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great. we have ebout 16,000 of our lead nutrition packets thet they can take with them for each clinic. they key is buying lunch for the practices - then you will have an audience, Mona Hanne-Altisha MID MIPH FAAP ectar Pedistde Residency Hudey Children’s Hospital at Hurley Michigan State U lege Denartment of Mhannal @hurleyme.com

if it would be of any help, we could have a lead case manager attend as well to put a name and contact infarmation in physicians hands. This morning Lasked the case managers to contact the largest pediatric practices and see about meeting with them regarding case management services, sources for filters, nutrition and answer any general questions they might have. Torti L LaRocce MS, RN Director of Nursing Services Genesee County Health Deparirnent 810.237 4544 [email protected] Goatihadte attoeke bee Sectrese af tke, (0 bared whet we have tle exoagh, aad mare, (0 toons densal ate # 4 fe F ty, 18 sae Sager 2 itd ee @ feast, a daiage its a dime, a Soranpon 3 5 o motes aa Sa otpoete oe csaeheceoing Bs ok BOGE PEED, GREE OO OLOM, GORRUSION UF Obs xxxEND_PAGE:dhhs03_b0236_0908_0932_01 000909 a é f é db keatitade makes wre of eae fae, f you have received this ¢- copes. Thank you. ‘Bere Ey

Okay....f just dort want peaple falling through the cracks. TorwwL LaRocco Ms, RN Director of Nursing Services Genesee County Healih Depariment 810.237 4544 [email protected] Se o. werk BO GaaBe, RES sOee, £8 tases dew’ ate ra fF oe. é a & rat . . z geonstance, chaos te eetes, conpasine & obenig, f wend ale a feast a ease whe a howe, a Sh ee a frvord, Grade Wake saber sense af our past, dolege coats. fos tala, get cmeates a ase fom Gemcnnsis~ 8 intended for ihe excuse . you are 4 of the content use of the addressee and may contain ded recipient, any d ute, u nsfribation, ted. HP you he scehved this &- Stroy alloomles Thank you, fidential or pros ney Of any sothon iy Ing f HF a website al hitec/Awwwy For & copy o' he Health Department's Notice of information Practices, contect the Health Denartrnent ar visit the Heallh ond uss Department's

Good morning , fwilrelay, with your permission of course, this email te our Medical Services Administration, with whorn | have had the same discussions. Rest assured that | saw a multi-point plan from this health plan about how to address the issues in their patient population, and these comrnunity engagement pieces are just one part. One issue all are trying to capture is the urgency under which the enhanced testing needs to be conducted, so this is one of a number of strategies the health plans are utilizing. Another part is of utmost concern, that i know is also in multiple health olans’ strategic approaches, is that of provider engagernent. Despite the news and the blast faxes and the Health Alerts and the Pravider Letters and the Toolkits, we continue to hear fron citizens, the Governior’s Task Force and EBL case investigators and case managers, that providers are not asking about lead exposure to Flint water since April 2014, nor asking about testing/screening, or whether families have filters. f tried to set up @ provider forurn in Nov-Dec to Httle or no interest, but ami now working to get one rolling regardless, in partnership with health plans, by end of this month. twould really be helpful ff you could be there to speak about this very issue and give the perspective of 2 local physician responding to the crisis, andi a leader of best practices. We will webinar it and archive it as well (lam wondering if car make it CME-able as weil}, and Dr. Reynoids, tt would be great to have you involved as well--- Eden Eden V. Wells, ME, MPH, FACRM Chieti Medical Executive ichigan Departrnent of Health and Hurnan Services 201 Townsend St, 5™ Floor CV8 Lansing, Mi48923

xxxEND_PAGE:dhhs03_b0236_0908_0932_02 000910 Thanks for your reply, Eden. Yes, | have had discussions with Matt Davis about this as well and it was my understanding that it was recommended to expand screening, but dical homes as you said. if we all agree te drive kids te their medical homes first, the primacy of the medical home, why is that not being cone first? What are the medicaid HMOs doing to push kids fo their medical homes? How are they incentivizing visits, providing case Management, partnering with practices, enhanced transportation, etc? This is what needs te happen - nat only will all of this improve lead screening rates, but also immun rates and all other HEDIS measure that HMOs land providers} care about. Monu Hanne-Alticha MD MIPH FAAP Prograr rector Pech Residency Michiga Date: Human Me Denerira § aad Huraan Deyelonraent Mhaonal @hurleyme.corn

Hi Mona, The Governor's Task Force has made a number of preliminary recommendations to MDHHS last month, and a major one is to maximize blood lead screening. The primary care home is best, all agree, and health plans are identifying any children that have not been tested. Current thoughts are that there could be thousands. Health plans will be closely monitoring the provider follow up as well post initial screens. And, while it does not pick up potential lead exposure prior to Oct 1, water is still a potential source if public health measures are not being used, or used appropriately. Also there is a need to establish the prevalence of EBL in this impacted community- | have had long discussions with Matt Davis about this, and Larry is aware as well. | can discuss further if needed. But all, including Medicaid, agree with the primacy of the patient primary care home. E Sent from my iPhone

Okay. Thanks. Toni l LaRocco MS, RN Director of Nursing Services Genesee County Health Department 810.237 4844 [email protected] aad wore, & beoas dental te wy oberg, & eae tore 2 ao it a feest @ Hinge ts & Hee, & Seeraegee e . ra of. f wos o ae ee & poe sah, Gratiade wales. Y goatee af BAP LRG, bvtege, perce for tokeg, ued txoaind & wisien Sor Gomorresd, ~ : fi of y fs ‘ Pattie Es #NOTICE: Tins om proprietary, confidential eepying, of faking of any a i m tera, please nobfy me we is intended for ine exchusi ve use of ihe address: Se and may co Hl nended recipier i *, USS, distribution, . is strictly @ peaelved this e- a and RHEE RAS delete the original aad desimy all copies. Thenk you, Hee aR Department's N jee ef information Pract conlacl ihe Healih Depariment of visi ine Health For a copy off

ichigan.gov> When talked with Or. Mona Hanna-Attisha last Wednesday, they are still working on the IRB supplemental information requested. E

xxxEND_PAGE:dhhs02_b1194_4563_4568_1 004564 Where are we with this issue? Bath the case rnanagement and how itis being sent to the state data base? Toni L LaRocco MS, RN Director of Nursing Services Genesee County Health Department 610.237 4544 [email protected] femny lensak pele i a . e os elf thee fellhes OP 8 if ihe, fb Laees wheal we have ote é g : : oot fear U8 683 ty, 10 ean taser a meal its RUS & howe, & Suranger Fesed va if Ea baa, dad eeaates & aisir See Comores, f f HS SENS OE Par £48, heise Posie soe 2 ive use of the ad ended recipier aoe For a copy Deparment h Deparmeni’s Notice of information Practices, contact the al Rip Awa sohd us! jeaglin Decariment or visi

Toni- that is an excellent point as well- and will discuss with heads of Medicaid and Population health first thing in AM! Sent from my iPhone Yes I understand however sometimes the common sense doesn't rule the contract. Toni LaRocco MS, RN Director of Nursing Services Genesee County Health Department

Given that this is a research study, the Hurley lab may not be handling the results in the same way as they handle other lead tests. Can the lab be contacted and asked about that, by someone on Dr. Hanna-Attisha's team? If the results are handled under a research protocol, would the results be required to be reported under the Public Health Code, or would they be considered confidential under the terms of the consent form signed by the research participants? In other words, what does the research protocol and the consent form say? | assume/hope the family would would welcome a home intervention, but need to be sure the research protocol re confidentiality isn't being violated. If it appears that way, then someone on the research team should get consent from the family for public health followup, | would think.

| so know it....

Yes | understand however sometimes the common sense doesn't rule the contract. Toni LaRocco MS, RN Director of Nursing Services Genesee County Health Department Right, of interest is that this is cord blood from a newly born baby....!!! There should be NO lead...

Right, of interest is that this is cord blood from a newly born baby....!!! There should be NO lead...

Toni l LaRocco MS, RN Director of Nursing Services Genesee County Health Department 810.237 4544 flarocco@achd us 28 Bags bat sae 2g AE tans ahal we Base ees Bre 2, oe " gle, ff Exeere é& nee 4 stn bape & mead MLS Ronegatee, GhaEs ke oedee, confewon Ue ebine lo & feast, & house stl & f . foe ra é ie bone, « stranger inte a fled Goatitude makes cease of van past, doings peace fox lodag, and é £8 2 me: 2? Ltalee 8 eneor per forcreis Mledidy oats ad for the exc if you are : # afin error, sflzane notty me vig amall and permanently delete the cradle an x! deduce al copies. Thank you. visit the Health Department's wepsiie a f informant: a ies. contact the Health Cepartment or nit anene GONE US,

Ok! No worries- case closed!!!! Sent from my iPhone

Great, thank you!! DO you know if this is it- CC’ing Mark and Hilda to be sure, as then will run through Medicaid and back to you with final version?

Hi Eden, Below are the only other two things | can think of: xxxEND_PAGE:dhhs02_b1249_4708_4711_3 004711 physicians can make referrals for case management at 810-257-3833 Call 2-1-1 for locations for filter distribution Toni

11.24.15.xIsx Torw L LaRocce MS, RN Director of Nursing Services Genesee Coury Health Department 810.237 4544 [email protected] eo eae? eae EE TP? ERE HE bade ented, Sle endagh, ash save, 2 & Larne denied ite aocedlanes, L8G0° GP Geese, eongfreiee te sdasvia, f© ean awe a 2 xxxEND_PAGE:dhhs03_b0432_1584_1586_2 001586 not the intended recipient, any disclosure, , distribution, copying, or laking of any acdion in reliance of the cont of this e-1 prohibited, if you have received ihis email in era, please nollfy me via e-mall and nermanently delete the orginal and destroy aH copies. Thank you. Fora sneer ¥ ° Hea Rh ne rae Notioe of infor mation Practices, cof a act the FHealin

;>; Cupal, Suzanne <3 ¢ >; Miller, Corinne (DHHS) eralyn (DHHS) <i; >; Minicuci, Angela (DHHS) ‘>; Eisner, Jennifer (DHHS) <é > doc —— Agree, Linda, can you get the communications people to fix up? | remember this came from another source (?CDC) rather quickly--and needs to be further adapted to needs of Flint (no tap water/flushing, etc)-- For right now would pull off website?? CC'ing our website folks too.... Eden xxxEND_PAGE:dhhs02_b0430_1626_1628_1 001627

Dr. Larry Reynolds had some concerns about the nutrition hand out that we have been using regarding 1 minute cold water flush and washing fruit. See below. Can MDHHS weigh in and potentially revise? Tow L LaRocco MS, RN Director of Nursing Services Genesee County Health Department 810.237 4844 [email protected] 4 2. oP é Gentil aneoeke bee Sovtrese af like, 1% tarae what we hase tle oxeagh, ? ded wore, fo teese demal ate vaerliew Fncon fe comet xunetecgten Ge pita: Gl corn it, sped ROGEPUENED, GREE OO OOMOM, GORRUSIOR Th Chisel, FL Sar base B ROE Ree a fenst, @ hiage Rts & hime, & Soraepee 5 . f. ¢ 4 “4 of p f . » foe £ » #£ f J ot wee 8 fran, ipeatvtnde wakes sods OF fae £OEE, Beitehe ote fur boa, dad Ereried & aStte foe Reoreest ~~ “fidenilal or privilaged # nH you are ne’ conlenis of nk any disclosure, use, distribution, ng of any ackon hy io e-miafl is strictly o d. you have recsived this e- Hy Hase nolly me via e-mail and permanently delete ine original and d coplas. Thank you. Fors capy of the Health Department's Motice of Informetion Practices, contect ihe Health Denartrmeni ar vied the Heelin Department's website al biter eof th

Importance: High Hi Eden, This is the up to date version of the spread sheet. Please lat re know if there is other information that you want collected Tonk Toni L Lakocoe MS, RN Director of Nursing Services Genesee County Health Department 810.237 4544 [email protected] a és the é fallhegs af fife. ME teens whak ve face ile one aoteptante, Shas? bi oedkse, aangasien fo foes tgs, A nan bao a wad ike x F ta haute ube & bees, a Siewger # g ase Pee beings POREG AGF Ee bug, aed ereates a eves fie igscapegee, if you are tenis of this e-miall is strictly o ranently delete ine original and de Hed. H you have received t copies. Thank you. migi in error, please notly me via ernall and p yy al For 3 copy of the Health Depariment’s Notice of Informetion Practices, contact the Health Denariment aor visi the Helin Depariment’s website at h

Hi, Pwanted to give you 2 aurnriary of the lead screering and case management activilies. i will not be on the call ihis aferrioon. Getting things set for Thursday. Overall, things went very well last week wilh @ much smaiier turnoul than hoped. Bul nol necessarily surpriging. Tori L LaRocco MS, RN Director of Nursing Services Genesee County Health Deparirnent 810.237 4544 [email protected] és S the fellhe £8 af £E basus what we have kee anougl, aad move, £8 axes oxen’ ibe 7 . EGA ‘ Bi i Pe ¢ ronpasin te be Séaey ia FE 2nx tava weak ile x frost, a: sone. E8 a howe, & &beaeger ie 2 4 e Ez HOR for domes, = cory) 9g, of faking of any ¢ foal in airar, ploase notty irs via ema and p seni Ge late ine engined and destroy gi Copies. “rise He you, For a copy Deparim Health Depenment’s Notice of Information Practices, contact the Healin Deparment or visi ihe Hea Swaleie at hitouAwww.cohd us! xxxEND_PAGE:dhhs03_b0571_1977_1978_2

Hi Toni, The updated letters are attached. DEQ requested we add this language to each letter: These recommendations will stay in effect until the Genesee County Health Department lifts the restrictions on water usage. Thanks! Angela

Yes, | will send the final letters in a moment. Angats