09/01/2004
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NEW HANOVER COUNTY
HEALTH DEPARTMENT
August 26, 2004
To:
New Hanover County Board of Health
From:
Cynthia W Hewett,MSIS fJ.'I-
Business Manger
Subject:
Revenue and Expenditure Report for Month Ending July 31, 2004
The Revenue and Expenditure Report was not finalized at the time the NHC BOH packet was
ready for distribution. A copy of this report will be distributed to each of you at the Board of
Health Meeting on Wednesday, September 1,2004.
Thank you.
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9
"Healthy People, Healthy Environment, Healthy Community"
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NHCHD BOARD OF HEALTH APPROVED GRANT APPLICATION STATUS FY 04-05
Date (BOH) Grant Renu8sted Pending Received Denied
Office of the State Fire Marshal- Ne Department
of Insurance- Risk Watch continuation funding
8/412004 (3years) $ 25.000 $ 25.000
NC Physical Activity and Nutrition Branch-Eat
Smart Move More North Carolina $ 20.000 $ 20.000
Ne March of Dimes Community Grant Program-
71712004 Smoking Cessation $ 50.000 $ 50.000
Wolfe.NCPHA Prenatal Grant- Diabetic Supplies
for Prenatal Patients $ 5,000 $ 5,000
6/212004 No activity to report for June 2004.
Kate B. Reynolds Foundatlon- Transportable
5/5/2004 Dental Unit Grant $375.000 $375,000
Cape Fear Memorial Foundation- Dental Grant $185,000 $185.000
Cape Fear Memorial Foundatlon- School Health
41712004 Emergency Dental Services Grant $ 15,000 $ 15,000
Safe Kids Coalltlon- Govemo~s Highway Safety
program- (Coalition Vehicle Request) $ 16.000 $ 16.000
Safe Kids Coalitlon- Safe Kids Buckle Up
3/3/2004 Program- Child Safety Seat Grant $3,500 $3.500
2/4/2004 No activity to report for February 2004.
Cape Fear Memorial Foundation- Funds needed to
enhance health education in 4 areas other than Diabetes
11712004 (an enhancement to Diabetes TocIay Grant). (Living Well) $20.000 $18,500 $1.500
12/3/2003 No activity to report for December 2003.
Cape Fear Memorial Foundation- Funds needed to
cover dental services for needy children as identified by
11/512003 School Health Nurses. $3.000 $3.000
NC Medical Foundation - Through the Good Shephard
Ministries for nursing services to the population
frequenting the shelter. $25.000 $25.000
Duke Unlverstty. To provide 10 hours of nursing services
for TB Outreach. $10.388 $10.700 -$312
NC Tobacco and Control Branch, DHHS- Continuation
of Tobacco Prevention Program. $100.000 $64.093 $35.907
10/1/2003 No activity to report for October 2003.
New Hanover County Safe Schools- Uniting for
Youth "U4Youth"(funding will be received over a 3
9/3/2003 year grant period) $49,000 $ 12.702 $36.298
Safe Kids Coalitlon- Fire Prevention (Please note
this grant was pulled- coalition not able to meet deadline
for request) $2,500 $2,500
8/6/2003 HC DHHS- OPH Preparedness and Response $82.350 $31,950 $50.400
Smart Start- Partnership for Children (Grant
7/3/2003 Increase for Part Time Nurse Position) $5,523 $5,523
Cape Fear Memorial Foundation. Diabetes
Today (two-year request; $42,740 annually)
(Received $25,00 year 1 and $20,000 year 2) $85.480 $45.000 $40.480
Duke University Nicholas School of the
Envlronment-Geographic Information Systems
Grant (Env Health) $10.000 $10.000
Safe Kids Coalltlon- Safe Kids Mobile Car Seat
Check up Van $50,000 $50.000
Totals $1,137,741 $675,000 $224,445 $238,296
59.33%
19.73%
20.94%
Pending Grants 7 33%
Funded Total Request 5 24%
Partiallv Funded 5 24%
Denied Total Request 4 19%
Numbers of Grants Applied For 21 100%
As of 8/24/2004
. NOTE: Notification received since last report.
10
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NEW HANOVER COUNTY BOARD OF COMMISSIONERS
Request for Board Action
Agenda:D Consent Meeting Date: 09/07/04
Agenda: [8J
Department: Health Presenter' Cindy Hewett, Business
Manager
Contact: Cindy Hewett, Business Manager, ext 6680
Subject: Additional funds received from the Office of the State Fire Marshal, NC
Department of Insurance: $2,500
Brief Summary' The New Hanover County Health Department has received $2,500 from
the Office of the State Fire Marshal (OSFM - NC Department of Insurance (NCDOI) for
use in the existing Risk Watch ProlU'am.
Recommended Motion and Requested Actions: To accept and approve the additional
$2,500 funds received from the OSFM-NCDOI to be used in the existing Risk Watch
Pro ram and the associated bud et amendment.
I Funding Source: OSFM-NCDOI
Will above action result in.
DNew Position Number ofPosition(s)
DPosition(s) Modification or change
[8JNo Chan e in Position s
Explanation: The New Hanover County Health Department has been awarded $2,500
additional funding from the OSFM-NCDOI for use in the existing Risk Watch Program.
These funds were unsolicited by the health department. No local match is required. The
county is under no obligation to continue the Risk Watch Program upon expiration of
rant funds.
I Attachments: Copy of Check and budget amendment.
11
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DEPARTMENT OF,lN$URANCE..;J,~' . _0,$, . ..N. (hi, -1004..87'J~'
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PAY [Viothousand:jive'hundred afl~ 001100 DolIll,[s
lOTHE OHDER OF .
0' NEW HANOVER COUNTY SAFE KIDS
NEW HANOVER CO HEALTH DEPT
2029 S 17TH ST
WILMINGTON NC 28401-4946
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AUTHORIZED SIG TURE'" "
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STATE OF NORTH CAROUNA
DEPARTMENT OF INSURANCE
430 N. SALISBURY STREET. RALEIGH. N.C. 27611
NO.
10048712
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DATE INVOICElCREDIT MEMO TYPE OESCAJPllON INVOICE AMOUNT DEDUCTIONS OR NET AMOUNT
DISCOUNT
CI7130104 RISK WATCHlGRANT 080204.5015 $2,500.00 $2,500.00
SUPPL ~ENTAL RISK WATCH 3RANT
TOTALS ~2 500.00 ~? 5OO.M
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NEW HANOVER COUNTY BOARD OF COMMISSIONERS
Request for Board Action
Agenda:U . Consent Meeting Date: 09/07/04
Agenda: ~
Department: Health Presenter Cindy Hewett, Business
Manager
Contact: Cindy Hewett, Business Manager, ext 6680
'.
Subject: Additional Aid-to-County funding received for New Hanover County Health
Department for FY05. $8,333
Brief Summary: The New Hanover County Health Department has been awarded $8,333
additional Aid-to-County funding to be used to support quality assurance activities within
the health department. These funds can be used to support such items as the quality
improvement structure and process, to develop and ensure compliance with the agency's
quality improvement plan, to develop critical incident reporting and management plans
and to assist with the accreditation process.
Recommended Motion and Requested Actions: To accept and approve the $8,333
additional Aid-to-County state grant funding for FY05 and the associated budget
amendment.
Funding Source: NC Division of Public Health, Administrative, Local and Community
Su ort Section, Local Technical Assistance and Trainin Branch.
Will above action result in.
ONew Position Number ofPosition(s)
OPosition(s) Modification or change
~No Chan e in Position(s
Explanation: NC Division of Public Health, Administrative, Local and Community
Support Section, Local Technical Assistance and Training Branch has awarded the New
Hanover County Health Department $8,333 additional Aid-to-County state grant funding.
These funds are to be used to support quality assurance efforts within the health
de artment and are to be ex ended in FY05.
I Attachments: State documentation and budget amendment.
15
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DIVISION OF PUBLIC HEALTH
AGREEMENT ADDENDA
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New Hanover County Health Department
Contractor Name
Administrative, Local, and Community Support
Section
Local Technical Assistance and TraininE
Branch
4110 General Aid to Counties
Activity Number and Title
Unit
07/01/04 - 06/30/05
Effective Period (Beginning and Ending Date)
3
Revision #
8/16/04
Date
Program Objectives and Instructions:
A IT ACHED YOU WILL FIND A REVISED CHART SHOWING FY 04-05 BUDGETARY ESTIMATE FOR YOUR COUNTY IN
THE GENERAL AID TO COUNTIES ACTIVITY
THESE FUNDS ARE FOR USE IN ANY PUBLIC HEALTH PROGRAM AS DETERMINED BY LOCAL NEED.
IN ADDITION, $8,333 OF THESE FUNDS MUST BE USED FOR ONE OR MORE OF THE FOLLOWING PURPOSES:
(I)
. (2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(10)
To facilitate the creation of Quality Officers in each agency to oversee the quality improvement structure and process,
develop and ensure compliance with the agency's quality improvement plan against internal and external requirements,
develop critical incident reporting and management plans, assess organizational and workforce development gaps and
oversee the accreditation process.
To facilitate the development of private or public partnerships through contracts, interlocal agreements, memoranda of
understanding, and community grants.
To provide incentives to agencies to collaborate and partner with other counties in the development of regional public
health incubators to improve service delivery, organization and preparedness.
To enable accredited agencies to assist other counties in their efforts to achieve public health accreditation
To promote partnerships between local agencies and universities through development of academic health departments
To provide incentives to develop local and regional business plans to create hybrid health departments, including public
health authorities and public health districts, and identify new sources of public health revenue
To create community health plans to improve community health and reduce health disparities, including the creation of a
Community Wellness Index
To strengthen the role ofJocal boards of health through training, technical assistance and consultation
To create public internships at the local level
To support new insights and innovative solutions to health problems that will result in improved quality, great
accountability, improved health outcomes, and the elimination of health disparities
.
Page _1_ of _1_
11/01
A /$;ftI{/?
County Health Director Signature and Date
16
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N.C. Division or Public Health
Budgetary Estimate to Local Health Departments, SFY 04-05
Originsl _
Revision#_3_
Activity # 4110
Activity Name: General Aid-to-Counties
ROW 1 FundIRCCIf'RC FundIRCClFRC FundlRCClfRC fundIRCClFRC FuncllRCClFRC
1410....110.00 Total or All
Payment Period
07/04-06105 Payment Period. Payment Period . Pavment Period . Payment Period .
Service Period
06/o.-G5/CU Service Period . Service Period . Service Period - Service Period .
COUNlY Sources
01 ALAMANCE 50.00
202 ALBEMARLE REG so.oo
02 ALEXANDER 50.00
CU ANSON SO.DO
201 APPALACHIAN $8,333.00 58.333.00
07 BEAUFORT 50.00
09 BLADEN 50.00
10 BRUNSWICK 50.00
11 BUNCOMBE $8.333.00 58.333.00
12 BURKE 50.00
13 CABARRUS S8,333.00 58.333.00
14 CALDWEll $0.00
16 CARTERET 50.00
17 CASWEll $0.00
18 CATAWBA $0.00
19 CHATHAM S8,333.00 $8.333.00
20 CHEROKEE $0.00
22 CLAY $0.00
23 CLEVELAND $0.00
24 COLUMBUS 50.00
25 CRAVEN $0.00
26 CUMBERLAND $0.00
26 DARE $8,333.00 $8.333.00
29 DAVlOSON $0.00
30 DAVIE $0.00
31 DUPLIN $0.00
32 DURHAM $0.00
33 EDGECOMBE $0.00
34 FORSYTH 50.00
35 FRANKLIN $0.00
38 GASTON SO.OO
37 GATES $0.00
38 GRAHAM $0.00
203 GRAN-VANCE $0.00
40 GREENE $0.00
41 GUILFORD 50.00
42 HALIFAX $0.00
43 HARNETT $0.00
44 HAYWOOD $0.00
45 HENDERSON $0.00
46 HERTFORD $0.00
209 HERT-GATES $0.00
47 HOKE $0.00
48 HYDE 50.00
49 IREDEll $0.00
17
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NEW HANOVER COUNTY BOARD OF COMMISSIONERS
Request for Board Action
Agenda: Consent Meeting Date:
A enda: ~ ..
Department: Health Presenter: Cindy Hewett, Business
Mana er
Contact: Cindy Hewett, Business Mana er, ext 6680
Subiect: Part Time Interpreter
Brief Summary: The New Hanover County Health Department is requesting approval to
hire a part-time (20 hours per week) Spanish Interpreter with existing funds budgeted in
FY05
Recommended Motion and Requested Actions: To approve request to hire part-time
Spanish Interpreter (position with no benefits) for FY05 and associated budget
amendment.
I Funding Source: Existing funds in FY05 Adopted Budget
Will above action result in:
~New Position .5 Number ofPosition(s)
Dposition(s) Modification or change
DNo Chan e in Position s
Explanation: New Hanover County Health Department is requesting approval to hire a
second Spanish interpreter, who would be halftime and no benefits, for the remainder of
FY05. This would be a trial position, to determine the full extent of the need. Our one FT
interpreter is serving the OAS Clinic daily and stays busy Additionally, we are using
contract interpreters for all home visits, and for the busier days in clinic, as well as for
relief for the one regular interpreter when she is unavailable.
After reviewing the usage of contract interpreters, the anticipated continued increase in
Hispanic WIC clients, and the best use of dollars, we believe we could hire a 20
hour/week interpreter as a temporary, with no benefits.
Points to Consider:
WIC alone has increased services to Hispanics by 41% in the last year (02-03'418 clients;
03-04 590 clients).
Contract interpreters are being paid $23.50 per hour and we can hire a temporary county
employee as an Administrative Support Technician to serve as the part-time Spanish
Iterpreter with a lower salary
WIC has $12,000 budgeted for contract services for interpreting for this FY; Child
Service Coordination (CSC) has $4000 budgeted for interpreters. These are the fund that
would be used to fund the art-time osition. We are re uestin a roval to transfer the
20
remaining contract services money in these two budgets to temporary salaries and recruit
a PT interpreter (20 hours/week, no benefits). This position would provide Spanish
Interpreting coverage for WIC and CSC home visits. New Hanover County Human
Resources has a roved this re uest, rovided it is a roved b the NHC BOH.
I Attachments: Supporting documentation
.
. ,
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21
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.
, <: . .,. Janet McCumbee
: ;~t;~ 08/20/200402:46 PM
~e4:,
To: BettyJo McCorkle/NHC@NHC, Nancy Nail/NHC@NHC, Juanita
Richardson/NHC@NHC
cc: chewett@co,new-hanover,nc.us. (bcc: archive)
Subject: Re: Request for PT interpreter
FYI, we have to process through SOH, but this is good news, I think the plan will be to hire a 20 hour
interpreter to serve WIC no more than 16 hours. then use the other 4 hours for CSC home visits. This
would free up Jessie to work only the main clinic,
Cindy, if this passes the SOH, please remember when recruiting, we will need to have Nancy determine
the days she needs this person, and Juanita to figure out the best half day for CSC, The person hired may
need to be very flexible (if possible), Thanks,
----- Forwarded by Janet McCumbee/NHC on 0812012004 02:43 PM ---
I /J1A. _ Andre Mallette
'ifI.H.- 08/20/200401:31 PM
To: David E Rice/NHC@NHC
cc: jmccumbee@nhcgov,com, (bcc: archive)
Subject: Re: Request for PT interpreterEj
I have no problem with this request Please get budget to move the appropriate funds and provide HR
with a requisition for recruitment once the SOH approves,
Andre' R Mallette, Director
Human Resources Department
New Hanover County
320 Chestnut Street, Suite 405
Wilmington, NC 28401
(910) 341-7178
David E Rice
David E Rice
08120/2004 12:02 PM
To: Andre Mallette/NHC@NHC
ee: jmeeumbee@nhcgov,com, (bee: archive)
Subject: Request for PT interpreter
Please approve our request to hire a part-time interpreter We currently have monies budgeted for
contractual interpreters,
----- Forwarded by David E Rice/NHC on 08120/2004 12:00 PM ---
" ": "..j. Janet McCumbee
.. c.~~". 08/20/200411:55AM
..U'~.1
To: David E Rice/NHC@NHC
ee: (bee: archive)
Subject: Request for PT interpreter
I would like to request that HR consider approval of a request to hire a second Spanish interpreter, who
would be half time and no benefits, for the rest of this fiscal year This would be a trial position, to
determine the full extent of the need, Our one FT interpreter is serving the OAS clinic daily and is busy
We are using contract interpreters for all home visits, and for the busier days in clinic, as well as for relief
for the one regular interpreter when she is out
Looking at the usage of contract interpreters, the anticipated continued increase in Hispanic WIC clients,
and the best use of dollars, we feel we could hire a 20 houriweek interpreter as temporary, no benefits,
Important points
. WIC alone has increased services to Hispanics by 41% in the last year (02-03:418 clients; 03-04: 590
clients),
. Contract interpreters are being paid $23,50 per hour and we can pay a temp county employee in the
22
AST class less.
. WIC has $12,000 budgeted for contract services for interpreting for this FY; CSC has $4000 budgeted
for interpreters
We would like to transfer the remaining contract money in these two budgets to salaries and recruit a PT
interpreter, who would cover WIC and CSC home visits.
I realize we would need to take this to the SOH, but wanted the advise/blessing of HR first, as you
recommended. Thanks.
... I
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NEW HANOVER COUNTY BOARD OF COMMISSIONERS
Request for Board Action
Agenda:U Consent Meeting Date: September
Agenda: D 1, 2004
Department: Health Presenter: David Rice
Contact:
Subiect: NHCHD Organizational Chart Revision
Brief Summary: The purpose of this request is to revise the NHCHD Organizational
Chart to reflect current operations. Two changes have been made from the September 9,
2003 version: 1. Change in the name of Quality Assurance to Health Planning, and 2.
Relocation of the Public Health Regional Surveillance Team (PHRST) to Health
Programs Administration. These changes will allow for better coordination of Health
Planning and PHRST. Both programs are funded by bioterrorism monies.
Recommended Motion and Requested Actions: Requested that the NHCBH approve the
revisions to the NHCHD Organizational Chart.
. I Funding Source: N/A
Will above action result in:
DNew Position Number of Position(s)
DPosition(s) Modification or change
[8jNo Change in Position(s)
I Explanation:
Attachments: 1. September 9, 2003 NHCHD Organizational Chart
2. September 1, 2004 NHCHD Organizational Chart - Draft
.
28
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New Hanover County Health Department
Revenue and Expenditure Summaries for July 2004
Cumulative: 8.33% Month 1 of 12
Revenues
Cumulative % 8.33% Month Reported Mon 1 012 Jul-04
Current Year Prior Year
Type of Budgeted Revenue Balance % BUdgeted Revenue Balance %
Revenue Amount Earned Remalnln Amount Earned Remalnln
Federal & State $1,780,890 $ 181,646 $1,599,244 $ 130,371 $1,529,249 7.86%
AC Fee. $ 570,161 $ 39,142 $ 531,019 $ 46,348 $ 523,813 8.13%
Medicaid $1,138,039 $ $1,138,039 $1,044,080 $ $1,044,080 0.00%
Medicaid Max $ 151,600 $ $ $
EH Fee. $ 300,212 $ 31,506 $ 268,706 $ 300,212 $ 17,304 $ 282,908 5.76%
Health Fee. $ 113,545 $ 14,297 $ 99,248 $ 113,850 $ 13,303 $ 100,547 11.68%
Other $2,390,519 1.79%
Expenditures
Type of
Ex endlture
Current Year Prior Year
Budgeted Expended Balance % " Budgeted Expended Balance %
Amount Amount Remalnln Amount Amount Remalnln
. .~
342,794 $ 964,585
19,823 $ 78,893
$
Summary
Budgeted Actual
FY 04-05 FY 04-05
Expenditures:
Salaries & Fringe $10,383,157 $342,794
Operating Expenses $1,517,904 $19,823
Capital Outlay $86,633 $0
Total Expenditures $11,987,694 $362,617
Revenue: $6,444,966 $269,613
Net County $$ $5,542,728 $93,004
%
3.02%
4.18%
1.67%
Revenue and Expenditure Summary
For the Month of July 2004
~
.,
New Hanover County Health Department
FY 04-05
MONTHLY REVENUE REPORT
As of July 31, 2004
.
.
Summary for the New Hanover County Health Department
Cumulative % 8.33%
Current Year
Type of Budgeted Revenue Balance
Revenue Amount Earned Remaining
Federal & State $ 1,780,890 $ 181,646 $ 1,599,244
AC Fee. $ 570,161 $ 39,142 $ 531,019
Medicaid $ 1,138,039 $ $ 1,138,039
Medicaid Max $ 151,600 $
EH Fee. $ 300,212 $ 31,506 $ 268,706
Health Fees $ 113,545 $ 14,297 $ 99,248
Other $ 2,390,519 $ 3,022 $ 2,387,497
Month Reported
Mon 1 of 12
Jul-04
Prior Year
% > , Budgeted Revenue Balance %
~::' Amount Earned Remaining
$ 1,659,620 $ 130,371 $ 1,529,249 7.86%
$ 570,161 $ 46,348 $ 523,813 8.13%
$ 1,044,080 $ $ 1,044,080 0,00%
$ $
$ 300,212 $ 17 ,304 $ 282,908 5.76%
$ 113,850 $ 13,303 $ 100,547 11,68%
$ 2,123,669 $ 38,075 $ 2,085,594 1.79%
.
.
Revenue Summary
For Month of July 2004
Type of Budgeted
Revenue Amount
. Federal & State $ 12,779 $
Other $ 135,000 $
.
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.
.
New Hanover County Health Department
FY 04-05
MONTHLY REVENUE REPORT
As of July 31, 2004
Cumulative %
8.33%
Month Reported
Mon10f12
Jul-04
Program:
5111
Environmental Health
Current Year Prior Year
Type of Budgeted Revenue Balance % ;.;,. Budgeted Revenue Balance %
Revenue Amount Earned Remaining i Amount Earned Remaining
15,973 15,973 16,473 16,473
300,212 31,506 268,706 300,212 17,304 282,908
Program:
5112
Vector Control
Current Year
Revenue Balance
Earned Remaining
Prlor Year
Revenue Balance
Earned Remaining
%
J~;,:
,.~
%
$ 12,779
$ 135,000
12,779 $
135,000 $
$
$
12,779
135,000
0.00%
0.00%
Program:
5114
Animal Control
Current Year Prior Year
Type of Budgeted Revenue Balance % ',0'\ BUdgeted Revenue Balance %
t,!.
Revenue Amount Earned Remaining t~ Amount Earned Remaining
.w
AC Fees $ 570,161 $ 39,142 $ 531,019 6.87% ; $ 570,161 $ 46,348 $ 523,813 8.13%
>,.
other $ $ 0.00% ~ $ $ 0.00%
Note; County Appropriation is not figured on the individual program report. The County appropriation in each program is
the difference between the total amounts on the program expenditure report and the totals on the program revenue report.
For Month of July 2004
Cumulative %
Program:
Type of
Revenue
Budgeted
Amount
Heallh Fees $
Fed & Slate $
Med Max $
Totals $
1,000 $
$
$
$
4,600
5,600
Program:
Type of
Revenue
Budgeted
Amount
Program:
Program:
.
New Hanover County Health Department
FY 04-05
MONTHLY REVENUE REPORT
As of July 31, 2004
8.33%
5121 Laboralory
Current Year
Revenue Balance
Earned Remaining
$ 1,000
$
$
$
4,600
5,600
5122
I
.
Month Reported
Mon10f12
Jul-D4
Prior Year
% ~ B:~~~~: R::;::: R:~:~~~g
O'OO%I"~ $ 1,500 $ $ 1,500
0.00%. .
0.00%
0.00% ,: $
%
0.00%
Public Health Bioterrorism
Current Year
Revenue Balance
Earned Remaining
$ 195,996
$ 31,000
3,154
%
Prior Year
Revenue Balance
Earned Remaining
$ 296,161
%
5123 Care Coordination
Current Year
Type of Budgeted Revenue Balance
Revenue Amount Earned Remaining
Fed & Slate $ 66,160 $ $ 66,160 0.00%
TXIX $ 1,039,039 $ $ 1,039,039 0.00%
Med Max $ $ $ 0.00%
Totals $ 1,105,199 $ $1,105,199 0.00% Ii ~ $1,041,167 1,041,167 0.00%
Note: Comprised of Child Service Coordination (5133), Maternity Care Coordination (5159), Maternal Outreach Workers (5157)
end Navl9ator (5154) Budgets
Current Year
Revenue Balance
Earned Remaining
91,646 $ 350,084
5124
Budgeted
Amount
%
Prior Year
Revenue Balance
Earned Remaining
$ 99.405
$ 941,762
.
Budgeted
Amount
%
Women's Preventive Health
Type of
Revenue
Budgeted
Amount
Prior Year
% ,1'1 Budgeted Revenue Balance %
;{' Amount Earned Remaining
0.00% 1;- 200,955 $ 2,758 $ 198,197 1.37%
0.00% ~. '1 31,000 $ 31,000 0.00%
"'::1';. 22,500 2,716 $ 19,784 12.07%
.
$
j~ .":e'" ," '.; ~./~," f.~>,,:
5,474 $ 229,197 2.15%
Note:County Appropriation is not figured on the individual program report. The County appropriation in each program is
the difference between the total amounts on the program expenditure report and the totals on the program revenue report.
.
For Month of July 2004
.
Cumulative %
Program:
Type of
Revenue
Program:
Budgeted
Amount
Program:
Type of
Revenue
Budgetad
Amount
.
Program:
Type of
Revenue
Budgated
Amount
Program:
Type of
Revenue
Budgeted
Amount
.
New Hanover County Health Department
FY 04-05
MONTHLY REVENUE REPORT
As of July 31, 2004
8.33%
Month Reported
Monlof12
Jul-Q4
5125
Community HeaUh
Revenue
Earned
Balance
Remaining
%
BUdgeted
Amount
Revenue
Earned
Balance
Remaining
%
5126
Health Promotions
Current Year
Revenue Balance
Earned Remaining
Prior Year
Revenue Balance
Earned Remaining
%
Budgeted
Amount
%
5131
Administration
Current Year
Revenue Balance
Earned Remaining
Prior Year
Revenue Balance
Earned Remaining
%
Budgeted
Amount
%
5134
Navigator-Partnership
Current Year
Revenue Balance
Earned Remaining
Prior Year
Revenue Balance
Earned Remaining
%
Budgeted
Amount
%
Note: County Appropriation is not figured on the individual program report. The County appropriation in each program is
the difference between the total amounts on the program expenditure report and the totals on the program revenue report.
For Month of July 2004
1
New Hanover County Health Department
FY 04-05
MONTHLY REVENUE REPORT
As of July 31, 2004
.
Cumulative %
8.33%
Month Reported
Man 1 of12
Jul-<l4
Program:
5141
Women Infants and Children (WIC)
Current Year Prior Year
Type of Budgeted Revenue Balance % Budgeted Revenue Balance %
Revenue Amount Earned Remaining Amount Earned Remaining
Federal & State 17,870 $ 430,873 355,261 $ 2,028 $ 353,233 0.57%
Program:
5142
Nutrition
Type of
Revenue
Budgeted
Amount
Current Year
Revenue Balance
Earned Remaining
%
Budgeted
Amount
Prior Year
Revenue Balance
Earned Remaining
%
.
Program:
5151
Epidemiology
Type of
Revenue
Federal & State
Medicaid
Health Fees
Med Max
Other
Budgeted
Amount
$ 73,140
$ 35,000
$ 69,545
$ 27,000
$ 36,500
Current Year
Revenue Balance
Earned Remaining
$ 11,722 $ 61,418
$ $ 35,000
$ 8,316 $ 61,229
$ $ 27,000
$ $ 36,500
%
Prior Year
Revenue Balance
Earned Remaining
$ 10,367 $ 62,988
$ $ 35,000
$ 7,702 $ 61,648
%
14.14%
0.00%
11.11%
Note: County Appropriation is not figured on the individual program report. The County appropriation in each program is
the difference between the total amounts on the program expenditure report and the totals on the program revenue report.
.
For Month of July 2004
.
Cumulative %
Program:
Type of
Revenue
Federal & State
Medicaid
Health Fees
Budgeted
Amount
Program:
BUdgeted
Amount
Program:
.
Program:
Type of
Revenue
Budgeted
Amount
Program:
Type of
Revenue
Other
.
New Hanover County Health Department
FY 04-05
MONTHLY REVENUE REPORT
As of July 31, 2004
8.33%
Month Reported
Mon 1 of 12
Jul-ll4
5152
TB
Revenue
Earned
Balance
Remaining
$ 79,249
$ 7,500
$ 13,305
%
Budgeted
Amount
Revenue
Earned
Balance
Remaining
$ 77,218
$ 7,500
$ 13,641
%
5155 Child Care Health Consultant
Current Year
Revenue Balance %
Earned Remaining
$ 62,800
Prior Year
Balance
Remaining
$ 60,630
%
5160
Health Check
Current Year
Revenue Balance
Earned Remaining
$ $ 41,747
Prior Year
Revenue Balance
Earned Remaining
$ $ 41,035
%
%
5162
Matemal Health
Current Year
Revenue Balance
Earned Remaining
Prior Year
Revenue Balance
Earned Remaining
%
BUdgeted
Amount
%
5166
Partnership for Children
Current Year
Revenue Balance
Earned Remaining
$ $ 172,500
Prior Year
Revenue Balance
Earned Remaining
$ 171,977
%
%
0.00%
$
Note: County Appropriation is not flgured on the individual program report. The County appropriation in each program is
the difference between the total amounts on the program expenditure report and the totals on the program revenue report.
For Month of July 2004
New Hanover County Health Department
FY 04-05
MONTHLY REVENUE REPORT
As of July 31, 2004
.
Cumulative % 8.33%
Program: 5167 Child Health
Current Year
Type of Budgeted Revenue Balance
Revenue Amount Earned Remaining
Federal & State $ 90,028 $ $ 90,028
Health Fees $ 1,000 $ 132 $ 868
Medicaid $ 10,000 $ $ 10,000
Month Reported
Monlof12
Jul-04
Prior Year
'10 ~~. Budgeted Revenue Balance %
;{,:."
1 Amount Earned Remaining
90,153 $ $ 90,153 0.00%
1,000 $ $ 1,000 0.00%
10,000 $ $ 10,000 0.00%
Program
5169
School Hea~h
Type of
Revenue
Other
Budgeted
Amount
$ 1,673,200 $
Current Year
Revenue Balance
Earned Remaining
$1,673,200
%
l:..,
';;:
Budgeted
Amount
$ 1,452,133 $
Prior Year
Revenue Balance
Earned Remaining
$ 1,452,133
%
0.00%
.
Program
5170
NC Wisewoman
Type of
Revenue
Budgeted
Amount
Current Year
Revenue Balance
Earned Remaining
%
'~~:
Budgeted
Amount
Prior Year
Revenue Balance
Earned Remaining
%
Federal & State $
20,328 $
3,755 $ 16,573
$
27,104 $
$
27,104
0.00%
.
For Month of July 2004
.
.
.
New Hanover County Health Department
FY 04-05
MONTHLY REVENUE REPORT
As of July 31,2004
Cumulative %
8.33%
Month Reported
Mon 1 0112
Jul-04
Program:
5181
Project Assist
Type 01
Revenue
Current Year
Revenue Balance
Earned Remaining
%
Prior Vear
Revenue Balance
Earned Remainl"
Budgeted
Amount
%
Budgeted
Amount
Program:
5183
Safe Communities
Type 01
Revenue
Current Year
Revenue Balance
Earned Remaining
%
Prior Year
Revenue Balance
Earned Remaining
Budgeted
Amount
%
Budgeted
Amount
Program:
5187
Project Stop
Type 01
Revenue
Current Year
Revenue Balance
Earned Remaining
%
Prior Year
Revenue Balance
Earned Remaining
Budgeted
Amount
%
Other
s
s
s
0.00%
Note: County Appropriation is not figured on the individual program report. The County appropriation in each program is
the difference between the total amounts on the program expenditure report and the totals on the program revenue report.
For Month of July 2004
New Hanover County Health Department
FY 04-05
MONTHLY REVENUE REPORT
As of July 31, 2004
.
Cumulative %
8.33%
Month Reported
Mon 1 0112
Jul-04
Program:
5188
TB Outrech
Current Vear
Revenue Balance
Earned Remaining
10,700
%
Budgeted
Amount
Prior Year
Revenue Balance
Earned Remaining
$
%
Program:
5189
Safe Schools
Type of
Revenue
Budgeted
Amount
Current Year
Revenue Balance
Earned Remaining
$ 51,900
%
Budgeted
Amount
Prior Year
Revenue Balance
Earned Remaining
$
%
Totals 51,900 $ 51,900 0.00% $ - $ - $
Note:County Appropriation is not figured on the individual program report. The County appropriation in each program is
the difference between the total amounts on the program expenditure report and the totals on the program revenue report.
.
.
For Month of July 2004
.
.
.
Type of
Expenditure
Salary & Fringe
Operating
Capital Outlay
New Hanover County Health Department
FY 04-05
MONTHLY EXPENDITURE REPORT
As of July 31, 2004
Summary lor the New Hanover County Health Department
Cumulative % 8.33% Month Reported Mon1of12 Jul-04
Current Year Prior Year
Budgeted Expended Balance % BUdgeted Expended Balance %
Amount Amount Remaining Amount Amount Remaining
$ 10,383,157 $
$ 1,517,904 $
$ 86,633 $
342,794 $ 10,040,363
19,823 $ 1,498,081
$ 86,633
3.30% $
1.31% $
0.00% $
9,699,406 $
1,366,405 $
35,000 $
964,585 $8,734,821
78,893 $1,287,512
$ 35,000
9.94%
5.77%
0.00%
Expenditure Summary
For Month of July 2004
New Hanover County Health Department
FY 04-05
MONTHLY EXPENDITURE REPORT
As of July 31, 2004
Program:
Cumulative %
5111
Environmental Health
8.33%
.
Month Reported
Mon 1 0112
Jul-04
Current Year Prior Year
Type of Budgeted Expended Balance % ~ Budgeted Expended Balance %
Expenditure Amount Amount Remaining Amount Amount Remaining
Salary & Fringe $ 1,011,926 $ 47,563 $ 964,363 $ 849,242 $ 83,820 $ 765,422 9.87%
Operating $ 69,992 $ 4,689 $ 65,303 $ 69,901 $ 8,026 $ 61,875 11.48%
Capital Outlay $ $ $ $ $ $
Program: 5112 Vector Control
Current Year Prior Year
Type of Budgeted Expended Balance % ~ Budgeted Expended 13alance %
~
Expenditure Amount Amount Remaining %f; Amount Amount Remaining
Salary & Fringe $ 329,389 $ 22,713 $ 306,676 $ 318,648 $ 49,262 $ 269,286 15.46%
Operating $ 124,463 $ $ 124,463 124,463 $ 792 $ 123,671 0.64%
Capttal Outlay $ $ $ $ $ 0.00%
.
Program: 5114 Animal Control
Current Year Prior Year
Type of Budgeted Expended Balance % r;;,.. Budgeted Expended Balance %
.
Expenditure Amount Amount Remaining Amount Amount Remaining
Salary & Fringe $ 766,164 $ 48,962 $ 717,202 $ 756,520 $ 88,996 $ 667,524 11.76%
Operating $ 179,293 $ 819 $ 178,474 $ 179,293 $ 2,237 $ 177,056 1.25%
Capitai Outlay $ $ $ $ $ $ 0.00%
Program: 5121 Laboratory
Current Year Prior Year
Type of Budgeted Expended Balance % .." Budgeted Expended Balance %
Expenditure Amount Amount Remaining ~ Amount Amount Remaining
Salary & Fringe 291,165 16,693 $ 274,472 296,531 33,970 $ 262,561
Operating 74,483 1,058 $ 73.425 74,483 1,532 $ 72,951
Capital Outlay $ $
.
For Month of July 2004
.
New Hanover County Health Department
FY 04-05
MONTHLY EXPENDITURE REPORT
As of July 31, 2004
Program:
5122
Public Health Bioterrorism
Cumulative %
8.33%
Current Year
Expended Balance
Amount Remaining
Month Reported
Budgeted
Amount
Men 1 of12
Prior Year
Expended Balance
Amount Remaining
Type of
Expenditure
Budgeted
Amount
%
Salary & Fringe $
Operating $
Capital Outlay $
318,091 $
122,937 $
$
18,315 $ 299,776
3,770 $ 119,167
$
$ 314,506 $
$ 55,344 $
$ $
33,298 $
8,542 $
$
281,208
46,702
Program: 5131 Administration
Current Year
Type of Budgeted Expended Balance
Expenditure Amount Amount Remaining
Salary & Fringe $ 688,546 $ 39,876 $ 648,670
Operating $ 204,941 $ 1,922 $ 203,019
Capital Outlay $ 85,833 $ $ 85,833
$ 41,798
. Program: 5132 Board Members
Current Year
Type of Budgeted Expended Balance
Expenditure Amount Amount Remaining
Operating $ 3,900 $ 595 $ 3,305
%
Prior Year
Expended Balance
Amount Remaining
~: B:~~:t~:
5.79% f $ 619,332 $
0.94%~. $ 191,841 $
0.00% ,~, $ 35,000 $
.,~.~
4.27% ~'\' $
62,136 $
44,873 $
$
557,196
146,968
35,000
Jul-04
%
10.59%
15.62%
0.00%
%
10.03%
23.39%
0.00%
%
Budgeted
Amount
Prior Year
Expended Balance
Amount Remaining
v;.
$
3,900 $
$
3,900
%
0.00%
Program: 5123 Care Coordination
Current Year Prior Year
Type of Budgeted Expended Balance % ~; BUdgeted Expended Balance %
Expenditure Amount Amount Remaining ~~' Amount Amount Remaining
Salary & Fringe $ 1,052,795 $ 14,015 $ 1,038,780 $ 980,294 $ 110,247 $ 870,047 11.25%
Operating $ 43,060 $ 641 $ 42.419 60,873 $ 2,075 $ 58,798 3.41%
Capital Outlay $ $ $ $ $ 0.00%
.
For Month of July 2004
1
I
New Hanover County Health Department
FY 04-05
MONTHLY EXPENDITURE REPORT
As of July 31, 2004
.
Program:
5134 Navigator Partnership
b
Cumulative %
8.33%
Month Reported
Type of
Expenditure
Budgeted
Amount
Current Year
Expended Balance
Amount Remaining
%
~
Budgeted
Amount
Mon1of12
Prior Year
Expended Balance
Amount Remaining
Jul-04
%
135,934
13,489
128,683
13,091
162,078
16,629
142.002
16,257
Program:
Type of
Expenditure
Budgeted
Amount
5141 Women, Infants and Children
Current Year
Expended Balance %
Amount Remaining
Budgeted
Amount
Prior Year
Expended Balance
Amount Remaining
%
Program:
5142
Nutrition
.
Type of
Expenditure
Budgeted
Amount
Current Year
Expended Balance
Amount Remaining
%
Budgeted
Amount
Prior Year
Expended Balance
Amount Remaining
%
Program: 5151 Communicable Disease (Epidemiology)
Current Year Prior Year
Type of Budgeted Expended Balance % I Budgeted Expended Balance %
Expenditure Amount Amount Remaining Amount Amount Remaining
Salary & Fringe 1,098,821 60,662 $ 1,038,159 5.52% I $ 1,143,164 131,845 $ 1,011,319
Operating 154,523 1,290 $ 153,233 0.83% .il $ 116,Q63 1,029 $ 115,034
Capital OuUay $ . $ $
.
For Month of July 2004
.
New Hanover County Health Department
FY 04-05
MONTHLY EXPENDITURE REPORT
As of July 31, 2004
Program:
5152
Tuberculosis
Cumulative %
Month Reported
Type of
Expenditure
Budgeted
Amount
%
I
Budgeted
Amount
Mon1of12
Prior Year
Expended Balance
Amount Remaining
Jul-04
%
276,667
38,886
261,113
38,429
240,817
38,886
215,762
38,267
Program:
Type of
Expenditure
Budgeted
Amount
5154 Navigator
Current Year
Expended Balance
Amount Remaining
%
Budgeted
Amount
Prior Vear
Expended Balance
Amount RemainIng
%
5,292
.
Program:
5124
Women's Preventive Health
Type of
Expenditure
BUdgeted
Amount
Current Year
Expended Balance
Amount Remaining
%
BUdgeted
Amount
Prior Year
Expended Balance
Amount Remaining
%
593,449
188,600
574,204
188,394
564,142
137,690
505,451
131,097
Program: 5155 Child Care Health Consultant
Current Year Prior Year
Type of Budgeted Expended Balance % ~ Budgeted Expended Balance %
Expenditure Amount Amount Remaining '..,' Amount Amount Remaining
Salary & Fringe $ 57,376 $ 3,994 $ 53,382 $ 58,599 $ 1,578 $ 57,021 2.69%
Operating $ 5.033 $ 79 $ 4,954 $ 3,938 $ 20 $ 3,918 0.51%
Capital $ $ $ $ $ $ 0.00%
.
For Month of July 2004
New Hanover County Health Department
FY 04-05
MONTHLY EXPENDITURE REPORT
As of July 31, 2004
.
Program:
5156 Komen Grant
Cumulative %
8.33%
Month Reported
Mon1of12
Jul.Q4
Type of
Expenditure
Budgeted
Amount
Current Year
Expended Balance
Amount Remaining
%
Budgeted
Amount
Prior Year
Expended Balance
Amount Remalnln
%
$
$
$
$
$
$
0.00%
Program: 5126 Health Promotions
Current Year Prior Year
Type of Budgeted Expended Balance % ;....,: Budgeted Expended Balance %
Expenditure Amount Amount Remaining ~: Amount Amount Remaining
Salary & Fringe $ 151,359 $ 5,037 $ 146,322 139,685 $ 16,031 $ 123,654 11.48%
Operating $ 11,821 $ 66 $ 11,755 11,821 $ 291 $ 11,530 2.46%
.
For Month of July 2004
Program
5163
Family Planning
Type of
Expenditure
Salary & Fringe
Operating
Capital Outlay
Budgeted
Amount
Current Year
Expended Balance
Amount Remaining
(28,544) $ 28,544
$
$
%
Prior Year
Expended Balance
Amount Remaining
$
$
$
%
0.00%
0.00%
.
For Month of July 2004
New Hanover County Health Department
FY 04-05
MONTHLY EXPENDITURE REPORT
As of July 31, 2004
.
Cumulative %
8.33%
Month Reported
Mon1of12
Jul-Q4
Program:
Type of
Expenditure
Budgeted
Amount
5161 Personal Health
Current Year
Expended Balance
Amount Remaining
%
I,';;" Budgeted
;;jt'
"';~':::' Amount
Prior Year
Expended Balance
Amount Remaining
%
(26,454)
26,454
Program: 5166 Partnership for Children
Current Year
Type of Budgeted Expended Balance %
Expenditure Amount Amount Remaining
Salary & Fringe $ 166,875 $ 9,467 $ 157,408
Operating $ 4,824 $ 126 $ 4,698
Capital $ 800 $ $ 800
Totals $ 172,499 $ 9,593 $ 162,106
Budgeted
Amount
Prior Year
Expended Balance
Amount Remaining
%
.
Program:
5167
Child Health
Type of
Expenditure
Budgeted
Amount
Current Year
Expended Balance
Amount Remaining
%
(j
'~'i: "
Budgeted
Amount
Prior Year
Expended Balance
Amount Remaining
%
Salary & Fringe
Operating
Capital Outlay
$ 332,107
$ 40,380
18,954
1,489
313,153
38,891
$ 327,069
$ 40,505
34,191
712
292,878
39,793
10.45%
1.76%
.
For Month of July 2004
.
New Hanover County Health Department
FY 04-05
MONTHLY EXPENDITURE REPORT
As of July 31, 2004
Program:
5168
Dental Health
Cumulative %
8.33%
Month Reported
Mon 1 of12
Jul.()4
Type of
Expenditure
Budgeted
Amount
Current Year
Expended Balance
Amount Remaining
%
r;~~
!iii, Budgeted
~ Amount
Prior Year
Expended Balance
Amount Remaining
%
Salary & Fringe
Operating
$
$
42,377 $
5,200 $
1,340 $
$
41,037
5,200
42,110 $
5,200 $
4,002 $
$
38,108
5,200
9.50%
0.00%
Program: 5169 School Health
Current Year Prior Year
Type of Budgeted Expended Balance % Ii Budgeted Expended Balance %
f, '~
Expenditure Amount Amount Remaining ; ,~ Amount Amount Remaining
1,599,761 17,804 $ 1,581,957 20,268 1,380,604
59,582 33 $ 59,549 20 51,241
$
.
Program: 5170 Wise Woman
Current Year Prior Year
Type of Budgeted Expended Balance % ..-~' Budgeted Expended Balance %
Expenditure Amount Amount Remaining ~}~ Amount Amount Remaining
Operating $ 20,328 $ 737 $ 19,591 $ 27,104 $ $ 27,104
v
Program:
Type of
Expenditure
Budgeted
Amount
Current Year
Expended Balance
Amount Remaining
%
~~~~ B~:~:~:
Prior Year
Expended Balance
Amount Remaining
%
$
$
- $
$
$
$
0.00%
.
For Month of July 2004
New Hanover County Health Department
FY 04-05
MONTHLY EXPENDITURE REPORT
As of July 31, 2004
.
Program:
5174
Jail Health
Cumulative %
8.33%
Month Reported
Mon1of12
Jul-04
Type of
Expenditure
BUdgeted
Amount
Current Year
Expended Balance
Amount Remaining
%
~~";'.i Budgeted
,"'~
i~~ Amount
Prior Year
Expended Balance
Amount Remaining
%
21,787
(21,787)
Program:
5178
Children Special Health Services
Type of
Expenditure
Budgeted
Amount
Current Year
Expended Balance
Amount Remaining
%
Budgeted
Amount
Prior Year
Expended Balance
Amount Remaining
%
.
Program:
5180
Risk Reduction
Type of
Expenditure
Budgeted
Amount
Current Year
Expended Balance
Amount Remaining
%
Budgeted
Amount
Prior Year
Expended Balance
Amount Remaining
%
.
For Month of July 2004
. Program: 5181 Project Assist
Cumulative % 8.33%
Current Year
Type of Budgeted Expended Balance %
Expenditure Amount Amount Remaining
45,609 2,441 43,168
18,210 39 18,171
New Hanover County Health Department
FY 04-05
MONTHLY EXPENDITURE REPORT
As of July 31, 2004
Month Reported
Mon1of12
Jul.()4
Budgeted
Amount
Prior Year
Expended Balance
Amount Remaining
%
5,482
143
Program: 5182 Health Education
Current Year Prior Year
Type of Budgeted Expended Balance % I Budgeted Expended Balance %
Expenditure Amount Amount Remaining Amount Amount Remaining
(5,311) 5,311 0.00% I $ 0.00%
0.00% '$ 0.00%
$
.
Program: 5183 Safe Communities
Current Year Prior Year
Type of Budgeted Expended Balance % I Budgeted Expended Balance '10
Expenditure Amount Amount Remaining Amount Amount Remaining
Salary & Fringe $ $ $ $ $
Operating $ 10,000 $ $ 10,000 10,000 $ $ 0.00%
Program:
5186
Smart Start for Asthma
Type of
Expenditure
Salary & Fringe
Operating
Budgeted
Amount
Current Year
Expended Balance
Amount Remaining
$
$
%
Ii BUdgeted
)!-" Amount
~
Prior Year
Expended Balance
Amount Remaining
$
$
%
.
For Month of July 2004
New Hanover County Health Department
FY 04-05
MONTHLY EXPENDITURE REPORT
As of July 31, 2004
"
Program: 5187 Project Stop
Cumulative % 8.33% Month Reported Mon1of12 Jul-04
Current Year Prior Year
Type of Budgeted Expended Balance % > BUdgeted Expended Balance %
Expenditure Amount Amount Remaining Amount Amount Remaining
Salary & Fringe $ 33,049 $ 414 $ 32,635 $ 45,062 $ $ 45,062 0.00%
Operating $ 500 $ 54 $ 446 $ 3,218 $ $ 3,218 0.00%
Capital Outlay $ $ $ $ $ $
.
Program: 5188 TB Outreach
Current Year Prior Year
Type of Budgeted Expended Balance % A'" Budgeted Expended Balance %
Expenditure Amount Amount Remaining 1': Amount Amount Remaining
,,;
Salary & Fringe $ 10,700 $ $ 10,700 $ $ $
Operating $ $ $ $ $ $
Capnal Outlay $ $ $ $ $ $
;:t ~j 4~~ ~:X.. "" ' 'ti" .
10,700 $
Program: 5189 Unned 4 Youth
Current Year Prior Year
Type of Budgeted Expended Balance % ,., Budgeted Expended Balance %
: "
Expenditure Amount Amount Remaining ?~ Amount Amount Remaining
;""<J
';<'
49,124 905 48,219 1.84% ;,-~
2,776 28 2,748 1.01% i~~
~;i\
.
For Month of July 2004
f
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Sign Here
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New Hanover County
Health Department
Last Name
First Name MI
Patient SS#:
PERMISSION TO USE AND DISCLOSE
PATIENT HEALTH INFORMATION
Date of Birth: ~----!
I hereby acknowledge that I have received a copy of the "Notice of Privacy Practices" for New
Hanover. County Health Department and understand that I may contact the New Hanover
County Privacy Officer if! have questions about the content of the notice.
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an answering machine or other device (such as a text pager), please complete the following.
o New Hanover County Health Department may leave a message regarding my medical
information or appointments on the device at the following number L)
NHCHD 08/31/04
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Inicial del SegundoNombre
New Hanover County
Health Department
Apellido Primer Nombre
.# del SS del paciente:
Fecha de Nacimiento: --.!--.!
PERMISO PARA USAR Y COMPARTlR
INFORMACION DE LA SALUD DEL PACIENTE
(Permission to Use and Disclose
Patient Health Information)
Por medio de la presente reconozco que he recibido una copia del formulario "Aviso de las Pnicticas de Privacidad "
del Departamento de Salud en el Condado de New Hanover y entiendo que puedo contactar al Oficial de la Privacidad
del Condado de New Hanover si ten go preguntas acerca del contenido de este aviso.
Finna del PacientelPadre/Representante Autorizado
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Porfavor denos una clave de palabras 0 frase (no mas de 10 letras). Esto va ser usado para verificar su identidad si
usted nos llama por telefono 0 para verificar la identidad de la persona que usted ha autorizado para que nosotros
podamos compartir la informaci6n de su salud. Si ha usted se Ie olvida la clave 0 frase, se Ie va ha pedir que presente
identificaci6n para poder darsela nosotros.
P ALABRA CLA VE 0 FRASE
Si usted desea que nosotros Ie dejemos informaci6n medica acerca de su cuidado y citas en su maquina contestadora u
otro aparato (como el celular), porfavor complete 10 siguiente.
EI Departamento de Salud de New Hanover puede dejar un mensaje respecto a mi informaci6n medica 0 citas en la
maquina al siguiente numero ( )
.~
NHCHD 08/31/04
Hepatitis A Reported cases, New Hanover County
By month and year of onset
. MTH ONSET
YR ONSET I 01 02 03 O. 05 06 07 08 09 10 11 12 I Total
-----------+-------------------------------------------------------------------------------------+------
1988 I 0 0 0 0 0 0 0 0 0 0 0 1 1
1989 I 0 0 0 0 0 0 0 0 1 1 0 1 3
1990 0 0 0 0 0 0 1 0 0 0 0 0 1
1992 0 0 0 0 1 0 1 1 0 0 0 0 3
1993 0 0 0 0 0 0 0 1 0 0 0 0 1
1994 1 0 0 1 0 0 1 0 0 2 0 1 6
1995 0 0 0 1 0 0 0 1 0 0 0 1 3
1996 0 0 0 0 0 0 0 0 0 1 1 0 2
1997 0 1 0 1 0 0 0 0 1 0 1 0 .
1998 0 0 0 0 0 0 0 0 1 1 0 0 2
1999 0 0 0 0 0 0 0 1 0 0 0 0 1
2000 1 0 0 0 0 0 0 0 1 0 0 0 2
2001 0 0 0 0 0 1 0 0 1 0 0 0 2
2002 2 0 0 0 1 0 1 0 1 0 0 0 5
2003 0 0 1 0 0 0 0 0 1 0 0 0 2
-----------+-------------------------------------------------------------------------------------+------
Total I . 1 1 3 2 1 . . 7 5 2 . I 38
.
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