners Annual
Appropriations section of the revenue attachment) .
b . Overall expenditures will not exceed available funding or budget authority ,
whichever is less , (either current year or from surplus trust funds ) in any service category .
Unless requested otherwise , any surplus at the end of the term of this Agreement in the
2
• ajejS aqj Aq pallloeds se lueuodwoo
wei6oad Aq jewjoj alq !jedwoo luauodwo0 }uawe6eueW 4lle9H/w9lsAS uolIewaoIul
lua! lo eqj u !owll � odai ll !m sea�(oldw3 • saanpaooad pue selru lauuosaad 9lels of joefgns
lauuosaad joealuoo-alelS ao 93ejS eq lle4s seeAoldwe OHO Ild emoleq ' • q 4dei6eiedgns
u ! 4:pol jas se saanpaooad 6ulse4oand A}unoo jo asn eqj sol pa}}nwad juo xe eqj
of Ideoxe ' saanpaooad pue sa !ollod 9jelS Ile mollol ( legs lauuosaad sl! pue OHO 941 ge
: OHO 94110 uo!}ejado eqj u ! ( ldde pino4s spiepues 6uimollol eqj
legl 99a6e olaia4 ss !ped a41 ' S bflO3 =tld (INV S310Ig0d 3AI1" 1SINIWOb 09
• (eys jauerjul s�tsAjeuy ejep 7 uo►lenlen3 `Buamueld jo eoyjp ay}
uo pa;eool podej welyojd y;/eaH � lunoo„ aoue nsse Aj!lenb piepue}s eyl st s►yl) aeeA 4oee jo 6 jago}oO
ue4} jejel ou salied eqj of jole.ilsuu ! wpe�aoloaalp OHO eqj �(q juas eq ll !M sioleolpu ! ael ! w ! s
pue seinseew ewoolno Aq psanseew se gllea4 oilgnd jo snje}s eqj 6uil ! elap :Podaa y
• ueld wea6oad a6ueU 6uo-1 s4} pue Al! unwwoo eqj w sailpoud glles4 o! lgnd ll !llnj of pasn
aie 6ulpunj jo ssoinos leo!aobajeo- uou legl ainsu ! lle4s OHO s4j jo jo}ealslulwpe�aoloaalp
a41 sAlunoO eqj jo eouaaanouoo eqj gjim 9lejS eqj Aq pajoeles eq lle4s
JOlea}s ! u ! wpe�� oIoaa ! p a41 G� ao!.4O 41Ie9H WIS �(lndaO a4;! jo uolloaj ! p �(ep-ofmAep eqj
aapun eq ll !M pue 9jejS eqj 4l!m }oeiluoo aapun jo 99Aoldws 9jejS a aq llegs OHO eqj 10
aolea}s ! u ! wpe/aoloomp eqj 99a6e serped 4lo8 HOlV*8lSINIV4GVrdOI0 UI OHO 69
£ 8£ £-096Z£ wlJ ' 4oes8 aaA
199JIS ,4LZ 006 6
elgeAlaosH slun000y : u:qV
AjunoO J9AIU ue ! puI
puna Isnu1 juawliedaO 4ile9H AlunoO
: si spew eq llegs sluawAed oqm of 99Aed leago eqj jo ssaippe pue aweu a41 • a
• luawabeueVq ls6pn8 jo neam8 ' 41le9H jo luew:pedaO eqj o} sa6ed p9SIAsa
a4} }o Adoo a puss pue 11 Ju9w43e:RV 941 aslAaa u941 ll !M OHO 941 ' OHO 941 Aj!lou lle4s
AlunoO eqj ' aseaaoep/aseaiou ! eqj sale!l ! u ! �(lunoO eqj 11 • luawabeueW j96pn8 Jo ne9in8
' 4}le9H jo juaw� edaO eqj pue AlunoO eqj of sa6ed pashas eqj jo �(doo a puss pue
II Iuaw4oe:4y a4j 9SIAaJ ll !M OHO 941 ` aseaaoap/aseaaou ! 941 sale!}! ui slelS eqj 11 * 6u ! punj
ul a6ue4o 94j jol asodind pue junowe eqj jo 6uipim u ! :ped i9gjo eqj 6uiAl!lou Aq joaaa4
waal eqj 6u !jnp luewaaa6y s ! 4l jo 6ulpunj aseaaoap jo aseajou ! Aew A:aed aa4l! 3 • p
• lA Iuaw43e}}y uo p91s ' l We pun j }snag lusw:pedsO 43Ie9H
AlunoO eqj of 6ulnaooe senuanaJ 991 411e94 leluawuoJIAua lenuue pajewllse a41 • eo !}}O
weJ6ad 411e9H leZu9wuoJIAu3 eqj Aq pap!Aoid s ! }e4l elnps4oS sad 411e9H leJu9wuoa !nu3
eqj u ! pue joealuoo sigl jo II fed II luew4oe:4V u ! pals! i aie saa3 salnpa4os 991 p ! eolpaw
eqj Isesl le of palsnfpe Alleoljewolne aq llegs seal 4ons ' elgeoildde aaa4M ' OHO
94110 sa!}!A!}oe punj of mel Aq pemolle se seal aovuss 4s! lgelse Aew :Ped ja4l! 3 • o
• poped joei}uoo �xeu eqj of piemiol
pa!ijeo eq 11e4s OHO a4; of pagnq !j:4e si le4l puna Isna1 luswljedsO 431e9H AlunoO
a
b . The CHD shall comply with all applicable provisions of federal and state laws and
regulations relating to its operation with the exception that the use of county purchasing
procedures shall be allowed when it will result in a better price or service and no statewide
Department of Health purchasing contract has been implemented for those goods or
services . In such cases , the CHD director/administrator must sign a justification therefore ,
and all county-purchasing procedures must be followed in their entirety , and such
compliance shall be documented . Such justification and compliance documentation shall
be maintained by the CHD in accordance with the terms of this Agreement . State
procedures must be followed for all leases on facilities not enumerated in Attachment IV .
c . The CHD shall maintain books , records and documents in accordance with those
promulgated by the Generally Accepted Accounting Principles ( GAAP ) and Governmental
Accounting Standards Board (GASB ) , and the requirements of federal or state law . These
records shall be maintained as required by the Department of Health Policies and
Procedures for Records Management and shall be open for inspection at any time by the
parties and the public , except for those records that are not otherwise subject to disclosure
as provided by law which are subject to the confidentiality provisions of paragraph 6 . i . ,
below . Books , records and documents must be adequate to allow the CHD to comply with
the following reporting requirements :
i. The revenue and expenditure requirements in the Florida Accounting
System Information Resource ( FLAIR ) .
/is The client registration and services reporting requirements of the
minimum data set as specified in the most current version of the Client
Information System/Health Management Component Pamphlet ;
iii. Financial procedures specified in the Department of Health ' s Accounting
Procedures Manuals , Accounting memoranda , and Comptroller' s
memoranda ;
iv. The CHD is responsible for assuring that all contracts with service
providers include provisions that all subcontracted services be reported
to the CHD in a manner consistent with the client registration and
service reporting requirements of the minimum data set as specified in
the Client Information System/Health Management Component
Pamphlet.
d . All funds for the CHD shall be deposited in the County Health Department Trust
Fund maintained by the state treasurer. These funds shall be accounted for separately
from funds deposited for other CHDs and shall be used only for public health purposes in
Indian River County .
e . That any surplus/deficit funds , including fees or accrued interest , remaining in the
County Health Department Trust Fund account at the end of the contract year shall be
credited/debited to the state or county, as appropriate , based on the funds contributed by
each and the expenditures incurred by each . Expenditures will be charged to the program
accounts by state and county based on the ratio of planned expenditures in the core
4
4
contract and funding from all sources is credited to the program accounts by state and
county. The equity share of any surplus/deficit funds accruing to the state and county is
determined each month and at contract year-end . Surplus funds may be applied toward
the funding requirements of each participating governmental entity in the following year.
However, in each such case , all surplus funds , including fees and accrued interest, shall
remain in the trust fund until accounted for in a manner which clearly illustrates the amount
which has been credited to each participating governmental entity. The planned use of
surplus funds shall be reflected in Attachment II , Part I of this contract , with special capital
projects explained in Attachment V .
f. There shall be no transfer of funds between the three levels of services without a
contract amendment unless the CHD director/administrator determines that an emergency
exists wherein a time delay would endanger the public's health and the Deputy State
Health Officer has approved the transfer. The Deputy State Health Officer shall forward
written evidence of this approval to the CHD within 30 days after an emergency transfer.
g . The CHD may execute subcontracts for services necessary to enable the CHD to
carry out the programs specified in this Agreement . Any such subcontract shall include all
aforementioned audit and record keeping requirements .
h . At the request of either party , an audit may be conducted by an independent CPA
on the financial records of the CHD and the results made available to the parties within
180 days after the close of the CHD fiscal year. This audit will follow requirements
contained in OMB Circular A- 133 and may be in conjunction with audits performed by
county government . If audit exceptions are found , then the director/administrator of the
CHD will prepare a corrective action plan and a copy of that plan and monthly status
reports will be furnished to the contract managers for the parties .
L The CHD shall not use or disclose any information concerning a recipient of
services except as allowed by federal or state law or policy .
j . The CHD shall retain all client records , financial records , supporting documents ,
statistical records , and any other documents ( including electronic storage media ) pertinent
to this Agreement for a period of five ( 5 ) years after termination of this Agreement. If an
audit has been initiated and audit findings have not been resolved at the end of five ( 5 )
years , the records shall be retained until resolution of the audit findings .
k . The CHD shall maintain confidentiality of all data , files , and records that are
confidential under the law or are otherwise exempted from disclosure as a public record
under Florida law . The CHD shall implement procedures to ensure the protection and
confidentiality of all such records and shall comply with sections 384 . 29 , 381 . 004 , 392 . 65
and 456 . 057 , Florida Statutes , and all other state and federal laws regarding
confidentiality . All confidentiality procedures implemented by the CHD shall be consistent
with the Department of Health Information Security Policies , Protocols , and Procedures ,
dated September 1997 , as amended , the terms of which are incorporated herein by
reference . The CHD shall further adhere to any amendments to the State' s security
requirements and shall comply with any applicable professional standards of practice with
respect to client confidentiality.
5
I . The CHD shall abide by all State policies and procedures , which by this reference
are incorporated herein as standards to be followed by the CHD , except as otherwise
permitted for some purchases using county procedures pursuant to paragraph 6 . b . hereof.
m . The CHD shall establish a system through which applicants for services and current
clients may present grievances over denial , modification or termination of services . The
CHD will advise applicants of the right to appeal a denial or exclusion from services , of
failure to take account of a client' s choice of service , and of his/her right to a fair hearing to
the final governing authority of the agency. Specific references to existing laws , rules or
program manuals are included in Attachment I of this Agreement .
n . The CHD shall comply with the provisions contained in the Civil Rights Certificate ,
hereby incorporated into this contract as Attachment III .
o . The CHD shall submit quarterly reports to the county that shall include at least the
following :
L The DE385L1 Contract Management Variance Report and the DE58OL1
Analysis of Fund Equities Report ,
ii. A written explanation to the county of service variances reflected in the
DE385L1 report if the variance exceeds or falls below 25 percent of the planned
expenditure amount . However, if the cumulative amount of the variance
between actual and planned expenditures does not exceed three percent of the
cumulative expenditures for the level of service in which the type of service is
included , a variance explanation is not required . A copy of the written
explanation shall be sent to the Department of Health , Bureau of Budget
Management.
6
Now
. f
p . The dates for the submission of quarterly reports to the county shall be as follows
unless the generation and distribution of reports is delayed due to circumstances beyond
the CHD ' s control :
i. March 1 , 2005 for the report period October 1 , 2004 through
December 31 , 2004 ;
ii. June 1 , 2005 for the report period October 1 , 2004 through
March 31 , 2005 ;
iii. September 1 , 2005 for the report period October 1 , 2004
through June 30 , 2005 ; and
iv. December 1 , 2005 for the report period October 1 , 2004
through September 30 , 2005 ,
7 . FACILITIES AND EQUIPMENT . The parties mutually agree that :
a . CHD facilities shall be provided as specified in Attachment IV to this contract and
the county shall own the facilities used by the CHD unless otherwise provided in
Attachment IV.
b . The county shall assure adequate fire and casualty insurance coverage for County-
owned CHD offices and buildings and for all furnishings and equipment in CHD offices
through either a self- insurance program or insurance purchased by the County.
c . All vehicles will be transferred to the ownership of the County and registered as
county vehicles . The county shall assure insurance coverage for these vehicles is
available through either a self-insurance program or insurance purchased by the County .
All vehicles will be used solely for CHD operations . Vehicles purchased through the
County Health Department Trust Fund shall be sold at fair market value when they are no
longer needed by the CHD and the proceeds returned to the County Health Department
Trust Fund .
8 . TERMINATION .
a . Termination at Will . This Agreement may be terminated by either party without
cause upon no less than one-hundred eighty ( 180 ) calendar days notice in writing to the
other party unless a lesser time is mutually agreed upon in writing by both parties . Said
notice shall be delivered by certified mail , return receipt requested , or in person to the
other party' s contract manager with proof of delivery .
b . Termination Because of Lack of Funds . In the event funds to finance this
Agreement become unavailable , either party may terminate this Agreement upon no less
than twenty-four (24 ) hours notice . Said notice shall be delivered by certified mail , return
receipt requested , or in person to the other party' s contract manager with proof of delivery .
c . Termination for Breach . This Agreement may be terminated by one party , upon no
less than thirty (30 ) days notice , because of the other party' s failure to perform an
f
obligation hereunder. Said notice shall be delivered by certified mail , return receipt
requested , or in person to the other party' s contract manager with proof of delivery .
Waiver of breach of any provisions of this Agreement shall not be deemed to be a waiver
of any other breach and shall not be construed to be a modification of the terms of this
Agreement .
9 . MISCELLANEOUS . The parties further agree :
a . Availability of Funds . If this Agreement , any renewal hereof, or any term ,
performance or payment hereunder, extends beyond the fiscal year beginning July 1 ,
2005 , it is agreed that the performance and payment under this Agreement are contingent
upon an annual appropriation by the Legislature , in accordance with section 287 . 0582 ,
Florida Statutes .
b . Modification . This Agreement and its Attachments contain all of the terms
and conditions agreed upon between the parties . Modifications of this Agreement shall be
enforceable only when reduced to writing and signed by all parties .
C , Contract Managers . The name and address of the contract managers for
the parties under this Agreement are as follows :
For the State : For the County :
Ernesto G . Rubio Jason Brown
Name Name
Business Manager Budget Manager
Title Title
1900 27th Street 1840 25th Street
Vero Beach , FL 32960-3383 Vero Beach , FL 32960-3365
Address Address
772-794-7464 772-567-8000 ext 1214 000000000
Telephone Telephone
If different contract managers are designated after execution of this Agreement , the name ,
address and telephone number of the new representative shall be furnished in writing to
the other parties and attached to originals of this Agreement .
d . Captions . The captions and headings contained in this Agreement are for
the convenience of the parties only and do not in any way modify, amplify , or give
additional notice of the provisions hereof.
a
In WITNESS THEREOF , the parties hereto have caused this 46 page agreement to be
executed by their undersigned officials as duly authorized effective the 1St day of October, 2004 .
BOARD OF COUNTY COMMISSIONERS STATE OF FLORIDA
FOR INDIAN RIVER COUNTY
DEPARTMENT OF HEALTH
SIGNED BY : c _ cci SIGNED BY : 4 / �� .
NAME . Caroline D - Ginn NAME : John O . Agwunobi , M . D . , M . B . A. , M . P . H .
TITLE : rhAi rman TITLE : Secretary
DATE : November 9 . 2004 DATE : / v �
may '
ATTESTED �O
• ) P
SIGNED BY : ` SIGNED BY . ` C
NAME : gv2r�s� , t; , ° �' �'° NAME . Jeai Kline R. N . M . P . H .
TITLE : TITLE : CHQ Director/Administrator
DATE : /d (� DATE :
PPROVED :
asst^� Adm istrator
AP `ROVED AS TO FORM
,PE SUFFICIENCY 'r
N E .
ISTANT T EY
9
ATTACHMENT
INDIAN RIVER COUNTY HEALTH DEPARTMENT
PROGRAM SPECIFIC REPORTING REQUIREMENTS AND PROGRAMS REQUIRING
COMPLIANCE WITH THE PROVISIONS OF SPECIFIC MANUALS
Some health services must comply with specific program and reporting requirements in addition to the Personal Health
Coding Pamphlet ( DHP 50-20 ) , Environmental Health Coding Pamphlet ( DHP 50-21 ) and FLAIR requirements because
of federal or state law , regulation or rule . If a county health department is funded to provide one of these services , it
must comply with the special reporting requirements for that service . The services and the reporting requirements are
listed below :
Service Requirement
1 . Sexually Transmitted Disease Requirements as specified in FAC 64D-3 and F . S . 384 and
Program the CHD Guidebook Internal Operating Policy STD 6 and 7 .
2 . Dental Health Monthly reporting on DH Form 1008* .
3 . Special Supplemental Nutrition Service documentation and monthly financial reports as
Program for Women , Infants specified in DHM 150-24* and all federal , state and county
and Children . requirements detailed in program manuals and published
procedures .
4 . Healthy Start/ Requirements as specified in the Healthy Start Standards
Improved Pregnancy Outcome and Guidelines 1998 and as specified by the Health Start
Coalitions in contract with each county health department .
5 . Family Planning Periodic financial and programmatic reports as specified
by the program office and in the CHD Guidebook , Internal
Operating Policy FAMPLAN 14*
6 . Immunization Periodic reports as specified by the department regarding
the surveillance/investigation of reportable vaccine
preventable diseases , vaccine usage accountability, the
assessment of various immunization levels and forms
reporting adverse events following immunization and
Immunization Module quarterly quality audits and duplicate
data reports .
7 . Chronic Disease Program Requirements as specified in the Community Intervention
Program (CIP ) and the CHD Guidebook .
8 . Environmental Health Requirements as specified in DHP 50-4* and 50-21 *
9 . HIV/AIDS Program Requirements as specified in Florida Statue 384 . 25 and
6413-3 .016 and 3 .017 F .A. C . and the CHD Guidebook . Case
reporting on CDC Forms 50 ,4213 (Adult/ Adolescent) and
50 .42A ( Pediatric) . Socio-demographic data on persons
tested for HIV in CHD clinics should be reported on Lab
Request Form 1628 or Post-Test Counseling Form 1633 .
These reports are to be sent to the Headquarters HIV/AIDS
office within 5 days of the initial post-test counseling
appointment or within 90 days of the missed post-test
counseling appointment .
ATTACHMENT I (Continued )
10 . School Health Services HRSM 150-25* , including the requirement for an annual plan
as a condition for funding .
*or the subsequent replacement if adopted during the contract period .
ATTACHMENT II
INDIAN RIVER COUNTY HEALTH DEPARTMENT
PART I . PLANNED USE OF COUNTY HEALTH DEPARTMENT TRUST FUND BALANCES
Estimated State Share Estimated County Share
of CHD Trust Fund of CHD Trust Fund
Balance as of 09/30/04 Balance as of 09/30/04 Total
1 . CHD Trust Fund Ending Balance 09/30/04 561 , 836 5399803 19101 , 639
2 . Drawdown for Contract Year ( 1249892 ) ( 1159285) (240 , 177)
October 1 , 2004 to September 30 , 2005
3 . Special Capital Project use for Contract Year
October 1 , 2004 to September 30 , 2005
4 . Balance Reserved for Contingency Fund 436 , 944 424 , 518 8619462
October 1 , 2004 to September 30 , 2005
Note : The total of items 2 , 3 and 4 must equal the ending balance in item 1 .
Special Capital Projects are new construction or renovation projects and new furniture or equipment associated with these projects, and
mobile health vans.
Pursuant to 154 .02 , F . S . , At a minimum , the trust fund shall consist of: an operating reserve , consisting of 8 . 5 percent of
the annual operating budget ,
maintained to ensure adequate cash flow from nonstate revenue sources .
• . r s . i 'a v <e• . k.., z as nas5 a^l "€< s. « 5,
c
{� i X S�Yr t s,. .s §= a ! 'F9a 3 t i • Y # `s i � k l a a i >_ 2a a ; ,a
� d. kxy, �
'€�' �# + � $ s a ..i`` .• , a<' z .x{.' E d p� �rih yy _� wa i _�qx*cjk$s �.y>A +. l ! �i €
n dk �N�y�. , , a [€ s a . a a
« �. § s�, M €�S si _ •a. fir, � , $ �.a S`-h i ' P a a f'r �'S °9c ,� ,: r
++#ys=f E•
4�`t4 a4 ., '��4t 4 tr , 5� ::� * a r •. s 3 .:+, r� 3�' . � 4*>3, t a .__ rrs ;a 4 ,e, `ri<
�sisn` , `,..`� «. $ 3.+ +. �z t{t� y ; rs : +
.s k�i'`i. Pz �t € :d +H �-F ,,%" �t: ± ¢� ?� , ' r' §n rx..,. . .:t ^ St "),+ .'e •. 3 i
� $� i4 ",yam. y " g "'� ye{t$ a f xr�'sw
r}m �h"s a #v 7 a at c-§ � � a �, r e i f a • $ 4 # I "� µ t ! �. � k « € x {. °„
7" 3 '3a'Y ' �„° rl. d `i x ,>; ^, %i`
1 1 • 1 11 1 ' • • • • . • • • • " • 1 1 . .
1 � 1 • 1 • • 1 1 1
' 1 1 . - 1 - • ' - • 1 . 1 1 1 . 1 . 1 . 1 • 1 1 11
11
• � � i • 1 ' 1 1 ' • 1 • 1 • 1 • • ' 1 1 •
•
11 . 1 - 1 1 11 1 1 1 1 1 1 1 1 1
; 1 1 1 1 ' 11 1 . 11 1 • 11 1 • tl 1 • 11 . 11
1 1 - 1 - • 1 1 11 1 1 1 1 1 1 1 1 1
11 • : 1 1 111 111 • • . ' • . ' • '
1 • - 1 • • : 1 1 • 1 • 1 1 1 : • • 1 1 ' 1 : •
� - • 1 1 • 11 111 I . 1 ' 1 . 1 ' 1 . 1 • • 1 . 1 • • . ' .
- . - • I . • • 1 1 : 1 : 1 : 1 : 1 •
' • 1 1 . 1 1
' ' 1 • • 1 11 1 • 1 • 1 � 1 • . 1 • •
11 • 1 • 1 • ' 1 : 11 : 11 : 11 : 11 11 1 11
: 11 • 111 1 • • • � • 1
1 � 1 1 1 1 • • 1 • • 1 • . 1 • 1 •
1 • 1 ! 1 1 1 • 1
' 1 • : . • 1 1 • • • 11 ' 1 1 11 • 11 ' : � • • ' 1 : 1
• ` 11 . • 1 1 • 1 1 1 1
t '3F •'5 5 eeii„„v 4 6'
a 7 . - 4;4k +, ? 3§ e^ S,✓^bk`x 'Mte. - " �Yf .° r } t ''•3 sa ¢ tis ca a r s
Zi
~�,.,z ' c .v' x .�S Z Y;^. � `, 4,f `�` 9 � _, dei �,•S°& R . ,# I t y $ : i; i � . „iY`? � �" : r � . : C ( mw�,.+as
,pra +s ^xYti a @ 84 � a, z 4
v Own
re w i, q k kic 49€X> dS .4s• ,u, a^S v' 3� i' ^a<xf e r a da ^,.k:. u,+ ry:», 3 4 , 4tl s
"�,-r s a if , a.4 t ' yC 2S t s t n ., . , r
,-
r iy fa< 3 a �"�; £ 3'�'� A � k e � +y ,ga p9 # ; rr5 � pr�i� y • p g r e q'pn e t
M �n �1'i M F • '� 4i �} �.+1 .`i 1 �`� � M � i 2 9 „Y % rf � • 1� �:[e V � 3 K b.�
S^ .j t3f y, � 1 ��'y �'� t i•"#"%t 1 L317Y f 3 A.
�a a §y e a .Jaa +a rk, s. '9s: � z "' s3 f rT � a a f •
�-
4�'
1 slz ` Ic
Ix
^�E
• � . . 1 11 1 1 1 ' •
1 1 1 al 1
' . r . . a . 1 1 • • : a : . : • : . 1 1 � 1
• r . . 1 1 1 11 11 " • ' • ' 1 • '
• . . 1 • 1 1 " 1
. � 1 • 1 11 ' • 1 1 1
� � � 1 ' � • a ` 1 • • 1 • 1 1
. - . • ' 1 11 1 1 1 1 1 1 1 1 1
• • � . ' 1 ' 1 . . 11 1 1 1 '
` Yx£;, K s w s rs$ s r y,a ,.. S ; *D' ✓ ti3 7n �.: ' $ . •, ;� � d ,us ' e r s c
n � as.-uY
"��t'y a '
��xk�t� .� z', aa a ,dt .. aye $ :.. �"" n a•:ia: .r n , ; `' , _ � t axp. ,tr s, r a' >
ssx '#
N a t py • ,i„ 'e�} ga, rR-"f ri. 's >�' i *;:: wi��P' '
N�L�' et gams yy P
4 `Y 3 4 � �1 " Prv „4• Y ,. § M : ,� B"a' +�e x . .a ata{ r• �gx^ x�'Y B�?�"
� }
{ t s z, i7 �p ^ ,y s fad : 16 z i i } � ^":z v 1 £ a s ® I ffi , 3A• P'�,' €e"#. �."�}�
aa P�z�nd
a y;
1 1 • • 1 • 1 1 • 1 1 •
1 1 r • r r r • 1 1
1 1 1
1 1 1
1 1 1 ' • • I • I • 1 1
1 1 1
1 1 1 • • I • : 1 „ 1 • •
1 1 1 • • I • • r r • ♦ 1 • 1 •
1 1 1 • • / I • ' • 1 1
1 1 1
1 1 1 • • 1 I • • ' • • • • • • 1 ♦ ♦ ♦ 1
1 1 1 • • I • 1 1
1 1 1
1 1 1 • ' • 1 1 1 1 1
1 1 1 • : " • 11 1
11 1 11
1 1 1 • • / / ' • • 1 1
1 1 1
1 1 1 " • • • / • 1 1
1 1 1
1 1 1 ; • • ' 1 1 1 1 1
1 1 1 • 1 1
1 1 1
1 1 1 I • • ' 1 1 1 1 1 1 1 1
1 1 1
1 1 • • • / 1 ' • • ' 1 1 111 1 11 111 1 11 111
1 1 1
1 1 1
1 • 1 1 1 1 1
1 • • • • • • 1 1 1 1 1
1 1 1
1 ' • • ' 1 1 1 1 1
1 ' • ' • 1 1 1 1 1
1 1 1
1 ' • • ' ' • • 1 1 1 1 1
1 1 1
1 r ' • 1 1 : 1 1 1
1 1 1
1 • ' " • 1 1 : 1 1 1
1 1 1
1 • • • ' 1 1 : 1 111 1 111 1 111
1 • • I / • 1 1 1 1 1
1 • ' I • • • " • 1 1 1 1 1
1 • 1 • • " 1 1 1 1 1
1 11 : • ' I I 11 1 1 1 1 1
1 1 1 / 1 • : • ' ll 1 ' ll 1 ' ll
1 1 1 ' • ' • • • ' • 1 1 1 1 1
1 1 1 • " • 1 1 1 1 1
1 1 1 1 1 1 1 1
1 1 1 ' • • / 1 1 1 1 1
1 1 1 • • / I " • ' I " • I 1 1 1 1 1
1 1 • • • I • • I I I • • • ' 1 • • • 1 • • • '
1 1 • • I I ' I I 1 1 1 1 1
t
'"�' "V{ at � "�+, x` d b t ��`3•"# a�, -iP -7�a' � r R F �� 6 y i ri b { 9 '#' ,., n� � n. dA z°`} P Y �
(b�. r,} g p � E °Pr" t 9E r# {� i+'e�3
` _. ,r ` , `�, a�'r off; '�" ��'� °° �*s� ;^ : �r ss , `• c ��' a�x`rr a
.ay .. `a„ � s
•• � '• ,�,. ` _ " �` r'.'>a �� r , rc w; � � n, t E .� = o ,, e v 5j. e i a d a 3€
a � � c d � e 1 a d d ' ' :�,e { x °
. s-s#- `•%� � 9s lts"#°�?§a� s Pa��S Fs'� # �'§` tom$'" :: x ..rs ?? -i � # fr .d
a s
wwr �P z, • .SP`f d a$ �'w iE; '�a $ s x`23 ., ��'�" _ �" t' �; . r �s u` � �dT 0.= a� •E p .i � �
�r� f s .1�� 1.". �d � `'^:7i ��
44% dR , r:: . Y°°re x s ! 4 ,` s Fz pal a1Ei' r e • 4t¢ w1k• z.s a,�+ sr ,y;., , ,$d
'+wts : � `'t9'ws8 '.aat a'�`-E,? 7 .+ s st §R.+k f"��,m.. S' ` 'Iw' s Y i? d . b� id e t �'` i 6 2 .• s r,
''�"•� R ( � u '°P , � A'�L y n�` .=-. .� rv°
a
1 , 1 1 •
1 • • • : • 1 11 1 1 11 1 1 11
1 1
11 111 • ' • 1 1 1 1 1
11 11 ► • • • • • ' • • • 1 1 1 1 1
11 111 • • ' • • ' • • 1 1
1 1 1
11 111 • • • • • ' " • ' 1 • 1 ' •
11 111 • • " • • • • 1 1 1 1 1
11 111 ' • • • • : 11 1 • 1 1 1 1 1
11 1 1 : • ' • 1 1 1 1 1
11 1 • ' • • • • 1 1 1 1 1
11 1 • ' • ' • • 11 1 1 1 1 1
1 1 1
11 1 • ' • " • • 1 1 1 1 1
11 1 • ' • ' • • • ' • • 1 1 1 1 1
11 1 • • • ' • • 1 1 1 1 1
11 1 • • 1 1 1 1 1 •
11 1 " • • • 1 1 1 1 1
11 1 . : • 1 1 1 1 1 1
11 1 . : • ' • • • ' • • ' • 11111 1 11111 1 11111
11 1 . • • • • • • 1 1 1 1 1
11 1 . , • • • 1 1 1 1 1
11 1 . • • 1 1 1 1 1
11 1 . . • 1 1 1 1 1
11 1 . . • • ' • • • • 111 1 1 11 1 111
11 1 . . • • ' 1 1 1 1 1
11 1 . • • • • 1 1 1 1 1
11 1 . : • • 1 1 1 1 1
11 1 : • • ' • • • • • • • • 11 . 1 1 1 1 1 1
11 1 : • • • • • ' • • 1 1 1 1 1
111 : • • • • I • 11 • 1 11 ` 1 11 '
11 1 • • • • 1 1 1 1 1
11 1 : • • 1 1
11 1 ; • • " • • 1 1 1 1 1
11 1 : • • 1 1 1 1 1
11 1 ; • • • 11 • 11 • . 1 1 . pl 1 • . 1
11 1 : • • • 11 • 1 1 1 1 1
11 1 ; • • " • 1 1 1 1 1
11 1 : • • • • : 1 1 : 1 1 : 1
11 1 : • • 11 • 1 1 1 1 1
11 1 : • • " • ' 11 1 1 1 1 1
11 1 : : • • 1 1 1 1 1
11 • 1 1 1 1 1
3` * �, ;;. ,y: F� �,} z E C's`€. h�� c ,� �ayc` r - sea k # - , R I ' # B N s ♦ ." e � 4 d :«
`� �� � "'x#� ti" br £ t uK �
�k n.
# a t assess# � }`s 3',:� ,• , � � " F #d's ;ta � .
Mp rsn
re o pp a� '. � � n � Y � ,.4' `fi'�.•*'`«�,c} ,:
.`.
,��} g ^`c P3 >i.. � r+a. i+r a.: f � "7�,& ti .•^-d"!€ t!# .A 6 * «a:. 'ry .t «(, ,„� +h°
� ifs,
%*
1s 4.
S ..n J• S"P '9' � #*�?, .
yrsee
'' ' ,+ e � $a {M' %r=s -c" } rn +"z , f#{k .* „gyp � „3 . �.. ,�,�'#`f �Y� � � p,ia� t I�
;: piy'x?� s ✓nr
°a 4
. ` ka , 1 r j}e «t 4sYe L ? r r r a ° t s uxa qqa, s"• gia Ne n1 ,
� t: t ' . p Pg;t .ny h f`� R ! ��� : 5:.. ` ae f h . P Apt • ' % ? � �`� i i � fi"14"�
nft�
,?
f,
*� ` a
1 1 • /
1 '
� � X11 1 � � 1 � � •
� � 1 • 1 1 1 1 ' � � '
1 � , 1 1 1 • , 1 1 ♦ • , • 1 ♦ • � 1 1
x
X
E x s
v
, � . 0 hs 4eu . " ��` ao- :.ux . " v . • . a , � 1 # L y4 .e� }, "¥C i � i1H v �. f3 �.5pp ^
t �. zF "-s ti
aj AF
a
,� . '?-* .,+-„�e3. . t# w,,�, 4k a °” `£s'�'`45 ttJ . r �^�� c Y � � ! ," v • G. d } M :,"i I 1 . +b 1
} S °„�Lir J a xt ; -�, t �} ' � S ``
1
IT
y�s ,t4a`
+ t � x ass ��u@€�c 4..#,ea � of 4 �'' N.xN�" , xw " •� �" ° � . k ' x � 9f n
k�
i rR f r
i
�kg p "°4° ¢ rz
I I i I
1 1 1 • 1 • • 1 ' 1 1 • 1 1 ' 1
1 • 111 1 , 111
1 • , ' . 1 1 1 1 1 1
1 . 111 1 • 1 1 • • • 1 • • 1 • •
1 I i • I 1 1 1 1 1
• 1 1 •
1 1 1
11 1 � , , • 1 • ' 1 • 1
11 1 • , , 1 1 1 1 1
11 1 : 1 1 , , • • 1 1 • 1
11 1 : 1 � , , , , • : 1 1 1 : 1 1
11 1 : I , , I 1 • � 1 '
11 1 : 1 • , 1 1 1 1 1
1 1 1
11 , , • ' : 1 1 1 1 1
11 • / • , 1 , • 1 . • • 11 1 • • 11
11 ' • � , • C 1 1 1 1 1
1 1 1 ' ; , • • 1 1
• t '
1 : 11 • , , � 1 1 1 1 1
1 : 1 1 , , • 1 1 1 1 1 1
1 : 1 , • � 1 1 1 1 1
1 : 1 / , , 1 • • 11 1 1 1 1 1
1 111 1 1 1 1 1 1
1 : 111 1 • • 1 1 1 1 1
: • 1 1 1 1 1 • •
1 1 1 1 1
1 1 1 1 1 1
1 1 1 1 1 1
r
r
w «+ rY
o-
Y s
t t10
1
H�} s P Y :n#x gy .Y �^ 8 eL ; i ;u �,' ;fir & � 8 .$ .Iry�!. 1 ¢ 1 y d S 4� :41pC". �I� �Y • 5 e$ 9
i� '� 3.?"". :_: ."�s a r t {
$ t . >"£ Y' dda � y,iq `v"yF' � # , .r;_ e't • # a ° n• : 'n�g `' '
x "Yr tr as3'{��'',, _ - .,• it k k b r 1 '$ �t �i '' ra3.# P,yx` Y`$#'-
r '$
5' fty�" J -S. Sr^n` Y." Y •i3�' hGi% i ,u,3a4' 4 .£'1' °%Ss z€ # g'x .t�
,yy
: � , »x� �. a� , r= , ";�' % rsc t � �€ # � � ' � r. i,..�"a" *ss 1 c w 1 baa ii o � i � l
. > ats [ [ �ii�'•f � � .
'`$',;_ a i t m£ ir*. w a >#'`fYad � � ' € "�.„, $. € i " n$' a•�+
.rs, J � 4. : s r
,^' r{ Y •qkt. „ t44
;�. ti`s $ a a *.,� c . G % =r erx•;.. - ;: i ,. ,- %' ' , § i q 3 A, t
n$ 4«,,, d
+ \ _ Cpm
�vn ;
t ;-
_
d . ,
,
11 , 1 1 I
• 1 ' 1 1 1 1 1
• , ' 1 I 1 1 1
• 1 1 1 1 1 1
• , ` 1 1 1 1 1
• • • ' i • • 1 1 1 1 : I 1 : ,
11 . 1 1 • � 1 1 1 1 1
11 11 • , 1 • 1 1 1 1 1
11 1 . 1 • 1 11 11 1 11
1 1 1
11 1 1 1 1 1 I 1
11 1 1 • , • � 1 ' ,
11 1 ' 1 : , • 1 1 1 1 1
11 1 ' • 1 I 1
11 C 1 • • 1 •
11 • , 1 � 1 , , I ,
11 11 ' � , • ; , , 1 I 1 1 1
1 1 1
11 I • 1 1 1 1 • 1 1 1 1 1
11 1 • , , 1 1
11 1 1 1 1 1 1
11 1 1 1 1 1 1
11 1 1 I 1 1 1
11 1 ` 1 , 1 • • • , 1 • •
11 ` 1 • • . • 1 1 1 1 1
11 1 • 1 1 1 111 Itl 1 111
11 : 1 1 • � � 1 1 1 1 1
11 : 1 1 • , 1 1 1 1 1 1
11 : 1 1 C • . , � 1 111 111 1 111
11 ' 1 . 1 • • • • 1 I 1 1 1
11 : 1 ' • 1 1 • 1 I , 1 , ,
11 : 1 • • 1 1 ' • 1 1 1 1 1
11 : 1 • ' , • . , , � 1 1 1 1 1 1 1
1 1 11 • 11 , 1 1 • • , • 1 • '
c
r
P
k
P
:s ,'�, ,„, . , , •4 , 3 ; e a rK ;"� £ + 1v Q : t > a. , d aPs , "% o- ,PJ '"T t Pj� t ,
. €* a u , ,a+ ham` f , �' ,..
` '$f`§- ^t �`'s` t w sr aa" �.. aa;je? 4 i± p,3s` ''s-�. ,t' ak3 :y: •s,a t� , '�_ '«.•�«r ';sr :i Six'''
Slims ,r 'j° +. ' � e�"xa x't4 , w y° n
rr 6
°,' w a 3 ``4d � ti ? a r> ;i o- ' s,°. -°„ w, r . = :r �i; : � sd � � :.i h ,• „iii �” �y
'lx � ' rs- g fa.., z? ,�.a
Am
CxTI'.n,"P'.
r esus x 3 ' yid, °'" ' Mr s r •i s �" ;r y'd,ri�"r �Sr��,s+P .�. ,3` Viv'+�:s+ ® i.Tt a r, '�y7v.,
3 ss ' `�` . r+ .�-s;d° <,'sr
P rtx, a > ash ; Lim ✓A r" c s
P
f :.
• 1 1 / i 1 1
1 1 . 1 11 / • 1 1 11 11 1 11
1 1 . 1 : 1 , 1 11 11 1 11
1 1 . 1 ' / 111 • 1 - 1 - 1 1 1 1 1
1 1 11 1 • 1 - / 1 1 I 1 1
1 11 • 1 1 1 I 1 1 1
1 1 . • 1 1 1 � 1 1 1 1 1
1 1 ` • • • 1 1 • 1 1
1 1 1 1 1 I 1
1 : 1 1 1 • � 1 1 1 1 1
• 1 1 1 1 1 1 : , : i1 ; 1 : , ;
1 : 11 • ' 1 1 1 1 1 1
1 : 11 , 1 • , . , • 1 1 1 1 1
1 : 1 ' ' , • 1 1 1 1 1
1 111 / 1 1 1 1 1
1 : 111 1 • , 1 1 1 1 1
1 1 1 1 1
1 •
1 1 1 1 ' •
1 1 1 , , •
• , 1 1 1 1 1
• , 1 1 1 1 1
• , 1 1 1 1 1
• , 1 1 1 1 1
• , 1 1 1 1 1
1 1 1 1 1 . • , •
• 1 1 1 1 1 1 •
• 1 / , 1 1 / / 1 1 1 1 1 1
• 1 1 , 1 1 1 1 1 1 1
• 1 / r 1 , � 1 1 1 I 1
• 1 1 1 1 , 1 1 I 1 1
• 1 1 , 1 1 1 1 1 1 1
OTHER COUNTY CONTRIBUTIONS TOTAL 0 0 0 0 0
GRAND TOTAL CHD PROGRAM 41571 ,391 49257,434 8,8289825 2,602,058 t 1 ,430,883
ATTACHMENT III
INDIAN RIVER COUNTY HEALTH DEPARTMENT
CIVIL RIGHTS CERTIFICATE
The applicant provides this assurance in consideration of and for the purpose of obtaining federal grants , loans ,
contracts (except contracts of insurance or guaranty) , property, discounts , or other federal financial assistance to
programs or activities receiving or benefiting from federal financial assistance . The provider agrees to complete
the Civil Rights Compliance Questionnaire , DH Forms 946 A and B (or the subsequent replacement if adopted
during the contract period ) , if so requested by the department.
The applicant assures that it will comply with :
1 . Title VI of the Civil Rights Act of 1964 , as amended , 42 U . S . C . , 2000 Et seq . ,
which prohibits
discrimination on the basis of race , color or national origin in programs and activities receiving
or
benefiting from federal financial assistance .
2 . Section 504 of the Rehabilitation Act of 1973 , as amended , 29 U . S . C . 794 , which prohibits discrimination
on the basis of handicap in programs and activities receiving or benefiting from federal financial
assistance .
3 . Title IX of the Education Amendments of 1972 , as amended , 20 U . S . C . 1681 et seq . , which prohibits
discrimination on the basis of sex in education programs and activities receiving or benefiting from
federal financial assistance .
4 . The Age Discrimination Act of 1975 , as amended , 42 U . S . C . 6101 et seq . , which prohibits discrimination
on the basis of age in programs or activities receiving or benefiting from federal financial assistance .
5 . The Omnibus Budget Reconciliation Act of 1981 , P . L . 97-35 , which prohibits discrimination on the basis
of sex and religion in programs and activities receiving or benefiting from federal financial assistance .
6 . All regulations , guidelines and standards lawfully adopted under the above statutes . The applicant agrees
that compliance with this assurance constitutes a condition of continued receipt of or benefit from federal
financial assistance , and that it is binding upon the applicant, its successors , transferees , and assignees
for the period during which such assistance is provided . The applicant further assures that all contracts ,
subcontractors , subgrantees or others with whom it arranges to provide services or benefits to
participants or employees in connection with any of its programs and activities are not discriminating
against those participants or employees in connection with any of its programs and activities are not
discriminating against those participants or employees in violation of the above statutes , regulations ,
guidelines , and standards . In the event of failure to comply, the applicant understands that the grantor
may, at its discretion , seek a court order requiring compliance with the terms of this assurance or seek
other appropriate judicial or administrative relief, to include assistance being terminated and further
assistance being denied .
ATTACHMENT IV
INDIAN RIVER COUNTY HEALTH DEPARTMENT
FACILITIES UTILIZED BY THE COUNTY HEALTH DEPARTMENT
Facility
Description Location Owned By
Clinic , Dental , Vital Statistics , 1900 27th Street County of
Environmental Health , WIC , Vero Beach , FL 32960-3383 Indian River
Administrative Headquarters
39 , 200 sq . ft .
Gifford Health Center 4675 28th Court Indian River County
10 , 642 sq ft Vero Beach , FL 32967- 1330 Hospital District
Co- Located Site :
WIC 12196 County Road 512 Fellsmere Medical
Fellsmere , FL 32948-5463 Center
ATTACHMENT V
INDIAN RIVER COUNTY HEALTH DEPARTMENT
SPECIAL PROJECTS SAVINGS PLAN
IDENTIFY THE AMOUNT OF CASH THAT IS ANTICIPATED TO BE SET ASIDE ANNUALLY FOR THE PROJECT.
CONTRACT YEAR STATE COUNTY TOTAL
2002-2003 $ - $ - $
2003-2004 $ - $ - $ _
2004-2005 $ - $ - $ _
2005-2006 $ - $ - $
2006-2007 $ - $ - $
PROJECT TOTAL $ - $ - $
SPECIAL PROJECT CONSTRUCTION/RENOVATION PLAN
PROJECT TITLE : No projects are planned .
LOCATION :
CATEGORY : NEW FACILITY ROOFING
RENOVATION PLANNING STUDY
NEW ADDITION
SQUARE FOOTAGE :
PROJECT SUMMARY : Describe scope of work in reasonable detail.
ESTIMATED PROJECT INFORMATION :
START DATE (initial expenditure of funds) :
COMPLETION DATE :
DESIGN FEES : $
CONSTRUCTION COSTS: $
FURNITURE/EQUIPMENT $
TOTAL PROJECT COST: $ -
COST PER SQ FOOT: $ #DIV/0 !
ESTIMATE OF ENVIRONMENTAL HEALTH FEES
FISCAL YEAR 2004 - 2005
DESCRIPTION FEEDEPOSIT ORG EO OBJECT REVENUE SI OCA FUND BUDGET IBI PROGRAM
AMOUNT AMOUNT 1-411-5 CODE CATEGORY GF-SF-FID ENTITY COMPONENT
PUBLIC SWIMMING POOLS AND BATHING PLACES
1 . Annual Permit - Up to (and including) 25,000 gallons 100.00 90.00 XX-360 DK 001145 000100 CD 81<000 20-2-141001
64200700 1306000000
1a . Transfer to headquarters 10 . 00 99-910 SM 001205 000100 RV K3000 10-2-021042 64200600 00 1302000000
2. More than 25,000 gallons 200.00 180.00 XX-360 DK 001145 000100 CD 81<000 20-2-141001 64200700 1306000000
2a . Transfer to headquarters 20. 00 99-910 SM 001205 000100 RV K3000 10-2-021042 64200600 00 1302000000
3. Exempted Condo Pools (over 32 units) 50.00 45.00 XX360 DK 001145 000100 CD 81<000 20-2-141001 64200700
1306000000
3a . Transfer to headquarters 5. 00 99-910 SM 001205 000100 RV K3000 10-2-021042 64200600 00 1302000000
OTHER FEES
Collected by the 13 delegated counties
Broward , Dade , Duval , Hillsborough , Lee, Manatee ,
Collier, Palm Beach , Pinellas , Polk , Sarasota , Volusia , Escambia.
Permits and variances for Okaloosa , Santa Rosa , Walton , Bay ,
Homes , and Washington Counties are processed by Escambia
County and variances and permits for Pasco County are processed
by Pinellas County as follows :
1 . Plan review (new construction) 350.00 350.00 XX-360 DK 001092 000100 CO 81<000 20-2-141001 64200700
1306000000
2. Modification to a contsduc ion permit (permit issued and pool not finished 100.00 100.00 XX-360 DK 001092 000100 CO 81<000
20-2-141001 64200700 1306000000
with contruction)
3. Modification to a completed pool, one that has been in operation 150.00 150.00 XX-360 DK 001092 000100 CD 8K000 20-2-141001
64200700 1306000000
4. Plan/application review for bathing place development 275.00 275.00 XX-360 DK 001092 000100 CD 8K000 20-2-141001
64200700 1306000000
5. Initial operating permit 150.00 150.00 XX-360 DK 001092 000100 CD 81<000 20-2-141001 64200700 1306000000
:-Variance applications 240.00 216.00 XX-360 DK 001092 000100 CD 8KOD0 20-2-141001 64200700 1306000000
6a. Transfer to Headquarters 24 . 00 99-910 SM 001205 000100 RV K3000 10-2-021042 64200600 00 1302000000
All other counties are to send the fee to Bureau of Water
Programs in Tallahassee or the Environmental Engineering
section in Orlando as follows :
1 . Plan review ( new construction ) 350 . 00 350 . 00 XX-360 DK 001092 000100 CD 81<000 20-2- 141001 64200700 1306000000
2. Modification to a contsrtuction permit (permit issued and pool not finished 100 . 00 100. 00 XX-360 DK 001092 000100 CD 81<000
20-2- 141001 64200700 1306000000
with contruction)
3. Modification to a completed pool , one that has been in operation 150 . 00 150 . 00 XX-360 DK 001092 000100 CD 81<000
20-2- 141001 64200700 1306000000
4 . Plan/application review for bathing place development 275. 00 275. 00 XX-360 DK 001092 000100 CD 81<000 20-2- 141001
64200700 1306000000
5. Initial operating permit 150 . 00 150 . 00 XX-360 DK 001092 000100 CD 8K000 20-2- 141001 64200700 1306000000
6. Variance applications 240 . 00 216 . 00 XX-360 DK 001092 000100 CD 8K000 20-2- 141001 64200700 1306000000
"Must use County Health Department 1131 (01 -67) Page 1 11 /2/2004
DESCRIPTION POSIT ORG EO OBJECT REVENUE SI OCA FUND BUDGET IBI PROGRAM
LAaMOUNTAM( UNT L41L5 CODE CATEGORY GF-SF-FID ENTITY COMPONENT
MOBILE HOME & RECREATIONAL VEHICLE PARKS
( FEES ARE PRORATED ON A QUARTERLY BASIS)
1 . Annual permit for 5 to 14 spaces 50 .00 45.00 XX-354 DK 001113 000100 CD 81<000 20-2-141001 64200700
1306000000
1a . Transfer to headquarters 5. 00 99-910 MP 001113 000100 RV 00000 10-2-021042 64200600 00
1302000000
3.50 per
2. Annual pemvt for 15 to 171 spaces space XX-354 DK 001113 000100 CD 8K000 20-2-141001 64200700 1306000000
2a . Transfer to headquarters 10% 99-910 MP 001113 000100 RV 00000 10-2-021042 64200600 00 1302000000
3. Annual permit for 172 and above spaces 600.00 540.00 XX-354 DK 001113 000100 CD SK000 20-2-1410( 1 64200700
1306000000
3a . Transfer to headquarters 60 . 00 99-910 MP 001113 000100 RV 00000 10-2-021042 64200600 00 1302000000
MIGRANT LABOR CAMPS
1 . Annual pemrt for facilities with 5-50 occupants 125.00 125.00 XX-352 DK 001139 000100 CD 81<000 20-2-141001 64200700
1306000000
2. Annual pemdt for facilities with 51 -100 occupants 225.00 225.00 XX-352 DK 001139 000100 CD 8K000 20-2-141001 64200700
1306000000
3. Annual permit for facilities with over 100 occupants 500.00 500.00 XX-352 DK 001139 000100 CD 8K000 20-2-141001 64200700
1306000000
BIOMEDICAL WASTE GENERATORS
1 . Initial permit (prorated after 3/31 for generator, storage and treatment) 55.00 55.00 XX-364 DK 001140 000100 CD
81<000 20-2-141001 64200700 1306000000
2. Renewal of annual pemid except physician office generating
less than 25lbs/30 days) postmarked by October 1 55.00 55.00 XX-364 DK 001140 000100 CD 81<000 20-2-141001 64200700
' 1306000000
3. Renewal of annual permit except physician office generating
less than 25lbs/30 days) postmarked after October 1 75.00 75.00 XX-364 DK 001140 000100 CD 81<000 20-2-141001 64200700
1306000000
4 . Initial Transporter Registration (prorated after 3/31 , includes 1 truck) 55.00 55.00 XX-364 DK 001140 000100 CD 81<000
20-2-141001 64200700 1306000000
5. Initail Registration of Each Additional Truck 10.00 10.00 XX-364 DK 001140 000100 CD 8K000 20-2-141001
64200700 1306000000
6. Annual Registration Renewal (postmarked by 10/01 , includes 1 truck) 55.00 55.00 XX-364 DK 001140 000100 CD 8K000
20-2-141001 64200700 ' 1306000000
7. Annual Registration Renewal (postmarked after 10/01 , includes 1 truck) 75.00 75.00 XX-364 DK 001140 000100 CD 8K000 20-2-141001
64200700 1306000000
8. Annual Registration of Each Additional Truck 10 .00 10.00 XX-364 DK 001140 000100 CD 8K000 20-2-141001 64200700
1306000000
TANNING FACILITIES
1 . Annual license fee 150.00 135.00 XX-369 DK 001144 000100 CD 8K000 20.2-141001 64200700 ' 1306000000
1a . Transfer to headquarters 15 . 00 99-910 TN 001144 000100 RV R9000 10-2-021042 64200600 00 1302000000
2. Fee for each additional device 55.00 49.50 XX-369 DK 001144 000100 CD 8Ko00 20-2-141001 64200700
1306000000
2. a. Transfer to headquarters 5. 50 99-910 TN 001144 000100 RV R9000 10-2-021042 64200600 00
1302000000
3. Late fee 25.00 25.00 XX-369 DK 001092 000100 CD 8K000 20-2-141001 64200700 1306000000
BODY PIERCING
1 . Initial License (prorated quarterly) 150 .00 135.00 XX-349 DK 001149 000100 CD 81<000 20-2-141001 64200700
1306000000
1a . Transfer to headquarters 15. 00 99-910 iE 001149 000100 RV PIERS 10-2-021042 64200600 00
1302000000
2. Temporary Establishment 75.00 67.50 XX-349 DK 001149 000100 CD 8K000 20-2-141001 64200700 1306000000
2a . Transfer to headquarters 7 . 50 99-910 iE 001149 000100 RV PIERS 10-2-021042 64200600 00
1302000000
3. Annual Renewal License Fee 150.00 135.00 XX-349 DK 001149 000100 CD 81<000 20-2-141001 64200700 1306000000
3a . Transfer to headquarters 15 . 00 99-910 iE 001149 000100 RV PIERS 10-2-021042 64200600 00
1302000000
4. Late fee 100.00 100.00 XX-349 DK 001149 000100 CD 81<000 20-2-141001 64200700 1308000000
"Must use County Health Department 1131 (01 -67) Page 2 11 /2/2004
DESCRIPTION FEE DEPOSIT ORG EO OBJECT REVENUE SI OCA FUNDBUDGET IBI PROGRAM
AMOUNT AMOUNT L4/L5 CODE CATEGORY GF-SF-FID ENTITY COMPONENT
FOOD ESTABLISHMENTS
1 . Annual Permit for Fratemal/Civic 160.00 144.00 XX-348 DK 001132 000100 CD 81<000 20-2-141001 64200700
1306000000
1a . Transfer to headquarters 16. 00 99-910 FP 001132 000100 RV 10000 10-2-021042 64200600 00
1302000000
2. Annual Permit School Cafeteria Operating for
9 months or less 130.00 117.00 X0(-348 DK 001132 000100 CD 61<000 20-2-141001 64200700 1306000000
2a . Transfer to headquarters 13 . 00 99-910 FP 001132 000100 RV 10000 10-2-021042 64200600 00
1302000000
3. Annual Pemmt School Cafeteria Operating for more
than 9 months 160-00 144.00 XX-348 DK 001132 000100 CD 81<000 20-2-141001 64200700 1306000000
3a . Transfer to headquarters 16. 00 99-910 FP 001132 000100 RV 10000 10-2-021042 64200600 00 1302000000
4. Annual Permit for Hospital/Nursing Food Service 210.00 189.00 XX-348 DK 001132 000100 CD 81<000 20-2-141001 64200700
1306000000
4a . Transfer to headquarters 21 . 00 99-910 FP 001132 000100 RV 10000 10-2-021042 64200600 00
1302000000
5. Annual Permit for Movie Theaters 160.00 144.00 X0(-348 DK 001132 000100 CD 81<000 20-2-141001 64200700
1306000000
5a Transfer to headquarters 16. 00 99-910 FP 001132 000100 RV 10000 10-2-021042 64200600 00 1302000000
6. Annual Permit for Jails/Prisons 210.00 189.00 X0(-348 DK 001132 000100 CD 81<000 20-2-141001 64200700 1306000000
6a . Transfer to headquarters 21 . 00 99-910 FP 001132 000100 RV 10000 10-2-021042 64200600 00
1302000000
7. Annual Permit for Bars/Lounges (Drink Service Only) 160.00 144.00 XX-348 DK 001132 000100 CD 8K000 20-2-141001
64200700 1306000000
7a . Transfer to headquarters 16 . 00 99-910 FP 001132 000100 RV 10000 10-2-021042 64200600 00
1302000000
8. Annual Permit for Residential Facilities 110.00 99.00 XX-348 DK 001132 000100 CD 81<000 20-2-141001 64200700
1306000000
8a. Transfer to headquarters 11 . 00 99-910 FP 001132 000100 RV 10000 10-2-021042 64200600 00 1302000000
9. Annual Permit for Child Care Centers without C&F license 85.00 76.50 XX-U8 DK 001132 000100 CD 81<000 20-2-141001
64200700 1306000000
9a . Transfer to headquarters 8 . 50 99-910 FP 001132 000100 RV 10000 10-2-021042 64200600 00
1302000000
10. Annual Permit for Limited Food Service 85.00 76.50 XX-348 DK 001132 000100 JRVI
K000 20-2-141001 64200700 1306000000
10a . Transfer to headquarters 8 . 50 99-910 FP 001132 000100 0000 10-2-021042 64200600 00 1302000000
11 . Annual Permit Other Food Service 160.00 144 .00 XX-348 DK 001132 000100 K000 20-2-141001 64200700 1306000000
11 a . Transfer to headquarters 16 .00 99-910 FP 001132 000100 0000 10-2-021042 64200600 00
1302000000
12. Plan Review $35/hour $35/hour XX-348 DK 001092 000100 K000 20-2-141001 64200700 1306000000
13. Food Worker Training (per person) 10.00 10.00 XX-U8 DK 001092 000100 CD I 81<000 20-2-141001 64200700
1306000000
14. Request for Inspection 40.00 40.00 XX-348 DK 001092 000100 CD 81<000 20-2-141001 64200700 1306000000
15. Re-inspection (after the first reinspection) 30.00 30.00 XX-348 DK 001092 000100 CD 81<000 20-2-141001 64200700
1306000000
16. Late Renewal 25.00 25.00 XX-348 DK 001092 000100 CD 81<000 20-2-141001 64200700 1306000000
17. Alcoholic Beverage Inspection Approval 30.00 30.00 XX-348 DK 001092 000100 CD 8K000 20-2-141001 64200700
1306000000
"Must use County Health Department IN (01 -67) Page 3 11 /2/2004
DESCRIPTION FEE DEPOSIT ORG I EO OBJECT REVENUE SI OCA FUND BUDGET IBI PROGRAM
AMOUNT AMOUNT L4/L5 CODE CATEGORY GF-SF-FID ENTITY COMPONENT
ONSITE SEWAGE DISPOSAL PROGRAM (OSTDS)
1 . Application for permitting of an onsite sewage 50.00 46.00
treatment and disposal system which includes
application and plan review for new and repair permits
1a . Transfer to headquarters 4 . 00 99-910 ST 001203 000100 RV 1E000 10-2-021042 64200600 00
1302000000
2. Application and approval for existing system, does not include system 35.00 32.20 XX-361 DK 001092 000100 CD 81<000
20-2-141001 64200700 1306000000
inspection
2a. Transfer to headquarters 2. 80 99-910 ST 001203 000100 RV tE000 10-2-021042 64200600 00
1302000000
3. Application for permitting of a new Performance-based treatment system 125.00 115.00 XX-361 DK 001092 000100 CD 81<000 20-2-141001
64200700 1306000000
3a . Transfer to headquarters 10 . 00 99-910 ST 001203 000100 RV 1E000 10-2-021042 64200600 00
1302000000
4 . Site evaluation for a new system 115.00 105.80 XX-361 DK 001092 000100 CD 81<000 20-2-141001 64200700
1306000000
4a . Transfer to headquarters 9 . 20 99-910 ST 001203 000100 RV lE000 10-2-021042 64200600 00
1302000000
5 . Site evaluation for a system repair or modification of system 75.00 69.00 XX-361 DK 001092 000100 CD 81<000
20-2-141001 64200700 1306000000
5a . Transfer to headquarters 6 . 00 99-910 ST 001203 000100 RV 1E000 10-2-021042 64200600 00
1302000000
6. Site re-evaluation , new or repair or modification 75.00 69.00 XX-361 DK 001092 000100 CD 81<000 20-2-141001
64200700 1306000000
6a . Transfer to headquarters 6 . 00 99-910 ST 001203 000100 RV lE000 10-2-021042 64200600 00
1302000000
7. Permit for new systems , or modification to system 55.00 50.60 XX-361 DK 001092 000100 CD 81<000 20-2-141001
64200700 1306000000
7a . Transfer to headquarters 4 . 40 99-910 ST 001203 000100 RV 1E000 10-2-021042 64200600 00
1302000000
8 . New system or system modification installation inspection 80 . 00 73.60 XX-361 DK 001092 000100 CD 81<000 20-2-
141001 64200700 1306000000
8a . Transfer to headquarters 6 . 40 99-910 ST 001203 000100 RV lE000 10-2-021042 64200600 00
1302000000
8b . Research fee to be collected in addition , and concurrent with 5 . 00 5 . 00 99-910 RF 001201 000100 RV 89000 10-2-021042
64200600 00 1302000000
the permit for a new system installation fee .
9. Repair permit issuance which includes inspection 50 .00 41 .40 XX-361 DK 001092 000100 CD 81<000 20-2- 141001
64200700 1306000000
9a . Transfer to headquarters 3. 60 99-910 ST 001203 000100 RV 1E000 10-2-021042 64200600 00
1302000000
9b . Transfer to headquarters for training center 5. 00 99-910 TC 001067 000100 RV SEWTN 10-2-021042
64200600 00 1302000000
10. Inspection of system previously in use 50.00 46.00 XX-361 DK 001092 000100 CD 8K000 20-2-141001 64200700 1306000000
10a . Transfer to headquarters 4 . 00 99-910 ST 001203 000100 RV lE000 10-2-021042 64200600 00
1302000000
11 . Reinspection fee per visit for site inspections after system 50. 00 46.00 XX-361 DK 001092 000100 CD 81<000
20-2-141001 64200700 1306000000
construction approval
11 a . Transfer to headquarters 4 . 00 99-910 ST 001203 000100 RV lE000 10-2-021042 64200600 00
1302000000
12. Installation reinspection of noncompliant system per 50.00 46.00 XX-361 DK 001092 000100 CD 81<000 20-2-141001
64200700 1306000000
each site visit
12a . Transfer to headquarters 4 . 00 99-910 ST 001203 000100 RV 1E000 10-2-021042 64200600 00
1302000000
13 . System abandonment permit, includes permit 40 .00 36 .80 XX-361 DK 001092 000100 CD 81<000 20-2-141001
64200700 " 1306000000
issuance and inspection
13a. Transfer to headquarters 3. 20 99-910 ST 001203 000100 RV lE000 10-2-021042 64200600 00 1302000000
14 . Annual operating permit fee for systems in IM and 150 .00 138 .00 XX-361 DK 001092 000100 CD 81<000 20-2- 141001
64200700 1306000000
equivalent areas , and for systems receiving commercial waste
14a . Transfer to headquarters 12. 00 99-910 ST 001203 000100 RV 1E000 10-2-021042 64200600 00
1302000000
15. Amendments or changes to the operating permit during 50 . 00 46 . 00 XX-361 DK 001092 000100 CD 8K000 20-2-
141001 64200700 1306000000
the permit period per change or amendment
15a. Transfer to headquarters 4 . 00 99-910 ST 001203 000100 RV 1E000 10-2-021042 1 64200600 1
00 1302000000
"Must use County Health Department 1131 (01 -67 ) Page 4 11 /2/2004
DESCRIPTION FEE DEPOSIT ORG EO OBJECT REVENUE SI OCA FUND BUDGET IBI PROGRAM
AMOUNT AMOUNT L4/1.5 CODE CATEGORY GF-SF -FID ENTITY COMPONENT
16. Aerobic treatment unit operating permit (biennial ) 100 .00 92.00 XX-361 DK 001092 000100 CD 81<000 20-2-
141001 64200700 1306000000
16a . Transfer to headquarters 8 .00 99-910 ST 001203 000100 RV lE000 10-2-021042 64200600 00
1302000000
17. Biennial operating permit fee for performance-based treatment systems. 100.00 92.00 XX-361 DK 001092 000100 CD 8K000
20-2-141001 64200700 1306000000
A prorated fee is to be charged beginning with second year of operation.
17a . Transfer to headquarters 8 . 00 99-910 ST 001203 000100 RV 1E000 10-2-021042 64200600 00
1302000000
18. Review of application due to proposed amendments or changes after 75.00 69.00 XX-361 DK 001092 000100 CD 81<000
20-2-141001 64200700 1306000000
initial operating permit issuance for a performance-based treatment system
18a . Transfer to headquarters 6.00 99-910 ST 001203 000100 RV 1E000 10-2-021042 64200600 00
1302000000
19. Tank manufacturer's inspection per annum 100 .00 50.00 XX-361 DK 001092 000100 CD 81<000 20-2- 141001 64200700
1306000000
19a . Transfer to headquarters 50 . 00 99-910 ST 001203 000100 RV lE000 10-2-021042 64200600 00
1302000000
20 . Septage disposal service permit per annum 75.00 69 .00 XX-361 DK 001092 000100 CD 81<000 20-2-141001 64200700
1306000000
20a . Transfer to headquarters 6 . 00 99-910 1 ST 001203 000100 RV lE000 10-2-021042 64200600 00
1302000000
21 . Additional charge per pump out vehicle 35.00 32.20 XX-361 DK 001092 000100 CD 8K000 20-2- 141001 64200700
1306000000
21 a . Transfer to headquarters 2. 80 99-910 ST 001203 000100 RV lE000 10-2-021042 64200600 1
00 1302000000
22. Portable or temporary toilet service permit per annum 75.00 69.00 XX-361 DK 001092 000100 CD 81<000 20-2-141001
64200700 1306000000
22a . Transfer to headquarters 6 . 00 99-910 ST 001203 000100 RV 1E000 10-2-021042 64200600 00
1302000000
23. Additional charge per pump out vehicle 35.00 32.20 XX-361 DK 001092 000100 CD 81<000 20-2-141001 64200700
1306000000
23a . Transfer to headquarters 2 . 80 99-910 ST 001203 000100 RV lE000 10-2-021042 64200600 00
1302000000
24 . Septage stabilization facility inspection fee per annum 150 .00 138.00 XX-361 DK 001092 000100 CD 8K000 20-2- 141001
64200700 1306000000
24a . Transfer to headquarters 12. 00 99-910 ST 001203 000100 RV lE000 10-2-021042 64200600 00
1302000000
24 . Septage disposal site evaluation fee per annum 200 . 00 184 .00 XX-361 DK 001092 000100 CD 8K 000 20-2- 141001
64200700 1306000000
24a . Transfer to headquarters 16 . 00aXX-36lDK
001203 000100 RV tE000 10-2-021042 64200600 00 1302000000
24 . Aerobic treatment unit maintenance entity permit per annum 25.00 23 . 00 001092 000100 CD 8K000 20-2-141001 64200700
1306000000
24a . Transfer to headquarters 2 . 00 001203 000100 RV lE000 10-2-021042 64200600 00 1302000000
25 Variance application for a single family residence per 150 . 00 75. 00 001135 000100 CD 81<000 20-2- 141001
64200700 1306000000
each lot or building site
25a . Transfer to headquarters 75. 00 99-910 CR 001204 000100 RV BY000 10-2-021042 64200600 1 00
1302000000
26. Variance application for a multi-family or commercial 200 . 00 100 .00 XX-361 DK 001135 000100 CD 8K000 20-2-141001
64200700 " 1306000000
building per each building site
26a . Transfer to headquarters 100 . 00 99-910 CR 001204 000100 RV BY000 10-2-021042 64200600 00
1302000000
27 Inspection for construction of an injection well (FL Keys) 125.00 125. 00 XX-361 DK 001092 000100 CD 81<000 20-2-
141001 64200700 1306000000
FEE COLLECTED AT HEADQUARTERS - Onsite Sewage Program
1 . Application for Innovative product approval 500 . 00 For headquarters use only
2 . Application for registration including initial examination 75. 00 For headquarters use only
3 . Initial registration 100 . 00 For headquarters use only
4 . Renewal registration 100 . 00 For headquarters use only
5. Certificate of authorization each two year period 250 . 00 For headquarters use only
"Must use County Health Department 1131 (01 -67 ) Page 5 11 /2/2004
DESCRIPTION FEE DEPOSIT ORG EO OBJECT REVENUE sl OCA FUND BUDGET IBI PROGRAM
AMOUNT AMOUNT L4/L5 CODE CATEGORY GF-SF-FID ENTITY COMPONENT
DRINKING WATER
1 . First Year Public Water Annual Operation Permit and 75.00 67.50 XX-357 DK 001166 000100 CD 8K000 20-2-141001
64200700 1306000000
Construction Pernrit - Limited Use
1 a . Transfer to headquarters 7 . 50 99-910 64 001166 000100 RV M5000 10-2-021042 64200600 00 1302000000
2. Second Year Public Water Annual Operation Permit -
Limited Use 70.00 63.00 XX-357 DK 001166 000100 CD 8K000 20-2-141001 64200700 1306000000
2a . Transfer to headquarters 7 . 00 99-910 64 001166 000100 RV M5000 10-2-021042 64200600 00 1302000000
3. Multi-Family Water Construction Pemut - serving 3 or 4 40.00 36.00 XX-357 OK 001165 000100 Co 81<000 20-2-141001
64200700 1308000000
non-rental residences
3a . Transfer to headquarters 4 . 00 99-910 64 001165 000100 RV M5000 10-2-021042 64200600 00
1302000000
4. Initial Operating Permit Fee After March 31 of Any Year 35.00 31 .50 XX-357 DK 001166 000100 CD 8K000 20-2-141001
64200700 1306000000
4a . Transfer to headquarters 3 . 50 99-910 64 001166 000100 RV M5000 10-2-021042 64200600 00
1302000000
5. Non-SDWA Lab Sample (Sample Collection/Review
of Analytical Results/Health Risk Interpretation):
Bacterial Sample Collection 40.00 40.00 XX-357 DK 001142 000100 CD 8K000 20-2-141001 64200700 1306000000
Chemical Sample Collection 50.00 50.00 XX-357 DK 001142 000100 CD 8K000 20-2-141001 64200700 1306000000
Combined Chemical microbiological 55.00 55.00 XX-357 DK 001142 000100 CD 8K000 20-2-141001 64200700 1306000000
6. Reinspection of Multi-family Water System 25.00 25.00 XX-357 DK 001092 000100 CD 8K000 20-2-141001 64200700
1306000000
7. Reinspection of Public Water System 40.00 40.00 XX-357 DK 001092 000100 CD 81<000 20-2-141001 64200700
1306000000
8. Delineated Area Clearance Fee 50.00 50.00 XX-357 DK 001092 000100 CD 8K000 20-2-141001 64200700 1306000000
9. Limited Use Commercial Registered System 15.00 15.00 XX-357 DK 001092 000100 CD 8K000 20-2-141001 64200700
1306000000
10. Limited Use Commercial Public Water System 25.00 25.00 XX-357 DK 001092 000100 CD 8K000 20-2-141001 64200700
1306000000
Operating Permit Family Day Care Establishment
11 . Limited Use Commercial Public Water System Operating Permit 15.00 15.00 XX-357 DK 001092 000100 CD 8K000 20-2-141001
64200700 1306000000
Family Day Care Establishment After March 31 of Any Year.
Safe-Drinking Water Act (Delegated Counties)
1 . Construction pewit for each Category I through III treatment
plant, as defined in Rule 62-699.3109 F .A.C. . , with treatment
other than disinfection only.
a. Treatment plant - 5 MGD and above 70500.00 7$ 00.00 XX-358 WC 001211 000100 CD SDWCH 2O-2-141001 64200700
1306000000
b. Treatment plant - 1 MGD up to 5 MGD 69000.00 69000.00 XX-358 WC 001211 000100 CD SDWCH 2O-2-14100164200700
1306000000
c. Treatment plant - 0.25 MGD up to 1 MGD 41000.00 41000.00 XX-358 WC 001211 000100 CD SDWCH 2O-2-141001 64200700
1306000000
d. Treatment plant - 0. 1 MGD up to .25 MGD 21000.00 21000.00 XX-358 WC 001211 000100 CD SDWCH 2O-2-141001 64200700
1306000000
e. Treatment plant - up to 0. 1 MGD 1 ,000.00 1 ,000.00 XX-358 WC 001211 000100 CD SDWCH 2O-2-141001 64200700
1306000000
2. Construction permit for each Category IV treatment plant, as
defined in Rule 62-699.310, F .A.C . . , with treatment other than
disinfection only.
"Must use County Health Depaf rant 1131 (01 -67) Page 6 11 /2/2004
DESCRIPTION FEE DEPOSIT ORG EO OBJECT REVENUE SI OCA FUND BUDGET IBI PROGRAM
AMOUNT AMOUNT L4/L5 CODE CATEGORY GF-SF-FID ENTITY COMPONENT
a. Treatment plant - 5 MGD and above 7,500.00 71500.00 XX-358 WC 001211 000100 CD SDWCH 2O-2-141001 64200700
1306000000
b. Treatment plant - I MGD up to 5 MGD 6,000.00 61000.00 XX-358 WC 001211 000100 CD SDWCH 2O-2-141001 64200700
' 1306000000
c. Treatment plant - 0.25 MGD up to 1 MGD 4 ,000 .00 41000.00 XX-358 WC 001211 000100 CD SDWCH 2O-2-141001
64200700 1306000000
d. Treatment plant - 0. 1 MGD up to .025 MGD 2,000.00 29000.00 X0(-358 WC 001211 000100 CD SDWCH 2O-2-141001 64200700
1306000000
e. Treatment plant - 0.01 up to 0. 1 MGD 1 ,000.00 11000.00 XX-358 WC 001211 000100 CD SDWCH 2O-2-141001
64200700 1306000000
f. Treatment plant - up to 0 .01 MGD 400.00 400.00 XX-358 WC 001211 000100 CD SDWCH 2O-2-141001 64200700
1306000000
3. Construction permit for each Category V treatment plant, as
defined in Rule 62399. 310, F.A.C. . , - Disinfection Only
a. treatment plant - 5 MGD and above 5,000.00 5,000.00 XX-358 WC 001211 000100 CD SDWCH 2O-2-141001 64200700
' 1306000000
b. Treatment plant - 1 MGD up to 5 MGD 39000.00 31000.00 XX-358 WC 001211 000100 CD SDWCH 2O-2-141001 64200700 1306000000
c. Treatment plant - 0.25 MGD up to 1 MGD 19000 .00 11000.00 XX-358 WC 001211 000100 CD SDWCH 2O-2-141001 64200700
1306000000
d. Treatment plant - 0. 1 MGD up to .025 MGD 500.00 500.00 XX-358 WC 001211 000100 CD SDWCH 2O-2-141001 64200700
' 1306000000
e. Treatment plant - up to 0. 1 MGD 300.00 300.00 XX-358 WC 001211 000100 CD SDWCH 20-2-141001 64200700
•' 1306000000
4. Distribution and transmission systems, including raw water
lines into the plant, except those under general pennit.
a. Serving a community public water system 500 .00 500.00 XX-358 WC 1211 000100 CD SDWCH 2O-2-141001 64200700
' 1306000000
b. Serving a non-transient non-community public water systems 350.00 350 .00 XX-358 WC 001211 000100 CD SDWCH 2O-2-141001
64200700 1306000000
c . Serving a non-community public water system 250.00 250.00 XX-358 WC 001211 000100 CD SDWCH 2O-2-141001 64200700
1306000000
5. Construction permit for each public water supply well .
a. Well located in a delineated area pursuant to Chapter 62-524,
F .A.C . . 500.00 500.00 XX-358 WC 001211 000100 CD SDWCH 2O-2-141001 64200700 1306000000
b. Any other public water supply well . 250 .00 250.00 XX-358 WC 001211 000100 CD SDWCH 2O-2-141001 64200700
1306000000
6. Major modifications to systems that atter the existing treatment
without expanding the capacity of the system and are not
considered substantial changes pursuant to
Rule 62-4 .050(7) below.
a. 1MGD and above 21000.00 21000.00 XX-358 WC 001211 000100 CD SDWCH 2O-2-141001 64200700 1306000000
b. . 1 MGD up to 1 MGD 11000.00 1 ,000.00 XX-358 WC 001211 000100 CD SDWCH 2O-2-141001 64200700
1306000000
c. 0.01 upto . 1 MGD 500.00 500.00 XX-358 WC 001211 000100 CD SDWCH 2O-2-141001 64200700 1306000000
d . Up to 0.01 MGD 100 .00 100 .00 XX-358 WC 001211 000100 CD SDWCH 2O-2-141001 64200700 1306000000
e. Lead and Copper Corrosion Fee 100 .00 100.00 XX-358 WC 001211 000100 CD SDWCH 2O-2-141001 64200700 1306000000
7. Minor modifications to systems that result in no change in the
treatment or capacity.
a . . 1 MGD and above 300.00 300.00 XX-358 WC 001211 000100 CD SDWCH 2O-2-141001 64200700 1306000000
b. Upto0. 1 MGD 100.00 100.00 XX-358 WC 001211 000100 CD SDWCH 2O-2-141001 64200700 1306000000
8 . Fines and Forfeitures Variable Variable XX-358 WC 012020 001200 CD SDWCH 2O-2-141001 64200700
1306000000
9. General Permit Fee for any General Permit not specifically listed: 100.00 100.00 XX-358 WC 001211 000100 CD SDWCH 2O-2-
141001 64200700 1306000000
a. General Permits requiring Professional Engineer or Professional 250.00 250.00 XX-358 WC 001211 000100 CD SDWCH 2O-2-141001
64200700 1306000000
Geologist certification
a . General Permits not requiring Professional Engineer or 100 .00 100.00 XX-358 WC 001211 000100 CD SDWCH 2O-2-141001
64200700 1306000000
Professional Geologist certification
Radioactive Materials Licenses - General
"Must use County Health Department IN (01 -67 ) Page 7 11 /2/2004
DESCRIPTION FEE DEPOSIT ORG EO OBJECT REVENUE SI OCA FUND BUDGET IBI PROGRAM
AMOUNT AMOUNT L4/L5 CODE CATEGORY GF-SF-FID ENTITY COMPONENT
1 . Annual fee: static elimination devices $25.00 For headquarters use only
2. Annual fee: measuring, gauging and control devices $25.00
For headquarters use only
3. Annual fee: in vivo testing license $125.00 For headquarters use only
4. Annual fee: in vitro testing license $125.00 For headquarters use only
5. Annual fee: depleted uranium license $125.00 For headquarters use only
Radioactive Materials Licenses - Specific
Application Fees
1 . Source Material .
a . Concentration of uranium from phosphate ores for the
production of uranium as "yellow cake" or powdered solid; $6,907 For headquarters use only
b. Concentration of uranium from phosphate ores for the
production of "green cake" or equivalent, moist or solid; $3,768 For headquarters use only
c . All other specific source material licenses excluding depleted
uranium used as shielding and counterweights . $544 For headquarters use only
2. Special Nuclear Material (SNM).
a. SNM in sealed sources contained in devices in measuring systems; $653 For headquarters use only
b. SNM not sufficient to form a critical mass, except as in 2.a. ,
2.c . and 5.e. $ 1 ,340 For headquarters use only
c . SNM to be used as calibration and reference sources. $205 For headquarters use only
3 . Byproduct, naturally occurring or accelerator produced material .
a . Processing or manufacturing for commercial distribution or
industrial uses; $2,923 For headquarters use only
b. Processing or manufacturing and distribution of
radiopharmaceuticals . This category includes radiopharmacies . $2,560 For headquarters use only
c . Industrial radiography performed only in an approved shielded
radiography installation, $1 ,558 For headquarters use only
d . Industrial radiography performed only at the address indicated
in the license, or at temporary job sites of the licensee; $ 1 ,643
For headquarters use only
e . Radioactive materials in sealed sources for irradiation of
materials where the source is not removed from the shield and is
less than 10,000 curies; $605 For headquarters use only
f. (I ) Radioactive materials in sealed sources for irradiation of
materials when the source is not removed from the shield and is
greater than 10,000 curies and less than 100,000 curies, or where
the source is less than 100,000 curies and is removed from the
shield , $ 1 ,414 For headquarters use only
(11 ) Radioactive materials in sealed sources for irradiation of
materials when the source is equal to or greater than 100,000
curies and less than 1 ,000 ,000 curies, $3,659 For headquarters use only
( III ) Radioactive materials in sealed sources for irradiation of
materials when the source is greater than 1 ,000,000 curies; $9 , 780 For headquarters use only
g . Distribution of items containing radioactive materials to
" Must use County Health Department 1131 (01 -67 ) Page 8 11 /2/2004
DESCRIPTION FEE DEPOSIT ORG EO OBJECT REVENUE SI OCA FUND BUDGET IBI PROGRAM
AMOUNT AMOUNT L4/L5 CODE CATEGORY GF-SF-FID ENTITY COMPONENT
persons under a general license; $1 ,643
For headquarters use only
h. Distribution of exempt quantities or items containing naturally
occurring or accelerator produced material to persons exempt
from licensing; $ 1 ,643 For headquarters use only
i. Well logging
(1 ) Sealed sources or sub-surface tracer studies $1 , 135 For headquarters use only
(II) Sub-surface tracer studies and sealed sources $ 1 ,436 For headquarters use only
'. Nuclear Laundry; $3,200 For headquarters use only
k. Industrial or medical research and development; $1 , 184 For headquarters use only
1 .(I ) Fbced and portable gauging devices $605 For headquarters use only
(11 ) In Vitro and clinical laboratory $725 For headquarters use only
(III ) Academic $978 For headquarters use only
IV) Possession of uranium or thorium, or their decay products, as
a result of mining or processing $978 For headquarters use only
(V) All other specific licenses except as otherwise noted $725 For headquarters use only
m. Licenses of broad scope
(1 ) Academic $39200 For headquarters use only
(II ) Medical $3,200 I For headquarters use only
(III ) Industrial or Research and Development $3,200 For headquarters use only
n. Gas chromatography devices; $434 For headquarters use only
o. Reference or calibration sources equal to or less than one
millicurie total; $314 For headquarters use only
p. Nuclear service licenses, such as leak testing, instrument
calibration, etc. ; $518 For headquarters use only
4. Waste disposal or processing
a Commercial waste disposal or treatment facilities, including
burial or incineration; $275,842 For headquarters use only
b. All other commercial facilities involving compaction,
repackaging, storage or transfer; $27,084 For headquarters use only
c. Commercial treatment of radioactive materials for release to
unrestricted areas. $5,760 For headquarters use only
5. Medical use.
a. Teletherapy or high dose rate remote after loading devices; $19414 For headquarters use only
b. Medical institutions including hospitals, except 5.a. and 5.e. ; $1 ,643 For headquarters use only
c. Private practice physicians except 5.a. and 5.d. ; $1 , 184 For headquarters use only
d . Private practice physicians using only strontium 90 eye
applicators, materials authorized by Rule 64E-5.631 , F.A.C. , and
materials authorized by Rule 64E-5.630; F .A. C . $605 For headquarters use only
e. Nuclear powered pacemakers; $434
For headquarters use only
f. Mobile nuclear medicine services . $1 ,414 For headquarters use only
6. Civil defense. $544 For headquarters use only
7. Device, product, or sealed source safety evaluation.
"Must use County Health Department 81 (01 -67) Page 9 11 /2/2004
DESCRIPTION FEE DEPOSIT ORG EO OBJECT REVENUE SI OCA FUND BUDGET IBI PROGRAM
AMOUNT AMOUNT L4/L5 CODE CATEGORY GF-SF-FID ENTITY COMPONENT
a. Device evaluation, per device; $1 ,208 For headquarters use only
b. Sealed source design, per source. $528 For headquarters use only
Radioactive Materials Licenses - Specific
Annual Fees
1 . Source Material.
a. Concentration of uranium from phosphate ores for the
production of uranium as "yellow cake" or powdered solid; $11 ,942 For headquarters use only
b. Concentration of uranium from phosphate ores for the
production of "green cake" or equivalent, moist or solid; $7,439 For headquarters use only
c. All other specific source material licenses excluding depleted
uranium used as shielding and counterweights. $229 For headquarters use only
2. Special Nuclear Material (SNM ).
a. SNM in sealed sources contained in devices used in
measuring systems; $518 For headquarters use only
b. SNM not sufficient to form a critical mass, except as in 2.a. ,
above, and 2.c. and 5.e. , below; $ 1 ,944 For headquarters use only
c. SNM to be used as calibration and reference sources . $109 For headquarters use only
3. Byproduct, naturally occurring or accelerator produced material .
a. Processing or manufacturing for commercial distribution or
industrial uses; $2,802 For headquarters use only
b. Processing or manufacturing and distribution of
radlophannaceuticals. This category includes radiopharmacies. $39840 For headquarters use only
c. Industrial radiography performed only in an approved shielded
radiography installation, $2, 161 For headquarters use only
d. Industrial radiography performed only at the address indicated
in the license, or at temporary job sites of the licensee; $2,657
For headquarters use only
e. Radioactive materials in sealed sources for irradiation of
materials where the source is not removed from the shield and is
less than 10,000 curies; $605 For headquarters use only
f(l) Radioactive materials in sealed sources for irradiation of
materials when the source is not removed from the shield and is
greater than 10,000 curies and less than 100,000 curies, or where
the source is less than 100,000 curies and is removed from
the shield ; $1 ,630 For headquarters use only
(II ) Radioactive materials in sealed sources for irradiation of
materials when the source is equal to or greater than 100,000
curies and less than 1 ,000,000 curies; $3,961 For headquarters use only
(III) Radioactive materials in sealed sources for irradiation of
materials when the source is greater than 1 ,000,000 curies; $4,398 For headquarters use only
. Distribution of items containing radioactive materials to persons
undera general license; $2, 150 For headquarters use only
h. Distribution of exempt quantities or items containing naturally
"Must use County Health Department 1131 (01 -67) Page 10 11 /2/2004
DESCRIPTION FEE DEPOSIT ORG EO OBJECT REVENUE SI OCA FUND BUDGET IBI PROGRAM
AMOUNT AMOUNT L4/L5 CODE CATEGORY GF-SF-FID ENTITY COMPONENT
occurring or accelerator produced material to persons exempt
from licensing; $2, 150 For headquarters use only
L Well logging
(1 ) Sealed sources or sub-surface tracer studies $19498 For headquarters use only
(II ) Sub-surface tracer studies and sealed sources $19594 For headquarters use only
j . Nuclear Laundry; $5,651 For headquarters use only
k. Industrial or medical research and development; $19474 For headquarters use only
L(l) Fixed and portable gauging devices $966 For headquarters use only
(11) In Vitro and clinical laboratory $918 For headquarters use only
(III ) Academic $ 1 , 171 For headquarters use only
IV) Possession of uranium or thorium, or their decay products, as a
result of mining or processing $870 For headquarters use only
(V) All other specific licenses except as otherwise noted $19002 For headquarters use only
m. Licenses of broad scope
(1 ) Academic $7,346 For headquarters use only
(II ) Medical $5,474 For headquarters use only
(III) Industrial or Research and Development $41568 For headquarters use only
n. Gas chromatography devices; $314 For headquarters use only
o. Reference or calibration sources equal to or less than one
millicurie total ; $132 For headquarters use only
p. Nuclear service licenses, such as, leak testing, instrument
calibration, etc. ; $410 For headquarters use only
4. Waste disposal or processing
a. Commercial waste disposal or treatment facilities, including
burial or incineration; $2509555 For headquarters use only
b. All other commercial facilities involving compaction,
repackaging, storage or transfer; $24,971 For headquarters use only
c. Commercial treatment of radioactive materials for release to
unrestricted areas. $5,735 For headquarters use only
5. Medical use.
a. Teletherapy or high dose rate remote after loading devices; $1 ,378 I For headquarters use only
b. Medical institutions including hospitals, except category 5.a.
and 5.e. ; $1 ,908 For headquarters use only
c. Private practice physicians except category 5.a. and 5.d. ; $1 ,340 For headquarters use only
d . Private practice physicians using only strontium 90 eye
applicators, materials authorized by Rule 64&5.631 , F .A.C. , and
materials authorized by Rule 64E-5.630; F.A.C . $748 For headquarters use only
e. Nuclear powered pacemakers; $266
For headquarters use only
f. Mobile nuclear medicine services. $1 ,625 For headquarters use only
6. Civil defense. $821 For headquarters use only
7. Device, product, or sealed source safety evaluation.
a. Device evaluation, per device; NONE
"Must use County Health Department 1131 (01 -67) Page 11 11 /2/2004
DESCRIPTION FEE DEPOSIT ORG EO OBJECT REVENUE SI OCA FUND BUDGET IBI PROGRAM
AMOUNT AMOUNT L4/L5 CODE CATEGORY GF-SF-FID ENTITY COMPONENT
b. Sealed source design, per source. NONE
Reclamation Fee 5% of annual For headquarters use only
licensing fee
X-Ray Machine Annual Registration Fees
1 . Medical, chiropractic, osteopathic, or naturopathic machines
- First tube $ 145 For headquarters use only
Each additional tube $85 For headquarters use only
2. Veterinary machines - First tube $50 For headquarters use only
Each additional tube $34 For headquarters use only
3. Educational or industrial machines - First tube $47 For headquarters use only
Each additional tube $23 For headquarters use only
4 . Dental or podiatry machines - First tube $31 For headquarters use only
Each additional tube $11 For headquarters use only
5. Medical accelerators $258 For headquarters use only
Each additional tube $148 For headquarters use only
6. Non-medical accelerators $81 For headquarters use only
Each additional tube $48 For headquarters use only
Radiologic Technologist Certifications
1
"Must use County Health Department 81 (01 -67) Paye 12 11 /2/2004
DESCRIPTION FEE DEPOSIT ORG EO OBJECT REVENUE SI OCA FUND BUDGET IBI PROGRAM
AMOUNT AMOUNT L4/L5 CODE CATEGORY GF-SF-FID ENTITY COMPONENT
1 . Application and study guide (applicant also pays whatever fee
the testing service charges) $75 For headquarters use only
2. Application without study guide (applicant also pays whatever
fee the testing service charges) $50 For headquarters use only
3. Application through endorsement (no test needed) $45 For headquarters use only
4. Repeat examinations (applicant also pays whatever fee the
testing service charges) $35 For headquarters use only
5. Renewal - first category $55 For headquarters use only
Each additional category $40 For headquarters use only
6. Change in status from active to inactive $40 For headquarters use only
7. Late renewal fee $100 For headquarters use only
8. Duplicate certificate $10 For headquarters use only
9. Listings and mailing labels , per name $0.05 For headquarters use only
Setup charge $55 For headquarters use only
10. Study guide $25 For headquarters use only
Pre and Post Mining Fees
1 . Gamma radiation exposure measurement ( 1 per acre) $7.50 For headquarters use only
2. Soil characterization measurement (1 per 20 acres) $320 For headquarters use only
3. Air monitoring measurements $165 For headquarters use only
4. Surface and ground water measurements $300 For headquarters use only
Low-Level Radioactive Waste Inspection Fee
Cubic foot of waste shipped (minimum fee = $50 per shipment) $1 .95 For headquarters use only
Low-Level Radioactive Waste Transport Fee
Annual transport permit $100 For headquarters use only
Water Analysis Fees
1 . Gross alpha $28 For headquarters use only
2. Gross beta $28 For headquarters use only
3. Radium 226 $110 For headquarters use only
4. Radium 228 $110 For headquarters use only
5. Uranium $110 For headquarters use only
6. Tritium $40 For headquarters use only
7. Strontium 89, strontium 90 $95 For headquarters use only
8. Iodine 131 $110 For headquarters use only
9. Photon emitters $128 For headquarters use only
Laboratory Certification Fees
1 . Safe drinking water certification $500 For headquarters use only
2. Clean water certification $500 For headquarters use only
3. Resource conservation recovery $500 For headquarters use only
4. Field of testing application $200 For headquarters use only
"Must use County Health Department 1131 (01 -67) Page 13 11 /2/2004
ATTACHMENT VII
Primary Care
" Primary Care" as conceptualized for the county health departments and for the use of categorical
Primary Care funds (revenue object code 015011 ) is defined as :
" Health care services for the prevention or treatment of acute or chronic medical conditions or minor
injuries of individuals which is provided in a clinic setting and may include family planning and
maternity care . "
Indicate below the county health department programs that will be supported at least in part with
categorical Primary Care funds this contract year :
. x Comprehensive Child Health (229/29 )
x Comprehensive Adult Health (237/37 )
x Family Planning (223/23 )
Maternal Health/IPO (225/25 )
Laboratory (242/42 )
Pharmacy (241 /93 )
Other Medical Treatment Program (please identify)
Describe the target population to be served with categorical Primary Care funds .
The target population served with categorical Primary Care funds are the residents of Indian River
County , who fall at or below 200 % of Federal Poverty .
Does the health department intend to contract with other providers for the delivery of primary health
care services using categorical (015011 ) Primary Care funds ? If so , please identify the provider(s ) ,
describe the services to be delivered , and list the anticipated contractual amount by provider. In
addition , contract providers are required to provide data on patients served and the services provided
so that the patients may be registered and the service data entered into HCMS .
No
INDIAN RIVER COUNTY HEALTH DEPARTMENT
FEE SCHEDULE -- Effective Oct 1 , 2004
VISIT DESCRIPTION E/M CODES 0% - A 17% - B 33% - C 50% - D 67% - E 83% - F 100% - G COST
Medical Visit - New Patient
99201 Level One �- $0 . 00 $9. 35 $ 19 .80 $27 . 50 $36 . 85 $45.65 $55.00 $55.00
99202 Level Two $0.00 $9 .35 $ 19 . 80 $30 . 00 $40 .20 $49 .80 $60 . 00 $60 . 00
99203 Level Three $0 .00 $ 11 . 05 $21 .45 $32 .50 $43 . 55 $53 . 95 $65. 00 $65.00
99204 Level Four $0 . 00 $ 11 .90 $23 . 10 $35 .00 $43 . 55 _ $58 . 10 $70 .00 $70 .00
Nurse Protocol $0 . 00 $9 . 35 $ 18 . 15 $27 . 50 $36.85 $45 . 65 $55 00 $55 . 00
Medical Visit - Established Patient -
99211 Level One $0 .00 $5 .44 $ 10 . 56 $ 16.00 $21 .44 $26 .56 $32 .00 $32 .00
99212 Level Two _ $0 .00 $6 .29 $ 12 .21 _ $ 18 . 50 $24 . 79 $30 . 71 $37 . 00 $37 . 00
99213 Level Three $0 .00 __$77 -_14 $ 13 . 86
�- _ - _ $21_. 00 - $28 . 14 1 $34 .86 1 $42 . 00 $42 .00
99214 Level Four 1 $0.00 $7 . 99 $ 15 . 51 1 $23. 50 $31 .49 $39 .01 $47 .00 $47 . 00
Nurse Protocol $0 .00 $5 .44 $ 10 .6 $ 16 $21 .44 $26 . 56 ! - $32 . 00 $32 .00
School/Work Physicial (CHCU )* $0.00 $5 .44 $ 10 . 56 $ 16 .001 $21 .44 $26 . 56 $32 .00 $32 .00
Immigration Physical** $0 .00 $ 10 .20 $ 19.80 1 $30 . 00 ; $40 .20 $49 .80 $60 . 00 $60 . 00
*Medicaid "Child Health Check-Up" and routine physical do not include applicable in-house laboratory services .
Must be established primary care patient to receive physical on sliding fee scale .
**Does not include immunizations or contracted laboratory services
Out of County Primary Care Fee* $0 . 00 $30 .00 $30 . 00 $30 .00 $30 .00 $30 . 00 $55 .00 $55 . 00
*Deposit for services. Must be paid prior to clinic visit with balance due at completion of visit. ;
Family Planning I -
Initial/Annual Family Planning Visit* $0 . 00 $ 14.45 $28 .05 $42 .50 $56 .95 $70 .55 $85 . 00 $85. 00
Subsequent Family Planning Visit(s ) 1 $0 . 00 $5 .44 $ 10 . 5_6 $ 16 . 00 $21 .44 _ $26 .56 $32 . 00 1 $32 .00
*Includes all applicable laboratory services
11 /2/2004CLFEE2004-05 Page 1 of 7
INDIAN RIVER COUNTY HEALTH DEPARTMENT
FEE SCHEDULE - Effective Oct 1 , 2004
Procedures not included in office visit 0% = A 17% - B 33% - C 50% - D 670% - E 83% - F 100%
- G COST -
57454 Colposcopy (with biopsy) _ $0. 00 $8 . 50 $ 16 . 50 $25 . 00 1 $33. 50 $41 .50 $50 . 00 $50 . 00
57452 Colposcopy (without biopsy) $0 .00 $6.80 $ 13.20 $20 .00 $26 . 80 $33.20 $40 .00 $40.00
58300 IUD Insertion $0.00 $9 . 35 $ 18 . 15 $27. 50 $36.85 $45 . 65 $55.00 $55.00
58301 IUD Removal $0.00 $ 10 .20 $ 19.80 $30 .00 $40 .20 $49 .80 $60 . 00 $60 . 00
11975 Norplant Removal - $0 .00 $21 .25 $41 .25 $62 . 50 $83 . 75 $ 103. 75 $ 125.00 $ 125.00
11765 Ingrown Toenail Treatment $0 .00 $6 .80 $ 13 .20 : $20 . 00 $26.80 $33 .20 $40 .00 $40.00
17000 Wart Treatment - First $0 .00 $5.95 $ 11 . 55 $ 17. 50 $23 .45 $29.05 $35.00 $35 . 00
17003 Wart Treatment - Second - 14 $0.00 $ 1 .02 � � � $ L- 98I $3.00 $4 .02 $4. 98 $6,00 $600
10060 Incision and Drainage $0 .00 $9 . 35 _ $ 18 .1 $27 . 50 $36.85 $45 . 65 $55 . 00 $55. 00
94640 Respiratory Treatment_ $0.00 $ 1 . 36 $2.64 $4.00 $5 .36 $6.64 $8.00 $8 . 00
57170 Diaphragm Fitting $0 .00 $9 . 35 $ 18 . 15 $27 . 50 $36 .85 ! $45 . 65 $55.00 $55.00
93000 EKG $0 .00 $5. 10 $9.90 $ 15.00 $20 . 10 $24 . 90 $30 . 00+ 30 . 00
- -
Procedures with set charges 0% - A 17% - B 33% - C __50o/0_=_
0% D 67% - E 83% - F 100% - G COST
71020 Chest X-Ray $0.00 $9 . 35 $ 18 . 15 - $27.50 $36 . 85 $45. 65 $55 .00 $55. 00
Tubal Ligation -
Surgical _ $ 1 ,000.00 $ 1 ,000.00 1 $ 1 ,000.00 $ 1 , 000 .00 $ 19000 . 00 $ 19000 . 00 . $ 19000 .00
$ 1 ,000 .00
Band or Clip $ 1 ,000.00 $ 1 ,000 . 00 $ 1 ,000 .00 $ 19000.00 $ 1 ,000 . 00 $ 1 ,000 .00 $ 11000.00 $ 1 , 000.00
Postpartum $ 1 ,000.00 $ 1 ,000.00 $ 1 ,000.00 $ 1 ,000 . 00 $ 1 ,000 .00 $ 10000 .00 $ 19000 .00 $ 19000.00
Post Cesarean $ 1 ,000 .00 $ 1 ,000 .00 $ 19000 . 00 : $ 19000.00 $ 1 ,000.00 $ 11000 . 00 $ 19000.00 $ 1
,000 .00
Inpatient Per Diem 1 $ 1 ,000.00 $ 11000 .00 $ 19000.00 $ 1 ,000 .00 $ 11000 .00 $ 19000 .00 $ 19000 . 00 $ 19000.00
Outpatient Fee $ 1 ,000 .00 $ 1 ,000 .00 $ 19000 . 00 $ 19000 .00 $ 11000.00 $ 1 ,000 .00 $ 19000 .00 $ 1 ,000
.00
Vasectomy $450.00 $450 .00 $450.00 $450 . 00 $450 . 00 $450 .00 $450 .00 . $450 .00
Nutritional Counseling - per hour $0 . 00 $5. 95 $ 11 . 55 $ 17. 50 $23.45 $29.05 $35 .00 $35.00
PPD TB Test $0 .00 $ 1 . 70 $3.30 $5 . 00 $6 . 70 $8 . 30 $ 10.00 $ 10 .00
E
ons 0% - A 17% - B 33% - C - 50% - D 67% - E 83% FF - 0% = G COST
$0 . 00 $3.06 $5 . 94 $9.00 $ 12 .06 $ 14.94 $ 18 . 00 $ 18. 00
cal Pneumonia $0.00 $4 . 76 $9.24 $ 14.00 $ 18.76 $23 .24 $28.00 $28.00
mps/Rubella $0 .00 $8 . 50 $ 16.50 $25.00 $33.50 $41 .50 $40 . 00 $50.00
$0. 00 $2 .55 $4.95 $7 . 50 $ 10.05 $ 12.45 $ 15.00 $ 15 .00
Injected Polio Vaccine $0 .00 $5 . 10 $9 .90 $ 15.00 $20 . 10 $24 .90 $30.00 $30. 00
Varivax (Chicken Pox) $0 .00 $ 13.60 $26.40 $40 . 00 $53.60 $66.40 $80 .00 $80 .00
Meningococcal $0 .00 $ 12 . 75 $24. 75 . $37.50 $50 .25 $62 .25 $75.00 $75.00
Rabies Vaccine (per injection ) $ 125 .00 $ 125.00 $ 125 .00 $ 125 . 00 $ 125.00 $ 125. 00 $ 125 .00 $ 125 . 00
kHea
Per 2cc Vial $ 150.00 $ 150 . 00 $ 150 .0 $ 150 .00 $ 150 .00 $ 150 .00 $ 150. 00 $ 150 .00
tis A Vaccine (per injection) $0 .00 $4.25 $8 .25 $ 12 . 50 $ 16. 75 $20. 75 $25 . 00 $25. 00
tis B Vaccine (per injection ) $0.00 $5.95 $ 11 .55 $ 17.50 $23 .45 $29 .05 $35.00 $35.00
x -Hep A & B (perinjection) $0 .00 $8. 50 $ 16 . 50 $25 .00 $33. 50 $41 .50erCDC guidelines , vaccine for childhood immunizations
are covered under the Vaccine for Children Program and are provided at no cost
to children age 0- 18. Charges for communicable disease control issues will be waived with authorization .
11 /2/2004CLFEE2004-05 Page 2 of 7
INDIAN RIVER COUNTY HEALTH DEPARTMENT
FEE SCHEDULE -- Effective Oct 1 , 2004
Travel Immunizations (Sliding Fee Scale does not apply -- Per Injection)
Travel Immunization Consult Visit $32 .00
Hepatitis B Vaccine $35 .00
Hepatitis A Vaccine $25 .00
Hepatitis A Vaccine - Children $25.00
Twinrix (Hep A & B) $50 . 00
Hep A Immune Globulin* $30.00 Per 2 ml dose -
Meningococcal $75. 00
Tetanus _F__-$ 15.00
Typhoid $65 .00
Yellow Fever _ $90.00
*As available
Dental Services (Sliding Fee Scale does not apply)
D0120 Periodic OralExam $ 15.00 D5211 Acrylic Partial ( Upper) _ $ 165.00
D0140 Emergency Examination $8 . 00 1D5212 Acrylic Partial (Lower) $ 165 . 00
D0150 Oral Examination $ 16.00 D5213 Cast Metal Partial ( Upper) $315.00
D0210 Intra Oral Complete Sen (inc BW ) $32 .00 D5214Cast Metal Partial (Lower) $315.00
D0220 Periapical First Film $4.00 D5281 Partial Denture $243. 75
D0230 Periapical Addt'l Film $3 . 00 D5410 Adj Denture Max $ 14.00
D0240 Intra Oral - Occlusal _ $8.00 D5411 Adj Denture Man $ 14.00
D0270 Bitewing - Single Film $6 . 00 D5412 Adj Partial Denture Max $ 14.00
D 0272 Bitewing - Two Films $9.00 D5413 Adj Partial Denture Man $ 14 ,00
D0274 Bitewing - Four Films $ 11 .00 D5510 Repair Complete Denture Base $44.00
000470 Diagnostic Casts $22.00 1 D5520 Replace Teeth Complete Denture $39.00
D1110 Prophylaxis - Adult $34.00 D5640 Replace Teeth Partial Denture _ $39.00
$ 14 . 00 D5650 Add Tooth Partial Existing Denture T
01120 Prophylaxis - Child $42 .00
D1203 Topical Fluoride - Child $ 11 .00 D5660 Add Clasp Partial Denture $52 .00
D1204 Topical Fluoride - Adult $ 16 .00 D5730 Reline Complete Max - Chairside $63.00
D1330 Oral Hygiene Instructions $6 .00 D5731 Reline Complete Man - Chairside $63.00
01351 Sealant - Per Tooth $ 13.00 D5750 Reline Complete Max - Lab $ 113.00
D1510 Space Maintainer - Fixed Unilateral $72 .00 D5751 Reline Complete Man - Lab $ 113.00
D1515 Space Maintainer - Fixed Bilateral $ 117.00 D5820 Acrylic Flipper - Upper $ 110 . 00
D1550 Recement Space Mait $ 17 .00 D5820 Acrylic Flipper - Lower - $ 110 ,00
D2140 Amalgam - One Surface D or P $31 .00 D6242 Pontic Porcelain Fused to Gold $232 .25
D2150 Amalgam - Two Surface D or P $41 .00 D6752 Crown Porcelain Fused to Gold $237.50
D2160 Amalgam - Three Surface D or P $51 .00 D7111 Single Tooth Extraction (Child ) $27 .00
D2161 Amalgam - Four or more D or P $61 .00 D7140 Single Tooth Extraction (Adult) $27.00
D2330 Resin - One Surface Anterior Primary $34 .00 D7210 Surgical Removal of Tooth $40 .00
D2331 Resin - Two Surface Anterior Primary $39.00 D7220 Removal of Impacted Tooth (Soft Tissue) $62 .00
D2332 Resin - Three Surface Anterior Primary $44 .00 D7230 Removal of Impacted Tooth Partial) Bon $77 .00
11 /2/2004CLFEE2004-05 Page 3 of 7
INDIAN RIVER COUNTY HEALTH DEPARTMENT
FEE SCHEDULE -- Effective Oct 1 , 2004
Dental Services (Sliding Fee Scale does not apply) CONTINUED _
D2335 Resin - Four or more Anterior Primary $72 . 00 D7240 Removal of Impacted Tooth (Completely Bony) $79 .00
D2390 Anterior Composite Resin Crown $72 .00 D7241 Removal of Impacted Tooth (Completely Bony unusual ) $82 .00
D2391 Resin - One Surface Post Primary $31 .00 D7250 Root Recovery - Sergical _ $54 . 00
D2392 Resin - Two Surface Post Primary $41 .00 D7270 Tooth Reimplant/Stabilization _ $27.00
D2393 Resin - Three Surface Post Primary $51 .00 D7281 Surgical Exposure to Aid Eruption $38 . 00
D2394 Resin - Four or more $78 .00 D7285 Biopsy - Hard Tissue $ 110 .00
D2752 Permanent Crown $231 .25 D7286 Biopsy - Soft Tissue $77 . 00
D2792 Gold Crown (Posterior) $228 .25 D7310 Alveolectomy With Extraction $45.00
D2920 Recement Crown $ 17 .00 D7320 Alveolectomy No Extraction $56 .00
D2930 Prefabricated Steel Crown Primary $68 . 00 D7410 Surgical Excision< 1 .25cm $ 110 . 75
D2931 Prefabricated Steel Crown Permanent $68.00 D7411 Surgical Excision> 1 .25cm $ 167.25
D2940 Sedative Filling _ $1 18 . 00 D7450 Cyst Removal $ 125 .25
D2950 Crown Build-Up I $65.00 . _� D7471 Removal of Exotosis t $ 170 .25
D2951 Pin Retention - Per Tooth } 1 $2 . 00 D7510 18-D - Intraoral (Dranage Abcess) $47 . 00
D2954 Prefab Post/Core in Add Crown $53.00 D7960 Frenulectomy $ 106. 75
D2970 Temp Crown $42 .00 D9110 Palliative Services $ 13 .00
D3110 Pulp Cap Direct $ 13. 00 D9230 Analgesia (Nitrous) $28 .00
D3120 Pulp Cap Indirect $ 11 .00 D9310 Consultation $ 18.00
D3220 Therapeutic Pulpotomy - $50 . 00 D9630 Drugs $ 18 .25
D3310 Root Canal (Anterior) $ 148.00 D9920 Behavior Management $24,00
D3320 Root Canal (Bicuspid ) $ 190 . 00 D9930 Unsched Post Op - Surgery $33 . 75
D3330 Root Canal (Molar) $235.00 D9940 Occlusal Guard - Hard $ 153.00
D4240 Periodontal Surgery $ 184 .00 D9941 Occlusal Guard - Soft $ 125.00
D4341 Root Planning per Quadrant T $40.00 D9951 Occlusal Adjustment - Limited $49.00
D4355 Full Mouth Debridement $46.25 D9972 External Bleaching $ 139. 30
D5110 Upper Denture (Full) $310.00 Resin Elected - One Surface" $50. 75
D5120 Lower Denture (Full ) $310.00 1 Resin Elected - Two Surface" $64.05
D5130 Immediate Denture - Max $418.00 Resin Elected - Three Surface" $78. 75
D5140 Immediate Denture - Man $412 .50 Resin Elected - Four or more"* $ 100 .45
"If client requests Resin fillings .
11 /2/2004CLFEE2004-05 Page 4 of 7
INDIAN RIVER COUNTY HEALTH DEPARTMENT
FEE SCHEDULE - Effective Oct 1 , 2004
Laboratory Services 0% - A 17% - B 33% - C 50% - D 67% - E 83% = F 1100% - G COST
IN-HOUSE LAB - -
LAB $0 . 00 $ 1 . 70 $3 . 30 $5.00 $6 . 70 $8 . 30 $ 10 . 00 $ 10 . 00
Contracted Laboratory Services
LAB $0 .00 $3 .40 $6.60 $ 10 . 00 $ 13 .40 $ 16 . 60 $20 . 00 $20 .00
NOTE : Tests which exceed a charge of $ 100 .00 will be billed individually on sliding fee scale percentage based on IRCHD cost
of lab service .
IN and CONTRACTED LAB Fee is for all labs performed at the time of service .
Pharmacy - -�--- � -� -
Pharmaceutical items will be billed on a per pill basis at IRCHD cost. An itemized pharmaceutical listing is updated weekly and
is available
by contacting the cashier. Items received from the State Pharmacy as in-kind donation at no cost to IRCHD will not be charged
to the patient.
Medical Records Fees
Copy of Medical Record/per page $ 1 .00 per page for the first 25 pages ; $ .25 each additional a e thereafter.
NOTE: Florida Statutes regarding release of medical records must be met prior to release of medical records to any source .
No fees are
charged to physician offices/other medical agents with the understanding that IRCHD will also be exempt from such payment.
Vital Statistics Fees - -
Birth Certificates $ 12 .00 �-
Additional Copies $8.00
Death Certificates $ 10 .00
Research Fee (per year) $3.00
Expedite Fee $5.00 1
Overnite Shipment $ 10 . 00 _
Birth Certificates are provided free of charge to the following only: Children & Families Case Workers who are involved in a custody
case .
Case Worker must present proper ID , completed application request and copy of the signed court petition . Only one certified copy
will be
provided per six (6) month period .
Environmental Health County Fees
Well Permit (Potable ) $75.00 Environmental Health Plan Review $75.00
Well Permit (Irrigation ) $50 .00 Environmental Assessment $ 150 .00
Well Permit (2 Sites or more) $ 100 .00 Grease Trap Construction Permit $75 .00
Well Abandoment $0 . 00 _ JGrease Trap Annual Operating Permit $50 . 00 _
Well Permit Construction Variance $ 100 .00 Hazardous Waste (SQG ) Annual Fee $50 .00
Public Supply Well Permit L $250 .00 "After the Fact" OSTDS New System $400 .00
Demolition Permit $50.00 "After the Fact" OSTDS Repair Permit $230 . 00
Demolition Permit $ 100 . 00 Bacteriological Water Sample (Drinking Water) $20 . 00
Reinspection for Demolition Permit $25 .00 Chemical Water Sample $5.060- 25.00
Environmental Health Misc. Lab $20.00 Indoor Air Quality Permit $50 .00
Environmental Health State Fees
Please see Attachment VI
11 /2/2004CLFEE2004-05 Page 5 of 7
INDIAN RIVER COUNTY HEALTH DEPARTMENT
FEE SCHEDULE -- Effective Oct 1 , 2004 `
f
Florida Administrative Code, Chapter 10D421
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 .
r
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.
_ I _
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 .
11 /2/2004CLFEE2004-05 Page 6 of 7
INDIAN RIVER COUNTY HEALTH DEPARTMENT
FEE SCHEDULE -- Effective Oct 1 , 2004 i
Y
IRCHD POLICIES -- - - -
School Year Policy Regarding Physicals : If a patient is already established at IRCHD as a primary care patient, physicals will
be given
based on sliding fee scale; however, if they are new to the clinic for medical care, they must pay the advance fee of $30. 00
unless they
register as a primary care patient and transfer all current medical records to the health department.
L _
County of Residence : (Primary Care) If a patient has Medicaid , other confirmed medical coverage , or prepays out of county charge
, we will
see them in the clinic and bill for service . However, all sliding fee or zero pay patients must be seen at the health-department
in the county of
their residence . Failure to show confirmation of county residence will result in payment of 100% until such confirmation is obtained
.
(Exception to this rule will be for treatment of communicable diseases and family planning services .
Insurance will not be billed for family planning services . -
I
Employee medical care will be provided based on approved policy and procedure .
Hepatitis A & B vaccines are provided free of charge to ages 0- 18 per CDC Vaccine for Children guidelines . If a patient has
Medicaid
coverage . Medicaid will cover Hep A & B to age 21 . Vaccines will not be provided on a sliding fee scale for non-established
patients over
the age of 18. EXCEPTION : Vaccine will be provided free of charge or on reduced fee if vaccine is treatment for communicable
disease .
Anon ous HIV Testin $25. 00 fee applies to all patients who request HIV test. However, test will be given regardless of f
abili to pay.
---
Anonymous 9 � PP P � q 9� 9 ability P Y
Reduced fee will be accepted for hardship cases . T
Per agreement with Partners in Women's Health , a reduced fee of $ 10 .00 will be billed to those patients who are pregnant and referred
to IRCHD for HIV testing .
Access to dental services will be limited to those patients who make 200% or less of the Federal Poverty Level . (Effective May 8,
2002 )
I
I
i -
11 /2/2004CLFEE2004-05 Page 7 of 7
J4 r ,
INDIAN RIVER COUNTY HEALTH DEPARTMENT FORMULARY PRICE LIST
Cost Cost
Unit per Unit per
Product Name Issue UI Product Name Issue UI
Ace hen suppositories 120 mg Each $0 .49 Kenalog 40 , in " 1 cc in ' $5 . 61
Actifed tabs Box $2 . 34 Lisinopril 20 mg Each $0 .20
Albuterol inhaler Kit $2 . 97 Lisinopril 5 mg Each $0 . 07
Aldactone 50 mg Each $ 1 . 03 Medroxyprogesterone Acetate tabs 10 mg . Each $0 .24
Amitriptyne hcl 25 mg Each $0 . 02 Metformin hcl 500 mg Each $0 .08
Amoxicillin 250 mg susp Bottle $ 1 . 58 Motrin , childrens berry Bottle $4 .29
Aspirin EC 325 mg Each $0 . 011 Na roxin 500 mg Each $0 .06
Aspirin EC 81 mg Each $0 . 011 NeoPol B o thalmic solution Bottle $ 16 .81
Atenolol 25 mg Each $0 .04 NeoPol HC otic suspension (drops ) Bottle $ 16 . 81
Atenolol 50 mg Each $0 . 05 Nitrotab sub lingual 3mg Each $0 . 03
Aurodex ear drops Bottle $0 . 90 Nix Bottle $7 .24
Captopril 25 mg Each 0 .011 Pen VK suspension, 250 mg Bottle $2 . 68
Captopril 50 mg Each $0 . 02 1 Pen VK tabs 500 mg Each $0 . 15
Cephalexin 250 mg Each $0 . 15 Phene ran suppositories 12 . 5 mg Each $3 .46
Cephalexin 500 mg Each $0 . 10 Pink bismuth Each $0 . 06
Cephalexin suspension 250 m2. Bottle $ 10 .68 Prednisone 10 mg Each $0 .02
Ci rofloxin hcl 500 mg Each $0 . 111 Q-Tussin Bottle $0 . 84
Clonidine . 1 mg Each $0 . 05 Ranitidine 150 mg Each $0 .07
Clonidine .2 mg Each $0 .07 1 Silvadene cream 10/6 Tube $5 . 14
Clotrimazole cream 1 % Tube $ 1 . 24 Triam/HCTZ 37 . 5/25 Each $0 .08
Coreg 3 . 12 mg Each $ 1 .47 Tri le anitbiotic ointment Tube $ 1 . 39
Coreg 6 .25 mg Each $ 1 .47 Vera amil 240 mg Each $0 .21
C anocobal 1000mcg 1 cc in ' $0 . 54 Warfarin 1 mg Each $0 .20
Depo-Medrol 80 mg 1 cc in ' $7 .84 Warfarin 5 mg Each $0 .22
Dexamethone Sod Phos 4 mg 1 cc in ' $0 . 33 Nitrotab sub lingual 3mg Each $0 . 03
Diabetic tussin Bottle $3 . 96 Nix Bottle $7 .24
Digoxin .25 mg Each $0 . 07 Pen VK suspension 250 mg Bottle $2 . 68
Elimite Tube $25 . 91 Pen VK tabs 500 mg Each $0 . 15
Ery eye ointment Tube $0 . 59 Phene ran suppositories 12 . 5 mg Each $3 .46
Erythromycin Stear 500 mg Each $0 . 13 Pink bismuth Each $0 . 06
Furosemide 20 mg Each $0 . 39 1 Prednisone 10 mg Each $0 . 02
Furosemide 40 mg Each $0 . 38 Q-Tussin Bottle $0 .84
Genahis allergy 25 mg Box $ 1 .26 Ranitidine 150 mg Each $0 .07
Genapap caplet 500 mg Each $ 1 .87 1 Silvadene cream 1 % Tube $5 . 14
Genapap infant drops Bottle $0 . 96 Triam/HCTZ 37 . 5/25 Each $0 . 08
Glyburide 5 mg Each $0 .08 Tri le anitbiotic ointment Tube $ 1 . 39
Hydrochlorothiazide 25 mg Each $0 .02 Vera amil 240 mg Each $0 .21
Hydrocortisone 1 % cream ITube $0 . 83 Warfarin 1 mg Each $0 . 20
lbu rofen 400 mg Each $0 .03 Warfarin 5 mg Each $0 .22
CLFEE2004-05 1 : 55 PM 11 /2/2004