PWS_WHNP_MFT_Revision_V5.doc

PERFORMANCE WORK STATEMENT

FOR

Women's Health Nurse Provider July 18, 2014

1. DESCRIPTION OF SERVICES/GENERAL INFORMATION.

1.1. The Contract Personnel (CP) shall provide personal services as a Women's Health Nurse Provider at San Antonio, Texas Department of Defense Military Treatment Facilities (MTF) to be filled by Women’s Health Nurse Practitioners and/or Certified Nurse Midwives. Services shall be performed in the OB/GYN Clinic of Wilford Hall Ambulatory Surgical Center (WHASC). The CP will not be required to travel to other locations. However, transfer to another San Antonio MTF may be required in the unlikely event that the OB/GYN Clinic of WHASC is permanently closed. The CP shall perform services and support compatible with the medical facility’s operating capacity and equipment.

1.2. All services shall be provided in accordance with established standards, principles and ethics of the profession and applicable professional specialty organizations, The Joint Commission standards, Accreditation Association for Ambulatory Health Care, applicable Department of Defense (DoD), military specific regulations, directives, and policies, and MTF specific policies and procedures. CP shall give the highest regard to patient dignity and observe the precepts of the American Hospital Association’s Bill of Rights for Patients.

1.3. Relationship of the Parties and Professional Liability.

1.3.1. This is a personal services contract (as defined by Federal Acquisition Regulation [FAR] Subpart

37.104) and is intended to create an employer-employee relationship between the Government and the CP only to the extent necessary for providing the health care services required under the contract. The performance of the CP under this contract is subject to day-to-day supervision, clinical oversight and control by healthcare facility personnel.

1.3.2. Any personal injury claims alleging negligence by the CP within the scope of the CP’s performance of the personal services contract shall be processed by DoD in the same manner as claims alleging negligence by DoD military or civil service personnel. The authority for this contract is 10 United States Code 1089 and 10 United States Code 1091.

1.3.3. If any suit or action is filed or any claim is made against the CP, which occurred as a result of work performed by the CP under this contract, the CP shall immediately notify the Contracting Officer (CO) and furnish copies of all pertinent correspondence received.

1.3.4. The CP shall also cooperate with the Government, without further compensation, in the processing, review, settlement, or defense of the suit, action, or claim; and authorize Government representatives to settle or defend the claim and to represent the CP in, or take charge of, any litigation involved in such an action. The CP may, at the CP’s own expense; participate in defense of such claim or litigation.

1.4. Specific Duties. The CP duties shall include, but are not limited to:

1.4.1 Treat/evaluate all scheduled patients not to exceed 1,280 patients per month (average 320 patients per week / 64 patients per day). It is the contractor’s responsibility to ensure all appointments are rescheduled or transferred to another CP during scheduled and unscheduled absences. The contractor shall include in their planning a 7 – 30 calendar day credentialing and security clearance process. Missed patients due to this process exceeding 30 days for a complete package shall constitute a Government Delay. Missed appointments due to incomplete credentialing and security packages that have been returned to the contractor shall constitute a contractor delay. Treat patients with common acute and chronic conditions, illnesses, or minor trauma within accepted protocols, national and clinical guidelines, Nurse Practice Acts, and/or in collaboration with a physician, as well as, request consultation or referral as appropriate. The contractor is required to satisfy the requirement with Women’s Health Nurse Practitioners and/or Certified Nurse Midwives. For example, the contractor shall provide all Women’s Health Nurse Practitioners, all Certified Nurse Midwives, or any combination of the two.

1.4.2. Participates in the orientation, training, and evaluation of duty performance of assigned personnel to include Graduate Medical Education (GME) program and other health care programs.

1.4.3. The CP shall provide a full range of Gynecological and Obstetrical services in accordance with privileges granted by the Commanding Officer (e.g. provide general screening and medical care and examinations of patients for routine, acute and chronic conditions involving any and all organ systems; order immunizations; diagnose, treat, and counsel patients as indicated). This does not include the scheduled delivery of infants as all deliveries are scheduled at other MTF locations.

1.4.4. The CP must complete all patient care documentation within 3 business days of the patient encounter.

1.4.5 The Contractor shall have on staff a CP capable of providing Fetal Ultrasound Procedures. The contractor may either hire a CP with this certification or utilize the Travel CLIN to obtain this certification. Please see Paragraph 3.12.

1.5. Special Qualifications.

1.5.1. The CP shall meet the following education requirements for either the Women’s Health Nurse Practitioner or the Certified Nurse Midwife:

1.5.1.1. Continuing Medical Education (CME) and/or Continuing Nursing Education (CNE). The CP shall provide appropriate CME documentation and/or Continuing Nursing Education (CNE) to the Functional Requirements Evaluator Designee (FRED) on an annual basis.

1.5.1.2. Shall have completed at least twenty (20) hours in continuing medical/nursing education in the past twelve (12) months.

1.5.2. License and Certification Verification. Air Force Instructional (AFI) 44-119, Medical Quality Operation (Chapter 4 Paragraph 4.6)

1.5.2.1. The CP shall have and maintain a current Basic Life Support (BLS) certification.

1.5.2.2. The CP must be eligible to be granted “fee exempt” Drug Enforcement Administration (DEA) registration number (certificate).

1.5.2.3. The CP shall perform through the MTF all primary and annual licensure or certification document verifications. The CP shall maintain these certifications in a current status throughout the life of this contract.

1.5.2.4. The CP shall confirm that the clinical licenses or certifications have not been suspended or revoked by any healthcare facility, public or private, anywhere in the world. This does not preclude any CP whose licensure or certification, although originally suspended or revoked by a healthcare facility, were subsequently fully reinstated by the same.

1.5.2.5. Healthcare professionals who fail to maintain a license, registration or certification will be removed from patient care until the license, registration or certification is renewed. Issuing agency grace periods are not honored by the Air Force Medical Service (AFMS) when renewing a license, certification, or registration.

1.5.3. Education Requirements:

1.5.3.1. Graduation from an accredited baccalaureate degree program in nursing (BSN) acceptable to the USAF Surgeon General.

1.5.3.2. Hold a minimum of a Master’s degree fulfilling requirements for either Women’s Health Nurse Practitioner or Certified Nurse Midwife.

1.5.3.2.1. Women’s Health Nurse Practitioner: from an approved OB/GYN or women’s health nurse practitioner program or Advance Certification (Certificate of Authority) acceptable to the USAF Surgeon General as found at http://www.afms.af.mil/shared/media/document/AFD-130320-063.pdf.

1.5.3.2.2. Certified Nurse Midwife; from an approved nurse midwifery program acceptable to the USAF Surgeon General as found at http://www.afms.af.mil/shared/media/document/AFD-130320-056.pdf.

1.5.4. Licensure.

1.5.4.1. The CP must have a current, unrestricted Nurse Practitioner's license and a current, unrestricted Nursing license.

1.5.5. Certification.

1.5.5.1. The Women’s Health Nurse Practitioner must hold a current women’s health nurse practitioner certification by the National Certification Corporation for Obstetrics, Gynecologic, and Neonatal Nursing Specialties.

1.5.5.2. The Certified Nurse Midwife must hold a current certification by the American Midwifery Certification Board.

1.5.5.3. CP shall have a minimum of 18 months Obstetrical and Gynecological Advance Practice Nurse clinical experience within the past 36 months.

1.6. Privileging Requirements. The credentials of the CP shall meet the privileging requirements as outlined in the most current version of AFI 44-119, Medical Quality Operations (entire instruction applies).

1.6.1. The CP shall furnish the MTF Credentialing Office with copies of valid, current, active, unrestricted nursing licenses, registrations, education training certificates, and/or certifications in accordance with AFI 44-119, Medical Quality Operations (entire instruction applies). In addition, copies of board certifications are required, if applicable. The CP shall continuously maintain at least one active licensure or authorizing document from any U.S. jurisdiction throughout the life of this Contract. The CP shall be responsible for primary source verifications of all licenses and documents.

1.6.2. Applications for privileges shall be screened through the National Practitioners Data Bank (NPDB), Healthcare Integrity and Protection Data Bank (HIPDB) by the CP.

1.6.3. The CP shall also screen through The Department of Health and Human Services (DHHS) at http://exclusions.oig.hhs.gov/ and TRICARE sanction listing at www.tricare.osd.mil/. The listings must be reviewed prior to entering into Contract or hiring CP for the position.

1.6.4. Professional staff appointments and clinical privileges are specific to the facility and the provider. An Initial Medical Staff appointment will be granted to all newly accessed CP for a period of twelve (12) months. During this period, the CP performance will be under close review by their assigned clinical supervisor for clinical competence as well as for compliance with the facility’s policies, procedures, bylaws, and code of professional conduct. Thereafter, the CP privileges will be reviewed/ evaluated for an Active Medical Staff appointment, which is granted for a period of two (2) years.

1.7. General Information.

1.7.1. MTF Orientation. The CP shall attend the MTF Orientation at the outset of their working at MTF. The MTF Orientation will familiarize the CP with the policies and procedures of the MTF and will be scheduled by the Contracting Officer’s Representative (COR) within two months of employment. Orientation attendance shall be required of the CP during Government paid duty hours.

1.7.2. In-Process. The CP performing service under this Contract shall be required to in-process through the 59 MDW Medical Logistics Contract Personnel Office upon reporting. At this time, the CP shall initiate the process to receive Common Access Card (CAC), Base Identification Passes, Restricted Area Badges, and keys.

1.7.3. Out-Process. Upon termination or expiration of the Contract, the CP shall be required to out-process through the same office. Upon completion of performance, termination of the Contract, or termination of performance, the CP shall out-process and turn in Common Access Card (CAC), Base Identification Passes, Restricted Area Badges, and keys.

1.7.4. Conduct Requirements.

1.7.4.1. The Government reserves the right to restrict the performance on this contract by any individual who is identified as a potential threat to the health, safety, security, general well-being, or operational mission of the MTF and its population.

1.7.4.2. The CP shall not advise, recommend, or suggest to persons eligible to receive medical care at Government expense that such person should receive care at an outside agency or provider at any place other than as designated under this contract.

1.7.4.3. The CP shall not use Government facilities or other Government property for personal or other business not related to this contract.

1.7.4.4. The CP shall not respond to any media inquiries nor provide interviews, comments, or any other responses to the media with respect to this contract. All inquiries or complaints from the media or other sources shall be immediately relayed to the COR.

1.7.5 Health Requirements and Immunizations.

1.7.5.1. Prior to contract performance, the Contractor shall provide proof of immunization or immunity from or screening for the following diseases according to Air Force guidelines equivalent to that provided to active work Armed Forces: Hepatitis B, MMR (Measles, Mumps, and Rubella), Varicella, Tdap (Tetanus, Diphtheria, and Pertussis), Tuberculosis (TB), HIV (Contractor who has direct patient care) and influenza for all personnel. Contractor shall control and prevent disease in accordance with AFI 48-105, Surveillance Prevention and Control of Diseases and Conditions of Public Health or Military Significance (Paragraph 1.10.10.) and the American Public Health Association Publication, Control of Communicable Diseases Manual, and the Centers for Disease Control and Prevention (CDC) publication, Morbidity and Mortality Weekly Report, Air Force Policy (as applicable) and its supplements. For the TB screening, the Contractor shall provide proof of negative TB 2-step skin testing IAW CDC recommendations outlined in Appendix B of this document. If an individual has a past positive TB skin test, the Contractor shall provide proof of a negative chest X-ray within twelve (12) months prior to personnel performing. The Government reserves the right to require more frequent TB testing of personnel based on the facility annual TB risk assessment. Additional vaccines as they are made mandatory for health care workers may also be required in unusual circumstances. In summary, contractors should have and maintain, at their own expense, all requirements. See Appendix B.

1.7.5.2. Medical Tests. The CP shall not obtain medical tests or procedures at the MTF, unless identified in Section three (3). The CP shall be responsible for the cost of any emergency medical services received.

1.7.5.3. Influenza Immunization. CP shall receive the current influenza immunization, at CP’s expense, unless contraindicated by allergy; as an example, to eggs as evidenced by hives, difficulty breathing, itching, and other symptoms of anaphylactic hypersensitivity, this exemption requires a Physicians diagnosis. Proof of vaccination will be required.

1.7.6. Hazardous Materials. This PWS does not call for any hazardous material to be provided by the CP.

1.7.7. Reports. The CP shall submit reports to the COR and/or credentials office (as applicable) for use in monitoring performance. Such reports may include, but are not limited to:

Initial – Effective date of award

Quarterly – 1st Qtr (October 1), 2nd Qtr (January 1), 3rd Qtr (April 1), and 4th Qtr (July 1)

Annual – Anniversary date of award

Report

Timeline

Basic Life Support (BLS) As accepted by American Heart Association (AHA)

(Heart Savers, Admin) (Providers course) or

American Red Cross Initially and upon expiration date *

*Note: In accordance with Military Training Bulletin NO. 07-003 (7 Feb 07), this training will not be provided by the Government.

1.7.8. Quality Assurance. The Government will periodically evaluate the CP’s performance by appointing a Functional Requirements Evaluator Designee (FRED) to monitor performance to ensure services are received. The FRED will evaluate the CP’s performance in accordance with the Quality Assurance Surveillance Plan (QASP) for this requirement.

1.7.9. Hours of Operation. Clinic operating hours are from 0630 to 1730. Patient care hours are from 0730 to 1630. CP performing under this contract shall abide by the provisions of MDWI 41-101, Medical Expense and Performance Reporting Systems (MEPRS) (Paragraph 2.1.3). The contractor shall provide documentation through Wide Area Work Flow (WAWF) under inspector extension code: F9MMNP.

1.7.9.1. The CP shall ensure that scheduled and unscheduled absences do not interrupt service performance.

1.7.10. Holidays Observed. The following federal holidays will be observed:

Holiday

Projected Date

Should the official holiday fall on Saturday then the observed holiday is the previous Friday.

Should the official holiday fall on Sunday then the observed holiday is the following Monday.

1.7.10.1. Family/Down Days. Typically, a "Family Day/Down Day” is associated with, but not limited to, the following holidays: New Year’s Day, July 4th, Thanksgiving, and Christmas. The clinic may or may not be open on these days. The Contractor shall not work on a Family Day/Down Day unless the clinic is open.

1.7.11. Security Requirements.

1.7.11.1. General Security Requirements. The CP shall follow all guidelines found in the Security Requirements for Solicitations and Contracts clause.

1.7.11.2. Security Training. The CP shall be trained in accordance with AFI 31-501, Personnel Security Program Management, AFI 31-401A FGM2, Information Security Program Management, AFI 33-200, Information Assurance Management, AFI 31-101, Integrated Defense (FOUO), AFI 33-203V1, Emission Security (EMSEC), and AFI 33-200, Information Assurance Management.

1.7.11.3. Internal Operating Instructions (OI). The CP shall abide by the MTF’s current OIs for internal circulation control, the protection of resources, and the regulated entry into Air Force controlled areas during normal, simulated, and actual emergency operations.

1.7.11.4. Reporting Requirements. The CP shall comply with AFI 71-101, Volume 1, Special Investigations Criminal Investigations (Chapter 2, paragraph 2.7) and Volume-2, Special Investigations Protective Service Matters, (Paragraph 1.2). The CP shall report to Security Forces any information or circumstances which may pose a threat to DoD or CP, resources, or DoD information.

1.7.11.5. Removal of CP. The Government, through the CO, may require immediate removal from contract performance on the installation or any Government facility, any individual whose actions raise reasonable suspicion that patient care or services may be compromised in any way, or that pose a threat of harm to other Contractors/Government personnel or self. Removal under other circumstances will be subsequent to, and at the direction of the CO only.

1.7.11.6. If a situation meriting removal occurs as outlined in the previous paragraph, the COR will contact the CO and the CP. A meeting may be required with the CO, and CP to discuss further action.

1.7.11.7. The CO will notify the CP if and when permanent removal is required. In the event of a disagreement between the Government and the CP, the decision of the CO will be final.

1.7.11.8. The CP may be required to submit to drug/alcohol testing. The Government reserves the right to require temporary or permanent removal from contract performance any individual who refuses or fails testing.

1.7.11.9. The CP shall conduct themselves in a professional manner while on the installation and refrain from disruptive, offensive, or otherwise improper behavior that undermines order and discipline. Dress code shall be professional attire or clean scrub attire. The wearing of open toed shoes shall not be allowed. The CO may direct the CP to remove from performance of this contract on this installation engaging in such misconduct.

1.7.12. Performance of Services During Crisis Declared by the National Command Authority or Overseas Combatant Commander. The services provided under the terms of this PWS have been determined not to be essential as outlined in the provisions of DoDI 3020.37, Continuation of Essential DoD Contractor Services During Crises.

1.7.13. Records Management. The CP shall manage all data created for Government use or legally controlled by the Government, in support of the functional activity or required by AF publication, IAW with the AF records management procedures in AFI 33-322, Records Management Program, Paragraph 10, Air Force Manual (AFMAN) 37-123, Paragraph 7.4, Air Force Manual (AFMAN) 37-138, Paragraph 2.13, and the Air Force Records Disposition Schedule (AF RDS) located at https://afrims.amc.af.mil/rds_series.cfm or http://www.amc.af.mil/shared/media/document/AFD-060803-003.pdf

1.7.14. Air Force Antiterrorism (AT) Program. The AT program seeks to deter or limit the effects of terrorist acts against the AF by giving guidance on collecting and disseminating timely threat information, providing training to all AF members, developing comprehensive plans to deter and counter terrorist incidents, allocating funds and personnel and implementing AT measures. In accordance with AFI 10-245, Antiterrorism (AT), Paragraphs 2.18 and Paragraph 2.25, DoD Contractors and sub-contracts personnel shall be offered Level 1 – AT Awareness Training. Compliance with the training will be monitored by the CORs.

1.7.15. Contractor Full-Time Equivalent Reporting. The CP shall report ALL CP labor hours (including subcontractor labor hours) required for performance of services provided under this contract for the Women's Health Nurse Practitioner (WHMP) or Certified Nurse Midwife (CNM) via a secure data collection site. The CP is required to completely fill in all required data fields at https://afcmra.hqda.pentagon.mil/login.aspx.

1.7.15.1. Reporting inputs will be for the labor executed during the period of performance for each Government Fiscal Year (FY), which runs 1 October through 30 September. While inputs may be reported any time during the FY, all data shall be reported no later than 31 October of each calendar year. CP may direct questions to the CMRA help desk.

1.7.15.2. Reporting Period:

CP is required to input data by 31 October of each year.

Uses and Safeguarding of Information: Information from the secure web site is considered to be proprietary in nature when the contract number and CP identity are associated with the direct labor hours and direct labor dollars. At no time will any data be released to the public with the CP name and contract number associated with the data.

1.7.15.3. User Manuals: Data for Air Force service requirements must be input at the Air Force CMRA link. However, user manuals for government personnel and CP are available at the Army CMRA link at http://www.ecmra.mil.

2. SERVICE DELIVERY SUMMARY.

P.

0.

Performance Objective (PO)

WOMEN’S HEALTH NURSE PROVIDER

PWS

Paragraph Performance Threshold

evaluation of duty performance of assigned personnel to include Graduate Medical Education

(GME) program and other health care programs.

3. GOVERNMENT FURNISHED PROPERTY AND SERVICES.

3.1. The Government will provide use of all available MTF facility’s and support services, materials, publications and forms, use of equipment, and specialty clothing required for contract performance (except as designated in the contract). The CP shall keep Government furnished supplies, equipment, and work areas in a safe, orderly and clean condition.

3.2. The Government will schedule and furnish initial and annual training which may include but shall not be limited to various applicable software, data base systems, quality assurance policies, radiation safety, local in-service, safety briefings, compliance, patient safety, performance improvement, risk management, infection control, fire protection, security, and patient sensitivity training. The classes may be scheduled during the MTF’s normal operating hours as required throughout the life of the contract.

3.3. Any space used by CP in performance of this contract may be used for other purposes during their absence. Items of clothing, personal effects, or equipment may not be able to be secured at the MTF. The Government will not incur any liability for theft, damage to, or loss of such personal items.

3.4. The Government will provide local telephone service, Class-A telephone lines and Defense Switching Network lines limited to matters related to the performance of this contract. Personal long distance calls are not authorized.

3.5. The MTF will provide emergency healthcare for injuries occurring while on duty. The CP shall reimburse the Government for such services. This includes blood borne exposure protocols after start of work. The Government will provide initial testing at no cost, but the CP shall provide follow-up testing or reimburse the Government for such services performed within the MTF. The CP shall provide the MTF with documentation for follow-ups performed outside the MTF as required by MTF policy. The Government will provide post-exposure tuberculosis testing at no charge to the CP when required (ex. following exposure to active TB case with in MTF) to avoid testing delays.

3.6. The Government will provide MTF ID badges which will be worn/displayed at all times while on duty.

3.7. The Government will furnish the CP with appropriate common use Personal Protective Equipment (PPE). The Government will be responsible for any repair, cleaning, and inventory required for the PPE. Items shall be used and returned as directed by the MTF.

3.8. The government will provide MTF/WHMC identification badges which will be worn/displayed at all times when in the MTF while on duty.

3.9. In-house pager. The CP shall use the communication device (pager) or other electronic device issued by MTF. The contractor shall be charged for negligent loss/damage of any such device by the CP.

3.10. The MTF shall furnish surgical scrubs and a physician’s coat if required by the position. These items will be cleaned at the MTF’s expense.

3.11. The MTF shall provide self-inking stamps in accordance with MTF policy, as required by the position.

3.12. Travel: Travel shall be IAW FAR 31.205-46.

3.12.1 CONTRACT PERSONNEL may be required to travel to locations or installations other than San Antonio, TX DoD MTF. The Government will schedule TDY requirements as far in advance as possible to allow the

Contractor to obtain the best travel rates. Whenever possible, TDY will be planned at least thirty (30) days in advance of the travel.

3.12.2. There is no required training that all CP must attend. However, the contractor may use the Travel CLIN to certify a CP in Fetal Ultrasound Procedures, if no other CP are certified.

3.12.3. The Government will reimburse authorized travel in accordance with the terms and conditions of this

Contract. The Joint Travel Regulation is not applicable to Contractor travel. However, the not-to-exceed travel costs identified by the JTR will be used as a cost ceiling that the Government will not exceed.

3.12.4. The Contractor will invoice the Government for the travel costs along with documentation to verify the expenses. This documentation will be similar to DoD requirements for reimbursing mileage or TDY.

4. APPENDICES.

APPENDIX A. Referenced Air Force Instructions, DoD Regulations, & Medical Wing Instructions APPENDIX B. Contract Specific Requirements Prior to Performance APPENDIX C. Historical Data from FY 2013 and 2014

APPENDIX A

REFERENCED AIR FORCE INSTRUCTIONS, DEPARTMENT OF DEFENSE REGULATIONS, AND MEDICAL WING INSTRUCTIONS

(Note: In all instances, most current version applies. Publications can be found electronically at http://www.dtic.mil or www.tricare.mil AFI 10-245, Antiterrorism, (Paragraphs 2.18 and Paragraph 2.25.)

AFI 31-101, Integrated Defense (FOUO) (Entire instruction applies)

AFI 31-401AFGM2, Information Security Program Management (Entire instruction applies)

AFI 31-501, Personnel Security Program Management (Entire instruction applies) AFI 33-200, Information Assurance Management, (Entire instruction applies)

AFI 33-203V1, Emission Security (EMSEC) (Entire instruction applies)

AFI 33-322, Records Management Program. (Paragraphs 1, 2 & 10)

AFI 44-119, Medical Quality Operations (Entire instruction applies)

AFI 48-105, Surveillance, Prevention and Control of Diseases and Conditions of Public Health or Military Significance. (Paragraph 1.10.10.)

AFI 71-101, Vol. I, Criminal Investigations. (Chapter 2, Paragraph 2.7.) (IAW 802 CONS & 802 SFS MOA)

AFI 71-101, Vol. 2, Protective Service Matters. (Paragraph 1.2) (IAW 802 CONS & 802 SFS MOA)

AFMAN 37-123, Management of Records, (Paragraph 7.4)

AFMAN 37-138, Records Disposition—Procedures and Responsibilities, (Paragraph 2.13) DoDI 3020.37, Continuation of Essential DoD Contractor Services During Crises (Entire instruction applies) Air Force Records Disposition Schedule. On the portal https://www.my.af.mil/gcss-af61a/afrims/afrims MDWI 41-101, Medical Expense & Performance Reporting System (MEPRS) for Fixed Military Medical & Dental Treatment Facilities. (Paragraph 1.12)

APPENDIX B

CONTRACT SPECIFIC REQUIREMENTS

PRIOR TO PERFORMANCE

WILFORD HALL AMBULATORY SURGICAL CENTER/59TH MDW

FAXED TO:__________________________FAX:__________________DATE:_____________

Contract Position: __________________________________________

Name:____________________________________________________

The following items are Contract Specific requirements provided by the CP prior to performance:

_______Pre-employment medical exam (no earlier than 45 days before start date)

_______Immunization Record

_______Varicella (Serologic evidence of immunity or documentation of 2-shot series)

_______Tdap (Documentation of tetanus/diphtheria vaccination within two (2) years or current Tdap vaccine.)

_______TB- 2 Step Testing or Neg. Chest X-Ray for Past Positive Tests (see screening criteria below)

Screening Criteria

Required Testing No Previous Documented TST result

Two-step baseline TST

Previous documented Neg TST >12 months before new employment

Two-step baseline TST

Previous documented Neg TST < 12 months before new employment

Single TST

> 2 previous documented Neg TST but most recent TST >12 months

Single TST

Previous documented Positive TST

Chest X-Ray (negative)

_______MMR (Serologic evidence of immunity or documentation of 2-shot series)

_______Hepatitis B (Serologic evidence of immunity or documentation of 3-shot series)

_______HIV (direct contact with patients or body fluids) (Frequency shall be based on exposure risk per hospital employee program)

_______Influenza (current series)

_______Drug Testing

_______Security Background Check ____SF 86 (If applicable) ____ State ____NAC

____LFC

Affidavit signed and dated by the CP. Copy of signed AF FM 2583 or Sentinel Key verification printout from a Security Manager.

_______Copy of license

_______Copy of certifications

_______Credentials package

All personnel performing service under this contract shall be required to in-process through the 59th MDW Medical Logistics Contract Personnel Office upon reporting for duty.

APPENDIX C

HISTORICAL DATA

FY13

FY14

*see explanation below.

Timeline

· October 2013 – All positions filled

· November 2013 – One vacant position

· December 2013 – Two vacant positions

· January 2013 – One vacant position, One filled 13 Jan

· February 2014 – Last open position filled 25 Feb

· March 2014 – One provider on emergency leave

· April – Provider returns as part time, sees patients twice a week The current contract was for 4 Full Time Equivalents (FTE). When there was contractor personnel turnover, the contractor had to advertise, interview, and submit a new candidate for credentialing and security clearance. The credentialing and security clearance process takes between 7 and 30 days. The clinic was not able to operate at maximum capacity and the historical appointments above are based on the number of providers available. In a monthly contract, the performance objective will be the number of patients seen, the actual need of the clinic. The contractor is able to staff however many FTEs they deem necessary without running out of hours on the contract. The contractor is responsible for staffing to meet the scheduled patient load, not to exceed 1,280 patients per month, even in the event of unexpected turnover. The monthly CLIN gives the contractor the flexibility to decide how best to do this, in any way that meets the requirement.