HomeMy WebLinkAboutCONTRACT WITH UNIVERSITY HEALTH CARE SYSTEM- OCCUPATIONAL HELATH TO PROVIDE BASELINE ANNUAL & PRE-EMPLOYMENT MEDICAL EXAMS PROFESSIONAL SERVICES CONTRACT
THIS PROFESSIONAL SERVICES CONTRACT("Contract")is made and entered into by and between
Augusta,Georgia,a political subdivision of the State of Georgia,by and through its Board of Commissioners,
whose address is 535 Telfair Street, Augusta, Ga. 30901, hereinafter referred to as "Augusta", and
University Health Care System, whose address is 3121 Peach Orchard Road, Suite 201,Augusta, Georgia
30906,hereinafter referred to as "Consultant".
WHEREAS, Augusta desires to engage a qualified and experienced medical provider with in-depth
knowledge regarding fire service specific medical assessments in accordance with the IAFFI IAFC Joint
Labor Management Wellness Fitness Initiative, the Firefighter Life Safety Initiative and Curren t
NFPA 1582: Standard on Comprehensive Occupational Medical Program for Fire Departments, to provide
consolidated medical assessments, possible immunizations, possible referrals, and data record-keeping
services of all uniformed personnel ofthe Augusta Fire Department (AFD").
k
WHEREAS, Consultant responded to Augusta's RFP # 17-196 and has represented to Augusta
that it is experienced and qualified to provide the services contained therein; and,
WHEREAS, Augusta has relied on such representation and Consultant was chosen as the most
qualified respondent based on its submittal.
NOW,THEREFORE, in consideration of the foregoing, the provisions contained herein and the mutual
benefits derived here from and for other good and valuable consideration, the receipt and sufficiency of
which are hereby acknowledged,Consultant and Augusta agree as follows:
1. Scope of Work.
Consultant shall provide baseline annual and pre-employment medical exams to all uniformed
personnel of the Augusta Fire Department in accordance with the IAFF/ IAFC Joint Labor
Management Wellness Fitness Initiative; the Firefighter Life Safety Initiative; the most current NFPA
1582: Standard on Comprehensive Occupational Medical Program for Fire Departments, and as set
forth in RFP #17-196(Scope of Services),including, but not limited to:
a) Medical and Occupational/Environmental History questionnaire to be completed by employee &
reviewed by Physician. The Medical and Occupational/Environmental History Questionnaire will be
provided to employee by Vendor and employee shall complete and submit the history questionnaire
electronically to the Vendor.
b) The Vendor shall assign a nurse as case manager to coordinate with their primary care physician or
Augusta, Georgia's Wellness Clinic and to follow up on a bi-weekly basis with those employees
whose physical examination does not permit them to return to work. The Augusta, Georgia Wellness
Clinic will be utilized, when applicable, for referral and consultation; or the Vendor's nurse will assist
in making appointments with the employee's primary care physician for referral and consultation.
Vendor will provide documentation of each contact per employee that need referrals or consultations to
resolve the medical issues the employee has,until the issues have been resolved.
c) General Physical and Neurological Examination;
d) Complete Blood Count/Differential/Platelet Count;
e) Urinalysis (Routine and Microscopic);
Page 1of10
f) Blood Chemistry Profile;
g) Electrocardiogram (12 Lead Stress);
h) Cancer Screening;
i) Chest X-ray(PA)one view;
j) Spirometry/Pulmonary Function Test(FVC,FEV1,(FEV1/FVC%); and
k) Visual Acuity.
2. Term. This Contract shall commence as of the date executed by Augusta, Georgia
("Commencement Date") and shall have an initial term of three (3) years. This Contract shall
automatically extend for two additional (1) year terms unless either party provides notice of
termination at least ninety(90)days prior to the end of the then current term. This Contract shall:
(i) terminate absolutely and without further obligation on the part of Augusta each and every
December 31 at 11:59 pm, as required by O.C.G.A. §36-60-13, as amended, unless sooner
terminated in accordance with the termination provisions of this Contract; (ii) automatically
renew on each January 1 at 12:00am, unless terminated in accordance with the termination
provisions of this Contract; and (iii)terminate absolutely, with no further renewals, five (5)years
from the Commencement Date.
3. Standard of Performance. Consultant represents and warrants that it has the necessary
knowledge, experience, abilities, skills and resources to perform its obligations under this
Contract, and agrees to perform its obligations in a professional manner, consistent with
prevailing industry standards and practices.
4. Oualifications. Licenses. and Permits: Compliance with Law. Consultant represents and warrants
that it has all licenses and permits necessary to conduct its business and perform its obligations under this
Contract, and agrees to comply with all applicable federal, state, and local statutes regulations, codes,
ordinances and policies in performing its obligations under this Contract.
5. Independent Consultant Relationship. The parties intend that Consultant's relationship to
Augusta in providing services hereunder shall be that of an independent Consultant. Nothing in
this Contract, nor any performance hereunder,is intended or shall be construed to create a partnership,
joint venture or relationship of agency or employment between Augusta and Consultant. In providing
services hereunder, Consultant shall represent itself to third parties as an independent Consultant to
Augusta and shall not hold itself out as having any authority to obligate Augusta. Consultant shall
have no authority for any complaints related to employment with Augusta, Georgia and has no
authority to hire, fire, discipline or otherwise effect the terms and conditions of Augusta, Georgia
employees,except as specifically set forthherein.
6. Confidentiality. Consultant agrees that its conclusions and any reports are for the confidential use and
information of Augusta and that it will not disclose its conclusions in whole or in part to any persons
whatsoever, other than to submit its written documentation to Augusta, and will only discuss the same
with it or its authorized representatives. This is to insure that information from medical examinations is
not improperly released and does not subsequently become harmful to uniformed personnel and their
careers, while being easily accessible for pre/post comparison in case of a major disaster.
a. The only medical information to be released to the Fire Chief without the permission of the
Page 2 of 10
firefighter is a report that the firefighter either passed or failed the medical examination in
accordance with NFPA Standard 1582.
b. At no time will an individual's medical information be released or shared with any Augusta
department and/or any other medical provider without written authorization by the employee.
c. Medical information must be collected in a database that can provide both aggregate reports as
well as specific individual information, that is electronically secure to only pre-authorized
medical providers.
d. The medical provider will identify and retain medical records in a manner of their choosing,
so the records are secured as Augusta Firefighter personal medical records.
e. Requests for authorization to transfer or destroy any or all of the medical information must be
made in writing to the Firefighter and the Fire Chief.
f. Aggregate data may be provided to the Fire Chief,to look at general trends, as long as data
from the report cannot lead to the identity of a specific individual.
It is further agreed that if the Consultant, without prior approval from Augusta, releases any
information, the release of same shall be immediate grounds for termination of this Contract without
indemnity to the Consultant. Should any such information be released by Augusta or by the Consultant
with prior approval, the same shall be regarded as public information and no longer subject to the
restrictions of this Contract.
7. Assignment. Consultant does hereby assign, grant, and deliver to Augusta, and Augusta hereby
accepts, the entire worldwide right, title, and interest of every kind and nature whatsoever in and
to the deliverables under this Contract, including but not limited to any related intellectual property
rights.
8. Records. Consultant shall maintain throughout the term of this Contract and for a period of seven
(7) years thereafter, records that indicate the date, time, and nature of the services rendered.
Consultant shall make available for inspection by Augusta all records,books of account, memoranda,
and other documents pertaining to Augusta, except medical records at any reasonable time upon
request.
9. Open Records. Consultant acknowledge that all records relating to this Contract and the services
to be provided under the contract, may be a public record subject to Georgia's Open Records Act
(O.C.G.A. § 50-18-70, et seq). Consultant shall cooperate fully in responding to such request and
make all records not exempt,available for inspection and copying as provided bylaw.
10. Fee; Expenses. In consideration of Consultant performing its obligations under this Contract,Augusta
will pay Consultant:
a. The amounts as described in Exhibit "A" Compensation/Price List attached hereto. This will be
the total compensation paid to the Contractor except for payments, if any, made under
subparagraphs b and c below.
Page 3 of 10
b. Additional Services: Augusta shall pay the Consultant for additional services requested or
authorized by Augusta, based on the fee schedule attached as Exhibit A. A properly
itemized invoice will be submitted for payment on a monthly basis, provided the service is
performed to standards and service is completed.
c. Additions or Deletions: Augusta may add or delete service requirements of this contract, in
writing. Such changes shall be negotiated based on a prorated price consistent with the
original price contained in the Consultant's response to RFP#17-196 as supplemented.
11. Invoicing. Consultant shall submit monthly invoices to the Augusta Fire Chief identifying this
Contract and the amount payable. Payment of undisputed amounts shall be due and payable
thirty (30) days after Augusta's receipt of the invoice. Notwithstanding anything in the Bid or
Consultant's Proposal, Augusta shall have the right to withhold or deduct payments in the event
of Consultant's non-performance.
12. Georgia Prompt Pay Act Not A,gplicable. The terms of this Contract supersede any and all
provisions of the Georgia Prompt Pay Act.
13. Defective Pricing. To the extent that the pricing provided by Consultant is erroneous and
defective,the parties may by agreement,correct pricing errors to reflect the intent of the parties.
14. Prohibition Against Contingent Fees. The Consultant warrants that no person or selling agency
has been employed or retained to solicit or secure this Contract upon an agreement or
understanding for a commission, percentage, brokerage, or contingent fee, excepting bona fide
employees or bona fide established commercial or selling agencies maintained by Consultant for
the purpose of securing business and that the Consultant has not received any non- Augusta fee
related to this Contract without the prior written consent of Augusta. For breach or violation of
this warranty, August shall have the right to annul this Contract without liability or at its
discretion to deduct from the Contract Price of consideration the full amount of such commission,
percentage,brokerage or contingent fee.
15. Termination. This Contract may be terminated prior to the completion of Consultant's
services:
a. upon ninety(90)days written notice to the other party, or
b. by either party upon a breach of this Contract (including, but not limited to, Consultant's
services being deemed unsatisfactory by Augusta). Provided however, the defaulting party
shall be given ten(10) days' written notice of the default. If the default remains uncured ten
(10) days after receiving written notice of such breach from the terminating party, the
terminating party can cancel this Contract.
c. This Contract may be terminated immediately if Consultant fails to maintain insurance
or fails to comply with the Workers'Compensation Act and applicable rules as described in
Section 21 herein. In the event of a termination of this Contract pursuant to this Section,
Augusta and Consultant will in good faith negotiate an appropriate reduction in the fees
Page 4 of 10
payable to Consultant pursuant to Section 10 above.
16. Liquidated Damages. Consultant agrees to pay as liquidated damages to Augusta the sum of
$100.00 for each consecutive calendar day for delay in services after expiration of the Contract
Term, except for authorized extensions of time by Augusta. This Section is independent of
Section 15 regarding default by Consultant. The Parties agree the provisions for liquidated
damages are not penalties for breach of contract. The liquidated damages set forth herein are not
to compensate Augusta for any damages other than inconvenience and loss of use or delay in
services. The existence or recovery of such liquidated damages shall not preclude Augusta from
recovering other damages in addition to the payments made hereunder which Augusta can
document as being attributable to the documented Consultant failures. In addition to other costs
that may be recouped, Augusta may include costs of personnel and assets used to coordinate,
inspect, and re-inspect items within this Contract, as well as attorney fees, if applicable.
17. Survival. Notwithstanding anything in this Contract to the contrary, the provisions of
Section 20 below shall survive any expiration or termination of this Contract, and each party shall
remain obligated to the other party under all provisions of this Contract that expressly or by their
nature extend beyond and survive the expiration or termination of this Contract.
18. Temporary Suspension or Delay of Performance of Contract. To the extent that it does not alter
the scope of this Contract, Augusta may unilaterally order a temporary stopping of the work, or
delaying of the work to be performed by Consultant under this Contract.
19. Specified Excuses for Delay or Non-Performance. Neither Augusta nor Consultant shall be liable
for any delay in the performance of this Contract, nor for any other breach, or for any loss or damage
arising from uncontrollable forces such as: fire,theft, storm, war, or any other major force that could not have
been reasonably avoided by the exercise of due diligence.
20. Indemnification. Consultant shall indemnify, hold harmless, protect and defend Augusta and its
Commissioners, elected officials, trustees, officers, employees, agents, and representatives (the "Indemnified
Parties") for, from, and against any and all demands, claims, suits, damages, losses, liabilities, costs and
expenses, including, but not limited to, court costs and attorneys' fees (the "Indemnified Matters"), of any
nature whatsoever (including, but not limited to, damage to or loss of property, bodily injury or death),
directly or indirectly arising out of or in connection with the performance of Consultant's obligations under
this Contract. Consultant's indemnification obligations shall apply whether the Indemnified Matters are due
in part to the concurrent fault or negligence of the Indemnified Parties or others, but shall not extend to such
concurrent fault or negligence. Consultant's defense obligations under this Section shall be with
attorneys approved by Augusta,which approval shall not be unreasonably withheld.
21. Insurance. Consultant shall at all times that this Contract is in effect, cause to be maintained in
force and effect an insurance policy(s) that will ensure and indemnify Augusta against liability or
financial loss resulting from injuries occurring to persons or property or occurring as a result of any
negligent error, act, or omission of the Consultant in performance of the work during the term of this
Contract. Consultant shall provide, at all times that this Contract is in effect, insurance with limits of not
less than:
a. Workmen's Compensation Insurance in accordance with the State of Georgia;
Page 5 of 10
b. Public Liability Insurance in an amount of not less than One Million($1.000,000)Dollars for
injuries,including those resulting in death to any one person,and in an amount of not less than One
Million($1,000,000)Dollars on account of any one occurrence;
c. Property Damage Insurance in an amount of not less than One Million ($1,000,000) from
damages on account of an occurrence, with an aggregate limit of One Million ($1.000,000) Dollars;
and
d. Professional Liability Insurance i n an amount of not less than One Million ($1,000,000) Dollars or
an amount that correlates to the aggregate fee on the project should it exceed $1,000,000.
All insurance policies required by this Contract will provide that they may not be canceled nor the
coverage materially changed without thirty(30)days prior written notice to Augusta.Augusta will be
named as an additional insured with respect to Consultant's liabilities hereunder in insurance
coverage identified in items B & C. Such policies shall name Augusta as a co-insured, except for
worker's compensation and professional liability policies, and a copy of such policy or a certificate
of insurance shall be filed with the Augusta at the time of the execution of this Contract.
22. Power and Authority: Due Authorization:No Conflict:Enforceability. Each party represents and
warrants to the other party that: (i)such party has the power and authority to execute,deliver and perform
its obligations under this Contract; (ii) the execution, delivery and performance of this Contract have
been duly authorized by such party and do not and shall not conflict with any agreement or instrument to
which it is bound; (iii) this Contract constitutes the legal valid and binding obligation of such party,
enforceable against it in accordance with its terms; (iv) no circumstances exist which will cause a Conflict
of Interests in performing the services required by this Contract, to include the Consultant and his or her
employees or agents performing under this contract and are NOT employees or agents of Augusta, or any
public agency or official affected by this contract; (v) no employee of Augusta or any public agency or
official affected by the contract be employed by the Consultant for the period of Contract duration.
23. Entire Agreement: Severability: Further Assurances. This Contract including any exhibits attached
hereto and RFP#17-196,including any attachments thereto, constitutes the entire Agreement between the
parties, and supersedes all prior and contemporaneous contracts, understandings and negotiations, with
respect to the subject matter hereof. In the event any provision of this Contract is determined to be invalid
or unenforceable, it is the desire and intention of the parties that such invalidity or unenforceability not
invalidate or render unenforceable the remainder of the Contract and that such provision be reformed and
construed in such a manner that it will, to the maximum extent practicable, be deemed valid and
enforceable, and the rights and obligations of the parties shall be construed and enforced accordingly. Each
party shall execute and deliver such further documents and take such further actions as may be required or
reasonably requested by the other party to effectuate the purposes of this Contract.
24. No Assignment; No Amendment: No Waiver. This Contract (i) may not be assigned or transferred,
in whole or inpart,by operation of law or otherwise,by either party without the prior written consent of the
other party, and(ii)may not be amended or modified by course of conduct or otherwise, except in a writing
duly executed by each of the parties.
25. Acknowledgement. Consultant acknowledges that this contract and any changes to it by
amendment, modification, change order or other similar document may have required or may require
the legislative authorization of the Board of Commissioners and approval of the Mayor. Under
Georgia law, Consultant is deemed to possess knowledge concerning Augusta's ability to assume
Page 6 of 10
contractual obligations and the consequences of Consultant's provision of goods or services to
Augusta under an unauthorized contract amendment,modification,change order or other similar
document, including the possibility that the Consultant may be precluded from recovering payment
for such unauthorized goods or services. Accordingly, Consultant agrees that if it provides goods or
services to Augusta under a contract that has not received proper legislative authorization or if the
Consultant provides goods or services to Augusta in excess of the any contractually authorized goods
or services, as required by Augusta's Charter and Code, Augusta may withhold payment for any
unauthorized goods or services provided by Consultant. Consultant assumes all risk of nonpayment
for the provision of any unauthorized goods or services to Augusta, and it waives all claims to
payment or to other remedies for the provision of any unauthorized goods or services to Augusta,
however characterized, including, without limitation, all remedies at law or equity. Any waiver of any
provision of this Contract shall be in writing duly executed by the waiving party. The failure or delay
by either party to seek redress for any breach or default under this Contract, or to insist upon the
strict performance of any provision of this Contract shall not constitute a waiver thereof or of any
other provision of this Contract, and such party shall have all remedies provided herein and at law
and in equity with respect to such act and any subsequent act constituting the same.
26. Notice. Any notices required under this Contract shall be made in writing, postage prepaid to the
following addresses, and shall be deemed given upon hand deliver, verified delivery by telecopy (followed
by copy sent by United States mail), or three (3)days after deposit in the United Stated Mail:
AUGUSTA: AUGUSTA FIRE CHIEF
AUGUSTA FIRE DEPARTMENT ADMINISTRATION
3117 DEANS BRIDGE ROAD
AUGUSTA,GA.30906
COURTESY COPY TO: GENERAL COUNSEL
AUGUSTA LAW DEPARTMENT
535 Telfair Street,Building 3000
AUGUSTA,GA. 30901
CONSULTANT: University Health Care System- Occupational Health
3121 Peach Orchard Road, Suite 201
Augusta, Ga. 30906
27. Right to Inspect Premises. Augusta may, at reasonable times, inspect the part of the plant, place of
business, or work site of Consultant or any subcontractor of Consultant or subunit thereof which is
pertinent to the performance of any contract awarded or to be awarded by Augusta.
28. Subcontract. The Consultant shall not subcontract any part of the work covered by this Contract or permit
subcontracted work to be further subcontracted without Augusta's prior written approval of the subcontractor.
29. Drug Free Workplace: Contractor will not engage in the unlawful manufacture, sale,
distribution, dispensation, possession, or use of a controlled substance or marijuana during the
performance of this contract. If Contractor has more than one employee, including Contractor,
Contractor shall provide for such employee(s) a drug-free workplace program, in accordance with the
Page 7 of 10
Georgia Drug-free Workplace Act as provided in O.C.G.A. Section 50-24-1 et seq., throughout the
duration of this Contract.
30. Non-Discrimination. During the performance of this contract, the Contractor shall comply with
all federal and state non-discrimination laws, regulations and policies in the administration of this
contract. In the event of the Contractor's non-compliance or refusal to comply with any non-
discrimination law, regulation, or policy in the administration of this contract, this contract may be
rescinded,canceled or terminated in whole or in part, and the Contractor may be declared ineligible
for further contracts with Augusta. The Contractor shall, however, be given a reasonable time in
which to correct any non-compliance.
31. Local Small Business Program. In accordance with Chapter lOB of the Augusta, Ga. Code,
Contractor expressly agrees to collect and maintain all records necessary for Augusta, Georgia to
evaluate the effectiveness of its Local Small Business Opportunity Program and to make such records
available to Augusta, Georgia. The requirements of the Local Small Business Opportunity Program can
be found at www.augustaga.gov. In accordance with AUGUSTA, GA. CODE § 1-10-129(d)(7), for all
contracts where a local small business goal has been established, the contractor is required to provide
local small business utilization reports. Contractor shall report to Augusta Georgia the total dollars paid
to each local small business on each contract, and shall provide such payment affidavits, regarding
payment to subcontractors as may be requested by Augusta, Georgia. Such documents shall be in the
format specified by the Director of minority and small business opportunities, and shall be submitted at
such times as required by Augusta, Georgia. Failure to provide such reports within the time period
specified by Augusta, Georgia shall entitle Augusta, Georgia to exercise any of the remedies set forth,
including but not limited to,withholding payment from the contractor and/or collecting liquidated damages.
32. E-VERIFY: All Contractors and subcontractors entering into Contracts with Augusta, GA for
the physical performance of services shall be required to execute an Affidavit verifying its
compliance with O.C.G.A. § 13-10-91 stating affirmatively that the individual, firm, or corporation
which is contracting with Augusta, Georgia has registered with and is participating in a federal work
authorization program. All contractors and subcontractors must provide their E-Verify number and
must be in compliance with the electronic verification of work authorized programs operated by the
United States Department of Homeland Security or any equivalent federal work authorization
program operated by the United States Department of Homeland Security to verify information of
newly hired employees, pursuant to the Immigration Reform and Control Act of 1986 (IRCA), P.L.
99-603, in accordance with the applicability provisions and deadlines established in O.C.G.A.§13-
10-91 and shall continue to use the federal authorization program throughout the contract term. All
Contractors shall further agree that, should it employ or contract with any subcontractor(s) in
connection with the physical performance of services pursuant to its contract with Augusta, Georgia
the contractor will secure from each subcontractor(s) each subcontractor's E-Verify number as
evidence of verification of compliance with O.C.G.A. §13-10-91 on the subcontractor affidavit
provided in Rule 300-10-01-08 or a substantially similar form. All contractors shall further agree to
maintain records of such compliance and provide a copy of each such verification to Augusta,
Georgia at the time the subcontractor(s) is retained to perform such physical services.
33. Governing Law; Jurisdiction and Venue; Attorneys' Fees. This Contract shall be governed by,
and construed and enforced in accordance with, the laws of the State of Georgia (without regard to the
conflicts or choice of law principles thereof). The parties irrevocably consent to the jurisdiction of the
State of Georgia, and agree that the Superior Court of Richmond County, Georgia, shall be an appropriate
Page 8 of 10
and convenient place of venue to resolve any dispute with respect to this Contract. In the event either
party commences any proceeding against the other party with respect to this Contract, the parties
agree that neither party shall be entitled to recover attorneys' fees except as otherwise specifically
provided for bylaw.
34. Contract. The parties acknowledge and agree that both parties substantially participated in negotiating
the provisions of this Contract; and, therefore, the parties agree that this Contract shall not be construed
more favorably toward one party than the other party as a result of one party primarily drafting the Contract.
The section and other headings in this Contract are for convenience of reference only and shall not be
construed, expressly or by implication, so as to affect the meaning or interpretation of any of the
provisions hereof. This Section and other headings in this Contract are for convenience of reference
only and shall not affect, expressly or by implication, the meaning or interpretation of any of the
provisions hereof.
35. Counterparts. This Contract may be executed in counterparts, each of which shall be deemed an original,
but all of which taken together shall constitute one and the same instrument.
IN WITNESS WHEREOF,Consultant and Augusta have duly executed and delivered this Contract.
CONSULTANT:
-L ' / ii I e
Printed name: Scoff A v,rep e date
Title: Li,,eF 0tae4A+,',3 0ch.e.c.L
(corporate seal)
AUGUSTA, GEORGIA
/5 ;
Printed name: Hardie Davis, Jr. -/ date
Title: Mayor,'',,ww-a ra/% fP‘
.�: '- {f:.." ,. ;mow 0,g ,F
r
Attest 1/�` y/� 4'x '''',4�
4 a
Ie a r r;� u � ,��-. � �
Title: T holoini s o
1 vi .4664,04.0040 off
Page 9 of 10
i
EYhrI2 , 4- 79-
I
SECTION 3
COMPENSATON/PRICE SHEET
Without exception, any organization/individual responding to this RFP shall use the protocols and
procedures as defined below. Price quotations shall be provided in each of the provided spaces($ ).
Any packaged price proposal for baseline, annual or pre-employment medical evaluations shall include,
without exception,each of the items outlined below. Price quotations must be provided for additional
items. Any difference in cost for any part of the baseline,annual,or pre-employment examinations shall
be listed separately. All price quotations need to include review of lab results for specific known fire
service cancer risks including testicular, prostate, skin, brain, rectum, stomach, bladder, and colon
cancer, non-Hodgkin's Lymphoma, multiple myeloma and malignant melanoma. The decision to
implement any listed items rests with the Fire Department not the organization/individual providing these
services.
Individualized Health Risk Appraisal (Included with Physical)
Written feedback to uniformed personnel concerning health risks and health status is required following
the annual examination. Reporting findings and risks and suggesting plans for modifying risks improves
the physician-patient relationship and helps uniformed personnel claim ownership of their health status.
Individualized health risk appraisals also must include questions that attempt to accurately measure the
uniformed personnel's perception of their health. Health perception can be a useful indicator of potential
problems.
Medical History Questionnaire (Included with Physical)
An initial pre-employment history questionnaire must be completed to provide baseline information with
which to compare future medical concerns.
Hands-on Physical Examination ($ 83.00 )
To Include:
• Vital Signs-Head, Neck, Eyes, Ears, Nose,and Throat
• Cardiovascular-Inspection,Auscultation, Percussion and Palpitation
• Pulmonary-Inspection,Auscultation, Percussion and Palpitation
• Gastrointestinal-Inspection,Auscultation, Percussion and Palpitation
• Genitourinary-Hernia Exam(Also,see cancer screening)
• Lymph Nodes -The examination of organ systems must be supplemental with an evaluation of
lymph nodes in the cervical,auxiliary,and inguinal regions.
• Neurological-The neurologic exam for uniformed personnel must include a general mental status
evaluation and general assessment of the major cranial/peripheral nerves (motor, sensory,
reflexes).
• Musculoskeletal - Includes an overall assessment of range of motion (ROM) of all joints.
Additionally, observation of the personnel performing certain standard office services or
functions is helpful in assessing joint mobility.
SUBMIT THIS PAGE IN A SEPARATE SEALED ENVELOPE LABELED
RFP 17-196 Baseline Annual&Pre Employment Medical Exams
RFP Due Tuesday,June 13,2017 0 11:00 a.m.
Page 21 of 39
Blood Analysis ($ 80.00 )
The following are components of blood analysis. At a minimum,laboratory services must provide these
components in their automated chemistry panel (aka SMAC 20) and complete blood count (CBC)
protocols.
• C-Reactive Protein
o White Blood Cell Count
o Differential
o Red Blood Cell Count(Hematocrit)
o Platelet Count
o Liver Function Tests
■ Includes SGOT/AST,SGPT/ALT,LDH,Alkaline Phosphatase, Bilirubin
o Triglycerides
o Cholesterol
■ Includes Total Cholesterol, Low Density Lipoprotein (LDL-C) Level, High Density
Lipoprotein(HDL-C)Level, and Total Cholesterol/HDL Ratio Glucose.
• HbAlc
o Blood Urea Nitrogen
o Creatinine
o Sodium
o Potassium
o Carbon Dioxide
o Total Protein
o Albumin
o Calcium
Urinalysis ($ 20.00 )
To include:
•
• Dip Stick
o pH,Glucose,Ketones,Protein,Blood,and Bilirubin
• Microscopic
o WBC,RBC,WBC Casts, RBC Casts,and Crystals
Vision Tests ($ 32.00 )
Assessment of vision must include evaluation of distance, near,peripheral,and color vision. Evaluate for
common visual disorders.
Pulmonary(Spirogram) ($ 40.00 )
Chest X-Ray *Includes radiologist reading ($ 70.00* )
Stress EKG w/Vo2 Calculated ($ 240.00 )
SUBMIT THIS PAGE IN A SEPARATE SEALED ENVELOPE LABELED
RFP 17-196 Baseline Annual&Pre Employment Medical Exams
RFP Due Tuesday,lune 13,2017(a 11:00 am.
Page 22 of 39
Oncology Screening Elements
• Prostate Specific antigen(PSA) ($ 20.00 )
• Fecal Occult Blood Testing ($ 0 )
• Skin Exam ($ 0 )
Per Individual Cost of Listed Items:
1-100 Exams ($ 355.00 )
101-350 Exams ($ 355.00 )
350-700 Exams ($ 355.00 )
700-1050 Exams ($ 355.00 )
Physical Only ($ 355.00 )
Physical W/EKG ($ 411.00 )
Physical W/Stress Test *Includes all testing,labs,resting, ($ 591.00* )
resting EKG,with stress test,and
Physical W/Stress Test and Vol with VO2 ($ 591.00* )
Per Individual Cost for Listed Items Additional Screening Costs:
Price quotations for these additional screenings,based on need or at the request of the patient,may
also be provided during the basic exam.
• Digital Rectal Exam ($ 0 )
• Testicular Exam ($ 0 )
• Clinical Breast Examination ($ 0 )
• Pap Smear ($ 44.00 )
SUBMIT THIS PAGE IN A SEPARATE SEALED ENVELOPE LABELED
RFP 17-196 Baseline Annual at Pre Employment Medical Exams
RFP Due Tuesday,June 13,2017 @ 11:00 a.m.
Page 23 of 39
immunization and Infectious Disease Screening
• Tuberculosis Screen(Annual PPD) ($ 20.00 )
• Hepatitis A Vaccine ($ 65.00 )
• Hepatitis C Virus Screen ($ 39.00 )
• Hepatitis B Virus Vaccine ($ 56.00 )
• Tetanus/Diphtheria Vaccine(Booster) ($ 40.00 )
• Measles,Mumps, Rubella Vaccine(MMR) ($ 65.00 )
• Measles Vaccine (ti cb.ided in MMR )
• Mumps Vaccine (included in MMR )
• Rubella Vaccine (tr1cluded in MMR )
• Polio Vaccine ($ 38.00 )
• Varicella Vaccine ($ 125.00 )
• Influenza Vaccine ($ 30.00 )
• HIV Screening(Required to be Offered) ($ 35.00 )
Heavy Metal and Special Exposure Screening
• Arsenic(Urine) * ($ 100.00* )
Arsenic,Mercury,Lead(urine)
• Mercury(Urine) included in Heavy Metals 24-hour ($ Included* )
urine testing @$100.00 inclusive.
• Lead(Urine)
($ Included* )
• Lead(Blood) ($ 30.00
• Aluminum ($ 60.00 )
SUBMIT THIS PAGE IN A SEPARATE SEALED ENVELOPE LABELED
RFP 17-196 Baseline Annual&Pre Employment Medical Exams
RFP Due Tuesday,June 13,2017 fp 11:00 a.m.
Page 24 of 39
• Antimony ($ 150.00 )
• Bismuth ($ 125.00 )
• Cadmium ($ 75.00 )
• Chromium ($ 75.00 )
• Copper ($ 75.00 )
• Nickel ($ 75.00 )
• Organophosphates(RBC Cholinesterase) ($ 75.00 )
• Polychlorinated Biphenyls(Blood) ($ 475.00 )
*Annualized for physical with EKG,
TOTAL for 1st-3rd Year ($ 143,439.00* labs)&testing$411.00 X 349
personnel
Price Per Year- The contractor shall also supply a percentage increase for possible extensions.
3% • 4th Year ($ 147,742.17 )
3% • 5th year ($ 152,174.44 )
SUBMITTED BY:
NAME: Kathryn Hennings,RN COHN-S/CM CCM Director of Occupational Medicine
COMPANY•University Health Health Services- Occupational Health
ADDRESS: 3121 Peach Orchard Road,Suite 201
CITY/STATE: Augusta,Georgia 30906
TELEPHONE NO.: 706-792-5002 Office/Direct Office 706-792-5017/ Cell 803-215-1970
FAX NO.: 706-792-5003
EMAIL: kathrynhennings@uh.org
SUBMIT THIS PAGE IN A SEPARATE SEALED ENVELOPE LABELE
RFP 17-196 Baseline Annual&Pre Employment Medical Exams
RFP Due Tuesday,June 13,2017 @ 11:00 a.m.
Page 25 of 39
UNIVERSITY
HEALTH CARE SYSTEM
Occupational Health
Addendum to Section 3 - RFP Item #17-196 Additional Services & Fees
At the request of the Augusta, Georgia Fire Department,the following items are added to RFP Item#17-
196 for baseline annual and pre-employment medical exams.
Electronic Forms
University Occupational Health will provide firefighters with an electronic option for completing medical
questionnaires and forms.
Telephonic/Electronic Case Management
Fitness for Duty Evaluations for Incumbent Firefighters
During the course of annual medical surveillance evaluations,firefighters with acute or chronic
conditions that are deemed by the Occupational Medical Provider, under the NFPA 1582 Standard
(Technical Committee on Fire Service Occupational Safety and Health [TCFSOSH], 2013),to limit or
prevent medical clearance to work,shall be offered case management assistance.
The purpose of occupational case management is to "coordinate the proactive efforts of the health care
team to facilitate health care services from the onset of injury or illness to safe return to work or optimal
alternative"with "the goal of returning the worker to pre-illness or pre-injury function or to the highest
level of functioning achievable" (American Board for Occupational Health Nurses[ABOHN], 2016).
1. Case management services will be provided with the written consent of the firefighter and will
be specific to the condition(s)affecting work clearance.
2. Confidentiality will be maintained for personal medical conditions according to HIPAA. The
firefighter may provide a written consent to release information to their employer or other
party.
3. Confidentiality will be maintained for work-related conditions within the provisions of the
workers'compensation statute. Information will be provided to designated employer
representatives. Information will be disclosed to the workers'compensation insurer/third party
administrator or others managing the workers'compensation case.
4. Telephonic nursing case management services will be provided to assist these firefighters with
accessing care with their primary care physician or specialist.
5. Case management services will include coordination of care with the firefighter's personal
physician(s)to coordinate return to work.
6. Nurse case management follow up will be at least bi-weekly with the firefighter or as
appropriate based on the individual medical disposition of the firefighter.
7. University Occupational Health Case Management will assist the firefighter in accessing the
employer's health clinic and/or health plan for referrals.
8/24/2017 Page 1
c..." UNIVERSITY
HEALTH CARE SYSTEM
Occupational Health
8. Release of information to the employer will include:
a. Whether the firefighter is participating with case management or not,
b. Whether the firefighter is cooperating with their physician's recommendations,and
c. Whether progress is being made toward return to work or clearance to full duty while
on conditional work status.
9. Reports to the employer will include a report of the number of contacts made with the
firefighter.
10. Services will be provided only for the duration of absence from work or the duration of a
conditional work period.
11. Case management services will end:
a. Upon the request of the firefighter or employer,
b. Upon full duty release by the occupational medicine physician,
c. Upon permanent job reassignment or termination of employment by the employer,
d. If the occupational medicine physician determines it is no longer necessary,
e. When the firefighter has failed to progress and has persistently failed to meet the NFPA
medical standards after an appropriate period of time,
f. Earlier for noncompliance by the firefighter,or
g. If the firefighter is determined by the occupational physician to be permanently
disqualified to perform the essential functions of their job.
12. Noncompliance by the firefighter may include:
a. Failure or refusal to consent to case management,
b. Failure or refusal to provide consent to release or obtain medical information,
c. Failure or refusal to submit to interim occupational fitness for duty evaluations,
d. Failure or refusal to comply with NFPA medical standards, or
e. Other activities that may impede progress toward return to work or release from
conditional work.
13. University Occupational Health is not responsible for completion or management of short-term,
long-term,or FMLA disability documents. This is the responsibility of the firefighter's treating
physician.
14. University Occupational Health providers will not provide temporary or long-term treatment for
personal medical conditions. The firefighter's primary care provider will be responsible for
evaluation,treatment,and management of personal conditions, including referrals for
therapies,diagnostics,and to other physicians.
15. Fitness for duty evaluations that may be required to ensure progress,compliance,or release to
work will be clinic-based fitness for duty evaluations by University Occupational Health and will
be billed separately from this agreement.
16. If the firefighter does not meet the NFPA standards on the day of the annual medical evaluation:
a. Additional evaluation by the occupational medicine physician within 90 days from that
date will be at no additional charge.
8/24/2017 Page 2
UNIVERSITY
737, HEALTH CARE SYSTEM
Occupational Health
b. Additional testing(e.g. lab, EKG,xray,etc.)will be at an additional charge regardless of
when the follow up evaluation occurs.
c. Additional evaluation by the occupational medicine physician on or after 90 days from
the annual evaluation will be charged to the Fire Department at the established rates
for Fitness for Duty examinations.
17. Case management does not imply or establish a doctor-patient relationship for personal medical
conditions;or for workers'compensation cases where another authorized treatment provider
(ATP) has been designated for the claim.
18. Workers'compensation cases:
a. In cases where University Occupational Health is not the ATP,the case management fee
schedule will apply and is the responsibility of the employer.
Nuclear Stress Test
During the course of incumbent firefighter annual medical surveillance,firefighters with abnormal
examinations may be referred by the University Occupational Health physician for additional cardiac
testing according to NFPA Standard Section 7.7.6.3 which states, "Stress test with ECGs and with or
without imaging(echocardiography or radionuclide scanning)shall be performed when clinically
indicated by history or symptoms" (TCFSOSH,2013).
1. University Occupational Health will provide a referral for nuclear(radionuclide)stress testing
and will coordinate scheduling with its designated cardiology practice.
2. Stress test services shall include performance and interpretation of stress tests and nuclear
stress tests. It does not include additional evaluation or examination,or care or treatment
during or after the stress test which is the responsibility of the firefighter.
3. These tests shall be based on criteria established by the NFPA Standard,2013 edition.
4. The University Occupational Health physician shall compare baseline and subsequent stress
tests,when available,to identify clinically relevant changes.
5. University Occupational Health will provide case management services according to the
agreement to assist the employee with referral and scheduling of stress tests. The occupational
medicine physician shall order and review results of stress tests,and make follow-up
recommendations to the firefighter.
6. In the event that the occupational medicine physician deems the firefighter to not be fit for
duty, case management services will be provided according to the agreement for these services.
7. University Occupational Health will be responsible for payment to its designated provider for
these nuclear stress tests.
8. University Occupational Health will not be responsible for arrangements or payment for stress
tests by providers who are not approved by University Occupational Health.
9. The Augusta Fire Department agrees to pay University Occupational Health for nuclear stress
tests provided through University Occupational Health.
8/24/2017 Page 3
I
UNIVERSITY
HEALTH CARE SYSTEM
Occupational Health
Nicotine Testing
Nicotine (cotinine)testing will be provided for firefighter candidates during the pre-employment
physical examination. Positive results for nicotine (cotinine)will be reported to the Augusta Fire
Department.
Audiogram
Audiograms will be provided for candidate and incumbent firefighters to assess for hearing loss that may
affect fitness for duty. Audiograms are performed according to the NFPA Standard Section 6.5.1
requirements.
C-Reactive Protein
This laboratory test will not be performed but will be made available if medically indicated. It has been
removed from the proposal and replaced with the correct lab test name"Comprehensive Metabolic
Panel".
Hepatitis A Vaccine—Water Rescue Team
Hepatitis A vaccine will be offered to incumbent firefighters who are assigned to the water rescue team
by the Augusta Fire Department. The Fire Department will provide University Occupational Health with
a list of members of the team members quarterly. Current and new water rescue team members will be
offered hepatitis A vaccine. The pricing is included in the original bid response.
References
Technical Committee on Fire Service Occupational Safety and Health (2013). NFPA 1582: Standard on
comprehensive occupational medical program for fire departments(2013 ed.).Quincy, MA: National
Fire Protection Association.
American Board for Occupational Health Nurses, Inc. (2016). Eligibility-case management: Definition of
occupational health nursing case management. Retrieved from
https://www.abohn.org/certification/cm-case-management-eligibility
8/24/2017 Page 4
UNIVERSITY
leor HEALTH CARE SYSTEM
Occupational Health
Additional Services Fee
1. Electronic forms No charge
2. Telephonic/electronic case management $60 per 30 minute units
3. Nuclear stress test $820.00
4. Nicotine/cotinine test $89.00
5. Audiogram $24.00
SUBMITTED BY:
NAME: Kathryn Hennings, RN COHN-S/CM CCM—Director of Occupational Medicine
COMPANY: University Health Services—Occupational Health
ADDRESS: 3121 Peach Orchard Road,Suite 201
CITY/STATE: Augusta, GA 30906
TELEPHONE: 706-792-5002 Office/Direct Office 706-792-5017/Cell 803-215-1970
FAX: 706-792-5003
EMAIL: kathrynhennings@uh.org
8/24/2017 Page 5