PWS-7 Aug 09.pdf

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Performance Work Statement

For

Medical Transcription Service

David Grant Medical Center

23 May 09

Revised 7 Aug 09

PERFORMANCE WORK STATEMENT (PWS)

FOR MEDICAL TRANSCRIPTION SERVICES

DAVID GRANT MEDICAL CENTER

1. Description of Services. The 60th Medical Group (60MDG) is a Department of Defense (DoD) TRICARE Regional Medical Center for 82,000 beneficiaries. It provides or arranges comprehensive community and referral health care, readiness, education, research, aeromedical staging and DoDN A Joint Venture. The objective of this service is to provide David Grant Medical Center, Travis Air Force Base with most accurate,,, cost-effective, timely, Joint Commission and Health Information Portability and Accountability Act (HIPAA) compliant and acceptable off-site medical transcription services. DGMC reports are comprised of specialized // vocabularies and encompass a variety of subjects in the field of medicine and surgery: ..

Vocabularies include but are not limited to: ambulatory care, anesthesiology, cardiology, dentistry, dermatology, drug and alcohol treatment, endocrinology, general medicine, gastroenterology, general surgery, geriatrics, gynecology, hematology, immunology, internal medicine, neurology, neurosurgery, nuclear medicine, oncology, ophthalmology, oral surgery, orthopedics, otolaryngology, otorhinolaryngology, pathology, psychiatry, psychology, plastic surgery, pulmonary, renal, rheumatology, spinal cord injury, thoracic surgery, transplant and urology

1.1. The contractor shall provide the management, supervision, personnel qualifications, skills and abilities, transportation, and other items and services necessary to perform medical transcription services dictated by DGMC healthcare providers as defined in this PWS. The contractor shall conform to the industry standards and follow all applicable instructions and directives as identified by the PWS. The terms, "must", "shall", and "will" denote mandatory actions in this PWS.

1.2. System. Dictated reports will reside on the Contractor's dictation system and a verification code will be provided at the time of dictation to retrieve reports. Contractor will ensure reports can be retrieved from a secure and encrypted website. Internet and websites will remain in compliance with HIPAA, DoD, and ,Air Force standards. The contractor will provide all necessary hardware and software, not currently owned by DGMC. Contractor shall pay for all connect/toll charges for dialing any and all DGMC provided phone numbers. The contractor shall notify the Inpatient Records Department, Quality Assurance Personnel (QAP) immediately of any equipment of connections that are not functioning properly and could adversely affect dictation or transcription.

1.3. Requirements.

1.3.1. The contractor shall provide off-site transcription service meeting the 24-clock hour turnaround time (TAT) requirement. Turnaround time is defined as the time between completion of the dictated report by the author and transmission of the report by the contractor.

1.3.2. Minimum Qualifications: The expectation is that the contractor has a stable workforce and will employ transcribers with sufficient education and training so that the objective of this

PWS is met. The contract should ensure at a minimum that employs have been trained and experience with medical terminology, anatomy and physiology, and completed a certified or approved transcription course.

1.3.3. Contract personnel shall be responsible for maintaining current transcription reference ./ material and any aforementioned regulations, laws, and/or policies.

1.4. Reports.

1.4.1 Report Quality. Each report must be of the highest professional quality to ensure at least 98% accuracy with respect to errors and legible. An error includes, but not limited to, medical word misuse, omitted dictation, misspellings, patient demographic, formatting, capitalization, punctuation, and minor style and grammar errors. Contractor will ensure any extra spaces have been deleted from each report.

1.4.2. TAT: TAT is the difference in time between the time the author hangs up at the conclusion of dictating into the dictation system, and the time the contractor's completed transcribed report are received at DGMC. The contractor shall type all dictated reports within 24-clock hours of the dictated time, including weekends and holidays. If failure to meet the 24-clock hour turnaround is due to circumstances beyond the contractor's control, the contractor will be expected to resolve backlog within a reasonable time agreed upon by the contractor and DGMC QAP. The contractor should expect to accomplish daily workload and 20% of backlog dictations on a daily basis until backlog dictations have been depleted.

1.4.2.1. Surges. During federal holidays, military deployments, minimal manning days and government system failures, workload may increase and/decrease by approximately 10%. The contractor will be required to maintain the standard, 24-clock hour TAT for completion of reports during normal workflow fluctuations.

1.4.2.2.Correcfed Reports TAT. Incorrect routine reports shall be corrected and retransmitted within four (4) hours of notification by DGMC QAP. STAT reports shall be corrected and retransmitted within one (1) hour of notifications by DGMC QAP. Corrected reports shall be flagged as corrected when transmitted.

1.4.3. Preparation and Report Formats:

1.4.3.1. Report TAT: The contractor will provide the date and time each report was dictated and transcribed.

1.4.3.2. Report Length. The length of each report shall vary according to the type of medical report required. The text is single spaced with double space between paragraphs and any excess spaces shall be deleted. No report shall include any text other than what was dictated; except for formatting as instructed by DGMC, comments or questions concerning a report must be sent as separate correspondence referencing the dictation system reference number.

1.4.3.3. Formatting Information. The contractor shall ensure all headers and footer information complies with DGMC standards as listed below (Appendix E):

1.4.3.3.1. Header Information. Each document shall include the specified header conforming to the standard provided by DOMC for specified type of document. This header includes the document type, date of exam, author, dictation date, and attending physician, when dictated.

Contractor shall delete any blanks spaces.

1.4.3.3.2. Footer Information. Each document shall include the specified footer conforming to the standard provided by DOMC for specified type of document (see Appendix E). The footer includes type of report which will be marked by the contractor, patients name, sex, unit, dictation date, and date typed, when dictated. If the report has multiple pages, the lines from the Footer on the first page can be counted for invoicing. Since the Footer from the first page will automatically transfer to the additional pages, those lines will not be counted.

1.4.3.3.3. Additional Information. The contractor shall type one-line two spaces below the end of the body the provider's signature block. The contractor shall type one-line below the signature block, report demographics and transcribers initials. (See Appendix E)

1.4.4. Monthly Workload Reports. Contractor will provide to the DOMC QAP a daily report of transcriptions sent to DOMC. This report will include report identification, number of lines, author, and line count. The contractor will provide to DOMC a monthly report of transcribed reports sent to DOMC for the respected month in which workload was completed to include the date and time the report was dictated, transcribed and sent.

1.5. Quality Control Program. The contractor is responsible for the quality of services under the terms of this contract. To ensure that requirements are met, the contractor shall implement an effective, economical quality control program to indentify, prevent, and insure non-recurrence of effective services and satisfactory performance of objectives listed in the Service Delivery Summary (SDS) are achieved. The contactor shall provide a copy of its quality control procedures to the government within 30 days of contract start date.

2. Service Delivery Summary. The service requirements are summarized into performance objectives that relate directly to mission essential items. The performance threshold 'briefly describes the minimum acceptable levels of service required for each requirement. The thresholds are critical to mission success and the percentages shown indicate acceptable (satisfactory) performance.

Performance Objective PWS Performance Method of Section/Para # Threshold Surveillance

All transcribed reports must 1.4.1 98% Review each report that meet the quality standard received for legibility requirements of legibility and and accuracy.

accuracy.

Transcribe reports within 24- 1.4.2 100% Monitor when report hours at the time of dictation. was dictated and received.

Provide monthly/calendar 1.4.4 100% Review monthly and year productivity reports. calendar year productivity reports.

Performance Objective 1 comprises 45% of monthly pricing.

Performance Objective 2 comprises 45% of monthly pricing.

Performance Objective 3 comprises 10% of monthly pricing.

2.1. Reduction in Price. Basic computation for reduction in the monthly price will be a function of the percentage of the non-performance/failed service as compared to the amount of the monthly invoice. Amounts reflected below are the methods that will be used to compute reductions. For Example, if the contractor failed to provide 4% of the required monthly services in accordance with the performance objective the following describes how to calculate a price reduction.

Example: Monthly estimated price for all inpatient medical transcription requirements is $20,000.00. (pricing example only!) Requirements to provide a performance objective 1 and performance objective 2 represents a combined total of 90% of the monthly price $18,000 Contractor failed to perform 4% of the required services, reduce monthly invoice by $720.00 ($18,000 x 4% = 720.00)

3. Reserved

4. General Information:

4.1. Security Requirements. All personnel employed by the contractor in the performance of this contract, or ,any representative of the contractor entering the governmental installation, shall / abide by all security regulations of the installation. Although this service shall be performed off-site, the following security requirements must be included in the event contractor enters Travis AFB for any reason pertaining to this contract.

4.1.1 Base Access. The contractor shall obtain personal identification photo passes for all employees and vehicle passes for all contractor and personal vehicles requiring entry onto Travis

AFB from Security Forces Pass and Registration, for the duration of the contract. Vehicle registration, proof of insurance and a valid driver's license must be presented for all vehicles to be registered. During Force Protection Condition (FPCON) of Normal and Alpha, personnel without base issued identification shall be sponsored onto the installation. During FPCON Bravo, Charlie and Delta, personnel without base issued identification shall be physically escorted onto the installation. Contractor shall require a Department of Justice (DOJ) or equivalent (i.e. Avert) background check for all personnel and subcontracting personnel requiring entry onto Travis AFB in performance of this contract. DOJ background check(s) to be initiated no later than 5 days after the contract start date. Continued employment is contingent upon successful completion of the background check. The results of the background checks will be submitted to the 60th Security Forces Squadron, 60 SFS/SFOXI, 510 Airlift Drive Bldg. 381, and Mr. 103, Travis AFB, CA 94535, (707) 424-3770 or 3499. During Higher FPCONs (Charlie and Delta) access by non-essential contractors may not be authorized or at least limited.

4.1.2. Criminal Convictions. Only criminal convictions will be considered in determining an applicant's suitability for employment. Detention and/or arrest without conviction do not constitute valid grounds for employment decisions and cannot playa part in the decision-making process. In determining the applicant's suitability for employment where the applicant has a criminal conviction on their record, consideration will be given to the specific duties of the position, the number of offenses and circumstances of each, the age of the conviction(s), and the accuracy of the explanation on the application. In instances where information is obtained that would appear to make the candidate a poor risk for hire, Security Forces can provide guidance and a recommendation to the hiring au~hority. The Fair Credit Reporting Act (FCRA) provides that written notice and the name of the criminal check agency be given to individuals when employment is denied.

4.2. Contractor Point of Contact: The contractor shall provide a point of contact (POC) and alternate(s) that shall be responsible for ensuring that the contract services are provided satisfactorily. The POC and alternate(s) shall be designated in writing to the contracting officer / within five days of contract award date. T~e contractor POC and alternate(s) shall have full / authority to act for the contractor on all contract matters relating to daily operation of this contract. The POC will conduct professional as-needed meetings with MTF staff members to discuss any issues and concerns.; teleconference is acceptable. It is preferred to have a POC available during normal duty hours M-F 0730-1630.

4.3. Contractor Employees:

4.3.1. The contractor shall not employ persons, for work on this contract, if such employee is / identified to the contractor by the contracting officer as a potential threat to the health, safety, security, general well being or operational mission of the installation and/or its population.

4.3.2. The contractor shall not employ any person who is an employee of the U.S. Government if employing that person would create a conflict of interest. Additionally, the contractor shall not employ any person who is an employee of the Department of the Air Force, either military or civilian, unless such person seeks and receives approval according to DOD 5500.7-R, the Joint Ethics Regulation (JER). The contractor shall not employ any person who is an employee of the

Department of the Air Force if such employment would be contrary to the policies in Air Force Instruction (AFI) 64-106.

4.3.3. The contractor is cautioned that off-duty active military personnel hired under this contract may be subject to permanent change of station, exchange in duty hours, or deployment.

Military Reservists and National Guard members may be subject to recall to active duty. The abrupt absences of these personnel could adversely affect the contractor's ability to perform;

however, their absence at any time shall not constitute an excuse for nonperformance under this contract.

4.4. Records Management. The contractor shall comply with the Privacy Act of 1974 (the Act) and AFI 33-332, the Air Force Privacy Act Program and the agency rules and regulations issued under the Act in the design, development operation of any system of records. Operation of a system means performance of any of the activities associated with maintaining the system of records, including the collection, use and dissemination of personal information. Systems of Records on individuals are defined as a group of any records under the control of an agency from which information is retrieved by the name of the individual or by some identifying number, symbol or other identification unique to the individual.

.4.4.1. The contractor shall comply with AFI 33-322, Records Management Program, paragraph 10 and DoD Regulation 5400_7 Air Force Supplement, Freedom of Information Act.

Disposition of records shall be in accordance with Air Force Records Information Management System (AFRIMS) schedule found at http://www.my.af.mil/gcss-af61a/afrims/afrims/ or use the Portal A-Z Applications List to locate the AFRIMS link. The Quality Assurance Evaluator (QAE) will review all records, paper and electronic, to ensure requirements of the Records Management Program, Freedom ofInformation Act Program, and Privacy Act Program, are met.

4.4.2. All records generated during the performance of the contract are considered Government records and shall be turned over to the Government upon termination of the contract.

4.4.3. Records are considered to be all books, papers, maps, photographs, machine-readable materials or other documentary materials, regardless of physical form or characteristics, made or received by any agency of the Government under federal laws, or in connection with the transactions of public business, and preserved or appropriate for preservation by any agency, or its legitimate successor, as evidence of the organization, functions, policies, decisions, procedures, operations or other activities of the Government or because of the informational value of data in them. This includes all electronic records, which must meet the requirements of

DOD STD 5015.2.

4.4.4. FOR OFFICIAL USE ONLY (FOUO). The contractor shall create and Maintain FOUO material IAW DoD 5400-7,R, DoD Freedom of Information Act Program, Chapter 4, AFI 33-129, Transmission of Information Via the Internet, paragraphs 7.4, 8.23, 16 and 17; and AFI 33-201, Communications Security (COMSEC), Table 1. Mark all documents meeting the requirements identified in DoD Regulation 5400.7/Air Force Supplement, paragraphs C3.2.1.2 thru C3.2.1.9 as "For Official Use Only" lAW instructions identified in paragraph C4.2.1.

Safeguard all sensitive data lAW DoD Regulation 5400.7/Air Force Supplement, paragraph http://www.my.af.mil/gcss-af61a/afrims/afrims/

C4.4. When documents containing FOUO material are authorized for destruction, shred the records so that the pieces cannot be reconstructed. Degauss or overwrite magnetic tapes or other magnetic media. Proper records maintenance and disposition shall be lAW with the Records Disposition Schedule available on the AFRIMS website at https://afrims.amc.af.mil

4.4.5. Patient Lists: Patient lists, no matter how developed, shall be treated as privileged information. Add the following to the bottom of all patient lists:, "FOR OFFICIAL USE ONLY." This document contains information exempt from mandatory disclosure under the Freedom of Information Act (FOIA), Title 5 U.S.C 552(b)(2) High and (b)(6) apply." Lists and/or names of patients shall not be disclosed or revealed in any way for any use outside the MTF without prior written permission by the Chief of Hospital Services.

4.4.6. DoD Freedom of Information Act (FOIA) Program. If the contractor receives a FOIA request the contractor shall immediately hand-carry it to the base FOIA manager for processing.

The FOIA manager will task a Government official. When tasked, the contractor shall be responsible for searching for the records and providing those records to a Government official who, as the authorized official, will make the decision on releasing Government records.

4.4.7. Functional Requests. A written request for DoD records that does not cite either the FOIA or Privacy Act may be received from any person (including a member of the public), or organization, or a business. The contractor shall be responsible for searching for the records and providing those records to a Government official who, as the authorized official, will make the decision on releasing Government records.

4.5. HEALTH INSURANCE PORTABILITY AND ACCOUNT ABILITY ACT (HIP AA) I

MAINTENANCE OF PATIENT PRIVACY

HIPAA is comprised of several different sections, each to be implemented by the Dept. of Health and Human Services. The medical facilities of the military services and the DOD health plans are specifically listed as covered by HIPAA. Currently, HIPAA Privacy and Security Rules, as set forth in the Code of Federal Regulations, are in effect for all MTFs. The specific implementation of HIPAA Privacy for DOD medical facilities is set forth in DOD 6025.18- R, andfor HIPAA Security, the requirements for AF MTFs are contained in DOD 8580.02-R and AFI 41-217, which also contains additional Information Assurance requirements for all AF MTFs. DOD 6025. 18-R, DOD 8580.02-R and AFI 41-217 are incorporated herein by reference. MTFs are responsible to insure overall compliance with HIPAA requirements, which includes incorporation of certain requirements in contracts entered or amended after the respective implementation dates.

IA W these regulations, the Contractor and its employees meet the definition of Business Associates. Therefore, a Business Associate Agreement is required by law to comply with both the HIPAA Privacy and Security regulations. This clause serves as that agreement for each MTF, whereby the Contractor and its employees agree to abide by all HIPAA Privacy and Security requirements regarding health information as defined in this clause, DoD 6025-18-R, DOD 8520.02-R and AFI 41-217. Additional HIPAA requirements will be addressed when implemented.

Introduction:

(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, DOD 8520.02-R or

AFI41-217.

Individual has the same meaning as the term "individual" in 45 CFR 164.50 1 and 164.103 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 164.501, limited to the information created or received by The Contractor from or on behalf of the Government.

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 164.501 and 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 Agreement 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 agrees to 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 agrees to 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 agrees 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 Contract.

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

(g) The Contractor agrees to 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 of.

(h) The Contractor agrees to 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 agrees to 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.

G) The Contractor agrees to provide access, at the request of the Government, and in the time and manner 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 agrees to 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 or an Individual, and in the time and manner designated by the Government.

(1) The Contractor agrees to 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 designated by the 'Government or the Secretary, for purposes of the Secretary determining the Government's compliance with the Privacy Rule.

(m) The Contractor agrees to 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 agrees to provide to the Government or an Individual, in time and manner 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:

(a) Except as otherwise limited in this Agreement, 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, DOD 6025.18-R, the HIPAA Security Rule, or DOD 8580.02- R if done by the Government.

Specific Use and Disclosure Provisions:

(a) Except as otherwise limited in this Agreement, 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 Agreement, 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 Agreement, 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 164.5020)(1).

Obligations of the Government:

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

(a) Upon request the Government shall provide the Contractor with the notice of privacy practices that the Government produces in accordance with 45 CFR 164.520, as well as any changes to such notice.

(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, DOD 6025.18R, the HIPAA Security Rule, or 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 provlSlons 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, HIPAA Privacy Regulation or DOD 8580.02-R, HIPAA Security Regulation, or any CFR or AFI provision means the section as 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.l8-R, the CFR HIPAA Privacy Rule, DOD 8520.02-R, the CFR HIPAA Security Rule and AFI 41-217.

5. Appendices

Appendix A

Work Load Estimates (Historic)

A. Contract Workload: Number of reports transcribed per month.

Fiscal Year Jan 2006 356

2007 425

2008 354

Feb

Mar Apr 448 465

429 399

250 500

May Jun 359 385

394 339

380 607

Jul

Aug Sep 417 373

419 399

507 434

Oct

Nov Dec 405 356

404 370

409 442

Total Line Count

FY06: 847,235,

FY07: 845,712

FY08: 965,142 /

B. Surges/Delays: During federal holidays, military deployments, minimal manning day and Government system failures, workload may fluctuate (decrease or increase) by approximately 10%. If unable to meet standards due to circumstances beyond contractor's control, contractor is expected to catch up with the workload within a reasonable amount of time as defined by the amount of backlog. Contractor will coordinate with QAP to identify reasonable timeline.

Health and Physical Summary Death Summary Progress Note Medical Evaluation Board Narrative Summary Consultations Tissue (Radiation Therapy) Transfer Summary Operation Report All STAT dictation

Appendix B

Turnaround Time (TAT)

24 hours 24 hours 24 hours 24 hours 24 hours 24 hours 24 hours 24 hours 24 hours 4 hours

Note: Copy of templates will be provided upon approval of contract.

Appendix C

Standard Abbreviations / DoD: Defense of Department DGMC: David Grant Medical Center: Military medical facility at Travis AFB PWS: Performance Work Statement TAT: Tum-around-Time QAP: Quality Assurance Personnel

Appendix D

Applicable Instructions, Directives and Regulations

./DEPARTMENT OF DEFENSE and AIR FORCE PUBLICATIONS:

Publications and templates applicable to this PWS are listed below, and are mandatory. The contractor shall follow those publications coded as mandatory to the. extent (that is, the specific / procedure in a paragraph, section, chapter or volume) specified, to meet requirements in this PWS. Applicable publications are located at http://www.e-publishing.af.mil/pubs. The Government may issue supplements or amendments to listed publications from any organizational level during the life of the contract. The contractor shall keep all issued publications up-to-date. The contractor shall immediately implement those changes in publications that result in a decrease or no change in the contract price. Before implementing any such revision, supplement, or amendment that will result in an increase in contract price, the contractor shall submit to the contracting officer a price proposal for approval. Price proposals shall be submitted within 30 calendar days from the date the contractor receives notice of the revision, supplement, or amendment-giving rise to the increase in cost of performance. The Government and the contractor will negotiate the changes into the contract under provisions of the Changes clause. The Government will continue to supply the Government templates needed for daily operations, by electronic means using Microsoft Word. Upon completion of the contract, the contractor shall return to the Government all issued publications and unused templates.

DoDI3020.37 Continuation of Essential DOD Contractor Services During Crises

Air Force Sup DoD Freedom of Information Act DoDR 6025.18-R Health Information Privacy Regulation DOD 5200.2-12 Personnel Security Program AFI 33-332 Air Force Privacy Act Information AFI41-210 Patient Administration Functions Air Force Systems Security Instruction (AFSSI) 5027

Number

DoD 5400.7-R/AF SUP

Title of Directive

DoD Freedom of Information Act

Para/Chapter

Chapter 4, Para,CA.4, 3.2.1.2 All

All All All All All All

OTHER DIRECTIVES:

MDGI 48-10 Employee Health Program All MDGI 44-96 Standard Abbreviations, Acronyms, and Symbols All Privacy Act Systems of Records Notice(s) at http://www.defenselink.mil/privacy/notices/usaf http://www.e-publishing.af.mil/pubs.

http://www.defenselink.mil/privacy/notices/usaf

Appendix E

Example Templates

Continued on pages 19-27

Note: Original templates will be forwarded as separate documents.

'I

EXAMPLE EXAMPLE EXAMPLE EXAMPLE EXAMPLE

MEDICAL RECORD

Date of Pre-op

HISTORY AND PHYSICAL

Date of Operation

(CLINICAL RESUME)

Dictated by:

CHIEF COMPLAINT:

HISTORY AND PRESENT ILLNESS:

PAST MEDICAL HISTORY:

PAST SURGICAL HISTORY:

ALLERGIES:

MEDICINES:

SOCIAL HISTORY:

PHYSICAL EXAMINA nON:

GENERAL:

IMAGING:

IMPRESSION:

PLAN:

Physician Information

XXX-XXXX-XX-XX-XXXXXX-XXX

(Example:XXX (Patient Initials: Last, First1 Middle-Last 4 ofSSN-PAT CAT-Report Type-Month, Day, Year-Transcribers Initials: AAA-1234-20-HP-Ol 0109-BBB)

HISTORY & PHYSiCAl EllAMlIlAnOI 0 OPERAnDI REPORT 1lAME:

ISF 504. SF 505 & SF 5061 ISF5161

COISULTAnOI SHED 0 IARRATM SUMMARY REGISTER 10.

ISF5131 ISF5021

CHROI! RECORD OFMmlCAl CARE ISF 6001 0 AUTOPSY PROTOCOL UIIT

UAVIUGM USAf MmlCAl CEITER TRAVIS ISF5031 PROGRESS Ion ISF 5091 DAnDIer DAnTYpm

5-115-102 MmlCAl RECORD REPORT---

OrnOllAllllBMS 215 n2-m

_brGlll ••••1C11B

MEDICAL RECORD

Date of Admission

DEATH SUMMARY

Date of Death

(CLINICAL RESUME)

Dictated by:

DATE OF BIRTH:

ATTENDING PHYSICIAN:

ADMITTING DIAGNOSIS:

CAUSE OF DEATH:

ADMITTING HISTORY AND PHYSICAL:

PAST MEDICAL HISTORY:

PAST SURGICAL HISTORY:

SOCIAL HISTORY:

ALLERGIES:

ADMISSION MEDICA nONS:

ADMISSION PHYSICAL EXAMINA nON:

ADMISSION LABS:

ADMISSION STUDIES:

ASSESSMENT AND PLAN:

HOSPITAL COURSE:

PROCEDURES:

DISPOSITION:

FINAL DIAGNOSIS:

Physician Information

XXX-XXXX-XX-XX-XXXXXX-XXX

(Example:XXX (Patient Initials: Last, First, Middle-Last 4 ofSSN-PAT CAT-Report Type-Month, Day, Year-Transcribers Initials: AAA-1234-20-HP-Ol 0109-BBB)

HISTORY&PHYSiCAlEllAMlNAnOI 0 OPERAnDI REPORT IlAME:

!SF 5114,SF505 &SF 5061 [SF 5161

CONSUlTAnOMSIIHT 0 NARUTJVESUMMARY REGISTER10.

1SF5131 1SF5021

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Date of Visit

PROGRESS NOTE (CLINICAL RESUME)

Dictated by:

Physician Infonnation

XXX-XXXX-XX-XX-XXXXXX-XXX

(Example:XXX (Patient Initials: Last, First, Middle-Last 4 ofSSN-PAT CAT-Report Type-Month, Day, Year-Transcribers Initials: AAA-1234-20-HP-OIOI09-BBB)

MEDICAL RECORD MEDICAL EVALUATION BOARD SUMMARY

Dictated by:

(CLINICAL RESUME)

CHIEF COMPLAINT:

HISTORY OF PRESENT ILLNESS:

PAST MEDICAL HISTORY:

REVIEW OF SYMPTOMS:

PERTINENT FAMILY HISTORY:

PHYSICAL EXAMINATION:

LABORATORY:

OFFICE NOTE:

RADIOLOGY:

HOSPITAL COURSE:

CONSULTATIONS:

OPEATIONS AND PROCEDURES:

WORLD-WIDE QUALIFIED:

LINE OF DUTY:

FINAL DIAGNOSIS:

RECOMMENDATIONS:

DUTY AFSC:

LENGTH OF SERVICE:

Physician Signature Block xxx-xxxx-xx-xx-xxxxxx-xxx Example:XXX (Patient Initials: Last, First, Middle-Last 4 of SSN-PAT CAT-Report Type-Month, Day, Year-

Transcribers Initials: AAA-1234-20-HP-010109-BBB)

HISTORY&PHYSICAlElIAMlllAnOI D OPERAnOI REPORT IIAMl:

ISf 504, Sf 505 &Sf 5061 1Sf5161 COllSUlTAnOISHHT D IlABRATM SUMMARY REGISYlIIIG.

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COlIIPuter Generated Form Prescribed by GSAand lCI

Date of Admission

PREADMISSION DIAGNOSIS:

PROCEDU RES/OPE RATIONS:

PHYSICIANS:

HISTORY OF THE PRESENT ILLNESS:

PERTTINENT LABORATORY/RADIOLOGY:

PAST MEDICAL HISTORY:

PAST SURGICAL HISTORY:

SOCIAL HISTORY:

ALLERGIES:

MEDICATIONS:

HOSPITAL COURSE:

FOLLOW-UP:

DISCHARGE DIAGNOSES:

DISCHARGE INSTRUCTIONS:

DISCHARGE MEDICATIONS:

Physician Information

NARRATIVE SUMMARY

Date of Discharge

(CLINICAL RESUME)

Dictated by:

xxx-xxxx-xx-xx-xxxxxx-xxx (Example:XXX (Patient Initials: Last, First, Middle-Last 4 of SSN-PAT CAT-Report Type-Month, Day, Year-

Transcribers Initials: AAA-1234-20-HP-010109-BBB)

HISTORY& PHYSiCAlEllAMINAnllll 0 OPlRAnON REPORT NAME:

ISf5OUf50hSf50&1 1Sf51&1

CONSUITlnON SIlIlT 0 NARRATIVESUMMARY RlGISTEIINO.

lSf5131 lSf5021

CHRONRlCOROOFMmlCAl CARl [SF&081 0 AUTOPSYPRDnlCOI UNIT

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CIllqluter Generated form PresaIbed br GSAand lCB

MEDICAL RECORD CONSULTATION SHEET

TO: FROM: DATE OF REQUEST:

REASON FOR REQUEST:

PROVISIONAL DIAGNOSIS:

REFERRING PROVIDER: APPROVED: PLACE OF CONSULTATION:

CHIEFCOMPLAINT:

HISTORYAND PRESENTILLNESS:

PASTMEDICAL HISTORY:

PASTSURGICALHISTORY:

MEDICATIONS:

ALLERGIES:

SOCIAL HISTORY/HABITS:

PHYSICALEXAMINATION:

IMPRESSION:

PLAN:

Physician Information xxx-xxxx-xx-xx-xxxxxx-xxx (Example:XXX (Patient Initials: Last, First, Middle-Last 4 of SSN-PATCAT-Report Type-Month, Day, Year-

Transcribers Initials: AAA-1234-20-HP-010109-BBB)

HISTORY&PIIYSlCAl EllAMlllAnON [J OPERAnON RlPORT IIAME:

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5-21lt-102 MEDiCAl RECOROREPORT emollAl fORMS 215 02.n

MEDICAL RECORD RADIATION THERAPY SUMMARY

DIAGNOSIS: SEX: RACE: AGE: DATE OF REQUEST:

DIAGNOSIS:

STAGE:

BRIEFCLINICAL HISTORY:

PLAN OF TREATMENT:

DATESOF TREATMENT:

TUMOR DOSESUMMARY:

RESPONSE:

TOLERANCE:

DISPOSITION:

Physician Information xxx-xxxx-xx-xx-xxxxxx-xxx (Example:XXX (Patient Initials: Last, First, Middle-Last 4 of SSN-PATCAT-Report Type-Month, Day, Year-

Transcribers Initials: AAA-1234-20-HP-010109-BBB)

HISTORY& PIIYSICAl EXAMINATION 0 OPERATIONRIPORY IIAME:

!SF 504. SF 505 & SF 5061 !SF 51&1

COIISUlT.TlON SHEET 0 IlARRATM SUMMARY RlGIS1IIIIIO.

!SF 5131 !SF5021

cnON RlCORD OFMmlCAl CARE!SF &t01 0 AUTOPSYPROTOCOl UNIT

DAVIDGRAIITDSAf MmICAl CEIITBITRAVISAFB. !SF5D3J PROGRESSlion !SF 5091 DARDICT

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Date of Admission:

TRANSFER SUMMARY

Date of Transfer:

(CLINICAL RESUME)

Dictated by:

ATTENDING PHYSICIAN:

RESIDENT:

INTERNS:

PROCEDURES/STUDIES:

HISTORY AND PRESENT ILLNESS:

PAST MEDICAL HISTORY:

PHYSICAL EXAMINATION:

DIAGNOSTIC STUDIES:

HOSPITAL COURSE:

CONDITION ON DISCHARGE:

DISCHARGE MEDICATION:

DICHARGE INSTRUCTIONS:

Physician Information

XXX-xxxx-xx-xx-xxxxxx-xxx (Example:XXX (Patient Initials: Last, First, Middle-Last 4 ofSSN-PAT CAT-Report Type- Month, Day, Year-Transcribers Initials: AAA-1234-20-HP-OIOI09-BBB)

HISTORY& PllYSlCAl UAMINAnON D

ISf 504. Sf 505 &SF 5061 CONSULTAnONSHIll D

1Sf5131 CDON RICaRD OFMmlCAl CABlISf &Om D

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5-215-102 opwnON REPORT

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NARRATIVESUMMARY

1Sf5021

AUT8PSY PROTOCOL

1Sf5031

NAME:

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UNIT

DAnDICT

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MEDICAL RECORD OPERATION REPORT

Preoperative Diagnosis:

Surgeon: First Assistant: Second Assistant:

Anesthetist: Anesthesia: See AF Form 1864

Circulating Nurse: Instrument Nurse: See AF Form 1864 for surgery beginning and ending time

Operative Diagnosis: Drains: (Kind & NO.) Sponge Count Verified Correct

Material Forwarded to Laboratory for Examination:

Operation Performed:

Major: I Minor: I Date of Operation:

DESCRIPTIONOF DIAGNOSIS:

STAFF:

EBl:

INDICATIONS:

SPECIMENS:

PROCEDUREIN DETAIL:

Physician Information

XXX-XXXX-XX-XX-XXXXXX-XXX

(Example:XXX (Patient Initials: last, First, Middle-last 4 of SSN-PATCAT-Report Type-Month, Day, Year-

Transcribers Initials: AAA-1234-20-HP-010109-BBB)

HISTORY& PllYSlCAl UAMlllAnOI 0 OPERAnOI REPORT NAME:

ISf 504, SF505 & SF 50&1 1Sf5161 COllSUlTAnOI SHEET 0 IARU1IVE SUMMARY REGISTEIIN'.

ISF5131 1SF5021

CHRONRECORDOFMmlCAl CAllEISF 6001 0 AUTOPSYPROTOCOl UIIT

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