RFP 0215156 Physical Exams

PART I – THE SCHEDULE

SECTION B – SUPPLIES OR SERVICES AND PRICES/COST

B.1.0

DESCRIPTION OF SERVICES

The Contractor shall provide complete physical examinations from board-certified physicians for the Federal Bureau of Investigation (FBI).

B.2.0

TYPE OF CONTRACT

This is an Indefinite Delivery, Indefinite Quantity (IDIQ), Fixed-Price type contract for one (1) base year and four (4) additional one-year option periods. This requirement may be met through the award of a single or multiple IDIQ contracts for multiple locations: New York, NY, Newark, NJ, Los Angeles, CA, Boston, MA, Portsmouth, NH, Portland, ME, Philadelphia, PA, and Houston, TX.

B.3.0

ORDER LIMITATIONS

A. Minimum order. When the Government requires supplies or services covered by this contract in an amount of less than $5.00, the Government is not obligated to purchase, nor is the contractor obligated to furnish, those supplies or services under the contract.

B. Maximum order. The Contractor is not obligated to honor:

(1) Any order for a single line item in excess of $5,000.00

(2) Any order for a combination of items in excess of $600,000.00.

(3) A series of orders from the same ordering office within thirty (30) calendar days that together call for quantities exceeding the limitation in subparagraph (1) or (2) above.

C. Notwithstanding paragraph (b)above, the Contractor shall honor any order exceeding the maximum order limitations in paragraph (b), unless that order (or orders) is returned to the ordering office within ten (10) working days after issuance, with written notice stating the Contractor's intent not to ship the item (or items) called for and the reasons. Upon receiving this notice, the Government may acquire the supplies or services from another source.

B.4.0

PLACEMENT OF ORDERS

Orders against this contract will be placed in writing, by means of a written delivery order. The Contracting Officer (CO) or his/her designee is/are the only person(s) authorized to place these orders.

The Contractor shall not commence work until a delivery order, executed by a CO, has been received or the Contractor has been given a verbal order by the CO to proceed. If any performance difficulties are anticipated or arise due to the terms and conditions of the delivery, the Contractor shall promptly notify the CO. Each delivery order shall be treated, for purposes of payment and expenditure, as an independent document.

If the Contractor experiences any difficulties in performance of his duties as required by the delivery order, he/she shall promptly notify the CO in writing and provide a written justification.

B.5.0

TRAVEL POLICY

The Government will reimburse the Contractor for the allowable travel costs for the base year incurred by the Contractor in performance of the contract subject to the following provisions:

General. Travel required for tasks assigned under this contract shall be governed in accordance with rules set forth for temporary duty travel in the Federal Travel Regulations and the Standardized Regulations (Government Civilians, Foreign Areas). The Federal Travel Regulations are available on a subscription basis from the Superintendent of Documents, U. S. Government Pricing Office, Washington, DC 20402, Stock No. 022-001-81003-7. The Standardized Regulations (Government Civilians, Foreign Areas), Section 925 is available on a subscription basis from the Superintendent of Documents, U.S. Government Printing Office, Washington, DC 20403, Stock No. 744-008-00000-0.

Travel. Travel, subsistence, and associated labor charges for travel time are authorized for travel beyond a 50-mile radius of the Local Office, whenever a task assignment required work to be accomplished at a temporary alternate worksheet. No travel, subsistence or associated labor charges for travel shall be charged at the Contractor's Local Office or any other worksite within a 50-mile radius of the Contractor's Local Office.

Per Diem. Per diem for travel on tasks assigned under this contract will be reimbursed at a rate not to exceed the amount authorized in the Federal Travel Regulations and the Standardized Regulations (Government Civilians, Foreign Areas).

Lodging. Lodging will be reimbursed up to the limits established in the Government travel regulations for Federal Government personnel.

Meals and Incidentals. Meals and Incidentals (M&IE) shall be reimbursed at the applicable rate allowable established by the Government regulations and published in the Per Diem Supplement 925 to the Standardized Regulations.

Automobiles. For travel where use of personal automobile has been specifically authorized, mileage reimbursement shall be computed on the basis of miles traveled from starting point to destination per the current Rand McNally Mileage Guide. Other actual related miscellaneous expenses, such as toll and parking fees, accrued in conducting business associated with tasks assigned under this contract, will be reimbursed. Car rentals require written advance approval except under unusual circumstances and will be authorized only when consistent with good business practice and generally at a cost not to exceed actual cost of renting compact automobile (one for maximum of five (5) Contractor personnel), unless extenuating circumstances (e. g., excess baggage) require other arrangements.

Travel arrangements. The Contractor is responsible for making all travel arrangements to support his personnel during the conduct of tasks assigned under this contract. All air travel shall be on Commercial Airlines Coach Class, unless authorized in advance in writing by the Contracting Officer's Technical Representative. The Contractor shall make no direct labor charges for making travel arrangements.

B.6.0

TRAVEL APPROVAL BY COTR

Travel, subject to prior written approval of the COTR, will be paid in accordance with the Federal Travel Regulations.

B.7.0

TRAVEL HEALTH EDUCATION

As appropriate for projected itinerary of official travel destination(s). The vendor should include a written report of travel health education provided in the medical record.

Physician(s) shall provide Medical consultations and answer medical related questions as well as perform employee medical examinations and laboratory analysis.

Physician(s) shall provide expert testimony services. Travel, subject to prior written approval of the COTR, will be paid in accordance with the Federal Travel Regulations.

B.8.0

PRICING/FIVE (5) YEAR ESTIMATED CONTRACT COST

Refer to pricing matrices located at - LIST OF ATTACHMENTS; Attachment 1, SECTION B - SUPPLIES OR SERVICES AND PRICES/COST, of the solicitation package for the base year and four option year periods. Pricing shall be entered onto the pricing matrices. Offeror shall complete one pricing matrix for each Field Office they are proposing. No other form, formatting, or notations will be accepted. Line items left blank will be viewed as "Non Responsive."

B.9.0

EXPERT TESTIMONY SERVICES

Physician(s) shall provide expert testimony services as required.

SECTION C - FITNESS FOR DUTY PROGRAMS

STATEMENT OF WORK

C.1.0

GENERAL DESCRIPTION

The Government has a need to acquire complete physical examinations by board-certified physicians in accordance with the criteria of the Federal Bureau of Investigation (FBI) as set forth in this section.

C.2.0

SCOPE

A.

Provide a complete health examination of Special Agent Applicants, Special Agents (SAs), other specialized applicants, employees, and selected dependants and FBI personnel in order to enable the determination of fitness for duty, ability to perform essential job functions including, but not limited to strenuous physical exertion, world-wide deployment, and any defects which would restrict or prohibit participation in defensive tactics and dangerous assignments which might entail the practical use of firearms.

B.

Provide Occupational Health Services to FBI Field Office locations as specified by the Contracting Officer Technical Representative (COTR), including emergency response, immunizations, venipuncture, health education and medical consultations.

C.

Having a quality assurance plan in place for all services provided.

C.3.0

TASKS TO BE PERFORMED BY PHYSICIANS

A.

Physician(s) shall assist in establishing local compliance for FBIHQ medical policy as required.

B.

Physician(s) or licensed professional employees shall provide training lectures as required or requested by the Division.

C.

Physician(s) shall provide Medical consultations and answer medical related questions as well as perform medical examinations and laboratory analysis.

D.

Physician(s) shall provide expert testimony services. Travel, subject to prior approval of the COTR, will be paid in accordance with the Federal Travel Regulations.

E.

Physician(s) shall provide Bloodborne Pathogen post exposure and follow‑up procedures as needed, for occupationally exposed employees. The protocol used will be according to current Centers for Disease Control (CDC) guidelines at the time of the evaluation or procedure. The U.S. Public Health Service is responsible for the guidelines and the recommendations for vaccination(s), evaluations and follow‑up. Refer any questions to the HCPU Bloodborne Pathogens Program Manager.

F.

Prescriptions: Physician(s) shall provide written prescriptions for travel medicine, i.e. malaria prophylaxis and sleep aids.

G.

Physician(s) shall provide other duties as assigned by COTR including serving as the local Medical Director for the Automatic External Defibrillator Program.

H.

Physician will perform hands on examination for all exam types.

I.

Physician(s) shall conduct employee reviews and provide a written summary at the end of each examination except the applicant examination. At the conclusion of all physical examination, the physician shall be available for consultations.

C.4.0

APPLICANT/PRE-EMPLOYMENT PHYSICAL REQUIREMENTS

Refer to FBI Applicant Exam Authorization Form (FD-945).

A. Vital signs - temperature, pulse, blood pressure - sitting, respirations.

B. Height (HT) - without shoes.

C. Weight (WT) - in examination gown or undershirt and shorts, without shoes.

D. Distant and near visual acuity (with and without correction). Give results in Snellen equivalents, with updated chart, where E = 20/200.

E. Visual fields, strabismus and color vision. Color vision (Ishihara plates, use 14 plates and state how many are correct). An Ishihara equivalent test can also be used.

F. Intraocular tension (tonometry) on applicants for baseline.

G. Pulmonary Function Testing (PFT) will be conducted by an individual with a current certification from a approved NIOSH course. The test performed on an applicant is the baseline. Testing equipment needs to adhere to ANSI and OSHA standards in regards to preventive maintenance and calibration.

H. Complete gynecologic exam including: pelvic, breast exam, digital rectal, and Papanicolaou (PAP) test. Documentation from Personal Medical Doctor (PMD) of exam done within 6 months of applicant physical is acceptable in lieu of gynecologic exam; the cytology report must be included.

I. Chest X-ray (PA and lateral views) reviewed by board certified radiologist.

J. Resting Electrocardiogram (12-lead) with interpretation.

K. Screening audiometric testing following Occupational Safety and Health Administration 5CFR1910.95, testing performed in HZ levels: 500, 1000, 2000, 3000, 4000, 6000, 8000. Performed by an individual who has a current certificate from a hearing conservation course recognized by the Council of Accreditation in Occupational Hearing Conservation (CAOHC) OR by using a micro processing audiometer. Physician shall provide information regarding hearing conservation program to the examinee at the time of the physical examination. Hearing booths and other testing equipment need to adhere to ANSI and OSHA standards in regards to preventive maintenance and calibration.

C.4.1

APPLICANT/PRE-EMPLOYMENT LABORATORY TEST REQUIREMENTS

Refer to FBI Applicant Exam Authorization Form (FD-945).

Interpretation of laboratory tests will be made by the reviewing physician. Tests performed are as follows:

A. Urinalysis- dipstick- clean catch is sufficient. Components of dipstick (10 SG multistix) include: glucose, bilirubin, ketone, specific gravity, blood, pH, protein, urobilinogen, nitrite, and leukocytes. IF THE URINALYSIS TEST RESULTS ARE ABNORMAL, a microscopic examination including the following: color, appearance, pH, glucose, ketones, blood, bilirubin, urobilinogen, nitrite, WBC, RBC, epithelial cells, bacteria will be necessary. Other tests as indicated.

B. Complete blood count: WBC, RBC, hemoglobin, hematocrit, indices, differential white blood cell count and platelet count.

C. Blood group and type.

D. Blood chemistry - glucose, blood urea nitrogen, creatinine, uric acid, total bilirubin, alkaline phosphatase, SGOT, SGPT, and GGT.

E. Tuberculin Test with interpretation by medical professional (physician or nurse). This is a mandatory test for applicants, unless it is contra-indicated by a prior history of a positive conversion or BCG vaccination within the last 5 years.

F. Alternative TB testing, Interferon Gamma Release Assays (IGRA) should be available if needed to assist in diagnosing latent Tuberculosis infections. Use MUST be approved by Health Care Programs.

G. Occult Blood (3 slides) Offer only.

H. Sickle Cell (Black/Mediterranean descent ONLY)

I. G6PD

J. Lipid Panel: Total Cholesterol, Triglycerides, HDL, LDL and Chol/HDL ratio.

C.4.2

COMPLETE MEDICAL HISTORY

Use Standard Form-93 (Report of Medical History). The examiner shall comment in block 25 regarding all positively marked items on this form by the item number. This is very important. The examiner must verify that the applicant has answered all questions completely.

A. Past medical history must address items included on SF-93 (may also be recorded on the SF-88, block 42). The examiner will also address the following:

a. Alcohol Usage - type of beverage, frequency and pattern of use.

b. Medications - prescription and nonprescription.

c. Smoking/Tobacco - Use/History.

d. Level of exercise - specific activities, frequency and intensity.

e. Suspected or known Tuberculosis (TB) contact or foreign travel to an area known to be endemic for TB since last examination.

B. Family history (SF-88, block 42) of medical significance (e.g., diabetes, heart disease hypertension, anemia, mental disorder, cancer, stroke).

C. Immunization history - Each applicant is given a FD-864 (Immunization Questionnaire) to complete. The examiner is to review the form and make recommendations to the applicant for any required updates. The examiner should pay special attention to MMR, Polio (IPV), Td or Tdap and Meningococcal Vaccines. NO FBI PROVIDED IMMUNIZATIONS ARE TO BE GIVEN TO APPLICANTS. ADVISE APPLICANT TO OBTAIN IMMUNIZATIONS FROM PERSONAL MEDICAL DOCTOR OR BILL SEPARATELY IF OFFERED FROM VENDOR SUPPLY DURING THIS VISIT.

C.4.3

HANDS - ON EXAMINATION TO BE PERFORMED BY THE PHYSICIAN

Refer to Report of Medical Examinations (SF-88).

The essential tasks list for Special Agent will be provided to the selected contractor and can be used as a guide for the physical examination. Please note that this information is proprietary and should not be shared outside of its appropriate application to FBI business. It will need to be returned upon cessation of contract duties.

A. Head, face, neck, scalp.

B. Nose, mouth, sinuses, dental, and throat.

C. Ears - drums (movement/perforation).

D. Eyes - general, pupillary reaction, ocular motility, fundus exam, visual fields.

E. Lungs and chest - auscultation, percussion.

F. Heart - thrust, rate, rhythm, murmurs, gallops.

G. Vascular system - varicosities, pulses, bruits.

H. Abdomen and viscera - hernias, tenderness, masses, megaly.

I. Anus and rectum- for males ONLY, note hemorrhoids

J. Fistulas, (include results of digital examination of rectum and prostate, hemoccult of digital material).

K. Endocrine - thyroid nodules, enlargement. Gynecologic: Females-complete gynecologic exam, including pelvic, breast exam, digital rectal, and Papanicolaou (PAP) test. Documentation from Personal Medical Doctor (PMD) of exam done within 6 months of applicant physical is acceptable in lieu of gynecologic exam, the cytology report must be included.

L. Upper and lower extremities - strength, range of motion.

M. Feet - arches, tenderness, corns, calluses.

N. Spine - scoliosis.

O. Identifying body marks, scars.

P. Skin, lymphatic.

Q. Neurological - gait, reflexes, cranial nerves, motor strength, sensation, Romberg.

R. Psychiatric - affect, orientation.

C.5.0

FITNESS FOR DUTY (FFD) PERIODIC EXAM (ON-BOARD EMPLOYEES)

Refer to FBI Fitness for Duty Periodic Exam Form (FD-943).

C.5.1 Physical Requirements A. Vital signs - temperature, pulse, blood pressure sitting, respirations.

B. Height (HT) - without shoes.

C. Weight (WT) - in examination gown or undershirt and shorts, without shoes.

D. Visual Fields and Strabismus (include COLOR VISION ONLY IF NO PRIOR DOCUMENTED REPORTS). Refer to 6.1.b for guidelines of color vision).

E. Distant and near visual acuity (with and without correction). Give results in Snellen equivalents, with updated chart, where E = 20/200.

F. Intraocular Tension (tonometry) if employee is greater than 40 years old.

G. Offer complete gynecologic exam including: pelvic, breast exam, digital rectal, and Papanicolaou (PAP) test.

H. Chest X-ray (PA and lateral views) for on-board employees are based on the examiner's findings, the employee's past and current medical history, as well as specific job requirements.

I. Resting Electrocardiogram (12-lead) with interpretation.

J. Screening Mammography - Offer to females over 40 years of age with each FFD.

K. Screening audiometric testing following Occupational Safety and Health Administration 5CFR1910.95. Physician shall provide information regarding hearing conservation program to the examinee at the time of the physical examination. Hearing booths and other testing equipment need to adhere to ANSI and OSHA standards in regards to preventive maintenance and calibration. Reference Applicant Exams C.4.0.K.

C.5.2

FFD PERIODIC LABORATORY TEST REQUIREMENTS

Refer to FBI Fitness for Duty Periodic Exam Form (FD - 943). The interpretation of the laboratory test results will be made by the reviewing physician.

Tests performed are as follows:

A. Urinalysis- dipstick- clean catch is sufficient. Components of dipstick (10 SG multistix) include: glucose, bilirubin, ketone, specific gravity, blood, pH, protein, urobilinogen, nitrite, and leukocytes. IF THE URINALYSIS TEST RESULTS ARE ABNORMAL, a microscopic examination including the following: color, appearance, pH, glucose, ketones, blood, bilirubin, urobilinogen, nitrite, WBC, RBC, epithelial cells, bacteria will be necessary. Other tests as indicated.

B. Complete blood count - WBC, RBC, hemoglobin, hematocrit, indices, differential white blood count and platelet count.

C. Blood group and type - IF NO DOCUMENTATION OF PRIOR TEST RESULTS.

D. Blood chemistry - glucose, blood urea nitrogen, creatinine, uric acid, total bilirubin, alkaline phosphatase, SGOT, SGPT, and GGT.

E. Tuberculin Test with interpretation. On-Board employees may complete and submit a SELF READ card to their field office FFD Coordinator. Examiners should stress the importance of interpreting any questionable test results within 48 - 72 hours by a medical professional (physician or nurse). This is a mandatory test for all on-board employees unless it is contraindicated by prior history of a positive conversion or BCG vaccination within the past 5 years.

F. Alternative TB testing, Interferon Gamma Release Assays (IGRA) should be available if needed to assist in diagnosing latent Tuberculosis infections. Use MUST be approved by Health Care Programs.

G. Stool for Occult Blood (3 slides) - OFFER but NOT REQUIRED.

H. Lead and ZPP - REQUIRES PRIOR AUTHORIZATION BY FBIHQ HCPU or field office employee responsible for scheduling the exam and is restricted to lead surveillance groups ONLY.

I. Sickle Cell (Black/Mediterranean decent) - IF NO DOCUMENTATION OF PRIOR TEST RESULTS - ONE TIME ONLY.

J. G6PD - IF NO DOCUMENTATION OF PRIOR TEST RESULTS - ONE TIME ONLY.

K. Lipid Panel - Total Cholesterol, Triglycerides, HDL, LDL and Chol/HDL ratio.

L. Prostate Specific Antigen (PSA) - males over 40 years old.

C.5.3

COMPLETE MEDICAL HISTORY

Use SF-93 which will be provided by the FBI. The examining physician shall comment in block 25 regarding all positively marked items on this form by the item number. This is very important. The examining physician must verify that the employee has answered all questions completely.

A. Past medical history must address items included on SF-93 (may also be recorded on the SF-88, block 42). The examining physician will also address the following:

(1) Alcohol Usage - type of beverage, frequency and pattern of use

(2) Medications - prescription and nonprescription

(3) Smoking/Tobacco - Use/History

(4) Level of exercise - specific activities, frequency and intensity

(5) Suspected or known Tuberculosis (TB) contact or foreign travel to an area known to be endemic for TB since last examination.

B. Family history (SF-88, block 42) of medical significance (e.g., diabetes, heart disease hypertension, anemia, mental disorder, cancer, stroke).

C. Immunization history - Each employee should arrive with copy of his/her INTERNATIONAL CERTIFICATE OF VACCINATION (PHS-731 OR CDC-731). The examiner is to review the certificate and make recommendations to the employee for any required updates. If international travel is expected, the examining physician should review guidelines set forth by the CDC and the World Health Organization to make recommendations for additional required and recommended vaccinations and should offer these vaccines to the FBI individual. ALL administered vaccines should be documented in the PHS-731 (if one is established) or CDC-731 if the PHS-731 is full or the individual does not have a PHS-731). The examining physician should make a copy of this record to be sent with the exam package to FBIHQ. Return the original to the individual. PLEASE NOTE: The International Certificate of Vaccination (Yellow Shot Card), PHS-731, has been replaced with the International Certificate of Vaccination or Prophylaxis, CDC-731 and though the CDC allows existing documentation on the PHS-731 to be used for 10 more years or until full, newly issued cards should be the CDC-731.

C.5.4

PHYSICIANS HANDS - ON EXAMINATION

Refer to FORM SF 88.

The essential tasks list for Special Agents will be provided to the selected contractor and can be used as a guide for the physical examination. Please note that this information is proprietary and should not be shared outside of its appropriate application to FBI business. It will need to be returned upon cessation of BPA duties.

A. Head, face, neck, scalp.

B. Nose, mouth, sinuses, dental, and throat.

C. Ears - drums (movement/perforation).

D. Eyes - general, pupillary reaction, ocular motility, fundus exam, visual fields.

E. Lungs and chest - auscultation, percussion.

F. Heart - thrust, rate, rhythm, murmurs, gallops.

G. Vascular system - varicosities, pulses, bruits.

H. Abdomen and viscera - hernias, tenderness, masses, megaly.

I.

Anus and rectum- for males ONLY, note hemorrhoids, fistulas, (include results of digital examination of rectum and prostate, hemoccult of digital material).

J.

Endocrine - thyroid nodules, enlargement.

K.

Offer Gynecologic: Females-complete gynecologic exam including pelvic, breast exam, digital rectal, and Papanicolaou (PAP) test.

L.

Upper and lower extremities - strength, range of motion.

M.

Feet - arches, tenderness, corns, calluses.

N.

Spine - scoliosis.

O.

Identifying body marks, scars.

P.

Skin, lymphatic.

Q.

Neurological - gait, reflexes, cranial nerves, motor strength, sensation, Romberg.

R.

Psychiatric - affect, orientation

C.6

EXERCISE STRESS TEST - BRUCE OR BLAKE PROTOCOL

Exercise stress testing is to be performed on Special Agents (SA) every four years, beginning with the first FFD examination conducted at the age of 40 years (ages 40, 44, 48). At age 50, sequence of stress tests is every two years (ages 50, 52, 54, etc.). Recommendations arising from the FFD examinations of non-SA employees to clarify concerns regarding coronary artery disease require referral of examination information to the FBHQ HCPU for approval of specialized testing on non-SA employees.

All stress testing is to be performed using Bruce or Blake protocols. The physician and/or staff conducting the stress testing must hold current Advanced Cardiac Life Support (ACLS) certification and possess training and experience in cardiac stress testing. All equipment requires a preventative maintenance contract and calibration is per ANSI standards.

For equivocal or non-emergent positive findings, actual ECG tracings of abnormal stress tests shall be provided to the FBI field office contact. This information will be forwarded via overnight mail to the FBIHQ cardiology consultant to review at his/her next opportunity. He/she will make a recommendation regarding appropriate follow-up (i.e., nuclear imaging or stress echocardiography).

Required Emergency crash cart and equipment shall be within the same room in which stress testing is conducted. If any emergent situation should arise during testing, the standard of care should be followed with notification of the FBI field office. SUCH EMERGENT REFERRAL IS NOT COVERED FOR PAYMENT UNDER THIS CONTRACT AND PAYMENT IS THE RESPONSIBILITY OF THE EMPLOYEE AND SHOULD BE COVERED BY HIS/HER PERSONAL HEALTH INSURANCE PLAN.

C.6.1 Enhanced Stress Tests Enhanced cardiac stress testing such as the Thallium Stress Tests or Stress Echocardiograms on a non-emergent basis require PRIOR AUTHORIZATION FROM FBIHQ HCPU as discussed above. Testing will be performed by a state licensed, Board Certified Cardiologist after concurrence from FBIHQ. Staff involved in testing must possess current ACLS certification. Emergency equipment will be within the same room in which stress testing is conducted.

C.7.0

LANGUAGE SPECIALISTS - AUDIOMETRIC SURVEILLANCE

Audiograms are to be performed in accordance with section C.4.0.K for all applicants seeking employment as Language Specialists and every two (2) years afterwards in accordance with Section C.5.1.K for on-board Language Specialists.

C.8.0

LEAD SURVEILLANCE

Blood lead and Zinc Protoporphyrin (ZPP) levels may be required on employees having occupational exposure to lead. This testing requires PRIOR AUTHORIZATION BY FBIHQ HCPU or the field office employee responsible for scheduling the exam. This testing is RESTRICTED TO members of the HAZARDOUS MATERIALS RESPONSE GROUP and/or FIREARMS INSTRUCTORS. The examiner should follow OSHA guidelines as they relate to occupational exposure.

C.9.0

DRUG AND ALCOHOL TESTING

The Contractor shall have ability to perform drug and alcohol testing in compliance with Executive Order 12564 and/or Omnibus Employee Transportation Act of 1991 (Pub. L. No. 102-143) when requested by HCPU Unit Chief or Medical Officer.

C.10.0

LEGAL ATTACHE (LEGAT) PHYSICALS

Refer to Fitness for Duty Periodic Exam forms FD-949, FD-950, and FD-951 and Department of State (DS) forms 1843 and 1622.

C.10.1

PRE-ASSIGNMENT EXAMS

In addition; refer to DEPARTMENT OF STATE Form (DS)-1843 (for employees, spouse and dependents 12 -17) and Form DS-1622 (for children under 12). ALL ORIGINAL FORMS MUST BE SUBMITTED. These forms need to be accompanied by all reports - in English. Page two of the form must be signed by the examinee (patient or for children, signed by parent). Page four must be signed by the examiner (doctor).

C.10.1.A SPECIAL AGENT EMPLOYEES

Include all physical exam requirements located on the following forms:

1) Department of State Form DS-1843, pages 2-6.

2) Department of State Form DS-1843 items 5.0 through 6.4, the examining physician must document race.

3) SF-88; SF-93 and physical fitness forms FD-949 and 943. Examiner must comment on all items indicated as yes on page 2 of SF-93.

4) Lab test: Include all standard lab tests as indicated for a FFD exam, FD-943. In addition, STD, Hepatitis A antibody, Hepatitis B surface antigen, Hepatitis B surface antibody, Hepatitis C antibody, Viral- Lysed Assayed (EIA) method HIV I, HIV II. If no documentation available, do G6PD.

5) PSA for males over the age of 40.

6) Chest x-ray, PA and lateral views, (for pre and post-assignment physical, and if indicated on periodic). Over read by board certified radiologist.

7) TB skin test (Mantoux testing - start PPD testing 5 years after positive history of BCG administration).

8) Alternative TB testing, Interferon Gamma Release Assays (IGRA) should be available if needed to assist in diagnosing latent Tuberculosis infections. Use MUST be approved by Health Care Programs.

9) Females-Complete gynecologic exam including: pelvic, breast exam, digital rectal, and Papanicolaou (PAP) test. Documentation from Personal Medical Doctor (PMD) of exam done within 6 months of applicant physical is acceptable in lieu of gynecologic exam. The cytology report must be included.

10) Mammogram for women over the age of 50 with clinical interpretation (repeat every 5 years).

11) Colonoscopy, Flexible Sigmoidoscopy or Double Contrast Barium Enema for individuals > 50 years of age. Repeat every 5 years.

12) Review and give immunizations as country appropriate.

Special indications:

1) If SA is diabetic, do hemoglobin A1C.

2) If SA assigned to Egypt, Columbia, or Chile (elevations > 8000 ft) or when medically indicated; i.e. smoker, asthma, COPD, do Pulmonary Function Test.

C.10.1.B SUPPORT EMPLOYEES AND ADULT DEPENDENTS

Refer to Fitness for Duty Periodic Exam forms FD-949, FD-950, and FD-951 and Department of State (DS) forms 1843 and 1622.

Examiner must comment on all items indicated as “yes” page 2 and document race on form.

1.

Height, weight, pulse and blood pressure 2.

Lab tests: CBC with differential, STD, Lipid panel, creatinine, fasting blood sugar, ALT, GGT, Hepatitis A antibody, Hepatitis B surface antigen, Hepatitis B surface antibody, Hepatitis C antibody, Viral-Lysed Assayed (EIA) method HIV-1, HIV-2.

3.

Blood group and type, (pre-assignment physical only)

4.

G6PD (Pre-assignment physical only)

5.

Urinalysis (include microscopic)

6.

Chest X-ray (PA and Lateral views for ages 18 and over) 7.

TB skin test (Mantoux - start PPD testing 5 years after positive history of BCG administration).

8. Alternative TB testing, Interferon Gamma Release Assays (IGRA) should be available if needed to assist in diagnosing latent Tuberculosis infections. Use MUST be approved by Health Care Programs.

9.

Hemoglobin A1C for all diabetics 10.

AGE SPECIFIC TESTS

a.

Complete gynecologic exam including: pelvic, breast exam, digital rectal, and Papanicolaou (PAP) test. Documentation from Personal Medical Doctor (PMD) of exam done within 6 months of applicant physical is acceptable in lieu of gynecologic exam (women age 21 and over). The cytology report must be included.

b.

Mammogram as a baseline for women age 50 and over with clinical interpretation or if clinically indicated - unless provided by personal medical doctor within 6 months prior to this exam.

c.

Colonoscopy, Flexible Sigmoidoscopy or Double Contrast Barium Enema for 50 years of age or > is requested.

d.

PSA on all males age 50 and over e.

ECG (12 lead) with interpretation at age 40 and above.

f.

Hemoccult slides (3 required- for age 50 and over) g.

Pulmonary function testing (PFT) needs to be performed on everyone who will be assigned to Egypt, Columbia, and Chile (elevation > 8000 feet, or when indicated medically ex: smoker, asthma, COPD).

C.10.1.C

CHILDREN AGES 12-17

Refer to Department of State Form DS-1843 and FD-949, document race on physical exam form.

1.

Height, weight, blood pressure and pulse.

2.

Lab tests - CBC with differential, STD, EIA,(HIV-1,HIV-2), urinalysis with microscopic.

3.

Blood type and group - one time only 4.

G6PD - one time only 5.

Lipid profile, hepatitis profile including: Hep A antibody, Hep B surface antigen & surface antibody, Hep C antibody, fasting blood sugar, ALT, GGT, creatinine.

6.

If diabetic, perform a hemoglobin A1C 7.

TB skin test (Mantoux - do not test prior to 5 years after BCG administration).

8.

Pulmonary function tests if assigned to Chile, Egypt or Columbia (elevations over 8000 feet).

C.10.1.D CHILDREN AGE 11 AND YOUNGER

Refer to Department of State Form DS-1622 and FD-950, document race on physical exam form.

1. Vitals signs including: HT, WT, pulse, blood pressure (over age 5).

2. Distant vision (both uncorrected and, if applicable, corrected).

3. Head circumference (18 months and younger).

4. Hematocrit (age 1 and > - finger stick -acceptable), blood lead level (ages 9 months to 6 years).

5. Urinalysis (age 2 and over, if potty trained).

6. TB skin test (Mantoux).

7. Blood group and type- one time only.

8. G6PD - one time only.

9. Sickle cell test (Mediterranean and African-American descent).

10. Please note if development is appropriate to age.

11. Review immunizations, provide as appropriate to country.

C.10.1.E

INFANTS ONE YEAR OR YOUNGER

Refer to Department of State Form DS-1622 and FD-951, document race on physical exam form.

1. Vital signs including height, weight and heart rate, head circumference.

2. Blood lead level (if over 9 months).

3. If any response to questions in section II (page 2)is marked yes, the examiner needs to comment in section V.

C.10.2

PERIODIC EXAMS

For continuation of the Department of State medical clearance, physicals may need to be performed on the following:

A. Special Agent examinations are required every 2 years per FBI requirements. (Use standard FD-943 physical forms and checklist, as well as the DS-1843).

B. FBI support employees.

C. Spouses of Special Agents and Support employees.

D. Eligible dependents (under age 21) of both Special Agent and Support employees.

E. Employees on temporary duty assignment (TDY) for more than 60 calendars days per year.

Determination for these examinations will be made by HCPU FFD Legat Program Manager.

C.10.2.A Employees and Dependents (age 50 and over)

1. Height, weight, blood pressure, pulse.

2. Vision.

3. CBC with differential.

4. Screening chemistry including: fasting blood sugar, lipid profile, hepatitis profile, creatinine, GGT, ALT, STD, EIA (HIV- 1, HIV-2).

5. Urinalysis with micro.

6. TB skin test (Mantoux).

7. Stool for ova and parasites (if symptomatic and coming from third world country).

8. Electrocardiogram (12 Lead) with Interpretation on all Special Agents at required interval.

9. Electrocardiogram (12 Lead) with Interpretation on support employees and dependants age 50 and over.

10. Colonoscopy, Flexible Sigmoidoscopy or Double Contrast Barium Enema at age 50 and then every 5 years.

11. ADDITIONAL TESTING FOR FEMALES:

a. Screening mammogram (at age 50 and then every 5 years)

b. Female Employees and Dependents age 21 years of age and over add: Complete gynecologic exam including: pelvic, breast exam, digital rectal, and Papanicolaou (PAP) test. Documentation from Personal Medical Doctor (PMD) of exam done within 6 months of applicant physical is acceptable in lieu of gynecologic exam, the cytology report must be included.

C.10.2.B

CHILDREN AGES 12 - 17

1. CBC with differential.

2. Fasting blood sugar.

3. Creatinine.

4. ALT.

5. GGT.

6. HbA1c (if diabetic).

7. STS.

8. EIA (HIV-1, HIV-2).

9. Lipid profile.

10. Hepatitis profile.

11. Urinalysis with microscopic.

12. TB skin test (Mantoux).

13. Vitals - HT, WT, pulse, blood pressure.

14. Vision.

C.10.2.C CHILDREN AGES 11 AND YOUNGER

1. HT, WT, pulse, blood pressure (over age 5)

2. Snellen acuity

3. Head circumference (18 months and younger)

4. Hematocrit (finger stick acceptable), urinalysis (age 2 and over, if potty trained).

5. blood lead level (age 9 months to 6 years),

6. blood type (one time only),

7. G6PD (one time only),

8. sickle cell test (as above)

9. TB skin test (Mantoux)

10. Note if development is appropriate for age

C.10.3

ADDITIONAL STUDIES FOR LEGATS/DEPENDENTS

A. Chest X-ray (PA and lateral views-age 18 and over) upon entering and exiting the program and if clinically indicated. Reviewed by board certified radiologist.

B. Pulmonary functions - If history of smoking, COPD, and asthma, or patients with clinical findings or if assigned to a high altitude location, Columbia, Chile, Egypt.

C. Stool for ova and parasites (for GI symptoms of gas, bloating, and/or frequent bouts of diarrhea.

D. Colonoscopy, Flexible Sigmoidoscopy or Double Contrast Barium Enema for age 50 and over, repeat every five years.

E. Mammogram for females age 50 and over, repeat every five years.

F. HbA1c if diabetic

C.11.0

HAZARD MATERIALS RESPONSE UNIT (HMRU) PHYSICALS

Refer to HAZMAT forms FD-944, 947, 900, 899 and 995.

C.11.1

HMRU INITIAL (APPLICANTS/ONBOARD TEAM MEMBERS WITHOUT PRIOR EXAMINATION)

A. Complete medical history, including immunization and heat tolerance history.

B. Completion of the "Respiratory Medical Evaluation Questionnaire" FD-900.

C. Completion of the"FBI Hazardous Materials Response Unit Physicians Report", FD-899, noting respirator use, clearance by physician for SCBA negative pressure, air-line supplied (includes HEPA, N95, and other variants) in accordance with OSHA 1910.120. Examiner needs to note in block # 42 on SF 88.

D. Complete medical history and exposure history for any biochemical hazards including blood borne pathogens or zoonoses. Note any positive exposures in block #42 on SF 88.

E. Complete physical examination by physician in accordance with all components in Sections 5.0, including rectal exam and stool hemoccults if age 40 or above.

F. Offer complete gynecologic exam including: pelvic, breast exam, digital rectal, and Papanicolaou (PAP) test.

G. Vision screening - see Section 5.1.

H. Audiogram - see Section C.5.1.

I. EKG (12 lead) with interpretation.

J. Chest x-ray (PA and Lateral views) over read by board certified radiologist.

K. Pulmonary function test (spirometry) by certified technician.

L. CBC with differential.

M. Blood Chemistry- see Section C.5.2.D N. RBC (serum) and plasma cholinesterase level two separate blood draws on two separate days.

O. Urinalysis - see Section C.5.2.A

P. Lead and ZPP.

Q. Intermediate PPD (if not previously tested within two years do “two step “ test).

R. Single baseline G6PD if not already documented within normal limits.

S. PSA for males age 40 or above.

T. Review Immunizations per HMRU immunization schedule. Record on CDC-731, International Certificate of Vaccinations. Copy CDC-731 and send to FBI with examination paperwork. Return original to examinee. Pleaser refer to Section C.5.3.C and F.6.0 regarding the International Certificate of Vaccination card.

C.11.2

ONBOARD TEAM MEMBERS

Refer to FD-947, 899 and 900.

A. Periodic physical examination in accordance with all components on FD form 943 and delineated in Section 5 B. Complete medical history (include immunizations and heat tolerance) and exposure history for any biochemical hazards (including blood borne pathogens or zoonoses). Note in block #42, SF-88.

C. Complete medical respiratory exam questionnaire (FD-900).

D. Medical advice concerning risk factors identified in social history. Examiner to also complete and include FD-899 (Hazardous Materials Unit Physical's Report). Note on this report is medical clearance for SCBA, negative pressure airline supplied (includes HEPA, N95 and other variants) in accordance with OSHA 1910.120. Note this in block #42, SF-88.

E. Offer gynecologic: Females-complete gynecologic exam, including pelvic, breast exam, digital rectal, and Papanicolaou (PAP) test.

F. Blood Chemistry See Section C.5.2, G. Urinalysis See Section C.5.2, H. Intermediate PPD if previously negative. See Section 5.2, I. PSA for males age 40 or above.

J. Pulmonary Function Testing, by certified technician K. Review and update of immunization per HMRU immunization schedule, see sections C.5.3.C and F.6.0. Record on CDC-731 International Certificate of Vaccinations. Copy CDC-731 and send to FBI with examination paperwork. Please refer to Section C.5.3.C regarding the International Certificate of Vaccination card.

L. Serum and RBC Cholinesterase levels.

C.11.3 ADDITIONAL TEST TO BE PERFORMED IN THE PERIODIC EXAMINATION IF CLINICALLY INDICATED AND APPROVED BY FBIHQ, HCPU, FFD PROGRAM

A. STD/HIV testing and counseling.

B. Stools for ova, parasites and fecal leukocytes.

C. Lead and Zinc Protoporphyrin (ZPP) blood test.

D. Chest X-Ray ( PA and Lateral views). Over read by board certified radiologist.

E. Specific heavy metal blood testing as requested by HCPU.

C.11.4 HMRU Exit Examinations Refer to FD form 995.

C.12.0 DEPARTMENT OF TRANSPORTATION PHYSICAL EXAMS FOR DRIVERS

Refer to Attached DOT Exam form FD-964.

A. These exams are authorized for specific position descriptions requiring a commercial driver's license. Please refer to attached FD-964 and 49 CFR 391.41- 49, especially pertaining to minimum qualifications.

B. Components of these exams include:

a. Distant vision with and without correction.

b. Audiometry, note physician needs to complete requirements of 5CFR1910.95 guidelines.

c. Vital signs including pulse after exercise (jog in-place for several minutes per 49CFR 391.41-49 guidelines).

d. Abdomen including the presence of any hernias.

e. Genitourinary exam and rectal required per 49CFR 391.41 - 49 guidelines.

f. Urine dip stick with specific gravity, albumin and sugar.

g. SF 93 plus specific form for the patient to fill out regarding his/her medical history, and that includes a section for the provider to complete. This form should include certificate for the provider to sign. Be sure you have these forms available for our employees requiring this exam. The State's Department of Motor Vehicles (DMV) can assist the selected vendor in obtaining these forms.

C.13.0

RESPIRATORY PROTECTION EXAMS

Refer to FD-946 as well as FD-900 and FD-899.

These exams are performed on employees whose job positions require the use of a respirator; reference Code of Federal Regulations (CFR) 29 1910.120. Components of this exam are on FD-946.

C.13.1

INITIAL RESPIRATORY PROTECTION EXAM

A. Respiratory Questionnaire, FD-900

B. Chest X-ray, PA & Lateral views - AS BASELINE. A report showing negative results within the past five (5) years, either brought by the individual or on record is sufficient. Over read by a board certified radiologist.

C. Pulmonary Function Test (PFT) within the past 2 years. If the results indicate a ratio of forced expiratory volume in one second (FEV1) to forced vital capacity (FVC) observed which is less than 70%, or measured FEV1 of less than 80%, or measured FVC of less than 80%, then a focused physical examination should be conducted.

D. Focused Physical Examination as requested by FBIHQ:

a. Height, weight, blood pressure, pulse

b. Corrected visual acuity

c. Physical examination of:

i. Head

ii. face, neck,

iii. ears - drums,

iv. nose, sinuses, mouth, throat,

v. eyes - opthalmoscopic, pupils, ocular motility,

vi. lungs, chest, heart

vii. vascular system

viii. abdomen, viscera,

ix. testicular areas for evidence of a hernia.

d. Documentation on the Standard Form (SF)-88, Report of Medical (5) Examination, clinical evaluation blocks "a" through "n: and "p".

C.13.2

PERIODIC RESPIRATORY PROTECTION EXAM

A. FD-900 and FD-899

B. SF-93

C. If changes or significant findings are noted on FD 900 or SF 93 medical history forms, additional PFT and/or chest x-ray testing may be ordered as appropriate.

C.14.0

HAZARDOUS DEVICE SCHOOL EXAMS

Refer to FD-965.

These exams are for employees attending the Hazardous Device School in Alabama.

C.15.0

DIVER EXAMS - NOAA STANDARDS

Refer to FD-966.

These are for employees assigned to a dive team. These exams will be coordinated through Health Care Programs Unit at Headquarters.

C.16.0

FAA EXAMS

Refer to FD-963.

All FAA physical examinations, class I, class II, and class III (when authorized by HCPU) will be conducted by a certified FAA examiner.

C.17.0

IMMUNIZATION REQUIREMENTS

Refer to FD-864.

Required guidelines are based upon current FBIHQ/HCPU policy, CDC, Public Health and manufacturer’s recommendations which include safe storage and handling of vaccines. When refrigeration is required, each offeror is required to have a refrigerator devoted to vaccine storage with either a digital recording thermometer or include use of temperature logs.

Immunizations can be performed as directed by FBI at the time of physical examination or as circumstances necessitate on a separate office visit. Each individual shall be furnished a copy of the appropriate vaccine information sheet (VIS) in accordance with Centers for Disease Control (CDC) guidelines for Federal Agencies.

C.17.1

STANDARD IMMUNIZATIONS

Standard immunizations for Special Agents and those positions that have the potential for worldwide deployment are as follows:

A. Polio (IPV) - adult dose.

B. All adults born in 1957 or later should receive a measles, mumps, and rubella (MMR)booster unless there is laboratory evidence of immunity.

C. Tetanus/diphtheria booster every 10 years. (If there is no documentation of a Tetanus/Diphtheria/Pertussis booster within a 10 year period, should consider this in lieu of the Td).

D. Hepatitis A series OR TWINVAX.

E. Hepatitis B series OR TWINVAX.

F. Typhoid (either oral or injectable).

G. Influenza (seasonal).

H. Twinrx (Hepatitis A and B combination vaccination).

C.17.2

SPECIAL USE IMMUNIZATIONS

For special team international travel needs, as specified by FBIHQ policy.

A. Yellow Fever - every 10 years, requirement for Hazardous Materials Team members and country specific.

B. Rabies Vaccine - according to CDC travel advisories. Based on FBIHQ/HCPU approval.

C. Anthrax Vaccine - as directed by FBIHQ/HCPU. Vaccine supplied by HCPU.

D. Botulinum Toxin Vaccine - only as directed by FBIHQ/HCPU.

E. Japanese Encephalitis - only as directed by FBIHQ/LEGAT FFD Nurse.

F. Meningococcal vaccine - every 5 years, requirement for Hazardous Materials Team members.

C.17.3

MALARIA PROPHYLAXIS

According to CDC travel advisories. Vendor should either conduct a limited travel use interview and provide country specific travel guidelines and should also provide the employee with a written prescription for the appropriate anti-malarial medication OR should conduct a limited travel interview and provide country specific travel guidelines and dispense the appropriate anti-malarial medication.

C.18.0

LOCATION AND VENDOR WORK ENVIRONMENT

A. The work environment shall comply with OSHA 1910.141 standards.

B. The vendor shall comply with Bloodborne Pathogens and Bio-Hazardous Waste disposal regulations in accordance with OSHA 1910 subpart 1930.

C. The vendor shall provide FBI employees with a secure location for storage of personal belongings including weapons during their examinations separate from other patient medical records and belongings.

D. It is required that the vendor’s facility is within a 15 mile radius of the field office being serviced plus or minus 10%.

E. The vendor shall advise if parking is available for FBI personnel and identify any associated costs.

F. The vendor shall identify where all services are to be performed, whether at the vendor’s office facility or at an off-site facility.

C.19.0

STORAGE OF PAPER MEDICAL RECORDS

All records relating to FBI physical examination maintained by the Contractor or subcontractors shall be marked For Official Use Only (FOUO) and maintained in a secure manner with access restricted to individuals with a need to know and authorized as noted above in accordance with federal medical confidentiality laws.

C.20.0

ACCESS/USE OF FBI SOFTWARE

When notified of system availability, the examining physician or FBI cleared designee, must transmit and/or scan the results of the examination via secure internet connection, as instructed by FBIHQ/HCPU. Purchase of a scanner, with adequate compatible features to conduct this service is required. Submission of medical information must be accomplished within the same ten day period as original documentation is sent to the local field office. Instructions will be provided for obtaining a secure password for the data entry person. This should not be shared with anyone else for purposes of data transmissions. Any other person entering data must also obtain an individual password. Any computer used to document FBI information must have fire walls, password protection and other sufficient security mechanisms to protect integrity of records. The physician and the clinic staff are required to receive formal HIPPA and medical confidentiality training on a yearly basis. Documentation of this training will be made available to the FBI upon request.

C.21.0 REGULATIONS APPLICABLE TO THIS CONTRACT INCLUDE BUT ARE NOT LIMITED TO THE FOLLOWING OCCUPATIONAL SAFETY AND HEALTH ADMINISTRATION (OSHA) REGULATIONS AND HEALTH GUIDELINES:

A. Occupational Safety and Health Administration (OSHA) 29CFR.1910.141 Cleanliness of Health Care Facilities.

B. Occupational Safety and Health Administration 29CFR1910.1030 Blood-borne Pathogens Standard.

C. Occupational Safety and Health Administration 29CFR1910.95 Hearing Conservation Standard.

D. Occupational Safety and Health Administration 29CFR1910.120 Hazardous Materials Response Team Standard.

E. Occupational Safety and Health Administration 29CFR1910.134 Respiratory Protection Standard.

F. American National Standards Association (ANSI) Prevention and Calibration of Medical Equipment.

G. CDC Immunization Guidelines including safe handling and storage of vaccines

H. US Public Health Immunization Guidelines

I. Health Information Portability and Protection Act (HIPPA)

J. Privacy Act C.22.0

MALPRACTICE INSURANCE

The Contractor's physicians shall hold malpractice insurance during the term of the contract. Proof of such insurance is required with the submission of the proposal. Proof of insurance coverage shall be submitted with proposal and each subsequent option renewal.

C.23.0

SAME SEX OBSERVER

All vendors are to provide same sex observer if requested by any FBI employees, dependents, selected FBI personnel, or applicants.

C.24.0

REQUEST FOR FEMALE DOCTORS

If at all possible, all vendors are to provide female Medical Doctors for OB/GYN exams.

C.25.0 NEW YORK LOCATION ONLY - OPTION OF PERFORMING SERVICES AT FBI LOCATION OR MEDICAL DOCTOR’S LOCATION The…