Amendment 0002_3(g)_SOW Optometrist.docx

Note: The terms Contractor, Contract Provider and optometrist shall mean the provider or providers of care throughout this document.

1. Scope of Work. The Contractor shall supply an individual to provide personal medical services to all Active Duty beneficiaries within the capabilities normally granted to an Optometrist.

A. The Optometrist shall meet or exceed the industry standards in accordance with established principles, practices and ethics of the Optometry profession. The standards of performance for all employees provided by the contractor shall reflect the degree and care, skill and learning expected of a reasonably prudent healthcare provider in the Optometry profession in the state of their practice.

B. The Optometrist will provide professional service, instruction and supervision to U.S. Coast Guard locations specified in the Performance Work Statement (PWS) (Attachment 3).

2. Qualifications. The provider of Optometry service shall possess and maintain for the duration of this agreement:

A. Diploma from an accredited School of Optometry;

B. A current unrestricted active license to practice Optometry from one of the 50 states, District of Columbia, Puerto Rico, Guam, or the U. S. Virgin Islands.

C. A current certification in Basic Cardiac Life Support (BLS) for the Health Care Provider by the American Heart Association (AHA), American Red Cross (ARC), American Safety and Health Institute (ASHI), or the American College of Emergency Physicians (ACEP);

D. A minimum of two (2) years recent experience (immediately preceding the submission of this offer);

E. “No adverse information on file” with the National Practitioners Data Bank (NPDB).

3. Credential Review. The contractor shall submit the following credentials in order to be evaluated for technical acceptability.

A. A current curriculum vitae including AT LEAST the following information:

(1) Social security number;

(2) Date of birth (to be used only for the purposes of independent query of the NPDB);

(3) Degrees earned;

(4) Career history;

(5) Professional Training/Courses attended in the past two years;

(6) Professional organization affiliations and memberships;

(7) Previous work references including name of organization, number of years services rendered, address and name of point of contact with telephone number;

(8) Awards and certifications received.

ATTACHMENT 3(g)

OPTOMETRY SERVICES

Rev. 11/1/18

B. Copies of:

(1) A diploma from an accredited school of Optometry (a “Polaroid” picture is acceptable as a copy);

(2) A current unrestricted active license to practice Optometry from one of the 50 states, District of Columbia, Puerto Rico, Guam, or the U. S. Virgin Islands;

(3) Evidence of immunity to Hepatitis “A” and “B” and evidence of freedom from chronic communicable disease(s) i.e., HIV, TB and Sexual transmitted diseases(within 30 days of start of work);

(4) A current certification in Basic Cardiac Life Support (BLS) for the Health Care Provider by the American Heart Association (AHA), American Red Cross (ARC), American Safety & Health Institute (ASHI) or the American College of Emergency Physicians (ACEP);

(5) Proof of insurability against malpractice in the amount of one million ($1,000,000.00) dollars per occurrence;

(6) At least three (3) letters of recommendation from recent employers addressing dental hygiene services.

4. Professional Services. The Contractor shall perform a full range of professional Optometry concepts and practices on site using Government furnished facilities, equipment and supplies for a variety of patients. All aspects of Optometry service shall be commensurate with the capabilities of the provider and the Medical Department including but not limited to the items listed below; and in PWS.

A. History, detailed examination, testing, diagnosis and treatment.

B. Use of vision testers, phoropter, and other optometry equipment.

C. Eye refraction (both manifest and cycloplegic).

D. Unaided and aided distant and near visual acuity testing.

E. Occulomotor balance evaluation.

F. Slit lamp biomicroscopy.

G. Tonometry, Accommodation, Pupillary reflexes red lens testing. Night vision testing.

H. Visual field defect and muscle balance evaluation.

I. Case consultation with authorized referring provider and treatment plan recommendation and review.

J. Color vision determination.

K. Treatment plan recommendation and review.

L. Case consultation with referring Medical Department Representative.

M. Expert opinion in related medical board action.

N. Provide immediate evaluation and management of emergent problems as they occur in addition to regular scheduled appointments.

O. Prepare and submit appropriate documentation as specified in applicable regulations.

P. Instruction of clinic staff on an ad hoc basis

5. Hours of Performance. The contractor shall provide all aspects of personal Optometry services at locations in the PWS (Attachment 3) and hours specified by the Clinic Administrator.