STATEMENT_OF_WORK_.pdf

STATEMENT OF WORK

FOR

PRE-EMPLOYMENT PHYSICALS

Joint Base San Antonio (JBSA)

1. GENERAL INFORMATION. The Contractor shall provide all management, tools, supplies, equipment, and labor necessary to complete Pre-employment Physical Examinations for all Joint Base San Antonio (JBSA) appropriated fund civilian selectees specifically referred by the Civilian Personnel Office (CPO). The Contractor must have locations within 20 miles of Joint Base San Antonio Lackland, Randolph, and Fort Sam Houston.

2. DESCRIPTION OF SERVICES:

2.2.1. VERIFICATION OF ELIGIBILITY. The contractor will verify that each selectee is eligible. The contractor will maintain a log containing selectee’s name, name of person authorizing treatment, and date of services provided. The CPO will provide the selectee with a Treatment Authorization form listing the type of examination that is required and the position description for the purpose of verifying eligibility of services. Failure to get pre-approval for selectee eligibility may result in non-payment for services rendered.

2.2.2. Physical examinations will be conducted in accordance with requirements as determined by a review of the Certificate of Medical Examination, Optional Form (OF) 178 and the position description provided by the CPO. Professional performing examination will ensure all requirements are addressed.

3. GOVERNMENT REPRESENTATIVE: The Government Representatives for this Agreement are: Primary Name, phone, email. Alternate: Name, Phone, email (WILL BE GIVEN UPON AWARD). These representatives will be able to ensure all standards referenced herein are adhered to and respond to any concerns you may have.

4. GENERAL INFORMATION:

4.1. BILLING: Contractor must be willing to accept the Government Purchase Card as payment.

Contractor should submit invoice to the 802 FSS/FSC, Attn: Ms. Lynda Lazo at lynda.lazo@us.af.mil (WILL BE GIVEN UPON AWARD) no later than the 10th of the following month. A fully itemized invoice to include, at a minimum, BPA Number, selectee name; type of exam; date of exam; and name of person authorizing services. Upon receipt of the invoice, the Government Representative will validate charges. All items MUST be submitted for payment in full and must be billed on one invoice, for payment. Payment for charges not authorized will not be paid. The Government is only obligated to the extent of authorized calls placed against this BPA by authorized personnel, against authorized line items. Do not accept calls from individuals not identified on the authorization letter.

4.2. RELEVANT EXPERIENCE. The key personnel for this Blanket Purchase Agreement as a minimum must have a degree of Doctor of Medicine and be Board certified by the American Board of Medicine in Family Medicine or equivalent.

4.2.1. SPECIAL QUALIFICATIONS: Contractor personnel shall be certified by appropriate Federal and state regulatory agencies to meet Federal and local certification requirements for a licensed professional.

4.3. PERFORMANCE REQUIREMENTS. The contractor must demonstrate sufficient experience providing Physical Examination services. Contractor shall provide:

4.3.1. A staff of qualified licensed professionals. The staff shall have required qualifications and have demonstrated the ability to identify and assess a variety of mental, physical, chemical dependency, and/or emotional problems and provide short-term counseling as required.

4.3.2. Facilities, professional staff, and support personnel to handle workload, record keeping, and reporting. The contractor shall operate from its own facilities and provide maximum confidentiality to selectee’s and selectee’s records in accordance with and abide by the Health Insurance Portability and Accountability Act of 1996 (HIPPA), Public Law 104-191, which establishes national standards to protect the individuals’ medical records and other personal health information. The HIPAA Rule requires appropriate safeguards to protect the privacy of personal health information, and sets limits and conditions on the uses and disclosures that may be made of such information without patient authorization.

4.3.3. The contractor shall comply with all local, state, and Federal regulations and laws that apply to the work being performed under this Agreement.

4.3.4. All financial, statistical, personnel and technical data which is furnished, produced or otherwise available to the contractor during the performance of this contract is considered confidential business information, potentially containing confidential and/or personally identifiable information, and shall not be used for purposes other than the performance of work under this contract nor be released by the contractor without prior written consent of a CPO Government Representative.

5. HOURS OF OPERATION. The contractor will provide a scheduling system to offer routine appointments within 24 hours of the initial call as well as weekend and walk-in availability for selectee’s.

6. SELECTEE REQUEST FOR RECORDS. The CPO has the sole responsibility of providing the selectee with a copy of the Physical Examination record when requested by selectee.

7. PERIODIC PROGRESS MEETINGS. The Contracting Officer, Government Representative, and other Government personnel, as appropriate, may meet periodically with the contractor to review the contractor’s performance. At these meetings, the Contracting Officer will apprise the contractor of how the government views the contractor’s performance and the contractor will apprise the Government of problems, if any, being experienced. Appropriate action shall be taken to resolve outstanding issues. These meetings shall be at no additional cost to the government.

3 Attachments

1. OF 178 Wage Grade

2. OF 178 Medical Field

3. OF 178 Aircraft Wage Grade