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LOCAL GOVERNMENT AGREEMENT, ATTACHMENT A0.1 <br />VIRGINIA DEPARTMENT OF HEALTH <br />COMMUNITY HEALTH SERVICES <br />OFnONAL PUBLIC HEALTH SERVICES <br />For Each Service Provided, Check Block for Highest Income Level Served <br />SPECIALTY CLINIC SERVICES - Please identify <br />services <br />Income <br />A only <br />Defined by <br />Federal <br />Re ulations <br />All <br />DENTAL HEALTH SERVICES - Please identify <br />services <br />income <br />A only <br />Defined by <br />Federal <br />Regulations <br />All <br />Revised 0712018 <br />