SECTION III. SOW. AMEND3.doc

SECTION III - STATEMENT OF WORK

PHYSICAL EXAMINATIONS

FITNESS FOR DUTY PROGRAMS

III.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.

III.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 for 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 or potential exposures to hazardous substances.

B.

Provide Occupational Health Services to FBI Field Office locations including immunizations, venipuncture, health education, local Automated External Defibrillator (AED) oversight and medical consultations.

III.3.0

TASKS TO BE PERFORMED BY PHYSICIANS

A.

Physician(s) shall provide medical consultations and answer medical related questions as well as conduct medical examinations and laboratory analysis with the exception of GYN and Papanicolaou (PAP) portion of exams which may be performed by Nurse Practitioners (NP) or Physicians’ Assistants (PA).

B.

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

C.

Physician(s) shall have access to current travel information from the Centers for Disease Control and Prevention (CDC) and provide travel health education as appropriate for projected itinerary of official travel destination(s).

D.

Physician(s) shall provide Bloodborne Pathogen post exposure evaluation and follow‑up as needed for occupationally exposed employees. The protocol used will be according to current CDC guidelines at the time of the evaluation or procedure. Refer any questions to the FBI-HCPU Blood-borne Pathogens Program Manager.

E.

Physician(s) shall provide written prescriptions and instructions for use of travel medicine, e.g. malaria prophylaxis, sleep cycle regulation, and antibiotics for travelers’ diarrhea.

F.

Physician(s) shall serve as the local Medical Director for the Automated External Defibrillator (AED) Program. As such, the Medical Director shall authorize the use of the device in accordance with state and local regulations. He/she shall ensure that the local AED program is in compliance with local and state laws. He/she shall ensure that the AED program is linked to the appropriate local and EMS and community hospital systems and participates in quality assurance, post-accident debriefing sessions and reviews. He/she shall also complete, review and submit any/all necessary documents in a timely, and correct manner, as required.

G.

Physician will perform hands on examination for all exam types; with possible exception of GYN and Papanicolaou (PAP) portion of exams, which may be performed by a female Nurse Practitioner (NP) or Physicians’ Assistant (PAS).

H.

Physician(s) shall conduct employee reviews and provide a written summary at the end of each examination. For applicants, the examination report of findings will be completed by the Health Care Programs Unit (HCPU) and no qualification determination is to be made at the clinic site. At the conclusion of all physical examinations, the physician shall be available for consultations.

III.4.0

APPLICANT/PRE-EMPLOYMENT PHYSICAL REQUIREMENTS

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

A. Vital signs - temperature, pulse - resting, blood pressure – sitting.

B. Height (HT) - without shoes.

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

D. Applicants with screening distant vision of worse than 20/20 in one eye and 20/40 in the other eye, with or without correction, should be informed that a full eye examination by a licensed optometrist or ophthalmologist will be required, using FAA Form 8500-7, Report of Eye Evaluation, if verification is not able to be performed at the examination site. If a full eye examination by a licensed optometrist or ophthalmologist cannot be provided by the contractor, the applicant will be required to obtain the examination at her/his own expense.

D.1 Distant and near visual acuity (with and without correction). Give results in Snellen equivalents.

D.2 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. All color vision tests will include type of test performed, the number of color plates used and the number of color plates correctly identified.

E. Pulmonary Function Testing (PFT). Testing equipment needs to adhere to ANSI and OSHA standards in regards to preventive maintenance and calibration.

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

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

H. 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. Hearing booths and other testing equipment need to adhere to ANSI and OSHA standards in regards to preventive maintenance and calibration.

I. Tuberculin Test with interpretation by medical professional (physician, nurse or other trained medical personnel) within 48 – 72 hours as specified by CDC guidelines.

J. It is preferred, not required, that Alternative TB testing, Interferon Gamma Release Assays (IGRA) be available if needed to assist in diagnosing latent Tuberculosis infections. This additional expense MUST be approved by HCPU.

K. Complete gynecologic exam including: pelvic, breast exam, digital rectal, and PAP test. Documentation from Personal Medical Doctor (PMD) of exam done within 12 months of applicant physical is acceptable in lieu of gynecologic exam; the cytology report must be included.

III.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 shall be performed.

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

C. Blood chemistry – Comprehensive Metabolic Panel (minimum of glucose, blood urea nitrogen, creatinine, uric acid, total bilirubin, alkaline phosphatase, SGOT, and SGPT).

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

E. Stools for Occult Blood (3 slides) - Offer, but may be declined.

III.4.2

COMPLETE MEDICAL HISTORY

Use Standard Form-93 (Report of Medical History) or FD-1065, (FBI Report of Medical History).

A. The examiner shall comment regarding all positively marked items on this form. The examiner must verify that the applicant has answered all questions completely. Medical history must address alcohol usage, current medications, drug allergies, tobacco history, and level of exercise.

B. 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 routine series for overseas travel applies primarily to Special Agent applicants (examiner should pay special attention to MMR, Polio, 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 THE APPLICANT SEPARATELY FOR IMMUNIZATIONS IF OFFERED FROM VENDOR SUPPLY DURING THIS VISIT.

III.4.3

HANDS-ON PHYSICIAN EXAMINATION

Refer to Report of Medical Examination (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 shall not be shared outside of its appropriate application to FBI business. It must be returned upon cessation of contract duties.

A. SF-88, Block 17, Clinical Evaluation: Head, face, neck, scalp, ears, drums (perforation), nose, sinuses, mouth and throat, eyes (general and ophthalmoscopic), pupils (equality and reaction), ocular motility (associated parallel movements, nystagmus), lungs and chest, heart (thrust, size, rhythm, sounds), vascular system (varicosities, etc.), abdomen and viscera (include hernia), prostate (over 40 or clinically indicated), testicular, anus and rectum (hemorrhoids, fistulae, hemoccult results), endocrine system (thyroid), G-U system, upper and lower extremities (strength, range of motion), spine, other musculoskeletal, identifying body marks, scars, tattoos, skin, lymphatics, neurological, psychiatric (specify any personality deviation).

B. Gynecologic: Females-complete gynecologic exam, including pelvic, breast exam, digital rectal, and Papanicolaou (PAP) test. Note exception that NP and/or PA can perform this portion of examination.

Documentation from Personal Medical Doctor (PMD) of exam done within 12 months of applicant physical is acceptable in lieu of gynecologic exam; the cytology report must be included.

III.5.0

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

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

III.5.1

PHYSICAL REQUIREMENTS:

A. Vital signs - temperature, pulse - resting, blood pressure – sitting

B. Height (HT) and weight

C. Visual Fields and Strabismus (include COLOR VISION ONLY IF NO PRIOR DOCUMENTED REPORTS). Refer to III.4.0.D.2 for guidelines of color vision.

D. Distant and near visual acuity (with and without correction). Give results in Snellen equivalents.

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

F. 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 III.4.0.H.

G. Tuberculin Test with interpretation. On-board employees may complete and submit a SELF READ card to their field office Fitness for Duty 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.

H. It is preferred, not required, that Alternative TB testing, Interferon Gamma Release Assays (IGRA) be available if needed to assist in diagnosing latent Tuberculosis infections. This additional expense MUST be approved by HCPU.

III.5.1.1

AGE, GENDER, OR SPECIAL CIRCUMSTANCE PHYSICAL REQUIREMENTS

A.

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

B. Chest X-ray (PA and Lateral views for on-board employees if indicated based on examiner’s findings, the employee’s past and current medical history, as well as specific job requirements. Over-read by board certified radiologist is required.

C.

Offer complete gynecologic exam including: pelvic, breast exam, digital rectal, and PAP test.

D.

Screening Mammography – Offer to females over 40 years of age.

III.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 shall be made by the examining 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 shall be performed.

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

C. Blood chemistry – Comprehensive Metabolic Panel (minimum of glucose, blood urea nitrogen, creatinine, uric acid, total bilirubin, alkaline phosphatase, SGOT, and SGPT).

D. Lipid Panel – Total Cholesterol, Triglycerides, HDL, LDL and Chol/HDL ratio

E. Stool for Occult Blood (3 slides) - Offer, but may be declined.

III.5.2.1

AGE, GENDER OR SPECIFIC CIRCUMSTANCE LABORATORY TEST REQUIREMENTS

A.

Blood Group and Type – If No Documentation of Prior

Test Results.

B.

G6PD – If No Documentation of Prior Test Results.

C.

Lead and ZPP – REQUIRES PRIOR AUTHROIZATION BY FBIHQ HCPU or field office representative responsible for scheduling the exam and is restricted to lead surveillance groups ONLY.

D.

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

III.5.3

COMPLETE MEDICAL HISTORY

Use Report of Medical History (SF-93 or FD-1065) which will be provided by the FBI. The examiner must verify that the employee has answered all questions completely. The examining physician shall comment in the summary regarding all positively marked items on this form by the item number. Medical history must address alcohol usage, current medications, drug allergies, tobacco history, and level of exercise.

A. 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. All Special Agents should be advised to keep the following immunizations current in the event of overseas travel: hepatitis A, hepatitis B, typhoid, polio, measles/mumps/rubella, and tetanus/diphtheria. Anticipated overseas travel should follow recommendations of the CDC. 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 two copies of this record. A copy is to be sent with the original exam package to FBI. Return the original CDC-731 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.

III.5.4

PHYSICIANS HANDS - ON EXAMINATION

Refer to FORM SF-88 and paragraph III.4.3. 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 contract duties. Offer Gynecologic: Females-complete gynecologic exam including pelvic, breast exam, digital rectal, and Papanicolaou (PAP) test.

III.6.0

EXERCISE STRESS TEST - BRUCE OR BALKE 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.). The examinee will be provided with an explanation of the stress test results.

Recommendations arising from the FFD examinations of non-SA employees to clarify concerns regarding coronary artery disease require referral of examination information to the FBI HCPU for approval of specialized testing on non-SA employees.

If not performed by a board certified cardiologist, a 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. Interpretation of all stress test results are to be performed by a board certified cardiologist. Nuclear Imaging Stress Tests, Stress Echocardiograms, and other advanced special cardiac studies need to be supervised/overseen by a board certified cardiologist. All equipment requires a preventative maintenance contract and calibration as per ANSI standards.

EKG Tracings will be included with ALL written stress test reports.

For equivocal or non-emergent abnormal findings, actual ECG tracings of abnormal stress tests shall be provided immediately to the FBI field office contact. This information will be forwarded via overnight mail to: Fitness for Duty Supervisor, FBIHQ Health Care Programs Unit, Fitness for Duty Room 6362, 935 Pennsylvania Ave, N.W., Washington, DC 20535-0001 within 24 hours of the abnormal test. FBIHQ will review the documentation and make a recommendation regarding the necessity and type of follow-up testing.

Required Emergency crash cart and equipment shall be within the same room or in an adjacent area of the room in which stress testing is conducted. Emergency equipment will be easily accessible. 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.

III.6.1

ENHANCED STRESS TESTS

Enhanced cardiac stress testing such as the Nuclear Imaging Stress Tests or Stress Echocardiograms on a non-emergent basis require PRIOR AUTHORIZATION FROM FBI HCPU as discussed above. Testing will be performed by a state licensed, board certified cardiologist after concurrence from FBI HCPU. If enhanced stressed testing is performed, the cardiologist will provide the examinee an explanation of the results.

III.7.0

DEPARTMENT OF STATE/EMBASSY PERSONNEL - LEGAL ATTACHE (LEGAT) PHYSICALS

Refer to Fitness for Duty Periodic Exam forms FD-949, and Department of State (DOS) Form DS-6561. 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).

III.7.1

PRE-ASSIGNMENT EXAMS

III.7.1.1 EMPLOYEES and ADULT (age 12 and above) DEPENDENTS and DOMESTIC PARTNERS

Include all physical exam requirements located on the following forms:

A. Department of State Form DS-6561, pages 2-4.

B. If the individual scheduled for the DOS exam is an employee with required periodic exams (i.e., a Special Agent), then additional forms (SF-88; FD-1065 or SF-93, and FD-943) are to be used in addition to the DOS forms listed above and the FD-949.

C. Vital signs, including height, weight, pulse, blood pressure, and BMI.

D. Lab tests: Include all standard lab tests as indicated for a FFD exam, FD-943. In addition, Viral-Lysed Assayed (EIA) method HIV I, HIV II is required. Other lab tests may be requested by HCPU, i.e., blood group and type, G6PD, TSH, etc.

E. PSA for males over the age of 50.

F. Chest x-ray, PA and lateral views for individuals with a history of previously positive PPD (Mantoux) and/or if indicated on periodic). Over-read by board certified radiologist.

G. TB skin test (Mantoux) testing required for all ages unless previously positive.

H.

It is preferred, not required, that Alternative TB testing, Interferon Gamma Release Assays (IGRA) be available if needed to assist in diagnosing latent Tuberculosis infections. This additional expense MUST be approved by HCPU.

I.

Review and give immunizations as country appropriate (refer to CDC guidance). Provide travel counseling and travel medications as may be indicated, e.g., doxycyline, duration of exposure plus one month supply for malaria prophylaxis; ciprofloxacin, 500mg, #14 tablets for travelers diarrhea; zolpidem, 10mg, maximum #14 for sleep cycle adjustment.

At direction of HCPU only, the following procedures are to be done (HCPU will notate on the FD-949 at time of exam):

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 is acceptable in lieu of gynecologic exam. The cytology report must be included.

Mammogram for women over the age of 50 with clinical interpretation.

Colonoscopy with procedural report. If polyps excised, pathology report is required.

SPECIAL INDICATIONS:

1) If individual is diabetic, do hemoglobin A1C.

2) If individual is assigned to Egypt, Columbia, Chile, or Ethiopia (elevations > 7000 ft) or when medically indicated; i.e. smoker, asthma, COPD, do Pulmonary Function Test. Refer to III.4.0.E.

Examiner must comment on all items indicated as “yes” page 2 on a separate sheet of paper.

EMPLOYEES DEPLOYING TO IRAQ OR AFGHANISTAN:

1) Examiner must read, sign and date DOS Document #3389.5, Iraq/Afghanistan Pre-deployment Physical Exam Acknowledgement Sheet.

2) Employee deploying to a war zone must also complete the supplemental DOS medical history on Form ISO:3389.5 and provide it to the examining physician for review. The physician must comment upon positive responses on a separate sheet of paper.

GENDER, AGE SPECIFIC TESTS

a.

ECG (12 lead) with interpretation at age 50 and above.

b.

PSA on all males age 50 and over.

c.

Pulmonary function testing (PFT) needs to be performed on everyone who will be assigned to Egypt, Columbia, Chile, and Ethiopia (elevation > 7000 feet, or when indicated medically ex: smoker, asthma, COPD). Refer to III.4.0.E.

III.7.1.2 CHILDREN AGE 11 AND YOUNGER

Refer to Department of State Form DS-6561 and FD-949, Document race on physical exam form.

A. Vitals signs including: HT, WT, pulse are required for all children. In addition blood pressure (over age 5).

B. Complete blood count (CBC)

C. TB skin test (Mantoux)

D. Review immunizations, provide as appropriate to country.

III.7.1.3

INFANTS ONE YEAR OR YOUNGER

Refer to Department of State Form DS-6561.

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

B. If any response to questions on page 2 is marked “yes,” the examiner needs to comment on a separate sheet of paper.

III.7.2

PERIODIC EXAMS

While at Post, for continuation of the Department of State medical clearance, physicals may need to be performed on the individuals listed below:

A. Special Agent examinations are required every 2 years per FBI requirements.

B. If an employee or family member has a new medical condition since their last physical examination or has an existing medical condition that required monitoring he/she will need to have a focused physical examination for that condition, at a minimum every 2 years or more frequently as determined by the treating physician.

III.8.0

HAZARD MATERIALS RESPONSE UNIT (HMRU) PHYSICALS

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

III.8.1

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

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

B. Completion and review 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 Section III.4.0 – III.4.3.

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

G. Vision screening – Refer to III.4.0.D

H. Audiogram – Refer to III.4.0.H.

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). Refer to III.4.0.E.

L. CBC with differential

M. Blood Chemistry- Comprehensive Metabolic Panel. Refer to III.4.1.C.

N. Lipid Panel. Refer to III.4.1.D

O. RBC (serum) and plasma cholinesterase level two separate blood draws on two separate days.

P. Urinalysis – Refer to III.4.1.A

Q. Lead and Zinc Protoporphyrin (ZPP)

R. Intermediate PPD

S. Single baseline G6PD if not already documented.

T. PSA for males age 40 or above.

U. Review Immunizations per Special immunization schedule. Record on CDC-731, International Certificate of Vaccinations. Copy CDC-731 and send to FBI with examination paperwork. Return original to examinee. Please refer to III.5.3.A regarding the International Certificate of Vaccination card.

III.8.2

ONBOARD TEAM MEMBERS

Refer to FD-947, 899 and 900.

A. Periodic physical examination in accordance with all components on FD-943 and delineated in Sections III.5.0 – III.6.1

B. Complete medical history (includes 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 and complete FD-899).

D. Medical advice concerning risk factors identified in social history. Examiner to also complete and include review of 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. CBC with differential

G. Blood Chemistry – Comprehensive Metabolic Panel. Refer to III.5.2.C

H. Lipid Panel. Refer to III.5.D.2.D

I. Urinalysis. Refer to III.5.2.A

J. Intermediate PPD if previously negative.

K. PSA for males age 40 or above.

L. Pulmonary Function Testing. Refer to III.4.0.E.

M. Review and update of immunization per Special immunization schedule, see sections III.5.3.A and III.16.1 – III.16.3. Record on CDC-731 International Certificate of Vaccinations. Copy CDC-731 and send to FBI with examination paperwork.

N. Serum and RBC Cholinesterase levels. One draw only with periodic exam.

III.8.3

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

A. Serology

B. HIV testing and counseling.

C. Stools for ova, parasites and fecal leukocytes.

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

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

III.8.4

HMRU EXIT EXAMINATIONS

Refer to FD-995.

III.9.0 DEPARTMENT OF TRANSPORTATION PHYSICAL EXAMS FOR

COMMERCIAL 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 49CFR391.41- 49, especially pertaining to minimum qualifications.

B. Components of these exams include:

1. Distant vision with and without correction.

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

3. Vital signs including pulse after exercise (jog in-place for several minutes per 49CFR391.41-49 guidelines).

4. Abdomen including the presence of any hernias.

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

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

7.

SF-93 or FD-1065 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.

III.10.0 FEDERAL AVIATION ADMINISTRATION (FAA) PILOT EXAMS

If FAA physical examinations are available for either class I, class II, and occasional Class III pilots, they shall be conducted by a certified FAA examiner.

Though not required, it is preferred that contractors for all locations, be able to provide FAA examinations for FBI Class II pilots. Selection preference may be given to those contractors who can provide this service as added value to the government. Refer to FD-963.

III.11.0

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.

III.11.1 INITIAL RESPIRATORY PROTECTION EXAM

A. Respiratory Questionnaire, FD-900, including physician review with the employee.

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 head, face, neck, and scalp, ears, drums, nose, sinuses, mouth and throat, eyes (general), ophthalmoscopic, pupils (equality and reaction), ocular motility (associated parallel movement, nystagmus), lungs, and chest, heart (thrust, size, rhythm, sounds), vascular system (varicosities, etc.), abdomen and viscera (include hernia), prostate (over 40 or clinically indicated), and testicular.

III.11.2

PERIODIC RESPIRATORY PROTECTION EXAM

A. FD-900 and FD-899

B. SF-93 or FD-1065, Report of Medical History

C. If changes or significant findings are noted on FD-900 or medical history forms, additional PFT and/or chest x-ray testing may be ordered as appropriate. Refer to III.11.1.

III.12.0

HAZARDOUS DEVICE SCHOOL EXAMS

Refer to FD-965.

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

III.13.0

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.

III.14.0

MEDICAL SURVEILLANCE EXAMS

These are for employees assigned to jobs or job tasks that require medical surveillance for compliance with OHSA CFR 1910.

III.14.1

LANGUAGE SPECIALISTS - AUDIOMETRIC SURVEILLANCE

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

III.14.2

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 FBI HCPU or the field office employee responsible for scheduling the exam. This testing is RESTRICTED to those employees whose job duties include potential exposures. Currently these include members of the HAZARDOUS MATERIALS RESPONSE GROUP and/or FIREARMS INSTRUCTORS. The examiner should follow OSHA guidelines as they relate to occupational exposure.

III.15.0

DRUG AND ALCOHOL TESTING

It is requested, not required that 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 FBI HCPU Unit Chief or Medical Officer.

This request counts towards value added to the government.

III.16.0

TRAVEL HEALTH EDUCATION

The contractor shall provide travel health education as appropriate for projected itinerary of official travel destination(s). A written report of travel health education shall be provided in the medical record.

III.16.1

IMMUNIZATION REQUIREMENTS

Refer to FD-864.

Required guidelines are based upon current FBI/HCPU policy, Centers for Disease Control (CDC), Public Health guidelines 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. Temperature must be recorded daily during regular operating hours and must remain within safe storage and handling temperature guidelines, reference CDC guidelines.

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) available from the Centers for Disease Control (CDC) website.

FBI will supply select vaccines to the vendor as requested, however, in general cannot provide MMR or Yellow Fever vaccines. If FBI supplied vaccine are not available, vendor supplied vaccines can be used and invoiced accordingly.

III.16.2

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 MUST 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 Tdap in lieu of the Td).

D. Hepatitis A series OR TWINRIX.

E. Hepatitis B series OR TWINRIX.

F. Typhoid (either oral or injectable).

G. Influenza (seasonal as well as additional strains as necessary).

H. TWINRIX (Hepatitis A and B combination vaccination)

III.16.3

SPECIAL USE IMMUNIZATIONS

For special team international travel needs- country specific, as specified by FBI 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. Meningococcal vaccine - requirement for Hazardous Materials Team members, those traveling to destinations recommended by CDC, and Rapid Deployment Team members.

III.16.4

TRAVEL MEDICINE PRESCRIPTIONS

III.16.4.1

MALARIA PROPHYLAXIS

In accordance with CDC travel advisories, the contractor shall either conduct a limited travel use interview, provide country specific travel guidelines, and provide the employee with a written prescription for the appropriate anti-malarial medication OR conduct a limited travel interview, provide country specific travel guidelines, and dispense the appropriate anti-malarial medication.

III.16.4.2

SLEEP AIDS

Contractor should either conduct a limited interview and provide the employee with a written prescription for an appropriate sleep aid OR should conduct a limited travel interview and dispense an appropriate sleep aid. Sleep aid prescriptions should be limited to no more than 14 pills with 0 refills.

III.16.4.3

TRAVELERS DIARRHEA

Contractor should both conduct a limited interview and provide the employee with a written prescription for an appropriate antibiotic to treat travelers diarrhea (should it occur) OR should conduct a limited travel interview and dispense an appropriate antibiotic to treat travelers’ diarrhea (should it occur). Antibiotics for the treatment of travelers diarrhea should be limited to no more than 7 days with 0 refills.

III.17.0

EMERGENCY TRANSPORT

The FBI Office being served shall be informed by the contractor or subcontractor whenever an FBI employee is transported by emergency rescue squad within two hours of the incident.

III.18.0

LOCATION AND VENDOR WORK ENVIRONMENT

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

B. The vendor shall comply with Bloodborne Pathogens and Bio-Hazardous Waste disposal regulations in accordance with OSHA 1910.1030.

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

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

D. The following equipment must have annual preventive maintenance: EKG, Audiometry Screening equipment, Hearing Booth, and Spirometry. Documentation of preventive maintenance will be current and prominently displayed on the equipment and/or available for review during site visits.

III.19.0

STORAGE OF PAPER MEDICAL RECORDS

All records relating to FBI physical examinations maintained by the Contractor or subcontractors shall be marked For Official Use Only (FOUO) and maintained in a secure, locked filing cabinet or locked room, separate from other medical files and with access restricted to individuals with a need to know and authorized as noted above in accordance with federal medical confidentiality laws.

Paper medical records should be kept in a location separate from other patient medical records.

III.20.0

ACCESS/USE OF FBI SOFTWARE

When notified of system availability, the examining physician or FBI cleared designee will be required to transmit and/or scan the results of the examination via secure internet connection, as instructed by FBI/HCPU. 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 and be compliant with HIPAA regulations. The physician and the clinic staff are required to receive formal HIPAA and medical confidentiality training on a yearly basis. Documentation of this training will be made available to the FBI upon request.

III.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 Insurance Portability and Accountability Act (HIPAA)

J. Privacy Act

K. 5 CFR.339.301 Medical Qualifications Determinations for federal employees

L. Department of Transportation- Omnibus federal employees testing act

M. Federal Aviation Administration - medical certification for pilots

N. Department of State - medical certification for overseas assignments

III.22.0

MALPRACTICE INSURANCE

In accordance with clause 52.237-7, Indemnification and Medical Liability Insurance (Jan 1997), the physicians under contract shall maintain during the term of this contract liability insurance issued by a responsible insurance carrier of not less than the following amount(s) per specialty per occurrence: [$1,000,000.00 and $3,000,000.00]. Proof of such insurance is required with the submission of the proposal.

III.23.0

SAME SEX OBSERVER

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

III.24.0

REQUEST FOR FEMALE EXAMINERS FOR OB/GYN EXAMS

If at all possible, all vendors are to provide at least one female Medical Doctor, Nurse Practitioner or Physician’s Assistant for OB/GYN-PAP Exams. Selection preference may be given to vendors who can provide this service as added value to the government. Use of female Nurse Practitioners or Physician’s Assistants is reserved for OB/GYN-PAP EXAMS ONLY.

III.25.0

VENDOR PERSONNEL QUALIFICATIONS

A.

The maximum number of physicians that may perform the duties stated in this contract is FIVE (5) per FBI office location. This number can be adjusted by the COTR if necessary to provide adequate service to a field office.

B.

Physician(s) shall be currently board certified in any of the following: cardiology, emergency medicine, internal medicine, family medicine, or preventive medicine (aerospace, occupational, or general preventive medicine and public health) to qualify for performance of physical examinations under this contract. Exceptions must be approved by the Chief Medical Officer or Unit Chief, Health Care Programs Unit (HCPU), FBI Headquarters (FBIHQ) and will only be considered for rural or low density medical provider areas.

C.

Each physician, and other medical professional, i.e. Optometrist, Nurse Practitioner, Physician Assistant and nurse shall have a current and unrestricted license to practice medicine in the jurisdiction of delivery of care.

D.

All Federal Aviation Administration (FAA) physical examinations; class I, class II, and occasional Class III, if available, shall be conducted by a certified FAA examiner.

E.

All physicians and staff who have clinical “hands-on” contact with FBI examinees and/or files are required to adhere to all security requirements outlined in this solicitation/contract. This includes but is not limited to primary physicians, FAA examiners, and all staff who assist with FBI examinations, records and billing.

F.

Staff certifications for Hearing Conservation by a CAOCH approved program are required for technicians conducting audiometric testing UNLESS an audiometric microprocessor is used. Refer to III.4.0.H.

III.26.0

VENDOR CLINIC ENVIRONMENT

As part of a comprehensive quality assurance program, it is anticipated that FBI personnel will conduct annual monitoring site visits. These visits help to ensure requirements are met by inspecting contract performance against the requirements of the contract. The maintenance of required certifications, licenses, and training for personnel as well as the quality care and services that are provided may be reviewed. In addition, equipment may be checked to ensure it is maintained per ANSI and OSHA standards with preventive maintenance agreements.

A post-award site visit may also be conducted by FBI personnel to ensure compliance with all contractual requirements prior to commencement of any services.

[End of Section]

RFQ-OSCU-FFDPE2011