Appendix B_Required Operational Fields_12.22.22_FINAL.xlsx

XLSX spreadsheet 18 KB Posted

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Q301--Copy of Tumor Molecular Testing Services 0004
Solicitation number
36C10G24R0013
Issued by

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This document contains an appendix outlining required operational fields for tumor molecular testing services. Key details include required fields for ordering provider and facility information, patient demographics, specimen information, test details, order and result statuses, comments, attachments, and billing/account codes. It also lists the related federal contract opportunity as solicitation number 36C10G24R0013 for tumor molecular testing services with the Department of Veterans Affairs as the agency. The appendix provides a template for the data fields needed to order and process tumor molecular testing services under the terms of this federal contract.

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Other files

File Type Posted
36C10G24R0013 0004_1.docx DOCX document
36C10G24R0013 0004.docx DOCX document
36C10G24R0013 0003_1.docx DOCX document
36C10G24R0013_2.docx DOCX document
36C10G24R0013 0001.pdf PDF
Attachment 1 Invoice Inquiry Tracker.docx DOCX document
Attachment 5 - HIPAA-Business Associate Agreement Tumor molecular profiling services.docx DOCX document
Attachment 3 - Excel Price-Cost Schedule 36C10G24R0013 Tumor Molecular Testing.xlsx XLSX spreadsheet
36C10G24R0013_1.docx DOCX document
Attachment 4 Pay.gov Vendor Submittal Instructions.docx DOCX document
Attachment 9 Quarterly Reporting Tool.xlsx XLSX spreadsheet
Appendix A_data format for Tumor Molecular Profiling_12.22.22_FINAL.xlsx XLSX spreadsheet
Attachment 7 - Past Performance Questionnaire.docx DOCX document
There is no Attachment 8.docx DOCX document
Attachment 6- Question Submission Format.xlsx XLSX spreadsheet
Attachment 2 Contractor Discrepancy Report.pdf PDF
RFP 36C10G24R0013 Tumor Molecular Testing.pdf PDF
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Sheet1

CategoryField Name
Ordering Provider/Facility Information
VA facility station name
VA facility station ID
Ordering Provider Name
Ordering Provider email
Additional Physician to be Copied
Ordering Provider NPI
Patient Demographics
First Name
Last Name
Middle Initial
Date of birth
Patient SSN, Medical Record Number (MRN) or a second identifier
Sex (biological)
Patient Treatment Facility Name/Number
Vendor Assigned Requisition Numner (patient specific)
Current Dx / Patient History
Suspected Diagnosis (entered by ordering provider)
Patient ICD-10 codes
Patient ICD-O-3 codes (Topology, Primary Site)
Patient ICD-O-3 codes (Histology)
Cancer Stage
Prior/Current Therapies (optional)
Additional Diagnosis Information (optional)
Disease Status (metastatic, refractory, recurrent, relapse, or none)
If previously tested by the Vendor, has the disease progressed (Y/N)
Patient has received transplants
Test(s) to be performed/Test Name
Indication of Reflex Testing (when applicable)
Specimen Information
Specimen collection date/time
Specimen type
Specimen ID (specific to the received specimen and patient)
Stage
Pathologist's Name
Patient Station Name/Number
Alternate Specimen ID (if needed)
Pathologist's phone number/fax number
Diagnosis (confirmed by Contractor as assigned in provided pathology report and following Contractor pathology review)
Sample Status (ex: In progress, reported, etc.)
Date of sample status
Date/Time of Specimen Collection
Date/Time Specimen Received at Reference Lab
Date Test signed and Reported
Order Information
Order status (ex: order placed, specimen received, completed, etc.)
Order Status date
Date Clinical Report Issued
Comments & Attachments
Comments
Attachments (Pathology Report)
Other Information
Vendor Billint/Account Code (if applicable)
IHC Ordering Selection
Results Summary (TBD per assay)
Costs

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