36C24924R0089.pdf

PAGE 1 OF 1. REQUISITION NO.

2. CONTRACT NO. 3. AWARD/EFFECTIVE DATE 4. ORDER NO. 5. SOLICITATION NUMBER 6. SOLICITATION ISSUE DATE

a. NAME b. TELEPHONE NO. (No Collect Calls) 8. OFFER DUE DATE/LOCAL

TIME

9. ISSUED BY CODE 10. THIS ACQUISITION IS UNRESTRICTED OR SET ASIDE: % FOR:

SMALL BUSINESS

HUBZONE SMALL

BUSINESS

SERVICE-DISABLED

VETERAN-OWNED

SMALL BUSINESS

WOMEN-OWNED SMALL BUSINESS

(WOSB) ELIGIBLE UNDER THE WOMEN-OWNED

SMALL BUSINESS PROGRAM

EDWOSB

8(A)

NAICS:

SIZE STANDARD:

11. DELIVERY FOR FOB DESTINA-

TION UNLESS BLOCK IS

MARKED

SEE SCHEDULE

12. DISCOUNT TERMS

13a. THIS CONTRACT IS A

RATED ORDER UNDER

DPAS (15 CFR 700)

13b. RATING

14. METHOD OF SOLICITATION

RFQ IFB RFP

15. DELIVER TO CODE 16. ADMINISTERED BY CODE

17a. CONTRACTOR/OFFEROR CODE FACILITY CODE 18a. PAYMENT WILL BE MADE BY CODE

TELEPHONE NO. UEI: EFT:

PHONE: FAX:

17b. CHECK IF REMITTANCE IS DIFFERENT AND PUT SUCH ADDRESS IN OFFER

18b. SUBMIT INVOICES TO ADDRESS SHOWN IN BLOCK 18a UNLESS BLOCK BELOW IS CHECKED

SEE ADDENDUM

19. 20. 21. 22. 23. 24.

ITEM NO. SCHEDULE OF SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT

(Use Reverse and/or Attach Additional Sheets as Necessary)

25. ACCOUNTING AND APPROPRIATION DATA 26. TOTAL AWARD AMOUNT (For Govt. Use Only)

27a. SOLICITATION INCORPORATES BY REFERENCE FAR 52.212-1, 52.212-4. FAR 52.212-3 AND 52.212-5 ARE ATTACHED. ADDENDA ARE ARE NOT ATTACHED.

27b. CONTRACT/PURCHASE ORDER INCORPORATES BY REFERENCE FAR 52.212-4. FAR 52.212-5 IS ATTACHED. ADDENDA ARE ARE NOT ATTACHED

28. CONTRACTOR IS REQUIRED TO SIGN THIS DOCUMENT AND RETURN _______________ 29. AWARD OF CONTRACT: REF. ___________________________________ OFFER COPIES TO ISSUING OFFICE. CONTRACTOR AGREES TO FURNISH AND DATED ________________________________. YOUR OFFER ON SOLICITATION DELIVER ALL ITEMS SET FORTH OR OTHERWISE IDENTIFIED ABOVE AND ON ANY (BLOCK 5), INCLUDING ANY ADDITIONS OR CHANGES WHICH ARE ADDITIONAL SHEETS SUBJECT TO THE TERMS AND CONDITIONS SPECIFIED SET FORTH HEREIN IS ACCEPTED AS TO ITEMS:

30a. SIGNATURE OF OFFEROR/CONTRACTOR 31a. UNITED STATES OF AMERICA (SIGNATURE OF CONTRACTING OFFICER)

30b. NAME AND TITLE OF SIGNER (TYPE OR PRINT) 30c. DATE SIGNED 31b. NAME OF CONTRACTING OFFICER (TYPE OR PRINT) 31c. DATE SIGNED

AUTHORIZED FOR LOCAL REPRODUCTION (REV. NOV 2021)

PREVIOUS EDITION IS NOT USABLE Prescribed by GSA - FAR (48 CFR) 53.212

7. FOR SOLICITATION

INFORMATION CALL:

STANDARD FORM 1449

SOLICITATION/CONTRACT/ORDER FOR COMMERCIAL PRODUCTS AND COMMERCIAL SERVICES

OFFEROR TO COMPLETE BLOCKS 12, 17, 23, 24, & 30

36C24924R0089

10-04-2024

April Cody 10-31-2024

10:00AM CT

Network Contracting Office 9 Department of Veteran Affairs Network Contracting Office (90C) 1639 Medical Center Parkway Suite 204 Murfreesboro TN 37129

X 100

X

Y

621112

$13.5 Million

N/A

Department of Veterans Affairs Lexington VA Health Care System Franklin R. Sousley Campus 1101 Veterans Drive Lexington KY 40502

90C

Network Contracting Office 9 Department of Veterans Affairs Network Contracting Office (90C) 1639 Medical Center Parkway Suite 204 Murfreesboro TN 37129

90C

FSC e-Invoicing Payment http://www.fsc.va.gov/fsc/einvoice.asp Invoice Setup Information 1-877-489-6135 Invoice must be submitted electronically

Setup 1-877-489-6135

See CONTINUATION Page

After-Hours Psychiatry Services

Contractor shall provide onsite, on call, and call back services in accordance with the Schedule, Performance Work Statement, and all terms and conditions contained herein.

See Schedule on Page 7 See PWS on Page 13 See Instructions for Preparation of Proposal on Page 86

X 1

Angela Tucker, Contracting Officer

Table of Contents

SECTION B - CONTINUATION OF SF 1449 BLOCKS

B.1 CONTRACT ADMINISTRATION DATA

B.2 SCHEDULE OF SERVICES

B.3 PERFORMANCE WORK STATEMENT

SECTION C - CONTRACT CLAUSES

C.1 52.212-4 CONTRACT TERMS AND CONDITIONS—COMMERCIAL PRODUCTS

AND COMMERCIAL SERVICES (NOV 2023)

C.2 52.204-9 Personal Identity Verification of Contractor Personnel (JAN 2011)

C.3 52.204-21 BASIC SAFEGUARDING OF COVERED CONTRACTOR

INFORMATION SYSTEMS (NOV 2021)

C.4 52.216-18 ORDERING (AUG 2020)

C.4 52.216-19 ORDER LIMITATIONS (OCT 1995)

C.6 52.216-22 INDEFINITE QUANTITY (OCT 1995)

C.7 52.217-8 OPTION TO EXTEND SERVICES (NOV 1999)

C.8 52.228-5 Insurance-Work on a Government Installation (JAN 1997)

C.9 SUPPLEMENTAL INSURANCE REQUIREMENTS

C.10 52.232-19 AVAILABILITY OF FUNDS FOR THE NEXT FISCAL YEAR (APR

1984)

C.11 VAAR 852.201-70 CONTRACTING OFFICER’S REPRESENTATIVE (DEC 2022)

C.12 VAAR 852.203-70 COMMERCIAL ADVERTISING (MAY 2018)

C.13 VAAR 852.211-76 LIQUIDATED DAMAGES – REIMBURSEMENT FOR DATA

BREACH COSTS (FEB 2023) ALTERNATE I (FEB 2023)

C.14 VAAR 852.232-72 ELECTRONIC SUBMISSION OF PAYMENT REQUESTS

(NOV 2018)

C.15 VAAR 852.237-74 Nondiscrimination in Service Delivery (OCT 2019) C.16 VAAR 852.237-75 Key Personnel (OCT 2019) C.17 VAAR 852.239-76 Information and Communication Technology Accessibility (FEB 2023)

C.18 VAAR 852.242-71 ADMINISTRATIVE CONTRACTING OFFICER (OCT 2020) ...59

C.19 52.252-2 CLAUSES INCORPORATED BY REFERENCE (FEB 1998)

C.20 52.212-5 CONTRACT TERMS AND CONDITIONS REQUIRED TO IMPLEMENT

STATUTES OR EXECUTIVE ORDERS—COMMERCIAL PRODUCTS AND

COMMERCIAL SERVICES (MAY 2024)

SECTION D - CONTRACT DOCUMENTS, EXHIBITS, OR ATTACHMENTS

D.1 ATTACHMENT 1 – QUALITY ASSURANCE SURVEILLANCE PLAN (QASP)

D.2 ATTACHMENT 2 – CONTRACTOR CERTIFICATION: IMMIGRATION AND

NATIONALITY ACT

D.3 ATTACHMENT 3 – CONFLICT OF INTEREST CERTIFICATION STATEMENT

D.4 - Organizational Conflict of Interest

SECTION E - SOLICITATION PROVISIONS

E.1 52.212-1 INSTRUCTIONS TO OFFERORS—COMMERCIAL PRODUCTS AND

COMMERCIAL SERVICES (SEP 2023)

E.1.1 ADDENDUM to FAR 52.212-1 INSTRUCTIONS TO OFFERORS—

COMMERCIAL PRODUCTS AND COMMERCIAL SERVICES

INSTRUCTIONS FOR THE PREPARATION OF PROPOSAL

E.2 52.204-24 REPRESENTATION REGARDING CERTAIN TELECOMMUNICATIONS

AND VIDEO SURVEILLANCE SERVICES OR EQUIPMENT (NOV 2021)

E.3 52.204-29 FEDERAL ACQUISITION SUPPLY CHAIN SECURITY ACT

ORDERS—REPRESENTATION AND DISCLOSURES (DEC 2023)

E.4 52.209-7 INFORMATION REGARDING RESPONSIBILITY MATTERS (OCT 2018)

E.5 52.216-1 TYPE OF CONTRACT (APR 1984)

E.6 52.233-2 SERVICE OF PROTEST (SEP 2006)

E.7 VAAR 852.233-71 ALTERNATE PROTEST PROCEDURE (OCT 2018)

E.7 VAAR 852.233-70 PROTEST CONTENT/ALTERNATIVE DISPUTE RESOLUTION

(SEPT 2018)

E.8 52.252-1 SOLICITATION PROVISIONS INCORPORATED BY REFERENCE (FEB

1998)

E.9 VAAR 852.273-73 EVALUATION—HEALTH-CARE RESOURCES (NOV 2021)

E.10 VAAR 852.273-74 AWARD WITHOUT EXCHANGES (NOV 2021)

E.11 852.239-75 Information and Communication Technology Accessibility

(FEB 2023)

E.12 52.212-3 OFFEROR REPRESENTATIONS AND CERTIFICATIONS—

COMMERCIAL PRODUCTS AND COMMERCIAL SERVICES (MAY 2024)

SECTION B - CONTINUATION OF SF 1449 BLOCKS

B.1 CONTRACT ADMINISTRATION DATA

1. CONTRACT ADMINISTRATION: All contract administration matters will be handled by the following individuals:

a. CONTRACTOR:

Company Name: _____________________________ Contact Person: _____________________________ Title: _____________________________ Address: _____________________________ City/State/Zip: _____________________________ Phone: _____________________________ Fax: _____________________________ E-Mail: _____________________________ Tax ID No.: _____________________________ UEI No.: _____________________________

b. GOVERNMENT:

April Cody, Contracting Specialist Department of Veterans Affairs Network Contracting Office 9 - NCO 9 1639 Medical Center Parkway Suite 204 Murfreesboro TN 37129 Overnight Mailing Address: Same as above E-Mail: april.cody2@va.gov

i. The Contractor is advised that only the Contracting Officer, acting within the scope of the contract and his/her duties and responsibilities and, after advice and consultation with the Contracting Officer’s Representative (COR), has the authority to make changes which effect contract prices, quality, quantity, delivery terms and conditions, or the term of the contract.

ii. In no event shall any understanding or agreement, modification, change order, or other matters in deviation from the terms of this contract between Contractor and a person other than the Contracting Officer, be effective or binding upon the Government. All such actions must be formalized by the proper contractual document executed by the Contracting Officer.

iii. Contracting Officer’s representative: Prior to contract award, the Contracting Officer will designate a VA Medical Center employee as COR for this contract. All work coordination shall be made through the COR. The Contractor shall be provided a copy of the letter of delegation authorizing the COR at the commencement of the term of this agreement. No other person shall be authorized to act in such capacity unless appointed in writing by the Contracting Officer.

iv. All Invoices from the contractor shall be submitted electronically in accordance with VAAR Clause 852.232-72 Electronic Submission of Payment Requests. Invoicing shall be in accordance with the requirements of The Department of Veterans Affairs (VA) Financial Services Center (VAFSC). The latest information shall be used for invoicing and payments and may change during the Period of Performance of this acquisition. Current Invoicing information is located at http://www.fsc.va.gov/einvoice.asp

v. Secure Fax – Please review VA Handbook 6500 that requires the following statement on all fax cover sheets be included: This fax is intended only for the use of the person or office to which it is addressed and may contain information that is privileged, confidential, or protected by law. All others are hereby notified that the receipt of this fax does not waive any applicable privilege or exemption for disclosure and that any dissemination, distribution, or copying of this communication is prohibited. If you have received this fax in error, please notify this office immediately at the telephone number listed above.

[End of Contract Administration Data]

ACKNOWLEDGMENT OF AMENDMENTS: The Offeror acknowledges receipt of amendments to the Solicitation numbered and dated as follows:

AMENDMENT NO. DATE

B.2 SCHEDULE OF SERVICES

The Contractor shall furnish all personnel to provide services necessary to perform After Hours Psychiatry Services to eligible beneficiaries of the Department of Veterans Affairs Lexington VA Medical Center (hereinafter referred to as VAMC). The Contractors physician(s) care shall cover the range of psychiatric services as would be provided in a state-of-the-art civilian medical treatment facility and the standard of care shall be of a quality, meeting or exceeding currently recognized national standards as established by American Board of Psychiatry and Neurology.

https://www.abpn.org.

Place of Performance: Services shall be provided onsite at the following location:

Department of Veterans Affairs Lexington VAMC Franklin R. Sousley Campus 1101 Veterans Drive Lexington KY 40502

Pricing Instructions:

The Contractor shall propose a minimum of five (4) key personnel to be credentialed and be available for scheduling to meet the requirements of the contract.

Contractual minimum and maximum: The guaranteed minimum contract amount is $60,000.00 and the maximum contract amount shall not exceed $5,000,000.00.

Emergency Call Back: In the event the psychiatrist must come onsite responding to an emergency request, they will be compensated at the level of pay indicated under Line Item Number (LIN) ending in 1a or 1b (0001a, 1001a, etc.).

Orders: This is a Fixed Price (FP), Indefinite Delivery Indefinite Quantity (IDIQ) contract (see FAR 52.216-22). Task Orders shall be placed against this IDIQ contract at the time of contract award, and as needed during the term of the contract. The Task Orders shall specify the estimated quantities of services for each period of performance and shall comply with FAR 52.216-18 and 52.216-19.

Period of Performance: ORDERING PERIOD 1 (01-01-2025 TO 12-31-2025)

Period of Performance: ORDERING PERIOD 2 (01-01-2026 TO 12-31-2026)

LIN SLIN Description Qty. Unit Unit Cost Total

Annual Cost

0001 None

4.0 FTE Board Certified /Board

Eligible After-Hours Psychiatry Physician Services

6862.50 Hours

DO NOT

PRICE

DO NOT

PRICE

KEY PERSONNEL

None 0001a

Onsite Psychiatry Services Weekends (8:00AM – 4:30PM)

NAME: ____________

TITLE: ____________

832 Hours $__/hr. $__

None 0001b

Onsite Psychiatry Services Holidays (8:00AM – 4:30PM)

NAME: ____________

TITLE: ____________

88 Hours $__/hr. $__

None 0001c

On Call Psychiatry Services Weekdays (4:00PM – 8:00AM)

NAME: ____________

TITLE: ____________

4160 Hours $__/hr. $__

None 0001d

On Call Psychiatry Services Weekends (4:30PM-8:00AM)

NAME: ____________

TITLE: ____________

1612 Hours $__/hr. $__

None 0001e

On Call Psychiatry Services Holidays (4:30PM-8:00AM)

NAME: ____________

TITLE: ____________

170.50 Hours $__/hr. $__

TOTAL FOR BASE Hours $___________________

LIN SLIN Description Qty. Unit Unit Cost Total

Annual Cost

1001 None

4.0 FTE Board Certified /Board

Eligible After-Hours Psychiatry Physician Services

6862.50 Hours

DO NOT

PRICE

DO NOT

PRICE

KEY PERSONNEL

None 1001a

Onsite Psychiatry Services Weekends (8:00AM – 4:30PM)

NAME: ____________

TITLE: ____________

832 Hours $__/hr. $__

None 1001b

Onsite Psychiatry Services Holidays (8:00AM – 4:30PM

NAME: ____________

TITLE: ____________

88 Hours $__/hr. $__

None 1001c

On Call Psychiatry Services Weekdays (4:00PM – 8:00AM)

NAME: ____________

TITLE: ____________

4160 Hours $__/hr. $__

None 1001d

On Call Psychiatry Services Weekends (4:30PM-8:00AM)

NAME: ____________

TITLE: ____________

1612 Hours $__/hr. $__

None 1001e

On Call Psychiatry Services Holidays (4:30PM-8:00AM)

NAME: ____________

TITLE: ____________

70.50 Hours $__/hr. $__

TOTAL FOR Option Year 1 Hours $___________________

Period of Performance: ORDERING PERIOD 3 (01-01-2027 TO 12-31-2027)

LIN SLIN Description Qty. Unit Unit Cost Total

Annual Cost

2001 None

4.0 FTE Board Certified /Board

Eligible After-Hours Psychiatry Physician Services

6862.50 Hours

DO NOT

PRICE

DO NOT

PRICE

KEY PERSONNEL

None 2001a

Onsite Psychiatry Services Weekends (8:00AM – 4:30PM)

NAME: ____________

TITLE: ____________

832 Hours $__/hr. $__

None 2001b

Onsite Psychiatry Services Holidays (8:00AM – 4:30PM

NAME: ____________

TITLE: ____________

88 Hours $__/hr. $__

None 2001c

On Call Psychiatry Services Weekdays (4:00PM – 8:00AM)

NAME: ____________

TITLE: ____________

4160 Hours $__/hr. $__

None 2001d

On Call Psychiatry Services Weekends (4:30PM-8:00AM)

NAME: ____________

TITLE: ____________

1612 Hours $__/hr. $__

None 2001e

On Call Psychiatry Services Holidays (4:30PM-8:00AM)

NAME: ____________

TITLE: ____________

TOTAL FOR Option Year 2 Hours $___________________

Period of Performance: ORDERING PERIOD 4 (01-01-2028 TO 12-31-2028)

LIN SLIN Description Qty. Unit Unit Cost Total

Annual Cost

3001 None

4.0 FTE Board Certified /Board

Eligible After-Hours Psychiatry Physician Services

6862.50 Hours

DO NOT

PRICE

DO NOT

PRICE

KEY PERSONNEL

None 3001a

Onsite Psychiatry Services Weekends (8:00AM – 4:30PM)

NAME: ____________

TITLE: ____________

832 Hours $__/hr. $__

None 3001b

Onsite Psychiatry Services Holidays (8:00AM – 4:30PM

NAME: ____________

TITLE: ____________

88 Hours $__/hr. $__

None 3001c

On Call Psychiatry Services Weekdays (4:00PM – 8:00AM)

NAME: ____________

TITLE: ____________

4160 Hours $__/hr. $__

None 3001d

On Call Psychiatry Services Weekends (4:30PM-8:00AM)

NAME: ____________

TITLE: ____________

1612 Hours $__/hr. $__

None 3001e

On Call Psychiatry Services Holidays (4:30PM-8:00AM)

NAME: ____________

TITLE: ____________

TOTAL FOR Option Year 3 Hours $___________________

Period of Performance: ORDERING PERIOD 5 (01-01-2029 TO 12-31-2029)

LIN SLIN Description Qty. Unit Unit Cost Total

Annual Cost

4001 None

4.0 FTE Board Certified /Board

Eligible After-Hours Psychiatry Physician Services

6862.50 Hours

DO NOT

PRICE

DO NOT

PRICE

KEY PERSONNEL

None 4001a

Onsite Psychiatry Services Weekends (8:00AM – 4:30PM)

NAME: ____________

TITLE: ____________

832 Hours $__/hr. $__

None 4001b

Onsite Psychiatry Services Holidays (8:00AM – 4:30PM

NAME: ____________

TITLE: ____________

88 Hours $__/hr. $__

None 4001c

On Call Psychiatry Services Weekdays (4:00PM – 8:00AM

NAME: ____________

TITLE: ____________

4160 Hours $__/hr. $__

None 3001d

On Call Psychiatry Services Weekends (4:30PM-8:00AM)

NAME: ____________

TITLE: ____________

1612 Hours $__/hr. $__

None 3001e

On Call Psychiatry Services Holidays (4:30PM-8:00AM)

NAME: ____________

TITLE: ____________

TOTAL FOR Option Year 4 Hours $___________________

Total for all ordering periods: $_________________________

B.3 PERFORMANCE WORK STATEMENT

1. GENERAL:

1.1. Services Provided: The Contractor shall provide four (4) Board Certified /Board Eligible Psychiatrists on site in accordance with the specifications contained herein to beneficiaries of the Department of Veterans Affairs (VA) and the Lexington VA Health Care System.

1.2. Place of Performance: Contractor shall furnish services at the Lexington VA Health Care System, 1101 Veterans Drive, Lexington, KY 40502

1.3. Authority: Title 38 USC 8153, Health Care Resources (HCR) sharing Authority using FAR Part 12 in conjunction with VAAR 873.

1.4. Policy/Directives/Handbooks The contractor shall be subject to the following policies, including any subsequent updates during the period of performance. The policies listed below can be accessed electronically at the following: VA Publications VHA Publications

1.4.1. VA Directive 1663: Health Care Resources (HCR) Contracting – Buying Title 38 U.S.C.

8153:

1.4.2. VHA Directive 1003.04: VHA Patient Advocacy

1.4.3. VHA Directive 1065: Productivity and Staffing Guidance for Specialty Provider Group Practice

1.4.4. VHA Directive 1088(1): Communicating Test Results to Providers and Patients

1.4.5. VHA Directive 1100.18: Reporting And Responding To State Licensing Boards

1.4.6. VHA Directive 1100.21: Privileging

1.4.7. VHA Directive 1100.20 Credentialing of Health Care Providers

1.4.8. VHA Directive 1192.01: Seasonal Influenza Vaccination Program For VHA Health Care Personnel

1.4.9. VHA Directive 1220(1): Facility Procedure Complexity Designation Requirements To Perform Invasive Procedures In Any Clinical Setting

1.4.10. VHA Directive 1605.01: Privacy and Release of Information

1.4.11. VHA Directive 1907.01: VHA Health Information Management and Health Records

1.4.12. VHA Handbook 1100.17: National Practitioner Data Bank (NPDB) Reports

1.4.13. Privacy Act of 1974 (5 U.S.C. 552a) as amended:

http://www.justice.gov/oip/foia_updates/Vol_XVII_4/page2.htm

1.5. Acronyms/Definitions: Terms used in this contract shall be interpreted as follows unless the context expressly requires a different construction and/or interpretation. In case of a conflict in language between the Definitions and other sections of this contract, the language in this section shall govern.

1.5.1. ABPN: American Board of Psychiatry and Neurology

1.5.2. ACGME: Accreditation Council for Graduate Medical Education

1.5.3. ACLS: Advanced Cardiac Life Support

1.5.4. BLS: Basic Life Support

1.5.5. CDC: Centers for Disease Control and Prevention

1.5.6. CEU: Certified Education Unit

1.5.7. Clinical Privileging: Clinical Privileging is the process by which a practitioner, licensed for independent practice; e.g., without supervision, direction, required sponsor, preceptor, mandatory collaboration, etc.; is permitted by law and the facility to practice independently, to provide specific medical or other patient care services within the scope of the individual’s license, based upon the individual’s clinical competence as determined by peer references, professional experience, health status, education, training and licensure. Clinical privileges must be facility-specific and provider-specific, and within available resources.

1.5.8. CME: Continuing Medical Education

1.5.9. CMS: Centers for Medicare and Medicaid Services

1.5.10. CO: Contracting Officer: The person executing this contract on behalf of the Government with the authority to enter into and administer contracts and make related determinations and findings.

1.5.11. COR: Contracting Officer’s Representative: A person appointed by the CO to take necessary action to ensure the Contractor performs in accordance with and adheres to the specifications contained in the contract and to protect the interest of the Government. The COR shall report to the CO promptly any indication of non-compliance in order that appropriate action can be taken.

1.5.12. COS: Chief of Staff

1.5.13. CPARS: Contractor Performance Assessment Reporting System

1.5.14. Credentialing: Credentialing is the process of obtaining, verifying, and assessing the qualifications of a health care provider to provide care or services in or for the VA health care system. Credentials are documented evidence of licensure, education, training, experience or other qualifications.

1.5.15. DEA: Drug Enforcement Agency

1.5.16. EHR: Electronic Health Record - electronic health record system used by the VA

1.5.17. FSMB: Federation of State Medical Boards

1.5.18. FTE: Full Time Equivalent. VA’s definition for full time-working the equivalent of 80 hours every two weeks, 2080 hours per year. In calculating FTE, any hours not worked on national holidays shall not be included.

1.5.19. HHS: Department of Health and Human Services

1.5.20. HIPAA: Health Insurance Portability and Accountability Act

1.5.21. ISO: Information Security Officer

1.5.22. Key Personnel: The individuals specified in this contract who are essential to work performance.

1.5.23. NPI: National Provider Identifier. NPI is a standard, unique 10-digit numeric identifier required by HIPPA. The Veterans Health Administration must use NPIs in all HIPAA-standard electronic transactions for individual (health care practitioners) and organizational entities (medical centers)

1.5.24. POP: Period of Performance

1.5.25. PPD: Purified Protein Derivative

1.5.26. PWS: Performance Work Statement

1.5.27. QA/QI: Quality Assurance/Quality Improvement

1.5.28. QASP: Quality Assurance Surveillance Plan

1.5.29. QM/PI: Quality Management/Performance Improvement

1.5.30. VETPro: is VHA’s mandatory credentialing software platform to document the credentialing of VHA health care providers. This system facilitates completion of a uniform, accurate, and complete credentials file.

1.5.31. VHA: Veterans’ Health Administration

1.5.32. VISN: Veterans Integrated Services Network

1.5.33. VistA: Veterans Information Systems Technology Architecture

2. QUALIFICATIONS:

2.1. Staff/Facility

2.1.1. License: The Contractor’s physician(s) assigned by the Contractor to perform the services covered by this contract shall have a current license to practice medicine in any State, Territory, or Commonwealth of the United States or the District of Columbia when services are performed onsite on VA property.

All licenses held by the key personnel working on this contract shall be full and unrestricted licenses. Contractor’s physician(s) who have current, full and unrestricted licenses in one or more states, but who have, or ever had, a license restricted, suspended, revoked, prnot be considered for the purposes of this contract.

2.1.2. Board Certification: All Contractor’s Psychiatry physician(s) shall be Board Certified /Board Eligible by the American Board of Psychiatry and Neurology http://www.abpm.org/, and be currently certified in Basic Life Support (BLS) Advanced Cardiac Life Support (ACLS) or equivalency. All continuing education courses required for maintaining certification must be kept up to date at all times. Documentation verifying current certification shall be provided by the Contractor to the VA COR on an annual basis for each year of contract performance.

2.1.3. Credentialing and Privileging: Credentialing and privileging is to be done in accordance with the provisions of VHA Handbook 1100.20 and VHA Directive 1100.21 referenced above. The Contractor is responsible to ensure that proposed physician(s) possesses the requisite credentials enabling the granting of privileges. No services shall be provided by any Contractor’s physician(s) prior to obtaining approval by the Facility Professional Standards Board, Medical Executive Board and Medical Center Director.

2.1.3.1. If a Contractor’s physician(s) is not credentialed and privileged or has credentials/privileges suspended or revoked, the Contractor shall furnish an acceptable substitute without any additional cost to the government.

2.1.3.2. Proposals that do not contain the required licensing/certification at the time of offers due shall automatically be rendered technically unacceptable and will not be eligible for award.

2.1.4. Technical Proficiency: Contractor’s physician(s) shall be technically proficient in the skills necessary to fulfill the government’s requirements, including the ability to speak, understand, read and write English fluently. Contractor shall provide documents upon request of the CO/COR to verify current and ongoing competency, skills, certification and/or licensure related to the provision of care, treatment and/or services performed.

Contractor shall provide verifiable evidence of all educational and training experiences including any gaps in educational history for all Contractor’s physician(s) and Contractor’s physician(s) shall be responsible for abiding by the Facility's Medical Staff By-Laws, rules, and regulations (referenced herein) that govern medical staff behavior.

2.1.5. Continuing Medical Education (CME)/ Certified Education Unit (CEU) Requirements:

Contractor shall provide the COR copies of current CMEs as required or requested by the facility. Contractor’s physician(s) registered or certified by national/medical associations shall continue to meet the minimum standards for CME to remain current. Contractor shall report CME hours to the credentials office for tracking. These documents are required for both privileging and re-privileging. Failure to provide shall result in loss of privileges for Contractor’s physician(s).

2.1.6. Training (ACLS, BLS, EHR and VA MANDATORY): Contractor shall meet all VA educational requirements and mandatory course requirements defined herein; all training must be completed by the contractor’s physician(s) as required by the VA. Other training may become required. VA will communicate any changes to the training requirement to the contractor.

Training (The following training is mandatory per VHACO for Contracted Physicians)

Frequency (once a year, etc)

Annual Hours

ACLS/BLS Annually 1.0 hours

Active Threat Training Annually 1.0 hours

Blood Administration:

Complications

Annually 1.0 hours

EHR N/A N/A

Government Ethics Annually 1.0 hours

Hospice and Pallative Care for VA Clinicians

N/A N/A

Military Sexual Trauma (MST) for Medical Providers

Annually 1.0 hours

Moderate Sedation In- Service Training

Annually 1.0 hours

PACT Act 2022 Toxic Exposure Screening (TES)

Annually 1.0 hours

Patient Abuse Annually 1.0 hours

Patient Rights Annually 1.0 hours

Patient Safety Annually 1.0 hours

Prevention/Management of Disruptive Behavior/Violence Prevention Level I

Annually 1.0 hours

Prevention of Workplace Harassment/No Fear Act

Annually 1.0 hours

Suicide Prevention: Suicide Risk Management Training for Clinicians

Annually 1.0 hours

SUX Infection Control and Blood Borne Pathogens

Annually 0.5 hours

VA Core Values Training (ICARE Recommitment)

Annually 0.5 hours

VA Privacy and Information Security Awareness and Rules of Behavior

Annually 0.5 hours

VHA MRI Safety Training Level 1 Training (all who enter MRI suites)

Annually 0.5 hours

VHA Privacy and HIPAA Focused Training

Annually 0.5 hours

VISTA Imaging Annually 1.0 hours

2.1.7. Standard Infection Control Measures: Contractor shall provide proof of the following tests for physicians within five (5) calendar days after contract award and prior to the first duty shift to the COR and Contracting Officer. Tests shall be current within the past year.

2.1.7.1. TUBERCULOSIS TESTING: Contractor shall provide proof of a negative Tuberculosis Skin Test (TST) or interferon-gamma release assays (IGRA) for all Contractor’s physician(s) upon hire in accordance with CDC guidance. (This is applicable to all health care workers). A negative chest radiographic report for active tuberculosis shall be provided in cases of positive TST or IGRA results.

2.1.7.2. MEASLES, MUMPS, & RUBELLA TESTING: Contractors shall provide proof of immunity for all Contractor physicians {This is applicable to all health care workers}.

2.1.7.3. VARICELLA: Contractors shall provide proof of immunity for all Contractor physicians {This is applicable to all health care workers}.

2.1.7.4. ACELLULAR PERTUSSIS: Contractors shall provide proof of 1 dose of Tdap vaccination for all Contractor physicians {This is applicable to all health care workers}.

2.1.7.5. INFLUENZA: Contractors shall provide proof that all Contractor physicians have received the annual Influenza vaccine unless it is contraindicated. If the Contractor physician has a medical contraindication to the vaccine they shall be required to wear a mask during the Influenza season. {This is applicable to all health care workers}.

2.1.7.6. COVID-19: Pursuant to VHA Directive 1193.01(1), VHA Healthcare Personnel (HCP) are required to be fully vaccinated against COVID-19 subject to such accommodations as required by law (i.e., medical, religious or pregnancy).

2.1.7.7. OSHA REGULATION CONCERNING OCCUPATIONAL EXPOSURE TO

BLOODBORNE PATHOGENS: Contractor shall provide evidence of completing and passing generic self-study blood-borne pathogen training for all Contractor’s physician(s) {This is applicable to all health care workers}; provide their own Hepatitis B vaccination series and hepatitis B surface antigen test results following the hepatitis B vaccination series; maintain an exposure determination and control plan; maintain required records; and ensure that proper follow-up evaluation is provided following an exposure incident.

2.1.7.8. The facility shall notify the Contractor of any significant communicable disease exposures as appropriate. Contractor shall adhere to current CDC/HICPAC Guideline for Infection Control in health care personnel (as published in American Journal for Infection Control- AJIC 1998; 26:289-354 http://www.cdc.gov/hicpac/pdf/InfectControl98.pdf for disease control. Contractor shall provide follow up documentation of clearance to return to the workplace prior to their return.

2.1.8. National Provider Identifier (NPI): NPI is a standard, unique 10-digit numeric identifier required by HIPAA. The Veterans Health Administration must use NPIs in all HIPAA-standard electronic transactions for individual (health care practitioners) and organizational entities (medical facilities). The Contractor shall have or obtain appropriate NPI and if pertinent the Taxonomy Code confirmation notice issued by the Centers for Medicare and Medicaid Services (CMS) National Plan and Provider Enumeration System (NPPES) be provided to the Contracting Officer with the proposal.

2.1.9. DEA: Contractor shall provide copy of current DEA certificate.

2.1.10. Conflict of Interest: The Contractor and all Contractor’s physician(s) are responsible for identifying and communicating to the CO and COR conflicts of interest at the time of proposal and during the entirety of contract performance. At the time of proposal, the Contractor shall provide a statement which describes, in a concise manner, all relevant facts concerning any past, present, or currently planned interest (financial, contractual, organizational, or otherwise) or actual or potential organizational conflicts of interest relating to the services to be provided. The Contractor shall also provide statements containing the same information for any identified consultants or subcontractors who shall provide services. The Contractor must also provide relevant facts that show how it’s organizational and/or management system or other actions would avoid or mitigate any actual or potential organizational conflicts of interest. These statements shall be in response to the VAAR provision 852.209-70 Organizational Conflicts of Interest and fully outlined in response to the subject attachment in Section D of the solicitation document.

2.1.11. Citizenship related Requirements:

2.1.11.1. The Contractor certifies that the Contractor shall comply with all legal provisions contained in the Immigration and Nationality Act of 1952, As Amended; its related laws and regulations that are enforced by Homeland Security, Immigration and Customs Enforcement and the U.S Department of Labor as these may relate to non-immigrant foreign nationals working under contract or subcontract for the Contractor while providing services to Department of Veterans Affairs patient referrals;

2.1.11.2. While performing services for the Department of Veterans Affairs, the Contractor shall not knowingly employ, contract or subcontract with an illegal alien; foreign national non-immigrant who is in violation their status, as a result of their failure to maintain or comply with the terms and conditions of their admission into the United States.

Additionally, the Contractor is required to comply with all “E-Verify” requirements consistent with “Executive Order 12989” and any related pertinent Amendments, as well as applicable Federal Acquisition Regulations.

2.1.11.3. If the Contractor fails to comply with any requirements outlined in the preceding paragraphs or its Agency regulations, the Department of Veterans Affairs may, at its discretion, require that the foreign national who failed to maintain their legal status in the United States or otherwise failed to comply with the requirements of the laws administered by Homeland Security, Immigration and Customs Enforcement and the U.S Department of Labor, shall be prohibited from working at the Contractor’s place of business that services Department of Veterans Affairs patient referrals; or other place where the Contractor provides services to veterans who have been referred by the Department of Veterans Affairs; and shall form the basis for termination of this contract for breach.

2.1.11.4. This certification concerns a matter within the jurisdiction of an agency of the United States and the making of a false, fictitious, or fraudulent certification may render the maker subject to prosecution under 18 U.S.C. 1001.

2.1.11.5. The Contractor agrees to obtain a similar certification from its subcontractors. The certification shall be made as part of the offerors response to the RFP using the subject attachment in Section D of the solicitation document.

2.1.12. Annual Office of Inspector General (OIG) Statement: In accordance with HIPAA and the Balanced Budget Act (BBA) of 1977, the Department of Health and Human Services (HHS) Office of Inspector General (OIG) has established a list of parties and entities excluded from Federal health care programs. Specifically, the listed parties and entities may not receive Federal Health Care program payments due to fraud and/or abuse of the Medicare and Medicaid programs.

2.1.12.1. Therefore, Contractor shall review the HHS OIG List of Excluded Individuals/Entities on the HHS OIG web site at http://oig.hhs.gov/exclusions/index.asp to ensure that the proposed Contractor’s physician(s) are not listed. Contractor should note that any excluded individual or entity that submits a claim for reimbursement to a Federal health care program, or causes such a claim to be submitted, may be subject to a Civil Monetary Penalty (CMP) for each item or service furnished during a period that the person was excluded and may also be subject to treble damages for the amount claimed for each item or service. CMP’s may also be imposed against the Contractor that employ or enter into contracts with excluded individuals to provide items or services to Federal program beneficiaries.

2.1.12.2. By submitting their proposal, the Contractor certifies that the HHS OIG List of Excluded Individuals/Entities has been reviewed and that the Contractors are and/or firm is not listed as of the date the offer/bid was signed.

2.2. Clinical/Professional Performance: The qualifications of Contractor personnel are subject to review by VA Medical Center COS or his/her clinical designee and approval by the Medical Facility Director as provided in VHA Handbook 1100.20 and VHA Directive 1100.21.

Clinical/Professional performance monitoring and review of all clinical personnel covered by this contract for quality purposes will be provided by the facility COS and/or the Chief of the Service or his designee. A clinical COR may be appointed, however, only the CO is authorized to consider any contract modification request and/or make changes to the contract during the administration of the resultant contract.

2.3. Non Personal Healthcare Services: The parties agree that the Contractor and all Contractor’s physician(s) shall not be considered VA employees for any purpose.

2.4. Indemnification: The Contractor shall be liable for, and shall indemnify and hold harmless the Government against, all actions or claims for loss of or damage to property or the injury or death of persons, arising out of or resulting from the fault, negligence, or act or omission of the Contractor, its agents, or employees.

2.5. Prohibition Against Self-Referral: Contractor’s physicians are prohibited from referring VA patients to contractor’s or their own practice(s)

2.6. Inherent Government Functions: Contractor and Contractor’s physician(s) shall not perform inherently governmental functions. This includes, but is not limited to, determination of agency policy, determination of Federal program priorities for budget requests, direction and control of government employees (outside a clinical context), selection or non-selection of individuals for Federal Government employment including the interviewing of individuals for employment, approval of position descriptions and performance standards for Federal employees, approving any contractual documents, approval of Federal licensing actions and inspections, and/or determination of budget policy, guidance, and strategy.

2.7. No Employee status: The Contractor shall be responsible for protecting Contractor’s physician(s) furnishing services. To carry out this responsibility, the Contractor shall provide or certify that the following is provided for all their staff providing services under the resultant contract:

2.7.1. Workers’ compensation

2.7.2. Professional liability insurance

2.7.3. Health examinations

2.7.4. Income tax withholding, and

2.7.5. Social security payments.

2.8. Tort Liability: The Federal Tort Claims Act does not cover Contractor or Contractor’s physician(s). When a Contractor or Contractor’s physician(s) has been identified as a provider in a tort claim, the Contractor shall be responsible for notifying their legal counsel and/or insurance carrier. Any settlement or judgment arising from a Contractor’s (or Contractor’s physician(s)) action or non-action shall be the responsibility of the Contractor and/or insurance carrier.

2.9. Key Personnel:

2.9.1. The VA Full Time Equivalency (FTE) for the services required is 5657.5 hours = 2.72, 920 Saturday/Sunday/Holiday =.44 for a total of 3.16 FTE. FTE is defined by VA as a minimum of 80 hours every two weeks and does not include holidays. Additional FTE is needed to provide virtual consultation Monday-Sunday 4:00pm-8:00am local time shifts (.44).

2.9.2. The minimum number of Board Certified /Board Eligible Psychiatry physicians required to be on site daily is one (1) to be on site at the same time as defined in paragraph Hours of Operation in this section.

2.9.3. The Contractor shall be responsible for providing coverage to the VA during periods of vacancies of the Contractor’s personnel due to sick leave, personal leave, vacations and additional coverage as required. In the event a scheduled physician is unable to complete an assigned shift, the contractor shall provide replacement physician coverage within 2 hours and notify the Contracting Office Representative (COR) immediately of the schedule change.

2.9.4. Personnel Substitutions: During the first ninety (90) calendar days of performance, the Contractor shall make NO substitutions of key personnel unless the substitution is necessitated by illness, death or termination of employment. The Contractor shall notify the CO, in writing, within 15 calendar day(s) after the occurrence of any of these events and provide the information required below. After 90 days, the Contractor shall submit the information required below to the CO at least 15 calendar days prior to making any permanent substitutions.

2.9.4.1. The Contractor shall provide a detailed explanation of the circumstances necessitating the proposed substitutions, complete resumes for the proposed substitutes, and any additional information requested by the CO. Proposed substitutes shall have comparable qualifications to those of the persons being replaced. The CO will notify the Contractor within 15 calendar days after receipt of all required information of the decision on the proposed substitutes. The contract will be modified to reflect any approved changes of key personnel.

2.9.4.2. For temporary substitutions where the key person shall not be reporting to work for 15 consecutive work days or more, the Contractor shall provide a qualified replacement for the key person. The substitute shall have comparable qualifications to the key person. Any period exceeding two weeks will require the procedure as stated above.

2.9.4.3. The Government reserves the right to refuse acceptance of any Contractor personnel at any time after performance begins, if personal or professional conduct jeopardizes patient care or interferes with the regular and ordinary operation of the facility.

Breaches of conduct include intoxication or debilitation resulting from drug use, theft, patient abuse, dereliction or negligence in performing directed tasks, or other conduct resulting in formal complaints by patient or other staff members to designated Government representatives. Standards for conduct shall mirror those prescribed by current federal personnel regulations. Should the VA COS or designee show documented clinical problems or continual unprofessional behavior/actions with any Contractor’s physician(s), s/he may request, without cause, immediate replacement of said Contractor’s physician(s). The CO and COR shall deal with issues raised concerning Contractor’s physician(s) conduct. The final arbiter on questions of acceptability is the CO.

2.9.4.4. Contingency Plan: Because continuity of care is an essential part of the Facility’s medical services, The Contractor shall have a contingency plan in place to be utilized if the Contractor’s physician(s) leaves Contractor’s employment or is unable to continue performance in accordance with the terms and conditions of the resulting contract.

3. VA HOURS OF OPERATION/SCHEDULING

3.1. VA Business Hours: Local Time: Services are required every Saturday, Sunday, and all Federal Holidays from 8:00am to 4:30pm. Normal VA Business Hours are Monday – Friday 8:00am – 4:30pm.

Virtual Schedule: Services are also required for virtual consultation for psychiatric needs with the entire facility and emergency department Mon-Fri from 4:00pm-8:00am local time.

Onsite Work Schedule: 8:00am to 4:30pm. Saturday, Sunday and all Federal Holidays.

Virtual on call work schedule: Mon-Fri 4pm to 8:00am, weekends and Federal Holidays 4:30pm- 8:00am local time.

3.1.1. Patients must be seen by a Contractor’s physician(s) on-site at the facility in a timely manner in accordance with VA Rules and Regulations on clinic wait times and consult completion. Contractor shall notify the COR at least monthly about any obstacles to meeting this performance measure.

3.1.2. Contract Physicians shall be available and present in Acute Psych for inpatient rounds and consults (Saturday and Sunday) to include other mental health consults within the facility, which will be established, and may be revised, as deemed appropriate for patient care by the Chief of Mental Health and the Chief of Staff.

3.1.3. Off-hours Coverage: Off-hours coverage will be virtual on call Monday-Sunday evening/night.

3.1.3.1. On-call providers mut be available within 15 minutes by phone and on-site, within 60 minutes.

3.2. Federal Holidays: The following holidays are observed by the Department of Veterans Affairs:

New Year’s Day

President’s Day

Martin Luther King’s Birthday

Memorial Day

Juneteenth

Independence Day

Labor Day

Columbus Day

Veterans Day

Thanksgiving

Christmas

Any day specifically declared to be a national holiday.

3.3. Cancellations: In the event of a last-minute cancellation, the Contractor shall notify the Administrative Officer for Mental Health Services of cancellation by phone as soon as possible.

4. CONTRACTOR RESPONSIBILITIES

4.1. Clinical Personnel Required: The Contractor shall provide Contractor’s physician(s) who are competent, qualified per this performance work statement and adequately trained to perform assigned duties.

4.1.1. Contractor’s physician(s) shall be responsible for signing in and out when in attendance.

Time sheets will be used by the COR to confirm hours/day and services provided against the contractor’s invoices.

4.2. Standards of Care: The Contractor’s physician(s)’ care shall cover the range of psychiatry services as would be provided in a state-of-the-art civilian medical treatment facility and the standard of care shall be of a quality, meeting or exceeding currently recognized national standards as established by:

4.2.1. The American Board of Psychiatry and Neurology (ABPN): https://www.abpn.org .

4.2.2. The professional standards of the Joint Commission (TJC):

http://www.jointcommission.org/standards_information/hap_requirements.aspx

4.2.3. The standards of the American Hospital Association (AHA):

http://www.hpoe.org/resources?show=100&type=8 and;

4.2.4. The requirements contained in this PWS

4.3. Medical Records

4.3.1. Authorities: Contractor’s physician(s) providing healthcare services to VA patients shall be considered as part of the Department Healthcare Activity and shall comply with the 5 U.S.C.552a (Privacy Act), 38 U.S.C. 5701 (Confidentiality of claimants records), 5 U.S.C.

552 (FOIA), 38 U.S.C. 5705 (Confidentiality of Medical Quality Assurance Records) 38 U.S.C. 7332 (Confidentiality of certain medical records), Title 5 U.S.C. § 522a (Records Maintained on Individuals) as well as 45 C.F.R. Parts 160, 162, and 164 (HIPAA).

4.3.2. HIPAA: This contract and its requirements meet exception in 45 CFR 164.502(e), and do not require a BAA in order for Covered Entity to disclose Protected Health Information to: a health care provider for treatment of VA patients. Based on this exception, a BAA is not required for this contract. Health records generated by this contract or provided to the Contractors by the VA are covered by the VA Privacy Act system of records entitled ‘Patient Medical Records-VA’ (24VA10A7). Contractor generated VA Patient records are the property of the VA and shall not be accessed, released, transferred, or destroyed except in accordance with applicable laws and regulations. Contractor shall ensure that all records pertaining to medical care and services provided to VA patients are captured in the VA electronic health record system as required by VA policy as discussed in 4.4.4.

4.3.3. Disclosure: Contractor’s physician(s) may have access to patient medical records for the purpose of providing medical care and services to VA patients and performing services under the contract; however, Contractor shall obtain permission from the VA before disclosing any patient information outside VA. VA authorizes the Contractor to discuss patient health information for coordination of care with community health care providers in compliance with VA regulations, HIPAA and VHA Directive 1605.01, Privacy and Release of Information. The VA will provide the Contractor with a copy of VHA Directive 1907.01, Health Information Management and Health Records and VHA Directive 1605.1, Privacy and Release of Information. The penalties and liabilities for the unauthorized disclosure of VA patient information mandated by the statutes and regulations mentioned above, apply to the Contractor.

4.3.4. Professional Standards for Documenting Care: Care shall be appropriately documented in medical records in accordance with standard commercial practice and guidelines established by VHA Directive 1907.01 Health Information Management and Health Records and all guidelines provided by the facility.

4.3.5. Release of Information: The VA shall maintain control of releasing any copies of patient health information or health records and will follow policies and standards as defined, but not limited to Privacy Act requirements. Contractor will not release or disclose copies of records and will refer all such requests to the Release of Information Department at the VA facility were assigned.

4.3.6. Management for Medical Records: National Archives and Records Administration record disposition requirements are found in RCS 10-1 Chapter 6, 6000 series.

4.4. Direct Patient Care: estimated 100% of the time involved in direct patient care. Contractor shall be responsible for:

4.5. Scope of Care: Contractor’s physician(s) shall be responsible for: providing Psychiatry care, including, but not limited to: Physical Assessment, Psychiatric Evaluations and Mental Status Exams, Psychotherapy, Pharmacotherapy, Consultation, Clinical Supervision, General Medical Condition Care, Group Psychotherapy, Behavior Therapy, Family Therapy, Treatment Team meetings, Discharge Planning, referring patients to specialty care, histories and physicals, order prescriptions, labs, x-rays, and other pertinent tests, completes documentation requirements in a timely manner as per policy, completion of consults on other inpatient locations at the facility, and occasionally evaluates outpatients for medication during weekend clinic hours.

4.5.1. Inpatient Care: All psychiatrists will be required to work in collaboration with Mental Health staff who are part-time or full time salaried by the VA for inpatient care duties including but not limited to:

4.5.1.1. Operating and collaborating physician’s patients

4.5.1.2. Seeing 1C/1D Psychiatry Service - Ward Patients.

4.5.1.3. Admitting

4.5.1.4. Diagnosis of patients

4.5.1.5.…