J_03 Medical Statement.docx
DOCX document 23 KB Posted
- Attached to
- ManliftS MX
- Solicitation number
- FA448426R0003
About this file
This is a medical statement template that will be included in all solicitations, awards, task orders, delivery orders, and calls with performance at Joint Base Andrews (JBMDL). The statement establishes protocols for urgent medical care provided by the 87th Medical Treatment Facility (MTF) to contractor employees or agents who sustain injuries while on duty.
The statement defines urgent health care as medical treatment authorized to the extent necessary to save life or limb and prevent undue pain and suffering. Contractor employees receiving such care will be transferred to civilian medical facilities once appropriately stabilized. All treatment costs will be the responsibility of the contractor or the contractor's employee and will not be borne by the 87th MTF, United States Air Force, or the government. Billing is processed based on services documented on Air Force Form 552 (Pre-Hospital Evaluation Patient Care Report). If a contractor employee cannot pay at the time of billing, a statement of charges and letter of indebtedness will be issued. Contractor employees and agents are required to provide timely notice to their medical insurance companies and furnish adequate information and documentation to facilitate insurance payment for services rendered.
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Text version
The following statement will be placed in all solicitations/awards/TOs/DOs/calls with performance on JBMDL:
“The 87th Medical Treatment Facility (MTF) may provide urgent health care to any contractor employees or agents for injuries occurring while on duty. Urgent health care is defined as medical care authorized to the extent necessary to save life or limb and prevent undue pain and suffering. Contractor employees will be transferred to a civilian medical facility as soon as they are appropriately stabilized. The cost of such treatment will be paid for, in full, within a reasonable period of time (as determined with/by the Base Legal Office's assistance), by the contractor or the contractor's employee and will not be borne by the 87th MTF, the United States Air Force or the government. Billing/accounts receivable is processed based on services provided, which is captured on an Air Force FORM 552 (Pre-Hospital Evaluation Patient Care Report). If a contractor employee or agent cannot pay for the treatment at the time the bill is rendered, a statement of charges and a letter of indebtedness will be completed and billed to such contractor employee for medical services rendered. Contractor employee or agents shall ensure they provide timely notice to their medical insurance company and to the extent an insurance company is to make payment, provide the insurance company with adequate information and documentation necessary to make payment."
File details come from the government source that posted it. Updated .