addition to that, there were additional projects that are now going forward to the bore. >> yes. i just wanted to say that we've had a very extremely good relationship with the mayor's office and working on this budget. i really want to thank them for the work on it. gose respsibility to get that ready for us anboarthand now we're working on a board of supervisor presentation as well. so this is a long process. and lots of involvement and you'll see in the boar hearings,s as an example, lots of community members who are engaged in that budget process. so it is a really important process every year that we go through and one that i take very seriously and also listen very carey what our community mem e sayi and their needs. >> ok. thank you. commissioners, questions then to the ditor on an the items or any of the items.

were yogog to continue to present the report after the budget report that you gave us? >> let me add one more thing py to answer.'m h i do want to invite all of you, our staff really work hard on pride every year. and this year it's on jun4. and this year's theme is generations of pride. and so we'd love to have our commissioners join us. we'll give you the details of where we'll be walking and we've got a very good spot in the line-up and that is how you -- depends on if you are in the back of the line or the front of the line and how long you stay for the day. but we have ourselves in a more -- it will be a quicker pride march for us. but i do want to invite all of you to join us and our staff reallyut lot of eft thisd i always like to go to support them. when we'd love for all of you to come. >> thank you. >> i'm looking for any questions on the rest of the report.

i'm happy. >> commissioner bruno? oh, sorry. i thought you had -- >> [inaudible]. n commissioner loyce? quns the bun. -- on the budgets. i just wanted to mention that i marched last year with pride and i will be marching again with t depart >u soth commissioner. noe tion at is point. thank you. so, thank you for that very good report and i know that the commissioner bernal will deliver another good report for the third quarter budget at the time that we'll be hearing from him. >> i'll note there is no public comment to that item and wecan move o itemfour, which is general public comment. and there's one request. >> yes. at this time, i have a request from yolanda molinani, i'm sorry -- i'm trying to read and

i should not critique anybody's handwriting. >> yes. very bad handwriting. >> before we begin, i have a whe timer beeps, please on it. know your time is up. >> okay. i do want to say that i came here by myself for my sist but i'm here on behalf of my sister beatrice shueman who is a participant of adult day health care in the heart of tenderloin. and all of these par notice manls came here because they do want to have a word with you and at least express their desire not to lose their nurse. the department of public health nurse. she has been there for about 15 ars. she knows participants. she is experienced at dealing with participants and of all the medical beneficiaries. all of them would be eligible to be at laguna any nd

other nursing home. bfor the day health services that they're provided this very important beacon of our city. the presentation day health. last year, i understand that there is a -- you know, a demand for resources and there is always a balancing and a stress attention because of health care fraud attorney for the government, i understand how important public services are, particularly health care services. but the loss of her coming for a while, she was announced last october or september that she was going to go thcourage center and -- cause she was more needed there and with the great assistance of ms. garcia, director garcia, that was put off for six ntin order to ensure that an applicant --

because theyo a nts. it was raised from $35 an hour to $45s. plicand twefresh out of nursing school. how could people fresh out of nursing school care for people in the condition they're in. they're very frail. ry, eyry -- they need to have vital, vital needs. so, i'm here to plea to you and tes a letter from anpartr ipan to say a few words that. if you can't make her position permanent, which it should be -- why not? i understandw ibeing -- she has a tice on the 25th that she was being transfered to the laguna honda nurse advice line. an advice line when people need r and r care. and her vision when they have a bladder infection and chest pains. she is much more of a service to u, toall of you, to the city of san francisco if she is with them than answering phones end i understand again

attention of the resources of this field and for public services. but i just wanted to read this. so i just want to plea that please reconsider keeping her longer until somebody with experience to take care of the frailest of our seniors comes forward for th position or extend the period until sorry, atith myself. either extend the period for a while or make it permanent again. may i read this letter? >> thank you. your three minutes are up. however, is the letter from one of the residents or -- >> yes. >> one of your people from -- are they here in the room? >> she couldn't be here because she was sick. but if you'd rather hear from one of the people here i k help represent them, i'll allow you to read the letter >> ok.

it president, i am unfortunately unable to attend the meeting as a representive or the residents of presentation center where nurse ursula has served for many years and is a part of the family. she knows us well as we know her and there is trust and love between us. her loss to the community would be traumatic. please reconsider the bureaucratic intention of rotating ursula away om us where she belongs. we would so very much appreciate your consideration and your visit to er ou and thank ur help. presentation number 332 and then she has a phone number. and she has pictures. >> ok. thank you. >> i do want to thank you again. and i do thank you. >> and i would like to thank

those who were able tme also today. we understand your need. as you know, as public testimony we cannot tathe topic up, but we'll ask our director to look into this again. >> and log at the great services that she provides. >> thank you. we appreciate that. thank you very much. are there any other -- >> i'm not receiving any other requests. i'm not sure how to handle the room. >> so there being no further public comment, thenwik the -- - just see if we can get a .t's couple more commenters. >> sure. maybe shcropne over or something for them. >> [inaudible].

>> and ve it over for public comment and we'd be happy to hear from you. >> and we have translation. >> you have cantonese? [speaking cantonese]

>> interpreter: so she said that -- >> i think they have translation. >> no, we're asking for someone to translate. >> yes. you may please translate. >> interpreter: ok. i think she said that the nurse was very, very helpful to her when she had all kinds of ailments. and is very skilled and kind in .elping her with her kind of ol and that's pretty much what she said. >> thank you very much. >> you're welcome. >> do you have anything personally to add? >> no. my own comments? >> yes, plea. >> hello. i'm here also to speak for ursula. my mother -- >> say your name, please.

my name is michael xavier. my mother is vivien xavier and my mother was attending presentation until she passed away january 28 this year. and i have to say that ursula was really good with my mom. in the se at my wa very frail and she was sick all the time and she didn't want to go to the presentation. but hag someone like ursula was very smiling and nice to her made all thfference to her. and so kons quenltsly, i just found out that from -- that ursula might be not rk fuereanymore and i tht thwo big mistake to move her where she is so much needed in the center. pretty much my mom was home-bound and had nowhere to go and the homvisitation nurse from u.c. said -- suggested presentation as a place to go. and so she was able to go like go there for about six

months until she fell sick again and it made all the difference to my mom in terms of her mental health and terms of meeting other people and ursula was really so kind and so nice and very, very detailed. all the information about my mom. because she had a host illnesses, all kinds of health problems but ursula went through the details really well. and also she was very good with like the christian doctrine because my mom was catholic and ursula was able to kind of go beyond the surfacekind of get to the little details and understand what i was saying and comforting us and consoling us and helping my mom have confidence. pretty much that's what i have to sa thank you. >> any other participants wish eignake a comment before us?

anguage]. we need help, please. and ursula is a great help for me every time. i need her. everybody needs to understand it's hard for us without ursula. because is rience already in r center and please help her.

>> what is your name? >> [inaudible]. thank you. >> thank you very much. >> ok. well -- >> [inaudible]. >> we thank you very much. and we thank all those who are at the presentation program. and we'll ask our director to say few words. >> so, we definitely will -- i'll come and visit you. at thi'll sit down to read our redatcommenn that we gave you. so we'll dohat this next week. >> thank you very mu >> thank you. >> ok. thank you. thank you. all right, commissioners.

almove on to the next item? >> y, please. >> item five is a finance and planning committee report back from today's meeting. commiser beal, chairs? >> commissioner? >> yes. the and financing committee immediately preceded this meeting where we considered a number of items on the con sent calendar for tod ke to acknowledge that tor chelle wrigans the budget office for puttin together a comprehensive presentation for us, thank you. among those items are the monthlcontracts report as well as request for approval for new contracts. seven w contracts associated wite eltronic health records system representing roughly one third of the core implementation costs. so, those all be on the consent calendar as well as sole source request list under administrative code 21:41, which is basically nonprofit organizations.

it's a list of sole source providers currently providing ,r not currtliding ict would like to remain on the list. in addition to that, we received a report from greg warner aboutthe revenue and expenditure projection report for the third we lrned at the end of the third quarter, the depament projects to have a general fund surplus of roug$80 expend which youser below ets dg about $3.2 million. and operating revenues above by $94.6 million. om drew merrill, the eceived a l health anager, about the services authority. basically it waslearning here at the commission about complying with the ste

law that origin counties pay for mental health services for foster children placed out of the county >> if there's no public comment for that item. >> commissioners believe that not many are the sole source process we have here in the city. and i've asked michelles to please explain that. the rest of o the finae the commiss wours understand the sole source and what you will be approving unthar. h>t. ok. thank you. , i'm michelle.

i oversee the d.p.h. business office which includes contracting and this report is a little bit odd what we're asking. but we're asking for your approval. it's actually a list of vendors where we might need to ent nd sojuorder to reement. cont,in order to be allowed to contract.weheve to d solicitation, r.or r.s.q., requefor lificaons process or we obtain a sole source waiver from ficeoff contract administration. ia undese are op.d thenis a chrt whichthe health commission can apsole source -- can approve -- that can approve a

sole source for vendors that meet specific criteria. and thcriteria primarily -- th vendors is that they're not profit. they made our misn goals of the department. thinserted into the admin code where there was a gap-- we had to redo all of our solicitations so s ga in time where the arity under the prior solicitation and the upcoming one on an ongoing basis and our patiente rolled aso no conacting and imrsemen so, that's called chapter 2142. what it's translated to is we create a list that is potential vendors.

sod if we needed to add a sole ce into this particular chapter, then the office of contractmi ppro al to allow it. and the r having it is when there is a gap. and don' if -- do they have -- guyhave this? it's called a cheat sheet. >> everyone has your cover and should have the list of sole source. >> ok. so, the list that is attached to that memo is a list of we genes. do every year is we look at itwe eveloped a criteria a couple years ago about what vendors to remove because we haven't used them in a long time, or won't. aren't expecting to. and then we alw include our current contractors because it allows us the flexibility that's been extremely useful

when, for ampl, dr. e cong on board from rvices the mayor's office. it may be that we already have vendors that would be able to do that. it may be that we need to get something off the ground quickly. doing a solicitation process .r a brand-new contract can flibility to get a rvicup and running and that is one of he places where it often ppeha, like ad back. and then we can go out to bid. but we can still get the services started. so, what we're asking today is for your approval of this list. if we do enter into -- i should say in august, we'll come back with kind of a companion list whisa -- it's a usage report. so it will explain and show you

all the sole sources that we tht is a menthat we ubmit to the bo rvnually e in compliance with the sunshine ordnance but we'll come back tha this is a list of potential vendors, many of which we won't use at all. but that is what this is. and it allows us the flexibility so today is a request from you to approve this list so ensure that there's no gaps in services for existing vendors or if we're able start a new service quickly. >> so, commissioners, especially for the commissioners who ve not seen this report before. if there are questions in regards to this -- the appropriate to ask it now? cooner>> y.h. what'se ocess whereby you

analyze the effectiveness of these vesand wh ey'r ive, whether thr own structures within their businesses or appropriate and, you know, in keeping with the mission of department of public health and also our own, you ow, kind of econom analysis. >> it does include our current vendors. for our currenvendors, we have an annual monitoring process where they look at their compliance with the requirements and with their theijecontract to see if they -- not them.but ity annual process. there is also monthly invoicing and reporting to just oncan

ere how it says vendors productive. what's happening. are you not able to hire? or is there something else going on? it's pretty much an ongoing process. but there is a formal once a year process internal to d.. there's also the process rhd bthe controllers office which if you have agencies that share vendors, then there is a joint process where they go out and confir andoa monitoring for l ca compliance and fiscal stability. so, yeah. that's what we do. and the solicitation process, for example, and behavioral health services are just finishing up about 15 solicitations which is about $200 million worth of services. so in terming which vendors to receive the funding, that is eher comparison. so, the socition process

also allows you to compare rates and mof rateat veor's ceive, for example, in substance abe from methadone services, those set by the state so we use those necessaryinging neged rates. >> this staggered evaluations? is stagger a process that has at the same time and then how do you balance continuity of care against, you know, changing vendors? >> it's staggered. so, federal funded. -- funded programs have cycl. it's usually not a quick process. it'svey rare that someon closes their door today.

and if somebody is at high risk -- there is an agency that's showing problems that require really concentrated attention, then we ve a corrective action plan process, which is a formal process where the issues are documented and followed with and work withe vendor and their bod and they ve deliverables that they have to provide. but it is rare that there is always transition phase. even now if the vendor wasnt esi there's usually a six-month tale that people need to be transe in my time, in 20 year never -- it's barely ever happened that someone just closes the door.

? c >> i have tuestio the first one is -- one category is not current contractors requesting to remain on the list. >> they are on the list of soul source, but they just don't have a current contract? >> this whole concept littlean what it means is we have a li r current vendors.t e secti lecurrr t vendor, the vendor samishe -- >> yeah. currt contractor. so, for current contractor, maybe last solicitation, but they're still on there and or be successful in solicitation. they may stay on here. buok it every year

and we establish criteria for going through and the particular onesthat we quds to is outlined in the memo and when it is an example, there is a group of hospitals and so it's always possible that we will have to enter into an agreement. we don't take -- we have kept these vendorsese th contractors on the list because, as we placements for youth, sometimes foster care youth and we're not sure what the needs are going to b or ifthey're from out of county and we left these in case we're under a contract to provide these services for a use that we don't know rt now is going to be placed. >> and the seco question, unless it's a really complex process. could you describe to me how

does a contractor or ndquesto rn >> they don't really request. here it s current rao >>i read that language the exact same way that you did. isbualrerees t the list. >> ok. so, it is from the d.p.h.s >> yeah. i thought the same thing when i read it. >> thank you. >> but yeah. >> and do you have any further questions? yeaissioner loyce? san francisco -- what did i with it? publati on this list. if that is a foundation that i set on bo reprntive of then ould be abstained from voting because to me th confli. to continue thatn i just tot known publicly that because i'm on that board, thati need to

cula item. >> one thing i should say is that this is just a list of -- if there is a contract, if somebody who doesn't havea contract receives additional ges added through a formal modification through the ontract and then the contract comes to the health commission. it's just by having the list, we have the flexibility to -- r it just expedites the process because then the office of contract administration is comfortable that this list has a rationale and has criteria that we've developed. which we did, i think, in 2015 and brought here about why something is on the list. i'm not arguing. i'm just telling you. if we do enter into a contract with someone that is not a vendor, it will come before you as a contract. >> i still wouldn't be able to vote, though.

>> commissioners, i just got a quick confirmation that it does make sense, commissioner, for you to ask to recuse yourself from a vote. and my ndinis that th request by honoring a request to recuse before you vote. >> correct. so, when we get to the consent calendar, we'll take the sole source report out of the calendar and then we'll deal with it separately. >> great. thank you. >> commissioner sanchez. >> n, -- cou again just sort ofmmarizesinnce we've process. as you shared initially thats this review process is sort of independent of us and now you t wanto -- you're recommending that this new revision would, under the charter, gives the health commission some degrees of freedom in rto accept

and recommend these suggestions and recommendations you have which would include sole contract, deletion of contract, nonsubmission of contract. is that pretty much what -- >> yeah. what llow a-- what you wld be d list of vendors that should we enter -- so when we prepare a contract and assemble it and submit it to the office of contract administration, they will look at all the programs and say under what authority are you contracting. and then for those particular ones, we can say, oh, we had this. 2142 that met this iteria and onthis list, then that is what the authority is for them to approve that full source. >> ok. now internally, within our rank and we still have

our staff to due diligence pertaining to how, factthe sole contractors have been operating in case there is a flare-up where we need to take at situations house, make recommendations on -- so, ther, efore aren't giving away any of this due diligence, which we used before as an example, i can think of one where we had oneth -- it was a couple of superintendent ago in the school district where there was some conflict with some stafd f ane department was very much aware and was citing it and then finally there was an audit and they found major appropriatations that were not followed through on the district's problem and had our group not, in fact, you know, reviewed it, it would have cost the city and the tea money. so i want to make surwe are still -- >> yeah.

>> ensuring that our due diligence process which we've had is not deleted but is inedtaor even increased in the e contact. >> right. right. and nothing changes. it's really that -- this is ere comes up the most. we get an aded back from the board of supervisors, so funding and they'd like to have that service -- they want the service. they want to address the identified and so it's still put into a contract. we have two options, we can -- we can wait a year or whatever and do a whole solicitation process or start the services and do a solicitation process and, ifecessary, change the vendor. is iswa-- that is one of the ways that we end up using it. but it doesn't change hing because once you have a

contract, you approve them and we do the annual monitoring. erhi is done in exactly the same way. it's just saying thfor this piece of funding, the office tract ministon is alu say it's ok to contract for that amount of moneys in -- as a sole source while you're developing a solicitation. so nothing else. everything else is safe. >> maybe the format is a little difffor erent you because we've been doing this for several years. ed usto be a very long list and then weall said what kind of services do these people do just to see what kind of work they all did.d f what purposes. and so they've developed this very large matrix in which it beg totell us where those services would be if they we to be contracted for services.

but the due diligence is not removed at all. it's only putting this on and commissioner sanchez, you may remember that because of the change in interpretation of how to do work the sole source process was given to us by the board of supervisors to allow us to move forward when, in fact, they rvmo promptn gohang through a for the purposele mall r.f.p. >> right. and when i come back in august with a usage report, there's other types of le source that don't have this option at all. we go through a formal process with the office of administration where they approve each and every one and there's just -- the authority wrests with the office of contract administration and when they come back in augu you'll get to see where we entered into sole sources and how many we actually used and why. >> great. so, that's the diligence over sole source, which is why this

is before us here. yes, commissioner. >> i' not going to ask to recuse myself. but for the record, i wanted to dignity health, the corporate board. not the hospital board that's listed on this list. it's st. mary's. >> on the corporate board. and not st. mary's. >> so, a few spaces removed but there is a connection. >> thank you. ok. all right. any further comment on the report from the finance and planning committee? i think there was one typo also that we were going to cranberrising, right, -- going to correct, right, under the net smart technology in terms of the annual amounts because that is under the contracts report. >> correct.

>> so maybe you can help us to understand that. it's the contract -- >> so, it is the last one on your contracts report. it's called net smart technologies. and what we were changing is there is a column called prior annual no without contingency and it said $28 million and then it said the proposed annual amount without contingency of $7.8 million. so, those two numbers are wrong. they're actually $2.8 million and $2.6 million. and just in case you're looking at this later and had another question why the contract went down so much from the prior period to the proposed period, it's because the original contract s longer. it was 10 years and paying for both the plementation and licens avatar, which is the behavioral health services,

electronic health record an billinsystem and now s thgoing, what the contract is paying for is the maintenance. nge was to corr the two amounts that were not correctly listed. [please stand by] we'll vote on

remain of the consent calendar. all those in favor say aye? all those opposed? >> the rules require that that be approved by the commission, and i will then ask for your approval. all those in fav say aye? all those opposed? you are recused from that line item. we'll now go onto the request of the entire committee for approving the sole source report -- the sole source list. all t in favor, please say aye. all those opposed, and we will

note the recusal on the one item by commissioner loyce. >> thank you, commissioners. i'll note there was no owe significance on that item, and we'll move onto the next item. [agenda item read] >> right. the report is before you for approval, there has come before you to our attention that has nothrough completely the iteration with the city andn a t document, so we are deferring this item until the city attorney's office has completed their review. thank you. >> next item, please. >> yes. em eight is a health commission revised rules and regulations. this is the second time it's before you. it first came before you on april 17. >> so you have before you the rules and regiulations that we

introduced at our last meeting. tu' now places a formal structure regarding our other two committees. he t substantive ames now,but changes that we received are before you, think modified -- we got a new copy, but i was told that it only right.es the pages. the conte w the its only didn't match onpages, so you could have a more difficult time to discuss it. >> one of the things i te past that's been more contentious is how a commissioner participates in one of our committees if, i fact, ies a quoum of the health commission, and

therefore, also, how that action would be taken because normally, committee particularly our finance mmit t -- the public ti ctteein for recommendations to the full commission. and so you see that it's spelled out more carefully exactly where, then, if commissioners came to one of those two committees, then they would become the committees became a special meeting of the commission, and the only actionsy could take still were the full commission. so that was to help spell that out further. >> are there any furth estio inegard to this

item? no further questions, then, the item is available for a motion for adoption as amendments to our andregutions. o moved. >> there is a motion. is there a second? >> second. >> any further discussion? if not, all thosefavor, please say aye. all t opposed? our revised rules and regulations have been approved. thank you. >> commsioners, i stepped out for a second, and you all moved on.t. the next i the agendas other business. i mde commissioners for your calendar for the august 7 meeting in the -- in the commy, it's -- it's -- the date-i'm sorry, the location has been confirmed to be at th avenue, and we're all doing planning in earnest to make sure you get the data. secondly, i received an e-mail

from the plan be department to discuss the joinmeeting between the planning commission and the health commission. the two dates ty've gave me are will before you, and just so you know, the two commissions get together and review data annually and vote whether or n tept i or those meetings are usually between 10:00 and noon on thursdays, so we'll go with the planning commission's schedules. so i'll be checking with you all on those dates. i just wanted to give you a heads up. sho d be mentioned that is a mandated function from the development agreement, and it occursver e year, a then s a repoha submitted by cpmc and then following which there are recommendations both the planning and the public health directors after our hearing.

,o to the board of supervisors. so please look at your calendars. usually it'well attended meeting. >> yes. >> any other comments? do we have any oth announcements? no? thank you. we're prepared for our next item. >> item ten is the report back from the may 22 zcfg. >> yes. i did have the report, but now, it turns out to be -- here it is. okay. i have the wrong report. during our open session, the committee reviewed and

discussed the start reports which did include the regulatorrepo, the hospital administrator's report, the patient care and human resources and medical staff report. there was a presentation on optimizing a care experience model that was reviewed, and the committee approved the physician assistant delegation of agreement, a surgery standards procedures, pharmacy pain consultation standard procedures and revised emergency department airway management privileges. and in our closed sessio approved the credentials report and the report of thephipps committee. any questions on that? you will receive the full report -- the full set of minutes as usual? so questions, we'll move onto our next item, please.

>> the next item is consideration of a closed session, and there's no public comment. >> we are we will enterta motion to go into closed session. all those in favor? >> okay. we are back in open session, and we need a vote whether to disclose or not disclose any of our discussions in closed session. >> motion not to disclose what happened in closed session. >> second. >> there is a motion not to disclose. all those in favor, please say aye. all those opposed? we shall not disclose. there are no other items on the agenda, so a motion for adjournment is in order. >> so moved. >> actually, commissioners, if

i may, today is -- well, i'm going to misphrase this, but it's long-term survivors of hiv i would like you to consider adjourning in honor of thday >> excellent idea. so moved. >> and so that's a motion from commission commissioner bernal? >> second. >> there's a motion and a second. all those in favor? all those opposed? okay. we shall adjourn in that memory. [music]

>> san francisco city clinic provides a broad range of sexual health services from stephanie tran medical director at san francisco city clinic. we are here to provide easy access to conference of low-cost culturally sensitive sexual health services and to everyone who walks through our door. so we providestd checkups, diagnosis and treatment. we also provide hiv screening we provide hiv treatment for people living with hiv and are uninsured and then we hope them health benefits and rage into conference of primary care. we poso provide both pre-nd exposure prophylactics for hiv prevention we also provide a range of women's reproductive health services including

contraception, emergency contraception. sometimes known as plan b. pap ears d [inaudible]. we are was entirelnaudib]people will come as soon as were open even a little before opening. weight buries a lip it could be the first person here at your in and out within a few minutes. there are some days we do have a pretty considerable weight. in general, people can just walk right in and register with her front desk senthat day. >> my name is yvonne piper on the nurse practitioner here at sf city clinic. he was the first time i came to city clinic was a little intimidated. the first time i got treated for [inaudible]. i walked up to the redline and was greeted with a warm welcome i'm chad redden and anna client of city clinic >> stenicce all the back to 191 at that time, the clinic was founded to provide std diagnosis treatment for sex workers. there's been a big increase in std rates after the earthquake and the fire a lot

of people were homeless and there were more sex work and were homeless sex workers. w are pretty me public health progressive for their time thought that by providing std diagnosis and treatmsex workers that we might be able to get a handle on std rates in san francisco. >> when you're at the clinic you're going to wait with whoever else is able to ster at the desk first. after you register your seat in the waiting room and wait to be seen. after you are called you come to the back and meet with a healthcare provider can we determine what kind of testing to do, what samples to collect what medication somebody might need. plus prophylactics is an hiv prevention method highly effective it involves folks taking a daily pill to prevent recommended both by the cdc, center for disease control and prevention, as well as fight

sf dph, two individuals clients were elevated risk for hiv. >> i actually was in the project here when i first started here it was in trials. i'm cut n prep. i do prep through cinic.li you know i get my tests read here regularly and i highly recommend prep >> a lot of patients inclined d tolday fore no wa prep we really encourage people to come in and talk to one of our prep navigators. we find that we can help almost everyone find a way to access prep so it's affordable for them. >> if you times o have opponents would be on thursday morning. we have two different clinics going on at that time. when is women's health services. people can make an appointment ei bcalling them a dropping in or emailing s for that. we also hav hiv care clinic that happens on that morning as well also by appointment only. he was city clinic has been like home to me. i been coming here nce 20name iskim troy,

client of city clinic. when i first learned i was hiv positive i do not know what it was. i felt life uld be just ending there but all the support they gave me and all the information i need to know wasvery helpful. so i [inaudible] hiv care with their health >> about a quarter of our patients are women. the rest, 75% are men and about half of the men who come here are gay men or other men who have sex with men. a small percent about 1% of our clients, identify as transgender. >> we ask at the front for $25 fee for services but we don't turn anyone away for funds. we also rk with outside it's going out so any amount people can pay we will be happy to accept. >> i get casted for a pap smear and i also informed the

contraceptive method. accessibility to the clinic was very easy. you can just walk in and talk to a registration staff. i feelm caref nd m been supportive. >> all the information were collecting here is kept confidential. so this means we can't release your information without your explicit permission get a lot of folks are concerned especially come to a sexual health clinic unless you have signed a document that told us exactly who can receive your information, we can give it to anybody outside of our clinic. >> trance men and women face really s gndirimination and sti their daily lives. and in healthcare. hiv and std rates in san francisco are particularly and strikingly high were trans women. so we really try to make city clinic a place that strands-friendly trance competent and trans-welcoming >> everyone from the front

desk to behind our amaznt there are completely knowledgeable. they are friendly good for me being a sex worker, i've gone through a lot of difficult different different medical practice and sometimes they weren't competent and were not friendly good they kind of made me feel like they slapped me on the ndbut living sex life that i do. i have been coming here for seven years. when i come here i know they my services are going to be met. to be confidential but i don't have to worry about anyone looking at me or making me feel less >> a visit with a clinician come take anywhere from 10 minutes if you have a straightforward concern, to over an hour if something goes on that needs a little bit hee you on site. so all of our samples we collect here. including blood draws. we sent to the lab from here so people will need to go elsewhere to get their specimens collect. then we have a few test we do run on site. so those would be

pregnancy test, hiv rapid test, and hepatitis b rapid test. people get those results the same day of their visit. >> i think it's important for transgender, gender neutral people to understand this is the most confidence, the most comfortable and the most knowledgeable place that you can come to. >> on-site we have condoms as well as depo-provera which is also known as [inaudible] shot. we can prescribe other forms of cos, h and rain. we provide pap smears to women who are uninsured in san francisco residents or, to women who are enrolled in a state-funded program called family pack. pap smears are the recommendation-recommended screening t for monitoring for eay signs of cervical cancer. we do have a fair amount of our own stuff the day of his we can try to get answers for folks while they are here. whenever we have that as an option we like to do that

obviously to get some diagnosed and ted on the same day as we can. >> in terms of how many people were able to see in a day,e say roughly 100 people.if people are very brief and straightforward visits, we can sternly see 100, maybe a little more. we might be understaffed that they would have a little complicated visits we might not see as many folks. so if we reach our target number of 100 patients early in the day we may close our doors early for droppings. to my best advice to be senior is get here early.we do have a website but it's sf city clinic.working there's a wealth of information on the website but our hours and our location. as well as a kind of inion out stds, hiv,there's a lot of information for providers on our list as well. >> patients are always welcome to call the clinic for there's a lot of information for providers on our list as well. >> patients are always welcome to call the clinic for 75500. e during hours for clients to questions. >>

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>> it's tuesday, may 15th, 2018. can you read the roll? ll call ] >> you have a cm. >> the ringing and use of cell ic des are prohibitundng p the. any person responsible for one going off may be asked to leave the room. we request they be turned. for approval of minutes of the may 1 regular meeting. >> do i have any public comment on the