CRHC22-05Part2.pdf

CRHC23-05

Mobile MRI Servicee - SECTION J

LIST OF ATTACHMENTS

(Fixed-Price, Services, Commercial ttems)

1) Business Associate Agreement

2) Additional Contractor Responsibilities

3) Ethics

(i) Standards of Conduct Self Certification

(ii) Memo dated 9/3/2015, Mandatory Seasonal Influenza lmmunizations for Civilian Health Care personnel

Working in Indian Health Service Health Care Facilities

(iii) Memo dated 5/1211995, Violence in the Workplace

(iv) Memo dated 6/01/1995, Workplace Violence

(v) Memo dated LO/06/20t4, Courtesy and Respect in the Workplace policy

(vi) HHS Residual Standards ofConduct,45 CFR part 73, updated 05/2012015

(vii) 5 C.F.R' Part 2535, standards of Ethical Conduct For Employees ofThe Executive Branch, Basic obligation of public service, as amended at 81FR81041, effe Ctive OL/OL/20L7

(viii) 5 C.F.R. Part 5501(101-108) Supplemental Standards of Ethical Conduct For Employees ofThe

Department of Health and Human Services, dated LO/26|ZOO' 4I SCA Labor Standards

Appendix-: Business Associate Agreement

II.

Authority:

Pursuant to 45 C.F.R. $ 164.502(e), the lndian Health Service (lHS), as a covered entity, is required to enter into an agreement with a "business associate," as defined by 45 C.F.R. $ 160.103, under which the business associate must agree to appropriately safeguard Protected Health Infbrmation (PHl) that it will use and disclose when performing functions, activities or services pursuant to its contract with the IHS. By signing Contract No. _ (Contract), that it is a Business Associate and will comply with the terms below, in addition to other applicable Contract terms and conditions, and applicable law, relating to the safekeeping, use, and disclosure of PHI. This Appendix comprises the Business Associate Agreement (Agreement).

Definitions:

The following terms shall have the same meaning as those terms in 45 C.F.R. Part

160 and Part 164, which are the federal regulations implementing the Health lnsurance Portability and Accountability Act of 1996 (HIPAA), as amended: Breach, Designated Record Set, Disclosure, I Iealth Carc Operations, Individual, Minimum Necessary, Notice ofPrivacy Practices, PHI, Required by Law, Secretary, Security Incident, Subcontractor, Unsecured PHl, and Use.

A. Business Associate. "Business Associate" shallgenerally have the same meaning as the term "business associate" at 45 C.F.R. $ 160.103, and in reference to the party to this Agreement shall mean _.

B. Covered Entity. "Covered Entity" shall generally have the same meaning as the term "covered entity" at 45 C.F.R. S 160.103, and in reference to the party to this Agreement, shall mean the IHS.

C. HIPAA Rules. 'HIPAA Rules" shall mean the Privacy, Security, Breach Notification, and Enforcement Rules at 45 C.F.R. Part 160 and Part 164.

D. Master Patient Index (MPI). The "Master Patient Index" or "MPI" is composed of a unique list ofpatients and a current list of medical centers where each patient has been seen, This enables the sharing ofpatient data between operationally and regionally diverse systems. Each record (or index entry) on the MPI contains a small amount ofpatient data used to identity individual entries.

The mission of the MPI is to uniquely identify a patient and to "link" that patient's data throughout the IHS facilities using the lntegration Control Number (lCN). The MPI is the authoritative source of a patient's lCN, the enterprise-wide identifier for IHS facilities and the key to accessing a patient's record. The

Appendix_: Business Associate Agreement accuracy ofpatient information and patient identification directly affects clinical, administrative, billing, and interdepartmental processes.

III. Oblieations and Activities ofBusiness Associate:

A. Compliance: Business Associate agrees not use or disclose PHI other than as authorized by the Agreement or as required by law. Business Associate acknowledges that it is directly liable under the HIPAA Rules and subject to civil and, in some cases, criminal penalties for making uses and disclosures ofPHl that are not authorized by the Agreement or required by law. Business Associate agrees that it will require all of its agents, employees, subsidiaries, and affiliates, to whom Business Associate provides PHI, or who create or receive PHI on behalf of Business Associate for Covered Entity, to comply with the HIPAA Rules and to enter into written agreements with Business Associate that provide the same restrictions, terms, and conditions as set forth in the Agreement.

B. Subcontractors: In accordance with 45 C.F.R. $$ 164.502(e)( lXii) and

164.308(bX2), which govem relations with subcontractors, Business Associate agrees to ensure that any subcontractors that create, receive, maintain, or transmit PHI on behalf of Business Associate agree to the same restrictions, terms, and conditions that apply to Business Associate with respect to such PHI.

C. Safeguarding PHI: Business Associate shall develop and use appropriate procedural, physical, and electronic safeguards to protect against the use or disclosure ofPHI in a manner not authorized by this Agreement or required by law. Business Associate will limit any use, disclosure, or request for use or disclosure of PHI to the minimum amount necessary to accomplish the intended purpose ofthe use, disclosure, or request.

D. Safeguarding f,lectronic PHI: Business Associate agrees to use appropriate safeguards, as set forth in Subpart C of45 C.F.R. Part 164 with respect to electronic PHI, to prevent use or disclosure ofelectronic PHI other than as authorized by this Agreement or required by law.

E. Reporting Use or Disclosures Not Authorized By this Agreement or Required by Law: Business Associate agrees to report to Covered Entity any use or disclosure ofPHI not authorized by this Agreement or required by law within thirty (30) days ofdiscovering the use or disclosure, or any security incident of which it becomes aware. In addition, Business Associate shall mitigate, to the extent practicable, any harmful effect that is known to Business Associate ofthe use, disclosure, or security incident.

F, Reporting ofBreach: In accordance with the policy ofthe Department ofHealth and Human Services, Business Associate will report, within one hour of discovery, all suspected or confirmed breaches to Covered Entity.

G. Notilication of Breach ofUnsecured PHI: In addition to the above, Business Associate shall notify Covered Entity ofa breach, as set forth in 45 C.F.R. S

164.410, ofthe security ofany unsecured PHI that Business Associate received from, or created or received on behalfol Covered Entity within thirty (30) calendar days after the discovery ofthe breach by Business Associate, its employees, officers, and/or other agents, unless notification is specifically excepted by 45 C.F.R. $ 164.412.

l. Requirements of Notice. Such notice shall include, to the extent possible, the identification ofeach individual whose unsecured PHI has been, or is reasonably believed by Business Associate to have been, accessed, acquired, or disclosed during such breach; a brief description ofthe circumstances ofthe breach ofsecurity, including the date ofthe breach and the date ofBusiness Associate's discovery ofthe breach; and the type ofunsecured PHI involved in the breach. Business Associate agrees to provide any other available information that Covered Entity is required to include in notification to the individual under 45 5164.404(c). In the event notification is delayed, evidence demonstrating the necessity ofthe delay shall accompany the notification.

Individual Access to PHI: Business Associate shall maintain a designated record set for each individual for whom it maintains PHI. ln accordance with an individual's right to access his or her PHl, Business Associate shall make available all PHI in the individual's designated record set to the individual to whom that information pertains, or, upon the request ofthe individual, to that individual's authorized representative, as necessary to satisfy Covered Entity's obligations under 45 C.F.R. $ 164.524. Availability to access PHI shall be made within five (5) calendar days of receipt of a valid request.

Accounting ofDisclosures: Business Associate shall maintain records oiPHI received from, or created or received on behalfof, Covered Entity and shall document subsequent uses and disclosures ofsuch information by Business

Associate. Business Associate shall, within five (5) calendar days after receiving a request from Covered Entity, provide to Covered Entity such information as

Covered Entity may require to fulfill its obligations to account for disclosures of PHI pursuant to 45 C.F.R. $ 164.528.

Amendment of PHI: Business Associate shall, within five (5) calendar days of a request by Covered Entity, make PHI available to Covered Entity for Covered

Entity to fulfill its obligations under 45 C.F.R. S 164.526 to amend PHI and shall, as directed by Covered Entity, within five (5) calendar days ofreceipt ofsuch direction, incorporate any amendments into PHI held by Business Associate. In addition, Business Associate shallensure incorporation ofany such amendments into PHI held by its agents or subcontractors within ten ( l0) days of such direction, and shall notiry Covered Entity within five (5) calendar days ofwhen

H.

J.

K.

those agents or subcontractors have completed the incorporation ofthe amendments. Business Associate shall forward to Covered Entity all requests to amend PHI that it receives directly from individuals within five (5) calendar days of its receipt of a request.

Carrying out Covered Entity's Obligations: To the extent Business Associate is to carry out one or more ofCovered Entity's obligation(s) under Subpart E of45 C.F.R. Part 164, Business Associate agrees to comply with the requirements of Subpart E that apply to Covered Entity in the performance ofsuch obligation(s).

Disclosures for Veriffing Compliance: Upon request, Business Associate shall permit access by the Secretary and Covered Entity during normal business hours to its facilities, books, records, accounts, and any other sources of information, including PHI and any agreements that it has with subcontractors, vendors, and/or other agents relating to the use and disclosure ofPHI received from Covered Entity, or created or received by Business Associate on behalfofCovered Entity, for purposes of determining both Business Associate's and Covered Entity's comoliance with the HIPAA Rules.

Permitted Uses and Disclosures bv Business Associate:

A. Business Associate shall not use or disclose PHI except to perform functions, activities, or services on behalfofCovered Entity as provided for in the Contract, this Agreement, the HIPAA Rules, or other applicable law.

B. Business Associate agrees that it may use or disclose PHI on behalfofCovered Entity only:

I . Upon obtaining the authorization ofthe individual to whom the PHI pertains;

2. For the purposes oftreatment, payment or health care operations unless Covered Entity has agreed to a restriction pursuant to 45 C.F.R. $ 16a.520(b)(iv)(A) or 45 C.F.R. $ 164.522; or

3. Without an authorization or consent, if in accordance with 45 C.F.R. $ 164.510,45 C.F.R. $ 164.512,45 C.F.R. $ 164.514(e),45 C.F.R. $ l64.sl4(f), or45 C.F.R. $ l6a.sla(g).

C. Business Associate shall use and disclose PHI in compliance with each applicable requirement of45 C.F.R. $ 164.504(e), which section is fully incorporated herein.

D. Business Associate agrees to make uses, disclosures, and requests for PHI consistent with Covered Entity's minimum necessary policies and procedures.

E. It is anticipated that Business Associate will have access to the MPI.

IV.

F. Business Associate may not use or disclose PHI in a manner that would violate Subpart E of45 C.F.R. Part 164 ifdone by Covered Entity, except for the specific uses and disclosures set forth below.

l. Business Associate may disclose PHI for the proper management and administration of Business Associate or to carry out the legal responsibilities of Business Associate, provided the disclosures are required by law, or Business Associate obtains reasonable assurances fiom the person to whom the infbrmation is disclosed that the information will remain confidential and used or further disclosed only as required by law or for the purposes for which it was disclosed to the person, and the person notifies Business Associate ofany instances of which it is aware in which the confidentiality ofthe information has been breached.

Oblieations of Covered Entitv:

A. Covered Entity shall provide Business Associate with its Notice of Privacy Practices and any changes to the Notice.

B. Covered Entity shall notifo Business Associate ofany limitation(s) in Covered

Entity's Notice ofPrivacy Practices under 45 C.F.R. $ 164.520, to the extent that such limitation may affect Business Associate's use or disclosure of PHI.

C. Covered Entity shall notiry Business Associate ofany change in, or revocation ol the permission by an individual to use or disclose his or her PHI to the extent that such changes may affect Business Associate's use or disclosure of PH l.

D. Covered Entity shall notify Business Associate ofany restriction on the use or disclosure of PHI that Covered Entity has agreed to or is required to abide by under 45 C.F.R. $ 164.522, to the extent that such restriction may affect Business

Associate's use or disclosure of PHI.

E. Covered Entity shall not request Business Associate to use or disclose PHI in any manner that would not be permissible under Subpart E of45 C.F.R. Part 164 if done by Covered Entity, except as provided in Part IV, Subpart F, Seclion l.

Termination:

A. Term: The Term ofthis Agreement shall be effective as ofthe date Business

Associate signs the underlying Contract and shall terminate when the Contract ends or on the date covered entity terminates for cause as authorized in paragraph

(b) ofthis Section, whichever is sooner.

B. Termination for Cause: Business Associate authorizes termination of this Agreement by Covered Entity, ifCovered Entity determines Business Associate vt.

has violated a material term ofthe Agreement and Business Associate has not ended the violation within the time specified by Covered Entity.

C. Obligations of Business Associate Upon Termination: Upon termination of this Agreement for any reason, Business Associate, with respect to PHI received from Covered Entity, or created, maintained, or received by Business Associate on behalf of Covered Entity, shall:

'1. Retain only that PHI which is necessary for Business Associate to continue its proper management and administration or to carry out its legal responsibilities;

2. Return to Covered Entity, or, if agreed to by Covered Entity, destroy, the remaining PHI that Business Associate does not need to continue its proper management and administration or to carry out its legal responsibilities;

3. Continue to use appropriate safeguards, in compliance with Subpart C of

45 C.F.R. Parr 164, with respect to electronic PHI to prevent use or disclosure ofelectronic PHI, other than as provided for in this Part, for as long as Business Associate retains the PHI;

4. Not use or disclose PHI retained by Business Associate other than for the purposes for which such PHI was retained and subject to the same conditions set out above, at Part IV, Subpart F, Section I ofthe Agreement which applied prior to termination;

5. Return to Covered Entity, or, if agreed to by Covered Entity, destroy, the

PHI retained by Business Associate when it is no longer needed by

Business Associate for its proper management and administration or to carry out its legal responsibilities; and

6. If Business Associate or its agent or subcontractor destroys any PHI' Business Associate will provide Covered Entity with documentation evidencing such destruction within thirty (30) days of completion of destruction.

D. Survival: The obligations ofBusiness Associate under this Part shall survive the termination of this Asreement.

VIl. Indemnification:

In the event Business Associate is investigated and/or becomes a party to a civil or criminal cause of action in any forum relating to its failure to comply with the

HIPAA Rules, Business Associate shall reimburse Covered Entity all reasonable costs and expenses Covered Entity may incur relating to such investigation and/or cause ofaction, and will otherwise hold Covered Entity harmless for any and all reasonable costs and expenses relating to the foregoing.

Vlll. Miscellaneous:

A.

B.

Incorporation: This Agreement is attached to and fully incorporated into the Contract.

Notices: All notices under this Agreement shall be provided by certified mailing, and shall require proofofdate ofreceipt.

Regulatory References: A reference in this Agreement to a section in the HIPAA Rules means the section as in effect or as amended.

Amendment: The Parties agree to take such action as is necessary to amend this Agreement from time to time as is necessary for compliance with the requirements of the HIPAA Rules and any other applicable law.

Interpretation: Any ambiguity in this Agreement shall be interpreted to permit compliance with the HIPAA Rules.

Successors and Assigns: This Agreement shall be binding upon, inure to the benefit of and be eniorceable by and against the Parties and their successors and assigns.

Severability: Ifa court of competent jurisdiction deems any provision ofthis Agreement unenforceable, such provision shall be severed from this Agreement and every other provision ofthe Agreement shall remain in full force and effect.

C.

F.

D.

E.

G.

CONTnACTORS PF.RfORMANCE CONDTTTONS & RESPONSIBIJTIES!

l, Contlsolor is rorponrlblo for rcportlng all tarer from wtggs asrnod undot thls contrsct 10 tho lppropriuc Srae and Fedcnl Agcncior, provldcd rhc lwardec it 8n individud,

2. Contreotor ls rcrponriblc for hl/hcr own ftlirblc tronrporbtion in thc porformanct oftbc pontrlsl.

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"lt' ti ooorn''rrl En&. C.'it .b. .. s'otd.b TL o'Fii'.n| Enrtt cdT rls -id !t' r..aortrar'coeooxrr.oco[Frntdhbo'h.|d.d$loy|!.|db.nrdo|jy.'b!.t&|.brddrj'{.nbolt'i3.!!ofio| ;;.'d; ;;il;;r;L; ft. o;n; ot nid rnFt.rb; d ot udld 'trtr.r dlJr b' Drd'shr to e'' 'L'r0(,i or t' o'p'ift"rl Erii.. Cdrt .ld $d tl. h..d o, t .'in b.toa.r.di9cohFr n d hb or i.r 4..5r-'

(c}o'lr,.b...old.,grndo||!d.rdh!.llllE,l|r'f..c!lq'i.l..n\..d!l..ot0Et'.Fttt.||iEh.c.cog...|o..t'|.d.ody.!'E

(1)Dca.lxaia.rb.totioLtbnorPolxta.ltitstlCrh.r|tldrltot'ir'otDtltttvo0rri't"dto'o{rtr' ardd- aa lt or h.. .rEtit h lri8rci s iri iiiio. ,|{ r 'ioL,r i raruf v|dd;. oa lh. ditd. o' h|| .dori t otnr bs h- oco'tr'd trxv @/( 'ro[ifr;;;-ffi;-.r;d ;i i a-i'ir a a. .i.c. .e tr' h a z!r'75'co4 b 'sr- " Fc"n ''d n'dv tn' ,rFby.. Ird l t o. i.. sr'.|\,to. h trl|rgi d irtS.ixi rtr .nllrgrr nd 'iorron ol tlltir,.odl o. od!.r I.l i'- cr,F l !x ittur' ot rh' drdtr t '*n hd |h' Iiorii trt ,l e.,r;rt ny .9.t rlv -ddl hbtrndi,t h.l vd'ld tqrn t!'drddti'o.r o{ h hili'l rndir'io srltc.n L-DkclgllndyAdron$ Zl.tl$t2ot)

! t3.751201 G.iq.l Fo*b.

(.) VloLtofl ol ur rqob|bE dr(.l|d h |n. Prt nry b. G1!. ld dlrjgthrv 'cdo.

whidr c'dd bt h-'ddlon b |nr Ffllt' od.ft.d by li. tFa.ld ol -t" C..t-. t **i;;+-r"itv-Oar niv rir*o rtC "rr!. Cdt' d' Eth.r|t Cro'ir||.|t S'dic'' iiiiii;'or *ni' m9r rrro .a!lt rt 6..itil.ry |cib6 r..

^r'.d||.. ^ .ln B ol t ! t,.nl

(D) D. ttP. oa cadtLct .dio. lo b. Lbn dul b. d.Lhh'd lo r'l.tio' b dr '9'ot'

Ydt{ol! 1Lt' t"&''riid' la '@'MttT dn9

.'. io. r.ths drtdr.h.ry..roi * +c'v r,,ogn-;;;iiii irrilc "ii i'""'ln l'r e"-'lo5i'co!'a or dr€{ne t'rv 'ror,i 'lnbar r*- d.r..dto d, rr 61t ..- U m rryov.. .'o ;iiiffi;t tnitdo||ht'g tiig.

'u6ditd' d'Ddot6 co''ucr td adic liiog'c.. sotn rn". ot ot "iirrtY

.;r; 'id' nit t cotdord L

O I Aditod.rv|r.il

(2) VJrl!.r DFit||..rd (3lR€*rnffr

(a) S'rr.rrao.

(5) D.,tidot' rct Srn!..u|dr..lmot .l, rn ticro\tt t" 'ovtB 'cttr!:

d r.'r |.Eh 'cddr.|.t t,li'n 'pdic*l.

l''t! nttfdio'lt' td pord6 ru{ ;ffi;; t{;;i ndrlJt" 23' !sr'.t.mrd'd' $ FR

'roe Ft i6 te€tl so!?.i iH.ton|lr' vloLllotr.

t 73,73t13O1 F.apdl.'Dr'tv td rcPo.tlt9 gCtlua "ttiult|{tb'i

A' ''n!bt..

tno rr. iloin.ldten'dt h' o' t!.

''r'on'uv

Dditr'3

6dic.L..Do3sU.ofi.rE.grr'rtltrumroouorti'ffiriolliriroborTr'arnvotrchdivldutl$'r'!9onb'hdotlt6 o-€irt .,t. t^rr imnrdrLt ,+o.t ..,ot 'n'dn'*'?

i. ifi *-pi.".-. i v n'c'"g.-.o -onotl,.

o' drr'crv b h' on€' of rb rnro.dor o.,sd. o.tl':d col.r.d ov * p'."t'"i i#i iialil ur -' 'irr n-ril o mu'v' r.e.d p"lsry' c$rcr ol hr"'!r' iiffi?-r,i'i.'"qrD,,E,r.o,*nr;'g94'olfil-uiifrumffgg.;'n';'?:'6'.#'tiilgf1*-' omr|lr|t.d br n!. 1E ol'r. un|t.d sld.. co(|. En9( lifrii'.ii,i ii.".l ro. ro..our rororns rrro roio'trg rrd hddlhs or &ch hn'r'luon ltPE|{ou a lo PAF! 7t-.!I'r oF 30r! oFFEXSII toR tfHlcll D|!]dPUNARY ACIIOX xaY aE llKlt{

;ffi ?#,rx:#:6ffif4[ffi fimffi h:lsffi #"##*iffi ,r;ffiffi l:rii''"'- .. Efi6 |u Godwrr. n sa'lc.'I r|ol clLo F6 r Cffih! E|n<incy oi Or.r.lix'r h G.o.rc.

Eng€glE in wa{6nt didL o. bcr.vir in !l. !€rlorm.n 6 ol .!.!n .t duti6; condxnn! no/lcro,er.nEnt b6l6! &rinC olllci.l $,ofi ho('l: d prdiip.ilng i6 a 6rrik ( t8 U.S.C. lgi 8), dl !!0pp.9., loi (b/n, lidrcot, o. oth.r ltmtr acto,!, Ab!.no. wltlioul loav.. ld!.c lo .dhrft lo th€ nl.r..d

'tlul.fbru bl r.qr-!ng ard otrridng l.we, o. inF.6D.r ui. ol r.l16.v..

Ub.r|l. lltlbo.dhati). o $n^r.l b csry o{rt lr{tr, o.!.'t 6 .trig.@nlr glvrr Olnr{ru b.|!.!br. $clt .3:

.. ldi*t! 6r dtr.df,h! d r{bnpt lc b hnd boCry inlct on aiod'.r (rtclpr ro. i..ery d.€@ ot .dt d dn 6) riri. 6 in.Jo6d6 F.d..! r.f,r|L-.

b. D..oorlGy. di3..Arld. qduci d u!. ol inlullilg, .!.iv. o. obs..rl6 bngu.F !o o. .!oul oth.. indv'.loals rha. d rh.

S6rrd har!$r'..l ol omploys.! o. ns.n!€rE ol lhe psblic- Fdllur. io obi.m p.acsrtmr ldr eLty, ruch .. fiih,t io us. uLv .aulF[nt etldr il . F.lndod o. lg.orfp ,gnr, oorLd Nl.. or r6!ul.1bnr, d wdn n or vaorl rt6ly ldlrLrdroB.

url.dl!.E d u... p....*Io.. or dlrttsto.r oa .icoholc bcvs..o.. (5 U.SC. 7352) a. colldl.d rub.lt'c.r (..9.. h.||jdioapd.

sh .5 l-SO: dlnubnB. .ud I coc.irr rd .rnp6.brir.q rddr,€. $.h $ b.ntnrd6i .roli.s id ol?br dqi$ o.

2.

3.

6, sb6trnc.., {d & h.rlitr rd .atr (*uu. .ub.tJu.}

6. Uduttro.iz.d gMUinCi d orysiE, lolldlno, o. p.ddirE fi GovlrmEnl p..n$.d

9. F.ilur. lo crry o. .tror, troo.r ld.r{tri.lih d dr.boti.l! .s i.q'Ind ry cooFi€.rl tuuN)rlvi n.t t ot dcnlii6l€.! d& o.

6v.rlh.t|l6 or 6.ntin6i6n .6d.dinli or bntlca, r0. F.ilur. to di6do.. (i..., r.pon) hlort€do.r. wh.n.udr dlldo$o li not ip.dfslly proltibll.d by llw or Ex€cu ve Or&r, rh.l mvolv6s

(a, vld.tio. ot l*. nl., o. rilri.tkh {b) 6hrl,n g.ffit q s.6 rrr|. ot fq|ds o. obo.. ol .uflodt. o. (c) po.ing a $b.l.nl,.l .id .!.claE d.n!d to Frblh h.dih or sLti r.i|!a ro co.frrt h .. oandd O.oantri.nl l6qtt r1. F.nufe b 9.y iu.r d!b{r, hdx'.lg b!.. !o td lo€n. tqn eoldtrnrrd |..rr..

r2. Ooclit o.i*.ib.Fo. h. Ch/ilS.rvlor @r5a!dl (lE U.g,C,1917) o.h coin dioi*(haCot h|Ml lo.$rYrot acno.r'

13. FBr.l d lcr. !t.t nrdn. h. Goarnm.l odbr. (14 U.s,C. lool llrrouch 1003.)

I a. S@€M!o.r laibo !o ltlld. da:oCl..ty ot corr.clvc 6ciho ti.n lh. LcB t. l'Fff -.1 dr.<i9lisv or cd6liv. .dir a!

15, EmdoynMt of . nMb€. rt rl org.dzatir t|.l rdv@16 th€ .r6it ow d o., coGtitution l lod ol Eov€mhdl- (5 U S C t3l l:

50u,4.c. 764.)

B. Coic6irlg Gd/.nrnriit Fuid.. PDP.rtt, Ooddl.it!, !|td R@dt.

1. Actutr o. llrorpL.t mbotianli or |h.n ol Gsmmnt q F6€on l ntmy s Foo€ny .ill'€. dn4uy d lirough ue ot Go\,.rnd!nl doclm€rn6, auto.nabd aqutongrr, o. oris manr; .ctul o. lll6mphd dnb.2Zsm€.| o, lh.tt ol

|llfut oa oao!.lry ot anolh..

po.so^ h lh. po$elsbn ol.n dr{bv.. bv /....m ol t ! d hd.ndoYm6dt (18 U.S.c 6al 6nd 65'-) Faiu'.lo

'@lnt

lo. F/bUc.uFl. {18 u.S.C. 643.)

odi!6b tdbilyrhg ot of(i.l tm and sio.daaca r.cora!: InF.op€r !r. ot olfb.l ravol o. ,o.!ing, coq.l..iorltrg, o. oolctY,r3.

ilrlityios crnd.icoEmt t..v!l .!.0.(l d dodri..it! (16 u-Srcr s! rl Fds fto,{ .drioo d t lx t€tqtt o{ tstv o.3ocu,iti.. {18 u S.C. 2073 )

!s5o.dl!n!.D'o'd.'ld|toGo!'nNn|'o'{irtdd'..t9..ingp.r&.ltolGow.n'lg|lFop.'tytho{her.....,|€sdDy rchl nc**tr ...xtuct,

6. IvknLunc. d€|royn!, o. co@dlE pulic reco.&, (19 u S.C. 2071 )

7. M.!r. ol Fnrry oo.r.l) plryi|.g.. {18 u.s c 1719)

s. Fclur. b;l!g;; ad;r.rn'tdy 6nd$Il!r. tMnsd -rd tr!.,. ..cr.l!-ldom.to' -. -9. UMutho.lr.d ;|! ot d.cur|r..t. p.d!n!.d or uaad to p'@r! rh€ tlym.nr ol run.y lm.n or by |,nt ctovsnn nl, 1l ll u.s.c, 285. )

,6: u;*;;; ; t; G.vr"njnr 'rtoc; rrioor r ro..tro vlc.trofE or tn'6c n4vbrb" *rrr' (t'ivh!

s4'md-l v'HcL d

€h.lo cnt d d to.r4d td oatiCC Cd,..rrn .r p.rpo..a. rod&E .lhrhe d imFBd ot rtto. ol -t Ciov..rtnfil @rd td!.! ot be6 d nolo| vehicb. (31 U.S.C. 13.9(b).)

1 1 . Vid.tbt6 ol lhc P.ivecy Aa, Indudlig;

.. wllll/ic.ohibt i db&6,4 orind,v'd,6llY 'dont't'dL lnlo"'$o h {oL!ot\ ot 5 uSC 552s

o. unrui nuir'rrr,rfrg r rpcn ot Gco.dr Ltrod tbe!'g th6 rloic' €qdrt,Ml' ol lh' ttlv-f Acl a' r'q!ftd bv 5 U S C rz, vrdrtion oiiegtsto.6 cdrcrntrg th€ rct.$a ot cl.i3dt d i^tonnatioo. o.i&ndrr, d i€cldg end hwclg.liv. Inromtjon- (18

U.S.C. 7D! $d lto6l 21 U.S C- 33li; ttd 50 U.S C 733-)

c. co.tcsml^€ cdllds ot irnrwt..d R.lai€d undntllcd|duct

2.

3, 5.

3.

6.

7.

8_ viitlio.l. oa lE u.sc. chrrr l l : Bdo'v c"n and co'llnd! ol l'tlrtrl i'dlJdttg:'T-;;;-.-;i;;;fi;a rrino,at'ii,rdai Fruuoer e"proy.. or4l6lrp or5ro.r.. bsrd., o' p'dfrnordlb inr..!.i. in ,' an ry o.;ioyn ! ot rl|.hdoy*, rrr o s rpous, o. aipi^lcnr ch,kt) bd co.inEt.rilh m_s Gov.rffi.nt dlljt b€oeus.

n-n;div drr tt.tld.d w. n's d rt'kr !o io blitt'tt 5th d€ tgi|cy d n'r ltrY o'h€r ,.'ta& rullq wfn o' ffijic";lil il ;;:; ii'ii.v g- ^l r" .r- - .4,,e .onrir ; t!

'gc€'dE tr'ror' (ro u s c 208 ) b.6;;';;dbi;-.tr;"i'.dinhe';.cc.tried"'rtorrn&ldv'rvrt'i'!eo'nolr'i"!'ru'.i'tdud'rocifts!rxut'r' leB: 6i(odaim.nt, o. b6.s cltt"r $ co,tp.i'ra"n tw Ca"'nn!'nttl Fiir' or.l'cn irxlv'dudl5-*no to a6ehns

-r-l*i - "rr,".

tir.i.""" 6. rrlyl.xt ,.t uona 'dt rh.

-o.pinnHl. .'t @drrung op€r.b.a d- &*iti.r b.l ...

6iiG ii nj ri.i.i--t o. r*- r'r.'."r. Gi^vc 'uua'rtliJv 'n"r'd bv tt'o odrcrmn" o' dte€rrd'u@ o' rh'

.;dov.ts oltic.l dub.a t c.rso .CttY or t?y c'ilnirdo' lo or 3rtdtmtrtrto' o' t'lrry nom ' pr{tit dr.' r' cong;$.!on io. [rtc.. to. rh. Gov.mm.nl r la u s c 2or lnd ]oe r

" iajf iiiil.di'it "r;

kisn p.r*pd t.!lr!cl; undc' rrt Fot're'r a''nb Ft'l'rr"rs Act (16 u s c 210 )

Etr !ne. lf.dt 6. iidlr.dt t"r.*n t-"iiii'iiiua pri"giv 'Jy"g o".htqmtr" th'r ! otn'in€d rh@!h dr't onfui aiir-.n; t-ro

"or n .vdthb v.r. tr trplot€ tbl rn drtovf, "ih' F (t-rl Go'_n!.nr .

iJFitri" -i'iliu-l'"..,ort' carrov*a'or r snr ir ' otlritlieerir' meli'n a oo'uo x i 9 btnofidd &td!6 or

;;fi-";'i'i;;;;r,"vo .r*r"ng'r"rr p.v ih* '*"dr' {5 u s c 735r') iiiJ.!. -:rr'i,n,"+,,* i.-91". ".1"9.-T1";H*1ffi$:T**"ffi:5J;#llt#ffi1 ** ""I€acn'm. l€.luritgr or wrrkl h.l oep.dr h 4e{K htord.tlon ts ml olh.t*lt .v!rl.d. b oE p|n& F.il!f. to oolrh .qd.d d..t!"6 ol !n ohcd aa's'-h o' etd' Lrbby.o $lh .pFEg.ltld tutxl! (t6usc l9l3 )

R.Did.rnedon b.to.i . F..L.d qr-cv lottrr Urfln th' 9'oF dt€hrtg' ol fr! ol6c'l diuet E 'D-'o'd o| ato'mv h 5 c&m

'odd.l h! Unn d StrL. {0.,t-i,l,ne,tv gttt'V ot

'ni 'n'"t'v tt'd' Oi't tn -"r'Oaatbn to'

'tctl6rc!.9lvtn) d a tr

'gtn:

o' rn..n.y lo. a.yorE b.ro.. .nt d.t rtD'rt t!'ncv ;; ;j Oti*.. '" -ttttooi *lt' d'v p'ocsd|l€ 'pdh'tlon

Equ'31 ror tulm. o. cttd o. anv o0td prrtcub' '.,o " --ih"_ tii; Sorri 'r r paliy o' t'er r dr.t!

"r' 'ub'!"dtl

6l'E!r' {!8 U s c'

2trs i ,ror: Ihn !do. iort lot"c,,ap - -p'"v'J iiv irli '+ioaai'r i't' Lc p"to''-'a or h6 d f' oftod dutts *r slh@t co.tD.d.tio. $ rn .genr o :Ioncv ro. rmid-fioo-*t o u'c r''qctr ot tnv ahcq{-rv or orh'' 'dm'nltlrtds o.!c..dhq d.t.n ag.il d ttdEv lor o'E t p''!''r ;;; ora ot e'v p-n" - -tat 'd 'hod t|tlcn h' d J\s rtd€3 ri drsrd iducLrv .r..ot h t ro- "rn".

. *,-' * .i*r- h.r o.d;pd.d Fffi.r, .'n lrasLnli.llt )

O concon*lg Prchaitld Pblillctl.nd Eldjon A6tivtll"

I Acr,ri!.s floho'tcd !v 5 tJ 6 C chaol.r rJ Sub'napl' lll '"tuddo'' '--". _-i6itu rrzr' _potrilc'l co^hbl'lod p'*'lbod i i"il' riir' r.n,.""r"g 'r"ton'irdhg p'n ' ooftctl ctoP*)a pronb{bnti

'r@o$!

2. Aarh,b. prlaribli.d by ll U.S.C. C|rdd?g. hdrdn9:

a, sr.cb.r 5sa. 'lidmLdt n ot\rol.G."

t S.dron 507, Erpdldhur6 b InllLldu vothg,"

c. S.clq! 5€8. 'Co.idoi bt n!r6 ol Elict.cp€pn.Uo|ls.'

d. S.clld 600.'Prdt ol.6lloym.nt o. olt t b.n.n b.p.a{ii atsv.-

a. S.clL. 60! , .o.Frratidr ol dndoynonl o. Cho. b!r!.fl ior poattrl @nttulih.' l, sadia.| 60?, 'solclldon ol oolhlcd conribol,o.E-"

9. Sadh. ooa, "SolldLlbn tro.n c..!o.i. on DI.r."

h, s&lio. dlo. 'huml('ftbr b .!cir. Dolrlicel conrlhdorrr-"

E. Cdrcaani.t Proatn d Ptto.rd Pracd..l.

L Cdn|lLr'o.r of .,.!ribn d pfldril F.drc. (.r d.irn d h 5 us-G 2!o?pl ltl !l): tlial i5. nry mPlor.. rtF h6 &tEanv b llk .

.lircl o0ror b !rr., ..co.nDnd, or.pgos.nt p..r.dl.l Eidr, th, no{, su t3.0€.r to rEh rdtotilt, co.nt( ttly ol |h.

tolonli! F.clb6l

r. 6ii..lrin.b aor or alaln3r .ny srptoy.. 6r .OFti..nt ro. .mtoym.nt m th. b6irr ot ,..., .oio., dighn. !.t. n€tio.1 o.lgin.

!€p. h..ldEaptlg cdrdll,on. 'n nld 3ttllr., o. poltical dfttls

u. $r& o, ccriirer-'ly |ldtruiddlon o. ttda'B{ c.l d strli' slh r€ood lo .'v h6'it!.1 ttb sq'!c' or lt !nd'r cdtrrhrrion fo. .ny'Froir'.t .dD.r ud.aa $c|t rtcomniandado.l o. l.lohdnt a !..d on Ua ta.t .r.l r.o{,Ld!t ot @d. ollh. p...6 ftxnrhiig it lnd conlg. o, (l) in.vdu.to. or th. sofi ptro'n.t'.r

"'iV.

rpl|tid' d gf,nt'c

4rlitla.to.! i rLrl hdrvnd; (2) t svtlra0oi olth. chflcb' loyaltv t.uiLolty d tu'i td{butl-

c. (irt. rh. gdt l aCidy ot ty F.o.r (inddi0 tt ,.eitrf or .it FatkC@ttbrlioi d tt*r) ot LL. .nv ac!d!

s9sr6l ,n! rnoq/.! d ;pd..ni lr .htby@il .. € ta.isl h. rh! t.a|J3al ol tnv 9"e' to "|!Ege i' !!(,| toltc'l d, ooc.ivt or srturv obttwcl trv pdEn *nn nEo.cl lo sn Fr!o' ! ngN |o drpste ror entloymt4r' ., tot0.ic. my D.;a.t to wttdr.w rl!.n codFriio. (y

'|y po.rto,r rd 0- F pose ol hFetr.tg or lqlng rF 0r6Fcs o rnv dfs P{ton lo. .ndPtn€na L Ct{-..tryPFb|tn;;.dv.n!.!Enoa.ubs|:.dbvl.''i/bdr|9lJbtb'b'rysfitot€oo"9'li:drlldqnDlotF'

(ldodni afri||o Ul. EF d mr*l.r ot oonrctlrl o' lr r'C'it"t"n |o.

'nv portlt!) rs |n' 9nfro$ o' iip'o!l'! q .|inlE 6. to.c.dr ca .dv 9..ldlat 9.ttd td gr|CqtYl.'i

C, ^ctot( 6mqoy, ptottr@ ."* - rOiocrlr t' rai-urro! to9rotn|.r\ e@turEr!' r"6@|ml in o' ro t o!** o.€in h .riy itxtildvd *no b...l.tivo ir. d.fned h tu s c 3t lo) in'n bt dvhn podbo rn U\e c1'p{tn6 d s(bt hi3 or ho. luird6b. o. dlrd,

h. t.tc ot Lll to l,.lo a !.rr.nnd acM dn ttlo.cr !o

'nv €nployoG o' 4clrcltn lo| fitplqm.'n !t

FDit4 tt t$' lrttul

&ddor. of hldm.ion

r. firiiori"ror"i. rtv p"*ml..aon elrn.l si

'nprov4 or rpdirnl td dplovnEol dt Ecnld lor ht 'x'B't ol3^v

.!p€d dght $inl.d Dv try uv rvlo ot t'g!"lb'r I'tdudno HHg I tudo'E and |l'v'rEr' }o..'iri|.bro.o..g-!r..,yrnloy..iglorrt-dnco''|ol*o.||h.b€.|rolGo.l&cr!!rdo.sdot.dlc,tdy.n.cr" tt . D..idrry|c. ot d. ,'{roF" - .re6"i; h F ";;

or dE'r (deri ct6h'l €onvknon In d'iioiie{ 'uh'

&aty o. fita.l r #."'o. nii to iir. rw 9.nomsl ec!€' rhr tr' iiri'rg ol o' ltl4 lo tco dJcn tEl'm ed'L mv la'

'vle o' Esu"lioo h9lffai n9, or dlrt tlt sr..ftng ttr tl.|ll ttli'm plilcip|.t {d t't lofln n o u r'! '' ' '

[53 FR,1410, F.b. 16. lg8Al ufu.L.t:vl913

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DEPARTMEM OF HEALTH & IIUMAN SERVICES

Great Plsiru Area Indian Haanh SePics

MEMoRANDUM i;!".f,^?:,ltdpR@m3oe Abcrdc.n. SO 67401

DATE:

FROM:

SUBJECT:

TO:

ocT 06 ?0rl

Ron Comelius, Area Director

Courtesy and Respect in the Workplace Policy

All Great Plains Area, Civil Service Employccs, Commission CorPs

Officers. Contractors, Volunteers and Other Providers.

The single most important thing we can offer our patients, customers and coworkers is courtesy and respect in our daily interactions.

No matter what your job titte, grade, duties or responsibilities are, your number onejob is to perform those duties ard responsibilities in a manner $at is consistent with the standards of conducr oullined in the Department's Standard of Conduct' Subpafi C -conduct on the Job, 73.735-301 Courtesy and consideration for others. This subpart reads as follows:

(a) An employee's conduct on the job is, in all rcspects, of conc€rn to lhe Federal

Go"emnenr. courresy, considiration, and promptness in dealing with the public must be shown in carrying out official responsibitities, and actions which deny the

Jignity of inaiviauals or Jonduct which isdisrcspectful to others must recognize that inattention to matters of common courtesy can adversely affect the guality of scrvice the Dcpartment is rcsponsible for providing'

(b) Ofequal importance is the rcquirement that courtesy is shown in daily interaction '-' *itrti"*otrlrs. Employees shall be polite to and considerate of other employees and shall respect their nieds and concerns in the wotk environment'

I expect each individual who works for the Great Plains Area IHS to adhere to these

*",if*i*". f expect each supervisor and/or manager to hold rheir subordinates

;;lp"dil;t;"Jring tttis.r*aard and taking appropriate conective action when iiaiuiAual, violate it. i also expect managem"nt to take appropriate corrective action

*i*irr,jir. tfirvisors fail io cxercisJ their supeoisory responsibilities'

While I am emphasizing only one ofthe sections under Subpart C' I expect each

;;;;;;il-"g€'io Uiroi. iotniriar *ith rhe entirc subpart. I also expcct each

,r[*i[r a .r.*" fr" -vono ou.t t rtom they exercise supervisory control is 'r.l['iiJiirl-ur.liil"-at'""t" ro-utt *p":lt

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;;;;;Fil;tn{s Gdardsof conductbv following this link:

ittiliethics.od.nih. uov/l awreu/hhs'resid'std'htm*lt t

I am issuing this policy memorandum to dernonstrate my commitment to assuring

""*-,'tftp";, -a i,igrtity in the wo* ptacc' Everyonc from patients' clients' custome$ and employccs havc thc right to expcct a profcssional cnvironmcnt whcn thcy walk through the doors ofany Great Plains Area IHS facility.

This mcmorandum is to be distributed "d6k to dcak" with supewison assuring that each employee, officor, conhsct and/or volunteer has knowledge of it and initials a copy of the mcmorandum. Chicf Exccutive Offrcar and Division Directors arc to assurc that this mcmorandum is posted in appropriatc places in plain sight ofanyonc entering their work are&

If you have questions or nccd assistance, you may contact the Regional Human Rcsource

Ofticer, Employccrlabor Relations staff by calling (605) 226'7553.

Y,l'-Ib.Co'--- Ron Cornelius Arca Direcor

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OEPARTMENT OF HEALTH AND HUMAN SERVICES

lndian Health Servrce

Rockville, Maryland 20857

INOIAN HEALTH SERVICE CIRCULAR NO, 2016.04

Effective Date: July 28. 2016

Refer to OPHS

Sec.

1. Puroose

2. Backaround

3. Policv

4. aellliligle

5. Procedures

6. Comoliance

6' $Upersedure

7 ' Effective Date

1. purpose. This circular establishes the Indian Heallh Service (lHS) policy requiring mandatory

Gi!6iit inftuenza immunizations for civilian health care porsonnel working in IHS health care lacilitiet.

:. fi""f,oa""O. Influenza vaceination fot health care tacilrty statl and licensed independent practitioners is a rn"jo, p"o"nil"]"ty issue in the Unlted States and is an important component of comprehensive intectron conriot p-i'urnt tnoiu;o'"! Y:? ?::t'u infected are contag'or"'s at 'east one day before any srgns or sym'pfo-ms ol intluenza appear' and therefore these individuals can infect oihers without knowing they are contagious' s ;;;ic"";i cl;iiserv,ce emp-toye6s. .contracfstatf' temps-rarv

^empiovees' students' 3nd voiunteers who work in an IHS heatth car6 facility. must receive a sea$onal influenza vaccination by Qclober

31 of each year or have on tre-" uiiii '"oi""r ol

'9!91--'y?-"-1"^T.p.l':i^.t"Y':?i:]f::i.::ltl lii;;'.T:;,fiUd!:*:::^:J5f,#;#,:1r"gt""ilggg.i.'3iig5;"-!iffi:l!'J;J.f i::,''io ^.^^ri,i6 rim6h, v...in2trnnprelillJiimety vaccinalion. Commissioned Corps uErcers or trrs u

Service (PHS) are alreaoy t"q,'ttO ii Jtit iheit annual seasfialjnfluenza immunization {per

N4anual circular - commrssroned 'd"Iptl"i:i"""a - PH$ No 377' subchapter cc26 1 Instructron B'

PHS Readiness Standards)'

' @ff@Uruf*gu1t:t"*otf . All civil service employees' conlract staif' temporary employees' siudents, and ,orrnt"ii" *nou" crties and r'esponsibilities recuire them to work oermanent|y,'"-p'.?i.,o.I".""i"nirrvi^aniHSne"|tt'GarefacilityareconsideredHealth

Care Personnel (HCP) for the purpos€E ot thls polioy, rega.dless of their job c€t€gory or lcvcl of patient contact

B. H93lb_Q€(gledjily. Any Federal IHS hospital, clinic, or health station.

Proceduras.

A. Documentation. All HCP must provide aooeptablo dooumontation substantialing influenza vacclne recoipl or requost for oxemption wlthin 2 calcndar w€cks following issuance of this circular and by Oct. 31 annuElly in subgequent y€ars. Psrsonnel toutinely charged wlth infectlon control and/or employ€e health rcsponslbiliuca at tlro facility ar6 reeponsible for mainbining Gcotds ot amploye€ vacclnation, m€dlcal exemplion, or religious exemption ag part of the employe€ health rEcotd.

1. Recelpi ot lnfluanza Vaocine

a. Influ€nza Vecclne Administered Within IHS FacilitiFrs. Influenza vaccin8 will b€ offercd fro€ of chatg€ io atl HCP worklng In IHS h€alth care facilities ev€ry inf,u€nza s€aEon. At lhg time of vaccinstion, lho following lnfiorination lhould be r€cord€d in tho €mployee h€allh record: the date of sdministration, vaccine formulalion (i.e., bftind), vaccino manufacturer, do3e volum6, anatomic aite of admlnlstration, vaccine lot and expiration date, and nam€ of the provide, administering the vaccine. Upon requeEt' employ€€s may be provlded wrmen documentatlon of the influ€nza vaccinatior.

b. lnfluenza Vaccins Adminbtered Outsld6 IHS Facillties' Any HCP who recelve infuenza vaccine els€$/h€r€ must providg writtsn proof of vaccination that documents thg data of vaccination, vaccine formulation (i.e., brand), and name of provider edministering ths vaccine' This , .

infotmatlon will be filed along with any additional documentary prool ol vaccination 8E pad of he employae h€alth record'

2. Ecclerl&LElsDdbD- ' A requsst for medical exemptia-frcm 'nnfxrenza vaccination may be aPProved for any.petson contriindicated rc rec€lve influenza vaccine as outlined by Advisory . .

committit on lmmuni.ellon Preotico8 (ACIP) recomm€nd€tions (s€e link below). (htto://www.cdc'mv/fl dorofEssio als/vaccination/lnd9&nm I uas€ doncuroffimcndations,va||dmcdic€|excmptions|orinfluenza-.

vaccin€8inc|ud€ahi8ioryo|s€vgrea||orgicreactiontoanycomponenrol the innuenza vaccin6, i#luding e99 prot€in' or s€rious allefg'lc reaction to a previous doee oi infiusnza vacclne' itlstory of Guillain-Barr6 Syndroms iOgS) ons€t wif|in 6 weeks following a prlor Intluenza vaocine is a iL".i,uon rii'rinuenza vacanaion'-ani tly q :o1:'9-"'.1:,:111^T*':' ixemption lf a rnodicsl pro'Eer det€rmines th€ influenza vaccln'ruon pos6s a riEk lo $e Patiant .r. iiJJJ,rre tor reoue$ing.lmeoicat exlo?lion' Ar.Hc-P requ€sting iiffiicatexemptonfrominfluenzavaccinationmu6tplovide iocJmentatlon, slgned by a llc€ns€d' indePendint.lte?lt' caf^-

;;;ilil, ;fiffii^s thai a valid medroar ryI-?i11i:,"-tl?l-"J*:ffi;;ffi ;i;ld;'*""accination'1""9.11?l'-"-'-tplY.,:1"j9."i ;i'tl' i;fifi;il;t-t"l androiemplovee health reEPonsipilities at lhe

Tllcrltry-rlrrl,roEul

"r.t'orion raoucst in sccodance with cunent ACIP ffiri;il;d;4, and maintaln suitable r€cords to.documont

Ail;;;J;r6mes. Emplovees whose request for medical eximption B danl€d will rec.ive wrltten justficetion tor the denial ino niust receive intluenza vaccination wlthin 2 calendar weeks of th€ denial notificatlon.

siP;.:,s:|-"ffi :li'1"3:3;T.T"T:r'liil#ffi i!:

iiJiill i''iiil;ri apProv€d inedicat contraindication continues to preclude vacclnatbn. Suofi statemonts and other supportng documenblbn (8.9., sblern€nt fom employ€e'8 medical provide.)

will be robined as p€rt of the €mploye€'s health record.

R€lbbu3 Ex€molion from lnflu€nza Vecdnadon. Any HCP who fecl their rafg,ous belieb pracludc inllucnza immunizadon may tcqu.st an ex€mption from inf,uenze vtccination.

Pmccdure fur r€ouei0no r€lldbus exdnotion. Any HCP who focl theh tllhlous b€liet3 proclud€ influonza immunization must eubmli a 6l9ned' wdttod statement Juetlffing the requert by Oclober 31st annually tor review. Perconnal routln€ly ohargFd wlth hfection control andlor omployec health r€sponsibilitl€s al the facility will be designatdl to recshre, r8vbw, approve/deny toquo3ls fur reliCous o(emPtbn, and mainlain suilablo riiprds to document rrqu€sB and oubo.Ylss' SuPPoding statarnents and approval of ]€ligious ex€mption ruquests ftoan infiudrza vaocinatbn wil be mainlained ae pett of the €mployee hoalth t€cord.

c. Apgeslslda[isl!.fiEiFl examotion reouests. Revicw and adludicatron ol app€€ls witl be conductdby h€ facitity Clinhal Dir€ctor or S€rvice Unit

Chi€f Mcdical otrcer. S€condary appcab can b€ mrd€ to the Ar€a

Chief Mediqal Otficer. Third and final lcvel ol appoels can b€ made to th6…