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City of Santa Ana <br />Scope of Work <br />Name of Organization SHARE OUR SELVES <br />Name of Funded Program SOS Free Medical and Dental Clinic <br />Annual Accomplishment Goal <br />I. Total number of unduplicated clients (Santa Ana and Non -Santa Ana Residents) anticipated to be served by the <br />funded program, named above, during the 12 -month contract period. <br />5,900 Persons <br />II. Number of ONLY unduplicated Santa Ana residents to be served by the funded program, named above, during the <br />12 -month contract period. <br />7-12-0-01 Persons <br />Program and Funding Description <br />III. Description of Work - In the space below, describe the program to be funded during the 12 -month contract period. <br />What specific activities will be undertaken during the contract period. Please be concise in your response. Only the <br />viewaoie space wm print. <br />The goal of the SOS Free Medical Clinic is to help patients attain or maintain their highest level of health by <br />providing professional level medical care administered by knowledgeable, culturally sensitive paid and volunteer <br />providers. Clinic services include diagnosis, treatment, prescriptions, lab work, specialty care, and education. The <br />clinic is open each weekday and provides 8 walk-in urgent care and 3 chronic care sessions weekly. Specialty <br />care sessions are offered twice monthly. Chronic care patients receive ongoing care, medications, and education <br />for all family members in managing their disease. <br />The goal of the SOS Free Dental Clinic is to help adult patients preserve and maintain their natural, permanent <br />teeth whenever possible by providing emergency and preventive dental services to Orange County residents with <br />no other access to dental care. Treatment is provided by both paid and volunteer staff. The clinic contains four <br />dental chairs and one X-ray chair. Patients come to the Dental Clinic with a variety of severe and painful dental <br />problems that frequently require extensive procedures. Many have never been to a dentist. Lack of dental <br />insurance, inability to pay out of pocket, and lack of knowledge of good oral health practices are factors common to <br />SOS dental patients. About one-third of all visits are emergencies. Dental clinic services include extractions, <br />restorations, partials, root canals, radiographs, and oral hygiene education. <br />Schedule of Performace <br />Estimate the number of ONLY unduplicated Santa Ana residents to be served by the funded program during the 12 - <br />month contract period per quarter. (Enter number of new Santa Ana clients served each quarter. If they were served <br />in quarter 1 do not count them again in quarter 2 <br />Quarter 1: July 1 - September 30 300 Persons <br />Quarter 2: October 1 - December 31 300 Persons <br />Quarter 3: January 1 - March 31 300 Persons <br />Quarter 4: April 1 -June 30 300 Persons <br />1200 Total unduplicated Santa Ana Residents to be served. <br />Schedule of Invoicing <br />Estimate the amount of grant funds to be requested during the 12 -month contract period on a quarterly basis. <br />Quarter 1: July 1 - September 30 $ 2,500.00 <br />Quarter 2: October 1 - December 31 $ 2,500.00 <br />Quarter 3: January 1 - March 31 $ 2,500.00 <br />Quarter 4: April 1 -June 30 $ 2,500.00 <br />$ 10,000.00 Total Grant <br />Exhibit A <br />Page 1 of 1 <br />