SOW-OMS-10182016.docx

STATEMENT OF WORK

FOR

Occupational Medicine Services (OMS)

75th Aerospace Medicine Squadron 75th Medical Group Hill Air Force Base, Utah 18 Oct 2016

STATEMENT OF WORK

TABLE OF CONTENTS

SECTION PAGE

1 DESCRIPTION OF SERVICES 3

4 MISCELLANEOUS 45

5 APPENDICES 47

DESCRIPTION OF SERVICES. The Contractor shall provide Occupational Medicine Services (OMS) for the Ogden Air Logistics Center (OO-ALC), its subordinate commands and tenant organizations at Hill Air Force Base (HAFB), Utah. This includes furnishing all labor, transportation, consultation, teaching, reports, equipment, materials, supplies, and supervision.. Performance shall be according to the requirements contained in this Statement of Work (SOW). The Contractor (Corporate President) or senior company representative for the contract will be available to meet with local contract staff and HAFB contracting officer (CO), 75 MDG Logistics, Contracting Specialist and the Functional Requirements Evaluator Designee (FRED) The Contractor shall provide occupational medicine services for government employees in accordance with (IAW) all applicable laws, regulations, and Department of Defense (DoD), Air Force (AF) and HAFB Instructions (see Appendix F).. The Contractor will staff the OMS clinic. The OMS is a Flight of the 75th Aerospace Medicine Squadron (75 AMDS). The 75 AMDS is a component of the 75 MDG; the 75 MDG is an ambulatory care clinic that provides outpatient care, referral management, and dental care to approximately 33,000 TRICARE beneficiaries. The beneficiary population of the OMS clinic is approximately 18,500 federal, non-appropriated fund (NAF), and tenant unit employees as well as Active Duty (AD) receiving annual occupational medicine health exams (OHME). Approximately 8,500 federal and military work in industrial work areas with approximately 2,000 receiving annual physicals.

FUNCTIONAL REQUIREMENTS EVALUATOR DESIGNEE (FRED) The Chief, Occupational Medicine (COM) is the FRED and has over-site responsibility for OMS. This individual is a residency-trained, occupational medicine physician who is a government employee, either AD or federal civil service. The COM is assigned as the lead contract FRED. The COM is also appointed as the Consultant for OMS IAW AFI 48-145 and AFI 36-2104. The government will provide the COM, one AD board certified Occupational Medicine physician, an audiologist, two audiology technicians, one audiology administrative assistant and a credentialed staff psychologist.

CONTRACTOR REQUIREMENTS. The Contractor will provide occupational medicine providers, nursing staff (RN, CM, LPN, LVN), clinic management and secretarial support, medical administration and scheduling, records management, non-count coding, and respiratory protection fit testing. The Contractor staff will integrate into a combined government/contract occupational medicine clinic.

The Contractor will at minimum, staff the OMS as follows:

PERSONAL SERVICES

a) Four providers; 2 Physicians and 2 Physician Assistants (PA) as described in Appendix G.

b) Five nurses; One RN Supervisor, One Case Manager, three clinical nurses as described in Appendix G.

c) Five LPN/LVN, certified to perform spirometry testing as described in Appendix G.

NON-PERSONAL SERVICES

d) One Administrative Assistant (AA) to the COM, providers and psychologist as in Appendix G

e) Seven Medical Records Clerks (MRC) to include: recommend one as the lead medical records clerk (Admin Lead) to assist in managing administrative workload in the front desk area one PIMR data entry, one scheduler, and one pre placement/comparison clerk as described in Appendix G.

f) One respiratory protection fit test technician as described in Appendix G with one LPN/LVN trained and certified as backup.

g) Appointment clerk, Audiology clinic as described in Appendix G.

Anticipated workload factors are found in 3.0, 4.0 and 5.0 of this SOW.

1.0. OMS STAFF

1.1. Performance. When the contractor experiences any delays in accomplishing the specific tasks identified in subparagraphs (a), (b) and (c) below, the contractor shall notify the Contracting Officer Representative (COR) immediately. The Contracting Officer will evaluate the situation to determine if an extension of the dates is appropriate. If an extension is not approved, the Government may terminate the task order for default, seek remedies under the liquidated damages clause or seek other remedies as appropriate.

(a) Submit resumes of qualified individuals being considered for employment to the Logistics, Contracting Specialist at the MTF within 30 calendar days of Period of Performance. Period of Performance is considered to be performance by the contractor rather than the contracted Health Care Worker. This performance includes the Recruiting and Qualifying portion of the Task Order. The Government reserves the right to interview in person or telephonically and approve or disapprove all candidates.

(b) Credentialed Health Care Worker(s) shall physically begin performance 60 calendar days from the initial period of performance date or the date specified in the Task Order which shall not be less than 90 calendar days from the initial period of performance date. Health care workers may begin performance earlier than 90 calendar days if an earlier date is mutually agreed upon between the Contracting Officer and the contractor. A Task Order modification will be accomplished to adjust the date performance begins.

(c) Non-Credentialed Health Care Worker(s) shall not be less than 60 calendar days from the initial period of performance date. Health care workers may begin performance earlier than 45 calendar days if an earlier date is mutually agreed upon between the Contracting Officer and the contractor. A Task Order modification will be accomplished to adjust the date performance begins.

1.2. Retain. The continuity of high quality health care workers is a vitally important component in maintaining quality of care to OMS beneficiaries. The Contractor shall maintain a minimum of 99% of all HCW positions filled at any given time. However, the provider fill rate shall be maintained at a minimum of 85%. All absences will be coordinated/scheduled.

1.3. In-processing. All new OMS personnel shall in-process through the 75 MDG Personnel and Admin office within two duty days of start of work and complete a 75 MDG checklist for the purpose of in-processing.

1.4. Normal Hours of Operation. The OMS staff will perform the services required under this contract during the following hours: MON – FRI 0700-1600, Except Federal Holidays and planned closures of AFMC MAJCOM mandated Family Days which will not be compensated for. Extended hours may be requested with prior approval, to ensure timely completion of work at no additional cost to the government. This may include a designated minimal staff for alternate work schedules (i.e. Mon-FRI 0730-1630) for coverage of injuries which may present late in the afternoon. The government may request the Contractor to execute surge operations of the clinic to support national emergencies. The Contractor may anticipate reduced patient volume every other Friday and use this Friday for required training, in-services, etc. The clinic must remain open however.

1.5. Recognized Holidays and Planned Closures. The Contractor is not required to provide service on the following days: New Year’s Day, Martin Luther King Day, Presidents Day, Memorial Day, Independence Day, Labor Day, Columbus Day, Veterans Day, Thanksgiving Day, and Christmas Day and all planned AFMC Family days. If the holiday falls on Saturday, it is observed on Friday. If the holiday falls on a Sunday, it is normally observed on Monday; if it does not the Contractor will take the holiday on the federally-observed day.

1.6. Basic Life Support (BLS or CPR). All OMS employees will show proof of required BLS.

1.7. Base Access/ID Card. New personnel will be escorted by a current OMS employee to the 75 MDG Logistics, Contracting Specialist, who will initiate an application for DoD CAC to access HAFB.

1.8. Security Background Investigation. Since the health care workers under this contract have access to and/or process information requiring protection under the Privacy Act of 1974, these positions are considered “ADP III” positions. Compliance with DoD Directive 8500.1, DoD Directive 5200.2, AFI 31-501 and AFI 33-202 is mandatory for ADP III positions. Therefore, a National Agency Check with Inquiries (NACI) is required for each health care worker under this contract. The Contractor shall fully adhere with the provisions of referenced publications by having each of their employees who are performing under this contract make an appointment (through the COR) with the appropriate security organization at the installation where service is provided. Each individual will be fingerprinted and required to complete the appropriate forms, usually a Standard Form 85, Questionnaire for Public Trust Positions. The contractor shall advise their employees that a positive report is needed as a condition of employment under this contract. The Contractor shall apply for the NACI prior to the start of performance for each health care worker.

1.8.1. The Contractor shall submit an e-QIP direct shell (see Appendix H) to 75 MDG Logistics, Contracting Specialist as soon as employee is identified as a new employee to start the security clearance process. The Contractor will require each employee to complete a Security Background Investigation Certificate, SF 85 Worksheet (see Appendix H) for each employee requiring computer access. The Contractor will submit the employees SF85 and the e-QIP direct shell to the 75 MDG Logistics, Contracting Specialist before starting work. The SF85 and e-QIP direct shell will be forwarded to the 75 MDG Command Support staff for processing, preferably 15 days prior to the first day of work.

1.8.2. The contractor understands that, while the MTF commander may allow health care workers to temporarily occupy non-critical sensitive positions pending NACI, the health care worker will be immediately removed from the position if at any time the NACI receives unfavorable adjudication, or if other unfavorable information that would affect the NACI becomes known.

1.8.3. Any contracted employee has the right to obtain a copy of any background check pertaining to them, and to challenge the accuracy and completeness of the information contained in the report by contacting the 75 MDG security manager for the current process.

1.8.4. If the Contractor has previously received a background check, proof of the check shall be provided or a new one obtained. A new investigation is required if a break in service to the DoD results in a time lapse of more than 2 years. Re-verification shall be accomplished every 5 years.

1.8.5. Payment of fees incurred in the conduct of any criminal history background check is the responsibility of the Contractor.

1.8.6. In addition to all employees obtaining a clearance to access the government computer systems, two medical doctors must be assigned a line badge through the 75MDG/security office. All required security requirements to obtain a line badge must be met by both physicians. The line badge is required to conduct shop visits per this SOW. All employees must be briefed that they will not access any Secret or otherwise classified documents. If access is needed, the OMS Functional Requirements Evaluator Designee (FRED) or other military appointment personnel will conduct the shop visit.

1.9. English language Requirement. All contracted workers shall read, write, understand, and speak English fluently

1.10. Appearance. While at the 75 MDG on regular work day, OMS staff shall be neat and clean, well groomed, and in appropriate clothing. OMS staff shall not wear clothing made of “see through” material, cut-offs, tank tops or clothing that displays offensive slogans or pictures. Athletic styled clothing and footwear, e.g., jogging suits, sweat suits, or aerobic/jogging/open toed/tennis shoes shall not be worn by the OMS staff. As an exception to the prohibition against wearing athletic and athletic-styled footwear, such footwear may be worn provided the footwear is the same color as the wearer’s pants, skirt, or dress, e.g., white athletic shoes with white pants. In all cases, clothing shall be neat and clean. This means free from visible dirt and stains. No facial piercing, other than ear, is allowed, including tongue piercing. Facial hair, including beards, moustaches, side burns, shall be controlled, restrained, or trimmed so as to not interfere with professional, modest appearance in keeping with normally accepted community standards of dress for the work being performed. Any visible tattoos must not be offensive. Recommend for Fridays Per AFMC civ policy: jeans allowed must be in good repair cannot be torn, ripped, or see through. Professional looking shirts with sleeves, no torn or see through clothing, no tank tops, halter tops or bikini tops, scrub uniforms is an approved alternative.

1.11. Employee Identification. The OMS staff shall wear the 75 MDG identification badge; which will be worn on the outside layer of clothing between the neck and the waist. Providers requiring restricted area access will submit information required to acquire a line badge. All staff will be required to maintain a current CAC.

1.11.1. Contractor Identification. All contracted HCWs shall clearly be identified as such at all times, including conversations, mail, email, faxes, and/or other electronic communication whether with Government personnel, other contractor personnel, or with the public when supporting this contract. Likewise, HCWs shall abide by all applicable laws and regulations when using Government equipment and services in the performance of this contract. At a minimum, HCWs shall clearly identify themselves as contractors by (1) wearing badges that clearly and legibly identify themselves as contractors, (2) using the label “Contractor” in e-mail addresses IAW Federal Acquisition Regulation (FAR) 37.114, Special Acquisition Requirements, and (3) including the employing contractor’s name in the letterhead and/or signature block of any written correspondence. HCWs shall wear identifying badges (e.g., MTF-issued identification badge and/or contractor badge) above the waistline during duty hours.

1.12. Health Requirements. In accordance with AFI 48-105, all health care workers shall follow the methods for controlling and preventing disease as described in 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 (MMWR), and its supplements. Where applicable, the most recent guidelines from these publications are utilized as the standard.

1.12.1. Before start of work, health care workers shall provide proof of immunization from the following diseases according to CDC guidelines: Hepatitis B, measles, mumps, rubella, varicella, and influenza. The health care worker shall also provide proof of a negative TB skin test within 12 months (if positive, proof of negative chest X-ray and/or Quantiferon Gold test results within 12 months) prior to start of work. After start of work, the Government will provide post bloodborne exposure protocols according to applicable AFIs.

1.12.2. In those areas where there is a higher risk of transmission of tuberculosis, health care workers will be tested as frequently as directed by the MTF policy. This test will be provided by the MTF.

1.12.3. Immunization information will be tracked in DoD computer systems for all health care workers.

1.12.4. No medical tests or procedures required by the contract may be performed at the MTF (with the exception of Tuberculosis testing and recurrent immunizations required periodically after start of work). Expenses for all required tests and/or procedures (e.g., respirator fit testing where required) shall be borne by the health care workers at no additional expense to the Government.

1.12.5. Health care workers must be immunized annually with the influenza vaccine. This vaccine will be provided by the Government, if available as determined by the MTF. Although this vaccine may be provided by the Government, it may be obtained at other facilities with the cost being borne by the health care worker or the Contractor. Unless vaccinated by the Government, the health care worker shall be required to show proof of the vaccination. Immunizations that require booster or recurrent vaccination will be furnished by the MTF.

1.13. Out-processing. On the employee’s last duty day, the employee will report to the 75 MDG Command Support Staff to initiate the out-processing action application and relinquish his/her CAC card to the 75 MDG Logistics, Contracting Specialist. Parking pass and building keys will be turned into SGPB personnel. All actions will be completed by close of business this day.

1.13.1. Non-working Employees. The 75 MDG COR shall be notified by the Contractor of any contractor personnel no longer working at 75 MDG OMS clinic. The contractor will ensure all employees complete the 75MDG out-processing. Any contract personnel re-assigned by the Contractor to work after 120 days from the last day of work during the previous work period shall be treated as a new employee for the purpose of training requirements.

1.14. Conflict of Interest. The Contractor shall not employ any person who is an employee of the United States Government. The Contractor shall not employ any person who is an employee of the AF, either AD or civilian, unless such person seeks and receives approval IAW DoD Directive 5500.7 and AF instruction.

1.15. Complaints. Validated by the FRED/COM and/or SGH, shall be reported in writing to the 75MDG Logistics, COR and the Contractor for action. Failure of the Contractor to correct validated complaints submitted by the 75 MDG staff will be considered a failure to perform.

1.15.1 Personnel receiving complaints validated by the FRED/COM and/or SGH shall be subject to counseling and, depending on the nature and severity of the complaint, separation from performing services under this contract.

1.16. Incidents. Report any near miss and/or incidents i.e. medication error, patient fall, encountered using the correct documentation and process IAW the 75 MDG Instructions regarding the use of the Patient Safety Reporting (PSR) tool.

1.17. In-Service training. Document in-services and training attended in his/her six part training folder.

1.18. Surge. Expect surges in patient care to occur during or following contingency operations to meet military unique mission requirements. This may include pre-deployment medical processing.

2.0. SCOPE OF MEDICINE.

2.1 The Contractor shall provide initial and follow up care for injury and illness of government employees and equal tenant unit employees that occur on the job during OMS clinic operation hours. Medical care provided by the Contractor shall be within the scope of this OMS contract. The quality of medical practice shall meet or exceed the standards of care established by the 75 MDG Executive Council of Medical Staff (ECOMS) and Executive Council.

2.2. Evaluation of Patients. Patients shall be evaluated IAW their medical condition or medical injury. When a PA does the initial injury/illness evaluation for a work related incident, all documentation will be co-signed by a physician and all appropriate oversight to all care given will be maintained.

2.3. Refusal of Services. No civilian or qualified tenant unit employee shall be refused the right to see a provider if requested for care that is under the scope of this contract and the responsibility of OMS. If the condition allows, the employee may be scheduled for a following day’s appointment.

Except in emergency situations where immediate medical care will save life, limb or eyesight, all contract or non-approved tenant personnel working at HAFB will be referred to an off-base emergency treatment facility.

2.4. Chaperone Assistance. The Contractor shall provide chaperone assistance IAW the 75 MDG guidelines. It will be provided upon request by any patient. The Contractor shall ensure patients are aware of this service. The Contractor shall provide chaperone assistance for patients being examined by a practitioner of the opposite sex when disrobing is required.

2.5. Accreditation Association for Ambulatory Health Care (AAAHC) AND Health Services Inspection (HSI). All applicable AAAHC standards shall be met pertaining to the performance of this contract. Self-inspection MICT, or current process, checklist will be reviewed and updated as required by the AF and 75 MDG.

3.0. PHYSICALS

3.1. Occupational Safety and Health Administrations (OSHA) Expanded Standard Baseline, Periodic, and Termination Examinations. Approximate workload will be 1800 - 2300 annual physicals, 300 – 400 baseline physicals, and 8-200 terminations physicals per year. The Contractor shall conduct baseline, periodic, and termination examinations for AD, civilian, and qualified tenant employees, as per each unit’s tenant agreement, IAW AF Form 2766 (AF 2766). Bioenvironmental Engineering Flight (SGPB) will provide a similar exposure group (SEG) block month schedule and a list of personnel requiring these examinations to the Contractor one month prior to the designated block month. The Contractor shall work closely with the point of contact (POC) of each SEG, the SGPB and the Public Health Flight (PH) to ensure that all employees in a SEG are identified and required examinations are completed. To maintain currency within the SEGs for baseline and termination a good rapport must be maintained with the POCs of each SEG. All abnormal findings suspected to be due to occupational factors are reported to PH and SGPB via Standard Form (SF) 190 and OSHA Form 301/AFMC Supplemental (OSHA 301). The Contractor will follow up on abnormal findings with the employee within five duty days of clinic’s notification. The provider will discuss with the employee implications of continuing to work in his/her assigned area. The goal for completion rate is 95% at the end of the block month as SEG employee deployments, school, leave, physical qualifications, and Temporary Duties Yonder (TDY) allow. Forms needed for physicals will include AF 2755, AF 2766, OHME form, Physician’s Written Opinion (PWO), and questionnaires as required. See section 15.0. Forms, for more information.

3.2. Other Periodic Physical examinations. The OMS providers shall conduct other periodic physicals on civilian, AD, or qualified tenant employees to ensure the employee meets specific physical and mental standards necessary to meet the functional requirements and environmental factors of the job. Other physical exams include, but are not limited to:

3.2.1. Immunization Requirements in Conjunction with Exams. A list of personnel requiring these examinations will be provided to the OMS clinic by the government. Civilians who are candidates for overseas positions and civilians traveling under official orders to overseas locations shall receive any necessary serological tests and immunizations/medical disease prophylaxis required for travel to those countries. The immunizations may be given at the 75 MDG immunization clinic or at OMS clinic as available.

3.2.2 Physically Disqualified Program (PDP). 25-30 per year exams are to disqualify an employee from his/her current position and have him/her placed in the PDP program. Or this exam is to qualify or not qualify an employee who is currently in the PDP program with another position on base.

3.2.3. PDP Medical Record, Position Description (PD), and SF 78 will be reviewed for Job Placement. 75-200 medical records, PDs, and SF 78s reviewed per year. While the HAFB employee is in the PDP, he/she will be actively looking for a full time position. When a potential job is found by the PDP administrator, the OMS provider will review the employee’s permanent restrictions, the new SF 78, and PD to see if the PDP employee medically qualifies for the proposed position. If the job requirements are amenable to his/her medical condition then the employee will be scheduled for a PDP physical. If the job requirements are not amenable then the OMS providers will write “not medically qualified” on the SF 78. The original is scanned and e-mailed to the PDP administrator then filed in the employees medical record. See section 15.0. Forms for more information.

3.2.4. Comparison physicals exams 300-500 per year, is to qualify a current employee to a new position with different job requirements than his/her current position.

3.2.5. Courtesy physicals exams 25-70 per year, is to qualify for a new position an applicant who will not be working at HAFB but another AF base/DoD facility. Physical exam data that is part of the courtesy physical shall be scanned, faxed, or mail per the OMS data entry MRC into the computer and sent via encrypted e-mail to the requesting Base or Facility.

3.2.6. TDY physical exams 5-50 per year, is to qualify a civilian or qualified tenant employee to travel and work temporarily at another site.

3.2.7. Permanent Change of Station (PCS) 5-40 per year, to qualify a civilian or qualified tenant employee who is transferring to a different home base.

3.2.8. Civilian Deployments physical exams 9-40 per year, is to qualify a civilian employee or qualified tenant employee who is deploying for a determined length of time to complete mission essential functions.

3.3. Pre-Placement Examinations. 320 – 550 per year. The OMS providers shall perform pre-placement exams for applicants referred by Department of Personnel (DP), to determine if the applicant’s general health is compatible with the job assignment requirements. The schedule will be on a shared public folder of SHAREPOINTE for the DP staffers, DDR staff, fingerprinting staff, and OMS pre-placement MRC. All laboratory components, exam requirements and other necessary information are received then the determination is made by the OMS provider after his/her exam for the applicant to work with or without restrictions for the safety of the individual and worksite. The OMS provider does not decide if the employee is employable or not employable. The OMS clinic shall obtain, from the applicant, additional medical information, when necessary to make a decision. The applicant is responsible to furnish all required additional information at the applicant’s expense to the OMS provider when the applicant’s medical qualification is in question. See section 15.0. Forms, for more information.

3.3.1. Pre-Placement/Increased/New Workload. The Contractor will be advised when HAFB has increased requirements for pre-placement physicals. This may be an increased workload, but will not be considered an actual surge.

3.4. Child Development Center and Youth Center Physicals. 90 - 150 per year. The Contractor will complete the NAF requirements for these positions. These two SEGs are category III but need monitoring to maintain compliance. Required immunizations, every three year physicals, and yearly health questionnaires are reviewed. These requirements are incorporated into the OHME completion rates reported to Occupational and Environmental Health Working Group (OEHWG) monthly. See section 15.0. Forms for more information.

3.5. Audiology Referrals and Hearing Exams. The OMS physician shall see referred civilian, AD, and qualified tenant employees with job related hearing issues from the 75 AMDS audiologist after fitness and risk assessment evaluations are competed and a consultation is needed for consideration of appropriate duty limitations/removal from hazardous noise environments. The Contractor shall provide the medical consultation and documentation in support of the audiologist for action taken IAW AFI 48-123 and AFI 48-101 and AFI 48-20. This consultation shall include visual examination of the ear canals, drums, cerumen management, and a brief history. The documentation shall provide medical support for removal from hazardous noise or to controvert compensation claims.

3.6. Fitness-for-Duty (FFD) Examination. 30 - 75 per year. The OMS physicians may perform FFD exams. The provider shall provide a written document regarding the employee who may have performance or behavioral issues due to a known or suspected medical/mental deficiency. The supervisor will set up a time to meet with the AA who will review the steps of the FFD and what does and does not qualify for a FFD exam. The AA will give the supervisor resource information also. When all paperwork is completed by the supervisor including signatures from Squadron CC/directors the AA will schedule the employee for the FFD exam. FFDs are justified IAW 5 Code Federal Regulation (CFR) Part 339, Section 339.302 and 339.303. The providers will refer the employee when necessary to obtain specialty consultation as part of the FFD. Funding and authorization for such referrals will be coordinated through the Administrative Assistant and 75 MDG’s Resource Management Office (RMO).

3.7. Impaired Employee Evaluation. The OMS providers should see workers referred by his/her supervisor for an assessment for safely working in current condition without harm to self or others and make a recommendation regarding duty limitations after the supervisor has contacted the unit Employee Relations Specialist (ERS) and the employee has been to drug demand reduction (DDR). At the time of such a visit, the Contractor should determine if referral for treatment is appropriate. When non-urgent treatment is indicated, the worker will be referred to the Employee Assistance Program (EAP) or other helping agencies as appropriate . When work limitations are given or the worker is sent home, and driven by another person; arrangements for a follow up assessment should be made to clear the worker to return to work. When a diagnosis of alcohol/substance abuse or dependence is made, and the worker performs hazardous duties, he/she should not be returned to perform those duties until appropriate treatment and compliance with aftercare is verified. If the worker has a security clearance; similar evidence of resolution and compliance should be documented prior to return to duties requiring that clearance.

3.8. OHME Completion Reporting. The OMS clinic’s goal is to complete all exam requirements for the HAFB employees within the scheduled block month as able due to TDY, deployments, qualification requirements, etc. The clinic shall strive to maintain a minimum 12-month rolling average of 90-percent completion rate for all OHMEs. 75 MDG Major Command (MAJCOM) reviews the completion rates in ASIMS which includes OHME completion and audiogram only SEG completion. The contract is responsible for OHME completion rate only. The completion rate is routed to the 75 MDG Executive staff via OEHWG and the Aerospace Medical Counsel (AMC).

3.9. Other Exams. Exams with specific components may be required by other federal agencies through written agreement with the 75 MDG, e.g., Department of State, Peace Corps, teachers for DoD overseas dependent schools, etc.

3.9.1. The OMS providers may provide Disability Retirement Examination (DISRET) reviews and as appropriate exams for employees for whom DP has provided a request and DISRET package, IAW guidance from the Office of Personnel Management (OPM) and 5 CFR. The provider shall evaluate the supporting medical data as to completeness and timeliness and shall make reasonable efforts to help the employee obtain the necessary data. The AA shall forward the entire medical package to the appropriate office in DP when complete.

3.9.2. Medical Records Review Programs. The OMS providers conduct professional reviews of medical records. Examples of medical records review programs are: Security clearance; PRP/Sensitive Compartmented Information (SCI); assignment to positions of special trust, request for review of suicides, security investigations, PDP, etc.

4.0. INJURY/ ILLNESS EXAMS

4.1. Tuberculosis (TB) Patients. OMS does not treat TB patients. When an employee has a positive reaction to the TB skin test placed in the OMS clinic, the patient will be referred to 75 MDG PH, and to either his/her primary care provider and to the County Health department as appropriate for diagnosis and treatment.

4.2. Work Related Injuries and Illnesses. 40 - 200/month; OMS providers shall evaluate and offer to treat all civilian and qualified tenant employees with occupational injuries or illnesses associated with employment by the DoD. Civilian employees may exercise their right to seek treatment from a civilian source rather than from the OMS clinic. At the time of the OMS visit, the injured/ill employee will fill out an OSHA 301. The employee will also sign a form stating if he/she would like to have OMS providers be his/her treating provider for this injury. Emergent patients will be triaged and seen prior to scheduled patients.

4.2.1. Injury and Illness Documentation. All injury/illness exams and treatment given at the OMS clinic shall have appropriate and defensible medical documentation entered into the medical record. Additional items that should be included relate the medical condition to the employee’s work environment or to his/her work. The documentation shall reflect accepted standards of care.

4.3. Occupational Illness referral. 1 - 20/month. OMS providers shall refer an employee to PH when the employee has a new occupational illness. This is for the PH investigation of work relatedness. This referral will be conducted while the patient is in the OMS clinic if PH personnel are available. PH personnel enter their investigation information into the Air Force Safety Automated System (AFSAS) which automatically notifies SGPB to complete a work site evaluation. PH’s conclusion of the investigation is brought to the OMS referring provider for signature and the report is filed in the patient’s medical record.

4.4. Return-to-Work (RTW) Examinations. 200 - 500/month. The OMS providers shall determine whether an employee is fit to RTW after an illness or injury, occupational or non-occupational. Any employee who is placed, or is working light/limited duty, or is sent home will be followed by the OMS clinic every 30 days IAW HAFB Light Duty Policy. The RTW exams are documented by the OMS provider in Armed Forces Health Longitudinal Technology Application (AHLTA) and the RNCM enters the appointment information into the OMS Injury/illness database (OMS I+I) for tracking purposes. Workers are informed of how to contact the OWCP, NAF, or qualified tenant unit’s workman’s compensation liaison for assistance at the time of their initial appointment for this injury/illness.

4.5. Life Threatening Situations. The OMS providers or RNs shall triage and stabilize all patients with life threatening injuries or illnesses prior to or at the same time as activating the Emergency Medical System (EMS) system. EMS will be contacted by dialing 911 with a LAN line.

4.5.1. E-mail notification of Executive Staff at 75 MDG. As the patient is being taken to the ambulance, the RN Supervisor will send an e-mail to the 75 MDG /CC, director of Medical Staff (SGH), director of Nursing Staff (SGN), 75 AMDS/CC, and the COM to inform them of the EMS transport.

4.5.2. If a supervisor or coworker calls OMS regarding a patient emergency either physical or mental, the OMS staff will advise that person to call 911 for faster response of the EMS team to the employee.

4.5.3. The LAN line is directly linked to the HAFB Fire Department dispatch. The dispatcher will call the county 911 and notify the closest HAFB gate security staff when and where the ambulance is going.

4.6. Injuries/Illnesses Occurring Outside OMS Clinic Hours. Civilian and qualified tenant employees who sustain work related injuries/illnesses when the OMS clinic is closed shall be referred to off-base resources, preferably to the nearest emergency facility.

5.0. SHOP VISITS

5.1. Scheduling Annual Shop Visits. The RN Supervisor shall provide a schedule of annual shop visits in January to OEHWG for coordination and approval. The shop visit list will contain all SGPB designated Category 1 critical shops that receive OHME. Category 1 shops will be visited by an OMS provider . The OMS providers shall comply with the established schedule from January to December.

5.2 Shop Visit Preparation. The AA shall arrange shop visits with appropriate shop supervisors/POC. The AA shall obtain a personnel listing of employees from the OMS scheduler. The OMS provider will compare the employee list of the scheduler and the POC and review the list on site. OMS provider should review the shop folder (both SGPB and Tab F), any relevant Injury/Illness data from the OMS I+I database, the AF 2766, and AF 2755/OEHED prior to the visit. The AA invites Flight surgeons, PH, optometrist, RN, and audiologist to attend the shop visit.

5.3. SEG Trend Analysis. The RNCM shall search the OMS I+I database and report to the OEHWG any adverse injury/illness trends detected on each Category 1 SEG. The OMS provider will review all lab work completed for the OHME. The trend analysis is reviewed again prior to the shop visit, approximately three months after the shop physical examination block month.

5.3.1. Reporting of Trend Analysis Findings. The purpose of the trend analysis is to identify and determine possible causality between clinically significant laboratory abnormalities in employees during their OHME and potential exposures to occupational hazards. All positive trends shall be reported at OEHWG and discussed with the POC/supervisor of the shop.

5.3.2. Request for SEG Survey. The OMS provider shall initiate an SF 513, Consultation form, or two-way memo, to request from SGPB a workplace survey or evaluation whenever a question arises regarding the effectiveness of workplace controls as it relates to health.

5.4. On-Site Shop Visit Report. This report identifies findings/recommendations from each shop visit of the health/medical aspects of the work environment. The on-site shop visit report will include observations, conclusions, and recommendations. Safety concerns should be reported immediately to 75 ABW Ground Safety or to a representative of the OO-ALC ESOH office. Exposure concerns should be reported immediately to SGPB and to PH. The onsite shop visit form is filed in the shop folder. Abnormal findings are reported at OEHWG.

5.5. Documenting Shop Visits. The OMS provider shall complete the on-site shop visit report. The AA will document the shop visit on the spreadsheet. A courtesy copy of the shop visit report will be forwarded to 75 AMDS/CC, SGPB, PH, and the shop supervisor.

5.6. Shop Folder Control. The AA will comply with the shop folder control procedures established jointly with SGPB and PH. Procedures will be developed jointly to ensure positive control. This will be documented in the OMS records management log and in the OMS File Plan.

6.0. TESTING

6.1. Laboratory Specimens. The OMS LPN/LVN shall obtain all appropriate laboratory specimens and ensure their timely and safe transportation to the 75 MDG laboratory.

6.1.1. Laboratory Reports. Laboratory results shall be followed up appropriately, reviewed and initialed by the OMS provider.

6.1.2. Laboratory Accreditation. The OMS LPN/LVN will maintain on-going communication with the 75 MDG Laboratory Officer regarding operations of the OMS laboratory IAW the College of American Pathologists (CAP) standards. The OMS laboratory area is a satellite of the 75 MDG laboratory, thus susceptible to all accreditation standards by the CAP. Failure to maintain the OMS Lab area IAW to the CAP standards will result in termination of laboratory services at the OMS clinic.

6.2. Radiology. X-rays will be obtained through the 75 MDG Radiology department. Digital Image Radiographs will be interpreted by the consulting radiologist via computer. The OMS providers will be able to view the x-rays on the computer with the Synapse computer software and will render initial interpretations.

6.2.1. Radiology Reports. Radiology results shall be followed up appropriately and filed in the patient’s medical record. If a patient needs a copy of the x-ray, a CD will be made and can be picked up by the patient at the Radiology department in bldg. 570.

6.2.2. Radiology Services. Advanced imaging services (i.e. MRI, CT, and U/S) are not available in the 75 MDG; these services should be arranged for through the appropriate OWCP liaison if related to an occupational injury or illness by referral and managed by the RN NCM.

6.2.3. Laboratory and Radiology Results. The LPN/LVN will follow-up on all laboratory and radiology results. Once results are obtained the lab LPN/LVN will have an OMS provider review. All results are also sent to the OMS RN Supervisor for the abnormal lab work report. Once the results are initialed by the OMS provider it is filed into the employee’s medical record.

7.0. CODING

7.1. Coding. Coding is accomplished by the OMS providers through AHLTA. The 75 MDG Coding contract will review the OMS provider’s coding and discuss recommendations for clarifications on codes or notify either the provider directly or the RN Supervisor if changes must be made. RN and LPN/LVN will complete their own encounter coding through AHLTA.

7.2. Ambulatory Data. The 75 MDG coding contract staff contacts the OMS providers for needed information or if the AHLTA chart doesn’t show completed in the Automated Data Management system (ADS). This could mean the transfer from the Standard Ambulatory Data Record (SADR) Daily Outpatient Workload Report (DOWR) did not process correctly; the coding clerk will code per the AHLTA note. OMS providers will provide feedback when required to the coding contract staff. The OMS clinic will maintain the AF’s 72 hour AHLTA completion compliance.

7.3. KGADM. The OMS MRC shall complete Composite Health Care System (CHCS) end-of-day (EOD) data into KG-ADS. The ADS system will be monitored for the SADR/DOWR miscommunication to maintain a 98% accuracy rate of the AF’s 72-hour compliance completion rate.

8.0. CHARTING

8.1. Documentation. The OMS providers shall document all patient encounters in AHLTA, on the SF 78, and/or on the SF 600 overprint as required. The OMS provider shall address all determinations of positive findings on the employee’s health history survey. Each encounter will conclude with the provider completing a RTW form or an OHME form. These will include permanent or temporary work restrictions and/or qualification for OSHA expanded standard clearance. All RTW forms are signed by the employee to acknowledge a copy is to be given to his/her supervisor.

8.2. Provider Charting. All patient encounters including telephone consults accomplished by the OMS providers shall be adequately documented to record pertinent medical and occupational history, clinical finding, related lab or x-ray results, diagnoses, whether the medical condition or significant abnormality is believed to be job related, treatment and disposition. Each employee seen for a new injury/illness will have pertinent history and circumstances of occurrence, a statement explaining how the injury/illness is related to the position, diagnosis, and treatment recommended. Confidentiality shall be maintained IAW the applicable OPM regulations, AFIs, the Privacy Act of 1974, and Health Insurance Portability and Accountability Act (HIPAA) of 1996.

8.3. Interpretation. The interpretation of the individual’s health status and disposition shall be made by the OMS provider and shall be related to the established job requirements and workplace environment.

8.4. Guidance. An employee shall have all encounters properly documented by the OMS provider in the individual’s medical record. OMS MRC will ensure a complete medical record is maintained IAW AFI 41-210. Each encounter shall be documented in AHLTA. The provider is bound by all guidelines IAW AFI 44-119 and 75 MDG instructions.

8.5. Validating Medical Documents. The OMS providers shall indicate responsibility and validate the content and correctness of all of his/her AHLTA documentation when he/she attaches his/her digital signature to the document.

8.6. Depression Screening. A depression screen will be completed as per the 75 MDG depression screening guidance.

8.7. Written Replies. The Contractor shall prepare written replies for requests other than medical information e.g., union grievances, Equal Employment Opportunity (EEO) complaints, OWCP, official investigations, labor law requests for administrative actions, or congressional inquiries. If needed, these replies shall be coordinated and forwarded through the appropriate chain of command to the 75 MDG/CC for review and approval prior to release within required suspense assigned by the FRED upon receipt of the request.

8.8. Provider Peer Review. Peer review will be conducted IAW the 75SGH policies. The COM will review and assemble compiled report. Tabulated results of this peer review will be submitted monthly to SGH and 75 AMDS/CC. The SGH will present the summary at the monthly ECOMS meeting. Procedures performed in the OMS treatment room will also be reviewed and tabulated monthly as required by the 75 MDG.

9.0. DATA ENTRY

9.1. Aeromedical Services Information Management System (ASIMS). The OMS data entry MRC must become familiar with and use the computerized occupational health information surveillance system, and any upgrades as provided by the government.

9.1.2. ASIMS must be done as a final part of completing the physical exams. A monthly error rate will be calculated; the data entry MRC will have an error rate of less than or equal to 2%. The data entry clerk will receive training and approval from the 75 MDG ASIMS staff.

9.2. Occupational Health Medical Exams (OHMEs). All OHME elements (e.g. lab, pulmonary function test (PFT), electrocardiogram (EKG), vision, and questionnaires) must be tracked, completed, and entered into AHLTA/HAIMS by the ancillary staff, and OMS provider, into ASIMS by data entry MRC, and into Defense Occupational and Environmental Health Readiness System (DOEHRS) by the respiratory protection fit tech.

9.3. Data Entry MRC. The data entry MRC shall enter all OHME data. All daily patient scheduling encounters and EOD processing data will be input into CHCS, ADS, AHLTA, ASIMS, and Defense Occupational and Environmental Health Readiness System (DOEHRS). Patient care data includes the OMS provider’s physical exam, lab/x-ray, PFTs, EKG, vision results, and a “yes” response to any of the questions of any of the questionnaires. EOD CHCS processing shall be completed daily to meet AF requirement of 100% daily compliance.

9.4. OMS I+I Database. The RNCM enters all data regarding injury or illness visits into the OMS I+I database.

10.0. SCHEDULES

10.1. Scheduling OHMEs. The Contractor shall schedule all OHME, associated Hearing Conservation Program Exams (HCPE), and Occupational Medical Services using CHCS and AHLTA as provided by the 75 MDG. The Admin Lead shall create appropriate provider appointment templates in CHCS. These schedules will be for each OMS provider, PA, and RN staff. Schedules will also be maintained for the COM, and psychologist. The Admin Lead shall maintain a minimum of 60 calendar days open in the CHCS schedule for patient appointments. Appointments are scheduled for physicals, illness or injury follow-up, FFD, RTW, PDP physicals, and others as required. Emergency situations shall have priority over the routine services listed above.

10.2. Hearing Referrals. The OMS providers will evaluate DoD civilian or qualified tenant employees when referred by the 75 AMDS audiologist. This appointment will be made by the MRC.

10.3. Appointments for the Psychologist. An appointment template will be built and patients will be scheduled. These appointments may be made for evaluation of distressed employees, return to work evaluations after work absences for mental illness, and FFD evaluations.

10.4. Appointments for Supervisors. The Contractor shall make available appointments for consultation with supervision/ management of employees being evaluated at OMS. . These will be for the purpose of discussing an employee’s qualifications or duty restrictions. These appointments will include how to help the employee remain at work effectively and options for the supervisor but not diagnoses or prognoses.

10.5. Managing Walk-in Patients. The Contractor shall provide for receiving and managing patients on a “walk-in” non-appointment basis when the patient claims the condition may impact all of his/her ability to accommodate all elements of his/her position or if it is aggravated by a work exposure. Patients shall be triaged and if he/she cannot be seen that day, an appointment shall be given or he/she is referred to ER.

10.6. Other Schedules. A schedule will be maintained for the respiratory protection fit tech and for scheduling necessary tests e.g. vision tests, EKG, and PFT.

11.0. COMPUTER SYSTEMS

11.1. Computers. The Contractor shall use all computer systems provided by the government such as CHCS, KG-ADS, DOEHRS, and AHLTA ASIMS etc. All automated data processing equipment (ADPE) requests, such as computers, printers, and monitors, will go through the 75 MDG Systems office for review and approval. All ADPE will be managed and used IAW governing standards. Any requests above the 75 MDG end user license availability, will be handled on a case-by-case basis.

11.2. Aeromedical Services Information Management System (ASIMS). ASIMS is an AF program where data is maintained in order to have data available for analysis of employees’ medical/physical status and/or trends. The COM may determine which components of the ASIMS system will or will not be used and should report any decisions to change how ASIMS is used to the OEHWG.