Attachment_1_Dental_Services_PWS_08AUG19_(Final).pdf

Ver. May 2018

PERFORMANCE WORK STATEMENT (PWS)

FOR

Comprehensive Annual Examinations and Dental Restorative Care Services

1.0 General:

1.1 Scope: The contractor shall provide all personnel, equipment, tools, materials, supervision, and quality control necessary, except as specified in Paragraph 3.0 as Government Furnished, to perform Comprehensive Annual Examinations and Dental Restorative Care Services, as defined in this PWS.

1.2 Background: The Guam Army National Guard (GUARNG) recognizes the importance of Soldiers Dental Readiness. Individual Medical Readiness (IMR) and Fully Medical Ready (FMR) are the basic principles of the force sustainment. Dental health is vital for the force health protection and failure to achieve a standard level of oral health may preclude a Soldier from Deployment or School (Military Occupational School or Enhancement) status. The PWS includes the components of dental classifications for the Department of Defense (DoD) in order to identify varying degrees of dental health and readiness. This is to cover the various components of IMR/FMR to include: annual dental exams, digital bitewings radiographs, digital panoramic radiographs, MEDCHART data entry of all radiographs and dental records, and identification and treatment of all Class 3 Soldiers eligible for treatment. The PWS identifies the purpose of the work to be performed by the contractor and provides a description of the work to be completed and any required outcomes. The contractor shall provide qualified personnel, material to perform the services, and / or Operational Safety & Health Administration (OSHA), Health Insurance Portability & Accountability Act (HIPAA), Americans with Disabilities Act (ADA), and Privacy Act Compliant Mobile, Self-Contained Dental Practices depending on the individual site needs for the Guam Army National Guard.

DoD established a uniform Dental Classification in AR 40-35 (Preventive Dentistry and Dental Readiness) and AR 40-501 (Standards of Medical Fitness). DoD policy requires dental screening examinations and remediation to be accomplished and documented on Service Members. Members of the GUARNG shall receive an annual dental screening examination to determine their dental classification. The DENCLASS database updates the Army Medical Protection Systems, MEDPROS. Dental Readiness is an essential component of Unit Readiness and is a prerequisite for Soldiers and Units to qualify for mobilization or MOS schools/enhancements. There are four U.S Army Classifications for Dental Readiness:

Class 1: Worldwide Deployable with no further treatment required.

Class 2: Worldwide Deployable with need for non-urgent routine treatment.

Class 3: Non-deployable without treatment for urgent conditions that likely will cause a dental emergency within 12 months.

Class 4: Non-deployable with no examination documented within the past 12 months.

1.3 Period of Performance (PoP): The Period of Performance shall be 1 Base Year of 12 months and three (3) 12-month option years.

1.4 General Information:

1.4.1 Quality Control (QC): The contractor shall develop and maintain an effective QC Plan (QCP) to ensure services are performed in accordance with 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 Technical Exhibit 1, Performance Requirements Summary (PRS).

1.4.2 Quality Assurance (QA): The Government will evaluate the contractor’s performance under this contract in accordance with the Quality Assurance Surveillance Plan (QASP). This plan is primarily focused on what the Government will do to ensure that the contractor has performed in accordance with the performance standards. It defines how the performance standards will be applied, the frequency of surveillance, and acceptable quality level(s) or defect rate(s).

1.4.3 Recognized Holidays: The following are recognized United States (US) holidays. The contractor shall not perform services on these days:

1.4.3.1 New Year’s Day: January 1st

1.4.3.2 Martin Luther King, Jr.’s Birthday

1.4.3.3 President’s Day

1.4.3.4 Memorial Day

1.4.3.5 Independence Day: July 4th

1.4.3.6 Labor Day

1.4.3.7 Columbus Day

1.4.3.8 Veteran’s Day: November 11th

1.4.3.9 Thanksgiving Day

1.4.3.10 Christmas Day: December 25th

1.4.4 Place and Performance of Services: The Contractor is responsible for conducting dental examination and/or restorative care upon request on any required day of the period of performance, except Federal Holidays or when the Government facility is closed due to local or national emergencies, administrative closings, or similar Government directed facility closings.

The Contractor must at all times maintain an adequate work force for the uninterrupted performance of all tasks defined within this statement of work when the Government facility is not closed for the above reasons. When hiring personnel, the Contractor shall keep in mind that the stability and continuity of the work force are essential.

1.4.4.1 Telework: Reserved.

1.4.4.2 Unscheduled gate closures by the Security Police may occur at any time causing all personnel entering or exiting a closed installation to experience a delay. This cannot be predicted or prevented. Contractors are not compensated for unexpected closures or delays.

Vehicles operated by contractor personnel are subject to search pursuant to applicable regulations. Any moving violation of any applicable motor vehicle regulation may result in the termination of the contractor employee’s installation driving privileges.

1.4.4.3 The contractor’s employees shall become familiar with and obey the regulations of the installation; including fire, traffic, safety and security regulations while on the installation.

Contractor employees should only enter restricted areas when required to do so and only upon prior approval. All contractor employees shall carry proper identification with them at all times, and shall be subject to such checks as may be deemed necessary. The contractor shall ensure compliance with all regulations and orders of the installation which may affect performance. The Government reserves the right to direct the removal of an employee for misconduct, security reasons, or any overt evidence of communicable disease. Removal of contractor employees for reasons stated above does not relieve the Contractor from responsibility for total performance of this contract.

1.4.5 Security Requirements. The contractor shall comply with all applicable installation/facility access and local security policies and procedures, which may be obtained from the Contracting Officer Representative. The contractor and all associated subcontractor employees shall provide all information required for background checks to meet installation access requirements to be accomplished by installation Provost Marshal Office, Director of Emergency Services or Security Office. The contractor shall ensure compliance with all personal identity verification requirements as directed by Department of Defense (DoD), Headquarters Department of Army (HQDA) and/or local policy. Should the Force Protection Condition (FPCON) change, the Government may require changes in contractor security matters or processes.

1.4.5.1 For contractors requiring Common Access Card (CAC): Reserved.

1.4.5.2 For contractors that do not require a CAC, but require access to a DoD facility or installation: Contractor and all associated sub-contractors employees shall comply with adjudication standards and procedures using the National Crime Information Center Interstate Identification (NCIC-III) and Terrorist Screening Database (TSDB) (Army Directive 2014-05/AR 190-13), and applicable installation, facility and area commander installation/facility access, and local security policies and procedures (provided by a government representative).

1.4.5.3 Communications Security/Information Technology (COMSEC/IT) Security. All communications with DoD organizations are subject to 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 personnel place or receive a call they are subject to COMSEC procedures. The contractor shall ensure wide and frequent dissemination of the above information to all employees dealing with DoD information. The contractor shall abide by all Government regulations concerning the authorized use of the Government's computer network, including the restriction against using the network to recruit Government personnel or advertise job openings.

1.4.5.4 Use of Government Information Systems (IS) and access to Government networks. Not applicable.

1.4.5.5 Protection of Personally Identifiable Information (PII). The contractor shall protect all PII encountered in the performance of services in accordance with Defense Federal Acquisition Regulation Supplement (DFARS) 224.103 Personally Identifiable Information and Department of Defense Directive (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 whose PII has been compromised.

1.4.5.6 AT Level 1 Awareness Training (AT): All contractor employees, including subcontractor employees, requiring access to Army installations, facilities, and controlled access areas shall complete Level 1 AT within 30 calendar days after contract start date and within 30 calendar days of new employees commencing performance. The contractor shall submit certificates of completion for each affected contractor and subcontractor employee to the COR within 15 calendar days after completion of training. Level 1 AT is available at http://jko.jten.mil/courses/atl1/launch.html .

1.4.5.7 Information Assurance (IA)/Information Technology (IT) Training: Not applicable.

1.4.5.8 Information Awareness: Not applicable.

1.4.5.9 iWATCH Training: Not applicable.

1.4.5.10 OPSEC Training: Not applicable.

1.4.5.11 OPSEC SOP/Plan. Not applicable.

1.4.5.12 Classified Information. Not applicable.

1.4.5.13 Threat Awareness and Reporting Program (TARP). Not applicable.

1.4.6 Physical Security. The contractor shall safeguard all Government property provided for contractor use. At the close of each work period, Government facilities, equipment and materials shall be secured.

1.4.6.1 Key Control. Reserved.

1.4.6.2 Lock Combinations: Reserved.

1.4.7 Special Qualifications: The Contractor is responsible for ensuring that all staff members are Certified Dental Professionals. All dental assistance and staff shall be trained and professional with good morals and ethics.

1.4.7.1 Contractors must have a full understanding of Individual Medical readiness (IMR) and Fully Medically Ready (FMR) in order to provide services to the GUARNG Soldiers. They must know the requirements of Dental Readiness for the GUARNG and be proficient with DENCLASS requirements and MEDPROS.

HIPAA certified Privacy Act OSHA & ADA Compliant

1.4.8 Post Award Conference/Periodic Progress Meetings: The contractor agrees to attend any post award conference convened by the KO in accordance with 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 KO 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.

1.4.9 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, 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.

1.4.10 Identification of Contractor Employees: All contractor personnel attending meetings, answering Government telephones and working in other situations where their contractor status is not obvious to third parties are required to identify themselves as such to avoid creating an impression that they are Government employees. The contractor shall ensure that all documents or reports produced by contractor personnel are suitably marked as contractor products or that contractor participation is appropriately disclosed.

1.4.11. 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 severe forms of trafficking in persons during the period of performance of the contract; procure commercial sex acts during the period of performance of the contract; or use forced labor in the performance of the contract. The Contractor shall notify its employees of the United States Government’s zero tolerance policy, the actions that will be taken against employees for violations of this policy. The contractor shall take appropriate action, up to and including termination, against employees or subcontractors that violate the US Government policy as described at FAR 22.17.

1.4.12 Contractor Travel. Contractors will be fully responsible for the travel and all expenses for their staff.

1.4.13 Data Rights. The Government has unlimited rights to all documents/materials produced under this contract. All documents and materials, to include the source codes of any software, 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.

1.4.14 Organizational Conflicts of Interest (OCI): The contractor and subcontractor personnel performing services under this contract may receive, have access to or participate in the development of proprietary or source selection information (e.g., cost or pricing information, budget information or analyses, specifications or work statements, etc.) or perform evaluation services which may create a current or subsequent OCIs, as defined in FAR Subpart 9.5. The contractor shall notify the KO immediately whenever it becomes aware that such access or participation may result in any actual or potential OCI and shall promptly submit a plan to the KO to avoid or mitigate any such OCI. The contractor’s mitigation plan will be determined to be acceptable solely at the discretion of the KO. In the event the KO unilaterally determines that any such OCI cannot be satisfactorily avoided or mitigated, the KO may impose other remedies as he or she deems necessary, including prohibiting the contractor from participation in subsequent contracted requirements which may be affected by the OCI.

1.4.15 Phase In / Phase Out Periods. Reserved.

2.0 Definitions and Acronyms:

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 Representative (COR): An employee of the U.S. Government designated by the KO to monitor contractor performance. Such appointment will be in writing and will 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 PWS.

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

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 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 ensure 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 privy of contract with the subcontractor.

2.2 Acronyms:

ADA Americans with Disabilities Act

ADCS Army Dental Care System AEI Army Enterprise Info-structure AR Army Regulation AT/OPSEC Antiterrorism/Operational Security BI Background Investigation CM Contract Manager CMRA Contractor Manpower Reporting Application COR Contracting Officer Representative DA Department of the Army DD254 Department of Defense Contract Security Classification Specification DENCLASS Dental Classification System DFARS Defense Federal Acquisition Regulation Supplement DoD Department of Defense FAR Federal Acquisition Regulation FDA Food and Drug Administration FMR Fully Medically Ready GFP/M/E/S Government Furnished Property/Material/Equipment/Services GUARNG Guam Army National Guard HIPAA Health Insurance Portability and Accountability Act HQDA Headquarters, Department of the Army HSPD Homeland Security Presidential Directive IA Information Assurance IMR Individual Medical Readiness IS Information System(s) KO Contracting Officer MEDCHART Medical Electronic Data (for) Care History and Readiness Tracking NGB National Guard Bureau OCI Organizational Conflict of Interest OSHA Occupational Safety and Health Administration PII Personally Identifiable Information PIPO Phase In/Phase Out POC Point of Contact PRS Performance Requirements Summary PSR Periodontal Screening and Recording PWS Performance Work Statement QA Quality Assurance QASP Quality Assurance Surveillance Plan QC Quality Control QCP Quality Control Program SSN Social Security Number TE Technical Exhibit USD(I) Under Secretary of Defense for Intelligence

3.0 Government Furnished Property, Material, Equipment and Services (GFP/M/E/S): The Government will provide the property, material, equipment, and/or services listed below solely for the purpose of performance under this contract:

3.1 Property: The Government will furnish appropriate workspace on a military installation as necessary for the contractor to perform services outlined in this PWS should a particular service or scenario warrant the use of government property.

3.2 Materials: Soldier Dental/Medical Records

3.3 Equipment: Reserved.

3.4 Services: Reserved.

3.5 Utilities: All utilities in a military facility will be available for the contactor’s use in the performance of this contract as necessary. The contractor shall instruct employees in utilities conservation practices. The contractor shall operate under conditions that preclude the waste of utilities, which include turning off the water faucets or valves after using the required amount.

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 Paragraph 3.0, the contractor shall furnish everything required to perform these services as indicated in Paragraph 1.1.

4.2 Secret Facility Clearance: Reserved.

5.0 Requirements:

5.1 Digital Bitewings, D i g i t a l P e r i a p i c a l R a d i o g r a p h s , Digital Panoramic Radiographs & Dental Exams: The Contractor shall perform required dental examinations to include digital bitewings, D i g i t a l P e r i a p i c a l R a d i o g r a p h s , and digital panoramic radiographs if clinically indicated in support of the annual dental screenings in accordance with the AR 40-501 and AR 40-35. Location(s) of screening examinations and treatments will be responsibility of the contractor. The contractor must use HIPAA, Privacy Act, OSHA & ADA-Compliant Mobile Dental Practice or Portable Dental equipment. The contractor shall ensure all soldiers have a current Panoramic Radiograph on file and if missing, the contractor shall perform new radiographs. Adherence to all OSHA requirements, State and Federal Regulations are mandatory. Film or 'digitized' radiographs will not be accepted.

5.2 Exam. A periodic c o m p r eh e n s i v e oral evaluation shall assess the current state of oral health, risk for future dental disease as well as assessing general health factors that relate to the treatment of the patient. The dental exams shall be documented on the latest versions of DD 2813, SF 603 and DA Form 5570-E and submit ted according ly to the COR for archiv ing to the appropr iate government database.

The following measures are required for each periodic c o m p r eh e ns i ve oral evaluation:

5.2.1. Caries risk assessment - Classify Soldiers as low, moderate or high risk for caries as outlined by the American Dental Association's 2009 Special Supplement or latest version.

This assessment will allow the Army Dental Care System (ADCS) to identify those at high risk for future disease and appropriately manage their care.

5.2.2 Periodontal assessment - Periodontal Screening and Recording (PSR), a screening procedure endorsed by the American Dental Association and the American Academy of Periodontology, should be utilized to determine the need for periodontal treatment.

5.2.3 Tobacco risk assessment - Classify Soldiers as a smoker, user of smokeless tobacco or as both.

5.2.4 Oral cancer screening - Perform a thorough oral cancer screening on all beneficiaries as part of all annual examinations.

5.2.5 Digital radiographs shall be taken only for clinical reasons according to FDA guidelines as determined by the patient's dentist. Radiographs shall be of diagnostic quality, properly identified and dated. A panograph is required to be present in dental record and that it is of adequate quality for diagnostic/identification purposes. There is no time requirement on updating panographic radiographs. However, the panographic radiograph will adequately represent the current oral condition of the Soldier. Digital radiographs shall be performed on all service members who do not have a panograph on file in the DENCLASS system, regardless of when the hardcopy panograph is dated.

5.3 Contractor shall notify the GUARNG Medical Detachment POC (or designated representative) at the end of each event.

5.4 Quality Assurance Program. Contractor s h a l l have an in house quality assurance program to ensure accuracy of dental classifications. All exams where the soldier is identified as a Class 3 will be reviewed by the State Denta l Of f icer or o ther government denta l of f icer for accuracy.

5.4.1 Class 3 Conversion. If a Soldier is classified as Class 3 and recommended for treatment after government review, the Soldier shall receive minimal dental treatment necessary to upgrade classification to Class 2. The Contractor shall not provide dental treatment to upgrade a Soldier’s dental readiness classification from Class 2 or Class 3 to a Class 1.

5 .4 .2 T reatment Dol lar L im i ta t i on. Con t rac tor sha l l not exceed $1 ,200 wor th o f den ta l serv ices (exam and rad iog raphs inc luded) per per iod o f per fo rmance of t h is cont rac t (12 months) per So ld ie r . I f a t rea tment w i l l exceed $1 ,200 to conver t So ld ie r to C lass 2 , a wr i t ten approva l f rom the Sta te Denta l O f f i cer sha l l be ob ta ined pr ior to t reatment .

5.5 Contractor Qualification. Contractor shall be licensed on any services rendered and equipment operated during dental examination and restorative care.

5.6 Prescription Medication Services: Contractor shall not provide a prescription for medication when indicated and dispense medication at no cost to the Soldier.

5.7 On site at Event & Post-Event Case Management of Dental Exam & General/Specialty Treatment:

5.7.2 Upon need of dental treatment of soldier & approved by GUARNG State dental officer or representative, Contractor shall arrange for fulfillment of dental treatment for soldier.

5.7.2 Contractor shall explain post-operatory instructions to GUARNG treated soldier if necessary.

5.7.2.1 Upon approval from government representative, Contractor shall follow-up with Soldier if necessary for cases complicated in nature.

5.8 Contractor Manpower Reporting Application (CMRA):

5.8.1 The contractor shall report ALL contractor labor hours (including subcontractor labor hours) required for performance of services provided under this contract for the Guam Army National Guard via a secure data collection site.

5.8.2 The contractor shall completely fill in all required data fields using the following web address: http://www.ecmra.mil/. Reporting inputs shall be for the labor executed during the period of performance during each Government fiscal year (FY), which runs October 1 through September 30. While inputs may be reported any time during the FY, all data shall be reported no later than October 31 of each calendar year, beginning with 2019. Contractors may direct questions to the help desk at http://www.ecmra.mil.

6.0 Applicable Publications: Publications applicable to this PWS are listed below:

Publication (Chapter/Page)

Date of Publication

Mandatory or Advisory

Website

Federal Acquisition Regulation https://www.acquisition.gov/?q=browsefar or http://farsite.hill.af.mil/

Defense Federal Acquisition Regulation Supplement http://www.acq.osd.mil/dpap/dars/dfarspgi/cu rrent/index.html or http://farsite.hill.af.mil/

Homeland Security Presidential Directive (HSPD)-12 Policy for a Common Identification Standard for Federal Employees and Contractors

08/27/2004 https://www.dhs.gov/homeland-security-presidential-directive-12

DoDD 5400.11 Department of Defense Privacy Program

10/29/2014 http://www.dtic.mil/whs/directives/corres/dir.h tml#

DoD 5400.11-R Department of Defense Privacy Program

05/14/2007 http://www.dtic.mil/whs/directives/corres/pub 1.html

AR 25-2

Information Assurance

10/24/2007 http://armypubs.army.mil/ProductMaps/PubF orm/AR.aspx

AR 530-1

Operations Security

09/26/2014 http://armypubs.army.mil/ProductMaps/PubF orm/AR.aspx

DoD 5220.22-M National Industrial Security Program Operating Manual

02/28/2006 (Change 2:

05/18/2016) http://www.dtic.mil/whs/directives/corres/pub 1.html

AR 381-12

Threat Awareness and Reporting Program (TARP) (Section II, ¶ 2-4.b)

06/01/2016 http://armypubs.army.mil/ProductMaps/PubF orm/AR.aspx

AR 40-501

Standards of Medical Fitness

14 June http://armypubs.army.mil/ProductMaps/PubF orm/AR.aspx

AR 40-3

Medical, Dental and Veterinary Care

23 April http://armypubs.army.mil/ProductMaps/PubF orm/AR.aspx

AR 40-35

Preventive Dentistry and Dental Readiness

21 July http://armypubs.army.mil/ProductMaps/PubF orm/AR.aspx

6.1 Applicable Forms: Forms applicable to the PWS are listed below:

Form Date Website

SF 603

Health Record - Dental

October https://www.esd.whs.mil/Portals/54/Documents/DD/form s/sf/sf0603.pdf

DD Form 2813 Department of Defense Active Duty/Reserve Forces Dental Examination

October https://www.esd.whs.mil/Directives/forms/dd2500_2999/

DA Form 5570-E Health Questionaire for Dental Treatment

October https://armypubs.army.mil/ProductMaps/PubForm/DAFor m.aspx

TECHNICAL EXHIBIT 1

Performance Requirements Summary (PRS)

This PRS includes performance objectives the Government will use to determine contractor performance and will compare contractor performance to the Acceptable Quality Level (AQL).

Performance Objective

Performance Standard Acceptable Quality Levels (AQL)

Surveillance Method / By Whom

5.1 - 2 Digital Bitewings, Digital Periapical Radiographs, Digital Panoramic Radiographs & Dental Exams

Contractor shall perform required dental examinations to include digital bitewings, digital periapical radiographs and digital panoramic radiographs if clinically indicated in support of the annual dental screenings in accordance with the AR 40- 501 and AR 40-35.

Minimum of 85% of documentation shall be submitted to COR 15 calendar days after examination

Documentation inspection & acceptance / COR

5.4 Quality Assurance Program

All exams where the soldier is identified as a CLASS 3 will be reviewed by the State Dental Officer or other government dental officer for accuracy.

100% of Class 3 Soldiers

Documentation inspection & acceptance / State Dental Officer / COR

5.4.1 Class 3 Conversion

Soldier shall receive minimal dental treatment necessary to upgrade classification to DRC2.

Contractor shall not provide dental treatment to upgrade a Soldier’s dental readiness classification from DRC2 or CLASS 3 to DRC1.

100% of Class 3 Soldiers

Documentation inspection & acceptance / State Dental Officer / COR

5.4.2 Treatment Dollar Limitation

Contractor shall not exceed $1,200 worth of dental services per period of performance of this contract (12 months) per Soldier. If a treatment will exceed $1,200 to convert Soldier to DRC2, a written approval from the State Dental Officer shall be obtained prior to treatment.

100% of Class 3 Soldiers

Documentation inspection & acceptance / State Dental Officer / COR

5.5 Contractor

Qualification

Contractor shall be licensed on any services rendered and equipment operated during dental

Random inspection / COR examination and restorative care.

TECHNICAL EXHIBIT 2

Deliverables Schedule

PWS Reference / Deliverable Title

Frequency Number of Copies

Medium/Format Submit To

3.2 Materials

Soldier dental/medical records shall be returned to Government 15 calendar days after examination

Originals Hard Copy COR or government medical representative

5.1 Digital Bitewings, Digital Periapical Radiographs, Digital Panoramic Radiographs & Dental Exams

Minimum of 85% of documentation shall be submitted to COR within 15 calendar days after examination

Originals Hard Copy or Digital Copy

COR or government medical representative

5.2 Exam DD2813, SF 603 and

DA Form 5570-E shall be submitted to the COR within 15 calendar days after examination

Originals Hard Copy or Digital Copy

COR or government medical representative

TECHNICAL EXHIBIT 3

Estimated Workload Data

This information is provided for historical background only. It is not a guarantee of workload quantities.

ITEM NAME ANNUAL ESTIMATED QUANTITY

1 Medical Examination 750 (2016)

800 (2017) 850 (2018)

2 Radiographs Bitewings 750 (2016) 800 (2017) 850 (2018) Panographs

100 2016 75 2017 65 2018

3 Class 3 Conversion 100 (2016) 75 (2017) 65 (2018)