36C10G18Q9140-001.docx

B.3 PERFORMANCE WORK STATEMENT

Performance Work Statement:

Veterans Health Administration Dental Patient Satisfaction Survey

I. Background The mission of the Veterans Health Administration (VHA) is to provide high quality medical and dental care to eligible veterans. The VA Office of Dentistry (OOD) is responsible for policy, oversight and new program development for veteran dental care. Executive Order 12862, dated September 11, 1993, calls for the establishment and implementation of customer service standards, and for agencies to “survey customers to determine the kind and quality of services they want and their level of satisfaction with current services”. The VA’s Blueprint for Excellence emphasizes customer feedback, and encourages services to measure their patient satisfaction.

II. Deliverables

Surveys will be conducted to assess dental care down to the individual site level (approx. 231) Number of completed surveys per site level will depend upon the number of staff dentist FTE at each site according to the following:

1 DDS 45/yr.

2-3 DDS 120/yr.

>3 DDS 200/yr.

III. Description of Required Services

a. Production and Fielding of Surveys and Data Collection The OOD is seeking a contractor to provide the following products and/or services as soon as VA receives approval from OMB: VHA-wide use of the survey instrument, access to detailed data files for comparable analysis, statistical consulting on an as needed basis, and data collection services, survey data file transfers (FTP), white mail handling, and translation into Spanish used in the territory of Puerto Rico for the each surveyed patient population, and selected data analysis and reporting. Please note that any survey questions used by VHA must be approved by OMB in accordance with the Paperwork Reduction Act of 1995. It is expected approximately 48,000 to 60,000 veterans will receive a survey each year based on the data sent from the OOD identifying veterans receiving care.

b. Data Analysis and Results Reporting The contractor shall provide all services and written materials required to support the analyses of data and report preparation needed to produce the quarterly reports from the Dental Patient Satisfaction Survey (DPSS). The contractor shall develop full national, VISN, parent facility and site level reporting on a monthly, quarterly and yearly basis. The contractor will provide proof of concept and demonstrate their ability to successfully analyze and report results.

Technical training and documentation shall be provided to OOD and other VHA staff as needed to ensure maximum practical use at all organizational levels.

c. Web-Based Reporting Site The contractor shall create and maintain a website that allows secure access for VHA reports.

These secure, web-based reports shall, at a minimum, contain descriptive elements about the surveyed group and their responses displayed in both text and graphical format. Critical informational elements include mean ratings on the DPSS, sample sizes, response rates, trending, statistically significant results, external (non-VHA) comparisons, correlation analysis, and other demographic variables. Additionally, the contractor shall provide a secure web-based reporting site updated real time; the website shall experience no more than a 24hr down time at any period during the Period of Performance.

d. Comparative questionnaire database VHA’s success in achieving a patient driven culture has been the result of using consistent survey methods and instruments/questionnaires since the inception of the satisfaction program as well as the ability to compare these results to an external referent (i.e. patients completing the same survey outside the VHA health care system). VHA is seeking a contractor that can field the survey for data collection purposes and conduct routine analysis and reporting of the results.

e. Referent Data A key to measuring the success of VHA in achieving a patient driven culture is the ability to compare VHA performance on the DPSS to a comparable non-VHA patient population. OOD is seeking a contractor that can provide comparable results on a non-VA patient population.

Critical to the comparison of performance on the DPSS is the ability for the contractor to subset the non-VA population on key demographic characteristics, such as the age and gender of respondents, and to report results on dimensions of care and key survey questions, like self-reported health status and overall quality.

f. Training The contractor will provide up to four (4) hours of training on accessing and reviewing the survey data via online video/teleconference to be scheduled by the Program Office (PO). All instructional material will be reviewed by the PO two weeks prior to the scheduled event and provide technical training and documentation to OOD and other VHA staff as needed to ensure maximum practical use at all organizational levels.

g. Monthly Meetings The contractor will provide the Office of Dentistry with updates to the Dental Patient Satisfaction survey through regular scheduled monthly meetings. The agenda will be distributed to attendees two days prior the meeting for approval.

IV. General Description of Additional Services Required Services The OOD is seeking a contractor to provide the following products and services: VHA-wide use of the survey instruments, access to detailed non-VA data files for comparable analysis, statistical consulting on an as needed basis, address file cleaning, and data collection services, survey data file transfers (FTP), white mail handling, and translation into Spanish used in the territory of Puerto Rico for each of the following patient-survey populations.

V. Data Collection Methodology The OOD requires that the surveys are completed utilizing a modified Dillman Total Design Methodology (TDM). The mailing sequence is a multiple step process consisting of a pre-notification letter, a first survey and cover letter, and a thank you/reminder postcard The timing sequence of the mailings in each study is as follows:

Week 1 Pre-notification letter mails Week 2 First survey with cover letter mails Week 3 Thank you / reminder postcard mails Week 5 Close of data collection

The OOD will provide text for the survey pre-notification letter explaining the nature and goals of the upcoming survey and encouraging the veteran to participate, survey cover letter, postcard, and survey questionnaire to the contractor.

VI. Details of Process and Deliverables The OOD expects the DPSS to be conducted monthly. The table below outlines some details regarding the frequency and sample size of each survey project. The estimated total number of completed surveys is approximately 48,000 to 60,000 annually. Active Data Collection, regular reports of progress, and delivery of accurate final data sets and related files will be the prime responsibility of the contractor. The approximate numbers of patients and the reporting frequency are described as follows:

Survey - Patient Population Survey Cycle and Data Collection Frequency Number of Patients per cycle Booklet Characteristics

Frequency

Eligible Veterans treated by VA dental clinics Monthly, with Quarterly and Yearly roll-up

Class I-VI program recently cared for by VA dental services Quarterly written reports.

Web based reporting service updated weekly

VII. Sampling Methodology VA dental services annually provide care to approximately 460,000 veterans at 141 parent facility sites. Each parent site may include one or more smaller ambulatory clinics with dentists per parent site ranging from one (1) to twenty-two (22) Full Time Equivalent Employees (FTEE). Sampling of veterans will be performed based upon the number of dentist FTEE per 141 parent facility sites.

The total annual number of completed surveys per facility will be:

· 1 dentist FTEE at facility: 45 completed patient surveys per year

· 2-3 dentist FTEE at facility: 120 completed patient surveys per year

· 4 or greater dentist FTEE at facility: 200 completed patient surveys per year

Veteran patients included in the sampling methodology will be all those receiving dental care under eligibility Classifications I-VI. Survey reports will further delineate survey results based upon whether veterans are receiving care as a Class I, II, IIc or IV, or receiving care as a Class III or VI. Attachment A provides a breakdown of dentist FTEE at each parent facility and will routinely be updated by the OOD as required. Based upon this methodology, it is anticipated approximately 48,000 – 54,000 completed surveys will be required each year.

VIII. Process

a. The OOD obtains the sample of patients by accessing appropriate VA databases. The samples will be drawn monthly from Department of Veteran’s Affairs medical facilities throughout the United States and Puerto Rico. The program office selects targeted patient types that meet the inclusion criteria from each specified medical facility’s location. Inclusion data will be all veterans receiving facility dental treatment under eligibility rules as outlined under dental Classifications I-VI. The contractor will randomly select dental patients from each facility to receive a survey with the goal of 25% of total targeted number of surveys per dentist FTEE completed each quarter. At the end of the first year, each facility will have the total targeted number of dental patient satisfaction surveys completed.

b. The contractor will be supplied with the patient name, dental classification and address files in ASCII comma delimited format (compressed if necessary using PKZIP) or in a SAS dataset, and must undergo Code 1 mail-streaming and National Change of Address (NCOA) cleaning. The contractor’s systems must be compatible with these methods. Before beginning the project, a test of contractor/OOD system compatibility must be conducted.

c. Once a mailing list is received by the contractor, an output able file must be created containing each clinic and medical facility’s number, corresponding facility name, and the number of patients sampled. The contents of the output file must be verified and approved by OOD before proceeding to Code 1 mail streaming and NCOA cleaning. To do this the output file must be transmitted electronically to the OOD so they can verify that the contractor has received the full contents of the address file. Examples of the layout and content of this file can be furnished.

d. The mailing list must undergo standard Code 1 mail streaming and NCOA cleaning to remove any undeliverable addresses before printing of the names and addresses on the surveys begins. An output file containing the rejected names and addresses must be provided to OOD along with the reject code or some explanation for reason of rejection. The output containing the names and addresses of those records retained after NCOA cleaning (i.e. cleared for mailing) must be provided to OOD in the layout described above. Information regarding the NCOA process can be obtained from the Post Office or other survey vendors that provide mailing services. NCOA software is available through a software retailer. NCOA software must be updated monthly to guarantee accuracy.

e. The contractor shall coordinate with the GPO representative to ensure that patient files are sent over to the GPO representative as specified by OOD.

f. The contractor must adhere to Secure Socket Layer (SSL) Protocols and Public Key Infrastructure (PKI), as appropriate, in the transference of any sensitive patient identifiable data. All data transfers must be completed via secure FTP sites between the contractor and OOD in accordance with the attached Business Associate Agreement and all parts.

g. All answered surveys shall be returned to the contractor for evaluation and reporting purposes.

IX. Personalization of Survey Materials

a. The purpose of the patient unique identification number serves as a way of tracking respondents so that their names will not appear directly on the questionnaire. The OOD guarantees survey respondents’ anonymity. The identification numbering system used to track surveys specifies a unique number to each individual in the sample. This number will be used during data analysis to link survey respondents to their demographic data. The numbering system can be sequential or non-sequential and can be developed collaboratively between the contractor and the OOD.

b. The contractor shall develop a unique identification number for each survey that will monitor the delivery and receipt of patient correspondence in accordance the survey components. The tracking mechanism for the survey must include a unique identifier for each survey participant. The unique identifier must also serve as a link with the name and address file. The number also must include an identifier designating which survey cycle and mailing sequence the survey questionnaire belongs to.

X. Data Collection Data collection for the surveys shall be done using optical scanning or digital image capture techniques backed up by direct double entry keypunching where necessary for damaged surveys. OOD requires that survey data collected be made available in ASCII or SAS file types, on request.

XI. White-mail Processing Additional comments veterans enclose on attached sheets of paper, recorded audiocassettes, photographs, etc. are commonly called “white mail”.

a. The contractor shall be required to screen all white mail for veterans in distress or in need of critical assistance. Indications of these conditions include: language consistent with threats of suicide, homicide or other threats self or others, threats of lawsuit, indications of depression and or desperation, or complaints being brought to the President, members of Congress or the local media,

b. Any instance of a critical alert in white mail must be brought to the attention of OOD immediately for review and response via telephone, email and/or fax, depending on the urgency, and a next day follow up mailing of any original correspondence to OOD.

c. Non-critical white-mail must be returned to OOD for processing at least once a week from receipt as some of the material may be time sensitive. Each piece of white mail sent to OOD must have the patient’s ID code to allow rapid follow-up in critical situations. Special care must be taken to ensure the security of these identified documents in transit. Details regarding this process and the contact information for the recipients of the white mail will be worked out with the contractor upon award of the contract.

XII. Return to sender (RTS) and deceased patients The file containing the sample of patients provided by OOD will only include veterans that were known to be alive at the time of the sample pull. OOD requires the contractor to run the mailing list through National Change of Address (NCOA) and Code 1 mail streaming to remove any incorrect addresses or ambiguities; some veterans pass away or move before the surveys reach them. Any survey returned to the contractor as undeliverable will be coded in the data set as “returned to sender” or “deceased” according to the reason noted on the envelope. The name of the veteran must be removed from the mailing list of non-responders to prevent future mailings. This information is vital for statistical purposes of computing the true and adjusted response rates. Any white mail forwarded to the OOD from returned surveys marked as deceased must have some indicator written on them by the contractor that the accompanying survey has been coded as deceased in the data file.

XIII. Mailing

a. The contractor shall incur all cost related to mailing and shipping costs to the Office of Dentistry.

b. The business reply envelopes must have the name of the VHA Office of Dentistry (10NC7) as the recipient of the returned piece along with the address of the data processing facility of the contractor.

XIV. Term of Contract This contract will include a base period that will begin at the Date of Award through September 30, 2019 and have 4 option periods.

XV. Dental Sites image1.emf

Dental Sites for DPSS 20180823.xlsx Sheet2

Dental Site Name VA ST Name VA ST City VA ST State VA ST Zip

Togus VAMROC Togus VAMC Augusta ME 4330

Bangor Bangor VA Clinic Bangor ME 4401

White River Junction, VT White River Junction VAMC White River Junction VT 5009

VA Montana HCS at Ft. Harrison Fort Harrison VAMC Fort Harrison MT 59636

Billings Billings VA Clinic Billings MT 59102

Fargo Fargo VAMC Fargo ND 58102

Sioux Falls Royal C. Johnson Veterans' Memorial Hospital Sioux Falls SD 57117

Cheyenne Cheyenne VAMC Cheyenne WY 82001

Honolulu Spark M. Matsunaga VAMC Honolulu HI 96819

Wilmington Wilmington VAMC Wilmington DE 19805

Anchorage Anchorage VAMC Anchorage AK 99508

New Mexico VA Health Care System at Albuquerque Raymond G. Murphy VAMC Albuquerque NM 87108

New Mexico VA Health Care System at Rio Rancho Northwest Metro VA Clinic Rio Rancho NM 87124

Alexandria Alexandria VAMC Pineville LA 71306

Lafayette Lafayette VA Clinic Lafayette LA 70501

Lake Charles Lake Charles VA Clinic Lake Charles LA 70607

Altoona James E. Van Zandt VAMC Altoona PA 16602

Amarillo VA health Care System at Amarillo Thomas E. Creek VAMC Amarillo TX 79106

Amarillo VA health Care System at Lubbock Lubbock VA Clinic Lubbock TX 79412

Ann Arbor Healthcare System at Ann Arbor Ann Arbor VAMC Ann Arbor MI 48105

Ann Arbor Healthcare System at Toledo OPC Toledo VA Clinic Toledo OH 43614

Atlanta Atlanta VAMC Decatur GA 30033

Fort McPherson Fort McPherson VA Clinic Atlanta GA 30310

Oakwood Oakwood VA Clinic Flowery Branch GA 30542

Carrollton Trinka Davis Veterans Village Carrollton GA 30117

Atlanta VA Clinic Atlanta VA Clinic Decatur GA 30030

Augusta (uptown) Augusta VAMC-Uptown Augusta GA 30904

Maryland HCS at Baltimore Baltimore VAMC Baltimore MD 21201

Maryland HCS at Perry Point Perry Point VA Medical Center Perry Point MD 21902

VA Medical Center Battle Creek Battle Creek VAMC Battle Creek MI 49015

Wyoming VA Health Care Center Wyoming VA Clinic Wyoming MI 49519

Bay Pines C.W. Bill Young VAMC Bay Pines FL 33708

Lee County Lee County VA Clinic Cape Coral FL 33916

Bradenton Bradenton VA Clinic Bradenton FL 34208

Beckley Beckley VAMC Beckley WV 25801

Bedford, MA Edith Nourse Rogers Memorial Veterans' Hospital Bedford MA 1730

West Texas VA Health Care System at Big Spring George H. O'Brien, Jr., VAMC Big Spring TX 79720

VA Gulf Coast Veterans Healthcare System at Biloxi Biloxi VAMC Biloxi MS 39531

VA Gulf Coast Veterans Healthcare System at Pensacola Pensacola VA Clinic Pensacola FL 32503

Panama City Panama City Beach VA Clinic Panama City Beach FL 32407

VA Operations at Elgin AFB Eglin Air Force Base VA Clinic Eglin Air Force Base FL 32542

Birmingham Birmingham VA Medical Center Birmingham AL 35233

VA Boston Healthcare System at Boston-Jamaica Plain, MA Jamaica Plain VAMC Boston MA 2130

VA Boston Healthcare System at Brockton, MA Brockton VAMC Brockton MA 2301

Bronx James J. Peters VAMC Bronx NY 10468

New York Health Network at Buffalo, NY Buffalo VAMC Buffalo NY 14215

New York Health Network at Batavia, NY Batavia VAMC Batavia NY 14020

New York Health Network at Canandaigua, NY Canandaigua VAMC Canandaigua NY 14424

New York Health Network at Bath, NY Bath VAMC Bath NY 14810

New York Health Network at Syracuse, NY Syracuse VAMC Syracuse NY 13210

New York Health Network at Albany, NY Samuel S. Stratton VAMC Albany NY 12208

New York Health Network at Rochester OPC, NY Rochester VA Clinic Rochester NY 14620

Erie East VA Clinic Erie East VA Clinic Syracuse NY 13210

Butler Butler VAMC Butler PA 16001

Boise Boise VAMC Boise ID 83702

Charleston, SC Ralph H. Johnson VAMC Charleston SC 29401

Chicago Health Care System at Chicago (Westside) Jesse Brown VAMC Chicago IL 60612

Chicago Health Care System at Crown Point Adam Benjamin Jr., Veterans' Administration Outpatient Clinic Crown Point IN 46307

Chillicothe Chillicothe VAMC Chillicothe OH 45601

Cincinnati Cincinnati VAMC Cincinnati OH 45220

Clarksburg Louis A. Johnson VAMC Clarksburg WV 26301

Cleveland Healthcare System at Cleveland (Wade Park) Louis Stokes Cleveland Department of Veterans Affairs Medical Center Cleveland OH 44106

Coatesville Coatesville VAMC Coatesville PA 19320

Columbia, SC Wm. Jennings Bryan Dorn VAMC Columbia SC 29209

Greenville OPC Greenville VA Clinic Greenville SC 29605

Miami Bruce W. Carter VAMC Miami FL 33125

Broward OPC William "Bill" Kling Department of Veterans Affairs Outpatient Clinic Sunrise FL 33351

West Palm Beach West Palm Beach VAMC West Palm Beach FL 33410

North Texas Health Care System at Dallas Dallas VAMC Dallas TX 75216

North Texas Health Care System at Bonham Sam Rayburn Memorial Veterans Center Bonham TX 75418

North Texas Health Care System at Fort Worth Fort Worth VA Clinic Fort Worth TX 76104

Danville Danville VAMC Danville IL 61832

Dayton Dayton VAMC Dayton OH 45428

Detroit[Allen Park] John D. Dingell VAMC Detroit MI 48201

Eastern Colorado Healthcare System at Denver Denver VAMC Denver CO 80220

Southern Colorado Healthcare System at Pueblo OPC Pueblo VA Clinic Pueblo CO 81008

Southern Colorado Healthcare System at Colorado Springs PFC Floyd K. Lindstrom Department of Veterans Affairs Clinic Colorado Springs CO 80905

Captain James A Lovell FHCC Captain James A. Lovell Federal Health Care Center North Chicago IL 60064

Dublin Carl Vinson VAMC Dublin GA 31021

Durham Durham VAMC Durham NC 27705

Greenville Greenville VA Clinic Greenville NC 27834

New Jersey HCS at East Orange East Orange VAMC East Orange NJ 7018

New Jersey HCS at Lyons Lyons VAMC Lyons NJ 7939

New Jersey HCS at Ocean City (Brick) James J. Howard Veterans' Outpatient Clinic Brick NJ 8724

Erie Erie VAMC Erie PA 16504

Fayetteville Fayetteville VAMC Fayetteville AR 72703

Fayetteville, NC Fayetteville VAMC Fayetteville NC 28301

Wilmington, NC Wilmington VA Clinic Wilmington NC 28405

Black Hills Health Care System at Ft. Meade Fort Meade VAMC Fort Meade SD 57741

Black Hills Health Care System at Hot Springs Hot Springs VAMC Hot Springs SD 57747

Central California Health Care System at Fresno Fresno VAMC Fresno CA 93703

North Florida South Georgia Veterans Healthcare System at Gainesville Malcom Randall VAMC Gainesville FL 32608

North Florida South Georgia Veterans Healthcare System at Lake City Lake City VAMC Lake City FL 32025

North Florida South Georgia Veterans Healthcare System at Jacksonville Jacksonville 1 VA Clinic Jacksonville FL 32206

North Florida South Georgia Veterans Healthcare System at Tallahassee Tallahassee VA Clinic Tallahassee FL 32308

North Florida South Georgia Veterans Healthcare System at the Villages The Villages VA Clinic The Villages FL 32162

Grand Junction Grand Junction VAMC Grand Junction CO 81501

Hines VA Hospital Edward Hines Junior Hospital Hines IL 60141

Houston Michael E. DeBakey VAMC Houston TX 77030

Huntington Huntington VAMC Huntington WV 25704

Indianapolis Richard L. Roudebush VAMC Indianapolis IN 46202

Iron Mt. Oscar G. Johnson Department of Veterans Affairs Medical Facility Iron Mountain MI 49801

Jackson G.V. (Sonny) Montgomery VAMC Jackson MS 39216

Kansas City Kansas City VAMC Kansas City MO 64128

Columbia, MO Harry S. Truman Memorial Veterans' Hospital Columbia MO 65201

Eastern Kansas Health Care System at Topeka Colmery-O'Neil VAMC Topeka KS 66622

Eastern Kansas Health Care System at Leavenworth Dwight D. Eisenhower VAMC Leavenworth KS 66048

Wichita Robert J. Dole Department of VAMC Wichita KS 67218

Hampton Hampton VAMC Hampton VA 23667

Southern Nevada Healthcare System at Las Vegas Las Vegas VAMC North Las Vegas NV 89106

Lebanon Lebanon VAMC Lebanon PA 17042

Lexington Healthcare System at Lexington (Leestown) Lexington VAMC-Leestown Lexington KY 40511

Lexington Healthcare System at Lexington (Cooper Drive) Lexington VAMC-Cooper Lexington KY 40502

Central Arkansas Veterans Healthcare System at Little Rock John L. McClellan Memorial Veterans' Hospital Little Rock AR 72205

Long Beach Long Beach VAMC Long Beach CA 90822

Louisville Robley Rex VAMC Louisville KY 40206

Loma Linda Jerry L. Pettis Memorial Veterans' Hospital Loma Linda CA 92357

Madison William S. Middleton Memorial Veterans' Hospital Madison WI 53705

Manchester, NH Manchester VAMC Manchester NH 3104

VA Northern Indiana Healthcare system at Marion, IN Marion VAMC Marion IN 46953

VA Northern Indiana Healthcare system at Fort Wayne Fort Wayne VAMC Fort Wayne IN 46805

Northern California Health Care System at Redding Redding VA Clinic Redding CA 96002

Northern California Health Care System at Mare Island Mare Island VA Clinic Mare Island CA 94592

Northern California Health Care System at Chico Chico VA Clinic Chico CA 95926

Northern California Health Care System at Sacramento (McClellan AFB) McClellan VA Clinic McClellan Park CA 95652

Martinsburg Martinsburg VAMC Martinsburg WV 25401

Memphis Memphis VAMC Memphis TN 38104

Minneapolis Minneapolis VAMC Minneapolis MN 55417

Ramsey Northwest Metro VA Clinic Ramsey MN 55303

Central Alabama HCS at Montgomery Central Alabama VAMC-Montgomery Montgomery AL 36109

Central Alabama HCS at Tuskegee Central Alabama VAMC-Tuskegee Tuskegee AL 36083

Central Alabama HCS at Ft. Rucker Wiregrass VA Clinic Fort Rucker AL 36362

VA Hudson Valley HCS, FDR Campus Franklin Delano Roosevelt Hospital Montrose NY 10548

VA Hudson Valley HCS, Castle Point Campus Castle Point VAMC Wappingers Falls NY 12511

Mountain Home James H. Quillen VAMC Mountain Home TN 37684

Muskogee VAMC at Muskogee Jack C. Montgomery VAMC Muskogee OK 74401

Muskogee VAMC at Tulsa Ernest Childers Department of Veterans Affairs Outpatient Clinic Tulsa OK 74145

VA Tennessee Valley Healthcare System at Nashville Nashville VAMC Nashville TN 37212

VA Tennessee Valley Healthcare System at Murfreesboro Alvin C. York VAMC Murfreesboro TN 37129

NULL Clarksville VA Clinic Clarksville TN 37043

VA Tennessee Valley Healthcare System at Chattanooga Chattanooga VA Clinic Chattanooga TN 37411

New Orleans VAMC at New Orleans New Orleans VA Clinic New Orleans LA 70112

New Orleans VAMC at Baton Rouge OPC Baton Rouge VA Clinic Baton Rouge LA 70809

New York Harbor HCS at Manhattan Manhattan VAMC New York NY 10010

New York Harbor HCS at Brooklyn Brooklyn VAMC Brooklyn NY 11209

New York Harbor HCS at St. Albans St. Albans VAMC Jamaica NY 11434

Northampton, MA Edward P. Boland VAMC Leeds MA 1053

Northport Northport VAMC Northport NY 11768

Oklahoma City Oklahoma City VAMC Oklahoma City OK 73104

Lawton OPC Lawton VA Clinic Fort Sill OK 73503

Central Plains Health Care System (636) at Omaha Omaha VAMC Omaha NE 68105

Central Plains Health Care System (636) at Grand Island Grand Island VAMC Grand Island NE 68803

Central Plains Health Care System (636) at Lincoln Lincoln VA Clinic Lincoln NE 68510

Central Iowa Health Care System (636) at Des Moines Des Moines VAMC Des Moines IA 50310

Central Plains Health Care System (636) at Iowa City Iowa City VAMC Iowa City IA 52246

Asheville Charles George VAMC Asheville NC 28805

VA Palo Alto Health Care System at Palo Alto Palo Alto VAMC Palo Alto CA 94304

VA Palo Alto Health Care System at Menlo Park Palo Alto VAMC-Menlo Park Menlo Park CA 94025

VA Palo Alto Health Care System at Livermore Palo Alto VAMC-Livermore Livermore CA 94550

Philadelphia Corporal Michael J. Crescenz VAMC Philadelphia PA 19104

Phoenix Carl T. Hayden VAMC Phoenix AZ 85012

Southeast Southeast VA Clinic Gilbert AZ 85297

Surprise Northwest VA Clinic Surprise AZ 85351

Pittsburgh Healthcare System at Pittsburgh(UD) Pittsburgh VAMC-University Drive Pittsburgh PA 15240

Pittsburgh Healthcare System at Pittsburgh (Aspinwall)) H. John Heinz III VAMC Pittsburgh PA 15240

Portland Portland VAMC Portland OR 97239

Vancouver OPC Portland VAMC-Vancouver Vancouver WA 98661

Northern Arizona VA Health Care System at Prescott Bob Stump VAMC Prescott AZ 86313

Providence, RI Providence VAMC Providence RI 2908

Richmond Hunter Holmes McGuire Hospital Richmond VA 23249

Roseburg Roseburg VAMC Roseburg OR 97470

Eugene VA Clinic Eugene VA Clinic Eugene OR 97404

Virginia Street VA Clinic Virginia Street VA Clinic Reno NV 89502

Saginaw Aleda E. Lutz VAMC Saginaw MI 48602

St. Cloud St. Cloud VAMC St. Cloud MN 56303

St. Louis VAMC at St. Louis Division #1 John Cochran John Cochran Veterans Hospital St. Louis MO 63106

St. Louis VAMC at St. Louis Division #2 Jefferson Barracks St. Louis VAMC-Jefferson Barracks St. Louis MO 63125

Poplar Bluff John J. Pershing VAMC Poplar Bluff MO 63901

Marion, IL Marion VAMC Marion IL 62959

Evansville Evansville VA Clinic Evansville IN 47715

Salem-VAMC Salem VAMC Salem VA 24153

Salisbury W.G. (Bill) Hefner Salisbury VAMC Salisbury NC 28144

Kernersville Kernersville VA Clinic Kernersville NC 27284

Charlotte South Charlotte VA Clinic Charlotte NC 28208

VA Salt Lake City Health Care System George E. Wahlen VAMC Salt Lake City UT 84148

San Francisco San Francisco VAMC San Francisco CA 94121

Santa Rosa Santa Rosa VA Clinic Santa Rosa CA 95404

Puget Sound Health Care System at Seattle Seattle VAMC Seattle WA 98108

Puget Sound Health Care System at American Lake American Lake VAMC Tacoma WA 98493

Puget Sound Health Care System at Mount Vernon Mount Vernon VA Clinic Mount Vernon WA 98274

VA San Diego Healthcare System San Diego VAMC San Diego CA 92161

Oceanside Oceanside VA Clinic Oceanside CA 92056

Sheridan Sheridan VAMC Sheridan WY 82801

Shreveport Overton Brooks VAMC Shreveport LA 71101

Spokane Mann-Grandstaff VAMC Spokane WA 99205

South Texas Veterans Health Care System at San Antonio Audie L. Murphy Memorial Veterans' Hospital San Antonio TX 78229

South Texas Veterans Health Care System at Kerrville Kerrville VAMC Kerrville TX 78028

VA Caribbean Healthcare System San Juan VAMC San Juan PR 921

San Juan Healthcare System at Mayaguez Clinic Mayaguez VA Clinic Mayaguez PR 682

James A Haley VA Medical Center at Tampa James A. Haley Veterans' Hospital Tampa FL 33612

Deer Park Deer Park VA Clinic New Port Richey FL 34653

Hidden River Hidden River VA Clinic Tampa FL 33637

Central Texas Health Care System at Temple Olin E. Teague Veterans' Center Temple TX 76504

Central Texas Health Care System at Waco Doris Miller VAMC - Waco Waco TX 76711

Central Texas Health Care System at Austin Austin VA Clinic Austin TX 78741

Orlando VA Medical Center Orlando VAMC Orlando FL 32803

Orlando VA Medical Center - Viera OPC Viera VA Clinic Viera FL 32807

Orlando VA Medical Center - Daytona Beach OPC William V. Chappell, Jr. Veterans' Outpatient Clinic Daytona Beach FL 32114

Orlando VA Medical Center - Lake Baldwin CBOC Lake Baldwin VA Clinic Lake Baldwin FL 32803

Tomah Tomah VAMC Tomah WI 54660

Southern Arizona Health Care system at Tucson Tucson VAMC Tucson AZ 85723

Tuscaloosa Tuscaloosa VAMC Tuscaloosa AL 35404

Walla Walla Jonathan M. Wainwright Memorial VAMC Walla Walla WA 99362

Washington DC Washington VAMC Washington DC 20422

Washington DC Andrews AFB Southern Prince George's County VA Clinic Camp Springs MD 20746

VA Connecticut HCS at West Haven, CT West Haven VAMC West Haven CT 6516

VA Connecticut HCS at Newington, CT Newington VAMC Newington CT 6111

Greater LA Healthcare System at West LA West Los Angeles VAMC Los Angeles CA 90073

Greater LA Healthcare System at Sepulveda Sepulveda VAMC Sepulveda CA 91343

Greater LA Healthcare System at Bakersfield Bakersfield VA Clinic Bakersfield CA 93301

Greater LA Healthcare System at LA OPC Los Angeles VA Clinic Los Angeles CA 90012

Greater LA Healthcare System at Santa Maria Santa Maria VA Clinic Santa Maria CA 93454

White City, Oregon White City VAMC White City OR 97503

Wilkes Barre Wilkes-Barre VAMC Wilkes-Barre PA 18711

Allen Town OPC Allentown VA Clinic Allentown PA 18103

Milwaukee Clement J. Zablocki VAMC Milwaukee WI 53295

Green Bay Milo C. Huempfner Department of Veterans Affairs Outpatient Clinic Green Bay WI 54311

Valley Coastal Bend at Harlingen Harlingen VA Clinic-Treasure Hills Harlingen TX 78550

Valley Coastal Bend at Corpus Christi Corpus Christi VA Clinic Corpus Christi TX 78405

Valley Coastal Bend at Laredo Laredo VA Clinic Laredo TX 78041

El Paso El Paso VA Clinic El Paso TX 79930

Columbus Chalmers P. Wylie Veterans Outpatient Clinic Columbus OH 43203