Attachment IV Tech Proposal Summary.pdf
PDF 44 KB Posted
- Attached to
- Comprehensive Medical Services (FCI Fort Worth)
- Solicitation number
- RFP-FTW-0007
About this file
Attachment IV
View the file
Other files
| File | Type | Posted |
|---|---|---|
| Amend 1.pdf | ||
| Answers.pdf | ||
| RFP FTW-0007 Questions.pdf | ||
| Sol Part 1.pdf | ||
| Sol Part 2.pdf | ||
| Attachment I-Medical Classification.pdf | ||
| Issue Solicitation.pdf | ||
| Attachment V Past Performance Questionnaire.pdf | ||
| Attachment II Outcome Measures.pdf | ||
| Attachments III.pdf |
On GovTribe
Work with this file
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
Text version
Attachment IV - Technical Proposal Summary Sheets
RFP FTW-0007
Comprehensive Medical Services - FCI Fort Worth
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 _____ Skilled Nursing______
Long-Term Care:______
Number/Type of Beds: _______________________________________________________________
Specialties Represented: _______________________________________________________________
Proximity to FCI: _______________________________________________________________
RFP FTW-0007
Comprehensive Medical Services - FCI Fort Worth
Physician Providers - Please provide the following information in a table format to detail physician providers utilized at each proposed facility.
Offeror:_______________________________________________________________
Specialty
Represented
Physician Group
Name
If applicable or
Name of Physician
Associated
Facility Provider
Inpatient, Outpatient, and/or
Office Setting
Number of
Physicians
Proposed for
Specialty
Proximity of
Provider
Offices to
FCI
(Minimum
Miles)
Proximity of
Provider
Offices to
FCI
(Maximum
Miles)
In addition, please provide the total number of physicians proposed.
RFP FTW-0007
Comprehensive Medical Services - FCI Fort Worth
Outpatient Institution Service Providers
Offeror: _______________________________________________________________
Please complete for outpatient institution services the offeror proposes to provide, as referenced in Solicitation Section A.1:
Specialty Represented Name of Physician Associated Facility
Provider
If Applicable
Will the Provider Provide
Services Within an
Inpatient, Outpatient, and/or
Office Setting?
Audiology
Cardiology
Dermatology
Endocrinology
ENT Specialist
Gastroenterology
General Surgeon
Infectious Disease
Mobility Services
Nephrology
Neurology
Oncology
Ophthalmology
Orthopedic
Orthotics
Podiatry
Psychiatry
Pulmonology
RFP FTW-0007
Comprehensive Medical Services - FCI Fort Worth
Outpatient Institution Service Providers
Offeror: _______________________________________________________________
Please complete for outpatient institution services the offeror proposes to provide, as referenced in Solicitation Section A.1:
Specialty Represented Name of Physician Associated Facility
Provider
If Applicable
Will the Provider Provide
Services Within an
Inpatient, Outpatient, and/or
Office Setting?
Rheumatology
Speech Therapy
Sleep Study
Urology
Vascular Surgery
Dietician
Lab Director
Optometry
Oral Surgery
File details come from the government source that posted it. Updated .