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Home My WebLink About02-04 - Res. Adopting Mason County Dept of Health Services Fee Schedule - 2004/06/03 Mason County Board of Health Resolution No. 02-04 Whereas, the provision of public health services and activities within Mason County requires the collection of fees to compliment other sources of revenue, Whereas, it is the role and responsibility of Mason County Board of Commissioners to set policy for Mason County Department of Health Services concerning the funding of public health programs and activities in Mason County and to set fees accordingly, Whereas, the Mason County Board of Health held a public hearing on June 3, 2004 for the purpose of taking public testimony and to deliberate on the appropriate fees for public health goods and services and recommended that they be forwarded to the Mason County Board of Commissioners for adoption, Now therefore be it resolved, the fee schedule,policy and fees for issuing birth certificates, and policy for refund of fees as shown in Attachment"A" is hereby adopted as the Mason County Department of Health Services Fee Schedule, effective July 1, 2004. Dated this P day of June, 2004 Mason County Board of Health Mason County,Washington Attest: Chair Clerk of the Board Board Member Approved as to Form: / Board Member M son County rosecuting Attorney Attachment A Mason County Dept of Health Services, Personal Health Policy and Fees for Issuing Birth Certificates _ VITAL RECORD APPLICATION INSTRUCTIONS FOR WASHINGTON STATE BIRTH CERTIFICATES Please print clearly. Incomplete applications will be returned without processing. Make check or money order payable to "Personal Health Services." 1. Effective July 26, 2003 the pre-paid fee for each certified copy of a birth certificate issued will be $17. Two dollars of the seventeen dollars goes to the Department of Health, Center for Health Statistics for the purpose of developing and maintaining the state vital records systems, including a web-based electronic death registration system. Five dollars helps fund the Forensic Investigation Council, a fund supporting autopsies and death investigation at the local/county levels. Eight dollars stays with the local health jurisdiction. 2. Birth certificates applied for before 3:00 p.m can be picked up after 4:00 p.m. the same day. Birth certificates applied for after 3:00 p.m. will be available for pick-up after 4:00 p.m. the following day (allow 2-3 weeks from date of birth for newborns). For expedited service (when applying in person), please add $3.00 for the total order. 3. Local County Health Departments are Finked into the Washington State Dept. of Health Center for Health Statistics birth database and can usually issue certified birth certificates state-wide. Currently, Washington State birth records from1938 to present are on this database. For births between 1907 and 1938, application must be made with the Center for Health Statistics in Olympia, (360) 236-4300. Washington State began filing birth and death records on July 1, 1907. Birth certificates prior to that date must be obtained in the county of event. 5. If a matching record is found, a certified copy will be issued for pick-up or will be sent to the mailing address indicated. If no record is found or cannot be issued at the local level, a letter will be sent followed by a refund of$5.00*. If a birth certificate is not picked up in 30 days, the certificate will be mailed to the address on the form. 6. Anytime a record is"searched for and is found or not, a search fee of$8.00 is charged that is not refundable or transferable. Send complete application and $17.00 fee for each certified copy requested to address below. Mason County Dept of Health Services, Personal Health 303 N 4"' Street Shelton, WA 98584 * $17.00 less$8.00 non-refundable search fee plus $4.00 processing fee. Attachment A r" r Mason County Department of Health Services Policy for Refunds of Fees The Mason County Department of Health Services (MCDHS)Director or their designee may authorize a refund of fees collected by the Department. Fees will be refunded according to the following guidelines: Vital Records Fees 1. Anytime a record is searched for and is not found a non-refundable $8.00 search fee plus a$4.00 processing fee is charged. All Other Program Fees 1. Fees will not be refunded after processing work has been substantially done (such as research for a travel clinic visit or a site visit for a septic system), or after a permit has been issued. 2. Not more than 80% of a fee may be refunded if no work has been done. 3. Requests for refunds shall be in writing utilizing MCDHS forms, shall be by the original applicant, and must be accompanied by the original receipt. 4. A minimum of$50 will be held for administrative costs. 5. Provided, however, that when the payment for a service or permit was an error of the Mason County Department of Health Services staff, a 100%refund shall be made. 1 Attachment A MASON COUNTY PERSONAL HEALTH 2O04 FEE SCHEDULE �oposa Minimal(5) 20.00* 23,00* 2.5 hr.cart.training (Per person) **15.00* **15.00* Problem Focused(20)(new) 42.00* 45.00* 4 hr.cart.training (Per person) **30.00* **30.00* �= (estblished) 36.00* 39.00* aSLtEENN7 iE g �� EE 1 Expanded Problem(60)(DELETED) 60.00* Initial TB Exam 36.00* 39.00* (established)(DELETED) 50.00* Follow-up TB Exam 22.00* 25.00* Detailed(new)(DELETED) 90.00* PPD (same as Imms Admin fee) 15.00* 16.00* (established)(DELETED) 75.00* X-Ray, 1 view cost* cost* Travel Clinic 45.00 60.00 Radiologist cost* cost* ADIVItNIST4i0. '; FB z Blood Pressure Check 1.00 1.00 Off-site Clinic Rate(Per Hour) 65.00 65.00 Liquid Nitrogen/Warts 49.00* 49.00* Copy immunization record to pt 1.00 1.00 Pre/Post Couseling 54.50* 56.00* Copy medical records(1st 30 pgs)**** 0.83 0.83 Case Management(Full month) 172.00 172.00 each add'I page**" 0.63 0.63 Case Management(Partial month) 86.00 86.00 Clerical fee for searching&handling**** 19.00116.00* Comprehensive Assessment 137.75 137.75 Public records-per RCW 42.17.300 0.1511iEDljr'�►�1CON3ISUPPLiES °�ja` E Pr poseda 11VIINUfJ12AT10N5 y, SEE Doxycyline 14 2.50* 2.00* DTaP 1 -2-3-4-5-B 15.60* Doxycyline 28 3.75* 3.00* DT(Ped) 1 -2-3-4-5 15.60* Erythromycin 408 5.00* 8.00* Td 1 -2-B-Adolescent 15.60* 16.00* Metronidazole 14/500 mg 2.50* 3.00* OPV 1 -2-3-4-B 15.60* 16.00* Amox/Prob 500 mg ea 2.50* 3.00* IPV 1 -2-3-4-B 15.60* 16.00* Rocephin Inj 250 mg 16.25* 17.00* HIB 1 -2-3-4 15.60* 16.00* Suprax(Cefixime)400 mg(DELETED) 6.50* MMR 1 -2 15.60* 16.00* Zithromax 250 mg 23.75* 24.00* HEP A 1 -2 Adolescent 15.60* 16.00* Tetracycline 28/500 mg 3.75* 4.00* HEB-B 1 -2-3-B(0-18 yrs old) 15.60* 16.00* Bacetracin Ointment 1.25* 4.00* Hep A/B Combo 45.20 46.00 Monistat/7 15.00 15.00 Varicella(Chicken Pox)0-18 15.60* 16.00* Nystatin Cream 3.75* 3.00* HEB-B 1 -2-3-B (Adult) 30.00 37.00 Lindane Lotion 5.25 6.00* HBIG($174.04/cc) (/cc) (/cc) Lindane Shampoo 5.50 6.00* Immune Globulin ISG 5:00 9.00 Podophyllum Treatment 6.00* 6.00* HEP A(Havrix)Adult 22.00 29.00 INH 300 mg 30 3.75* 5.00* Prevnar(Pneumococcal Conjugate) 15.60* 16.00* Rifamate 60 47.50* 48.00* Oral Typhoid 36.25 45.00 Rifampin 30/300 mg 21.50* 22.00* Injectable Typhoid 41.50 51.00 Rifampin 601300 mg 48.00* 45.00* Td(Adult) 16.25 19.00 PZA 60/500 mg 54.50* 55.00* Rabies(3 doses-PRE-PAID) 401.25 429.00 Ethambutol 60/400 mg 80.00* 84.00* Influenza 15.00 18.00 B6 Pyridoxine 50 mg 3.00* 3.00* Pneumonia 21.00 22.00 g RYi4� x 'wEE rFroposed=; Varicella(Chicken Pox)Adult 62.50 79.00 Test 12.50* 4.00* Yellow Fever 71.25 87.00 5.00 5.00 Meningococcal 71.80 93.00 ount 7.00* 7.00* Unlisted meds/vaccines-aquisition cost Cost Cost Pap Smear 16.00 16.00 CRTIFIEDS Fr,',. ,� p oposet Pathologist fee 31.25* 40.00* Birth Certificates(each copy) 17.00 17.00 UA(W10)Micro 3.00* 4.00* Death Certificates(first copy) 17.00 17.00 RPR/VDRL 4.50 5.00* Expedite Fee(NEW) 3.00 HSV-culture 35.25 39.00 Research Fee(non-refundable) 8.00 8.00 GC 4.50 5.00 Corrections to Death Certs(1st copy) 8.00 10.00 CT&GC urine 4.50 5.00 Additional corrected copies 3.00 3.00 HSV-antibody(Igg) 20.25 30.00 Birth Cert.refund charge++ 12.00 IgM Anti-HAV(Hep A) 18.25 20.00 MATERNITY SUPOR7 ee n Anti-HAV(Hep A Total) 19.50 22.00 Nursing Office Visit 58.00 30.00/unit HbsAI3(Hep B Titer)*"*+ 17.00 19.00 Nursing Home Visit 91.15 40.00/unit HBsAg(surface antigen) 17.00 19.00 Nutrition Office Visit 58.00 30.00/unit Anti-HBc(core antibody) 19.50 22.00 Nutrition Home Visit 91.15 40.00/unit Hep B Screen(HBsAg&Anit-HBs)*** 29.50 35.00 Behavioral Health Offic Visit 58.00 30.00/unit Hep B Panel(HBs Ag,Anti-HBs&Anti-HBc)** 44.50 63.00 Behavioral Health Home Visit 91.15 40.00/unit Hep Panel (acute) 62.00 84.00 ICM 7 25.00/unit Anti-HCV(Hep C) H.00 24.00 ___