Attachment 29.xls

XLS spreadsheet 45 KB Posted

Attached to
Occupational Health Services
Solicitation number
SP4702-11-R-0001
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SP4702-11-R-0001 Amend 0002 pg 1_Page_1.jpg JPG image
SP4702-11-R-0001 Amendment 0002 pgs 2-11.pdf PDF
Amend 0001 11-R-0001 Pg1.pdf PDF
Attachment 21d OF178 Example for Deployment.pdf PDF
Attachment 26 Health Promotions Screenings.doc DOC document
Attachment 7 DLA inj.docx DOCX document
Amendment 0001 Replacement pages.pdf PDF
Amendment 0001 SP4702-11-R-0001.pdf PDF
Attachment 18 Radiation monitoring.pdf PDF
Attachment 33 Foreign Travel Vacination Review.pdf PDF
Attachment 2 Govt Property.xls XLS spreadsheet
Attachment 31 WD05-2417(Rev.14) Amend 0001.pdf PDF
Attachment 6 DFAS inj.docx DOCX document
Attachment 8 DISA inj.docx DOCX document
Attachment 21d OF 178 Example for Pre-employment Medical Surveillance.pdf PDF
Attachment 7 DLA inj.docm DOCM document
Attachment 8 DISA inj.docm DOCM document
Attachment 25 DA Form 5006-R Authorization for Disclosure of Information.pdf PDF
Attachment 23 DoDI 6200.03 Public Health Emergency Mgmt within DoD.pdf PDF
Attachment 6 DFAS inj.docm DOCM document
Attachment 30.xlsx XLSX spreadsheet
Attachment 5 Refusal of Medical Services.pdf PDF
Attachment 14 CA16.pdf PDF
Attachment 13 CLIN sheet .docx DOCX document
Attachment 19 Mod 10 to USCENTCOM Indiv Protectection Indiv Unit Deployment.pdf PDF
Attachment 4 Potential exposure to BBP.pdf PDF
Attachment 21a DD2795 Pre Deployment Health Assessment.pdf PDF
Attachment 11 CA1.pdf PDF
Attachment 20 PPG-Tab A To accompany Mod 10.pdf PDF
Attachment 21h BMI for Deploying DoD Civilians to SWA.pdf PDF
Attachment 31-DOL 05-2417 dtd 9.14.10.pdf PDF
List of Attachments.docx DOCX document
Attachment 10 CA20.pdf PDF
Attachment 21c DD2766 Adult Prevention and Chronic Care Flowsheet.pdf PDF
Attachment 21g OSHA Respirator medical Evaluation Questionnaire.pdf PDF
Attachment 28 Privacy Act Statement - Health Care Records.pdf PDF
Attachment 16 Equipment Supplement.doc DOC document
Attachment 22 CENTCOM Medical waiver Request Documentation.pdf PDF
Attachment 1 Security Safety Fire.doc DOC document
Attachment 24 Government Records.doc DOC document
Attachment 21b DD2813 DoD Active Reserve Forces Dental Examination.pdf PDF
Attachment 21f DD 2808 Report of Medical Examination.pdf PDF
Attachment 17 Police Officers.pdf PDF
Attachment 9 Medical Officer Report.pdf PDF
Attachment 27 DSCC 2278-AED Class Registration Form.pdf PDF
Attachment 21i DD2807-1 Report of Medical History.pdf PDF
SF 1449 PAGE 1.pdf PDF
Attachment 3 Weather Emergencies.doc DOC document
Attachment 21e DD FORM 771 EYEWEAR PRESCRIPTION.pdf PDF
Attachment 21d SF78 Certificate of Medical Examination.pdf PDF
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Invoice

OCCUPATIONAL SERVICES INVOICE
DATE
(Original Invoice)
Date
Invoice # 00000000
Contractor NameCage Code:
AddressContract #:
City, State, ZipTerms: Net 30 Days
ServiceUnitUnit
CLIN #DescriptionTotalPriceAmount
CLIN002
CLIN051
CLIN003
CLIN004
CLIN005
CLIN006
CLIN007
CLIN008
CLIN009
CLIN010
CLIN013
CLIN014
CLIN015
CLIN016
CLIN017
CLIN018
CLIN020
CLIN021
CLIN023
CLIN030
CLIN033
CLIN034
CLIN035
CLIN038
CLIN039
CLIN040
CLIN041
CLIN043
CLIN044
CLIN045
CLIN046
CLIN048
CLIN049
CLIN050
CLIN052
CLIN055
CLIN056
CLIN057
CLIN060
CLIN061
- 0
INVOICE TOTAL:$ - 0
Invoice to:DLA Installation Support, Columbus
Environmental, Safety, and Occupational Health Office
Attn: Amy Manbeck
3990 E. Broad St.
Columbus, Ohio 43213
Remit to:Remit Payment to:Contractor
Attn:
Address
City, State, Zip

&RATTACHMENT 29

Fee Schedule

Effective Date4/5/114/5/124/5/134/5/144/5/15
IDX CodeDescriptionFeeFeeFeeFeeFee
CLIN Number
Clinic Services (P)
Clinic Services (A)
Nurse Stations
0005Physical Exams
0006Injury Evals
0007Audiograms
0008Masking Audiograms
0009Pulmonary Function
0010EKG
0011Chest x-ray (B read)
0012Extremity x-ray
0013Head/Spine x-ray
0014Splints
0015Blood Lead
0016Zinc Protoporphyrin
0017CBC w/Diff & Plts
0018Blood Chemistry
0019Cholinesterase
0020Carboxyhemoglobin
0021HIV blood test
0022PPD
0023Urine w/microscopy
0024Urine dip
0025Vision Screening
0026Cadmium (blood)
0027Cadmium (urine)
0028Beta 2 Microglobulin
0029Creatinine (urine)
0030Renal Panel
0031Pregnancy test
0032Mefloquine 250mg
0033Chloroquine 500mg
0034Doxycycline 100mg
0035Typhoid vaccine
0036Meningococcal vac
0037Japanese Encephalitis
0038Yellow Fever vaccine
0039Hepatitis A vaccine
0040Hepatitis A titer
0041Hepatitis B vaccine
0042Hepatitis B titer
0043Hepatitis C titer
0044Varicella vaccine
0045Varicella titer
0046Rubella titer
0047MMR vaccine
0048Diptheria vaccine
0049Polio vaccine
0050Pre-rabies vaccine
0051Influenza vaccine
0052Psychiatric Eval
0053OHP Consultation
0054Case Evaluation
0055CPR/AED training
0056Lipid profile (Fasting Lipids)
0057G-6-PD activity level
0058Tdap
0059HgA1c
0060Health Screenings/Ed.

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