AttachmentVTechProposalSummary.pdf
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- Attached to
- Comprehensive Medical Services (FCI Bastrop)
- Solicitation number
- RFP-BAS-0001
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Other files
| File | Type | Posted |
|---|---|---|
| Amendment1.pdf | ||
| Attachments2-4.pdf | ||
| Solicitation.pdf | ||
| IssueSolicitation.pdf | ||
| AttachmentI-MedicalClassification.pdf |
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Attachment V - Technical Proposal Summary Sheets
RFP BAS-0001
Comprehensive Medical Services - FCI Bastrop
Facility Providers - Complete one for each facility provider proposed
Offeror: _______________________________________________________________
Facility Name: _______________________________________________________________
Facility Address: _______________________________________________________________
Accreditation Type/Date: _______________________________________________________________ (Attach documentation for verification)
Facility Type: Acute Care _____ Tertiary Care _____
Number/Type of Beds: _______________________________________________________________
Specialties Represented: _______________________________________________________________
Proximity to FCI: _______________________________________________________________
RFP BAS-0001
Comprehensive Medical Services - FCI Bastrop
Physician Providers - Complete one to detail physician providers utilized at each proposed facility
Offeror: _______________________________________________________________
Physician Group Name, if applicable: _______________________________________________________________
Associated Facility Provider: _______________________________________________________________
Number of Physicians Proposed Under Contract: _______________________________________________________________
Specialties Represented by Proposed Physicians: _______________________________________________________________
Proximity of Provider Offices to FCI: Minimum _____ miles Maximum _____ miles
RFP BAS-0001
Comprehensive Medical Services - FCI Bastrop
Outpatient Institution Service Providers
Offeror: _______________________________________________________________
Please check which outpatient institution services the offeror proposes to provide, as referenced in Solicitation Section A.1:
Cardiologist General Surgeon
Infectious Disease Otolaryngologist
Orthopedic Surgeon
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