Lynn Shatz 12/10/2018 - Laserfiche WebLink

EXHIBIT A SCOPE OF WORK Specific Requirements-Dental Hygiene Services In consideration for the dental hygiene services provided by Service Provider,the City will provide a space in the Carl Gipson Senior Center of Everett(the " Senior Center")for Service Provider to perform the dental hygiene services under this Agreement.Pursuant to the terms of this Agreement, Service Provider will: a) Obtain from the client or responsible party,written consent for any work provided by Service Provider to the client. b) Obtain from the client's primary care physician patient medical information that is relevant to the provision of preventative dental care before providing services to the client. c) Collect data on the clients,including age,treatments rendered,insurance coverage,if any, and patient referral to dentists,the reason for the referral,any other information in accordance with federal,state and local laws and regulations. d) Supply instruments,supplies and portable equipment used to provide dental hygiene services. e) Perform comprehensive dental hygiene evaluations. f) Perform limited visual oral assessments. g) Perform routine therapeutic dental cleanings. h) Perform fluoride applications i) Perform denture/partial cleaning. j) Provide educational seminars. k) Offer financial and referral consultations. 1) At all times comply with RCQ 18.29.056,related to the provision of dental hygiene services in senior centers. FEES Fees for the dental hygiene services provided at the Senior Center will be paid directly by the client to Service Provider,and are the sole responsibility of the Service Provider.The Fee charged for each service payable to The Carl Gipson Senior Center of Everett will be set at$98 for a first time visit,$88 each subsequent visit of which 15% will be retained by the Senior Center. CLEANING Service Provider will: a) Clean and straighten up assigned work spaces after each use b) Return furniture to its original position c) Clean table and counter tops d) Sweep and mop floors as needed Comply with all federal,state and local laws and regulations related to the cleanup and disposal of medical waste including,without limitation,OSHA regulations regarding the cleanup and disposal of all medical waste containing Bloodbome Pathogens.All waste will be placed in standard Red Biohazard bags and removed from the facility by the Service Provider for disposal at another location. Page 12 (Form Approved by City Attorney's Office January 7,2010,updated November 21,2016)