List of Medical Examinatin Tests.pdf

This is a pricing template document for occupational health services provided in three package options: New Hire, Driver, and New Hire & Driver combined. The New Hire package includes a tuberculosis risk assessment, baseline chest x-ray (if recommended based on risk assessment), and an interferon gamma release assay (IGRA) if advised by the HU Medical Provider. The Driver package consists of a Department of Motor Equipment (DME) questionnaire, audiometry testing (if needed), urine testing (if needed), and chest x-ray for patients with high or moderate risk levels as determined by the HU Medical Provider. The New Hire & Driver combined package incorporates all services from both individual packages, including the TB risk assessment and DME questionnaire as base components, with conditional chest x-ray, IGRA, audiometry, and urine testing based on medical provider recommendations and risk assessments. All conditional services are contingent upon medical necessity as determined by the HU Medical Provider, with specific clinical thresholds noted for chest x-ray requirements. The document provides blank "Amount" columns for pricing to be filled in by the service provider. No response dates, award dates, federal agencies, contract vehicles, or set-asides are identified in this pricing template.