SOW - Vendor Contract Requirements 2022.doc

SOW for Local OMSP Contact

Baseline Medical Surveillance Exam for first time participant includes a Lab Profile, Audiogram, Chest x-ray, Spirometry and a Physical Exam.

For return participants, a fasting Lab test and a physical exam are required. Other tests and immunizations should be done based on exposures entered onto the 182-A/B form or at your Local Area’s requirement/discretion.

The SRRC Safety & Occupational Health Speciliast (Shannon Beltz) will provide the clinic with the required tests, screenings, and all USDA paperwork for each employee. Tests and Screenings should be done in accordance with the parameters below.

Test results should be given to USDA employees and sent to the USDA Medical Examiner in San Fransisco, CA. The local Safety & Occupational Health Specialist does not get the results (with the exception of the respirator fit test).

USDA VENDOR REQUIREMENTS for SERVICES Listed

VENDOR NAME:

MEDICAL HISTORY & PHYSICAL EXAM

OCCUPATIONAL HISTORY AND BASELINE PHYSICAL EVALUATION

(Height, weight, TPR, and blood pressure are considered normal components of the physical exam and there is not a separate charge for these items. The charge for this exam does not include Lab work and other exam components – these may charged separately as noted below)

USDA shall provide the required forms. They are USDA forms ARS 182 A/B, C, D. The Medical History Update Form (ARS C(2) should be used if the employee already has form C completed on their chart.

Respirator Medical Clearance may be required as part of exam.

We expect that the client who is having a physical exam shall be scheduled for a minimum of 30 minutes with the examiner, and in a medical setting. This time should include a full explanation of all lab, test, and exam results, a comprehensive physical examination, and an opportunity for the Federal Employee to get any questions answered. Employees are to receive copies of any tests or reports as requested.

Any employee who has a life-threatening condition, or serious finding requiring urgent evaluation or intervention, must be notified by the vendor as soon as the serious finding is noted (i.e. at the time of the exam, or immediately upon receiving significantly abnormal lab results).

YES, can meet criteria

NO, can't do these services

Examiners shall be currently licensed to practice in the state where services are provided. A Certified Occupational Health Physician would be preferred.

Please check which personnel would be performing the exams.

Certified Nurse Practitioner Physician

Certified Physician's Assistant Certified Occupational Health Physician

Originals of ALL USDA/ARS forms and ALL test results are to be sent WITHIN TWO WEEKS OF THE DATE OF THE EXAM-to the REVIEWING MEDICAL OFFICER

MEDICAL REVIEW OFFICER

Federal Occupational Health, Room 443 50 United Nations Plaza

450 Golden Gate Ave, Rm 5284, 2nd Fl, San Francisco, CA 94102. The REVIEWING MEDICAL OFFICER is Lee Wugofski, MD, MPH., Certified Occupational Health Physician. Please feel free to call Abbey Ampon at (415) 436-8282 for any questions or concerns about the medical review process.

YES, can meet criteria

SPECIFIC EXAM COMPONENTS

AUDIOMETRY

Using AAOHN Standards.

Audiometric tests must be conducted with equipment that meets the specifications of, and is maintained and used in accordance with ANSI Specifications for Audiometers S3.6‑1969.

Pulsed‑tone and self‑recording audiometers (microprocessor audiometers) must meet the requirements specified in 29 CFR 1910.95 Appendix C.

Required frequencies to be tested are 500, 1000, 2000, 3000, 4000, 6000, 8000 Hertz (all seven frequencies are required). “Screening Audiograms” i.e. testing only at 15 or 25 db are NOT acceptable. True hearing thresholds must be obtained at all frequencies.

Retest audiograms will be repeated within 30 days if a Standard Threshold Shift appears to have occurred – to validate the shift.

Copy of results (audiometer printout) to be sent to the REVIEWING MEDICAL OFFICER.

YES, can meet criteria

CHEST X-RAY (PA) (Including cost of interpretation.)

Usual standard: A chest x-ray should be done for any employee who

1) will need medical clearance for respirator use (baseline x-ray only)

2) who is an asbestos worker (follow OSHA standard for asbestos chest x-rays)

3) who has a Histoplasmosis antibody test that converts from negative to positive,

4) who has a TB test that converts from negative to positive,

5) who has severely decreased Pulmonary Function Tests, is Short of Breath, or symptomatic.

AS A GENERAL RULE, ROUTINE PERIODIC X-RAYS ARE NOT INDICATED (unless medically indicated).

Copy of Chest X-ray report (not the actual film) to be sent to the REVIEWING MEDICAL OFFICER.

YES, can meet criteria

RESPIRATOR MEDICAL CLEARANCE (RMC)

RMC is the responsibility of the local vendor. The Medical Review Officer does not make RMC decisions.

RMC is not standardized through out the country. The vendor should follow their own policies and the OSHA standards.

Recommendation: all employees who are to have medical clearance to wear a respirator should have a complete baseline physical exam (including spirometry and a baseline PA chest x-ray). Vendor to send Respirator Medical Clearance directly to USDA Local Contact. However, please note that the USDA Local Contact is to receive notification of clearance (or no clearance) only. No test results (such as spirometry) or confidential information is to be given to the USDA Local Contact.

Copy of results (complete print out of test curves and results) to be sent to REVIEWING MEDICAL OFFICER IF EMPLOYEE ALSO HAS A PHYSICAL EXAMINATION. (i.e. if employee has Respirator Medical Clearance without an exam, no forms need to be sent to the Medical Review Officer.)

SPIROMETRY

NIOSH Standards. Clinical Standard including FVC, FEV1/FVC, ratio.

Use certified, regularly calibrated equipment, and personnel who have successfully completed a NIOSH approved course in Spirometry (consistent with applicable sections of 29 CFR1910).

Best three curves to be printed out. Results to be expressed as observed, predicted, and percent of predicted.

Copy of results (complete print out of test curves and results) to be sent to REVIEWING MEDICAL OFFICER.

YES, can meet criteria

STOOL FOR OCCULT BLOOD TEST X3

Usually done as a patient self test at home.

Results to be noted on physical exam form and sent to REVIEWING MEDICAL OFFICER YES, can meet criteria

VISUAL ACUITY Includes near & far vision, with glasses or contacts.

Includes color vision and peripheral vision.

Copy of results to be sent to REVIEWING MEDICAL OFFICER.

YES, can meet criteria

PHOTOCOPYING

Originals of all USDA forms and all test results must be provided to the REVIEWING MEDICAL OFFICER.

You may want to make copies for your record.

NOTE: NO FORMS OR TEST RESULTS ARE TO GO TO USDA/ARS local management.

This is confidential medical information!

NOTE: There are three exceptions to this.

1) Hepatitis A & B Vaccination forms may go directly to the USDA Local Contact (with copy to Medical Review Officer).

2) The USDA local contact may keep (or receive) a copy of the ARS 182 B (exposures form).

3) Information regarding Respirator Medical Clearance (RMC) does go directly to the USDA Local Contact. However, please note that the USDA Local Contact is to receive notification of clearance (or no clearance) only. No test results (such as spirometry) or confidential information is to be given to the USDA Local Contact. (See specific section regarding Respirator Medical Clearance.)

If your clinic sends a formal letter to the employee regarding their exam results, please send a copy to the REVIEWING MEDICAL OFFICER.

YES, can meet criteria

If the examiner uses a different exam form (the clinic's own form), and then transcribes information onto the ARS form D, please send a copy of the completed actual exam form used to the

REVIEWING MEDICAL OFFICER.

YES, can meet criteria

POSTAGE/HANDLING

RECORDS MANAGEMENT

LAB TESTS

LAB PROFILE :

1)Complete Blood Count (CBC)

2) Routine Urinalysis

3) Liver Profile (ALT, AST, Alk. Phos, Total Bilirubin)

4) Kidney Profile (Creatinine, BUN).

Reports of all lab tests to be sent to REVIEWING MEDICAL OFFICER.

YES, can meet criteria

RBC & PLASMA CHOLINESTERASE

Baseline testing should be RBC & Plasma Cholinesterase. Need to have baseline at entrance to the Medical Surveillance Program if will be exposed to organophosphate or carbamate insecticides on the job. Also need to have a NEW baseline if vendor changes the lab where testing is done. All baselines should be collected at least FOUR WEEKS AFTER any pesticide spraying has been done, and must consist of two samples taken between 2 to 14 days. If unable to collect two specimens within this time frame, draw second specimen as soon as possible (but no later than 4 weeks from last exposure). LAB REPORT TO INDICATE DATE OF LAST EXPOSURE.

Reports of all lab tests to be sent to REVIEWING MEDICAL OFFICER..

YES, can meet criteria

RBC & PLASMA CHOLINESTERASE

Periodic RBC & PLASMA Cholinesterase testing for medical surveillance once the RBC & Plasma cholinesterase baselines have been established. Cholinesterase levels should be collected within one week of last potential exposure. Reports of all lab tests to be sent to REVIEWING MEDICAL OFFICER. as soon as they are available.

YES, can meet criteria

RETICULOCYTE COUNT

YES, can meet criteria

Thyroxin Serum Test (T4 total) and Thyroxin Serum Test (T4 free) This test is to be run for employees who work with certain fungicides.

YES, can meet criteria

OTHER SERVICES REQUESTED

YES, can meet criteria

YES, can meet criteria

YES, can meet criteria

YES, can meet criteria

YES, can meet criteria