ATTACHMENT_04_-_BLANK_PRICE_LIST__Scenario_1_-PRICING_LIST_(BASE_AND_OPTIO....xlsx

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Mobile and Dental Services
Solicitation number
W912L1-19-R-0002
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BLANK PRICE LIST SCENARIO 1-ATCH 4

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ATTACHMENT_03_-_TECHNICAL_QUESTIONS_AND_ANSWERS_SHEET_SCENARIO_2.docx DOCX document
W912L1-19-R-0002_Mobile_Medical_and_Dental_Services.pdf PDF
ATTACHMENT_09_-_Past_Performance_Questionnaire.docx DOCX document
ATTACHMENT_05_-_BLANK_PRICE_LIST_-Scenario_2_-PRICING_LIST_(BASE_AND_OPTIO....xlsx XLSX spreadsheet
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CLIN_Breakout

FOUO
Minimum Medical Professional/Medical Administrative List
EVENT STAFF ONLY - per day pricing with up to 250 miles roundtrip from Austin, TX (unless otherwise noted)5-Jan-196-Jan-19TOTAL
CLINDESCRIPTIONQuantityCostOpt Yr 1Opt Yr 2Opt Yr 3215 PAX215 PAXAMT
Dental
1Dentist (DR)
2Endodontist
3Oral Surgeon
4Registered Dental Assistant (RDA)
5Dental Assistant (DA)
6Radiograph Technician
Medical
7Medical Event Manager
8Medical Doctor (MD)
9Optometrist (OP)
10Optometry Tech (OT)
11Ophthalmologist
12Hearing Conservationist (HC)
13Audiologist (AU)
14Audiologist Technician
15Physician Assistant (PA)
16Nurse Practitioner (NP)
17Registered Nurse (RN)
18Certified Nursing Assitant
19Licensed Practical Nurse
20Behavioral Health Specialist (BHS)
21Phlebotomist (PL)
22Emergency Medical Technician (EMT)
23Case Manager
Admin
24Event Manager (EM)
25MEDPROS & Electronic PHA Data Entry Specialist
26Medical Technician (MT)
27IT Support Technician (IT)
SUPPLIES
CLINDESCRIPTIONQuantityCost
Dental
28Dental Exam Supplies
29Dental Exam Supplies
30Dental Exam Supplies
31Dental Treatment Supplies
32Dental Treatment Supplies
Medical
33Periodic Health Assessment Supplies per soldier
34Expanded Medical Exam Supplies (over 40 physicals and women's health)
38Blood Collection Supplies to perform (at a minimum) HIV, DNA, G6PD, PSA blood draws with proper collection tubes
39Immunization Supplies to include PPD screening
VEHICLES and (OSHA compliant) DURABLE MEDICAL EQUIPMENT
CLINDESCRIPTIONQuantityCost
Den/Med
404-Operatory Mobile Health Practice (dental or medical)
413-Operatory Mobile Health Practice (dental or medical)
422-Operatory Mobile Health Practice (dental or medical)
438-Person Mobile Hearing Practice (must include additional ISO-Booth for Individual Audiologist Exams)
Dental
44Portable Digital Panoramic X-ray Machine
45Portable Digital Dental Exam Equipment (Intra-Oral Bitewing & PANO X-Ray Capability) (i.e. PLANMECA)
46Portable Dental Treatment Equipment
Medical
4712+ Station Mobile Data Processing Practice
61Portable PHA Equipment
62DOEHRA Compatible Portable Hearing Equipment
53TITMUS Visual Acuity Screener
54CLEA-Waived Rapid Laboratory Screenings (Lipid Profile, Hemoglobin, Blood Glucose, Total Cholesterol, Urinalysis & Urine HCG)
55Blood Pressure, Pulse Oximetry, Height/Weight/Temperature Equipment
57EKG Equipment
58Optometry with Visual Refraction
Admin
59Mobile Office Trailer - Per Event (up to 30 consecutive days of service)
60Electronic PHA Sets (minimum 12 laptops,3 printers w/internet connectivity)
61Live Event-Soldier Tracking System
62Satallite Internet connection (stand-alone)
DATA ENTRY ONLY - POST EVENT (WITHIN 5 BUSINESS DAYS AFTER EVENT) - Per ServiceMember (unless otherwsie noted)
FOUO
CLINDESCRIPTIONQuantityCost
Dental IT
62Point of Service Live Denclass Data Entry
63Point of Service Live Electronic PHA Data Entry
64Point of Service e-Profile Data Entry
Medical IT
66Live Electronic Point of Service MEDPROS Web Data Entry (MWDE) access/entry
67Live Electronic Point of Service DOEHRS, Audio Evaluation, & SPRINT Data Entry
68Health Records Repository (HRR) Scan & Data Entry
NON-EVENT STAFFING
CLINDESCRIPTIONQuantityCost
69Health Readiness Branch Manager - Per Day Rate (medical or dental)
70Health Readiness Branch Manager - Per Month Rate (medical or dental)
71Health Case Manager - Per Day Rate (medical or dental)
72Health Case Manager - Per Month Rate (medical or dental)
73Health Records Clerk- Per Day Rate (medical or dental)
74Health Records Clerk - Per Month Rate (medical or dental)
SUPPORT SERVICE COSTS
CLINDESCRIPTIONQuantityCost
75Post Event Dental & Health Case ManagementPER PROCEDUREUtilize CPT Code
78Post Event DENCLASS entry
79Mobile Practice Mileage Rate (Applicable when site is over 250 miles roundtrip from Austin, TX)
IMMUNIZATIONS & SERUMSQuantityCost
CLINDESCRIPTION
108Hep-A
109Hep-B
110TWINREX (combination HEB A&B)
111PPD
112TDaP
113MMR
114Administer Influenza - injectable for those 50 and above. (Immunization provided to vendor by TXARNG)
114Varicella
LABS
CLINDESCRIPTIONQuantityCost
115PSA
116G6PD
117Thin Prep
118Gonorrhea
119Chlamydia
120Pregnancy Test (Urine)
121Hemoglobin (Hgb) A1C
122Fasting Lipid Panel (To include TC, HDL, LDL, TRIG and calculation of Framingham Risk Percentage)
123FBS
122ECG-Electrocardiogram
124HIV-cost to draw only. (TXARNG will provide blood tubes, labels, and shipping.)

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