Exhibits_June_2019.docx

TECHINCAL EXHIBIT A: RN—OPERATING ROOM

Certifications: The RN shall possess and maintain current certification in Advanced Cardiac Life Support (ACLS) and Pediatric Advanced Life Support (PALS).

Education: The RN shall have graduated from a preoperative nursing course either in the military situation or civilian equivalent.

Experience: The RN shall have at least one (1) year of full-time experience working as an RN in an Operating Room within the last five (5) years.

TECHNICAL EXHIBIT B: RN—INTENSIVE CARE UNIT, ADULT

Certifications: The RN shall possess and maintain a current certification in Advanced Cardiac Life Support (ACLS).

Experience: The RN shall have at least one (1) year of full-time experience working as an RN in an Adult Intensive Care Unit and a minimum of two (2) years (full-time) in clinical nursing within the last four (4) years.

Shall possess strong knowledge in Thermodynamic monitoring and intracranial pressure monitoring

TECHNICAL EXHIBIT C: RN—EMERGENCY DEPARTMENT (ED)

Certifications: The RN shall possess and maintain a current certification in Advanced Cardiac Life Support (ACLS), Trauma Nursing Core Course (TNCC) and Pediatric Advanced Life Support (PALS) or Emergency Nursing Pediatric Course (ENCP).

Experience: The RN shall have at least one (1) year of full-time experience in a Level I (one) trauma center or at least two (2) years or full-time experience in a Level II or III Emergency Department in the last four (4) years.

TECHNICAL EXHIBIT D: RN—POST ANESTHESIA CARE UNIT (PACU)

Certification: The RN shall possess and maintain current certification in Advanced Cardiac Life Support (ACLS) and Pediatric Advanced Life Support (PALS).

Experience: Minimum of one (1) year of full-time experience in the past three (3) years in the required specialty.

TECHNICAL EXHIBIT E: RN—BONE MARROW ONCOLOGY

Certifications: The RN shall possess and maintain a current certification in Advanced Cardiac Life Support (ACLS).

Experience: The RN shall have a minimum of three (3) years of full-time experience as a clinical nurse in medical/surgical. A minimum of one (1) year of oncology or bone marrow transplant experience is required.

The RN shall demonstrate completion of an Oncology Nursing Society (ONS) approved didactic chemotherapy training and clinical competency or will achieve that through the training provided at SAMMC/WHASC.

Management of multiple types of central catheters, including PICCS, implanted ports, tunneled catheters and aphaeresis catheters as well as administration and management of chemotherapy is required.

TECHNICAL EXHIBIT F: RN- NEONATAL INTENSIVE CARE UNIT (NICU)

Certifications: The RN shall possess and maintain a current certification in Advanced Cardiac Life Support (ACLS), Pediatric Advanced Life Support (PALS), and in Neonatal Resuscitation Program (NRP).

Experience: The RN shall have at least two (2) years of full-time experience working as an RN in a neonatal intensive care unit within the last five (4) years.

TECHNICAL EXHIBIT G: RN—PEDIATRIC INTENSIVE CARE UNIT (PICU)

Certifications: The RN shall possess and maintain a current certification in Pediatric Advanced Life Support (PALS).

Experience: The RN shall have at least two (2) years of full-time experience working as an RN in a pediatric intensive care unit within the last five (4) years.

TECHINCAL EXHIBIT H: RN— PEDIATRIC INPATIENT AND CLINIC

Certifications: The RN must possess and maintain a current certification in Pediatric Advanced Life Support (PALS) and Association of Pediatric Hematology/ Oncology Nurse (APHON) certified course.

Experience: The RN shall have at least (1) one year of full-time pediatric nursing experience within the last three (3) years and shall have knowledge of age specific criteria for ages from one (1) day to twenty-one (21) years old.

Must achieve at least 80% on the pediatric-specific pharmacology exam.

TECHNICAL EXHIBIT I: RN—CARDIAC CATHERIZATION UNIT/ INTERVENTIONAL RADIOLOGY

Certifications: The RN shall possess and maintain a current certification in Advanced Cardiac Life Support (ACLS). Interventional Radiology (IR) requires Pediatric Advanced Life Support (PALS). May be required to attend and maintain conscious sedation certification. If required, conscious sedation certification must be completed within 60 days of assignment.

Experience: The RN shall have at least two (2) years of full-time cath lab or IR nursing experience within the last four (4) years or two (2) years of full-time ICU experience within the last four (4) years.

TECHNICAL EXHIBIT J: RN—MEDICAL/SURGICAL/ORTHOPEDIC/CARDIAC INPATIENT SERVICE

Experience: The RN shall have at least one (1) year of full-time experience within the last five (5) years working as an RN in a Medical, Surgical, Orthopedic, or Cardiac unit (Must have one (1) year experience in the type of unit being assigned to).

Skill and Knowledge: Cardiac units require telemetry experience and passing the SAMMC Cardiac Telemetry Test (annually).

Health Requirements: The RN shall be able to stand for long periods of time and not have physical restrictions that limit their ability to perform independent patient care.

TECHNICAL EXHIBIT K: RN—MENTAL/BEHAVIORAL HEALTH UNIT

Experience: The RN shall have at least one (1) year of full-time experience within the last five (5) years working as an RN in a Mental Health Unit.

Must have knowledge of Non-Violent Crisis Intervention, de-escalation techniques, the Joint Commission recommendations for restraint application and experience in the application of mechanical restraints

Must have knowledge in the mental health nursing process, individual and family dynamics in health and during illness; individual and group modalities; theories of personality development, human behavior, psychopathology, diagnosis, chemotherapy, psychotherapies, and physiological response t alcohol and drug abuse withdrawal.

TECHNICAL EXHIBIT L: RN—GASTOENTEROLOGY CLINIC

Certifications: The RN shall possess and maintain a current certification in Advanced Cardiac Life Support (ACLS). Must attend and maintain conscious sedation certification. Conscious sedation certification must be completed within 60 days of assignment.

Experience: The RN shall have a minimum of two (2) years of full-time experience as an RN in the medical/surgical, gastroenterology or critical care inpatient setting within the last four (4) years. Minimum of one (1) year of experience in post anesthesia/sedation.

Skill in setting up, operating and monitoring specialized medical equipment such as IV infusion pumps, cardiac monitoring devices, EKG units, oxygen analyzers, nebulizers, and other unit specific equipment.

TECHNICAL EXHIBIT M: RN—RADIATION/ONCOLOGY

Certifications: The RN shall possess and maintain a current certification in Advanced Cardiac Life Support (ACLS) and Pediatric Advanced Life Support (PALS).

Experience: The RN shall have provided nursing services a minimum of two (2) years of full-time experience in Medical/Surgical or Radiation/Oncology nursing within the last four (4) years.

Knowledge required: Identifying and managing side effects relating to patients undergoing radiation therapy to include radiation skins reactions, fatigue and nutritional support. Knowledge of patients with radioactive seed implants.

TECHNICAL EXHIBIT N: RN—GENERAL SURGERY/ VASCULAR SURGERY CLINIC

Certifications: The RN shall possess and maintain a current certification in Advanced Cardiac Life Support (ACLS). Must attend and maintain conscious sedation certification. Conscious sedation certification must be completed within 60 days of assignment.

Experience: The RN shall have at least five (4) years full-time experience in Medical/Surgical Nursing within the last six (6) years.

TECHINCAL EHXIIBIT O: RN—CLINICS; OTOLARYNGOLOGY, ENT (EAR, NOSE AND THROAT), SAME DAY SURGERY, PLASTIC SURGERY, FAMILY PRACTICE, PRIMARY CARE, INTERNAL MEDICINE, BREAST CARE ELEMENT, ORTHOPEDIC, PULMONARY.

Experience: The RN shall have at least one (1) year full-time experience within the past three (3) years to the area assigned or two (2) years full-time Medical /Surgical Nursing experience within the last four (4) years. May be required to attend and maintain conscious sedation certification. If required, conscious sedation certification must be completed within 60 days of assignment.

TECHNICAL EXHIBIT P: RN—WOUND AND OSTOMY (WOCN)

Certifications: The WOCN RN shall possess and maintain certification from the Wound Ostomy Continence Nurse Credentialing Board. Exceptions may be made for new Wound Ostomy Continence Nurse Education Program (WOCNEP) graduates and they shall obtain certification with one year of employment.

Education: The RN shall have graduated from an accredited WOCN education program is mandatory.

Experience: The WOCN RN shall have at least one (1) year experience in the assigned specialty in the past three (3) years.

TECHNICAL EXHIBIT Q: RN- LABOR & DELIVERY/ ANTE PARTUM

Certifications: The RN shall possess and maintain current certifications in the Neonatal Resuscitation Program (NRP) and a National Fetal Heart Monitoring course within the last (2) years. Advanced Cardiac Life Support (ACLS) is preferred not required.

Experience: The RN shall have at least two (2) years of full-time experience working as an RN in a Labor & Delivery unit within the last five (5) years.

Health requirements: The RN shall be required to have an initial physical to include ocular history, visual acuity and Amsler Grid examination

Knowledge required: Prepare, circulate and recover cesarean section surgical patients with both regional and general anesthesia. Must also have experience managing patients with Magnesium Sulfate, Pitocin, and insulin drips and patients with epidurals and amnio-infusions.

TECHNICAL EXHIBIT R: RN- POST PARTUM

Certifications: The RN shall possess and maintain current certifications in Neonatal Resuscitation Program (NRP).

Experience: The RN shall have at least one (2) year of full-time experience working as an RN in a post partum or ante partum unit within the last four (4) years.

TECHNICAL EXHIBIT S: RESERVED

TECHNICAL EXHIBIT T: RN—ISR BURN UNIT/INTENSIVE CARE UNIT, ADULT

Qualifications.

Certifications: The RN shall possess and maintain a current certification in Advanced Cardiac Life Support (ACLS).

Experience: The RN shall have at least one (1) year of full-time experience working as an RN in an Adult Intensive Care Unit and a minimum of two (2) years (full-time) in clinical nursing within the last four (4) years.

Skills and Knowledge: Shall possess strong knowledge in Thermodynamic monitoring and intracranial pressure monitoring

Description of Duties:

Initiates infection control techniques when caring for all patients but especially for immunocompromised.

Assists in disaster casualty care procedures.

Manage patients requiring hemodynamic monitoring, titration of vasopressor drugs, and a wide range of procedures of an advanced nature and difficulty where there is a high risk for infection and bodily functions are mechanically assisted by life support equipment.

Assist with invasive procedures and management, such as Swan/Ganz insertion; balloon pump management, temporary pacemaker insertion, Continuous Renal Replacement Therapy and intracranial pressure monitoring.

TECHNICAL EXHIBIT U: RN—URGENT CARE CLINIC

1. Qualifications.

Certifications: The RN shall possess and maintain a current certification in Advanced Cardiac Life Support (ACLS), Pediatric Advanced Life Support (PALS).

Experience: The RN shall have at least one (1) year of experience as an urgent care clinic nurse within the last three (3) years.

Skills and Knowledge.

Complete unit orientation to include skill knowledge and assessment prior to performing as a primary nurse in the emergency department.

Perform nursing care for emergency and trauma patients to include pediatric thru adulthood.

Able to triage safely, rapidly and accurately, every patient that enters the emergency care system.

Description of Duties.

Basic duties as described in PWS

TECHNICAL EXHIBIT V: RN-DISEASE MANAGEMENT (DM)

Qualifications.

Education: Baccalaureate of Science in Nursing degree from an accredited educational institution is required. Advanced degree in a health care discipline and national certification by a professional organization or other disease-specific certifying institution (i.e. American Diabetic Association) is highly desirable.

Experience: Broad-based clinical nursing background is required with at least six (6) years of clinical assignments.

Experience in Disease Management (DM) and use of Clinical Practice Guidelines (CPG). Experience with case management, discharge planning, utilization management, performance improvement, or personnel management preferred.

Computer skills in data management/analysis, Excel, Power Point, and Access are desirable.

Skills and Knowledge: Thorough knowledge of medical facility organization, mission, purpose, philosophy, and objectives as well as those of the American Nursing Association, Disease Management Association of America, Accreditation Association for Ambulatory Health Care, and Health Service Inspection (HSI).

Extensive professional knowledge and skills of advanced concepts, principles, and practices to perform highly specialized Disease Management nurse consultant assignments to provide disease management and technical advice to medical clinic staff. Ensure the provision of quality patient care in the most economical manner, and provide administrative and professional solutions to complex health care problems.

Understand MTF, AFMS, and DoD data collection and analysis philosophy and techniques. Utilize MTF, AFMS, and DoD data marts. Interprets and evaluates data appropriately in coordination with the Health Care Integrator (HCI) and GPM. Skill in analyzing data defining health care needs of a defined population using standardized assessment tools.

Understand DM principles to include the use of CPGs, nurse-run clinics, concurrent and retrospective record reviews and Utilization Management (UM)/ Utilization Review (UR) data among other tools.

Knowledge of all aspects of disease and condition management to include evidence based primary, secondary, and tertiary prevention protocols as they pertain to patient care management.

Practical knowledge of demand management processes and how to integrate them into the total population health.

Ability to assess, plan, monitor, and evaluate patient care through use of UR activities such as prospective, concurrent, and retrospective reviews using appropriate tools (ie, McKesson InterQual® or Milliman Ambulatory Care Guidelines® and review of CPGs/clinical pathways for performance outcomes.

Ability to educate and manage complicated members with chronic disease and their associated co-morbidities.

Ability to collaborate, coordinates, and provides consultation with healthcare professionals/departments to identify and provide care to members needing additional education or clinical management of selected diseases.

Understanding of UM processes with MTF and Managed Care Support Contractor.

Ability to work in alliance with Quality Management to deliver “best value” health care that is performance based.

Basic knowledge of coding principles and practice.

Description of Duties:

Serve as a professional nurse to ensure the DoD beneficiaries receive timely, appropriate in both scope and level, cost effective, quality, sensitive and coordinated care to affect desired clinical outcomes utilizing the major components of Population Health and Disease Management to include health fairs and Community screenings.

These outcomes include improving patient clinical condition, reducing unnecessary healthcare costs and improving patient’s quality of life via protocol-based CPGs.

Ensure the population assigned to the Primary Care Element receive quality, cost effective care in a timely manner whether deployed or at home.

Participates in Population Based Health Care Management Services, applying and promoting DM and wellness/prevention concepts and strategies to the Primary Care assigned patients and those identified for DM. Identify candidates for DM using the Military Healthcare System Population Health Portal and professional judgment in collaboration with the Primary Care Manager and entire treatment team.

Coordinate with other healthcare individuals/departments/committees to include, but not limited to; the Population Health Committee/Function, HCI, Case Managers, Utilization Management, Managed Care Support Contractor and Group Practice Manager (GPM) in the development/support of the Business Plan. Ensure processes exist for collecting disease management data, monitoring performance, analyzing data, identifying and initiating performance improvement opportunities.

Serve as clinical resource in assisting the Primary Care team and other hospital staff in interpreting and implementing clinical practice guidelines. Orients entire health care team to the purpose and goals of disease management activities.

When not engaged in DM duties, the HCP shall assist the Primary Care team nurse with their duties to include, but not limited to, answering telephone consults, answering patient questions, notifying patients of lab values and ordering patient labs. Additional work taskings will be determined by the needs of the clinic and communicated to the HCP by the Flight Commander or Health Care Integrator.

EXHIBIT W: RN INTERMEDIATE CARE UNIT (IMCU) WITHIN MEDICAL OR SURGICAL NURSING

SECTION, ADULT

1. Certifications: The RN shall possess and maintain a current certification in Advanced Cardiac Life Support

(ACLS).

2. Experience: The RN shall have at least one (1) year of full-time experience working as an RN in an Adult Intermediate Care Unit (IMCU) or equivalent and a minimum of two (2) years (full-time) in clinical nursing within the last four (4) years.

2.1. Complete BAMC Telemetry test within the first 30 days.

3. Description of Duties:

3.1. The IMCU Nurse provides an advanced level of specialized comprehensive nursing for highly complex patients with real or potential life-threatening emergencies and involve labor intense nursing interventions. Plays an integral role in observing the patient's changing conditions and participates in developing and updating in the electronic medical record the patient plan of care and nursing diagnoses, based on comprehensive assessments in accordance with recognized professional and institutional standards of practice and scopes of care. Observes and monitors; vital signs, symptoms of deterioration in condition, and interpretation of normal and abnormal cardiac rhythms. Utilizing the early warning scoring system, takes emergent corrective action within his/her scope of practice and notifies the physician. Consults with the physician and ancillary personnel regarding medical and nursing management of difficult problems occurring in the IMCU setting. Provides information on disease process, pre and post-operative care, diagnostic procedures, use of equipment related to disease/care, health maintenance, etc. Leads patient care conferences, as needed or applicable.

3.2. Starts intravenous lines to administer emergency medications. Practices in accordance with institutional infection control standards. Competent in the use of specialized patient equipment to include but are not limited to:

mechanical ventilators, adjunctive airway devices, volume infusion pumps, specialty beds, suction devices, cardiovascular monitors, defibrillator, arterial and central venous catheters, renal replacement therapy equipment, electrocardiograph, pulse oximetry, transcutaneous and external pacing devices and mechanical ventilation (after IMCU Phase IV training). Performs a range of treatment procedures which include but are not limited to:

phlebotomy, arterial punctures, arterial line blood draws, inserting nasal/oral gastric and urinary catheters, applying external drainage devices, implementing pulmonary toilet, administering medication via oral, intramuscular, subcutaneous, topical routes. Cares for patients in isolation. Is competent in assisting with the application and maintenance of skeletal traction. Performs a range of diagnostic support duties and approved waived tests (i.e.

glucose, arterial blood gas point of care testing). Performs a vast array of direct patient care procedures to include but are not limited to: range of motion exercises, lifting, turning, transporting and positioning patients, personal hygiene care, changing linen and clothing and feeding patients. Transports seriously ill patients for various diagnostic procedures.

3.3. In the absence of the physician, independently makes decisions and implements emergency measures upon identification of life-threatening conditions. Initiates life-saving measures, which include, but are not limited to cardiopulmonary resuscitation; calculating dosages and mixing potent and potentially lethal drugs prior to arrival of a physician and administering these drugs upon physician directives. Performs arterial punctures and troubleshoots respiratory adjunctive therapy. Administers and monitors the use of medications in accordance with Department of Nursing and unit level policies/guidelines. Administers and titrates intravenous fluids and manages administration of non-titratable vasoactive drugs. Administers anticonvulsants, insulin and thrombolytics and monitors patient condition per recommended guidelines; is familiar with correct dosages and potential side effects. Assists the physician with complex and potentially life-threatening procedures to include insertion of endotracheal intubation, invasive arterial and central venous catheters and chest tubes. Inserts intravenous catheters, performs phlebotomy and arterial blood draws. Monitors intake and output of fluids and notifies physician when caloric and fluid requirements have changed. Assesses patient vital signs, level of consciousness and other neurological and early interventions or escalation of care utilizing methods outlined in the IMCU scope of service. Use emergency crash/code cart appropriately during patient emergencies. Maintains patency of patient airway to include suctioning patient nasopharyngeal airway, tracheostomy tube or endotracheal tube. After receiving IMCU Phase IV training, is able to manage chronic and stable mechanically ventilated patients.

TECHNICAL EXHIBIT X: RN-PERNATAL NURSE EDUCATORS

Qualifications: The Perinatal Educator shall have a Bachelor’s of Science in Nursing and a Master’s of Science in Nursing from a school(s) accredited by the National League of Nursing.

Experience: The Perinatal Educator must have a minimum of one (1) year experience with the last three (3) years routinely practicing as a Perinatal Educator in rendering clinical, administrative, educational, research and resource aspects of advance nursing practice with obstetrical patients.

Certification: The RN shall possess and maintain a current certification in Advanced Cardiac Life Support (ACLS).

Description of Duties:

1. The RN will work for the Department of Obstetrics and Gynecology at Brooke Army Medical Center. Contract providers shall perform services under the control and general supervision of the Chief, Department of OB-GYN or his/her designated representative. RN will apply specialized OB/GYN nursing and adult education concepts in order to serve as the Perinatal Educator and to provide direct nursing care for patients. Work independently to assist learning needs of obstetrical patient enrolled in care at BAMC.

2. The contract RN shall perform the following functions within the scope of accepted nursing practice. This list of duties is not intended to establish either a maximum or minimum acceptable level of effort or be an inclusive listing of anticipated duties. Health care nursing personnel provided by the contractor shall perform essentially the same services as those required by any Army or government service health care professional of similar experience. In similar duty assignments and within their scope of practice. Contract nursing personnel shall attend and participate in inpatient nursing reports, patient care conferences, team conferences, discharge planning, and ward staff conferences as deemed appropriate by the nurse manager.

3. HCP will apply specialized OB/GYN nursing and adult education concepts in order to serve as the Perinatal Educator and to provide direct nursing care for patients.

4. Work independently to assist learning needs of obstetrical patient enrolled in care at BAMC. Responsible for the designing, development, implementation, teaching and evaluation of both material and instructors for the OB Orientation Classes, Pregnancy PT OB Education Classes, and outpatient classes using principles of adult learning to include, but not limited to the following topics: breast feeding, physiology of pregnancy, critical aspects of selfcare, nutrition, exercise, signs and symptoms of premature labor, medical care, social services, family dynamics, medication use during pregnancy, and types and purposes of lab test to be expected.

5. Assists with the coordination and implementation of lactation services to include, but not limited to, antenatal intrapartum, discharge postpartum assessment and instruction of breast-feeding skills.

6. Responsible for pre-term assessment of all OB patients. This includes interviews with systematic collection of data pertaining to the health status of patients by obtaining health history. The assessment is comprehensive and requires collaboration of finding with health team members (Physician, Certified Nurse, Midwife, Advance Practice Nurse, Social Workers, Dieticians, etc.). Ensure continuity of care with follow-up requirements.

7. Assist in the maintenance of the OB database for OB/GYN Department, to include the initiation and maintenance of OB files for pregnant women, patients and other HCPs.

8. Serve on multidisciplinary hospital wide committees, to include but not limited to the Education Committee or clinic committee as appointed.

9 Maintain current knowledge in the field of OB/GYN by keeping abreast of the latest technology, reading medical journals and other pertinent material.

10. Participate in establishing and monitoring Quality Improvement indicators to evaluate the effectiveness of the education program.

11. Perform liaison task with all inpatient units, to include those utilized for antenatal evaluations, outpatient clinical areas involved with care and teaching of obstetrical patients, and other agencies involved with the care and teaching of obstetrical patients, to include the Pregnancy PT Program and Army Community Services Program, and New Parent Support Program.

12. Demonstrate competency in assessing data, formulating plans, implementing the teaching program evaluating outcomes, recommending the purchase of instructional materials, validating patient knowledge, and serving as the primary instructor for the OB Orientation Classes.

13. Assess health care needs of a variety of patients presenting with OB/GYN problems. Screen patient presenting with OB/GYN problems in person and by phone, utilizing specialized OB/GYN knowledge, elicits needed information to determine nature and urgency of health problems. Assists in the establishment of nursing protocols for information, guidance and instructions for home care.

14. Make appropriate referrals to medical doctor or OB/GYN Nurse Practitioner. Instruct patients on appropriate method for entry into the health care system.

15. Proved physical care for patients. Set up equipment and instruments and assists provider in all types of examinations and procedures such as coloscopy, endrometrial biopsy, culdocentesis and IUD placement. Prepare patients for examinations and ensure informed consent is obtained by the provider. Assess physiologic Parameters, recognizes abnormalities and immediately takes appropriate action. Assist during examinations and minor surgical procedures by draping positioning and holding the patient to facilitate the health care provider’s work hands health care provider instruments and materials. Monitors patient’s physical and emotional status during and after procedures.

16. Obtain specimens and perform procedures, i.e., catheterizations, draw blood, and start IVs. Administer diagnostic tests (e.g., urine glucose protein).

17. Prepare and administer prescribed medications by oral subcutaneous, intramuscular and intravenous methods such as penicillin, methatrexate, estrogens and analgesics. Maintain continual awareness of usual dosages of medication and call unusual dosage to the attention of the health care provider ot insure that no errors are made.

18. Recognize emergency situations and institute appropriate actions. Maintain continual awareness of common emergency medications to include knowledge of dosage and action i.e., epinephrine, sodium bicarbonate, lidocaine, calcium chloride, etc. Utilization crash cart, emergency supplies and equipment, suction and oxygen, and laryngoscope and blades when necessary.

19. Maintain records, document medications and any patient reaction. Complete all documentation in accordance with MEDDAC guidance.

20. Take phone lab reports. The RN must have knowledge of normal lab values to be able to notify health care provider or take action, depending on results and document it.

21. Assist in orienting new personnel in the OB/GYN clinic. Ensure competency and adherence to established policies and procedures. Assist in all training of skill and competency required for the provision of care in the OB/GYN clinic.

22. The publications have been coded as mandatory or advisory. The Contractor is obligate to follow those coded as mandatory only to the extent that they apply to his contract/task order. Supplements, amendments, or change to these mandatory publications may be issued during the life of the contract. Advisory publications may be used for information and guidance but are not binding for compliance.