Chiropractic Services PWS 22 Aug 08.doc

Attachment 1

PERFORMANCE WORK STATEMENT (PWS)

FOR

Chiropractic Services 22 August 2008 Section One.

1. Description of Services.

1.1. Requirements. The Contractor shall provide personal services for Chiropractic Services referred to as the Health Care Provider (HCP) at Wilford Hall Medical Center (WHMC). Locations include, but are not limited to, WHMC at Lackland AFB, also referred to as the Medical Treatment Facility (MTF), Brooke Army Medical Center (BAMC), Kelly, Reid, North Central Federal Clinic, Camp Bullis and any successor organization(s) of WHMC, if applicable. The Contractor shall perform services and support compatible with the medical facility’s operating capacity and equipment.

1.1.1. Relationship of the Parties and Professional Liability.

1.1.1.1. This is a personal services contract and is intended to create an employer-employee relationship between the Government and the HCP. The performance of the individual HCP under this contract is subject to day-to-day supervision, clinical oversight, and control by healthcare facility personnel comparable to that exercised over military and civil service HCP engaged in comparable work. The Personal services contract does not create an employer-employee relationship between the Government and any corporation, partnership, business association or other party or legal entity with which the individual HCP may be associated.

1.1.1.2. Personal services (as defined in FAR Subpart 37.104 and Defense FAR Supplement, DFARS 237.104 (b)(ii)). The relationship is a personal services contract. Therefore, pursuant to 10 USC 1089(a), the Department of Defense (DoD) processes any personal injury claim alleging negligence by the HCP while acting within the scope of their performance under this contract as claims alleging negligence by DoD military or civil service HCP. The HCP is not required to maintain medical malpractice liability insurance, and the Government will not reimburse or otherwise pay for such insurance should any be purchased.

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

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

1.1.2. Health Insurance Portability and Accountability Act (HIPAA) of 1996.

1.1.2.1. Contractor personnel shall abide by federal and local MTF regulations concerning the confidentiality of patient records, as embodied in federal statutes including the Privacy Act of 1974 and HIPAA. All medical records and reports will remain the property of the government. All financial, statistical, personnel, and/or technical data which is furnished, produced or otherwise available to the Contractor/contractor personnel during the performance of this contract are considered confidential business information and shall not be used for purposes other than performance of work under this contract. The Contractor/contractor personnel shall not release any of the above information without prior written consent of the CO or Quality Assurance (QA) personnel at the MTF.

1.1.2.2. All services shall be rendered in accordance with established principles and ethics of the medical profession, the national standards established by The Joint Commission, Accreditation Association for Ambulatory Healthcare, (AAAHC), HIPAA, the Occupational Safety and Health Administration, the professional standards at the MTF, the Council on Chiropractic Education, and National Board of Chiropractic Examiners. The HCP shall provide services to all patients eligible for care at the MTF or as directed by the designated government representatives who are referred for services. The HCP shall provide services and support typically provided in a civilian MTF of similar size. The Government will evaluate the quality of the professional and administrative services provided and retain control over the medical and professional aspects of services rendered (e.g., professional judgments, diagnosis for specific medical treatment).

1.1.3. Specific Duties. The HCPs duties shall include, but are not limited to:

1.1.3.1. The Chiropractor shall:

1.1.3.1.1. Perform standard osseous and soft tissue procedures only, as commonly taught in Chiropractic College accredited by the Council on Chiropractic Education.

1.1.3.1.2. Be responsible for delivery of treatment within the personnel and equipment capabilities of the MTF, provision of mandated medical surveillance and preventive services and the quality and timeliness of treatment records and reports required to document procedures performed and care provided.

1.1.3.1.3. Employ and record every measure of observation that will more substantially profile the patient during the initial patient interview and consultation.

1.1.3.1.4 Conduct a patent history and chiropractic physical examination (excluding vaginal examination) as clinically indicated.

1.1.3.1.5. Utilize X-ray and standard laboratory tests appropriate to the chiropractic diagnosis and within the MTF's capabilities as detailed by the standard MTF operating procedures. Radiological examinations shall be limited to musculo-skeletal radiographs, skull series, chest (PA and lateral views) and rib series. MRI and CT studies of the spine and Bone Scans may be ordered following protocols established by the department of orthopedics. Lab tests shall be limited to SMA6, UA/C&S, Occult Blood, Erythrocyte Sedimentation Rate and Complete Blood Count.

1.1.3.1.6. Utilize the physical therapy modalities of heat, cold, light, electricity, sound and rehabilitation exercises in patient treatment area.

1.1.3.1.7. Provide patient instructions and recommendations in all matters pertaining to hygiene, nutrition, exercise and life style changes and ergonomic factors in the activities of daily living.

1.1.3.1.8. Refer patients to specialty services available at the MTF.

1.1.3.1.9. Orient, instruct, direct, and evaluate work activities of clinical support staff.

1.1.3.1.10. Plan and conduct lectures and training programs on chiropractic related subjects for staff, students and patients. The HCP shall teach, conduct or participate in seminars concerning the basic and/or clinical sciences of chiropractic if requested by the Government.

1.1.3.1.11. Order orthotics, lifts, collars, and lumbar sacral supports if available at the

MTF.

1.1.3.1.12. Place active duty patients on limited duty status (profile) according to MTF bylaws.

1.1.3.1.13. Place active duty patients on quarters for a maximum of 72 hours.

1.1.3.1.14. Document, on forms provided by the MTF, actions taken such as patient history, patient evaluation, treatments/adjustments, unusual occurrences, and morbidity in accordance with the standard MTF operating procedures.

1.1.3.1.15. Participate in weekly meetings to review and evaluate the care provided to patients, identify opportunities to improve the care delivered, and recommend corrective action when problems exist.

1.1.3.1.16. Attend annual renewal of the following Annual Training Requirements: family advocacy, disaster training, Sexual Harassment, and other courses as directed.

1.1.3.1.17. Document, on forms provided by the MTF, actions taken such as patient history, patient evaluation, treatments/adjustments, unusual occurrences, and morbidity in accordance with the standard MTF operating procedures.

1.1.3.1.18. Utilize Government computer systems technology for data input and retrieval (orders, lab results).

1.1.3.2. Chiropractic Technician’s shall:

1.1.3.2.1. Work under the general supervision of a Doctor of Chiropractic and will provide physiotherapy treatments/procedures in the clinic in a safe and medically accepted manner as directed by the Doctor of Chiropractic.

1.1.3.2.2. Initiate intake of new patients into clinic by taking and recording vital signs, assembling a new patient record with all appropriate forms, and assisting patients in completion of questionnaires and other documentation as requested by treating chiropractor.

1.1.3.2.3. Provide physiotherapy treatments/procedures, to include ultrasound, electrical stimulation, vibratory massage, heat, cold, diathermy, transverse friction massage, trigger point therapy, and PNF stretches.

1.1.3.2.4. Document physiotherapy treatments in patient record and initial. Report any unusual reaction to treatment immediately to the Chiropractor.

1.1.3.2.5. Instruct patients regarding nutrition, ergonomics, proper posture, stretches and exercises, and locations of further testing/procedures.

1.1.3.2.6. Supervise patient exercise programs.

1.1.3.2.7. Keep the chiropractor appraised of patient progress and any changes in health status.

1.1.3.2.8. Immediately report hazardous or malfunctioning equipment to the chiropractor.

1.1.3.2.9. Ensure adequate supply of hot packs, ice packs, towels, ultrasound gel, proper levels of water in hydro collator, table paper, brochures, and etc. in treatment rooms and sufficient quantities in reserve in stockroom. Order supplies as necessary to maintain prescribed quantities.

1.1.3.2.10. Verify, maintain and clean equipment. Monitor cleanliness and proper functioning of all equipment and report any malfunctioning to chiropractor. Generate work orders as necessary.

1.1.3.2.11. Exchange linen daily, and store clean, folded linen under plinths.

1.1.3.2.12. Attend clinic or hospital in-services and required training and meetings.

1.1.3.2.13. Coordinate and communicate with other clinic staff (medical physicians, nurses, physical therapists, and technicians) to ensure patients receive excellent care in a timely manner.

1.1.3.2.14. Escort patients to treatment rooms and coordinate patient flow to ensure patients are not waiting for appointments or instructions.

1.1.3.2.15. Answer telephone and direct patient’s inquiries appropriately.

1.1.3.2.16. Request medical records, x-rays, and test results from appropriate clinics and hospital departments.

1.1.3.2.17. Maintain documentation regarding records requests, records releases, and supplies ordered and new patients scheduled.

1.1.3.2.18. Maintain/create provider schedules and book/cancel patient appointments.

1.2. General information.

1.2.0. Staffing. The Contractor shall provide qualified and trained HCPs to cover the required hours of performance. The Contractor shall staff HCPs that meet the all qualification requirements of paragraph 1.2.3 of this PWS and ensure continuity of performance.

1.2.0.1. Interviews / Candidate Approval. The government reserves the right to conduct a face to face or telephonic interview of potential candidates prior to their employment under this contract. If interviews are conducted, the Contractor shall, prior to final selection of the HCPs, coordinate through and request approval of the candidates from the contracting officer.

1.2.1. Contractor Representative. The Contractor shall identify the name and local telephone number of the Contractor’s local point of contact to the CO in writing prior to beginning performance. The Contractor shall identify in the designation letter any limitations on it’s representative's authority to act on behalf of the Contractor. The Contractor shall provide an updated designation letter whenever any changes occur. The Contractor may be required to meet with the government during the performance of this contract at the request of the CO.

1.2.2. Hours of Performance. Normal daily hours for all clinics are between 0700 and 1700. The duty week shall not exceed forty (40) hours in seven (7) calendar days. The Contractor shall provide full coverage (continuous presence) during the required hours of performance. The Contractor shall maintain personnel continuity to the maximum extent consistent with efficient resource management.

1.2.2.1. Scheduled Absences. Scheduled absences shall be scheduled thirty (30) calendar days in advance and mutually agreed upon by the QA or government designated representative, and the contractor.

1.2.2.2. Unscheduled Absences. Unscheduled absences shall be reported to the contractor or Program Manager no later than two (2) hours prior to the start of shift by the contract personnel communicated to the QA or government designated representative. If the HCP is absent for more than three (3) working days, the Contractor shall initiate replacement action.

1.2.2.3. Family/Down Days. Services may be required on holidays to include any Family Day/Down Day. Typically, a "Family Day/Down Day” is associated with, but not limited to, the following holidays: New Year’s Day, July 4th, Thanksgiving, and Christmas. The Contractor shall not bill the Government for a Family Day/Down Day unless the HCP is required to report to work.

1.2.2.3.1. The following is a list of legal federal holidays: New Year’s Day, January 1st; Martin Luther King’s Birthday, 3rd Monday in January; President’s, Day, 3rd Monday in February; Memorial Day, last Monday in May; Independence Day, July 4th; Labor Day, 1st Monday I September; Columbus Day, 2nd Monday in October; Veteran’s Day, November 11th; Thanksgiving Day, 4th Thursday in November; Christmas Day, December 25th.

1.2.2.4. Inclement Weather. In the event of inclement weather (snow, ice, etc.), the government will notify the contractor whether its personnel will report and, if so, when. The contractor will instruct its personnel scheduled to report for duty (who have not yet begun their shift) whether to report and, if so, when.

1.2.2.4.1. Contractor personnel on duty at the onset of inclement weather (as declared by local base officials) shall remain on duty until the end of their scheduled shift unless otherwise directed by government officials.

1.2.2.4.2. In the event that contractor personnel are on duty and cannot leave the installation due to inclement weather (as declared by local base authorities), the Contractor will be allowed to invoice for hours if the government determines contractor personnel are necessary for MTF operation and instructs the contractor accordingly.

1.2.2.5. Closures. During Command declared closure of the facility the contractor personnel shall be treated in the same manner as DoD non-essential civilian employees.

1.2.3. Qualifications. The HCP shall meet the following qualification requirements:

1.2.3.1. Chiropractor:

1.2.3.1.1. Education. The HCP shall meet education requirements:

1.2.3.1.1.1. Possess a degree from a chiropractic college accredited by the Council on Chiropractic Education.

1.2.3.1.2. Continuing Medical Education (CMEs). The HCP shall keep their cense/registration/certification current. Required continuing education for CMEs shall be at no additional cost to the Government. The HCP shall provide appropriate CMEs documentation to the QA or designated government representatives within one month after all CMEs accredited events.

1.2.3.1.3. License and Certification Verification. The HCP shall hold a current, unrestricted license to practice as a Doctor of Chiropractic in any one of the fifty States, the District of Columbia, the Commonwealth of Puerto Rico, Guam or the U.S. Virgin Islands.

1.2.3.1.3.1. The Contractor shall perform all primary and annual licensure or certification document verifications for the HCP to include all replacement HCPs not requiring credentialing. Verifications shall be submitted to the government at least ten (10) working days prior to the proposed backup/replacement beginning work in accordance with Appendix one (1).

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

1.2.3.1.3.3. Possess current certifications in Basic Life Support (BLS), The Contractor/HCP is responsible for maintaining this certification in a current status throughout the life of this contract.

1.2.3.1.4. The contract personnel shall complete the Initial profile package requirements (Appendix one (1)).

1.2.3.1.5. Experience. The HCP shall meet experience requirements:

1.2.3.1.5.1. Experienced as a chiropractor, licensed independent practitioner for at least 24 consecutive months within the last 36 months for both diagnostic and treatment services.

1.2.3.2. Chiropractic Technician:

1.2.3.2.1 Knowledge. The following knowledge is mandatory:

1.2.3.2.1.1. Medical terminology, anatomy and physiology; nursing theory, techniques and procedures; team nursing; patient needs; emergency medical treatment to include cardiopulmonary resuscitation, aseptic technique, medical ethics, and legal aspects; prescribed drugs and their administration; operating and maintaining therapeutic equipment, military hygiene and sanitation; risk management, contingency operations, disaster preparedness, and chemical warfare; and transportation of sick and wounded. Vaccination procedures; methods of properly administering intradermal, subcutaneous, and intramuscular injections; pollen counting; allergen identification; composition of various vaccines; mechanisms of anaphylaxis and shock and their treatment; and pharmacology of various drug groups.

1.2.3.2.2. Training. The following training is mandatory:

1.2.3.2.2.1. Completion of a medical assisting program recognized and accredited by the Commission on Accreditation of Allied Health Education Programs (CAAHEP) or the Accrediting Bureau of Health Education Schools (ABHES).

1.2.3.2.3. Experience. The HCP shall meet experience requirements:

1.2.3.2.3.1. Have at least 12 months of experience within the last 36 months administering care and treatment of patients within the scope of their training; operating and maintaining therapeutic equipment.

1.2.3.2.3.2. Experience conducting sub professional portions of physical examinations.

1.2.3.2.3.3. Have at least 12 months of experience within the last 36 months, in an outpatient clinic setting.

1.2.4. Privileging Requirements. The credentials of the HCP shall meet the privileges granted as outlined in the most current version of AFI 44-119, Clinical Performance Improvement:

1.2.4.1. Copies of valid, current, active, unrestricted medical licenses, registrations, education and training certificates, and/or certifications in accordance with AFI 44-119. Copies of board certifications if applicable. The HCP shall maintain active licenses or authorizing document from any U.S. jurisdiction. The Contractor shall be responsible to primary source all licenses and documents.

1.2.4.2. Applications for privileges shall be screened through the National Practitioners Data Bank by the Contractor.

1.2.4.3. Professional staff appointments and clinical privileges are specific to the facility and the provider, to include documents listed above, in accordance with the most current version of AFI 44-119. Initial appointment is for one year and reappointment shall occur and not to exceed two years, in accordance with the most current version of AFI 44-119.

1.2.4.4. The Contractor shall submit the HCP applications thirty (30) days prior to performance start date. If the HCP is currently credentialed at another DoD agency, the Contractor shall request an electronic transfer brief and printed copy of same. If credentialing will expire within sixty (60) days of scheduled start date of contract, a new package shall be submitted.

1.2.4.4.1. The Contractor shall submit package no more than ten (10) working days from date of initial request.

1.2.5. Compliance. The HCP shall comply with all applicable Air Force Instructions (AFI), Department of Defense Regulations, and Medical Wing Instructions (MDWI) as outlined in Appendix two (2).

1.2.5.1. Documentation. The HCP shall prepare all documentation to meet or exceed established standards as set forth in the most current version of MDWI 41-35, “Health Record Documentation”.

1.2.5.2. The Contractor shall manage all data created for Government use or legally controlled by the Government, in support of the functional activity or required by AF publication, IAW with the AF records management procedures in Air Force Instruction (AFI) 33-322, Records Management Program, Air Force Manual (AFMAN) 33-363, Management of Records, AFI 33-364, Records Disposition-Procedures and Responsibilities, and the Air Force Records Disposition Schedule (AF RDS) located at https://www.my.af.mil/gcss-af61a/afrims/afrims/rims.cfm.

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

1.2.6.1. The HCP shall not bill the patient for services rendered or accept compensation of any kind for patients treated, procedures performed, or any other actions performed, except under the terms and conditions of this contract.

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

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

1.2.6.4. The HCP shall not respond to any media inquiries nor provide interviews, comments, or any other responses to the media. All inquiries or complaints from the media or other sources shall be immediately relayed to the QA or designated government representatives.

1.2.6.5. The HCPs shall conduct themselves professionally and appropriately as contract employees. The HCPs are employees of the Contractor and not of the U.S. Government or the Air Force. The HCPs shall not discuss or disclose personal matters (e.g., their salary, disagreement with their employer, etc) with Government personnel. All matters/disagreements between the HCPs and the Contractor should be addressed outside the MTF and not during contract hours or using Government’s resources. The Government will not get involved in any matters between the HCP and their employer (the Contractor). Failure to comply or violations of this conduct policy will be deemed as a breach of contract and the Government will reserve the right to invoke any and all remedies available, including Termination for Cause.

1.2.7. Security.

1.2.7.1. Contractor Notification Responsibilities. The Contractor shall notify the 37 SFS Industrial Security Office (SFAD) at each operating location prior to the performance of the contract. The notification shall include the contract number, contracting agency, the date service performance begins and ends, the location(s) of service performance and future performance, and the reason for the contract (i.e., work to be performed).

1.2.7.2. Obtaining Pass and Identification Items. The Contractor shall ensure pass and identification items required for contract performance are obtained for the HCP providing service. The Government will provide MTF ID badges which will be displayed while performing duties in the MTF.

1.2.7.3. Removal of HCP. The government reserves the right to require immediate temporary or permanent removal of any individual whose actions raise reasonable suspicion that patient care or services may be compromised in any way or that pose a threat of harm to other contractor/government personnel or self. The HCP may be required to submit to drug/alcohol testing. The government reserves the right to require temporary or permanent removal of any individual who refuses testing. Notification of all removals will be made by the CO. Removal of any individual does not relieve the contractor of any performance requirement.

1.2.7.3.1. If a removal occurs, the QA will contact the CO and the contractor’s representative within twenty-four (24) hours. A meeting may be required with the CO, QA and Contractor representative to discuss further action.

1.2.7.3.2. The CO will notify the Contractor if and when permanent removal is required. In the event of a disagreement between the Government and the Contractor, the decision of the CO will be final. During the period of time between the removal and the final decision of the CO, the Contractor agrees to provide a backup/replacement HCP in accordance with the terms of this contract.

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

1.2.8. Health Requirements and Immunizations. All Contractor personnel shall control and prevent disease in accordance with AFI 48-105 Surveillance Prevention and Control of Diseases and Conditions of Public Health or Military Significance, and the American Public Health Association Publication, Control of Communicable Diseases Manual, and the Centers for Disease Control and Prevention (CDC) publication, Morbidity and Mortality Weekly Report, Air Force Policy (as applicable) and its supplements. The Contractor shall provide proof of immunization or immunity from or screening for the following diseases according to Air Force guidelines equivalent to that provided to active duty armed forces: Hepatitis B, MMR (Measles, Mumps, and Rubella), Varicella, Tdap (Tetanus, Diphtheria, and Pertussis), Tuberculosis (TB), HIV (HCP who have direct patient care) and influenza (IAW 1.2.8.2.) for all personnel prior to contract performance. For the TB screening, the Contractor shall provide proof of negative TB 2-step skin testing IAW CDC recommendations outlined in Appendix one (1) of this document. If an individual has a past positive TB skin test, the Contractor shall provide proof of a negative chest X-ray within twelve (12) months) prior to personnel performing. The Government reserves the right to require more frequent Tuberculosis testing of personnel based on the facilities’ annual TB risk assessment. Additional vaccines as they are made mandatory for health care workers may also be required in unusual circumstances.

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

1.2.8.2. Influenza Immunization. Contractor Personnel shall receive the current influenza immunization, at contractor’s expense, equivalent to that provided to active duty armed forces personnel unless contraindicated by allergy; as an example, to eggs as evidenced by hives, difficulty breathing, itching, and other symptoms of anaphylactic hypersensitivity and/or physician’s diagnosis. At Government’s discretion it can be accomplished as stated in paragraph 3.7.1. of the PWS.

1.2.9. Reports. The Contractor shall submit initial, quarterly, and annual reports to the CO as requested for use in monitoring performance. Such reports may include, but are not limited to:

Health and Immunization requirements (initially)

Personnel Changes (quarterly)

Basic Life Support (BLS)* – (initially and renewal) Continuing Education Units (initially and annually) Competency and currency of licensure/registration (initially and renewal) Security (initially) Timesheets (monthly) *NOTE: In accordance with Military Training Bulletin No. 07-003 (7 Feb 07), this training will not be provided by the government.

1.2.10. Non-Compete Conditions. The contractor shall not restrict personnel employed on this contract from performing on any successor contract.

Section Two.

2. Service Summary.

Objective

PWS

Paragraph Performance

Threshold

Zero complaints.

with staffing requirements.

95% compliance with staffing requirements.

Section Three.

3. Government-Furnished Property and Services.

3.1. Government-Furnished. The Government will provide use of all available MTF facilities and support services, materials, publications and forms, equipment, and specialty clothing required for contract performance (except as designated in the contract). The HCP shall keep government-furnished supplies, equipment, and work areas in a safe, orderly, and clean condition. The HCP shall notify the QA whenever maintenance of equipment is required.

3.2. Personal Protective Equipment (PPE). The Government will furnish the HCP with appropriate common use PPE (e.g., face shield, gloves, lead vests). The Government will be responsible for any repair, cleaning, and inventory required for the PPE. Items shall be used and returned as directed by the QA. This does not include any type of personal uniform items such as safety glasses or earplugs which are the Contractor’s responsibility.

3.3. MTF Orientation. The HCP shall attend the MTF Orientation at the outset of their working at MTF. The MTF Orientation will familiarize the HCP with the policies and procedures of the MTF and will be scheduled by the QA or designated government representatives within two months of employment. Orientation attendance shall be required of the HCP during government paid duty hours.

3.4. Training. The Government will schedule and furnish initial and annual training to include but are not limited to various applicable software, data base systems, quality assurance policies, radiation safety, local in-service, safety briefings, compliance, patient safety, performance improvement, risk management, infection control, fire protection, security, patient sensitivity training, local in‑service, and safety briefings. The classes may be scheduled individually throughout the year or scheduled at one time.

3.4.1. Security Training. The contract personnel shall be trained in accordance with AFI 31-501, AFI 31-401; AFI 33-202, Computer Security; AFI 31-101 Installation Security; AFI 33-203, Emission Security (EMSEC) and AFI 33-204, Information Protection Security Awareness, Training, and Education (SATE) Program.

3.4.2. Specialty Training. The Government may provide voluntary specialty training to contract personnel in a non-paid status.

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

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

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

3.7.1. Vaccine. Influenza 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 Contractor. Unless vaccinated by the Government, proof of vaccination will be required.

3.8. Badges. The government will provide MTF ID badges and will be worn/displayed at all times.

3.9. Uniforms. The MTF shall furnish a physician’s coat. This item will be cleaned at the MTF’s expense.

APPENDIX 1

CONTRACT SPECIFIC REQUIREMENTS

PRIOR TO PERFORMANCE

WILFORD HALL MEDICAL CENTER/59TH MDW

FAXED TO:__________________________FAX:__________________DATE:_____________

Contract Position: __________________________________________

Name:____________________________________________________

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

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

_______Immunization Record

_______Varicella (serologic evidence of immunity or documentation of 2-shot series) _______Tdap Documentation of tetanus/diphtheria vaccination within 2 years or current Tdap vaccine.)

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

Screening Criteria

Required Testing

No Previous Documented TST result

Two-step baseline TST

Previous documented Neg TST >12 months before new employment Two-step baseline TST

Previous documented Neg TST < 12 months before new employment Single TST

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

Previous documented Positive TST

Chest X-Ray (negative)

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

_______Hepatitis B (Serologic evidence of immunity or documentation of 3-shot series) _______HIV (direct contact with patients or body fluids) (Frequency shall be based on exposure risk per hospital employee program)

_______Influenza (current series)

_______Drug Testing

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

____LFC

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

_______Copy of license (if applicable)

_______Copy of certifications (if applicable)

_______Skills assessment checklist (if applicable)

_______Credentials package (if applicable)

APPENDIX 2

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

(Note: In all instances, most current version applies.)

AFI 31-101, The Air Force Installation Security Program. (IAW MOA: CONS & 37SF)

AFI 31-401, Information Security Program Management. (IAW MOA: CONS & 37SF)

AFI 31-501, Personnel Security Program Management. (IAW MOA: CONS & 37SF)

AFI 33-202, Network and Computer Security. (IAW MOA: CONS & 37SF)

AFI 33-203, Emission Security. (IAW MOA: CONS & 37SF)

AFI 33-204, Information Assurance Awareness Program. (IAW MOA: CONS & 37SF)

AFI 33-322, Records Management Program, Paragraphs 1 & 2

AFI 33-332, Air Force Privacy Act Program. (Entire instruction applies) AFI 33-364, Records Disposition - Procedures and Responsibilities. (Entire instruction applies)

AFI 41-210, Patient Administration Functions, Chapters 2 through 10

AFI 41-35, Health Record Documentation. (Entire instruction applies)

AFI 44-102, Medical Care Management, para.3.8.

AFI 44-119, Clinical Performance Improvement. (Entire manual applies)

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

AFI 71-101VI, Criminal Investigations. (IAW MOA: CONS & 37SF)

AFI 71-101V2, Protective Service Matters. (IAW MOA: CONS & 37SF)

AFMAN 37-123, Management of Records. (Entire manual applies)

AFMAN 37-139, Air Force Records Disposition Schedule. (Entire manual applies)

MDWI 10-4, Codes and Alarms. (Entire instruction applies) MDWI 32-6, Fire Prevention, Fighting and Evacuation Program. (Entire instruction applies) MDWI 40-1, Plan for Provision of Patient Care. (Entire instruction applies) MDWI 44-9, Infection Control Program. (Entire instruction applies) MDWI 48-8, Hazardous Materials, Waste Disposal Spill Prevention & Management. (Entire instruction applies) DoD Directive 5400.7, Freedom of Information Act Program, paragraphs 2 & 3

DoDI 6040.40, Military Health System Data Quality Management Control Procedures, paragraph 2.

DoDI 6040.42, Medical Encounter and Coding at Military Treatment Facilities, paragraph 2.1

DoDI 6040.43, Custody and Control of Outpatient Medical Records, paragraph 2.1.

DoDI 6025.8, Ambulatory Procedure Visit (APV) paragraphs 2.2., 2.3., and 2.4.

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