Holiday Invoice by ivr86917

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									                   2009-2010 S/PHCC Monthly Subcontractor Invoice                                               Subcontractor: Roanoke/Alleghany Health District
Service                                               Total            Units          Clients
Outpatient Medical Care                                    $0.00
Pharmacy Assistance                                        $0.00                                   Month
Oral Health Care                                           $0.00
Mental Health Care                                         $0.00
Medical Case Management                                    $0.00                                   Name
Substance Abuse Services, Outpatient                       $0.00
Case Management (Non-Medical)                              $0.00
Linguistics Services                                       $0.00                                   Authorized Signature
Medical Transportation                                     $0.00
Substance Abuse Services, Inpatient                        $0.00
Total:                                                     $0.00         0                         Date

          The signature above certifies this invoice and all supporting paperwork are true and correct under the terms of the subcontract with the Council of Community Services.
                          A signed copy of this invoice must accompany the request for payment to VDH with the monthly lead agency invoice. No exceptions.




Revised 4/1/2009                                                                                                                            Contract # DDP-611-45416-09-CON-2
                                 Southwest/Piedmont HIV Care Consortium Salaried 2009-2010 Employee Time and Effort Report
                         Month:
                         Name: Robin Knapmeyer                                                    Subcontractor: Roanoke/Alleghany Health District
                                                        List Hours Paid With Ryan White Part B Funds Only
 Date       Hours Worked          Vac./Sick Time Used       Holiday Time Used    Date          Hours Worked        Vac./Sick Time Used      Holiday Time Used
  1                                                                               16
  2                                                                               17
  3                                                                               18
  4                                                                               19
  5                                                                               20
  6                                                                               21
  7                                                                               22
  8                                                                               23
  9                                                                               24
  10                                                                              25
  11                                                                              26
  12                                                                              27
  13                                                                              28
  14                                                                              29
  15                                                                              30
                                                                                  31


                         Full Time Equivalent Medical CM:          1.00                                               Total Hours Worked             0
                    Full Time Equivalent Non-Medical CM:           0.00                                                 Total PTO Taken              0
                             Total Full Time Equivalent:           1.00                                                     Total Holiday            0
                                                                                                      Total Hours worked during month:               0



        Signature                                                                       Date


Revised 4/1/2009                                                                                                           Contract # DDP-611-45416-09-CON-2
                                     Southwest/Piedmont HIV Care Consortium Salaried 2009-2010 Employee Time and Effort Report
                             Month:
                             Name: Wayne Slusher                                                      Subcontractor: Roanoke/Alleghany Health District
                                                            List Hours Paid With Ryan White Part B Funds Only
     Date       Hours Worked          Vac./Sick Time Used       Holiday Time Used    Date          Hours Worked        Vac./Sick Time Used      Holiday Time Used
      1                                                                               16
      2                                                                               17
      3                                                                               18
      4                                                                               19
      5                                                                               20
      6                                                                               21
      7                                                                               22
      8                                                                               23
      9                                                                               24
      10                                                                              25
      11                                                                              26
      12                                                                              27
      13                                                                              28
      14                                                                              29
      15                                                                              30
                                                                                      31


                             Full Time Equivalent Medical CM:          0.80                                               Total Hours Worked             0
                        Full Time Equivalent Non-Medical CM:           0.10                                                 Total PTO Taken              0
                                 Total Full Time Equivalent:           0.90                                                     Total Holiday            0
                                                                                                          Total Hours worked during month:               0



            Signature                                                                       Date


Revised 4/1/2009                                                                                                                   Contract # DDP-611-45416-09-CON-2
                                     Southwest/Piedmont HIV Care Consortium Salaried 2009-2010 Employee Time and Effort Report
                             Month:
                             Name: Wendy St. Clair                                                    Subcontractor: Roanoke/Alleghany Health District
                                                            List Hours Paid With Ryan White Part B Funds Only
     Date       Hours Worked          Vac./Sick Time Used       Holiday Time Used    Date          Hours Worked        Vac./Sick Time Used      Holiday Time Used
      1                                                                               16
      2                                                                               17
      3                                                                               18
      4                                                                               19
      5                                                                               20
      6                                                                               21
      7                                                                               22
      8                                                                               23
      9                                                                               24
      10                                                                              25
      11                                                                              26
      12                                                                              27
      13                                                                              28
      14                                                                              29
      15                                                                              30
                                                                                      31


                             Full Time Equivalent Medical CM:          0.10                                               Total Hours Worked             0
                        Full Time Equivalent Non-Medical CM:           0.00                                                 Total PTO Taken              0
                                 Total Full Time Equivalent:           0.10                                                     Total Holiday            0
                                                                                                          Total Hours worked during month:               0



            Signature                                                                       Date


Revised 4/1/2009                                                                                                                   Contract # DDP-611-45416-09-CON-2
                                     Southwest/Piedmont HIV Care Consortium Salaried 2009-2010 Employee Time and Effort Report
                             Month:
                             Name: Teresa Byer                                                        Subcontractor: Roanoke/Alleghany Health District
                                                            List Hours Paid With Ryan White Part B Funds Only
     Date       Hours Worked          Vac./Sick Time Used       Holiday Time Used    Date          Hours Worked        Vac./Sick Time Used      Holiday Time Used
      1                                                                               16
      2                                                                               17
      3                                                                               18
      4                                                                               19
      5                                                                               20
      6                                                                               21
      7                                                                               22
      8                                                                               23
      9                                                                               24
      10                                                                              25
      11                                                                              26
      12                                                                              27
      13                                                                              28
      14                                                                              29
      15                                                                              30
                                                                                      31


                             Full Time Equivalent Medical CM:          0.05                                               Total Hours Worked             0
                        Full Time Equivalent Non-Medical CM:           0.00                                                 Total PTO Taken              0
                                 Total Full Time Equivalent:           0.05                                                     Total Holiday            0
                                                                                                          Total Hours worked during month:               0



            Signature                                                                       Date


Revised 4/1/2009                                                                                                                   Contract # DDP-611-45416-09-CON-2
                                      Southwest/Piedmont HIV Care Consortium Salaried 2009-2010 Employee Time and Effort Report
                             Month:
                             Name:                   Vanessa Givens                                    Subcontractor: Roanoke/Alleghany Health District
                                                             List Hours Paid With Ryan White Part B Funds Only
     Date       Hours Worked           Vac./Sick Time Used       Holiday Time Used    Date          Hours Worked        Vac./Sick Time Used      Holiday Time Used
      1                                                                                16
      2                                                                                17
      3                                                                                18
      4                                                                                19
      5                                                                                20
      6                                                                                21
      7                                                                                22
      8                                                                                23
      9                                                                                24
      10                                                                               25
      11                                                                               26
      12                                                                               27
      13                                                                               28
      14                                                                               29
      15                                                                               30
                                                                                       31


                             Full Time Equivalent Medical CM:           0.05                                               Total Hours Worked             0
                        Full Time Equivalent Non-Medical CM:            0.00                                                 Total PTO Taken              0
                                 Total Full Time Equivalent:            0.05                                                     Total Holiday            0
                                                                                                           Total Hours worked during month:               0



            Signature                                                                        Date


Revised 4/1/2009                                                                                                                    Contract # DDP-611-45416-09-CON-2
                                      Southwest/Piedmont HIV Care Consortium Salaried 2009-2010 Employee Time and Effort Report
                             Month:
                             Name:                                                                     Subcontractor: Roanoke/Alleghany Health District
                                                             List Hours Paid With Ryan White Part B Funds Only
     Date       Hours Worked           Vac./Sick Time Used       Holiday Time Used    Date          Hours Worked        Vac./Sick Time Used      Holiday Time Used
      1                                                                                16
      2                                                                                17
      3                                                                                18
      4                                                                                19
      5                                                                                20
      6                                                                                21
      7                                                                                22
      8                                                                                23
      9                                                                                24
      10                                                                               25
      11                                                                               26
      12                                                                               27
      13                                                                               28
      14                                                                               29
      15                                                                               30
                                                                                       31


                             Full Time Equivalent Medical CM:                                                              Total Hours Worked             0
                        Full Time Equivalent Non-Medical CM:                                                                 Total PTO Taken              0
                                 Total Full Time Equivalent:            0.00                                                     Total Holiday            0
                                                                                                           Total Hours worked during month:               0



            Signature                                                                        Date


Revised 4/1/2009                                                                                                                    Contract # DDP-611-45416-09-CON-2
                    Southwest/Piedmont HIV Care Consortium 2009-2010 Service Plan Reallocation Request Form

    Subcontractor Name:                   Roanoke/Alleghany Health Districts

                                                           Budget                                    Units                                 Consumers
    Line Item                                  Current              Proposed             Current             Anticipated           Current         Anticipated
    Outpatient Medical Care
    Pharmacy Assistance
    Oral Health Care
    Mental Health/Counseling
    Substance Abuse - Outpatient
    Medical Case Management
    Case Management, Non-Medical
    Linguistics Services
    Medical Transportation
    Substance Abuse - Inpatient
    Total:                                               $0.00                 $0.00         0                    0

                         Authorized by:                                                     Signature:                                      Date:
                                                                                 Instructions:
        Enter the subcontractor name at the top and then entercurrent and proposed budget, service units and consumers (Including the unduplicated consume totals).
                                           Attach a brief narrative statement explaining the need for reallocation of each line item.
                                                      Fax a signed copy of this form with the narrative to (540) 982-2935.
                                                             Final deadline for reallocation requests is March 15th.
                                          Line item reallocation requests are tentative until approved in writing by the Lead Agency.

                                                                           CCS Office Use Only:


                          Approved by:                                                      Signature:                                      Date:




Revised 4/1/2009                                                                                                                   Contract # DDP-611-45416-09-CON-2
                                          Southwest/Piedmont HIV Care Consortium 2009-2010 Salary Plan Reallocation Request Form

  Subcontractor Name:

            Medical Case Management                                    Approved Salary Plan                                       Proposed Revised Salary Plan
                Case Manager Name                        FTE         Salary           Fringe       Total Salary          FTE         Salary          Fringe         Total Salary   Difference
                                                                                                            0.00                                                            0.00            0.00
                                                                                                            0.00                                                            0.00            0.00
                                                                                                            0.00                                                            0.00            0.00
                                                                                                            0.00                                                            0.00            0.00
                                                                                                            0.00                                                            0.00            0.00
                                                                                                            0.00                                                            0.00            0.00
                                         Total FTEs:     0.00             Units:         0                  0.00         0.00            Units:         0                   0.00            0.00

         Non-Medical Case Management                                   Approved Salary Plan                                       Proposed Revised Salary Plan
                Case Manager Name                        FTE         Salary           Fringe       Total Salary          FTE         Salary          Fringe         Total Salary   Difference
                                                                                                            0.00                                                            0.00            0.00
                                                                                                            0.00                                                            0.00            0.00
                                                                                                            0.00                                                            0.00            0.00
                                                                                                            0.00                                                            0.00            0.00
                                                                                                            0.00                                                            0.00            0.00
                                                                                                            0.00                                                            0.00            0.00
                                         Total FTEs:     0.00             Units:         0                  0.00         0.00            Units:         0                   0.00            0.00

  Instructions: Enter the subcontractor name at the top and then enter current and proposed salary plans and attach a brief narrative statement explaining the need for reallocation of each line
                                                      Salary plan requests are tentative until approved in writing by the Lead Agency.
                                                               Fax a signed copy of this form with the narrative to (540) 982-2935.

                                      Authorized by:                                  Signature:                                                            Date:

                                                                                     CCS Office Use Only:

                                        Approved by:                                  Signature:                                                            Date:

Revised 4/1/2009                                                                                                                                     Contract # DDP-611-45416-09-CON-2

								
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