36C25024Q0346 - RFQ - Radiation Oncology Physician Services.pdf

COMBINED SYNOPSIS/SOLICITATION NOTICE

SUBJECT: Radiation Oncology Physician Services

GENERAL INFORMATION

CONTRACTING OFFICE’S ZIP CODE:

SOLICITATION NUMBER:

RESPONSE DATE/TIME/ZONE:

ARCHIVE:

RECOVERY ACT FUNDS:

SET-ASIDE:

PRODUCT SERVICE CODE:

NAICS CODE:

PLACE OF PERFORMANCE

CONTRACTING OFFICE ADDRESS:

POINT OF CONTACT:

45409 36C25024Q0346

11/1/2024; 14:00 EST

15 days after the response date N No Q522 621111 Dayton VA Medical Center in Dayton, OH Department of Veterans Affairs Network Contracting Office (NCO) 10 3140 Governor’s Place Blvd., Suite 210 Kettering OH, 45409-1337

Jennifer Bowden, Contract Specialist jennifer.bowden@va.gov

DESCRIPTION

This is a combined synopsis/solicitation for commercial items prepared in accordance with the format in

Subpart 12.6, as supplemented with additional information included in this notice. This announcement constitutes the only solicitation; quotes are being requested & a written solicitation will not be issued.

Solicitation number 36C25024Q0346 is hereby issued as a Request for Quote (RFQ). This document incorporates provisions & clauses that are in effect through Federal Acquisition Circular 2024-07 effective

August 29, 2024.

The associated NAICS Code for this combined synopsis/solicitation is 621111. The LINS associated with this

Combined Synopsis/Solicitation are contained within the attached SF1449. For extended descriptions, characteristics, & minimum needs please refer to the attached.

The estimated period of performance is Dec 2, 2024 – Dec 1, 2029, with five (5), 12-month ordering periods.

Place of Performance will be at the Dayton VA Medical Center.

The FAR Provision 52.212-1, Instructions to Offerors – Commercial, FAR Clause 52.212-4, Contract Terms &

Conditions -- Commercial Items, & FAR Clause 52.212-5, Contract Terms & Conditions Required to Implement

Statutes or Executive Orders -- Commercial Items, apply to this acquisition. Please see below for additional applicable terms & conditions which govern this action.

Vendors shall submit their responses by the date/time advertised in block 8 of the SF1449.

Quotes & questions shall only be accepted via email to the Contract Specialist at jennifer.bowden@va.gov.

mailto:jennifer.bowden@va.gov

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 ST&ARD:

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 & 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 &/or Attach Additional Sheets as Necessary)

25. ACCOUNTING & 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 & 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 & RETURN _______________ 29. AWARD OF CONTRACT: REF. ___________________________________ OFFER

COPIES TO ISSUING OFFICE. CONTRACTOR AGREES TO FURNISH & DATED ________________________________. YOUR OFFER ON SOLICITATION

DELIVER ALL ITEMS SET FORTH OR OTHERWISE IDENTIFIED ABOVE & ON ANY (BLOCK 5), INCLUDING ANY ADDITIONS OR CHANGES WHICH ARE

ADDITIONAL SHEETS SUBJECT TO THE TERMS & 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 & 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:

ST&ARD FORM 1449

SOLICITATION/CONTRACT/ORDER FOR COMMERCIAL PRODUCTS & COMMERCIAL SERVICES

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

36C25024Q0346 10-11-2024

Jennifer Bowden jennifer.bowden@va.gov 937-268-6511 x3041 10-28-2024

10:00 AM EDT

36C250

Department of Veterans Affairs

Network Contracting Office (NCO) 10

3140 Governor’s Place Blvd., Suite 210

Kettering OH 45409

X

621111

$16 Million

N/A

X

36C506

Department of Veterans Affair

Dayton VA Medical Center

Radiation Oncology Service

4100 W Third St.

Dayton OH 45428

36C250

Department of Veterans Affairs

Network Contracting Office (NCO) 10

3140 Governor’s Place Blvd., Suite 210

Kettering OH 45409

36C250

Department of Veterans Affairs

Financial Services Center

Invoices to be Submitted Electronically www.ob10.com/us/en/veterans-affairs// e-Invoice Setup Info Phone 877-489-6135 TX 78714-9971

877-353-9791 512-460-5540

X

See CONTINUATION Page

Contractor shall provide a quote for: Onsite Radiation Oncology

Services for the Dayton VA Healthcare System in Dayton, OH in accordance with the Performance Work Statement (PWS) and

Schedule of Services.

$0.00

See CONTINUATION Page

X X

X 1(one)

Br&i Holl&

CONTACTING OFFICER

Table of Contents

SECTION A

A.1 SF 1449 SOLICITATION/CONTRACT/ORDER FOR COMMERCIAL PRODUCTS & COMMERCIAL SERVICES

SECTION B - CONTINUATION OF SF 1449 BLOCKS

B.1 CONTRACT ADMINISTRATION DATA

B.2 SCHEDULE OF SERVICES

B.3 PERFORMANCE WORK STATEMENT (PWS) - Radiation Oncology Physician Services

SECTION C - CONTRACT CLAUSES

C.1 FAR 52.212-4 CONTRACT TERMS & CONDITIONS—COMMERCIAL PRODUCTS & COMMERCIAL SERVICES (NOV

2023)

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

C.3 FAR 52.204-9 PERSONAL IDENTITY VERIFICATION OF CONTRACTOR PERSONNEL (JAN 2011)

C.4 FAR 52.216-18 ORDERING (AUG 2020)

C.5 FAR 52.216-22 INDEFINITE QUANTITY (OCT 1995)

C.6 FAR 52.217-8 OPTION TO EXTEND SERVICES (NOV 1999)

C.7 FAR 52.232-19 AVAILABILITY OF FUNDS FOR THE NEXT FISCAL YEAR (APR 1984)

C.8 VAAR 852.201-70 CONTRACTING OFFICER'S REPRESENTATIVE (DEC 2022)

C.9 VAAR 852.203-70 COMMERCIAL ADVERTISING (MAY 2018)

C.10 VAAR 852.211-76 LIQUIDATED DAMAGES – REIMBURSEMENT FOR DATA BREACH COSTS (FEB 2023)

ALTERNATE I (FEB 2023)

C.11 VAAR 852.215-71 EVALUATION FACTOR COMMITMENTS (OCT 2019)

C.12 VAAR 852.232-72 ELECTRONIC SUBMISSION OF PAYMENT REQUESTS (NOV 2018)

C.13 VAAR 852.237-70 INDEMNIFICATION & MEDICAL LIABILITY INSURANCE (OCT 2019)

C.14 VAAR 852.237-74 NON-DISCRIMINATION IN SERVICE DELIVERY (OCT 2019)

C.15 VAAR 852.237-75 KEY PERSONNEL (OCT 2019)

C.16 VAAR 852.242-71 ADMINISTRATIVE CONTRACTING OFFICER (OCT 2020)

C.17 SUPPLEMENTAL INSURANCE REQUIREMENTS

SECTION D - CONTRACT DOCUMENTS, EXHIBITS, OR ATTACHMENTS

SECTION E - SOLICITATION PROVISIONS

E.1 FAR 52.212-1 INSTRUCTIONS TO OFFERORS—COMMERCIAL PRODUCTS & COMMERCIAL SERVICES (SEP 2023) . 49

E.2 FAR 52.252-1 SOLICITATION PROVISIONS INCORPORATED BY REFERENCE (FEB 1998)

E.3 FAR 52.209-7 INFORMATION REGARDING RESPONSIBILITY MATTERS (OCT 2018)

E.4 FAR 52.212-2 EVALUATION—COMMERCIAL PRODUCTS & COMMERCIAL SERVICES (NOV 2021)

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

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

E.7 VAAR 852.233-70 PROTEST CONTENT/ALTERNATIVE DISPUTE RESOLUTION (OCT 2018)

E.8 VAAR 852.233-71 ALTERNATE PROTEST PROCEDURE (OCT 2018)

E.9 FAR 52.212-3 OFFEROR REPRESENTATIONS & CERTIFICATIONS—COMMERCIAL PRODUCTS & 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:

b. GOVERNMENT: Department of Veterans Affairs | Network Contracting Office (NCO) 10

3140 Governor’s Place Blvd., Suite 210 | Kettering, OH 45409-1337

Jennifer Bowden, CS | 937-268-6511 x3041 | jennifer.bowden@va.gov

Brandi Holland, CO | brandi.holland2@va.gov

2. CONTRACTOR REMITTANCE ADDRESS: All payments by the Government to the contractor will be made in accordance with 52.232-33, Payment by Electronic Funds Transfer—System for Award Management

3. INVOICES: Invoices shall be submitted in arrears MONTHLY.

4. GOVERNMENT INVOICE ADDRESS: All Invoices from the contractor shall be submitted electronically in accordance with VAAR Clause 852.232-72 Electronic Submission of Payment Requests.

5. ACKNOWLEDGMENT OF AMENDMENTS: The offeror acknowledges receipt of amendments to the

Solicitation numbered & dated as follows:

AMENDMENT NO DATE

mailto:brandi.holland2@va.gov

B.2 SCHEDULE OF SERVICES

The contractor shall furnish all key personnel to provide services necessary to perform onsite Radiation

Oncology Physician Support Services at the Dayton VA Medical Center in Dayton, OH.

The contractor is instructed to edit the number of Sub-Line Items (SLIN) to correspond with the number of key personnel submitted for the line-item number (LIN). Affiliate Offerors shall include the “title” of the personnel submitted. Other commercial health care Offerors shall identify by title/position or level of experience the key personnel submitted. Also, renumber SLINs if adding or removing Key Personnel.

The Contractor shall propose key personnel to be credentialed & be available for scheduling to meet the requirements of the contract.

ORDERING PERIOD 1: Dec 2, 2024 to Dec 1, 2025

LIN SLIN DESCRIPTION

EST

QTY

UNIT

UNIT

COST

TOTAL EST

COST

1001 Board Certified Radiation Oncology Physician Services (inclusive of on-call)

2707.5 HRS

DO NOT

PRICE

DO NOT PRICE

KEY PERSONNEL

1001a

NAME:

TITLE:

HRS

1001b

NAME:

TITLE:

HRS

1001c

NAME:

TITLE:

HRS

OP 1

TOTAL

ORDERING PERIOD 2: Dec 2, 2025 to Dec 1, 2026

LIN SLIN DESCRIPTION

EST

QTY

UNIT

UNIT

COST

TOTAL EST

COST

2001 Board Certified Radiation Oncology Physician Services (inclusive of on-call)

2707.5 HRS

DO NOT

PRICE

DO NOT PRICE

KEY PERSONNEL

2001a

NAME:

TITLE:

HRS

2001b

NAME:

TITLE:

HRS

2001c

NAME:

OP 2

ORDERING PERIOD 3: Dec 2, 2026 to Dec 1, 2027

LIN SLIN DESCRIPTION

EST

QTY

UNIT

UNIT

COST

TOTAL EST

COST

3001 Board Certified Radiation Oncology Physician Services (inclusive of on-call)

2707.5 HRS

DO NOT

PRICE

DO NOT PRICE

KEY PERSONNEL

3001a

NAME:

TITLE:

HRS

3001b

NAME:

TITLE:

HRS

3001c

NAME:

OP 3

ORDERING PERIOD 4: Dec 2, 2027 to Dec 1, 2028

EST

QTY

UNIT

UNIT

COST

TOTAL EST

COST

4001 Board Certified Radiation Oncology Physician Services (inclusive of on-call)

2707.5 HRS

DO NOT

PRICE

DO NOT PRICE

KEY PERSONNEL

4001a

NAME:

TITLE:

HRS

4001b

NAME:

TITLE:

HRS

4001c

NAME:

OP 4

ORDERING PERIOD 5: Dec 2, 2028 to Dec 1, 2029

EST

QTY

UNIT

UNIT

COST

TOTAL EST

COST

5001 Board Certified Radiation Oncology Physician Services (inclusive of on-call)

2707.5 HRS

DO NOT

PRICE

DO NOT PRICE

KEY PERSONNEL

5001a

NAME:

TITLE:

HRS

5001b

NAME:

TITLE:

HRS

5001c

NAME:

OP 5

B.3 PERFORMANCE WORK STATEMENT (PWS) - Radiation Oncology Physician Services

1. GENERAL

1.1. SERVICES REQUIRED

1.1.1. The VA Radiation Oncology Services are accredited by a nationally recognized accrediting body contracted through NROP. As such any Contractor providing on-site radiation oncology services must adhere to Guidelines & Technical Standards for Radiation

Oncology promulgated by the American College of Radiology, American Society for

Radiation Oncology & American Association for Physicist in Medicine: A contractor providing on-site radiation oncology services must provide evidence the radiation oncology practice meets or exceeds the established clinical practice guidelines & standards.

1.2. PLACE OF PERFORMANCE

1.2.1. Dayton VA Medical Center | Radiation Oncology (114A) | 4400 W 3rd, Dayton, OH 45428

1.3. PERIOD OF PERFORMANCE:

1.3.1. Dec 2, 2024 – Dec 1, 2029, with five (5), 12-month ordering periods

1.4. AUTHORITY

1.4.1. FAR Parts 12, 13 & Title 38 USC 513 General Contracting Authority

1.5. POLICY/DIRECTIVES/H&BOOKS: 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.

1.5.1. VA Directive 1663: Health Care Resources (HCR) Contracting – Buying Title 38 U.S.C. 8153

1.5.2. VHA Directive 1003.04: VHA Patient Advocacy

1.5.3. VHA Directive 1065: Productivity & Staffing Guidance for Specialty Provider Group

Practice

1.5.4. VHA Directive 1088(1): Communicating Test Results to Providers & Patients

1.5.5. VHA Directive 1100.18: Reporting & Responding to State Licensing Boards

1.5.6. VHA Directive 1100.20: Credentialing of Health Care Providers

1.5.7. VHA Directive 1100.21: Privileging

1.5.8. VHA Directive 1192.01: Seasonal Influenza Vaccination Program for VHA Health Care

Personnel

1.5.9. VHA Directive 1220(1): Facility Procedure Complexity Designation Requirements to

Perform Invasive Procedures in Any Clinical Setting

1.5.10. VHA Directive 1605.01: Privacy & Release of Information

1.5.11. VHA Directive 1907.01: VHA Health Information Management & Health Records

1.5.12. VHA Handbook 1100.17: National Practitioner Data Bank (NPDB) Reports https://www.va.gov/vapubs/ https://www.va.gov/vhapublications/index.cfm

1.5.13. VHA Directive 1156 Accreditation of VHA Radiation Oncology Services/Sections

1.5.14. VHA Directive 1414 Stereotactic Body Radiotherapy

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

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

1.5.16. US Nuclear Regulatory Commission for management & use of radioactive materials for medical use & radiation safety requirements, to include (but not limited to) 10 CFR Parts

19, 20, 30, 33, 35, & 71: http://www.nrc.gov/reading-rm.html

1.6. ACRONYMS/DEFINITIONS

1.6.1. AAPM: American Association of Physics in Medicine

1.6.2. ACGME: Accreditation Council for Graduate Medical Education

1.6.3. ABR: American Board of Radiology

1.6.4. ACR: American College of Radiology www.acr.org/

1.6.5. ACO: Administrative Contracting Officer

1.6.6. ALARA: As Low as Reasonably Achievable (least & lowest radiation exposure possible)

1.6.7. AOA: American Osteopathic Association

1.6.8. ARRT(T): American Registry of Radiologic Technologists (T) in Radiation Therapy

1.6.9. ASTRO/APEx: American Society for Radiation Oncology/Accreditation Program for

Excellence® https://www.astro.org/Daily-Practice/Accreditation

1.6.10. BAA: Business Associate Agreement

1.6.11. CAMPEP: Commission on Accreditation of Medical Physics Educational Programs http://www.campep.org/default.asp

1.6.12. CDC: Centers for Disease Control & Prevention

1.6.13. CEU: Certified Education Unit

1.6.14. Clinical Privileging: Clinical Privileging is the process by which a practitioner, licensed for independent practice. They are facility-specific, provider-specific, & within available resources.

1.6.15. CMS: Centers for Medicare & Medicaid Services

1.6.16. CO: Contracting Officer

1.6.17. COR: Contracting Officer’s Representative

1.6.18. COS: Chief of Staff

1.6.19. CPARS: Contractor Performance Assessment Reporting System

1.6.20. CPRS: Computerized Patient Recordkeeping System

1.6.21. Credentialing: Credentialing is the process of obtaining, verifying, & assessing the qualifications of a health care provider to provide care or services in or for the VA health http://www.justice.gov/oip/foia_updates/Vol_XVII_4/page2.htm http://www.nrc.gov/reading-rm.html http://www.acr.org/ https://www.astro.org/Daily-Practice/Accreditation http://www.campep.org/default.asp care system. Credentials are documented evidence of licensure, education, training, experience, or other qualifications.

1.6.22. CS: Contract Specialist

1.6.23. DEA: Drug Enforcement Agency

1.6.24. EHR: Electronic Health Record – electronic health record system used by the VA

1.6.25. FSMB: Federation of State Medical Boards

1.6.26. Full Time Equivalent (FTE): 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.

1.6.27. HHS: Department of Health & Human Services

1.6.28. HICPAC: Healthcare Infection Control Practices Advisory Committee

1.6.29. HIPAA: Health Insurance Portability & Accountability Act

1.6.30. IGRT: Image Guided Radiation Therapy

1.6.31. IMRT: Intensity Modulated Radiation Therapy

1.6.32. IROC: Imaging & Radiation Oncology Core

1.6.33. ISO: Information Security Officer

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

1.6.35. MU: Monitor Unit

1.6.36. NHPP: National Health Physics Program http://www.patientcare.va.gov/NHPP.asp

1.6.37. NPI: National Provider Identifier

1.6.38. NROP: National Radiation Oncology Program

1.6.39. NRSC: National Radiation Safety Committee

1.6.40. POP: Period of Performance

1.6.41. PPD: Purified Protein Derivative

1.6.42. PWS: Performance Work Statement

1.6.43. QASP: Quality Assurance Surveillance Plan

1.6.44. QMP: Quality Management Program

1.6.45. SPE: Senior Procurement Executive

1.6.46. SRS: Stereotactic Radio Surgery

1.6.47. SBRT: Stereotactic Body Radiotherapy

1.6.48. TJC: The Joint Commission

1.6.49. TLD: Thermoluminescent Dosimeter- a device that measures radiation dose http://www.patientcare.va.gov/NHPP.asp

1.6.50. VA: Department of Veterans Affairs

1.6.51. 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, & complete credentials file.

1.6.52. VHA: Veterans Health Administration

1.6.53. VISN: Veterans Integrated Services Network

1.6.54. VistA: Veterans Information Systems Technology Architecture

2. QUALIFICATIONS

2.1. License: Contract 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.

2.1.1. All licenses held by the key personnel working on this contract shall be full & unrestricted licenses. Contract physician(s) who have current, full & unrestricted licenses in one or more states, but who have, or ever had, a license restricted, suspended, revoked, voluntarily revoked, voluntarily surrendered pending action, or denied upon application will not be considered for the purposes of this contract.

2.2. Board Certification: All contract physician(s) shall be board certified. All continuing education courses required for maintaining certification must be always kept up to date. Documentation verifying current certification shall be provided by the Contractor to the VA COR on an annual basis for each year of contract performance.

2.2.1. Radiation Oncology Physician: The Contractor shall provide American Board of Radiology

(ABR) certified physicians in Radiation Oncology & contract physicians shall maintain certification throughout the period of performance. If Contractor’s Radiation Oncology

Physician(s) is/are not directly employed by the treating facility, documentation must be provided to ensure adequate certification.

2.3. Credentialing & Privileging: Credentialing & privileging is to be done in accordance with the provisions of VHA Directive 1100.20 & 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 contract physician(s) prior to obtaining approval by the Facility Medical Executive Board & Medical Center Director.

2.3.1. If a contract physician(s) &/or other contract provider(s) are not credentialed & privileged or have credentials/privileges suspended or revoked, the Contractor shall furnish an acceptable substitute without any additional cost to the government.

2.4. Technical Proficiency: Contract physician(s) shall be technically proficient in the skills necessary to fulfill the government’s requirements, including the ability to speak, understand, read, & write

English fluently. Contractor shall provide documents upon request of the CO/COR to verify current & ongoing competency, skills, certification &/or licensure related to the provision of care, treatment &/or services performed. Contractor’s physicians & other contract provider (s) shall have knowledge of professional care theories, principles, practices, & procedures to serve radiation oncology patient population. Contractor’s physician & other contract provider (s) shall demonstrate knowledge of growth & development, & pathophysiology of disease processes specific radiation oncology patient population. Contractor shall provide verifiable evidence of all educational & training experiences including any gaps in educational history for all contract physician(s) & other contract provider (s) shall be responsible for abiding by the Facility's Medical

Staff By-Laws, rules, & regulations (referenced herein) that govern medical staff behavior.

2.5. Continuing CME Requirements: Contractor shall provide the COR copies of current CMEs as required or requested by the VAMC. Contractors registered or certified by national/medical associations shall continue to meet the minimum standards for CME to remain current. CME hours shall be reported to the credential’s office for tracking. These documents are required for initial & renewal privileging. Failure to provide shall result in loss of privileges.

2.6. Training: Contractor shall meet all VA educational requirements & 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 (mandatory per VHACO for Contracted Physicians) Frequency Annual Hours

BLS Quarterly 4.0

Active Threat Training Once 1.0

EHR-Cerner Annually

(Potentially) 24.0

Government Ethics Annually 1.0

Hospice & Palliative Care for VA Clinicians Annually 1.0

Military Sexual Trauma (MST) for Medical Providers Annually 1.0

Moderate Sedation In-Service Training Once 1.0

Patient Abuse Annually 0.5

Patient Rights Annually 0.5

Patient Safety Annually 0.5

Prevention/Management of Disruptive Behavior/Violence Prevention Level I

Annually 2.0

Prevention of Workplace Harassment/No Fear Act Annually 1.0

Suicide Prevention: Suicide Risk Management Training for Clinicians

Annually 0.5

SUX Infection Control & Blood Borne Pathogens Annually 0.5

VA Core Values Training (ICARE Recommitment) Once 1.0

VA Privacy & Information Security Awareness & Rules of Behavior

Annually 1.0

VHA Privacy & HIPAA Focused Training Annually 1.0

VISTA Imaging Once 2.0

2.7. Standard Infection Control Measures (PDP, Immunizations, Etc.): Contractor shall provide proof of the following for physicians within five (5) calendar days after contract award & prior to the first duty shift to the COR & CO/CS. Tests shall be current within the past year.

2.7.1. 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 (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.

2.7.2. MEASLES, MUMPS, & RUBELLA TESTING: Contractors shall provide proof of immunity for all Contractor physicians (applicable to all health care workers).

2.7.3. VARICELLA: Contractors shall provide proof of immunity for all Contractor physicians

(applicable to all health care workers).

2.7.4. ACELLULAR PERTUSSIS: Contractors shall provide proof of 1 dose of Tdap vaccination for all Contractor physicians (applicable to all health care workers).

2.7.5. 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. (applicable to all health care workers).

2.7.6. OSHA REGULATION CONCERNING OCCUPATIONAL EXPOSURE TO BLOODBORNE

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

2.7.6.1. 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.

2.8. Citizenship related Requirements:

2.8.1. The Contractor certifies that the Contractor shall comply with any & all legal provisions contained in the Immigration & Nationality Act of 1952, As Amended; its related laws & regulations that are enforced by Homeland Security, Immigration & Customs

Enforcement & 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.

2.8.2. 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 & 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” & any related pertinent Amendments, as well as applicable

Federal Acquisition Regulations.

http://www.cdc.gov/hicpac/pdf/InfectControl98.pdf

2.8.3. 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 & Customs Enforcement & 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; & shall form the basis for termination of this contract for breach.

2.8.4. This certification concerns a matter within the jurisdiction of an agency of the United

States & the making of a false, fictitious, or fraudulent certification may render the maker subject to prosecution under 18 U.S.C. 1001.

2.8.5. 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.

2.9. Annual Office of Inspector General (OIG) Statement: In accordance with HIPAA & the Balanced

Budget Act (BBA) of 1977, the Department of Health & Human Services (HHS) Office of Inspector

General (OIG) has established a list of parties & entities excluded from Federal health care programs. Specifically, the listed parties & entities may not receive Federal Health Care program payments due to fraud &/or abuse of the Medicare & Medicaid programs.

2.9.1. 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 contract physician(s) is 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 & 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 contracts with excluded individuals to provide items or services to Federal program beneficiaries.

2.9.2. By submitting their proposal, the Contractor certifies that the HHS OIG List of Excluded

Individuals/Entities has been reviewed & that the Contractors are &/or firm is not listed as of the date the offer/bid was signed.

2.10. Clinical/Professional Direction: The qualifications of Contractor personnel are subject to review by VA Medical Center COS or his/her clinical designee & approval by the Medical Center Director as provided in VHA Directive 1100.20 & VHA Directive 1100.21. Clinical/Professional direction of all clinical personnel covered by this contract will be provided by the facility COS &/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 &/or make changes to the contract during the administration of the resultant contract.

http://oig.hhs.gov/exclusions/index.asp

2.11. Non-Personal Healthcare Services: The parties agree that the Contractor & all contract physician(s) & other contract provider (s) shall not be considered VA employees for any purpose.

2.12. Inherent Government Functions: Contractor & Contract physician(s) & other contract provider

(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 & 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 & performance standards for

Federal employees, approving any contractual documents, approval of Federal licensing actions

& inspections, &/or determination of budget policy, guidance, & strategy.

2.13. No Employee Status: The Contractor shall be responsible for protecting Contract physician(s) & other contract provider (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:

2.13.1. Workers’ compensation

2.13.2. Professional liability insurance

2.13.3. Health examinations

2.13.4. Income tax withholding

2.13.5. Social security payments

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

2.15. Key Personnel: Contractor shall provide the number of qualified staff as is necessary to perform the services required under this contract, at the staffing level determined to be professionally acceptable by the Facility Chief of Staff and in accordance with national radiation oncology practice staffing guidelines.

2.15.1. The VA Full Time Equivalency (FTE): FTE for the services required is 1.3.

2.15.2. The minimum number of Board-Certified Radiation Oncology physicians required to be on site daily is 1 as defined in paragraph Hours of Operation in this section.

2.15.3. 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, & 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 & notify the Contracting Office Representative (COR) immediately of the schedule change.

2.16. Emergency 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 days after the occurrence of any of these events & 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.

2.16.1. The Contractor shall provide a detailed explanation of the circumstances necessitating the proposed substitutions, complete resumes for the proposed substitutes, & 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.

2.16.2. For temporary substitutions where the key person shall not be reporting to work for 2 consecutive workdays 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.

2.16.3. 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 & 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 contract physician(s), s/he may request, without cause, immediate replacement of said contract physician(s).

2.16.4. The CO & COR shall deal with issues raised concerning Contract physician(s) conduct. The final arbiter on questions of acceptability is the CO.

2.17. Contingency Plan: Continuity of care & uninterrupted operations of a Radiation Oncology

Program are essential components of this contract & will be primary factors in Contractor’s assignment of staff & frequency of substitutions. The Contractor shall have a contingency plan in place to be utilized if the contract physician(s) & other contract provider (s) leaves Contractor’s employment or is unable to continue performance in accordance with the terms & conditions of the resulting contract.

3. VA HOURS OF OPERATION/SCHEDULING

3.1. VA Business Hours: The Dayton VAMC is open 24 hours per day, seven days per week. Radiation

Oncology is open from 8:00 AM to 4:30 PM, Monday through Friday except for Federal Holidays.

3.2. Work Schedule: 8:00 AM to 4:30 PM Monday – Friday

3.2.1. Patients must be seen by a contract physician(s) on-site at Facility in a timely manner in accordance with VA Rules & Regulations on clinic wait times & consult completion.

Contractor shall notify the COR at least monthly about any obstacles to meeting this performance measure.

3.2.2. Contract Physicians shall be available & present in clinic during normal Facility clinic hours, Facility which will be established, & may be revised, as deemed appropriate for patient care by the Chief of Staff. Currently, normal clinic hours are Monday through

Friday, 08:00 to 16:30.

3.3. Off-hours Coverage: Contractor must make a Radiation Oncologist available on-call during all hours when the Facility clinic is closed, including evenings, weekends & holidays when the staff radiation oncologist is not available. In most cases, the contractor will be notified of on-call coverage 14 days in advance unless an emergent situation arises.

3.3.1. Contractor shall provide an afterhours telephone number to receive & route calls to the radiation oncologist.

3.3.2. Contract physician(s) shall not include time for carrying the on-call pager but may include call back hours for time spent on-site or time spent on telephone consultations will be paid at the physician(s) hourly rate as identified in the schedule.

3.4. 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.

3.5. Cancellation/Rescheduling: Contractor shall be responsible providing services unless a state of emergency exists.

4. CONTRACTOR RESPONSIBILITIES

4.1. SERVICES REQUIRED: The Dayton VAMC requires a board-certified radiation oncology physician for normal operating hours equating to 2363.5 hours annually. An additional minimum requirement of 344 hours on-call coverage annually. Estimated total hours will be 2707.5.

4.1.1. Standards of Practice: The medical practice & patient care provided by Contractor shall be evidence based best practices that meet or exceed all standards of professional practice & performance measures applicable to Dayton VA Medical Center medical professionals, including, but not limited to, NHPP, AAPM & TJC standards & national recognized accrediting body current practice guidelines in radiation oncology.

Contractor’s care shall cover the range of services as would be provided in a state-of-the-art civilian medical treatment facility. Contractor shall provide evidence the Contractor’s radiation oncology standard of care is of a quality that meets or exceeds currently recognized VA & ACR national standards as established by:

4.1.1.1. Applicable Radiation Oncology practice guidelines & standards promulgated by

ACR, ASTRO, & AAPM.

4.1.1.2. The professional standards of the TJC or equivalent accreditation:

http://www.jointcommission.org/standards_information/hap_requirements.as px

4.1.1.3. The requirements contained in this PWS.

4.2. MEDICAL RECORDS

4.2.1. Authorities: Contract physician(s) providing healthcare services to VA patients shall be considered as part of the Department Healthcare Activity & 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, & 164 (HIPAA).

4.2.2. HIPAA: This contract & its requirements meet exception in 45 CFR 164.502(e), & do not require a BAA for Covered Entity to disclose Protected Health Information to: a health care provider for treatment. 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 system of records entitled Patient Medical Records-VA’

(24VA10A7). Contractor generated VA Patient records are the property of the VA & shall not be accessed, released, transferred, or destroyed except in accordance with applicable laws & regulations. Contractor shall ensure that all records pertaining to medical care & 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.

4.2.3. Disclosure: Contract physician(s) may have access to patient medical records for the purpose of providing medical care & services to VA patients & 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 within community health care providers in compliance with VA regulations, HIPAA, & VHA Directive 1605.1, Privacy & Release of

Information. The penalties & liabilities for the unauthorized disclosure of VA patient information mandated by the statutes & regulations mentioned above, apply to the

Contractor.

4.2.4. Professional Standards for Documenting Care: Care shall be appropriately documented in medical records in accordance with standard commercial practice & guidelines established by VHA Directive 1907.01 Health Information Management & Health Records:

https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=9235 & all guidelines provided by the facility.

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

http://www.jointcommission.org/standards_information/hap_requirements.aspx http://www.jointcommission.org/standards_information/hap_requirements.aspx http://www.rms.oit.va.gov/SOR_Records/24VA19.asp http://www.rms.oit.va.gov/SOR_Records/24VA19.asp http://www1.va.gov/vhapublications/viewpublication.asp?pub_id=1423 http://www1.va.gov/vhapublications/viewpublication.asp?pub_id=1423 https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=9235

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

4.2.7. Direct Patient Care: 95%

4.3. BOARD CERTIFIED RADIATION ONCOLOGY PHYSICIAN SERVICES: Contractor shall provide, at a minimum, the following Radiation Oncology Physician services for Veteran patients in accordance with the terms & standards specified herein.

4.3.1. Services shall include evaluation & treatment of transported inpatient & outpatient clinical services for both palliative & curative cancer patients, follow-up, re-evaluation, & treatment visit.

4.3.2. Contract Radiation Oncologist shall provide evaluation & a treatment plan; follow patients for treatment management, continuing monitoring, & follow-up evaluations.

Contract Radiation Oncologist shall complete any documentation associated with the treatment provided to VA patients treated by them.

4.4. CONVENTIONAL RADIATION TREATMENT: Use of the following advanced modalities: IMRT, IGRT, & Stereotactic Radiotherapy, shall be fully justified in accordance with the appropriateness criteria of the American College of Radiology (ACR). ACR Quality-Safety Appropriateness Criteria promulgated by the American College of Radiology, American Society for Radiation Oncology, &

American Association for Physicist in Medicine

4.5. PATIENT CONSULTATION/PRETREATMENT EVALUATION: A radiation therapy consultation is defined as a comprehensive patient evaluation provided at the request of the referring physician. A consultation shall consist of a meeting of the patient & a radiation oncologist within the timeframes established by VA Rules & Regulations, a history & physical examination, & a review of pertinent x-rays & laboratory results as well as the patient’s medical record.

4.5.1. Review previous history, radiographic & lab studies.

4.5.2. Order any other test required for workup; &

4.5.3. Discuss with patient & perform examination.

4.5.4. Document the evaluation in CPRS, including at least:

4.5.4.1. Name of Attending Physician.

4.5.4.2. Radiation treatment type (e.g., conventional, IMRT).

4.5.4.3. Curative or palliative radiation treatment.

4.5.4.4. Dose amount & duration of radiation treatment, &

4.5.4.5. Discussion of evaluation with patient.

4.6. TREATMENT PLANNING: When it is determined radiation therapy is appropriate, a goal-oriented treatment plan from supporting data shall be developed by the Contract physician(s) for each patient, discuss treatment plan with patient & obtain patient’s signed consent, & made a part of the VA medical record. The treatment plan shall include the type of radiation to be administered, prescribed dose, treatment site location, Dose Volume (DV) based planning to include DV

Histograms (DVH), designation of Organs at Risk (OAR) for radiation injury, DV based radiation delivery goals for each OAR.

4.6.1. All treatment plans shall undergo peer review prior to initiation of treatment.

4.6.2. Treatment plans shall be altered as necessary during the patient’s treatment.

4.6.3. Contract physician(s) shall document initial consultation & full plan of care that includes name of attending physician on all clinical notes, indicate radiation treatment type (i.e., conventional, IMRT), date of simulation or procedure date, curative or palliative radiation treatment, dose amount & duration of radiation treatment & signed patient consent for treatment.

4.7. TREATMENT MANAGEMENT: Includes weekly examination of the patient under radiation therapy by attending physician. Weekly examination includes review of the daily &/or weekly port films by the attending physician, monitoring all therapy for side effects or complications, prescribed dose changes & other adjustment in treatment as needed, review of all cases at weekly case conferences or chart rounds & documented encounters & clinical progress notes in CPRS.

4.7.1. Prior to beginning radiation treatment, contract physician(s) shall instruct the patient & care givers on the risks involved including symptom management & symptoms requiring immediate intervention. This instruction must be documented in the medical record within 24 hours. The patient shall be given names & telephone numbers of persons to contact to report these symptoms. Informed consent shall be completed prior to implementation of initial treatments.

4.7.2. Contract physician(s) shall evaluate each patient for treatment management at a minimum of once per five treatments. These treatment management evaluations, addressing tumor response & side effects of therapy & medications prescribed, include pertinent laboratory & imaging studies. Patient’s progress shall be reported to the referring physician using the electronic medical record, Computerized Patient Record

System (CPRS), to include name of attending physician, treatment date, radiation treatment type, radiation dose amount & duration of treatment, radiation treatment dose to date & remaining dose to be provided, skin check of treated area, plan of care & number of treatments left to complete.

4.7.3. Contract physician(s) shall provide the patient with written guidelines regarding their rights & responsibilities. This includes keeping the patient informed of all issues affecting care & inviting full participation in planning & implementing care. Patient expectations of contract physician(s) should also be outlined. The patient must be advised of their right to submit complaints & procedures concerning such. This instruction must be documented in the medical record within 24-hours.

4.7.4. Contract physician(s) shall maintain written policies & procedures that clearly define guidelines for protecting patients & employees from all unnecessary radiation exposure, provisions for the safe use, removal, handling & storage of radiation & other radioactive elements.

4.7.5. Contract physician(s) shall monitor all therapy for side effects or complications; prescribe dose changes as needed; & review all cases at physician conference.

4.8. TREATMENT DISCHARGE: Contract physician(s) shall document treatment discharge summary

(End of Treatment Note) in CPRS to include total radiation treatment doses, patient’s condition at completion of treatment, discharge instructions to patient & a follow-up appointment with

30-60 days post treatment.

4.9. FOLLOW-UP EVALUATIONS: A board certified radiation oncologist must see each patient at least one (1) time following the radiation therapy treatment series within thirty (30) to sixty (60) calendar days of the end of a treatment series. The follow-up examination shall consist of a physical examination of the patient & a review of the current medical record including x-rays.

The purpose of this examination is to evaluate the patient’s response to therapy & a written evaluation shall be completed for the patient’s medical record within 48 hours. Prior to any initiation of new treatment, approval must be obtained from the VAMC COR.

4.10. PEER REVIEW CONFERENCES: Contract Staff shall attend & participate in weekly peer review conferences to discuss the appropriateness of treatment decisions, treatment goals & expected results related to Facility Radiation Oncology patients. These conferences may be joint conferences at which Contractor’s Radiation Oncology Service patients are also presented.

4.10.1. At a minimum, 100% of the following with respect to Facility Radiation Oncology patients shall be presented at these conferences:

4.10.1.1. Consultations

4.10.1.2. Re-evaluations

4.10.1.3. New start treatment fields, including boosts & off cord fields.

4.10.1.4. Staging evaluations, to assure that adequate staging & disease localizations have been performed; &

4.10.1.5. Patients seen in consultation for whom no treatment is recommended to assure the…