PWS_-_CATC_FBO_3.10.16.pdf

Performance Work Statement Civilian Air Traffic Control Specialist Medical Examinations

March ARB, California 9 January 2016

1.0. Introduction. Civilian Air Traffic Control Specialist (ATCS) Medical Examinations.

1.1. Scope. This contract will serve as a vehicle to provide certified physicians who can perform health assessments and medical examinations required by a specialized group of Department of Defense (DoD) civilian workers, “Air Traffic Control Specialists,” at March Air Reserve Base, CA. The frequency, scope, and applicability of the occupational health and medical examination will be determined by the Office of Personnel Management (OPM) Medical Standards and documented on applicable forms as indicated throughout this Performance Work Statement

(PWS).

1.2. Non-Personal Services. The services performed under this contract will be non-personal services and are not inherently governmental. The prime contractor’s staff, including all teaming partners, subcontractors, and their staff at the corporate level involved in the company’s or team’s administration of this contract, will hereafter be referred to as “contractor management staff.” The prime contractor retains responsibility for any teaming partner or subcontractor and will be accountable for their performance. The contractor management staff will provide all tools, labor, and materials required to recruit, qualify, train, place, manage, and retain the medical support services supporting healthcare operations for the Air Force in accordance with the terms and conditions of this contract.

1.3. Definitions.

Authorized Agency is/are an agency’s points of contact that are authorized to make appointments with the contractor. Those agencies are:

452 AMDS 452d Aerospace Medical Squadron 452 OSS/OSAB 452d Operations Support Squadron (Air Traffic Manager)

Contractor is a term used in this contract which refers to the prime medical services contractor.

Contracting Officer is a person with authority to enter into, administer or terminate contracts, and make related determinations and findings on behalf of the Government. Note: The only individual who can legally bind the Government.

Contracting Officer’s Representative (COR) is a person designated by the Contracting Officer as their representative whom manages the contract within its intended scope, terms, and conditions. Note: The COR does not have the authority to legally bind the Government.

Medical Surveillance Examination (MSE) is identified as pre-placement, periodic/annual, special purpose, termination, and fitness-for-duty examinations. Examinations are to be performed to assess the health status of individuals as it relates to their workplace assigned duties and/or essential job tasks.

Pre-placement examinations are tests and examinations accomplished to establish and document baseline medical status and capability required for specific job tasks and for future use in the evaluation of occupational health hazards from the workplace. These examinations are identified and directed by civilian personnel representatives and performed in accordance with federal directives to assess the health status of employees as it relates to the specific jobs they are applying for. (U.S. Office of Personnel Management Classification & Qualifications – General Schedule Qualifications Standards, Air Traffic Control Series, 2152, Medical Requirements:

Initial Employment)1

Periodic/Annual Examinations are scheduled and performed annually thereafter. Annual medical examinations are performed to assess the health status and to re-qualify individual for employment as directed in the U.S. Office of Personnel Management Classification & Qualifications General Schedule Qualifications Standards, Air Traffic Control Series, 2152, Retention Requirements.2

Special Purpose Examinations are physical examinations given when an employee is exposed to a workplace hazard (environmental, chemical, biological or radiological) during an incident or accident.

Termination Examinations are tests and examinations that are accomplished to establish and document the health of employees at termination of employment.

Fitness-for-Duty Examinations are performed after an ATCS incurs an illness, injury, or incapacitation, at any time, between annual examinations. They must be medically cleared before returning to duty. If required, laboratory tests and consultations will be accomplished to determine medical clearance for continued duties and/or essential job tasks.

Principal Technical Contact for Medical Contractor. 452 Medical Group (452 MDG) representative will serve as the principal technical/medical contact with the medical contractor.

The 452 MDG representative will provide advice and assistance, in concert with a Civilian Personnel representative, to the medical contractor in the application of policies, procedures, and clarification of official directives requirements.

1.4. Acronyms.

AFI Air Force Instruction CLIN Contract Line Item Number DD Department Defense DoD Department of Defense ECG Electrocardiogram ENT Ear Nose Throat FAA Federal Aviation Administration FSS/FSMC Civilian Personnel

1 https://www.opm.gov/policy-data-oversight/classification-qualifications/general-schedule-qualification-standards/2100/air-traffic-control-series-2152/ 2 https://www.opm.gov/policy-data-oversight/classification-qualifications/general-schedule-qualification-standards/2100/air-traffic-control-series-2152/

HIPAA Health Insurance Portability and Accountability Act IRAPT Invoicing, Receipt, Acceptance, and Property Transfer OF Optional Form OPM U.S. Office of Personnel Management PPE Personal Protective Equipment PTS Permanent Threshold Shift PWS Performance Work Statement SF Standard Form STD Standard STS Standard Threshold Shift USAF United States Air Force WAWF Wide Area Work Flow

2.0. General Requirements. The contractor will ensure that medical services are performed by medical personnel that are licensed as directed under this contract.

2.1. Qualifications. The physician who provides medical services under this contract shall possess a current license to practice medicine in California, must have graduated from an accredited medical school and have completed a residency program approved by the Council on Medical Education and Hospitals, and have a current Aviation Medical Examiner’s (AME) certification and be qualified to perform Federal Aviation Administration (FAA) medical examinations.

2.2. Audiograms. Audiograms must be administered by an individual certified by the Council of Accreditation on Occupational Hearing Conservation (CAOHC). Technicians who perform audiograms must be responsible to an audiologist or physician.

2.3. Validation of Qualifications, Licensure and Certification (as applicable). The contractor shall provide written verification (and photocopies where necessary) showing licensor, board certification, hospital affiliation, and provide a statement of health to the 452 AMDS via contracting officer within 10 calendar days after contract award and prior to performing services of this contract. When a change in medical professional personnel is anticipated, the contractor shall provide the contracting office representative the same documentation for any replacement personnel as for original providers at least three weeks prior to the change taking place. Review by 452 AMDS representative or designee, prior to contract award or change in contract personnel is required under this contract.

2.4. HIPAA. All contracted management staff performing services for the Air Force have been trained and/or familiar with HIPAA Privacy & Security Rule and will be held accountable for complying with health information privacy and security policies and procedures. Reference HIPAA of 1996 for detailed language.

3.0. Description of Services.

3.1. Performance. The contractor will provide all personnel, equipment, materials, and facilities necessary to perform required tests and procedures to complete designated physical examinations. All services will be for DoD civilian personnel assigned to March ARB, California. The contractor will perform all work in accordance with the PWS and this contract.

3.2. Location. All services will be executed at the contractor’s premises or within the Contractor’s network of facilities – affiliate or qualified subcontractor – which must be located within a 50-mile radius of March ARB, CA (zip code 92518).

3.3. Period of Performance and Annual Number of MSE. The period of performance for this PWS is for one (1) Base year from the date of contract award plus four (4) 12-month Options.

The estimated number of DoD civilian ATCS employees requiring MSEs on an annual basis is 45-50 personnel.

3.4. Medical Surveillance Examinations.

3.4.1. The contractor will conduct physical examinations and tests under this contract between the hours of 7:30 am and 4:30 pm PT, Monday through Friday. All federal holidays are excluded and identified under Appendix B. Physicals may be scheduled outside of these hours with the consent of both parties to the contract.

3.4.2. Health examinations and tests will be performed in accordance with requirements which have been established by OPM and the FAA. Examinations will be conducted within 5 calendar days after written or telephonic request from the authorized agency and documented on any or all of the below provided forms:

AF 1753 Hearing Conservation Examination DD 2215 Hearing Conservation – Reference Exam (Baseline) DD 2216 Hearing Conservation Data (Periodic) OF 78/OF 178 Certificate of Medical Examination SF 88 Report of Medical Examination SF 513 Medical Record Consultation Sheet

3.4.3. Physical examination techniques must comply or be equal to the examination requirements prescribed by any of the following directives:

AFI 48-123 Medical Examinations and Standards AFI 48-133 Physical Examination Techniques AFOSH Std 48-20 Air Force Hearing Conservation Program DoD 6055.05M Occupational Medical Examinations and Surveillance Manual 5 CFR 339.202 Medical Stds and Medical Evaluation Programs 5 CFR 339.205 Medical Evaluation Programs

U.S. Office of Personnel Management Classification & Qualifications – General Schedule Qualification Standards, Air Traffic Control Series, 2152 (Initial Hire and Retention Requirements)

Federal Aviation Administration (FAA), Guide for Aviation Medical Examiners (AME) –Synopsis of Medical Standards for Second-Class Airman Medical Certificates

Air Traffic Control Tower Operators/Supervisors 14 CFR, Aeronautics & Space, Part 67

– Medical Standards and Certifications, Subpart C – Second-Class Airman Medical Certificates; Subpart E – Certification Procedures, 67.401 Special Issuance of Medical

Certificates. See Attachment 1.

3.4.4. The contractor shall provide the 452 MDG representative a copy of all standards or guidelines used to interpret specific examinations and laboratory test results.

3.4.5. The approximate number of specific tests and number of tests required for each medical examination will be provided via email or through an Excel spreadsheet when the ATCS is scheduled for their medical exam appointment.

3.4.6. The medical contractor will determine if the government employee meets existing physical requirements and medical standards as outlined in the OPM, FAA, and 14 CFR, Part 67 references as noted in paragraph 3.4.3.

3.4.7. When appropriate and IAW medical standards of the certifying organizations noted in paragraph 3.4.4 above, the AME may initiate a "Special Issuance of Medical Certificates (Authorization)" for an ATC Specialist who did not meet medical standards listed under subpart "C" of 14 CFR, Part 67. The AME accomplishing the medical examination will provide the Federal Air Surgeon (FAS) the documentation required to demonstrate the ATC Specialist can perform all duties authorized by the Second-Class medical certificate without endangering public safety, himself or co-workers. March ARB Air Traffic Control Center may, on average, require 6-8 Special Issuance of Medical Certificates (Authorizations) per year (12 month period).

NOTE: When non-occupational medical problems are identified and are not disqualifying for purposes of issuance of a FAA Second-Class Medical Certificate, the employee will be informed of the abnormality by contracting physician and advised to seek proper medical care from their personal medical care provider. If a non-occupational abnormality is remedial (e.g., otosclerosis) or is likely to be temporary (e.g., external otitis), but may interfere with the ability of the person to wear PPE such as hearing protection or unable to perform their duties, appropriate temporary duty restrictions will be recommended. The contractor physician determination as to whether the employee meets the physical requirements and medical standards will be documented on 1) FAA Form 8500-9 and 2) any appropriate forms identified in paragraph 3.4.2. of this PWS by the contractor.

3.5. Pre-placement, Special Purpose, Termination Examinations.

3.5.1. Pre-placement physical examinations will be performed within five (5) working days after receipt of written or telephonic request for appointment from the authorized agency.

3.5.2. The contractor will deliver all medical documentation in accordance with guidelines identified under Section 4 of this PWS.

3.6. Periodic Examinations.

3.6.1. Periodic physical examinations will be performed within five (5) working days after receipt of written or telephonic request for appointment from the authorized agency.

3.6.2. The contractor will deliver all medical documentation in accordance with guidelines identified under Section 4 of this PWS.

3.7. Fitness-for-Duty Examinations.

3.7.1. The Fitness-for-Duty exam is scheduled by the 452 AMDS. All requirements for the physical will be listed on OF 78/178.

3.7.2. The physical will be accomplished within two (2) working days of receipt of written or telephonic request for appointment request from 452 AMDS.

3.7.2.1. In cases where there is a question about physical/psychological fitness-for-duty, the Government has an immediate need to determine whether to remove the employee from the duty area; therefore, the physical exam will be accomplished as soon as possible.

3.7.3. The contractor physician will contact 452 AMDS & 452 FSS/FSMC no later than (NLT) the morning of the next workday to provide diagnosis.

3.8. Audiograms.

3.8.1. The contractor will be responsible for performing audiograms in accordance with the standards specified within AFOSH STD 48-20.

3.8.2. Audiometric Environment and Audiometer Calibration.

3.8.2.1. Audiometric testing environment must be certified annually. The background octave band for Sound Pressure Levels (SPL) are not greater than the following standards listed in AFOSH STD 48-20, para 2.11.10.1. thru 2.11.10.5.:

For 500 Hertz (Hz), 27 dB For 4,000 Hz, 39 dB For 1,000 Hz, 29 dB For 8,000 Hz, 41 dB For 2,000 Hz, 34 dB

3.8.2.2. Audiometric Equipment Standards. Audiometers must comply with the standards of American National Standards Institute (ANSI) S3.6-2010 (or current STD). Audiometric testing room requirements are in ANSI S3.1-1999 (R2008), Maximum Permissible Ambient Noise Level for Audiometric Test Rooms.

3.8.2.3. Calibration, Testing, Daily Functional Checks, and Daily Calibration Check are explained in AFOSH STD 48-20, para 4.9. thru 4.11. The Biomedical Equipment Technician or equivalent will ensure all calibrations and certifications are performed according to ANSI S1.4-1983 (R2006) and ANSI S3.1-1999 (R2008) or current ANSI standards. As a minimum, Daily Functional Checks will include listening for: crackling sounds, changes in loudness when moving the cord; presence of tones at all frequency settings, presence of tones only in the appropriate headset, and periods of silence while listening to frequency and attenuation changes. The Daily Calibration Check is performed every day that hearing tests are administered. An examiner who operates the audiometer must perform the calibration. The calibration test subject can be an electroacoustic ear or someone with known stable hearing levels.

3.8.2.4. Annual Acoustic Calibration. An acoustic calibration will be accomplished by a Biomedical Equipment Technician or an appropriate provider of these services annually, per 29 CFR 1910.95, Chapter XVII, Attachment E.

Exhaustive Calibration is done every 2 years per sections 4.1 thru 4.5, ANSI S3.6- 2019 (or current ANSI Std). Only earphones meeting ANSI STD S3.6-2010 will used in the AF HCP. Earphones must ONLY be used with the audiometer they were calibrated with.

3.8.3. The completed DD 2216 will serve as written notification of audiogram results.

However, this does not preclude the contractor from providing other written patient disposition when warranted to describe the patient’s medical disposition.

3.8.4. Whenever a threshold shift has been verified by the second follow-up through audiometric testing, 452 AMDS will provide the contractor with AF 1753. The contractor will perform an examination of the employee and then, using the criteria found in AFOSH STD 48-20, para. 7, will determine whether a physiological problem caused the threshold shift. If so, notify 452 AMDS.

3.8.5. A clinical examination of the ears, nose and throat will be performed by the contractor physician on all employees getting a reference audiogram check, those with STS, those required to be examined based on history and those undergoing a duty fitness and risk evaluation.

3.8.6. During the examination the contractor physician must note:

3.8.6.1. Cerumen plugging the ear canals;

3.8.6.2. Otitis external;

3.8.6.3. Condition of the tympanic membranes;

3.8.6.4. Any middle ear disease;

3.8.6.5. Eustachian tube function;

3.8.6.6. Any other ENT disease or condition, which might adversely affect the audiogram results; and,

3.8.6.7. Any condition that may interfere with the wearing of hearing protection (permanently or temporarily).

3.8.7. The contractor will deliver all medical documentation and appropriate forms noted in paragraph 3.4.2. in accordance with guidelines identified under Section 4 of this PWS.

3.9. Final Assessment and Disposition.

3.9.1. The contractor physician will review all examination results and histories to make a final assessment and disposition.

3.9.2. All assessments and dispositions will be documented on the appropriate form identified in paragraph 3.4.2. of this PWS and all medical documentation will be delivered as identified under Section 4 of this PWS.

3.9.3. The contractor validates physical examination findings through verification of the original tests or any additional testing as prescribed by the attending contractor physician after telephonic coordination with the 452 AMDS. Further coordination/consultation will be acquired from the 452 FSS/FSMC concerning pre-placement and fitness-for-duty examinations.

3.9.4. The contractor physician will verbally notify the 452 FSS/FSMC at (951) 655- 4857/4086 and coordinate with 452 AMDS no later than one (1) workday after the determination that a limiting condition exists or that removal from performance of air traffic control duties is recommended or warranted.

3.10. Relationship of Parties.

3.10.1. It is expressly agreed and understood that the services rendered by the contractor and its employees are rendered in the capacity of an independent contractor. Although the government may evaluate the quality of both professional and administrative services for purposes of contract inspection and acceptance, it retains no control over the services rendered, including, but not limited to, professional judgments, diagnosis, or specific treatments.

3.10.2. The contractor will be solely responsible for any and all liability caused by the acts or omissions of its agents or employees.

3.11. Indemnification.

3.11.1. The contractor expressly agrees to indemnity, hold harmless, and to defend the government of the United States for all of its employees and agents acting officially or otherwise, from any and all liability, claims, demands, actions, debts, and attorney fees arising out of, claimed on account of, or in any manner predicated on loss or damage to the property of, injuries to, or death of any person whatsoever, which may occur as a result of or in connection with the services being provided under this contract.

4.0. Deliverables.

4.1. Standards, Guidelines, and References. The contractor will provide the 452 AMDS a current copy of all standards, guidelines and/or reference ranges used to interpret laboratory test results.

Provide updates when changes occur.

4.2. Forms and Documentation. Contract physicians will complete required form(s) and/or documentation in accordance with the corresponding Air Force Instructions, directives and policies identified in this PWS.

4.3. Reporting of Examination Results.

Type of Exam Organizations Delivered To Time Period

Pre-placement Fitness-for-Duty

452 AMDS

452 FSS/FSMC Within 3 workdays after exam completion

Periodic/Annual Special Purpose

Termination Audiograms

452 AMDS Within 3 workdays after exam completion

4.3.1. All physical examination results that medically disqualify air traffic controllers, either temporarily or permanently, must be immediately reported via telephonic means to 452 AMDS at (951) 655-2773/2839 and 452 OSS/OSAB at (951) 655-4848/4403. The Air Traffic Manager shall not permit air traffic personnel to control air traffic when temporarily or permanently medically disqualified in accordance with 14 CFR, Part 65.31(c). In addition, for employees with abnormal laboratory or ECG results that are not disqualifying, immediately notify via telephone the 452 AMDS at (951) 655-2773/2839 and email briarly.saavedra.1@us.af.mil and timi.bilal.1@us.af.mil after receipt of results.

4.3.2. The contractor will note the date, time, and name of person contacted.

4.3.3. All examination results will be reported on any forms identified under paragraph

3.4.2. (with additional documents as necessary) and distributed with original file in the employee’s medical folder and three (3) copies mailed to the following recipients:

4.3.3.1. Address.

452 AMDS

1485 Graeber Street March ARB, CA 92518

4.4. Monthly Lists/Reports.

4.4.1. The contractor will provide 452 AMDS a monthly list of all personnel examined and tests accomplished prior to invoicing within WAWF/IRAPT.

4.4.2. The list will be itemized for all tests administered to include the date and cost of each test per individual.

4.4.3. The contractor will annotate the monthly examination roster as follows:

Status Disposition

Completed Date Completed mailto:briarly.saavedra.1@us.af.mil mailto:timi.bilal.1@us.af.mil

No-Show Date and reason, if any, if the individual fails to meet their scheduled appointment

4.4.4. The contractor medical personnel will provide technical review of all examination data to ensure the highest level of quality control and accuracy of the completed medical surveillance examination. In addition, the contractor’s physician, nurse or technician will sign any form identified under paragraph 3.4.2. of this PWS provided by the member at the time of appointment as having provided a medical examination. The copies of the completed forms will be delivered under Section 4 of this PWS.

Attachments (2):

1. Guide for Aviation Medical Examiners (AME) (Most current revision)3

2. Clinical Occupational Health Examination Requirements (AF Fm 2766)

Appendices (2):

A. Medical Surveillance Examinations – Price Listing B. Medical Surveillance Examinations – List of Federal Holidays

3 The Guide for AME is frequently revised. The contractor must utilize the appropriate and most current revision when performing examinations under this PWS. The most current revision may be found at https://www.faa.gov/about/office_org/headquarters_offices/avs/offices/aam/ame/guide/

APPENDIX A

ATC SPECIALIST - MEDICAL SURVEILLANCE EXAMINATION

PRICE LISTING

BASE YEAR (CLIN 0001)

Description Unit Estimated Quantity

Unit Price

Total Cost

Pre-Placement:

Comprehensive Medical Hx, Med Eval -HEENT including Audiogram; Vision: Near, Distant, Intermediate (Snellen), Intraocular Tension, Peripheral Vision, Phorias, and Color Vision;

Cardiopulmonary (ECG [at 35 then annually at 40]; CXR[baseline]); BP and Pulse; Review of all systems to RULE OUT disqualifying medical conditions: GI & abdominal organs; urinary, reproductive system; spine, axial skeleton, extremities; neurological, psychiatric disorders. Hx of substance abuse; Lab: CBC, Chem & Lipid Panels. See ATC Specialist Medical Exam STDs

Each 10

Periodic/Annual:

Interval Medical Hx, Med Eval - HEENT including Audiogram; Vision: Near, Distant, Intermediate (Snellen), Intraocular Tension, Peripheral Vision, Phorias, and Color Vision; Cardiopulmonary (ECG [at 35 then annually at 40], BP and Pulse; Review of all systems to RULE OUT disqualifying medical conditions: GI & abdominal organs; urinary, reproductive system; spine, axial skeleton, extremities; Hx of neurological, psychiatric disorders, substance abuse

Each 45

Special Purpose:

Cardiopulmonary (BP, Pulse, ECG, CXR);

HEENT, Vision: Near, Distant, Intermediate (Snellen), Intraocular Tension, Peripheral Vision, Phorias, and Color Vision; Audiometric test; Lab:

blood, urine as needed; musculoskeletal; neuro-logical, psychological disorders; substance abuse

Each 10

Termination:

Audiogram, ECG, Medical, Psychological Evals

Each 10

Fitness-for-Duty: Injury or Illness Driven Musculoskeletal, extremities; Cardiovascular, Pulmonary System (ECG, CXR); Blood, urine tests as indicated; Hearing – Audiometric Test;

Visual Exams, Neurologic, Psychologic evaluation

Each 5

Audiograms:

Pre-Employment, Annual & Termination

Each 45

GRAND TOTAL CLIN 0001

MEDICAL SURVEILLANCE EXAMINATION

OPTION ONE (CLIN 1001)

Quantity

Unit Price

Total Cost

Pre-Placement:

Comprehensive Medical Hx, Med Eval -HEENT including Audiogram; Vision: Near, Distant, Intermediate (Snellen), Intraocular Tension, Peripheral Vision, Phorias, and Color Vision;

Cardiopulmonary (ECG [at 35 then annually at 40]; CXR[baseline]); BP and Pulse; Review of all systems to RULE OUT disqualifying medical conditions: GI & abdominal organs; urinary, reproductive system; spine, axial skeleton, extremities; neurological, psychiatric disorders. Hx of substance abuse; Lab: CBC, Chem & Lipid Panels. See ATC Specialist Medical Exam STDs

Each 10

Periodic/Annual:

Interval Medical Hx, Med Eval - HEENT including Audiogram; Vision: Near, Distant, Intermediate (Snellen), Intraocular Tension, Peripheral Vision, Phorias, and Color Vision; Cardiopulmonary (ECG [at 35 then annually at 40], BP and Pulse; Review of all systems to RULE OUT disqualifying medical conditions: GI & abdominal organs; urinary, reproductive system; spine, axial skeleton, extremities; Hx of neurological, psychiatric disorders, substance abuse

Each 45

Special Purpose:

Cardiopulmonary (BP, Pulse, ECG, CXR);

HEENT; Vision: Near, Distant, Intermediate (Snellen), Intraocular Tension, Peripheral Vision, Phorias, and Color Vision; Audiometric test; Lab:

blood, urine as needed; musculoskeletal; neuro-logical, psychological disorders; substance abuse

Each 10

Termination:

Audiogram, ECG, Medical, Psychological Evals

Each 10

Fitness-for-Duty: Injury or Illness Driven Musculoskeletal, extremities; Cardiovascular, Pulmonary System (ECG, CXR); Blood, urine tests as indicated; Hearing – Audiometric Test;

Visual Exams, Neurologic, Psychologic evaluation

Each 5

Audiograms:

GRAND TOTAL CLIN 1001

OPTION TWO (CLIN 2001)

Quantity

Unit Price

Total Cost

Pre-Placement:

Comprehensive Medical Hx, Med Eval -HEENT including Audiogram; Vision: Near, Distant, Intermediate (Snellen), Intraocular Tension, Peripheral Vision, Phorias, and Color Vision;

Cardiopulmonary (ECG [at 35 then annually at 40]; CXR[baseline]); BP and Pulse; Review of all systems to RULE OUT disqualifying medical conditions: GI & abdominal organs; urinary, reproductive system; spine, axial skeleton, extremities; neurological, psychiatric disorders. Hx of substance abuse; Lab: CBC, Chem & Lipid Panels. See ATC Specialist Medical Exam STDs

Each 10

Periodic/Annual:

Interval Medical Hx, Med Eval - HEENT including Audiogram; Vision: Near, Distant, Intermediate (Snellen), Intraocular Tension, Peripheral Vision, Phorias, and Color Vision; Cardiopulmonary (ECG [at 35 then annually at 40], BP and Pulse; Review of all systems to RULE OUT disqualifying medical conditions: GI & abdominal organs; urinary, reproductive system; spine, axial skeleton, extremities; Hx of neurological, psychiatric disorders, substance abuse

Each 45

Special Purpose:

Cardiopulmonary (BP, Pulse, ECG, CXR);

HEENT; Vision: Near, Distant, Intermediate (Snellen), Intraocular Tension, Peripheral Vision, Phorias, and Color Vision; Audiometric test; Lab:

blood, urine as needed; musculoskeletal; neuro-logic and psychological disorders; substance abuse

Each 10

Termination:

Audiogram, ECG, Medical, Psychological Evals

Each 10

Fitness-for-Duty: Injury or Illness Driven Musculoskeletal, extremities; Cardiovascular, Pulmonary System (ECG, CXR); Blood, urine tests as indicated; Hearing – Audiometric Test;

Visual Exams, Neurologic, Psychologic evaluation

Each 5

Audiograms:

GRAND TOTAL CLIN 2001

OPTION THREE (CLIN 3001)

Quantity

Unit Price

Total Cost

Pre-Placement:

Comprehensive Medical Hx, Med Eval -HEENT including Audiogram; Vision: Near, Distant, Intermediate (Snellen), Intraocular Tension, Peripheral Vision, Phorias, and Color Vision;

Cardiopulmonary (ECG [at 35 then annually at 40]; CXR[baseline]); BP and Pulse; Review of all systems to RULE OUT disqualifying medical conditions: GI & abdominal organs; urinary, reproductive system; spine, axial skeleton, extremities; neurological, psychiatric disorders. Hx of substance abuse; Lab: CBC, Chem & Lipid Panels; See ATC Specialist Medical Exam STDs

Each 10

Periodic/Annual:

Interval Medical Hx, Med Eval - HEENT including Audiogram; Vision: Near, Distant, Intermediate (Snellen), Intraocular Tension, Peripheral Vision, Phorias, and Color Vision; Cardiopulmonary (ECG [at 35 then annually at 40], BP and Pulse; Review of all systems to RULE OUT disqualifying medical conditions: GI & abdominal organs; urinary, reproductive system; spine, axial skeleton, extremities; Hx of neurological, psychiatric disorders, substance abuse

Each 45

Special Purpose:

Cardiopulmonary (BP, Pulse, ECG, CXR);

HEENT, ECG; Vision: Near, Distant, Intermediate (Snellen), Intraocular Tension, Peripheral Vision, Phorias, and Color Vision; Audiometric test; Lab:

blood, urine as needed; musculoskeletal; neuro-logic, psychological disorders; substance abuse

Each 10

Termination:

Audiogram, ECG, Medical, Psychological Evals

Each 10

Fitness-for-Duty: Injury or Illness Driven Musculoskeletal, extremities; Cardiovascular, Pulmonary System (ECG, CXR); Blood, urine tests as indicated; Hearing – Audiometric Test;

Visual Exams, Neurologic, Psychologicevaluation

Each 5

Audiograms:

GRAND TOTAL CLIN 3001

OPTION FOUR (CLIN 4001)

Quantity

Unit Price

Total Cost

Pre-Placement:

Comprehensive Medical Hx, Med Eval -HEENT including Audiogram; Vision: Near, Distant, Intermediate (Snellen), Intraocular Tension, Peripheral Vision, Phorias, and Color Vision;

Cardiopulmonary (ECG [at 35 then annually at 40]; CXR[baseline]); BP and Pulse; Review of all systems to RULE OUT disqualifying medical conditions: GI & abdominal organs; urinary, reproductive system; spine, axial skeleton, extremities; neurological, psychiatric disorders. Hx of substance abuse; Lab: CBC, Chem & Lipid Panels; See ATC Specialist Medical Exam STDs

Each 10

Periodic/Annual:

Interval Medical Hx, Med Eval - HEENT including Audiogram; Vision: Near, Distant, Intermediate (Snellen), Intraocular Tension, Peripheral Vision, Phorias, and Color Vision; Cardiopulmonary (ECG [at 35 then annually at 40], BP and Pulse; Review of all systems to RULE OUT disqualifying medical conditions: GI & abdominal organs; urinary, reproductive system; spine, axial skeleton, extremities; Hx of neurological, psychiatric disorders, substance abuse

Each 45

Special Purpose:

Cardiopulmonary (BP, Pulse, ECG, CXR);

HEENT; Vision: Near, Distant, Intermediate (Snellen), Intraocular Tension, Peripheral Vision, Phorias, and Color Vision; Audiometric test; Lab:

blood, urine as needed; musculoskeletal; neuro-logic, psychological disorders; substance abuse

Each 10

Termination:

Audiogram, ECG, Medical, Psychological Evals

Each 10

Fitness-for-Duty: Injury or Illness Driven Musculoskeletal, extremities; Cardiovascular, Pulmonary System (ECG, CXR); Blood, urine tests as indicated; Hearing – Audiometric Test;

Visual Exams, Neurologic, Psychologic evaluation

Each 5

Audiograms:

GRAND TOTAL CLIN 4001

APPENDIX B

ATC SPECIALIST – MEDICAL SURVEILLANCE EXAMINATION

Federal Holidays

The following Federal Legal Holidays are observed at March Air Reserve Base:

New Year’s Day – 1 January Martin Luther King’s Birthday – Third Monday in January Presidents Day – Third Monday in February Memorial Day – Last Monday in May Independence Day – 4 July Labor Day – First Monday in September Columbus Day – Second Monday in October Veterans Day – 11 November Thanksgiving Day – Fourth Thursday in November Christmas Day – 25 December

Note. When a Federal Holiday falls on a Saturday, the holiday will be observed the previous work day. If the Federal Holiday falls on a Sunday, the holiday will be observed on the first work day following the Federal Holiday.