SOH_Medical Surveillance_PWS_Sole Clinic_FY2021_FINAL.pdf

PERFORMANCE WORK STATEMENT

FOR

Maryland Army National Guard Occupational Health Medical Surveillance Sole Clinic

1.0. General:

1.1. Scope: Maryland Army National Guard (MDARNG) Occupational Health (OH) seeks contracted services for a qualified sole OH agency or clinic to conduct job-related medical surveillance screening examinations and OH services for employees who have the potential to become exposed to health hazards in the work environment. The clinic must be located within 55 miles of the respective employee shop and have a central billing process.

1.2. Background: In accordance with (IAW) the Occupational Safety and Health Administration (OSHA), Title 29 Code of Federal Regulations (CFR) § 1910, Army Regulation (AR) 40-501 Standards of Medical Fitness, National Guard Regulation (NGR) 40-5, The Army National Guard Preventive Medicine Program, AR 40-5 Preventive Medicine, and Department of Defense Instruction (DoDI) 6055.05-M, Occupational Medical Examinations and Surveillance Manual, employees must be monitored for the impacts of workplace exposures (known and potential) and provided medical surveillance evaluations based on job code and/or identified exposures. The medical surveillance program is a risk based medical screening and examination process intended to improve combat readiness through early recognition and prevention of occupational exposure. The program incorporates various elements that identifies employee workplace exposures to physical, chemical, biological, or radiological hazards, the effects of such exposure and directs measures to prevent occupational illnesses and injuries associated with these exposures. Program requirements vary based on the individual’s job code, the type of work performed, and the exposures at the worksite. Industrial hygiene (IH) surveys are conducted to identify hazards and measure exposure levels of known hazards based on the individual and the task, separating potential exposure from actual exposures.

1.2.1. In accordance with the requirements of the office of personnel management (OPM) for specific job codes and data obtained from IH surveys, screening is required for employees exposed to potential health hazards in the workplace.

1.2.2. While many hazards are mitigated through engineering controls, employees are provided with personal protective equipment (PPE) for known hazards that are not mitigated by engineering controls or administrative controls.

1.2.3. The medical surveillance services identify potential occupational exposures that may have an impact on the health of the employee, ensures the fitness of employees to perform tasks safely and examines the capability of employee in the use of required

PPE.

1.2.4. Employees, primarily vehicle and aircraft mechanics, exposed to a potentially hazardous environment or operation are required to obtain a medical surveillance examination as a baseline or prior to placement, semiannually dependent on exposure, annually, and upon termination of exposure or removal from hazardous duty. Some employees may require monitoring after termination from position to monitor for long term effects of exposures.

1.2.5. Return to work examinations allow the OH nurse (OHN) to manage illness and injury cases to ensure employees are able to perform the functional duties of their position.

1.3. The MDARNG is seeking a sole OH agency or clinic to provide OH medical screening and examination services at multiple locations throughout the state of Maryland that are geographically located within fifty-five (55) miles of each of the locations listed in paragraph 1.7.1. Services will be on a fee for service basis.

1.4. This contract is for “Non Personal Health Care Services”, as defined in Federal Acquisition Regulation (FAR) 37.101. IAW with FAR Part 37.4 the Government may enter into a non-personal health care services contract with physicians, dentists and other health care providers under authority of 10 U.S.C. 2304 and 41 U.S.C. 253. The Government shall evaluate the quality of professional and administrative services provided, while the Government retains no control over the medical, professional aspects of services rendered.

1.5. Period of Performance (PoP): The period of performance shall be one (1) year from the award date with a four (4) year option, dependent on quality of performance.

1.6. General Information:

1.6.1 Quality Control (QC): The contractor shall develop and maintain an effective QC Plan (QCP) to ensure services are performed IAW this PWS. The contractor shall develop and implement procedures to identify, prevent, and ensure non-recurrence of defective services. The contractor’s QCP is the means by which it assures itself that its work complies with the requirements of the contract. As a minimum, the contractor shall develop QC procedures that address the areas identified in the Quality Assurance Surveillance Plan (QASP), Performance Requirements Summary. After acceptance of the QCP, the contractor shall obtain the Contracting Officer’s (KO) acceptance in writing of any proposed changes to its QCP.

1.6.2 Quality Assurance (QA): The Government shall evaluate the contractor’s performance under this contract IAW the QASP. This plan is primarily focused on what the Government must do to ensure that the contractor has performed IAW the performance standards. It defines how the performance standards will be applied, the frequency of surveillance, and acceptable quality level.

1.6.3. Recognized Holidays: The following are recognized US holidays and the organizations observed days off. The holidays that fall on a Monday are observed on the Friday prior to the actual holiday. The contractor shall treat these days as a holiday when scheduling.

1.6.3.1. New Year’s Day

1.6.3.2.. Martin Luther King Junior Day

1.6.3.3. President’s Day

1.6.3.4. Memorial Day

1.6.3.5. Independence Day

1.6.3.6. Labor Day

1.6.3.7. Columbus Day

1.6.3.8. Veteran’s Day

1.56.3.9. Thanksgiving Day

1.6.3.10. Christmas Day

1.7. Place and Performance of Service: The contractor shall possess a standing clinic capable of providing OH services geographically located within fifty-five (55) miles from MDARNG duty stations. The specific duty stations are located in section 1.7.1. of this PWS. Services shall be provided between the hours of 0800-1700hrs on Tuesday through Friday except on recognized US holidays or when the Government facility/installation is closed due to local or national emergencies, administrative closings, or similar Government-directed facility/installation closings.

1.7.1. Services will be able to support employees at the following locations:

1.7.1.1. Field Maintenance Shop (FMS) 01, Reisterstown, MD 21136

1.7.1.2. FMS 02, Dundalk, MD 21222

1.7.1.3. FMS 04, Salisbury, MD 21801

1.7.1.4. FMS 05 and Army Aviation Support Facility (AASF), Edgewood, MD 21010

1.7.1.5. FMS 06, Cheltenham, MD 20623

1.7.1.6. FMS 07, Hagerstown, MD 21740

1.7.1.7. FMS 08, Laurel, MD 20708

1.7.1.8. FMS 09, Cumberland, MD 21502

1.7.1.9. Combined Surface Maintenance Shop (CSMS) and Warehouse (WH), Havre de Grace, MD 21078

1.7.1.10. Tactical Unmanned Aerial System (TUAS), Patuxent River, MD 20684

1.7.2. Testing requirements for the medical surveillance examinations are as follows but not limited to the following and will be ordered on a case by case basis as directed by the OHN: (cost by line item must be provided)

1.7.2.1. Audiogram-IAW Department of the Army Pamphlet (DA PAM) 40-506, Department of Defense (DoD) 6055.05-M (baseline, annual, transfer and/or termination)

1.7.2.2. Chest x-ray (CXR)-IAW DoD 6055.05-M (single view/ B reader with report only, results required only for those outside normal)

1.7.2.3. Lab work- IAW DoD 6055.05-M:

1.7.2.3.1. Complete Blood Count with differentials (CBC w/diff )

1.7.2.3.2. Comprehensive Metabolic Panel (CMP)

1.7.2.3.3. Heavy Metals

1.7.2.3.3.1. Blood Zinc Protoporphyrin (ZPP)

1.7.2.3.3.2. Blood Lead (BL)

1.7.2.3.3.3. Blood Cadmium (CdB) blood

1.7.2.3.3.4. Urine Cadmium (CdU)

1.7.2.3.4. B2 Microglobulin

1.7.2.3.5. Urinalysis (UA)- dipstick

1.7.2.4 Pulmonary Functions Test (PFT)-IAW DoD 6055.05-M (Spirometry)

1.7.2.5. Vision Screening-IAW DoD 6055-.05-M, DA PAM 40-506 (corrected near and distant monocular and binocular visual acuity, depth perception, color, confrontational visual fields)

1.7.3. Medical screening will consist of the following IAW DoD 6055.05-M and rendered on a case by case basis as ordered by the OHN: (cost by line item must be provided)

1.7.3.1. Medical History – past medical history, current, family, home exposures, work exposures, work related complaints (past and current), hearing, ergonomic, and vision.

1.7.3.2. Screening Exam – interview with employee to discuss available results and questionnaires and annotate notes in medical records.

1.7.3.3. Respiratory History/Clearance – IAW 29 CFR § 1910.134 App C and AR 11-34;

Review of spirometry results as applicable.

1.7.3.3.1. Fit Testing-Personnel will be appropriately trained to perform qualitative and quantitative fit testing IAW appendix A of 29 CFR § 1910-134 for mandatory fit testing procedures

1.7.3.4. Fitness for Duty (FFD)-IAW DoD 6055.5-M (determining whether an employee is medically and physically able to perform the assigned duties without substantial risk of harm to themselves, others or the mission)

1.7.4. Test results that are received after the service date will be reviewed by a Board Certified Occupational Health Physician (BCOHP) and provided to MDARNG Occupational Health Nurse (OHN) with relevant recommendations.

1.7.5. The services requested are for testing, screening and evaluation purposes therefore medical treatment is not required or authorized. In the event additional testing is required for a suspected occupational related issue consult with the contracting officer’s representative (COR) prior to conducting.

1.7.6. Contractor will consult with the COR on health concerns involving employees that may arise during operations or upon receipt of results that are not readily available on site (i.e. lab results).

1.7.7. The privacy of the employee must be ensured at all times.

1.7.8. Test Panels. Testing will occur based on the requirements of the job code/job title and known or suspected exposures. The list of testing requirements for each employee will be provided by the MDARNG OHN to the contracted agency and/or clinic.

1.7.9. If abnormal findings are identified that may be a serious health concern, the contractor shall notify the employee and the MDARNG OHN immediately to be referred accordingly.

1.7.10. Personnel files and medical information will only be sent to and discussed with the individual and MDARNG OHN.

1.7.11. Contractor will arrange for initial coordination of services with the designated COR within fifteen (15) working days after award of the contract. Instructions and required paperwork for employees will be forwarded to: Maryland Army National Guard, Safety and Occupational Health Office, Attn: Occupational Health Nurse, 2624 Fairview Point Rd, Building E-6812, Edgewood, MD 21040-3312 and received no later than 15 days prior to start date of service.

1.7.12. The contractor shall abide by applicable Army regulations governing the handling and storage of medical records IAW AR 40-66.

1.7.13. COMSEC/IT Security. All communications with DoD organizations are subject to communications security (COMSEC) review. All telephone communications networks are continually subject to intercept by unfriendly intelligence organizations. DoD has authorized the military departments to conduct COMSEC monitoring and recording of telephone calls originating from, or terminating at, DoD organizations. Therefore, the contractor is advised that any time contractor place or receive a call they are subject to COMSEC procedures. The contractor shall ensure wide and frequent dissemination of this information to all employees dealing with DoD information. The contractor is not authorized use of the Government's computer network.

1.7.14. Protected Health Information (PHI). The contractor shall not release any medical or personal information of an employee without first receiving written approval from the COR. The COR will provide the regulations upon request by the contractor IAW FAR 52.212-4, Privacy of Protected Health Information (DEC 2002) [Health Information Portability and Accountability Act (HIPAA)].

1.7.15. Protection of Personally Identifiable Information (PII). The contractor shall protect all PII encountered in the performance of services IAW Defense Federal Acquisition Regulation Supplement (d) 224.103 and DoDD 5400.11, Department of Defense Privacy Program, and DoD 5400.11-R. If a PII breach results from the contractor’s violation of the aforementioned policies, the contractor shall bear all notification costs, call-center support costs, and credit monitoring service costs for all individuals who’s PII has been compromised. Protection of Personally Identifiable Information training is available through this link and must be completed within fifteen

(15) days of service start date for staff:

https://securityawareness.usalearning.gov/piiv2/index.htm.

1.7.16. CAC Requirements: The Common Access Card (CAC) is the DoD Federal Personal Identity Verification (PIV) credential. Contractor is not authorized or required to have a CAC card in the performance of services. Contractor is not authorized to make photocopy, scan or hold the CAC identification of any employee that visits the location.

1.7.17. Special Qualifications: It is the responsibility of the contractor to ensure the health care team are current and appropriately licensed, trained, boarded and certified to perform medical surveillance screening and testing. License and certifications will be made available upon request. They will operate under the supervision and direction of a BCOHP provided by the contractor.

https://securityawareness.usalearning.gov/piiv2/index.htm

1.7.17.1. Personnel performing audiograms must be certified by the Council for Accreditation in Occupational Hearing Conservation (CAOHC) and able to perform an otoscopic examination IAW DA Pam 40-501. This certificate must be provided to verify training.

1.7.17.1.1. Personnel performing audiograms will ensure hearing aids and any other objects that may interfere with testing are removed prior to administering test.

1.7.17.1.2. The DD Form 2215 and DD Form 2216 are the forms of record for all audiograms and will be made available on each employee. The DD Form 2215 will be provided for all baseline hearing test and the DD Form 2216 will be provided for all annual test.

1.7.17.2. Audiometric testing will be conducted IAW DoDI 6055.12, 4(e) and DA PAM 40-501, chapter 3, (3-6), chapter 7, (7-5) guidelines. DOEHRS-HC is not a requirement.

1.7.17.2.1. Contractor will ensure all equipment is appropriately licensed, calibrated and maintained to the standards governing the use of equipment and the manufacturer’s guidance.

17.7.17.2.2. Annual comprehensive electro-acoustical calibration data for each audiometer must be conducted and provided to COR at any given time as well as documentation of daily calibration and functional checks.

17.7.17.2.3. Audiometric testing must be conducted in a sound booth in a testing environment with noise levels not to exceed the requirements outlined in DA PAM 40- 501, Table 3-2.

1.7.17.3. The contractor must ensure all testing, evaluation and examination procedures are conducted IAW applicable American Board of Occupational and Environmental Medicine (ABOEM), American Association of Occupational Health Nurses (AAOHN), U.S. Department of Labor, OSHA, National Institute for Occupational Safety and Health (NIOSH) and other standards as applicable.

1.7.17.4. The Contractor shall provide a board eligible or BCOHP to conduct job-related/hazard based OH medical surveillance examinations and OH consultation services IAW NGR 40-5. Provider will utilize historical records in the evaluation and examination of employee in the event a termination examination is requested.

1.7.17.5. Personnel conducting pulmonary function testing will be certified through a program approved by the NIOSH and IAW 29 CFR § 1910.134.

1.7.17.6. Personnel will be appropriately trained and licensed to operate an x-ray machine. The x-ray equipment will be in excellent working conditions, appropriately maintained, calibrated and licensed prior to use: see appendix E of part § 1910.1001 of for chest X-Ray schedule and B-reader requirements.

1.7.17.7. Personnel performing blood draw and lab operations will be trained and skilled in the task of specimen collection.

1.7.17.7.1. Contractor must ensure all clinical laboratory services are performed by a laboratory licensed through the U.S. Department of Health and Human Services (DHHS) Health Care Financing Administration pursuant to the terms of the Clinical Laboratories Improvement Act of 1967 (42 U.S.C. 263a) and the College of American Pathologists. Equipment and instrumentation must meet or exceed appropriate performance, calibration, and maintenance standards.

1.7.17.7.2. The contractor shall adhere to the Centers for Disease Control (CDC) guidelines related to standard precautions and Coronavirus Disease 2019 (COVID- 2019) as well as the MDARNG Blood Borne Pathogens Standards Manual (BBPSM), at all times while providing services under this contract. The BBPSM is available for review upon the contractor request.

1.7.17.7.3. The process for the storage, transport and handling of specimens must be in place to ensure the quality of the specimen to be analyzed. The contractor will be responsible for specimens that are ruined due to reason not the fault of the employee and will coordinate for the re-collection of specimen with the employee.

1.7.17.8. Personnel conducting visual acuity test will be trained and skilled in performance of task.

1.7.17.9. The MDARNG is not responsible for training contracted staff.

1.7.18. Post Award Conference/Periodic Progress Meetings: The contractor agrees to attend any post award conference convened by the KO IAW FAR Subpart 42.5. The KO, COR, and other Government personnel, as appropriate, may meet periodically with the contractor to review the contactor’s performance. At these meetings, the CO will apprise the contractor of how the Government views the contractor’s performance and the contractor shall apprise the Government of problems, if any, being experienced The contractor shall resolve outstanding issues raised by the Government. Contractor attendance at these meetings shall be at no additional cost to the Government.

1.7.19. Contract Manager (CM): The contactor shall designate a CM who shall ensure performance under this contract. The name of this person, and an alternate who shall act for the contractor when the CM is absent, shall be designated in writing to the KO.

The CM or alternate shall have full authority to act for the contractor on all contract matters relating to daily operation of this contract. The CM shall work through the COR, (or the KO if a COR is not assigned), to resolve issues, receive technical instructions, and ensure adequate performance of services. The CM shall ensure that contractor employees do not perform any services outside the scope of the contract without an official modification issued by the KO. The CM shall ensure contractor employees understand that services performed outside the scope of the contract are performed wholly at the expense of the contractor.

1.7.20. Combating Trafficking in Persons: The United States Government has adopted a zero tolerance policy regarding trafficking in persons. Contractors and contractor employees shall not engage in any form of trafficking in persons in performance of the contract. This includes but is not limited to procuring commercial sex acts, and the use of forced labor in the performance of the contract. The Contractor shall notify its employees of the United States Government’s zero tolerance policy. The necessary actions will be taken against contractor for violation of this policy. Such actions may include, but are not limited to, removal from the contract, revocation of contract, and termination of employment. The Contractor shall take the appropriate action, up to and including termination, against employees or subcontractors that violate the US Government policy as described at FAR 22.17.

1.7.21. Data Rights. The Government has unlimited rights to all documents/material produced under this contract. All documents and materials, to include the drafted reports and photographs produced under this contract shall be Government owned and are the property of the Government with all rights and privileges of ownership/copyright belonging exclusively to the Government. These documents and materials may not be used or sold by the contractor without written permission from the KO. All materials supplied to the Government shall be the sole property of the Government and may not be used for any other purpose. This right does not abrogate any other Government rights.

1.7.22. Antiterrorism (AT)/Operations Security (OPSEC):

1.7.22.1. Handling/Access to Classified Information. For contracts that require handling or access to classified information, the contractor shall comply with FAR Clause 52.204- 2, Security Requirements, including the National Industrial Security Program Operating Manual (DoD 5220.22-M) and applicable updates/changes. This clause involves access to information classified “Confidential/Secret/Top Secret” and requires contractors to comply with a Visitor Group Security Agreement (VGSA) with all contractor operations located on Air Force/Air National Guard installations in accordance with this PWS. Unauthorized Disclosure of Classified Information and CUI training is available through this link and must be completed within fifteen (15) days of service start date for staff:

https://securityawareness.usalearning.gov/disclosure/index.html.

1.7.22.2. Requirements for OPSEC Training. In accordance with AFI 10-701, Operations Security, OPSEC PMs/SMO/SMNCOs/Coordinators will provide OPSEC training or training materials to contract employees within 90 days of employees’ initial assignment to the contract and annually thereafter. General organizational orientations may need to be supplemented by duty-related orientations in the work center targeted https://securityawareness.usalearning.gov/disclosure/index.html toward specific critical information and vulnerabilities associated with the work. Initial training (OPSE 1301 - OPSEC Fundamentals) and refresher training (Protecting Sensitive Information) are available through this link and must be completed within fifteen (15) days of service start date for staff:

https://securityawareness.usalearning.gov/opsec/index.htm.

1.7.22.3. Threat Awareness Reporting Program. For all contractors with security clearances or contractors working directly with Service members' Personally Identifiable Information, Per AR 381-12 Threat Awareness and Reporting Program (TARP), contractor employees must receive annual TARP training by a CI agent or other trainer as specified in 2-4b.Past espionage cases and acts of international terrorism that have targeted Army personnel and facilities have demonstrated that coworkers, associates, friends, and supervisors of those engaging in espionage or terrorist activity have overlooked indicators of potential threats to the Army which, had they been reported, would have minimized the damage to national security or saved the lives of DA personnel. Contractors who have access to DA personnel or facilities can create a target for potential threats. Insider Threat Awareness training is available through this link and must be completed within fifteen (15) days of service start date for staff:

https://securityawareness.usalearning.gov/itawareness/index.htm.

2.0. Definitions.

2.1. Definitions:

2.1.1. CONTRACTOR. A supplier or vendor awarded a contract to provide specific supplies or service to the government. The term used in this contract refers to the prime.

2.1.2. CONTRACTING OFFICER (KO). A person with authority to enter into, administer, and or terminate contracts, and make related determinations and findings on behalf of the government. Note: The only individual who can legally bind the government.

2.1.3. CONTRACTING OFFICER'S REPRESENTATIVE (COR). An employee of the U.S. Government designated by the KO to monitor contractor performance. Such appointment shall be in writing and shall state the scope of authority and limitations.

This individual has authority to provide technical direction to the Contractor as long as that direction is within the scope of the contract, does not constitute a change, and has no funding implications. This individual does NOT have authority to change the terms and conditions of the contract.

2.1.4. DEFECTIVE SERVICE. A service output that does not meet the standard of performance associated with the Performance Work Statement.

2.1.5. DELIVERABLE. Anything that can be physically delivered and includes non manufactured things such as meeting minutes or reports.

https://securityawareness.usalearning.gov/opsec/index.htm https://securityawareness.usalearning.gov/itawareness/index.htm

2.1.6. KEY PERSONNEL. Contractor personnel that are evaluated in a source selection process and that may be required to be used in the performance of a contract by the Key Personnel listed in the PWS. When key personnel are used as an evaluation factor in best value procurement, an offer can be rejected if it does not have a firm commitment from the persons that are listed in the proposal.

2.1.7. PHYSICAL SECURITY. Actions that prevent the loss or damage of Government property.

2.1.8. QUALITY ASSURANCE. The government procedures to verify that services being performed by the Contractor are performed according to acceptable standards.

2.1.9. QUALITY ASSURANCE SURVEILLANCE PLAN (QASP). An organized written document specifying the surveillance methodology to be used for surveillance of contractor performance.

2.1.10. QUALITY CONTROL. All necessary measures taken by the Contractor to assure that the quality of an end product or service shall meet contract requirements.

2.1.11. SUBCONTRACTOR. One that enters into a contract with a prime contractor.

The Government does not have privity of contract with the subcontractor.

2.1.12 WORK DAY. The number of hours per day the Contractor provides services IAW with the PWS.

2.1.13 WORK WEEK. Tuesday through Friday, unless specified otherwise.

3.0 Government Furnished Property, Material, Equipment and Services (GFP/M/E/S):

The Government will provide materials listed below solely for the purpose of performance under this contract:

3.1 Property: Government property will not be utilized for the purposes of this contract.

3.2. Materials: Medical documentation related forms will be issued directly to each employee by the MDARNG OHN prior to their scheduled appointment. A copy of their PD will be provided for those employees in need of a return to work examination.

3.3 Equipment: Government equipment will not be furnished for the purposes of this contract.

3.4 Utilities: Government utilities will not be furnished for the purpose of this contract.

4.0. Contractor Furnished Property, Materials, and Equipment (CFP/M/E):

4.1 General: Except for those items specifically stated to be Government-Furnished in section 3.0, the contractor shall furnish required facilities, materials and equipment to perform services as indicated in section 1.7.2. and 1.7.3 of this PWS.

4.2. Requirements of the contractor:

4.2.1. Contractor shall furnish the facilities, equipment, labor and services required to provide OH medical surveillance examinations and services as prescribed by this document and the standards governing the OH profession. Equipment and instrumentation must meet or exceed appropriate performance, calibration, and maintenance standards for accuracy IAW manufacturer guidelines, OSHA and Department of Army regulations.

4.2.2. Contractor will provide the proper PPE to conduct medical surveillance screening examinations and OH services IAW CDC guidelines as indicated in section 1.7.17.7.2.

of this PWS.

4.2.3. The contractor will ensure adequate coverage for the safety and health of the employees designated to visit the OH site.

4.2.4. The contractor must ensure licenses, registrations, credentials, equipment calibrations, provider accreditation, and training are current and in compliance with applicable standards. Documentation will be furnished to COR as requested.

4.2.5. The contractor shall ensure conduct of medical screening and testing IAW section

1.7 of this PWS.

5.0. Services.

5.1. Process:

5.1.1. Scheduling: Appointments will be scheduled directly through the employee or employee supervisor and contracted agency or clinic.

5.1.2. Documentation: All required forms will be provided by the MDARNG OHN to each employee to include the exam requirements form. The employee is expected to have the required documents on their person, completed to their fullest capability, the day of their examination.

5.1.3. Contractor will consult with the COR to coordinate or resolve issues that may arise before, during, and after an appointment.

5.2. Reports: Contractor shall ensure two copies of the employee’s examination findings are furnished. One copy shall be sent to the MDARNG OHN as designated in section 5.2.1, and one copy shall be mailed directly to the individual employee’s home of record within fifteen (15) working days upon completion of testing services. Copies provided (sent) in bulk to the MDARNG OHN shall be sent in appropriately secured, correctly sized individual envelops not folded. If stapling is required; documents will be stapled in the upper left hand corner. Medical examination results shall include all diagnostic tests, graphs, charts, reports, questionnaires, waivers, employee consent forms, physical findings, and examination results.

5.2.1. Examination results/reports, invoices, and any other correspondence will be addressed to MDARNG Occupational Health, Attn: Erin Williams Occupational Health, 2624 Fairview Point Road, Building E-6812, Edgewood, MD 21040-3312. An itemized invoice (1 copy) will be submitted to the MDARNG OHN via encrypted email, see section 6.2 for email address, within fifteen (15) days of employee examination.

5.2.2. Contractor shall identify all medical records with the employee’s full name, last four digits of social security number, date of birth (DOB), and job code at a minimum.

The Contractor shall ensure work / health history forms and medical reports are complete and legible (typed / printed) with the date of service annotated on each form.

5.2.3. The Contractor will provide a cover letter to each employee to whom exam results are sent. The letter will be individualized and will summarize in lay terms individual test results; along with any recommendations as warranted by results, for the employee to follow up with their personal physician as indicated. A copy of the cover letter will also be sent with the screening examination to the MDARNG OHN. At the discretion of the Contractor, a disclaimer may be added to the exam cover letter stating, “If you require further information, and or have questions related to the exam results; you are welcome to reply within thirty days of receipt. If no response, we presume you acknowledge and accept”.

5.3. Conduct:

5.3.1. The contractor must be professional at all time with good customer service.

5.3.2. All providers and technicians accessing patient records, data or obtaining health information must complete the annual training and comply with the requirements of the HIPAA act of 1996. Training completion certificates will be submitted to the COR within 15 days of service start date for staff.

5.3.3. Personal appearance. The contractor and staff shall present a professional appearance and conduct themselves in a professional manner at all time.

5.3.3.1. Contractor and staff will present with good personal hygiene and ensure clothing is clean and neat on their person.

5.3.3.2. Clothing will not be derogatory or offensive in nature or suggestive of sexual behavior or conduct unbecoming in the presence of employees.

5.3.4. The contractor shall abide by applicable laws and regulations governing the safety and health programs.

5.4. Malpractice insurance. The contractor is responsible for purchasing medical malpractice insurance under this contract.

5.5. Complete disclosure. Complete disclosure of any past incidents involving the professional duties of staff which might have an impact on his professional standing, such as charges (unless acquitted) involving either felonies or misdemeanors (other than minor traffic violations) is a necessary part of competency process. This disclosure must also specifically include reports of any actions, claims, charges of malpractice ever brought against any of the staff or subcontractors (either individually or as a part of a group), as well as the outcome (or current status) of any such case. The OH representative will evaluate any such incident and determine whether it should be disqualifying.

5.5.1. If at any time during the contract period it is discovered through a medical center investigation or any investigation, that employee is currently pending charges, or has previously been convicted of any of the aforementioned incidents, the contract may be terminated pending further investigation. Upon discovery the COR will consult with the contractor and will handle situation on a case by case basis.

5.6. Unacceptable skills. The MDARNG reserves the right to assess the services provided and the staff providing the service, at any time during the contract. Should there be a question on the skill or employee is found to be unsatisfactorily or unfit for duty, they will be asked to cease performance of such services.

5.7. Misconduct/Disruption of Services. At any time during the performance of this contract, the COR may immediately request the removal of contractor staff whose actions, or impaired state, results in the clear disruption to the work force.

5.8. Litigation. In the event of litigation/investigation of a claim of liability or malpractice the contractor shall cooperate fully with government authorities and designated officials in the investigation of the claim or preparation of litigation. The contractor shall immediately notify the KO and COR of any claims and promptly furnish copies of all pertinent papers receives; cooperate with the government in the processing, review, settlement, or defense of the suit, action or claim; and authorize government representatives to settle or defend the claims and to represent the healthcare provider in, or take charge of, any litigation involved in such action.

5.9. Confidentiality. The contractor shall abide by Army Regulation (AR) 40-66 concerning the nature of limited privileged communication between patient and provider for security and personnel reliability programs. The contractor shall abide by AR 40-66 concerning confidentiality of patient records, as embodied in federal statues including the Privacy Act of 1974 and the Drug and Alcohol Act, Public Law 92-129.

5.10. Conflict of Interest

5.10.1. The contractor shall not introduce any new services without prior approval of the COR. In disagreements or deviations from established protocols, COR will be the deciding authority.

5.10.2. The contractor shall not use services rendered pursuant to this agreement as part of a study, research grant, or publication without the prior written consent of the

KO.

5.10.3. The contractor shall not bill the patient, an insurer, or anyone else for services rendered. The only compensation the contractor is entitled to for performance of the contract is payment as specified by this contract. The contractor and staff are not prohibited, under this contract, from conducting private medical practice if there is no conflict with the performance of duties under this contract and the contractor and staff does not use MDARNG facilities or other MDARNG property in connection therewith.

5.10.4. The contractor and staff shall not be an employee of the United States government if the employment would create a conflict of interest

5.11. The contractor shall be responsible for complying with all installation safety requirements in accordance with OSHA regulations. Such regulations include but are not limited to, general safety, fire prevention and waste disposal.

6.0. Additional Requirements and Notes:

6.1. The MDARNG has a strict policy against sexual harassment, sexual assault and discrimination of any kind. Contractor and employees must not engage in these acts will treat everyone with respect and without discrimination based on gender, race, sexual orientation, or religious beliefs.

6.2. Initial coordination of services will be coordinated within fifteen (15) working days after award of the contract. Instructions and required paperwork from the agency will be forwarded to the COR at 443-379-3474, email erin.e.williams49.civ@mail.mil or by mail within 15 calendar days of service start date.

6.3. Point of Contact (POC) for this contract will be the MDARNG OHN, Erin Williams.

All correspondence will be addressed to MDARNG OHN, Erin Williams, 2624 Fairview Point Road, Bldg. E-6812, Edgewood, MD 21040-3312.

7.0 Applicable Publications:

AFI 10-701, Operations Security;

AR 11-34, The Army Respiratory Protection Program;

AR 40-5, Preventive Medicine;

mailto:erin.e.williams49.civ@mail.mil

AR 40-66, Medical Record Administration and Healthcare Documentation;

AR 40-501, Standards of Medical Fitness;

AR 381-12 Threat Awareness and Reporting Program;

AR 385-10, The Army Safety Program;

DA PAM 40-501, Hearing Conservation Program;

DA Pam 40-506, The Army Vision Conservation and Readiness;

DFARS 224.103, Defense Federal Acquisition Regulation Supplement;

DoD 6055.05-M, Occupational Medical Examinations and Surveillance Manual;

DoDD 5400.11, Department of Defense Privacy Program;

DoD 5400.11-R., Department of Defense Privacy Program;

DoD 8570.01-M, Information Assurance Workforce Improvement Program;

FAR 37.101, Federal Acquisition Regulation;

FAR 52.204-2, Security Requirements;

NGR 40-5, The Army National Guard Preventive Medicine Program;

NG PAM 40-11, Army National Guard Occupational Health Program

Occupational Safety and Health Administration (OSHA) 29 Code of Federal Regulations

(CFR) § 1910