IGA CARTWRIGHT ESD DENTAL SEALANT SERVISES PE .PDF

INTERGOVERNMENTAL AGREEMENT
MARICOPA COUNTY
by and through the
DEPARTMENT OF PUBLIC HEALTH ;
4041 N. Central Avenue, #1400, Phoenix, Arizona 85012

1. Agreement No: C-86-23 2: Agreement Type: Non-Financial Service Agreement
3. Agreement Amount: $0:00 4. Purpose: Dental Sealant _
5, Start Date: January-1,-2023, 6. Expiration Date: December 31, 2026

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This Agreement is entered into by and between Cartwright Elementary School District (referred to herein ‘as “Contractor’), and
Maricopa County, by and through:its Department of Public Health (MCDPH) (referred to herein after as’ “County”). Contractor and
the County are:collectively referred to herein-as the “Parties” and individually as a “Party.” Contractor, forand in consideration of
the.covenants:and conditions set forth herein, shall provide and perform the services as set forth below. All rights and obligations
of ‘the Parties shall be governed by the terms of this Agreement, its exhibits, attachments, and appendices, including any
subcontracts:or amendments. as set forth herein and in:

Section | : General Provisions

Section It - Special Provisions

This Agreement contains all the terms: and conditions agreed to. by the Parties, .No other understanding, oral or otherwise,
regarding the subject matter of this Agreement shall be deemed:to’exist or to bind the Parties. Nothing in this Agreement shall
be construed as consent to any lawsuit.or waiver of any defense in a lawsuit brought against the County or the Contractor in’any.
State. or federal Court.

Section Ill - Work Statement

Legal Notice under this Agreement shall be given by personal delivery or by registered or certified mail, postage prepaid, return
receipt requested, to the addresses set forth below and'shall be effective upon receipt by the Party to whom addressed unless
otherwise indicated in the notice.

ee Phone! (623) 6

ist
joenix, ‘AZ a

Notice to Department: | MCDPH Grants/Contract Unit . Phone: (602) 372-0674
Address: 4041 North Central Avenue, Suite #1400, Phoenix, Arizona 85012

IN WITNESS WHEREOF, the partiés enter into this Agreement
PARTNER INFO MARICOPA COUNTY BOARD OF SUPERVISORS

suntue ZB.

Signature
Name vVirto@ 1) FARRAP Name Bill Gates
Title CEO Title Chairman, Board of Supervisors
Date = Jo fy (2022. Date
ATTEST:
Signature
Juanita Garza, Office of the Clerk of the
Board
Date

Pursuant to A.R.S. § 11-952, the Attorney for the Board of
Supervisors has determined that this Intergovernmental
Agreement is within the powers.and authority-granted-under the
laws of the State of Arizona.

Pursuant to A.R:S. § 11-952, the undersigned public agency

attorney has. determined that this Intergovernmental Agreement
is in proper form and.is. within the: powers and authority granted
under the laws:of the Sta

Signature

e
Date A of: ef ZZ

Signature

Anne Longo, Attorney for Maricopa.County

Date

SECTION!

PROVISIONS

4. EFFECT

To the extent the Special Provisions:are.in.conflict with the General Provisions, the Special
Provisions shall. control. To the extent the Work Statement(s) and the Special or General
Provisions are.in conflict, the Work Statement(s) shall control.

2. DEFINITIONS

As used throughout this Agreement, the.following tarms.shalt have the following meanings:

A.
B.

Cc.
D.

Agreement means this document and all attachments and amendments hereto.

School District means the person, firm or organization listed on the Cover Page
of this: Agreement.

Gounty means Maricopa County, Arizona.

Department means the Maricopa County Department of Public: Health.

3. GENERAL REQUIREMENTS

A.

The terms of this Agreement shall be construed in accordance with Arizona law.
Any lawsuit arising out of this Agreement shall be brought in the appropriate court
in Maricopa County.

The County’ shall, without limitation, obtain.and.maintain all licenses, permits, and
authority necessary to.do’business, render sérvices, and perform work under this
Agreement, and.shall comply, with: all laws regarding unemployment insurance,
disability, and workers’ compensation.

The County is an independent contractor in the performance of work and the
provision of services under this Agreement and is not to be considered an officer,
employee, or agent of the School District. : :

4. AMENDMENTS

All Amendments to this Agreement must be in-writing and signed by authorized persons
for- both Parties, All amendments shall clearly state the effective date of the:action.

5. RETENTION OF RECORDS

A.

This. provision applies to all: financial and programmatic records, supporting
documents, statistical records, and other records of the County and School District,
which:are reasonably considered as relevant to this. Agreement.

The County and the School District shall retain all financial books, records, and
other documents related to this Agreement for five (5) years after the expiration
date of this Agreement. County, federal, or State-auditors, and any-other persons
duly authorized by the County, shall have full. access to and the right: fo examine,
copy and make use of -any and all stich financial books, records and other
documents.

SECTION | PROVISIONS

6.

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ASSIGNMENT AND SUBCONTRACTING

No rights, liability, obligations or duties under this Agreement may be assigned, delegated,
or subcontracted without the prior written approval of the County.

AGREEMENT COMPLIANCE MONITORING

School District shall monitor the County's: compliance. with, and performance under, the
terms.and conditions of this Agreement. On-site visits for compliance monitoring maybe
made by the School District and/or its grantor agencies at any time during the School
District's normal business hours, aniounced-or unannounced. During’an on-site visit, the
County shall make its records and documents related to-work performed or services
provided under this Agreement available to the:Schoot District for inspection and copying.

DEFAULT

Either Party may suspend, modify, or terminate this Agreement immediately upon giving
written notice to the other Parly that sald Party has falled to perform under or otherwise
breached any obligation:under this Agreement, or upon the occurrence of any event that
may jeopardize the ability of the noticing Party to’ perform: any of its obligations under this
Agreement.

TERMINATION

A. Either Party may terminate this Agreement'at any time by giving the other Party at
least thirty (30) calendar days priof written notice. The notice shall be given by
personal delivery or by régistered or'certified.mall, postage prepald, return receipt
requested. :

B. This Agreement may be ‘terminated by mutual written agreement-of-the Parties
specifying the termination-date therein.

G, If not terminated by one of the above methods, this Agreement will terminate upon
the expiration. date: of’ this Agreement as: stated on the Cover Page of this
Agreement:

TERMINATION FOR BREACH .

If elther Party defaults under this Agreement and the default continues for more than ten
(10) days after the effective daté-of the other Party's written notice stating the specific
nature of the default, then the noticing Party may treat the default as a breach. of this
Agreement. Upon.a breach, the: aggrieved Partly may exercise any remedy available
under-the law, Including the termination-of this Agreement.

SEVERABILITY
Any provision of this Agreement that is:determined to be invalid, void, or illegal by a court

shall in no’ way affect, impair, or Invalidate any other provision hereof, and the:rematning
provisions shall remain in full force’and effect.

SECTION! PROVISIONS

12.

13.

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15.

46.

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18.

STRICT COMPLIANCE

Acceptance by the Parties of performance that is‘not in-strict compliance with the terms of
this Agreement shall not be-deemed to waive the requirement of strict compliance for all
future performance. All-changes in: performance. obligations under this Agreement must
be in writing and signed.by the Parties.

NON-LIABILITY

The: School District and its officers, representatives; agents; and employees shall not be
liable for any act or omission:by the County or any subcontractor, employee, officer, agent,
or representative. of the.County or any subcontractor occurring in the performance: of this
Agreement, norshall they be.tiable. for purchases or contracts made by the County or any
subcontractor in connection with this Agreement.

INDEMNIFICATION

Each Party (as "indemnitor") agrees to. indemnify, defend, and hold harmless the-other
Partly (as “indemnitee") from and against any and all clalms, losses, liability, costs, or
expenses (including. reasonable attorney's fees) (hereinafter collectively referred to. as
“claims") arising out of the negligent performance of this Agreement, but only to the extent
that such claims which resull in. vicarious/derivative liability to the indemnitee are caused
by the act, omission, negligence, misconduct, or other fault of the indemnitor, its officers,
officials, agents, employees, or volunteers.

COVENANT AGAINST CONTINGENT FEES

The County warrants that no person or entity has been employed.or retained to solicit or
secure this Agreement upon ah agreement or understanding for a commission,
percentage, brokerage, or contingent fee. For breach or violation of this warranty, the
Schoo! District may immeédiately terminate this Agreement without liability.

SAFEGUARDING CLIENT INFORMATION

The use or disclosure by any Partly: of any information, concerning an eligible individual
served-under this. Agreement is directly limited to the performance of this: Agreement.

RIGHTS IN DATA

The Parties shall have-the:use of data and reports resulting from-this Agreement without
cost or other restriction, except asotherwise: provided herein:or by law. Each Party shall
supply to the other Party, upon request, any-available information known to the supplying
Party that is relevant to.this. Agreement:and to the.performance hereunder.

NON-DISCRIMINATION

The: County, in connection with any service or other activity. under this Agreement, shall
notin any way discriminate against any person on the grounds of:race,.color, religion, sex,
national origin; age, disability, affiliation or belief. The County shall-include this clause In
all of its subcontracts related to this Agreement.

SECTION} PROVISIONS

19.

20.

21,

22,

23.

EQUAL EMPLOYMENT OPPORTUNITY.

The County shall ‘not discriminate against any employee or applicant for employment
because of race, age, disability, color, religion,.sex, or national origin. The County shall
take affirmative action to insure that applicants are employed and that.employees are
treated during employment without regard to their race, age, disability, color, religion, sex,
or national origin. Such action shall include, but is not limited to, the following:
employment, upgrading, demotion or transfer,,recruitment or recruitment advertising, lay-
off or termination, rates of pay or other forms of compensation, and selection for training,
including apprenticeship. The County’ shall, fo the extent such provisions-apply, comply
with Titles VI and Vil of the Civil Rights Act of 1964, as amended (42 U.S.C, §§ 2000a, ef
seq:); the Rehabilitation Act of 1973, as.amendad (29 U.S.C. §§ 701, ef seq.); the Age
Discrimination. In. Employment Act of 1967, as amended (29 U.S.C. §§ 621, ef seq.); the
Immigration Reform. and Control Act of 1986:(Pub, L. No. 99-603) CIRCA"); and Arizona
Executive Order 2009-09, which. mandates that all persons shall have equal access to
employment opportunities. The County shall also comply with all applicable provisions of
the Americans with Disabilities Act of 1990:(42 U.S.C, -§§ 12101, ef'seq.).

RIGHT OF PARTIAL CANCELLATION

If more than one activily is funded by this: Agreement, the Parties reserve the right to
terminate this Agreement or any part thereof without impairing, invalidating or canceling
the remaining Work Statement obligations.

RIGHT TO EXTEND AGREEMENT.

Subject tothe availability of funds and acceptable County performance, the Parties hereby
acknowledge and agree that they ‘shall have: the right. fo extend fhis Agreement for
additional one-year periods, not to exceed a total extended term of five (5) years. Any
extension of this Agreement shall:be:In writing mutually acceptable to and signed by both
Parties.

CIVIL SERVICES DIVISION

The Parties to:this agreement acknowledge: that they:are aware that the Civil Services
Division of the: Maricopa County Attorney's Office (Cwvil Division) may be chosen as the
attorney for. other Parties to:this agreement,and the signing Party acknowledges thatittis
aware of a potential conflict of interest, and it waives any claim of conflict of interest, which
may arise-by virtue of Civil Division’s representation of other Parties fo this agreement.

CERTIFICATION REGARDING DEBARMENT AND SUSPENSION

A. The undersigned, an authorized representative of the County, certifies, to the best
of his or her knowledge and belief, that the County, defined as the primary
participant in accordance with 45 C.F.R. Part 76, and ifs principals:

4) are not presently debarred, suspended, proposed for debarment, declared
ineligible, or voluntarily excluded from covered transactions by any federal
department or agency;

2): have not within the 3-year period preceding this: Agreement been convicted of
or had a civil judgment entered against them for the commission of fraud or a
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SECTION I PROVISIONS

criminal offense in connection with-obtaining, attempting to-obtain, or performing.a
public (federal, State or local) transaction or contract under a public transaction;
violation of federal or State antitrust statues or commission of embezzlement, theft,
forgery, bribery, falsification or-destruction of records, making false statements, or
receiving stolen praperty;

3) are not presently indicted or otherwise criminally or civilly charged by a
government entity (Federal, State or local) with the commission of any of the
offenses enumerated in paragraph. (2) of this certification; and

4) have not within the 3-year period precading this Agreement had one or more
public transactions (federal, State or local) terminated for cause or default.

B. lf the County is not able:to provide this certification, an explanation-as to why shall
be attached to this Agreement.

Cc. The County shall include, without modification, this Paragraph in: all lower tier
covered transactions (/.e., transactions with subcontractors) and in all solicitations
for lowef tier covered transactions related to this Agreement.

24. E-VERIFICATION OF EMPLOYEES

The Gounty: warrants that it is in compliance with A.R.S. § 41-4401 and ‘further
acknowledges:

A. That the County and its subcontractors, If any, warrant-thelr compliance with all
federal immigration laws and regulations that relate to their employees and their
compliance with A.R.S..§ 23-214;

B. That a breach of the. warranty under subsection A above shall be deemed a
materlal breach of this Agreement that entitles the School. District to, among other
things, Immediately terminate this Agreement without liability;

on That the School District retains the legal right to inspect the papers of any County
or subcontractor employee who works pursuant to this Agreement to ensure that
the: County or ‘subcontractor is complying with the warranty provided under
subsection A above. and that the County agrees fo make all papers and
employment records of said employee(s) avallable during normal working hours in
order to-facllitate such an inspection;

D. That nothing herein shall make any County or. subcontractor an agent or employee
of the-school district.

SECTION Il SPECIAL PROVISIONS

2.

EFFECT

To the extent that the Special Provisions are in contlict-with the General Provisions; the
Special Provisions shall control, To the extent that the Work Statement(s) are in conflict
with the Special or General Provisions, tha Work:Statement(s) shall control.

DISPUTES

Except as: otherwise provided by law, or otherwise: specifically agreed to by the Parties,
any dispute. not involving a question of law arising out of this Agreement that is not
resolved between the Parties within a reasonable time, which shall not exceed 120 days,
shall.be resolved as follows:

A. Disputes must be filed with the. person administering this Agreement for the
County, if one has been: appointed, or, if not, with the Department, within ten (10)
days from the date the Parties knew or should have known the basis of the dispute.

B. The person administering this Agreement or the Department, as applicable, shall
respond in writing to the:dispute within fourteen (14) days.

c. The Parties may abide by the décision‘or may choose to resolve the dispute as set
forth in the Mediation/Arbitration Clause of the Special Provisions of this
Agreement.

This. Paragraph shall not apply to claims arising from bodily Injury, death, or property
damage.

MEDIATION/ARBITRATION

In the event that any dispute arises out of this Agreement or involves a recipient of services
under the ferms of this Agreement, the Parties shall meet and confer in an effort to resolve
the-dispute. In the-event that such: efforts to resolve the-dispute are unsuccessful, the
Parties'shall resolve the dispute by’ arbitration pursuant to A.R.S.’§ 12-1518(A).
CHANGES

A. The Department may, at ariy-time,-by written order, make.changes within the Scope
of this Agreement.in any onevar more of the following areas:

1). Work Statement. activities reflectirig changes. in the scope of services,
funding: source, or County-regulations; policies, or requirements.

2). Administrative. requirements, such as changes in reporting periods,
frequency of reports, or report formats: required by funding source, or
County regulations, policies, or requirements.
3}. Gounty schedules and program budgets
B. Any dispute or disagreement caused by such. written order shall constitute a
"Dispute" within the-meaning of the Disputes Clause of the Special Provisions of
this Agreement and shall be administéred accordingly.

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SECTION Il SPECIAL PROVISIONS

5. UNIFORM ADMINISTRATIVE REQUIREMENTS

By entering into this Agreement the County agrees to comply with all applicable provisions
of Title 2, Subtitle A, Chapter Hl, PART 200—UNIFORM ADMINISTRATIVE
REQUIREMENTS, COST PRINCIPLES, AND: AUDIT REQUIREMENTS FOR FEDERAL
AWARDS contained in Title 2 C.F.R. § 200 et seq,

6. LAWS, RULES AND REGULATIONS

The Schoo! District and the.County understand ‘and agree that this Agreement is subject
fo all State and federal laws, rules, and regulations that pertain hereto.

A. Neither this Agreement, nor any portion thereof, may be assigned to another
person by the. School District without the written consent of the County's
designated representative. Any attempt by the School District to. assign any
portion of this Agreement without the written consent of the Gounty shall.constitute
a breach of this Agreement.

B. No. assignment: shall alter the School District's responsibility to the County to
assure that all of the provisions under this Agreement are. carried out by its
assignee. All terms and. conditions in this Agreement shall be included in the
Schoo! District's assignments.

7. SPECIAL REQUIREMENTS

A. lf the use of subcontractors:is approved by Schoo! District, the County shall use
written subcontracts or consultant agreements that conform to Federal and State
laws and regulations, and to the requirements of this Agreement appropriate to the
service or activity covered by the subcontract. These provisions apply with equal
force fo the subcontract as if the subcontractor were the County referenced herein,
The ‘County is. responsible for performing under this Agreement whether:or not
subcontracts are.used. The County shall submit a copy of each subcontract to the
School District.within fifteen (15) days of its effective date.

B, The County: shall include in any subcontracts a provision to the effect that the
subcontractor agrees: that the School District shall have access to the
subcontractor's facilities: and the right to examine any books, documents, and
records of fhe subcontract; involving transactions related to the subcontract and
that such books, documents; and ‘records’ shall ‘not be disposed of except as
provided herein.

8. STATUTORY RIGHT OF CANCELLATION FOR CONELICT OF INTEREST

Notice is given that pursuant to A:R.S. § 38-611, the County may cancel this Agreement
without penalty or further obligation.within three. years after execution of this Agreement,
if any person signiflcantly involved in initiating, negotiating, securing, drafting, or creating
this. Agreement on behalf of fhe County is at any time while this Agreement or any
extension of this Agreement is in effect, an employee. or agent of any other Party to this
Agreement in any capacity or consultant to any other Party of this Agreement with respect
to the subject matter of this Agreement. Addifionally, pursuant to A.R.S. §-38-511, the
County may recoup any fee-or commission paid-or due to any person significantly involved

SECTION It SPECIAL PROVISIONS.

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11.

12.

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in initiating, negotiating, securing, drafting, or creating this Agreement on behalf of the
County from any other Party to this Agreement arising. as.the result of this Agreement.

This Agreement may be cancelled pursuant:to A.R.S. § 38-511.
POLICY ON CONFIDENTIALITY

The School District and the County understand and agree that this Agreement is subject
to.all State and federal laws protecting: client confidentiality of medical, behavioral health
and drug treatment Information:

SPONSORSHIP ACKNOWLEDGMENT

All promotional materials, brochures, and flyers prepared by the County shall inclide the
following statement, “Sponsored by MGDPH.”

ISRAEL BOYCOTT

By submitting this Agreement the County. certifies. that they are in compliance with Article
9, A.R.S. Section 35-393 et seq.

WORKERS’ COMPENSATION

An employee:of elther parly shall be deemed to be an “employee” of both public agencies
while performing pursuant to this Agreement solely for the purposes of A.R:S. § 23-1022
and the Arizona Workers’ Compensation laws. The primary employer shall be solely liable
for any workers’ compensation benefits which may accrue.

“Bach party shall post a notice. pursuant to the provisions of A.R.S. § 23-1022 in

substantially the following form:

“All employees are hereby further notified that they may be required to work under
jurisdiction: or control of or within the jurisdictional boundaries of another public agency
pursuant to an intergovernmental agreement, or contract,and under such circumstances
they:are:deemed by the laws of Arizona, to be employees: of both: public.agencies for the
purposes of workers’ compensation.”

FINGERPRINT AND CERTIFICATION REQUIREMENTS/JUVENILE SERVICES

The Fingerprint and Cerilfication Requirements listed in this section apply to this
Agreement to the extent it partains to services to juveniles.

A. The County shall require: that all paid and unpaid personnel who are required or
are allowed to provide: services. directly to juveniles have met all fingerprint and
certification requirements of A.R.S. §§ 15-512, 36-882 and 36-425.03: and the
School District prior to providing-such services.

B. The County shall submit: verification of fingerprinting and certification of an
employee by the: Department of Economic:Security, the Department of Corrections
or the Arizona Supreme Court to meet this requirement.

SECTION ti SPECIAL PROVISIONS

Cc. The County shall require and verify that those employees who qualify only for a
restricted: certification shall be supervised. when providing services directly to.
juveniles.

D. The County:shall require that all subcontracts for services to juveniles Include a
provision requiring compliance by the subcontractors with A.R.S. §§36-882 and
36-425.03.

€. This Agreement may be'canceled if the fingerprint certifications or the Certification
for Employment required by A.R.S. § 36-425.03 of any employee, including
volunteers (whether or not paid) shows: that he or she has. committed, been
convicted of, or is awaiting. trial for any offense(s) listed on the Certification for
Employment form in this state or: similar offenses in another state or jurisdiction.

14. COMMUNICATION

The County shall assume primary responsibility for effective, efficient communication with
Office of Oral Health Representative,

15. IT 1S MUTUALLY UNDERSTOOD AND AGREED BY AND BETWEEN THE PARTIES

THAT:

A. This instrument is neither a fiscal nora funds obligation document. Any endeavor
or transfer of anything of value involving reimbursement or contribution of funds
between: the parties. to this iristrument will be handled in accordance with
applicable laws, regulations, and procedures. including those for Goverhment
procurementand printing. Such endeavors will be outlined in separate agreements
that shall be made in writing by representatives of the partles and shall be
independently authorized by appropriate statutory authority. This instrument does
not provide such authority, Specifically, this Instrument does not establish
authority for noncompetitive award to the cooperator of any contract or other
agreement

B. PARTICIPATION IN’SIMILAR ACTIVITIES

This agreement in no way restricts Department or School District from participating
in similar activities with other public or private agencies; organizations, and
individuals.

16. NOTICE:
Any notice given under this Agreement shall be sent to the attention of the following:

Maricopa County Department of Public Health

Jackie Sutter, Program: Supervisor

Office of Oral Health

1645 East Roosevelt

Phoenix, Arizona 85006

Phone No.: (602) 506-6946

Email: dalilaguerrero@mail.maricopa:gov

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SECTION} SPECIAL PROVISIONS

Maricopa Gounty Department of Public Health, Grants
and Contracts Unit

Grants and Contracts Administrator

4041 N. Central Avenue, Suite 1400

Phoenix, Arizona 85012

Phone No.: (602) 372-0675

Cartwright Schoo! District
Alta: Victoria Farrar

Chief Financlal. Officer
5220 W. Indian Schoot Rd.
Phoenix, AZ 85031

Phone: No: 623-691-4084

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SECTION Il! WORK STATEMENT.

Background

Tooth decay is the most prevalent chronic disease currently affecting children, accounting for
- approximately 51 million school -hours' lost each year in the United States. Tooth decay and
resultant pain:can have an adverse-effact.on overall health; good nutrition, ‘self-esteem, and ability
to learn. Among the 43 states that collect'data in the same way, Arizona ranks #3 in highest
percentage (over 40%) of third grade children with untreated tooth decay. Conversely, the state
of Washington has the lowest percentage of children with untreated tooth decay (less than 15%)
among the Western states.

Dental:sealants area proven best-practice for reducing tooth decay in the chewing surfaces of
permanent molars. These teeth are best protected if dental sealants are applied soon after these
molars erupt (second and sixth grades), Dental ‘sealants can protect these molar -chewlng
surfaces from decay for many years. The procedure takes about 15 minutes per child, is pain
free, and requires no “shots” or drilling.

School-based dental sealant programs are evidence-based and provide: a safe,. inexpensive
model for delivering sealants to. school-age ‘children, with less learning time lost. The Maricopa
County Department of Public Health (MCDPH), Office of Oral Health (MCOOH) requests that
Cartwright Elementary School District join MCOGH in partnership to prevent tooth decay.and
improve the health of their second and sixth grade students during the 2021-2022 school year.
This Intergovernmental Agreement (IGA) will bring dental screenings and sealants to eligible
schools in the Cartwright Elementary School District. A licensed dentist will provide written take-
home findings and a list of dental clinics’ to aif (insured and uninsured) second and sixth grade
students who. return “positive” parental consent forms. The program will then provide dental
sealants to any of fhese same students who are clinically eligible and uninsured, or currently
enrolled.in AHCCCS or KidsCare. These preventive sérvices are provided at no cost to the school
or the child.

1. PURPOSE
The purpose.of this IGA is to develop a framework of cooperation between MCDPH and
School District to. provide dental sealants to eligible-students for the prevention of tooth
decay.

2. STATEMENT OF MUTUAL BENEFIT AND INTERESTS
The mutual benefit for both parties is the prevention of tooth decay for students without
private dental Insurance,

3. MCDPH SHALL:

A. Contact and schedule a déntal sealant screening date for eligible District Schools
that have submitted ‘a Program application form fo. MCOOH.

B. Provide program Information.and parental consent forms, -one month in advance
of the scheduled screening date, to the school nurse or designated liaison.

Cc. Provide technical assistance tothe schoo! nurse or designated Haison to ensure
successful implementation of the Program.

D. Provide licensed dentists and dental hygienists, and trained dental assistants to
conduct the dental screening and dental sealant activities at each school.

E. Check State Board of Dental Examiners licensing records on licensed MCDPH
dental providers; conduct background checks of all dental providers.

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SECTION Il!

WORK STATEMENT

N.

Supply identification badges for dental providers.
Instruct-all dental providers to register in the-school office upon arrival en campus.

Furnish/bring. all necessary dental supplies needed to conduct the dental
sereening/sealant aciivities.on- School District prernises.

Ensure that assigned space for conducting the dental sealant activities is returned
to Its original condition.

Provide‘oral health education materials for parents, teachers:and school nurse.
Provide:community dental clinic: Information to patents, teachers.and schoo! nurse.

Pravide program evaluation.form for’school nurse or liaison to. submit following
program completion.

Provide. summary reports to:each school, which will include information such as
the number of children screened, the number: of ‘eligible: children needing and
recelving dental sealants, the: number of sealants placed and the dollar value, and
alist of students urgently needing dental treatment,

Maintain:all student information according to confidentiality requirements.

4, SCHOOL. DISTRICT. SHALE;

A.

Promote participation in the dental sealant program at district schools through
communication with principals, teachers, school office, and health office
personnel,

Require school health personnel and teachers:of second and sixth grade students
to make distribution and-receipt.of parental consent forms a_priority.

Keep returned consent forms:separated by class and give them to.the dental team
upon arrival.

Provide adequate physical space at each school for the dental screening ‘and
sealant treatment services to be delivered because the school-based dental
sealant program promotes the education function. of the- District. The space at
each: schoo! will include ata minimum:

1) Aroom or area large enough to.accommodate the dental team, equipment,
and several children.

2) A room or.area where the equipment may stay overnight if the team needs
to return the following.day.

3) One table-and large trash receptacle per dental:team:

4) Accessible electrical outlets.

Provide-assistance (if necessary, or if required):with student identification, release
and transport from class on the screening and sealant days

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SECTION Ill WORK STATEMENT

F. Provide outreach to parents/guardians with. children having urgent dental needs so
that referrals to. dental services occur within 24 hours of the initial dental: screening.

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