Combined Synopsis/Solicitation Number: HT001426QE022 – Request for Offers

This is a combined synopsis/solicitation for commercial items prepared in accordance with the format RFO FAR 12.603 – Streamlined Solicitation for Commercial Items and Services, as supplemented with additional information included in this notice. This announcement constitutes the only solicitation.

This requirement is set aside for small business under NAICS code 621340 . The size standard for this NAICS code is $12.5 million.

Description: Audiology Screening Services

Contract Line Items: Please refer to the contract line-item section starting on page two of this Combined Synopsis/Solicitation.

Proposal Submission and Basis for award: Please refer to 52.212-1 Addendum and 52.212-2 Addendum. Offerors are required to be actively registered with the System for Award Management (SAM) at www.sam.gov prior to award. Offerors are highly encouraged to download and review all attachments to this solicitation prior to submitting an offer.

Performance or Delivery shall take place at: Please refer to the Performance Work Statement of this announcement.

Ordering Period: 15 August 2026 through 14 August 2031

Date, Time, and Place Offers are Due: The closing date for the delivery of response to this combined synopsis/solicitation is on or before 1:00 PM Eastern Standard Time (EST), on 04 August 2026.

Offers should be emailed to the Point of Contact (POC) shown below by the closing date and time. Offers are only being accepted via email to the contact POCs below. If an offer is emailed to the POCs shown below, it is the offeror’s responsibility to ensure that the transmission is received by the Government prior to the closing date and time. Upon receipt of an electronic offer, the Government will acknowledge receipt of that offer via email to the offeror.

Proposal Submission and Basis for award: Please refer to 52.212-1 Addendum and 52.212-2 Addendum.

Offerors must submit the following documents for this solicitation:

1. Offeror may use the Price Table in the Blanket Purchase Agreement to propose Unit Prices.

2. A technical description of the services offered in sufficient detail to evaluate compliance with the requirements in the solicitation. This may include product literature, a statement affirming the services comply with the performance work statement, or other documents, if necessary.

3. Include a statement specifying the extent of agreement with all terms, conditions, and provisions included in the solicitation. Offers that fail to furnish required representations or information or reject the terms and conditions of the solicitation may be excluded from consideration.

4. Offerors are required to be actively registered with the System for Award Management (SAM) at www.sam.gov prior to award.

5. Offerors are highly encouraged to download and review all attachments to this solicitation prior to submitting an offer.

POC: Mr. Jessie Hart and Ms. Lorena Cruz Email: jessie.g.hart.civ@health.mil

Email: lorena.cruz.civ@health.mil

Solicitation/Contract Form Audio Hazard Screening - Fort Campbell

Product Service Code: Q403

HT001426QE022

Description/Specifications/Statement of Work PERFORMANCE WORK STATEMENT (PWS) - ROCK ISLAND ARSENAL, ILLINOIS AUDIOLOGIST EVALUATIONS

1.0. INTRODUCTION.

1.0.1. The Contractor shall provide health care support for Blanchfield Army Community Hospital. The contractor shall perform Audiology evaluations for eligible Department of the Army civilian employees from Rock Island Arsenal, Illinois (RIA) referred from the Occupational Health Nurse, RIA. The contractor shall provide the contract services at the contractor's office, which must be located within a 60-mile radius of RIA as a required condition for effecting the contract services.

These services will be in support of, as needed, audiometric testing, evaluation, and remedial services for patients with a variety of hearing problems, meeting or exceeding current recognized national standards as established by the Joint Commission and the American Medical Association (AMA). The services will be of a nature and scope described in the paragraphs below. The Contractor shall provide the personal services of Audiologist licensed to perform services of the nature and scope described in this Performance Work Statement (PWS).

1.0.1.1. The quality of care provided by the Contractor HCP shall be of a quality meeting or exceeding currently recognized national standards as established by the Joint Commission (JC). Contractor HCP shall give the highest regard to patient dignity and observe the precepts of the American Hospital Association's Bill of Rights for Patients.

1.1. GENERAL.

1.1.1. This contract is a non-personal services contract. Performance under a non-personal services contract means the personnel rendering the services are not subject, either by the contract's terms or by the manner of its administration, to the supervision and control usually prevailing in relationships between the Government and its employees and is viewed as an independent contractor. The Government may evaluate the quality of professional and administrative services provided.

1.1.2. Malpractice Insurance. In accordance with FAR Clause 52.237-7, the contractor will indemnify the Government for any liability producing act or omission by the contractor, its Contract HCPs and agents occurring during BPA performance. Direct health care providers in performance of services are not responsible for obtaining medical malpractice insurance under this contract in accordance with the Gonzales Act (10 U.S.C. Section 1089, also known as the Medical Malpractice Immunity Act). The Government will not reimburse or otherwise pay for medical malpractice insurance should it be purchased by the contractor or contractor employees.

1.1.3. Confidentiality / HIPAA. The Contractor HCP shall abide by AR 40-3 and AR 40-66 concerning the nature of limited privileged communication between patient and health care provider for security and personnel reliability programs. The Contractor HCP shall abide by AR 40-66 concerning the confidentiality of patient records, as embodied in federal statutes including the Privacy Act of 1974 and the Drug and Alcohol Act, Public Law 92-129 and HIPAA. The Contractor HCP shall direct all requests for medical information on patients to the Chief, Patient Administration Division. The Contractor HCP shall not release any medical or personal information on a patient without first receiving written approval from the government. Government will provide the regulations upon request by the Contractor HCP. The contractor shall abide by the Standards for Privacy of Individually Identifiable Health Information of the Health Insurance Portability and Accountability Act (HIPAA), Public Law 104-91. The contractor shall not use or further disclose Protected Health Information other than as permitted or required by this contract or as required by Law. The contractor shall use appropriate safeguards to prevent use or disclosure of the Protected Health Information. The contractor shall mitigate, to the extent practicable, any harmful effect that is known to the contractor of a use of disclosure of Protected Health Information by the contractor in violation of the requirements of this contract. The contractor shall report to the government any use of disclosure of the Protected Health Information not provided for by this Contract. The contractor shall document, in a time and manner designated by the government, any disclosure of Protected Health Information as would be required for the government to respond to a request by an individual for an accounting of disclosure of Protected Health Information.

1.1.4. Conflict of Interest.

1.1.4.1. Contractor HCP shall not use patient care rendered pursuant to this agreement as a part of a study, research grant, or publication without the prior written consent of the MTF Commander.

1.1.4.2. Contractor HCP shall not bill the patient, an insurer, or anyone else for services rendered. The Contractor HCP is prohibited from receiving compensation of any kind for eligible patients treated, procedures performed, or any other actions performed, except under the terms and conditions of this contract, at the rate specified in the contract.

1.1.4.3. Contractor HCP shall not, while performing services under this contract advise, recommend, or suggest to persons eligible to receive medical care at Army expense that such persons should receive care from the Contractor HCP at any place other than at the MTF. The Contractor HCP will not refer any patients to any company or service to which they have a direct or indirect involvement (including partnership programs and ancillary services not offered by the MTF).

1.1.4.4. Contractor HCP shall not be an employee of the United States Government if the employment would create a conflict of interest. The Contractor HCP who is an employee of the Department of Defense, civilian, shall not be employed unless such person seeks and receives approval in accordance with DoD 5500.7-R and MEDCOM Reg 600-3.

1.1.5. SCOPE OF WORK: The Contractor shall provide qualified personnel, services, materials, equipment, supplies and facilities necessary to perform Audiology examinations for Rock Island Arsenal, Illinois.

1.1.6. ANTITERRORISM / OPERATIONS SECURITY (OPSEC): Contractor personnel shall adhere to facility security policies and restrictions. The Contractor shall immediately report suspicious activities to security personnel.

1.2. SCHEDULE/PERIOD OF PERFORMANCE

1.2.1. The contractor shall perform services during weekdays, Monday through Friday, excluding legal Federal holidays, between the hours of 0800 and 1600, as scheduled by the Occupational Health Clinic (OHC), Rock Island Arsenal, Illinois.

1.2.2. The contractor shall schedule patients within 72 hours of telephonic request from the clinical staff of the OHC, Rock Island Arsenal, Illinois.

1.2.3. Contractor HCP working under this contract shall be paid only for audiology examinations actually performed at the rates established in the contract.

1.2.4. Holidays. The following is a list of legal federal holidays as referred to elsewhere in the contract/task order: New Year's Day, January 1st, Martin Luther King's Birthday, 3rd Monday in January, President's Day, 3rd Monday in February, Memorial Day, Last Monday in May, Independence Day, July 4th, Juneteenth 19th, Labor Day, 1st Monday in September, Columbus Day, 2nd Monday in October, Veteran's Day, November 11th, Thanksgiving Day, 4th Thursday in November, Christmas Day, December 25th

1.3. DESCRIPTION OF WORK.

1.3.1. PROFESSIONAL QUALIFICATIONS. All Contract employees provided by the contractor shall meet the qualifications for that specialty and perform essentially the same functions, within the scope of acceptable for their technical professional discipline and standard, as those required by Army or government service technical professionals of similar experience and in similar duty assignments.

1.3.2. The contract provider may be an audiologist or a physician who has successfully completed a residency in otolaryngology. The contract audiologist and/or contract physician shall be licensed to practice in the state in which the contractor's office/clinic is located.

1.3.3. Audiometric testing must be administered by a physician, audiologist, or an audiometric technician certified by the council for Accreditation in Occupational Hearing Conservation. Audiometric technicians must administer audiometric tests under the supervision of a physician or an audiologist.

1.3.4. The contract audiologist/physician shall not be the subject of a current or pending investigation of appeal by any certifying organization to determine whether the individual has engaged in unprofessional conduct or substandard practice which may result in the suspension or restriction of the individual's licensure. The contract audiologist/physician shall not have had any adverse actions, i.e. suspension or restrictions, in the past.

1.3.5. The contract audiologist/physician shall have education and training required for the position that is being applied for.

1.3.6. The contract employee performing under this Contract shall be able to read, write, speak and understand English well enough to effectively communicate with all patients and other health care providers.

1.3.7 SPECIFIC DUTIES/TASKS/RESPONSIBILITIES.

1.3.7.1. Evaluation. The contractor shall perform comprehensive audiology evaluations on Department of the Army employees referred by the Occupational Health Nurse, Rock island Arsenal, Illinois. Only physician may diagnose noise-induced hearing loss. The contractor shall use all reasonable methods of differential diagnosis to include, but not limited to: An investigation of the individual's auditory history and previous hearing tests. Pure-tone air conduction measurements. Pure-tone bone conduction measurements. Speech reception thresholds. Speech recognition measurements. Oto-immittance testing. Masking (when indicated).

1.3.7.2. Written Evaluation. The contractor shall provide a written report within fifteen (15) calendar days after conducting test(s). The report shall summarize findings and recommendations, and will advise if the individual's hearing condition is work-related and what additional follow-up actions, if any, are recommended.

Statements about non-occupational noise exposures (e.g., hunting, motorcycling, chain saw use) must be included in the patient history. The contractor shall send the written report to the following address:

Woodson Health Clinic c/o Occupational Health Department 1 Rodman Ave, BLDG. 110 Rock Island Arsenal, IL 61299

The fax number is 309-782-0810. Attn: Occupational Health.

1.3.7.3. The contractor shall include the following in the written report:

1.3.7.4. Descriptive terminology understandable to a lay person.

1.3.7.5. A summary of all test results including the type and degree of hearing loss. If the loss is sensorineural, indicate if there is any indication of possible retrocochlear involvement.

1.3.7.6. Recommendations for additional testing, medical evaluations and/or amplification. If amplification is discussed, please indicate its benefits and restrictions, e.g., hearing aids are not to be worn while exposed to hazardous noise.

1.3.7.7. If diagnostic testing reveals a medically related hearing loss, the contractor shall refer the patient back to the Occupational Health Nurse, Rock Island Arsenal, Illinois. Conductive hearing loss is not the result of exposure to loud noise, so treatment for conductive hearing loss is not the responsibility of the government. However, the patient should be advised to seek care at his/her own expense to ensure the medical problem is treated. The contractor shall discuss all finding and recommendations' with the patient at the time of evaluation. The contractor shall only perform and receive payment for the audiology evaluation, as requested by the Occupational Health Nurse, Rock Island Arsenal, Illinois.

1.3.8. Limitations. Department of the Army employees will not receive any additional testing or services at Government expense. The contractor shall not, while conducting services under this contract, perform any other examinations or services except as identified above.

1.4. TECHNICAL REQUIREMENTS

1.4.1. REQUIRED DOCUMENTATION OF QUALIFICATIONS.

1.4.1.1. The contractor shall submit the following documentation for qualifications no later than ten (10) working days after award.

Copy of current license/certification from the state in which services are to be provided.

Certifications/licenses shall be maintained in a current status at all times while performing services under this contract. If at any time during the contract, a contract provider does not renew any of the required certifications/licenses prior to the expiration date he/she will not be allowed to work for BACH. This expense shall be borne by the contractor.

1.4.2. DISQUALIFIERS.

No contractor who is chemically dependent or impaired shall be acceptable.

No contractor who has been previously convicted of a felony shall be acceptable.

No contractor who is awaiting possible adverse administrative action by any certifying board shall be acceptable.

1.5. DELIVERABLES.

1.5.1. Invoicing. Monthly invoices shall be submitted NTL the 30th of each month in Wide Area Workflow (WAWF) in accordance with Clause 252.232-7006 WIDE

AREA WORKFLOW PAYMENT INSTRUCTIONS.

1.5.2. Contractor's Point of Contact. The contractor shall provide both the Contracting Officer and the Contracting Officer's Representative (COR) the name and telephone number of an individual to act as his/her representative and Point of Contact no later than five (5) working days after award.

1.5.3. Written evaluation submitted in accordance with the specifications in paragraph 1.3.7.2 of this PWS. Written Evaluation. The written report shall adhere to all the specifications in paragraph 1.3.7 of this PWS.

1.5.4. REQUIRED DOCUMENTATION OF QUALIFICATIONS. submitted in accordance with the specifications in paragraph 1.4.1 of this PWS.

2.0. DEFINITIONS AND ACRONYMS.

2.0.1. DEFINITIONS

CONTRACTOR: The term as used in this contract refers to the prime.

CONTRACTING OFFICER: A person with authority to enter into contracts; administer, or terminate contracts. Make related determinations and findings on behalf of the government. Note: The only individual who can legally bind the government.

CONTRACTING OFFICER'S REPRESENTATIVE (COR): An employee of the U.S. Government appointed by the contracting officer to monitor contractor performance. Such appointment shall be in writing and shall state the scope of authority and limitations. This individual has authority to provide technical direction to the Contractor as long as that direction is within the scope of the contract, does not constitute a change, and has no funding implications. This individual does NOT have authority to change the terms and conditions of the contract.

MILITARY TIME: is on a 24-hour clock, i.e., 8:00 a.m.-0800 9:10 a.m.-0910 Noon -1200 8:00 p.m.-2000 9:10 p.m.-2110 Midnight-2400 12:01 a.m.-0001 MILITARY DATES: are written by placing the day of the month, followed by the first three letters of the month, followed by the last two digits of the year, i.e., September 02, 2001 - 02 Sep 01 November 10, 2004 - 10 Nov 04 May 1, 2005 - 01 May 05 QUALITY ASSURANCE: The government procedures to verify that services being performed by the Contractor are performed according to acceptable standards.

QUALITY ASSESSMENT AND IMPROVEMENT (QA& I): An ongoing program designed to objectively and systematically monitor and evaluate the quality and appropriateness of patient care, to pursue opportunities to improve patient care, and to resolve identified problems.

QUALITY CONTROL (QC): Those actions taken by the Contractor to control and ensure that performance of duties meet the requirements of the contract.

2.0.2. ACRONYMS.

AR - Army Regulation AMA - American Medical Association COR - Contracting Officer Representative DA - Department of Army DCCS - Deputy Commander for Clinical Services DOD - Department of Defense EFT - Electronic Funds Transfer FAR - Federal Acquisition Regulation HCP - Health Care Provider HIPAA - Health Insurance Portability & Accountability Act of 1996 HSPD - Homeland Security Presidential Directive JC - Joint Commission

KO - Contracting Officer MEDCOM - Medical Command MEDDAC - Medical Department Activity MTF - Military Treatment Facility OSHA - Occupational Safety & Health Association PAD - Patient Administration Division PL - Public Law POC - Point of Contact PPIMS - Past Performance Information Management System PWS - Performance Work Statement QA&I - Quality Assessment & Improvement QA - Quality Assurance QC - Quality Control QAP - Quality Assurance Program QASP - Quality Assurance Surveillance Plan QCP - Quality Control Program SF - Standard Form

3.0. ATTACHMENT/TECHNICAL EXHIBIT LIST

ATTACHMENT 1 - Reserved ATTACHMENT 2 - Performance Requirement Summary (PRS) ATTACHMENT 3 - Supplement to the PWS

ATTACHMENT # 1 - Reserved

ATTACHMENT #2 - PERFORMANCE REQUIREMENT SUMMARY

PERFORMANCE

OBJECTIVE

PERFORMANCE STANDARD REF PBWS METHOD OF ASSESSMENT

Designate a point of contact prior to start date of the contract

Written notification must be received by the KO and COR prior to start date of contract. 100%

1.5.2. Written notification to KO

Provider(s) maintain professional licenses, certifications

100% of licenses and certificates shall be renewed and maintained in current status during life of contract

1.4.1. Credentials records

Comply with Specific Tasks.

Comply at least 99% of the time. 1.3.7. COR maintain log.

Combating Trafficking in persons (awareness program)

100% compliance (zero tolerance) regarding trafficking in persons policy

FAR

52.222-50 and FAR 22.1703.

COR documentation and program review. Any non-compliance must be brought to the immediate attention of the KO.

Satisfactory: Performance meets contractual requirements.

Unsatisfactory: Performance does not meet contractual requirements.

Other performance evaluation factors that will be monitored and documented in the contractor's performance records but cannot be quantified by numerical measurements:

- Contractor providing personnel exceeding the minimum qualification standards.

Performance above or below the standard, for above factors, will be documented in the Contractor's Performance Assessment Reporting System (CPARS) for the reporting period.

ATTACHMENT #3 - SUPPLEMENT TO THE PWS

EMPLOYEE CREDENTIALING HISTORY

The Contractor shall not employ any individual to provide direct health care services who, within 5 years prior to employment:

a. Has had his/her clinical privileges limited, suspended, or revoked by any health care facility, public or private, anywhere in the world.

(1) This prohibition does not apply to any individual whose clinical privileges, although originally limited, suspended or revoked by a health care facility were subsequently fully reinstated by the health care facility.

(2) Limitation of clinical privileges, as used in this paragraph, refers to a partial withdrawal/reduction of clinical privileges as a result of a determination that or pending investigation to determine whether an individual has engaged in unprofessional conduct or substandard medical practice or is incompetent to perform certain medical practices.

(3) Is the subject of a current or pending hearing or appeal brought by any health care facility, public or private, anywhere in the world, which may result in the limitation, suspension or revocation of the individual's clinical privileges. (4) Requirements for privileging are the same for replacement contract HCPs as for contract HCPs they are replacing.(5) The MTF Commander is the sole authority that can revoke or otherwise restrict the privileges of any contract HCP who he/she determines is not qualified to perform the contract services. (6) Once privileges are granted, subsequent actions taken concerning the privileges of contract HCPs, including any limitation on privileges, will be governed by the procedures in AR 40-68. Action that suspends, revokes, places in abeyance, or otherwise restricts the privileges of the contract HCP results in that contract HCP not being authorized to perform under the contract. Such action does not excuse the contractor from performing. A replacement contract HCP must be provided according to the terms of this contract. (7) Adverse actions on contract HCP privileges, once the Commander takes action, may be appealed locally by the contract HCP under the provisions of AR 40-68, but may not be appealed by the contractor.

IMPAIRED PERSONNEL

The Contractor is required to remove immediately any contractor personnel whose actions or impaired state raises reasonable suspicion that clear and present danger or physical harm exists to a patient, other contractor employees, Government personnel or the impaired individual. If, after any investigation deemed necessary by government representatives and discussions with the contractor's representative, the Contracting Officer conclude that the contract HCPs impairment requires permanent removal from performance under the contract, the Contracting Officer will notify the contractor that permanent removal is required. In the event of disagreements between the government and the contractor's representative concerning matters of impaired contract HCPs, the decision of the Contracting Officer will be final. During the period of time between the removal on a suspicion of impairment by government personnel and the final decision of the Contracting Officer, the contractor agrees to provide a backup/replacement contract HCP in accordance with the terms of this contract.

NON-COMPETE CONDITIONS

The use of non-compete conditions in employment agreements (to prevent loss of personnel by contractor) effective only during the period of the contract performance is acceptable. However the use of non-compete conditions in employment agreements that prevent employees of the incumbent from being employed, or accepting offers of employment by the new contractor on the follow-on contract is UNACCEPTABLE. It hinders the Government's ability to accomplish the mission of providing medical care to beneficiaries. Inclusion of such conditions in an employer's employment agreement will result in an offeror's proposal being unacceptable. Awardee and their subcontractors may not include such conditions in employment agreements while performing under this contract.

UNAUTHORIZED SERVICES.

The Contractor shall not undertake any action that will increase the price of the contract without the written approval of the Contracting Officer. Any such unauthorized action taken by the contractor or any Contractor employee, which might be construed to be approved by the Government, shall be the responsibility of the Contractor and shall be resolved by the Contractor at no expense to the Government. Third party claims resulting from such unauthorized actions shall also be resolved by the Contractor without expense to the Government.

HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT (6 May 10) In accordance with DoD 6025.18-R "Department of Defense Health Information Privacy Regulation," January 24, 2003, the Contractor meets the definition of Business Associate. Therefore, a Business Associate Agreement is required to comply with both the Health Insurance Portability and Accountability Act (HIPAA) Privacy and Security regulations. This clause serves as that agreement whereby the Contractor agrees to abide by all applicable HIPAA Privacy and Security requirements regarding health information as defined in this clause, and in DoD 6025.18-R and DoD 8580.02-R, as amended. Additional requirements will be addressed when implemented.

(a) Definitions. As used in this clause generally refer to the Code of Federal Regulations (CFR) definition unless a more specific provision exists in DoD 6025.18-R or DoD 8580.02-R.

Individual has the same meaning as the term "individual" in 45 CFR 160.103 and shall include a person who qualifies as a personal representative in accordance with 45 CFR 164.502(g).

Privacy Rule means the Standards for Privacy of Individually Identifiable Health Information at 45 CFR part 160 and part 164, subparts A and E.

Protected Health Information has the same meaning as the term "protected health information" in 45 CFR 160.103, limited to the information created or received by the Contractor from or on behalf of the Government pursuant to the Contract.

Electronic Protected Health Information has the same meaning as the term "electronic protected health information" in 45 CFR 160.103.

Required by Law has the same meaning as the term "required by law" in 45 CFR 164.103.

Secretary means the Secretary of the Department of Health and Human Services or his/her designee.

Security Rule means the Health Insurance Reform: Security Standards at 45 CFR part 160, 162 and part 164, subpart C.

Terms used, but not otherwise defined, in this Clause shall have the same meaning as those terms in 45 CFR 160.103, 160.502, 164.103, 164.304, and 164.501.

(b) The Contractor shall not use or further disclose Protected Health Information other than as permitted or required by the Contract or as Required by Law.

(c) The Contractor shall use appropriate safeguards to prevent use or disclosure of the Protected Health Information other than as provided for by this Contract.

(d) The Contractor agrees to use administrative, physical, and technical safeguards that reasonably and appropriately protect the confidentiality, integrity, and availability of the electronic protected health information that it creates, receives, maintains, or transmits in the execution of this Contract.

(e) The Contractor shall, at their own expense, take action to mitigate, to the extent practicable, any harmful effect that is known to the Contractor of a use or disclosure of Protected Health Information by the Contractor in violation of the requirements of this Clause. These mitigation actions will include as a minimum those listed in the TMA Breach Notification Standard Operating Procedure (SOP), which is available at: http://www.tricare.mil/tmaprivacy/breach.cfm

(f) The Contractor shall report to the Government any security incident involving protected health information of which it becomes aware.

(g) The Contractor shall report to the Government any use or disclosure of the Protected Health Information not provided for by this Contract of which the Contractor becomes aware.

(h) The Contractor shall ensure that any agent, including a subcontractor, to whom it provides Protected Health Information received from, or created or received by the Contractor, on behalf of the Government, agrees to the same restrictions and conditions that apply through this Contract to the Contractor with respect to such information.

(i) The Contractor shall ensure that any agent, including a subcontractor, to whom it provides electronic Protected Health Information, agrees to implement reasonable and appropriate safeguards to protect it.

(j) The Contractor shall provide access, at the request of the Government, and in the time and manner reasonably designated by the Government to Protected Health Information in a Designated Record Set, to the Government or, as directed by the Government, to an Individual in order to meet the requirements under 45

CFR 164.524.

(k) The Contractor shall make any amendment(s) to Protected Health Information in a Designated Record Set that the Government directs or agrees to pursuant to 45 CFR 164.526 at the request of the Government, and in the time and manner reasonably designated by the Government.

(l) The Contractor shall make internal practices, books, and records relating to the use and disclosure of Protected Health Information received from, or created or received by the Contractor, on behalf of the Government, available to the Government, or at the request of the Government to the Secretary, in a time and manner reasonably designated by the Government or the Secretary, for purposes of the Secretary determining the Government's compliance with the Privacy Rule.

(m) The Contractor shall document such disclosures of Protected Health Information and information related to such disclosures as would be required for the Government to respond to a request by an Individual for an accounting of disclosures of Protected Health Information in accordance with 45 CFR 164.528.

(n) The Contractor shall provide to the Government or an Individual, in time and manner reasonably designated by the Government, information collected in accordance with this Clause of the Contract, to permit the Government to respond to a request by an Individual for an accounting of disclosures of Protected Health Information in accordance with 45 CFR 164.528.

General Use and Disclosure Provisions Except as otherwise limited in this Clause, the Contractor may use or disclose Protected Health Information on behalf of, or to provide services to, the Government for treatment, payment, or healthcare operations purposes, in accordance with the specific use and disclosure provisions below, if such use or disclosure of Protected Health Information would not violate the HIPAA Privacy Rule, the HIPAA Security Rule, DoD 6025.18-R or DoD 8580.02-R if done by the Government.

Specific Use and Disclosure Provisions

(a) Except as otherwise limited in this Clause, the Contractor may use Protected Health Information for the proper management and administration of the Contractor or to carry out the legal responsibilities of the Contractor.

(b) Except as otherwise limited in this Clause, the Contractor may disclose Protected Health Information for the proper management and administration of the Contractor, provided that disclosures are required by law, or the Contractor obtains reasonable assurances from the person to whom the information is disclosed that it will remain confidential and used or further disclosed only as required by law or for the purpose for which it was disclosed to the person, and the person notifies the Contractor of any instances of which it is aware in which the confidentiality of the information has been breached.

(c) Except as otherwise limited in this Clause, the Contractor may use Protected Health Information to provide Data Aggregation services to the Government as permitted by 45 CFR 164.504(e)(2)(i)(B).

(d) Contractor may use Protected Health Information to report violations of law to appropriate Federal and State authorities, consistent with 45 CFR 164.502(j)(1).

Obligations of the Government Provisions for the Government to Inform the Contractor of Privacy Practices and Restrictions

(a) The Government shall provide the Contractor with the notice of privacy practices that the Government produces in accordance with 45 CFR 164.520.

(b) The Government shall provide the Contractor with any changes in, or revocation of, permission by Individual to use or disclose Protected Health Information, if such changes affect the Contractor's permitted or required uses and disclosures.

(c) The Government shall notify the Contractor of any restriction to the use or disclosure of Protected Health Information that the Government has agreed to in accordance with 45 CFR 164.522.

Permissible Requests by the Government The Government shall not request the Contractor to use or disclose Protected Health Information in any manner that would not be permissible under the HIPAA Privacy Rule, the HIPAA Security Rule, or any applicable Government regulations (including without limitation, DoD 6025.18-R and DoD 8580.02-R) if done by the Government, except for providing Data Aggregation services to the Government and for management and administrative activities of the Contractor as otherwise permitted by this clause.

Termination

(a) Termination. A breach by the Contractor of this clause, may subject the Contractor to termination under any applicable default or termination provision of this Contract.

(b) Effect of Termination.

(1) If this contract has records management requirements, the records subject to the Clause should be handled in accordance with the records management requirements. If this contract does not have records management requirements, the records should be handled in accordance with paragraphs (2) and (3) below

(2) If this contract does not have records management requirements, except as provided in paragraph (3) of this section, upon termination of this Contract, for any reason, the Contractor shall return or destroy all Protected Health Information received from the Government, or created or received by the Contractor on behalf of the Government. This provision shall apply to Protected Health Information that is in the possession of subcontractors or agents of the Contractor. The Contractor shall retain no copies of the Protected Health Information.

(3) If this contract does not have records management provisions and the Contractor determines that returning or destroying the Protected Health Information is infeasible, the Contractor shall provide to the Government notification of the conditions that make return or destruction infeasible. Upon mutual agreement of the Government and the Contractor that return or destruction of Protected Health Information is infeasible, the Contractor shall extend the protections of this Contract to such Protected Health Information and limit further uses and disclosures of such Protected Health Information to those purposes that make the return or destruction infeasible, for so long as the Contractor maintains such Protected Health Information.

Miscellaneous

(a) Regulatory References. A reference in this Clause to a section in DoD 6025.18-R, DoD 8580.02-R, Privacy Rule or Security Rule means the section currently in effect or as amended, and for which compliance is required.

(b) Survival. The respective rights and obligations of Business Associate under the "Effect of Termination" provision of this Clause shall survive the termination of this Contract.

(c) Interpretation. Any ambiguity in this Clause shall be resolved in favor of a meaning that permits the Government to comply with DoD 6025.18-R, DoD 8580.02- R, the HIPAA Privacy Rule or the HIPAA Security Rule.

(END OF SUPPLEMENT TO THE PWS)

Requirements Audiology screening Performance Work Statement (PWS)

Packaging and Marking

Inspection and Acceptance Overall Contract Inspection/Acceptance Locations

Inspection and Acceptance Location

Both Destination Instructions: See Statement of Work (SOW) or Performance Work Statement (PWS) for Acceptance/inspection criteria.

DoDAAC: HT0783 CountryCode: USA

ACH BLANCHFIELD CAMPBELL - PB

20TH STREET, BLDG 2434

FORT CAMPBELL, KY 42223-1498

UNITED STATES

Jason Honeycutt Email: jason.a.honeycutt4.civ@health.mil Telephone: 1234567890

Deliveries or Performance

Line Item Delivery Schedule Quantity Address and POC

5,000 Each

Period of Performance From 15 Aug 2026 To 14 Aug 2031

Contract Administration Data

DFARS Clauses Incorporated by Reference

Number Title Effective Date

Alternate/ Deviation

Variation Effective Date

252.201-7000 Contracting Officer's Representative. Dec 1991 252.232-7003 Electronic Submission of Payment Requests and Receiving Reports. Dec 2018 252.232-7009 Mandatory Payment by Governmentwide Commercial Purchase Card. May 2018

DFARS Clauses Incorporated by Full Text

252.232-7006 Wide Area WorkFlow Payment Instructions. (Jan 2023)

WIDE AREA WORKFLOW PAYMENT INSTRUCTIONS (JAN 2023)

(a) As used in this clause-Definitions.

"Department of Defense Activity Address Code (DoDAAC)" is a six position code that uniquely identifies a unit, activity, or organization.

"Document type" means the type of payment request or receiving report available for creation in Wide Area WorkFlow (WAWF).

"Local processing office (LPO)" is the office responsible for payment certification when payment certification is done external to the entitlement system.

"Payment request" and "receiving report" are defined in the clause at 252.232-7003, Electronic Submission of Payment Requests and Receiving Reports.

(b) The WAWF system provides the method to electronically process vendor payment requests and receiving reports, as authorized byElectronic invoicing.

Defense Federal Acquisition Regulation Supplement (DFARS) 252.232-7003, Electronic Submission of Payment Requests and Receiving Reports.

(c) To access WAWF, the Contractor shall-WAWF access.

(1) Have a designated electronic business point of contact in the System for Award Management at https://www.sam.gov; and

(2) Be registered to use WAWF at https://wawf.eb.mil/ following the step-by-step procedures for self-registration available at this web site.

(d) The Contractor should follow the training instructions of the WAWF Web-Based Training Course and use the Practice Training SiteWAWF training.

before submitting payment requests through WAWF. Both can be accessed by selecting the "Web Based Training" link on the WAWF home page at https:// wawf.eb.mil/

(e) Document submissions may be via web entry, Electronic Data Interchange, or File Transfer Protocol.WAWF methods of document submission.

(f) The Contractor shall use the following information when submitting payment requests and receiving reports in WAWF forWAWF payment instructions.

this contract or task or delivery order:

(1) The Contractor shall submit payment requests using the following document type(s):Document type.

(i) For cost-type line items, including labor-hour or time-and-materials, submit a cost voucher.

(ii) For fixed price line items-

(A) That require shipment of a deliverable, submit the invoice and receiving report specified by the Contracting Officer.

N/A

(Contracting Officer: Insert applicable invoice and receiving report document type(s) for fixed price line items that require shipment of a deliverable.)

(B) For services that do not require shipment of a deliverable, submit either the Invoice 2in1, which meets the requirements for the invoice and receiving report, or the applicable invoice and receiving report, as specified by the Contracting Officer.

Invoice 2in1

(Contracting Officer: Insert either "Invoice 2in1" or the applicable invoice and receiving report document type(s) for fixed price line items for services.)

(iii) For customary progress payments based on costs incurred, submit a progress payment request.

(iv) For performance based payments, submit a performance based payment request.

(v) For commercial financing, submit a commercial financing request.

(2) ) Fast Pay requests are only permitted when Federal Acquisition Regulation (FAR) 52.213-1 is included in the contract.

[Note: The Contractor may use a WAWF "combo" document type to create some combinations of invoice and receiving report in one step.]

(3) The Contractor shall use the information in the Routing Data Table below only to fill in applicable fields in WAWF when creatingDocument routing.

payment requests and receiving reports in the system.

Routing Data Table*

Field Name in WAWF Data to be entered in WAWF

Pay Official DoDAAC HQ0490

Issue By DoDAAC HT0014

Admin DoDAAC HT0014

Inspect By DoDAAC ____

Ship To Code ____

Ship From Code ____

Mark For Code ____

Service Approver (DoDAAC) HT0782

Service Acceptor (DoDAAC) HT0782

Accept at Other DoDAAC ____

LPO DoDAAC ____

DCAA Auditor DoDAAC ____

Other DoDAAC(s) ____

(*Contracting Officer: Insert applicable DoDAAC information. If multiple ship to/acceptance locations apply, insert "See Schedule" or "Not applicable.")

(**Contracting Officer: If the contract provides for progress payments or performance-based payments, insert the DoDAAC for the contract administration office assigned the functions under FAR 42.302(a)(13).)

(4) The Contractor shall ensure a payment request includes documentation appropriate to the type of payment request inPayment request.

accordance with the payment clause, contract financing clause, or Federal Acquisition Regulation 52.216-7, Allowable Cost and Payment, as applicable.

(5) The Contractor shall ensure a receiving report meets the requirements of DFARS Appendix F.Receiving report.

(g) WAWF point of contact.

(1) The Contractor may obtain clarification regarding invoicing in WAWF from the following contracting activity's WAWF point of contact.

Jason HoneyCutt jason.a.honeycutt4.civ@health.mil

(Contracting Officer: Insert applicable information or "Not applicable.")

(2) Contact the WAWF helpdesk at 866-618-5988, if assistance is needed.

(End of clause)

Special Contract Requirements

Contract Clauses Blanket Purchase Agreement (BPA) Between

CONTRACTOR

And

United States Department of Defense

1. AUTHORITY. This agreement is established in accordance with the Revolutionary Federal Acquisition Regulation Overhaul (RFO)) Part 13, Subpart 12.201-1(e) (3), Blanket Purchase Agreements (BPAs). This BPA will be reviewed by the Contracting Officer at least once annually before the anniversary of the effective date, and revised to conform to all requirements of Statutes, Executive Orders, and the FAR. Revisions will be evidenced by a modification to the BPA.

2. DESCRIPTION OF AGREEMENT. Contractor shall provide all supplies as per this agreement and the BPA Schedule (Supplies or Services and Prices).

Supplies and services shall be provided in accordance with the terms and conditions of this agreement and the Performance Work Statement.

3. PRICING: Pricing will be reviewed by the contractor and the Military Treatment Facility prior to the end of each 12-month term of the agreement, to assess potential price adjustments based on actual volumes achieved during the year. During the term of this BPA, an authorized representative of the contractor may meet with the customer from each participating facility, either separately or together, on a quarterly basis to review compliance to the estimated levels.

4. EXTENT OF OBLIGATION. Contractor is hereby incorporated into this BPA. The Government is obligated only to the extent of calls (orders) placed by authorized individuals and the purchase limitations of this BPA. Calls (orders) will be made by placing calls for services required. Payment will be made for actual services rendered.

5. PURCHASE LIMITATION.

MAX BPA CALL Limit: $25,000.00 Maximum GPC Limit $10,000.00 Period of Performance: 5-year ordering period from time of award.

6. INDIVIDUALS AUTHORIZED TO PURCHASE UNDER THE BPA. Calls placed by individuals not identified are not authorized and shall not be honored by the contractor. Services provided by the contractor in violation of this authorization will be treated as an unauthorized commitment and may result in termination of this agreement by the government. Changes in the list shall require the signature of the Administering Contracting Officer.

Individuals authorized to place purchases/calls under this agreement are identified by the Defense Health Agency Contracting Activity (DHACA).

Authorized individuals to place orders/calls:

TBA after Award of BPA.

Authorized individuals to place Government Purchase Card (GPC) Call Orders not exceeding $2,500.00:

TBA after Award of BPA.DELIVERY TICKETS. Payment for calls issued under this BPA will be made by WAWF.

7. DELIVERY TICKETS. Payment for calls issued under this BPA will be made by WAWF. If a BPA Call is issued by the contracting office, monthly invoices are authorized for the duration of the BPA Call. If an order is placed using the Government Purchase Card (GPC) only one invoice is allowed per GPC order. All services under this BPA shall be accompanied by a delivery ticket that contains the following information:

Name of Supplier BPA Number and Call Number Date of Request Itemized List of services provided.

Quantity, Unit Price, and Extension of Each Item, Less Applicable Discounts Date of Delivery of Shipment/Service under this invoice

8. Pricing

Item Description Unit Price

0001 Basic Comprehensive Audiometry

0002 Tympanometry (Impedance Testing)

0003 Acoustic Reflex Decay Test

0004 Acoustic Reflex Testing

0005 Pure Tone Audiometry, Air and Bone

0006 Pure Tone Audiometry, Threshold Air Only

0007 Speech Audiometry, Threshold Only

0008 Speech Audiometry Threshold/Discrimination

FAR Clauses Incorporated by Reference

Number Title Effective Date

Alternate/ Deviation

Variation Effective Date

52.202-1 Definitions. Jun 2020 52.203-19 Prohibition on Requiring Certain Internal Confidentiality Agreements or Statements. Jan 2017 52.204-13 System for Award Management-Maintenance. (Deviation 2026-O0038) Feb 2026

52.209-6 Protecting the Government's Interest When Subcontracting With Contractors Debarred, Suspended, Proposed for Debarment, or Voluntarily Excluded. (Deviation 2026-O0038)

Feb 2026

52.209-10 Prohibition on Contracting With Inverted Domestic Corporations. (Deviation 2026-O0038) Feb 2026 52.219-6 Notice of Total Small Business Set-Aside. (Deviation 2026-O0038) Feb 2026 52.222-3 Convict Labor. (Deviation 2026-O0038) Feb 2026 52.222-36 Equal Opportunity for Workers with Disabilities. (Deviation 2026-O0038) Feb 2026 52.222-50 Combating Trafficking in Persons. (Deviation 2026-O0038) Feb 2026

52.222-51 Exemption from Application of the Service Contract Labor Standards to Contracts for Maintenance, Calibration, or Repair of Certain Equipment-Requirements. (Deviation 2026-O0038)

Feb 2026

52.222-90 Addressing DEI Discrimination by Federal Contractors. (Deviation 2026-O0040, Revision 1) Apr 2026 52.223-23 Sustainable Products. (Deviation 2026-O0038) Feb 2026 52.224-3 Privacy Training. Jan 2017 52.226-8 Encouraging Contractor Policies to Ban Text Messaging While Driving. May 2024 52.229-12 Tax on Certain Foreign Procurements. (Deviation 2026-O0038) Feb 2021 52.232-33 Payment by Electronic Funds Transfer-System for Award Management. Oct 2018 52.232-36 Payment by Third Party. (Deviation 2026-O0038) Feb 2026 52.232-39 Unenforceability of Unauthorized Obligations. Jun 2013 52.232-40 Providing Accelerated Payments to Small Business Subcontractors. Mar 2023 52.233-3 Protest after Award. (Deviation 2026-O0038) Feb 2026 52.233-4 Applicable Law for Breach of Contract Claim. (Deviation 2026-O0038) Feb 2026 52.240-91 Security Prohibitions and Exclusions. (Deviation 2026-O0038) Feb 2026 52.244-6 Subcontracts for Commercial Products and Commercial Services. (Deviation 2026-O0038) Apr 2026

DFARS Clauses Incorporated by Reference

Number Title Effective Date

Alternate/ Deviation

Variation Effective Date

252.203-7000 Requirements Relating to Compensation of Former DoD Officials. Sep 2011 252.203-7002 Requirement to Inform Employees of Whistleblower Rights. Dec 2022 252.204-7003 Control of Government Personnel Work Product. Apr 1992 252.204-7012 Safeguarding Covered Defense Information and Cyber Incident Reporting. May 2024 252.204-7018 Prohibition on the Acquisition of Covered Defense Telecommunications Equipment or Services. Jan 2023 252.204-7022 Expediting Contract Closeout. May 2021 252.225-7048 Export-Controlled Items. Jun 2013 252.225-7056 Prohibition Regarding Business Operations with the Maduro Regime.