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Home My WebLink AboutExhibit 3(Cif GLENN MARCOS CARLOS A. MEGOYA Chief Procurement Officer Cih' Mauaeer �.E Jai ADDENDUM NO. 9 RFP No. 220240 July 19, 2010 Request for Proposals (RFP) for Physical Examination Services TO: ALL PROSPECTIVE PROPOSERS: The following changes, additions, clarifications, and deletions amend the RFQ documents of. the above captioned RFQ, and shall become an integral part of the Contract Documents. Words and/or figures stricken through shall be deleted. Underscored words and/or -figures shall be added. The remaining provisions are now in effect and remain unchanged. Please note the contents herein and reflect same on the documents you have on hand. Section A. 2. Laboratory Work-Uo, of the City's Medical Protocol has been amended as shown below. Prospective Proposers shall refer to the enclosed revised City of Miami Medical Protocol. 2. LABORATORY WORK -UP a Complete Blood Count (CBC), with Differential Biochemistry Profilc.25 Comprehensive Metabolic PanelT Complete Lipid Prcf_lc with ratios, and TOIL c. Complete Lipid Profile with ratios d. TSH e. RPR f. Urinalysis (Microscopic) g• EKG (12 lead with rhythm strip) shall be interpreted by a cardiologist certified by the American Board,of Internal Medicine. h. Cardiovascular Stress Test, shall be performed by a Cardiologist (Police Officer, Police Auxiliary/Reserve, Detention Officer, and Firefighter) Page 1 Q1: Please provide information on the current provider of this service and the current price paid by the City of Miami. Al: The City's current provider of Physical Examination Services is: Mercy Medical Development dib/a Mercy Outpatient Center. The current prices paid by the City for Physical Examination Services are shown in the enclosed copy of Amendment No. 1 to RFP 03-04-079, Pre -Employment Physical Examination Services. Q2: Please provide a copy of the current contract from the City of Miami for Physical Examination Services. A2: Enclosed please find a copy of the City's current contract for Physical Examination Services. Q3: Must the proposal include fees for all four (4) groups or can it be a partial proposal, say for just non sworn classifications? A3: Proposer's Fee Proposal must include proposed fees for all of the line items shown in the RFP solicitation document, as required in Section 4 1 Submission Requirements, which states: 6. FEE PROPOSAL a) Proposer shall use the Lines section of this RFP to provide the proposed fee(s) on an annual basis for the provision of Employment and Promotional Physical Examinations for Non Sworn Classifications; Employment Physica! Examinations for Firefighters; Employment Physical Examinations for Police Officers; and Return to Work Physical Examinations for all Classifications. Q4: Can a Prospective Proposer submit photos of its' facilities along with the descriptions? A4: Yes, a Prospective Proposer may submit photos along with the description of its' facilities. Q5: May a Prospective Proposer see the prices that have been paid for these services in the past? A5: Yes. The current prices paid by the City for Physical Examination Services are shown in the enclosed copy of Amendment No. 1 to RFP 03-04-079, Pre -Employment Physical Examination Services. Q6: Is any drug testing included in this Request for Proposals (RFP)? A6: No, drug testing services are not part of the services required under this Request for Proposals. Q7: Can physicians who have the experience and background, but are not Board Certified in Family Practice or Internal Medicine, perform the physicals? A7: No, only Physicians that are Board Certified in Internal Medicine or Family Practice are allowed to perform physicals under this RFP as stipulated in Section 3.1.2, Scope of Work, which states as follows: "Pre -Employment, Promotional, and Return to Work Physical Examinations. 1. Examinations must be performed by a physician licensed in the State of Florida. Physician(s) performing pre -employment, promotional, and/or return to work physicals must be Board certified in Internal Medicine or Family Practice. A minimum of two (2) physicians must be available on staff to perform examinations on an as -needed basis. A licensed male and female physician, in addition to a full-time physician, must be available to perform examinations upon the City's request" Q8: - Please clarify Section 1,11, Bid Bond/Bid Security. Prospective Proposer does not understand this • section. A8: As stated in Section 1.11, a bid bond "guarantees that a bidder/proposer will accept the order or contract/agreement, as bid/proposed, if it is awarded to bidder/proposer." A bid bond is not applicable to this RFP. Page 2 Q9: Prospective Proposer has a question regarding submission and receipt of responses. Are responses for this RFP to be submitted both electronically and hardcopy or hardcopy only? A9: Pursuant to Section 4.1, Submission Requirements, "All responses shall be submitted in hard copy format only to include one (1) original and five (5) copies." Q10: Regarding Section 2.10, Insurance Requirements, does bidder provide Bid Bond at time of bid submittal or after award? A10: A bid bond is not applicable to this RFP. Prospective Proposers should note that this solicitation is not a "bid"; it is a Request for Proposals (RFP). Additionally, Section 2.10, Insurance Requirements, does not address bid bonds, it addresses the insurance requirements the Successful Proposer will be required to comply with pursuant to this Request for Proposal. Prospective Proposers are not required to submit proof of insurance coverage at time of proposal submittal. Q11: With regards to Hepatitis Screening, please clarify which of the following two (2) hepatitis tests are to be performed under this RFP by the Successful Proposer: Hepatitis B Surface Antigen or anti-HBS (immune status)? A11: The hepatitis test to be performed under this RFP by the Successful Proposer is the Hepatitis B Surface Antigen. Q12: The "Biochemistry Profile-25" (Comprehensive Metabolic Panel) specified in Section A.2., Laboratory Work -Up, of the City of Miami Medical Protocol, consists of 14 tests. Please provide a breakdown of each test. Al2: Although the basic CMP (Comprehensive Metabolic Panel) consists of 14 blood tests, the City's current provider of Physical Examination Services provides a Comprehensive Metabolic Panel of 22 blood tests. These tests are outlined below: 1. Iron 2. Glucose 3. BUN 4. Creatinine 5. BUN/Creat Ratio 6. Sodium 7. Potassium 8. Chloride 9. Carbon Dioxide 10. Anion GAP 11. Uric Acid 12. Calcium 13. Phosphorous 14. Total Protein 15. Albumin 16. Globulin 17. Alb/Glob Ratio 18. T Bili 19. AST 20. ALK 21. ALK Phos 22. LDH Q13: Please clarify what is meant by "complaints filed" against doctors in Section 4, Professional Experience. Is this referring to malpractice cases? If so, how many years back does a Prospective Proposer need to research? A13: Complaints filed would include, but not be limited to, malpractice cases within the past five (5) years. -.-Q14:---Is-the-Cif-y-r-equesting-a "Price --In- Futl"-for-the RFP,-or-just-the-itemized-pricing-list-with-the-Unit-Price - - and Total per -Line Item? . A14: Pursuant to Section 4.1, Submission Requirements, subsection 6 a), Fee Proposal, "Proposer shall use the Lines section of this RFP to provide the proposed fee(s) on an annual basis for the provision of Employment and Promotional Physical Examinations for Non Sworn Classifications; Employment Physical Examinations for Firefighters; Employment Physical Examinations for Police Officers; and Return to Work Physical Examinations for all Classifications." Page 3 Q15: Professional Services Agreement Package — Does this package need to be prepared and submitted along with the proposal response or after award? A15: Prospective Proposers are not required to submit the Professional Services Agreement at time of proposal submittal. A copy of the Professional Services Agreement is being provided as a sample of the type of agreement that will be executed between the City and Successful Proposer. Pursuant to Section 2.8, Contract Execution the following is stated: The selected Proposer(s) evaluated and ranked in accordance with the requirements of this Solicitation, shall be awarded an opportunity to negotiate a contract Professional Services Agreement with the City. The City reserves the right to execute or not execute, as applicable a Professional Services Agreement with the selected Proposers) -that is determined to be most -advantageous and -in the City's best interest Such Professional Services Agreement will be furnished by the 'City, will contain certain terms as are in the City's best interests, and will be subject to approval as to legal form by the City Attorney. For reference purposes oriiy, Prospectivee ProposerO may obtain a duff copy of -the Professional Services Agreement by downloading the file named "Professional Services Agreement DRAFT", located in the Header/Notes and Attachments section of the RFP, in the Oracle Sourcing system. Q16: Corporate Resolution — Does this form need to be filled out and signed at the time of proposal submittal or after award? A16: The Corporate Resolution is part of the Professional Services Agreement and therefore Prospective Proposers are not required to submit said document at time of proposal submittal, a sample is being provided for informational purposes. ALL OTHER TERMS AND CONDITIONS OF THE IFS REMAIN THE SAME. GMILRlyg Cc: Bid File Page 4 PO, CPPB, FCPM, FCPA curement Officer Attachment A City of Miami Medical Protocol Pre-Employment/Promotional and Return to Work Physical Examinations A. PHYSICAL EXAMINATION COMPONENTS PHASE I 1. MEDICAL HISTORY SHEET: Applicant/Employee will complete a family and personal medical history to be reviewed by the physician with him/her at the time of the physical exam. Note: Additional medical forms may be required for Sworn Police Officer and Firefighter applicants. The return to work physical examination involves the physician evaluating the employee to determine if he or she is physically fit to return to work from a personal illness or injury. 2. LABORATORY WORK -UP a. Complete Blood Count (CBC), with Differential b. Comprehensive Metabolic Panel c. Complete Lipid Profile with ratios d. TSH e. RPR f. Urinalysis (Microscopic) g. EKG (12 lead with rhythm strip) shall be interpreted by a cardiologist certified by the American Board of Internal Medicine. h. Cardiovascular Stress Test, shall be performed by a Cardiologist (Police Officer, Police Auxiliary/Reserve, Detention Officer, and Firefighter) PPD SKIN TEST/CHEST X-RAY -performed by Mantoux Method (required). If PPD test results are positive, a Chest X-Ray must be performed (standard size posterior - anterior view). Chest X-ray must be interpreted by a radiologist. City of Miami, Florida Physical Esaminarion Services RFP 223228 4. EYE TEST The acuity test should screen for both near and for distance acuity on a scientifically accurate instrument that checks for keenness of vision, depth perception, balance of eye muscles, and the ability to differentiate colors. Examination should be conducted with and without corrective lenses. There are specific vision requirements for Police Officer, Police Auxiliary/Reserve, Detention Officer, Public Service Aide (PSA) and Firefighter applicants. Requirements are as follows: Police Officer, Police Auxiliary/Reserve, Detention Officer, and Public Service Aide (PSA) Vision Requirements: 20/50 each eye, separately without corrective lenses of any kind - including contact lenses; With glasses, each eye should be corrected to 20/30 (NO CONTACT LENSES ALLOWED). Firefighter Vision Requirements: Far Visual acuity shall be at least 20/40 binocular, corrected with contact lenses or spectacles. Far visual acuity uncorrected shall be at least 20/100 binocular for wearers of hard contacts or spectacles. 5. AUDIOLOGICAL CHECK: Will test the normal hearing range, 500 to 4000 HERTZ, using high quality equipment. Provide written interpretation of results. PHASE II A. PHYSICAL EXAMINATION BY: Inspection, Palpation Percussion, Auscultation Must be performed by Board Certified Physician To include the following: Vital signs - - TPR, Blood pressure (both arms) Height Weight General Appearance Head, scalp, face Neck (thyroid, lymphs, vessels) Endocrine system Eyes (fundi, focus) general Ocular motility Pupils (equality and reaction) Ears (internal and external canals and cerumen,) City of Miami, Florida Physical E.xamina,ion Services RFP 223228 Ear drums (perforation) Nose (sinuses) Mouth (tongue, teeth, and gums) Throat (condition of tonsils) Lungs, chest (OPTIONAL - include breasts; PHYSICIAN WILL OFFER TO PERFORM BREAST EXAMINATION) Heart (thrust, size, rhythm, sounds) Abdomen, Viscera (check for hernias) -EVALUATION BY INSPECTION, PALPATION, PERCUSSION & AUSCULTATION) External Genitalia - EVALUATION BY INSPECTION, PALPATION, PERCUSSION & AUSCULTATION) ANUS AND RECTUM EVALUATION BY VISUAL INSPECTION FOR HEMORRHOIDS & FISSURES. Upper extremities (strength, range of motion) Lower extremities (strength, range of motion) Vascular System (varicosities, etc.) Spine, other musculoskeletal Skin (scars, rashes,) lymphatics Mental Status, memory, orientation, judgment, affect Neurological Equilibrium B. Additional/Optional Items - required for Police Officer, Public Service Aide (PSA), Police Auxiliary/Reserve, Detention Officers, Firefighters, Crime Scene Investigator, and Property Specialist ADDITIONAL 1. Chest X-ray (SWORN POLICE AND FIRE) Anterior/posterior and lateral views. Provide written interpretation of results. Deliver results to the Department of Employee Relations within 72 hours. HIV Testing and Counseling required for Firefighter, Crime Scene Investigator, and Property Specialist applicants/employees (NOTE: These applicants/employees have the option to decline HIV Testing) Consent forms signed by the applicant/employee will be provided at the time of the physical examination. All HIV test results must be provided to the City of Miami, Department of Employee Relations in a sealed envelope and marked CONFIDENTIAL. 3. Hepatitis A, B, and C Screening required for Firefighter, Police Officer, Crime Scene Investigator, and Property Specialist applicants/employees (NOTE: These applicants/employees have the option to decline HIV Testing). Consent forms signed by the applicant/employee will be provided at the time of the physical examination. All HIV test results must be City of Miami, Florida Physical Examination Services RFP 223 228 provided to the City of Miami, Department of Employee Relations in a sealed envelope and marked CONFIDENTIAL. OPTIONAL 1. Back X-ray (requested by City as needed) Provide two views of the back; Jumbo -sacral spine and pelvis. Provide written interpretation Radiologist. results from a 2. Pulmonary Function Test (requested by City as needed) Provide three (3) valid tracings of a forced vital capacity from which the Forced Expiratory Volume in one second can be delivered. 3. Blood Type and Rh Typing (requested by City as needed) 4. Rubella Titer (requested by City as needed) 5.Rubella Immunization (requested by City as needed) 6. Tetanus vaccine (requested by City as needed) 7. Review and provide written interpretation and/or medical resume of employee/applicant medical records from another agency. CITY OF ILIIAMI, FLORIDA INITEE-OFFYC4lit! t 9�ell�iih TO: Rosalie Mark, Director Department of Employee Relations: G1ennMarcos,.Director FROM : Purchasing Department .DATE IiR:1`rCT March S, 2007 FILE : Pre -Employment Physical Examination RFP No. 03-04-079(10) REFERENCES : AMV1ENDMENT NO. 1 E1.1CLOSURSS: Effective immediately, the Department of Purchasing approved the right to use Professional Services Agreement Section 5.A. Compensation. Thereby, reflecting a 5% increase for items awarded to Mercy Medical Development, Inc., for the provision of Pre -Employment Physical Examination, to be utilized by various City Departments. Please attach this amendment to the contract previously issued to you for future reference. When in need of any of these services, please refer to the contract to identify the vendor name, description and respective unit price. Should you require any additional information, please contact Maritza Suarez, Sr. Procurement Supervisor at (305) 416-1907 for assistance. C: Bid File CONTGACT AWARD AMENDMENT NO. 1 RFP NO.: DESCRIPTION: CONTRACT PERIOD: RENEWAL PERIOD: 03-04-079(10) Pre -Employment Physical Examination Services November.23, 2004 through November 22, 2006 November 23, 2006 through November 22, 2008 ORIGINAL TERM OF CONTRACT: Two (2) Years with the OTR for Two (2) Additional Two Year Periods COMMODITY CODE: 918-78; 948-42; 948-44; 948-55; 948-73; 948-74; 953-48 SECTION #1 - VENDOR AWARD Mercy Medical Development d/ba/ Metcy:OutpMierit'Center _ 3661 South Miami Avenue • - Miami, FL 33133 Contact: Reuben J. Camp : r. Phone: (305) 285-2944' Fax: (305) 285-2927 •_ E-mail: scampamernymiami.orcf SECTION #2 — AWARD/BACKGROUND INFORMATION C.C. AWARD DATE:..:SEPTEMBER23, 2004 ;:y • :AMENDED . AMOUNT.: z'N/A RESOLUTION NO: 05-0671;.:04-0617 • :;INSURANCE REQUIREMENTS: YES ANNUAL CONTRACT AMOUNT: See•Below' ' ;PERFORMANCE BOND:: N/A Pursuant to R-0641629,4111erm contracts have been converted to citywide contratts vvith funds allocated from the various , sources of fundstofIthe enckuser_departments,f subjecttto : • the availability of funds and budgetary approval:attneftirne of need. . SECTION #3 - REQUESTING DEPARTMENT DEPARTMENT OF EMPLOYEE'RELATIONS:3:„.:::::;,,:: .;' Contract Administrator::•: -Rosalie Mark t " Phone: (305) 416-2110 Fax: (305)416-2115 , . SECTION #4 - PROCURING AGE.NCY - ' ,'• CITY OF MIA1v1i, PURCHASING DEPARTMENT Sr. Buyer: Maritza Suarez Phone: (305) 416-1907 Fax: (305) 416-1925 Prepared By: Aimee Gandarilla, 3/5/07 Clry r.(Miami, Florida A1.7ACHMENT b Pre -Employment Physical F.xaminati, Services RFP 03.04.079 6.7. PRICE PROPOSAL FORM PRE -EMPLOYMENT PHYSICAL EXAMINATION SERVICES Employment Promotional and MiseehaneousjExeludingyiref ghters and Police OfJgrs) The following must be fully completed and returned with Proposal. Est. Extended 0014- Description Ouantity Unit Price Price f l A. Basic Physical Examination 425 St 0fl nn $ 47 , 50n cm I06' o0 (including lab work, visual exam, and audiological exam) B. Abbreviated Return to Work 400 Physical C. Optional Examination Components (included at this time to obtain quote) 1, .PPD test 40D $10.00 $ 4000.00 ( D ' S°_ 2. Back X-Ray S .$ Rn nn $_wort 00 (0?)'0ID 3. Chest X-Ray. .25 $70. 00 • $ 1730.00 (13 ra) -4, MO (12 lead) -425 s 45.00 :$ 19.125.00 L..f 1, a5 S. Rubella Titer S $ 30.0D $ 150.00 .3 (r 6. Rubella imrunization - S S 30. 00 .$ 150. OD 34 ,SD 7. Review ofMisc.lianeous 5 $ 15.00 4 75.00 15 r15 Medical Reconis E. Hepatitis A, B, and C Screening 5 $_ �n nn $ t 4D no i ,} " 9. Measles, Mumps, Rubella 5 S 40. 00 _$ "no . on 1+d ' Uz) Immunization $33. 00 $ .14,00000 10. Tetanus Vaccine 5 17.00 $ mho() I pl lOD 11. Plcase list any other charges associated with fulfilling this RFP and describe below: Subtotal 45 $ 5 82,460.00 City of Miami'. Pluridu Pre -Employment Physical Exomtnnrion Services RF° 21.O4.•OT9 Ern 'stratum-0 Physical Examinations-Firetiphters The following must be fully completed and returned with Proposal. Description Est. Extended GuantrW Unit Price Price A. Basic Physical Examination 60 $ 140.00 s 8400.00 NI (10 (including lab work, visual exam, and audiological exam) B Additionai/Optional Exarriinetion Components (Ineluded at this time to obtain quote) I. Chest X-Ray 2. EKG 60 70.00 6D s 45.00 3. HIV Testing & Counseling a. ELtSA Test 60 b. Western Blot 60 c. Pre Counseling 6() d. Post Counseling 60 4. PPD test 60 5. Hepatitis A, B and C Screening 60 C. Please list any other charges associated with fulfilling this RFP.and describe below: S 38.0D S 0 5 10.U0 $ 1U.UtT s 10.00 $ 35.00 Subtotal: $ 4200.50 s 2700.00 -73r3---) s 2280.00 31:3 �Gio S 0 S °DU.UU iD D $.60U.U0 gy. • 600.00 \ b SO :s 2100.00 JCv S. S S 21480.00 Amoipvment Physical Examinations - Pollce Officers Est. Extended Description Quantity Unit Price Price A. Basic Physical Examination 100 $ 140.00 .5 14,000.00 1 q ri , Db (including lab work, visual exam, and audiological exam) B. Additional/Optional Examination Components (included at this time to obtain quote) 1. Chest X-Ray 100 2. El{.G... - s 70.00 $ 7000.00 13 '60 .lop - -s 45_.00 $—6750.00 _._`'i' 1'a,c.,J.- CIO, of Miami, Florida Pre-&mploymrnt Physical ExtrminaltanServices RFP03-04-079 3. Back X-Ray 1 $ 12 5 , QD $ 125.00 131 "(25 4. Hepatitis A, B. and C Screening 100 $ 35.00 $ 350140 le' ri 5. Pulmonary Function I S 120.00 $ 120.00 `Dt4v . (�'j 15.00 15.00 �J'�✓ 6, Blood Type-& Rh Typing 1 $ $ 7, Rubella Titer 1 $ 30. 00 $ 30.00 �� ' Sa 8. Rubella Immunization 1 $ 40.00 S 40.00 L� tC)_ 9. Review &provide written interpretation 50 15.00 750. 00 (�j ' �� of medical.racord 10, CardiovascularStress Test 1 $ 425.00 S 425.00 t4r,/ e0Z C. Please list any other charges associated with fulfilling this RFP and describe below: 47 Subtotal: 5 5 00 TOTAL: S 136695,00 -tarng. 21 CONTRACT AWARD RFP NO.: DESCRIPTION: IERM_OF._CONTRAC CONTRACT PERIOD: FIRST RENEWAL: SECOND AND FINAL COMMODITY CODE: SECOND AND FINAL RENEWAL 03-04-079(10) PRE -EMPLOYMENT PHYSICAL EXAMINATION SERVICES I:_TWO_(2)_YEARSWITH.THE_OTR FOR TWO_(2)_ADDITIO.NAL_TWO YEAR_PERIODS___._____. SEPTEMBER 27, 2004 THROUGH SEPTEMBER 26, 2006 SEPTEMBER 27, 2006 THROUGH SEPTEMBER 26, 2008 RENEWAL: SEPTEMBER 27, 2008 THROUGH SEPTEMBER 26, 2010 918-78; 948-42_94844; 948-55; 948-73; 948-74; 953-48 SECTION #1 - VENDOR AWARD • Mercy Medical Development d/ba/ Mercy,,Outpatient Center 3661 South Miami Avenue Miami, FL 33133 Contact: Reuben J. Camp.7 Phone: (305) 285-2944: Fax: (305) 285-2927 E-mail: scamoOrnercvmiami.ore 'SECTION #2 — AWARD/BACKGROUND. INF•ORM'ATION•APRLICABLE ORDINANCE /iNOTES, C.C. AWARD DATE: -SEPTEMBER 23, 2004 RESOLUTION NO: 05-0671; 04-0617 ,: . ANNUAL CONTRACTAMOUNT: See`Below Pursuant to R-06-0629,:all-term .contracts. have been converted to citywide contracts with funds allocated from the various,. sources of funds of the end-user_departments;•subject=io;,_;; - the availability of funds and budgetary- approval: at the -time of need NOTES: THERE HAS BEEN A CORRECTION TO THE:CONTRACT"PERIOD VIA_AMENDMENT NO. 1. CONTRACT PERIOD, FROM: NOVEMBER22, 2008TO SEPTEMBER,26,'2008.,,(TYPO),, THIS CONTRACT AWARD SHEET REPRESENTS THE _SECOND:TAND"FINAL RENEWAL FOR THE PROVISION OF PRE- EMPLOYMENT PHYSICAL EXAMINATION, SEPTEMBER 27, 2008 THROUGH SEPTEMBER 26, 2010. AMENDED'AMOUNT: N/A INSURANCE REQUIREMENTS: YES PERFORMANCELBOND; N/A APPLICABLE:ORDINANCE: N/A r. SECTION #3 - REQUESTING DEPARTMENT DEPARTMENT OF EMPLOYEE RELATIONS Contract Administrator: Ana Cobelo Phone: (305) 416-2101 Fax: (305) 400 5206 SECTION #4 - PROCURING AGENCY____._. CITY OF MIAMI, PURCHASING DEPARTMENT Sr. Buyer: Yusbel Gonzalez Phone: (305) 416-1958 Fax: (305) 400-5104 Prepared By: Deborah Buchanan, 9/5/08 NOTE; This contract has been reassigned from Commodity Team 1 to Commodity Team.2; therefore, Pam Burns is no longer the buyer. This contract has been reassigned to Yusbel Gonzalez. A CONTRACT AWARD SHEET INSTRUCTIONAL GUIDE TO ASSIST YOU WITH THE INFORMATION CONTAINED HEREIN IS AVAILABLE IN THE (SUPPLIER INFORMATION SECTION OF OUR WEBPAGE AT: WWW. MIAMIGOV.COM/PROCUREMENT . PROFESSIONAL SERVICES AGREEMENT This 'Aereememis :entered into this .28 .:day f Septemher _2004 .by.and.bchv.een.the Cit). of:Miami, municipal-.corporaiion-of :the-State-.-.0fLEloridaPCitA-and4vIerev-Medical Dewrprnent dihhi'Merev Outnatient Cen ter. ("Providet''). RECITAL :The. City :has *issued ,Request ;for . Proposals (lREP77) for the provision of :pill. employment' Physical examination services ("Services") -and ?rovider's proposal CTroposan, in .response . thereto, .has been .selected .as the most rmaiiiied proposal for the provision .of .the Ser,iices. The 'RFP and the Proposal • are sometimes •referred o hereii,. collectively, as -.the :Solicitation :DOeuments, and are by this reference incorporated into and made. a --part. of:this :. • :Agreenient. ' .„.. . it. • The Commission ofthe City of Monti, byResolution:No.,R04,0475,.adopted on. itilv :22;2004, :approved the selectionof'Provider: and- authorized •the :City Manager to•eiceOpie :conmict, under the termand condtuoijs.set•forth herein. , : • • . :NOW, .TklEREFORE,:in iconsideration .0fithe mutual .covenants .and proniiscs heroin . • : . • :Contlizied,Trcviderarieihit:Cityagrceas•icillows: . . . . TERMS The recitals.aretratandeorrect:apdare•-hereby incorporated into and:niade a:partafthis:Aareement. 2.:" TER: The term ,tif this Agreement :Shall be ,for an initial :2 :year rporioci commeneingmn the effective_ date hereof. • • .. : • . • : " • . " • • OPTION''TD:EXTENT: The Giiy shall hi1VC'riva opnnn(s):w extend..thc..tcrm.hcrcoi 3nr rwo:(2) additional rwo-yearperiods: subject-.uc:uvuiiability anti appropriation (if:funds. City - ComtnisRion:.approval:shafl-notibc •required.as>]nng_.oriha;total.=tendedlent' .does.noi.exceed ior(d):yents. 4.._ ''SCOPE•OF.SEI2VICE ruvider.:uereestt7: provide. the-SCNICCS:as 5neeificaly.:described,:.and,under. the -special 'aerms:and t:onditicns..set.forth:in.Attnchment"'ri":#terew,:which .by tills reference: is nu:nrporated`ntttiandmad, 3part•ofthisAgreemanl, i3. 3rovderrepresents and ivarrnnts .to 'the City that: ,possesses :ill gualiS'Icaiittns, licenses .and = expertise ':required •under.. the ':Solicitation ::Documents =For Inc. performnnee'nftlte._Scraices (Ti) n i nntxkMnqucnt:in.niepaymem I -any surds :due the:City,' including:paym nt<of:permit'fecs, oeetipntinnti;aiccnses tt., nor.in:ilte;perfomence,t51'::any . ,nbligaucns-.to the City.::(iii) all, personnel: assigundloTettorm tb .Services are.and shuti'be at.uil • irrie,.during<ahetetnhcren ;'.ititiy quatifieil:nntl traineN:.to periorrn.,th `tashts>assrg etirto;.,ach; :autd (itt)titeSttrviceswlit be neifomtedin the niarntrr:tiesefib d in:Atrahmcnr A". �... 'Cp1'FPENSrlT1ON: The. amounraeomnensatien;payabie:by.the:Cityt:ro Providershalllin based:ontic ;.fatesnnd:schediilas=describedln'Anacbment" L'Itereto,:mbieh by ihis:ceferenc isAncorpomtcd' into tfits Ag,rcein ar,„proside:d,:'howevet;:iitat inme event shrill<.in, umounpJ't t-:orpeusatiori c.excced-St76;695O0',(per:ycai). Aniiioreasc.:not.to,exceeds%antheimouni:of.compensation •tuhichShatf be'effective:atrthe-rusrday oftha:firat vprinn;p rrotl.and remain in;cffecrthrough the liirsi.:reitaw4(: term :tni second:ttvir-{'} ycnr:ren wtti is:stibjectio;an Xncteuse of 5 a ,whith wits remuin:iir:eilcct ve.durin"'the se ondYatswal:term :. tbhteSR^.`Cmrid tccu Mnc¢2111F1 • .otherwise,vceffically provided:in Attachment ".6",, payment:shall be.made wiibin'-fogy fivc--(115) days kr. receipt:of f'ruder' hwic. hih-shall ibeitecompanied by •:suffivient .supporting....doeumentation .and :contain :sufficient diii, to allow .41 .proper..aujii. or. -texpendittire:should eity-requiretoneloMe:performerl-AFProvider,is entitletilo-reintbursemeni : of travel :.etmenscs- .1Le, .Attriehment -`13" -includes Travel tpnse ai.41 4flerifIC mem . of compensation], Mum rill [Mil is tfor ..trayel :expenses shall be. submitted in accordance ,wi hi *Section • I 12.061, Florida Statutes. • •:••OWINER.S1-111)-017.:DOCIIIVIENTS: :-.Provider ..understands .and :agrees • that any informuti on, (locum en t,„Teport tor: -.any ather mamtial twhatsotiver:thichie,giv.en.lity,the.-_City:to . : .. • . • Pitovitier or:Which: is-...otherwiit: °brained :ortprepareri by:Providertpursuant to: or•under.the: terns „ • • Agreenientis.uticl&briltimall tirnes.rerna in theffnctperr oftb :Provideragre,notio .• • • ' • - ..' • the ,written .:conseut .oft.Cite, :which :may :be Akithheickar „conditioned '.by iftCL�V in its. sok • 7. A (JIM'SkNIi _INSPECTI ON :RIGHTS: : ust any:such information,tiocument,.Teportor material Tor anY.othcrmurpose•Ataisoover without 1?, The,: Citymmy at ::reasonable %It mes..: and ;for le...net:lad :of „up ::to :three ) :years .• follatving:tliortate urfina(puyineirt.by the citytto,Provider under:this -Agreement,- auclii, or cause • • :10:betinlited,Tihose,:books,and records:otTrovicier-WhiCh areltilated:to;Providefl.st.performance ---funderlbis.Ahreemerit::lsovider:.agmei:to:mniinainthll-suth:•:bOcilts:andtlecords,:ntits • nine for %71;period •Of „three years :after..,fiziiii4itymeni i made:- under -Tite- Coy:pity, at irmsonable..mmes idurine The .terrn :•hereof, :inspect lac-tidies:and perform •:suetiest., •Cis:the: Cityliieenis:mnsonatity necessary, to :determine Whether:: • - • . ' .• • ..C.:01..,$M1',CotillitiW•ftl..4.3,2004. the goods or services required. to be provided hy•Provide: under .this A.greernert conform to the terms hereof andror the terms of the Solicitation 'Documents; "if applicable. Provider shad mike nt'rtilahle-to the,City.all reasonable facilities.nnd assistance to facilitate theperformuuce of:tests or insp,.ctions byCityleprescntatives. Alltests-ond-inspections-shall-be-uhject to and made -in accordanecwith•, the provisions o'5ection'1S-'5 .2 oftheCode ofthe:City-of.Miunti, Florida, as same.may:he amended or supplemented, from time to time. S. AWARD OF AGREEMENT: Provider represents and warrants mate City:that it has:nuremployed .orretained any -person Dr company: employed" by the City to solicit or secure 'This :Agreement and :that :it -has not -offered to;pay, paid, • or :agreed to pay tinyperson.any:fee, commissian,:percentage, :brcikerage :fee., : or gift 'cif any kind.contirtgent upon .or .connection .with, the award Of this'Aarcement. 9. PUII'UIC RECORDS: _: Provider :understands that t the:public shalthave access;:aetill .. reasonableaimes;ao.till:documents:and.:inforntation.oertaining to.City.contracts,-subject to the " provistons of Chapter:I1U,Floriela:Statutes; and Agrees coallogy:accessbythc"Citv.and.the;public:... to all documents :subject to :disclosure:under npnhcablc law. "Provider's :failure -or "refusal to comply -with .tbe;provisions:of .this section shall :result in the- immediate cancellation :of this Agreement:bythe City. OWIPLTANCEVITI FEDERAL, STATE AND LOCAL LAWS: Provider :understands that agreements between nrivatc entities:and'locaI governments are subject:to-certain .laws and:. regulations,. including laws pertaining io public records, :canftct:of :interest.:record keeping, etc: `Ctty.and_Prottdera,ree td compiywith.and observc.all.applicable taws;. codes. and ordinances as th mat 0 amended -from time. to time.:: C ,7:P8A ComAst041.1.4:2Un1 .: TiVDElti-NlFICATION: - Provider -shall .inrdetnnify, .ticfend and :hold -harmless -the City and its ollicirdi.,--cmployces.and.ngcnts (collectively referred to as -IndemniteeS").and -each of-thcm from. .and .against ,JOS -costs,. per.11 fits, 'fines, .cIamages, ims,expenses:(inel atiorney:s -ices) or liah-ilnies (collectively relerreci to as .Liankhues"f byreason ofnny.injhr-- -v to or dcath.rif.apy person Cr .danineelo or destruction or.loss.of any properry.ariSiite outof.resulting fronvorinhonnectionvith :Wino perfoonance ornon-!performance of the services contemplated bythis'greemeni:which oris'alleged to be directly or indilecily„coused, in whole or iin pat by • •• zny.aCt.„-ornission,.delitu It: or negligence (whetheror:passive) of Provider or:its-employees. agents:ofsubcontractors (hcillectivoly referred to as ''.!Provider"), regardless of whetherifis,-oris"-- a lleged ;to be tensed -in --wholeor part (wheinerjoini, .coneurrent.- or contributing) by::any .act, omission, kldfaidi or nogligenec (Whetheractive i-missive) of -the .Indemnitees.„-or.atty .of thein-or • (ii):the :failure o Malawi denufeorrinly,witirany.of:t he paragraphs'hertim Or the :•failure. of :the i!ilrovider to CarifOrM to.fscattim, ordinances, .or :tither ::•regtliatiOnS :Or -requireroenti ..of,any7 govornmentahauthority,lederal.br.state, -in connection...with Ithe.performanceiOf.this.Agrectnent.: r.Provider. esprosSlyagrcesqo ,intlininifyand:hrilditamiless theindemnitecs,- on any:Oftherrt,Trom and against:al winairrnay- beasserted livarrempioyee orformeremployee offrovider,. .--.or'aini::of ua :siiontramors, 'as -provided -above, Ior whntii'the Providers liabitnyto .. • employee :or ,.former:entployeeiwonld...otherwise be limited -AO ipayrucia.s....under•statt; .Workers ..:CorOperistaion or simitar ut• • : L. '..1t3LT-.: ..1171.mvidef fails tocomply,wiintnir terriror.condilion of this ..Anrehment.....:::. : • . , . • , , . . . •or fails4o-peiform iny:ofils..tililigations'nereunder;-thenTroviiier shall 'bein.default.: -itiponIne • • . .• :occurrence ofa default noreuntier.the.City, in addition r.oall reinerlies:ailailableioithy:latst,Inay . -iimmediately.,:opon written.rmtice. to Providet, terminate this Agreement Whereupon advances. orother.contpensation paid by. the.City.to•P'revider while Provider was-in„dcfault.s:hall • be.immediatciy reutrncri to Ilte,.City. Provider undersl.wds:and tierces -that termination :of :this Agreement under.this •secti oti shall :notrelcase;Pmviderfrom:any obiimitt on aeemingprior .to -the effective.datemf-termimttion-Shotrld7Provideric.unahlemr-umvillin tercommencemrperfnmi • the ervicos withinliteintc.provided•or.contemplateditereiu;tlten..in•addition to the .fore soing, Provider Shall.. be 'liable •tole City focadl.expenses:incurred .by:the •City .in preparation •turd negotiation of'this Agreenieny:as :well .as all costs:and expensesincurred byCiiyin:ihe. re - Tracy rement:oftheiServiecs, inel uding consequential rind. incidental damages 13. ?RESO! CITION O!"Cat\TRACT DISPUTES: .::Provides.utidetstands.and:agrees :that alldisputes between Provider.ancl the. City:based upon an alleged -violation -of the terms: of: this :3Aorecmcitt. by: the,City shall:.be submitted :tn the City'Maniager:for ins/her.resMutton, prior to • Pawl der:being::enlitled .:to:seek.judtcril reiicf sin - connection: there with. .In:the ..cvent::that : the ;amount :of .compensation :hereunder;execeels ;S25,000, :the :City <Mannger's decision shall::be :annrovei} or:disapproved by:the:City-Commission. "-Provider:shali:not.beentitied m-sce}c judicial. relief unless: (i) it:has'first:reeeiveti City.:Mattatter's'wrmen..decision,::approved .b; :rite Gin. Commission.i•f the.amount-of:compcnsatiomitcremirler.exceeds'S25,000,_or:(xi) rperind•nbsixty :.(fi0.):days bas-Aspired after:: submitting. to :Cit};TvManager:a.detailettstatementdithe.dispute, companied:b}'a1I npporiin..dueumentation (50days ifCityfivlanager.'s decision is: subject: to ssion:approval):.ar (iii) : Cily bas:waived<complian.:e With `the procednre7sea :rorth • thissection.by:writteMinstrum atts,•sitcried•b) tirCif}lganager. „, '9A, •Ct.'T'1.57'ERh31t1'ATf()NKl'GEITfi: The City:Sha0 thave:ihc ra..ht;tc:lemiincitc this.ttigrectncnt iaztszole discretion, at . y: iiiliitg:writtcn notice to Pravider_at i..ast h ire (5):business •days •peior:to the•: ffcetive • emr211111 . dotc: o f such .termination..ht such event.- the City shaf t ,pay to Provider compensation for services Tendered. an if.cxpensesancurred prior tothe.cfreetive;date:ortcmtittatiot:. In no •evern -shall the .City:bt:lhtbletoProvider .for anradditional campcniation, or her than that provided hcrcin,.orfor . nny t:onsetmentiai orincit1ental-damages, 11. The City shall have :the :right to ;erminnte :this Agreement, avithont :notice To :Provider,. upon the occurrence of:an.event of defauh'herctmder. •hrsuch event, the' Cityshtili-nor • be Obligated ta:payanyamounts:to'.Providcr.uttd.Prowidershah reimburse to the:GityafLamottnts • received whi leTroviderwas-in default• under this ftgrccment._ "15. INSURANCE: . 'Provider.shali,nt al( times _during:the.Term'.hereof,:maintain such nsurance cuverneeas nrar':be requited. btc.tite City,,;g11-sucl :insurance inotuding•rentnvats; shall be subject:authe:approval:or-the-Cityrfonedequney.or protection end evidence of such coverage boll>b :.furnishcd.Toahe-City:ou:Certificntesofansureace;indicating.snchinsurance.obe,in•force : ,:and-cffeet.and.pravidturthat.itavillnot.becenceled'dozing.th,performance.ofthe.services:undcr :this..contract-vithont.;:thirty:(30)..catcndar.days;.prior:written.noticeao.:the City, 'Completed ,'Certificates Or 'insurance shall:n filed •with :-the ':City°prior to:the:performance.:orservic`s.. thereunder, provided however, Thar Preividepthallatatly ime:upon request:fi1e.duplicatecnpics :of•We_policies.tifsuch insurance.witii:thc.City.. if in thejudgment oftlie:Cit_y,.iprevailing condiliont,warrunt:the-provis additionalainbiliiyiusutancecovatage.or:cnvcrtre:which:is.different:in:aind,ahc`:Cit) r&.5 rves. the :Tight ':w. require the ::provision h}':_Prttvideror Iat:.:nmount:or soverage: different :from ahc. urns ::or tkinil ;previously -.remitted 'shall ::afford written notice Of such :change in requirements :.thtm•<.(30) :days :prior as the :date :on' which the •ieduirements shall ;take :effect, .Should: the 'Provider fail or resist-- to sntisty'ihc:requirement of -chanced coveraee :within:ihiny . •CaAtINN&C.ri,IlcnnMei F'3 (30) days following •fhe City''s tvritten:notic ; this Contmet shill be. considcrctl.aerminatcd.on alit „dam that the required chnztge in-po1icy.coverag.e ttiould othenvisc mkt efacet. 16. • NONIfSC1 EMYNAT1OzN::Pravidcr represcnts.and warrants 'lb the City-thu't.Providcr docs:notand4vill icuengage,imdiscriminazoz3Lpraczicesanti_IhauhereshulLbc"no:discriminatioo in con cetia i-widi Pravidci's;perinrmance undcrthis.Agrecrocnt on mccouni of mac,:colo:. sex, -religion, :age, handicap, niuritol:stazus-or-:national origin. :Provider liirtlser covcnnprs that nn titiicritiisc gufili'ffeiJ,iii" roidiinT siiatl,`solety hy'reasonT000fliis/her ruce,•ctilkT,-sc:; rclig oii,?ale;— — andicap, marital status .oraiation:it Dunn, be:excluded:fromparticipation in, ba tienicd scrwiccs, ..orbesubjacrtodiscrimination under anvpravisiondithis :Aeereerncnt. .17. MINORITY AND "WOMEN 'BUSINESS ,iFJ7AlRS'AND ?PROCVJREiIEA'T 'PROGRAM.: The <Cit�' ':has established .:a. 'tMinority'=anal Vromcn.::flusincss :Affairs :and t:urement:,Prognuii:(the-"tvt/WB.E :Program'j.:desi fed -:to increase .the volume.nf::City rocurcmcnt:azuf.aontra:,ts :with Blaeks, hispanic and'' Women.ownted.busincss :The t�1?lir$E :Provram is' found. in' Ordinnncc;No. J.0052.a.•copy of which. has" becn'didivcred to nndrec atpt.of • adlil�6'is litresYaei tiat4l01ted by,:Praitider.:Protider:understands and agrees that.the CitV:shall lhcrightin.terniinare:and.cancel t]iis:Agreement:•wiihout:notice:o -pemtltrto:thc-:Gity,:and intinatePro Viflerfrom consideration _and .participation`ininnate .City -contracts ifPmvider;ar.. iiie:.preparatioo findior:submission:of the:i'.roposat, subraiued:fatsc of misleading infozmation:.as to ' -its stants<us:81ac1; 3lispanic:.andior' Wauien mired '.basilicas :midlo Ate qua Ihy and/or type:Of =niinorii arwar aiiowned buaineas,participation. ASSIGNMENT: This :::Agrecnientaftal nor oe assiumed:by'Provider; .in whole-or:in ,pan,:: tivithountbepilor:~written:consent ihe:City s nvtiieh.may'.be witlilteld or. condkiioned; in th e Zty''s saie.discrciion. nit ; c.mrit�mnacny 2wu . • .IJ. NOTICES: All notices or. other _•ummumwnion= retµrired uucicr this Agreemem shall he in writing and shalt-betiven by hand -delivery or byreprstercd ur ccrtifierh.U.S. Ma if, return receipt requested, -addressed to the oibey party:at -lhe_address •indicated herein onto such.other .ar(dresn.as.a:partyanWBestumu; by twice,_iven:as heroin provided. Noirce shalt be deemed . iven on thday,,on'whichjtersonnikytletivcrcrt;.or, ifby.Frail,-•on:thcfifth -d,ty.aher being -posted •=or the date:ofrtcuinireeei ;whiehever:iecurlier. "['O:Pkt01`IDE R:• TO.'fF E CITY: :Sandra:Cohun , Joe'Arrioln • <Administratar, ticrcy-0lpa»env.Center ...Chief:Admitiistrator/City?- Mercy McdicaGDcvcloptncnr :Citv.ofMianti •d/bla',Mercy°utpntienrCenter. :3500:PanAmerkcanDrive .. 31iG1'SoullrMinnii Avenue :Ulinmi::Florith 33J33. N1.ianti,;FL "x3k• 114I$C1 I:LANEDUS`PROvISf oNS: This: Agreement tha ��trrx A,C.0.P!" r€2: Joree L.:i errand= City. -Attorney -.Cft arh, iarni Office niche CitvAttorttev ' :SW-,nu;Avenlr4,:Stti["945 Miami.:Fiorida .331-30 onager c.ronirrued and -enforced -ace or•ding_to the: laws. oNhe State. of:Floridn. Ilc.andparueuiphheath ogc.arniuc.coin'wttent:re#crciteitnndarcnot.apurl :orxhis grccntenL >Crtt:r'nA;eirdq' u:,,. tvaivot: or of anyprovision,or.this Agreement shall constituter waiver of.tany subsw uent breach of the same or any other provision hereof, and no :waivershall be .eie tive..unless moat hi:writing, 771. S tocid. -any provision, .patnertph, sentence, word. or :pnrese. contained anthts .:Anrecment be.detennuted v.eoun .of.cnmpetem ;jurisdiction to be invalid, .ilien& or otherwise .:unenfnreeable under The hn r, • of the .State •oT Florida or tite:'Gity :of Isfiami,aoch,provision, '.paragraph, sentence:wordor phrase: shall be :deemed modified-toalte.rxtent'neeessar •.in order to •conform.withsuch laws,'orif:notjnodiiioble,.:then.sameshall.be-:deented.severable,:and in either ,.event, the remaining.termsnod provisions ofthis:Agreemencsb JI remain :unmodifiedrind .ir.-ftill end-eiTcca er iimitation of its use. :E. 'Phis' Agreement .cnnstitntes the :and 'entire aorecment:between :the parties hereto.. lao modification -or untcndmegl.heretristitilhbe:valid unless in'writingandexecuted_'by .properly:authorized represeniatives.of.the,panies hereto. •21: SUCCESSORSANA.ASSIONS: . '.This Agreement:shall,he •bindinn parties. hereto.theirheirs,exetutors,>t_gri representatives, successors, or.assi¢tu. INDEPENDENTCONTRACTOR:. :Provider has been procured: and is'beine ,:erigaticiltto.provideseri/ices.to:the>Clly:ns:an independent Contraetor,:and:notas:.an.agent:or, :ettiplovee.of ih CAy. Accorrlumlp, Trovider shnlJ_ nor-atnain,::nor he entitled>tn,'nriy riahis:-or . ::benefus..undertht Civil:Servichor:'Pension :Ortlinancee at'the:Cit},aror afforded •clussiued -or :uneiassified employees. :Provider `further understands ;hint ,Florida V rkers,:.Gompensoiion benefits available-toumployees.tifthe Citj nrettotavailaa elo:Proder., • - btid .a.rees: W provide worxeIC`'.eomp„nsotiotrinsumnec;for anv. employee iir..a enLof Provide rendc.rtng-scrvices tothe Ctty.under:this Agreement :a,t6.asn:e: ttvi, ta:diAledy2wu ATTEST: .CITYOFM[AJV a=munieipn] inn Yrrriliu r�. Thompson,:City icrk J6 1rriot ^'f cfAdministmtorlCity'Manager • ATTEST: "PCOYidtr" 'Merey.'Medieal Development ,dba,fiery7OutPtilaent Centex a not .for ,prof±tCorporOti011 -.prim l(imC: ,3 y-T1ashburn Title:.,Cnrparatc Secretary • .By: 7 pllnt;i\nmc: :l u ka Title 'President APPROVED .ASTO.PQRAM1::ANL) .:. APPROVED.AS:TQ.:INSURA'tNCE CORRECTNESS: o REQU1R MENTS: .Jorge nnndax Carrillo _ 0.1tiomcy .pir .• Risks:14nnattement4dmuiistrator,.-' t?Y t(n - 'zanfa5h-F:£ogiltcsir mem 20 -C4,,,PMermi, Pltr.eol faarrunatum Sernce, RFT 01.04479 Attachment A 'Medical 'Protocol (Physical Examinations- . Emaloyment, Promotional -and Miscellaneousl A. pHYSTCAL EXAMINATION COMPONENTS PEASE 1. MEDV7AL FrISTORY SHEET: Examinee will complete a family and ,personal medical history to .be reviewed .by he ph.ysician •with shimihert the .time of the :physical exam. -LABORATORY .:WOR(-UP • .a. ..Corsplete :Blond 'Count (CHM., with -IDifferential . . 'Complete Lipid ce .with 'ratios, ..and T-Sit . • . RPR .d. Drifl1Vi .(Microscopie) -. lath .zbby.thm „ ..3. PTD .KIN TEST .-mer-f toned :by Aaricoux ,Method trequired}.. • A., -FIT TEST . . •. , . - • - .. . . . . . • . . . . . . • The -acuity ,.test ..Shotild „screen for both :near ,and :tor distance acuity. --cm .a bcientifically .accurate .instruoent :.that :Cheeks tor.::keiness ..of arision; :depth ,merception, • • balance , -of. <eye :musc:les,.. .and. ..the • _ability ..:tc •differentiate :colors. Examination :should :be -conducted. .. . with--and.,..wittnut :corrective ...3-er-ses... ,Thez...^e are qmer.i.'fic....- . - ... . . ..: .... . . _L.. .. .... :vision requirements tor .-..pelice :officer :and ...f-ixef.1..Ohter . • • . . .. • • -.applicants.- :Requirements. -are ..as 'follows: . . . , 2e2J.ce :Officer la_s3,on atermirements: 20/-50 <each .eye, benarately :without corrective aenees r1f any kind - including Cont lenses4. with .glasses ,1110 • , ,CONTAOT ..1.iNBBELauciAtin0)_ 1r4relpahter vi±cIteonirements: _ Par ,visual :acuity , .shall be at least Min binocular, .carrected • contact:: lenses -cr -fspectadles- :Far visual -acuity. . • uncorrected be at least 20/13.0 :binocular -wearers had contacts :or -spectacles. . 4B •• CRyafAlieloei, Pre-Emplswenertt Ploysierd Learrtinotwo Service,' RFP 43.04'479 5. AUDIOLOGICAL CHECK: Will test the normal hearing range, 51:14 to 4000 :HERTZ, 'using 'high guality-eguipment. -Provide •written interpretation of results. . . • PHASE II A. PHYSICAL EXAMINATION:BY: Inspection, :Palpation .Percussion, Auscultation MuSt be performed nv Board .Certified Physician To .include-the-folIowing: . . Vital..-,.:TPE.,;.Bloo&pressure (both arms) . . . . Height-. • • . . -• • . Weight -• r 'General :Appearance ilead,..scalp, lace • ... Neck (thyroid, lymohs, vessels) Endocrine -aystem Eyes .(fundi, focus) general OcUlar•motility . . . . . . . . . . . Pupils (equality and -reactivness) Ears-tneernal and -external canals and cerumen,) Bar drums (perforation . • ... . . Nose (sinuseg) . . . . _. .. . . .,Mouth (tongue, teeth end gums) 'Throat :(condition of -tonsils) ' . . . . 1:usgs, chest- (OPTIONAL.- .include .breasts; '2HYSZCIAN .. :WILL.OFFEB TO PERFORM BREAST -EXAMINATION) • - -. . Heart Athrust, size, :rhythm, sounds) • " • • I . . -Abdomen, Viscera (cheek for terniRS)-EVALUATION -BY ZNSRECTION, :PAIS:PAT/ON, :PERCUSSION .ii :AUSCULTATION) 7Bsternal :Genitalia - 'EVALUATION 'By-.INSPECTIOM. •PALPATION, PERCUSSION.& ADSCULTATIONF . .. , . . ,ANUS,AND RECTUM - EVALUATION BY VISUAL INSPECTION FOR HEMORRHOIDS 4,RISSURES_ . . Upper. extremities '(strength, range:of motion) Dower.:extremirtiesAstrengtn, rrange•Of-motion) . • . .VascularSystem Avaricosizies, .-ecc.) spine, •.Other • musculoskeletal- . • - • . . . ... . . . . .. Skin (scars .rashes,) _lymphatics .' . _. . . . . . . _ Mental Statue, memory, .0=ientation, judgement, affect-. -Neurological ,• •-. ', - .. _ ...... _ . _. .._ . SqUilibrium " . - . . .. . ... .. . . ,.. 49 Ciof Miami. Florida C yof Mkovi,Floriec Pre Employment Physical Examination Services REP 03-04-079 PrelEmptovwen! FhnirnfEeamimnoriService RAT OJ-04.019 'B Add/rim-it). /optional 'Item9 - reoyj' -fOr `Prili„^e Offi'e+ -:Public Service .Aide (PSAL Pdlj,ce Auxi3ie v, Sr. Citj.aen Guard (CAVE.) •Pirefiahters and I:.P. Te-hnicians .7iDDITIONAL Chest X-ray (POLICE SAND 'FIRE) Anterior:/posterior and•lateral views.. :Provide written interpretation of -results. :Deliver -results to the Department of :Employee 'Relations :wit:hin '72 -hours . fl .Testing :and :Counseling — Required for -ire . .. -(HOWEVER,, AFIRE :APPLICANT EAS :OPTION :T0 :DECLINE Eiv • TEST) .and:TD Technician <employment c2ysigal.. 3..:. :Hepatitis :A, :S., :and 'C :Screening Required 'for Technician, .SWORN .FIRE AND • :POLICE .APPLICANTS) • employment:physical. dOPTIONAT I. -Back ;X-ray .(requested by._City :as :needed) provide :two views of :the back;":lumbo-sacral pelvss.. 'Provide .written -interpretation :of ;results. Dulmonary.Pun tion'Test freguested by.city as needed) :,provide three (3) :valid tracings rcif -a :forced ,vital capacity from whih :he Forced: Expiratory Volume.in:.-one second::at be delivered.. _Blood Type :and Rh :;'yping :(requested by City as needed) i.,:Rubella 'Titer dreguested by City as .:needed) S. Rubella Immunization irevuested.bv:City :as .needed) Tetanus •vaccime.:lreguesced by City .as :needed) 7 :Review and ;provide .w itten interpretation and/or medical .:resume of .employee/applicant -medical records from -another .agency. .:.8. L'ardiauasccller: Stress '.Test 50 City of Miami. Florida Pre Employment PJ•vsical ExaminaOen Services Gmn(Miami.Ph (th. Pre:E' ployment Phy veiEramiw,ain .trIrra 'P.TTACZM0I7 E RFP.0.1.4=A79 4.7. `PRICE.P.ROFOSAL:FORM PRE=EMPLOYMENT PHYSICAL EXAMINATIONSERVICF_S Empinvment;Promotionaland Miseellmieous Firefiehters and Police Olicers1 Tile following musk he fully completed and"xemmed:with `Proposal. Description rst. Extended •Ottantiw 'Uni.'Pricc Price h. :Basic Physical'Zxamintnion .425 ':$Jjn -nil 5 47: s'in 0D — -- '(including "lab "work,.viaual.maim and____: ... _ .audtologieal. exam) J0. .AbbreviasedRewm.to Work Ertysical C. .OptionatExamination Components (included: At: this time- to obtain "quote) 400 S2o•OD ,1. 'PPA:aesl 400 :aIOOD -4000.00 2. .1lack7CRsy r5 ' 4 fin ITC 4'inn no i3. 'CJtesi'a-'Ray. 2g. s20.:00 .51750..00 4, EKG(l2.kad) -425. y'45.00 5:29.;L25,DJ) 5. Rubella Titer 5 5.30:00 s 150.00" 6. :Rubella immunization 5 ;5 80..00 :fi 150.00 7. :Review.oftvliseClian ous '1"5 00 ... 75.00 MctrcnJRecords .. .. ... .. _ . Hepatitis:.'s..;:aad:CScreentgg ' 9, Mcastes,::Mumps, Rtib2Ih .,ammunizalion .. :10, ?clams Vaccine . incast list aaynthersirergranssodated -withfu ffiag"thisiiFPand�desciihohelow: 50 :s,no nn c ro nil REP OS-O4-079 CM, of Miami. Florida Pre —Employment Ph•vsical Examination Services l:ety ofMeami, rlarldu • Pre-Emplaymenl Phv ecrl Eaneninamoe Semler,, RFP OJ-P — 79 ,Emplotment Physical Exam itin tions—Fire ftehterg The followingmust be fully completed and returned with Proposal, Est. Extended Description Quantity Unit Price . Price A„Basic Physical Examination 60 .a .140. 0D 5 :8400.O0 (including lab work, v$auei-exam, and . midi °logical exam) • .13. AdditionaVOptional Examination Components (Included at this time -to obtain quote) 1..Chest 'X-Ray. • 2 EKG 6D 70.00 $ 4200.00 ., 60 s 45..00 .$ :2700.00 3.•HIV-Testing &'Counseling •38.00 228D.00 a. ELISATest •60 :5 F b. WesternBloi 6D STD--' F .0 c: Prc.Counscling '60 ,is 10.00 s boil. oll -d. Post Couteseling 60 a .tO. Du F. o00. UV '10 00 -600:00 - 4:PPD-test 60 S $ 5, Hepatitis A, B and CScreeding 63 $ 35.00 $ 2100:00 Please list:apy:otherehargesassociated with:fvl0lhng this RFP and.describebelow: :Employment PhvsicaI:Examinations - Police Officers Est. Extended :Description _ Quantity Unit Price Subtotal: ,t S 2148U.00 : A. Basic Physical lamination (including lab work, visual exam; and • • audioltigicdl:exan) E.-Addition VOptionat:Examinaiion. Components (included at this time to obtain quote) I. Chest-X-Ray ...EKG.. 46 100 -:S.-140::00 is 14;000_00 . 50 REP 03-04-079 6, Blood Typo&Rh Typing . 7, hubellsTiter iP;tibella Immunization Civ of Mitimi. Florida Pre -Employment Ph•psicalExaaliaation Services • Pre•Empkymeni Pityvnet Eravination.1;ervires RFP 0.40(.07S 1 BOCk ZABY I 1.c 12 5 . op 1 Hepatitis A, II, and C Screening 100 $ 15;00 5 3500.00 , ff 5. PUitnOttatV FUTICtiOa i s in . 00 :5 120 . 00 i!.. 17 REP 03-04-079 r I 1 : 5.00 15.00 5 1 Z ' 30-DO .30.00 -5 4IL 1 00 40-00 P. Aeview & provide: written interpretation .50 00 D0mccii=li=011:1 10:: Cardiovascular:StressTest • 'C, Please list nny other charges associated with fulfilling .this RE? and describe below: 50 750 00 -,425 00 4 425 ‘'00 - • • 77 Mount Sinai MEDICAL CENTER July 21, 2010 City of Miami — City Clerk 3500 Pan American Drive Miami, Florida 33133 Re: RFP NO. 220240 — Request for Proposals for Physical Examination Services, Mount Sinai Medical Center, Occupational Health Center located at 4300 Alton Road, Lowenstein Building, Miami Beach, FL 33140, Telephone Number (305) 674-2312, Fax Number (305) 674-2413, Federal Employer Identification Number 59-262442 is formally responding to .your Request for Proposal No. 220240, Request for Proposals for Physical Examination Services for the Provision of Various Medical Services that may be necessary or required by the City of Miami, Local, State, and Federal Laws: The Proposer is appointing Ms. Linda Arama as the primary contact person for this RFP; she can be reached at (305) 674-3910 (office) and 305-535-7904 (fax), e-mail address is Laramaaa msmc.com. Should you have any questions concerning the above, please do not hesitate to contact the undersigned. Sincerely, L"jrfda Arama Director Occupational Health Center Certification Statement Please quote on this form, if applicable, net prices for the item(s) listed- Return signed original and retain a copy for your files. Prices should include all costs, including transportation to destination. The City reserves the right to accept or reject all or any part of this submission. Prices should be firm for a minimum of 180 days following the time set for closing of the submissions. In the event of errors in extension of totals, the unit prices shall govern in determining the quoted prices. We (I) certify that we have read your solicitation, completed the necessary documents, and propose to furnish and deliver, F.O.B. DESTINATION, the items or services specified herein. The undersigned hereby certifies that neither the contractual party nor any of its principal owners or personnel have been convicted of any of the violations, or debarred or suspended as set in section 18-107 or Ordinance No. 12271. All exceptions to this submission have been documented in the section below (refer to paragraph and section). EXCEPTIONS: We (1) certify that any and all information contained in this submission is true; and we (I) further certify that this submission is made without prior understanding, agreement, or connection with any corporation, firm, or person submitting a submission for the same materials, supplies, equipment, or service, and is in all respects fair and without collusion or fraud. We (1) agree to abide by all terms and conditions of this solicitation and certify that I am authorized to sign this submission for the submitter. Please print the following and sign your name: SUPPLIER NAME. M0(II1i 2,rt6_G f//{,d%[ J (t4( I i--7-1-- 4,4_, ADDRESS 0 A I—TU tl.) &1O %U(P,(.Ge4 71G S& 331 it U PHONE: 50E- (D/4-at() (c,a EMAIL: C11 u-1-11,A a1 FJ i9t;n1 p , e'0r14 BEEPER: J1S` b 7y �i / O SIGNED BY: , �C1Ur-' FAX 30S- 674- 02,00'7 TITLE• 1� ! L-!(u- t-1., DATE: FAILURE TO COMPLETE, SIGN, AND RETURN THIS FORM SHALL DISQUALIFY THIS BID, Page 2 of 41 Certifications Legal Name of Firm: 0ukri- 61n4 Entity Type: Partnership, Sole Proprietorship, Corporation, etc, Year Established: Office Location: City of Miami, Miami -Dade County, or Other (tt& m� c_cc& t f- Corm DA Occupational License Number: Occupational License Issuing Agency: Occupational License Expiration Date: Mi C.L. 4/l t Ct _ JJZ. et)-(Adat—i C. cl \_*3 0 Respondent certifies that (s) he has read and understood the provisions of City of Miami Ordinance No. 10032 (Section 18-105 of the City Code) pertaining to the implementation of a "First Source Hiring Agreement.": ( +r No) Do you expect to create new positions in your company in the event your company was awarded a Contract by the City? (Yes or No` In the event your answer to question above is yes, how many new positions would you create to perform this work? A Please list the title, rate of pay, summary of duties, number of positions, and expected length or duration of all new positions which might be created as a result of this award of a Contract. Page 3 of 41 Line: 1 Description: Employment and Promotional Physical Examinations for Non Sworn Classifications Line: 1.1 Description: Basic Physical Examination (including lab work, visual exam, and audiological exam) Category: 94874-5(1 Unit of Measure: Each Unil Price: S; Z C CI Line: 1.2 Number of Units: 425 Total: 5; 3`1 000,00 Description: Additional/Optional Examination Components: PPI) Test Category: 94874-50 Unit of Measure: Each Unit Price: ; 7: 0CU Line: 1.3 Number of Units: 600 Total: 5 3, 000 . OZ) Description: Additional/Optional Examination Components: Back X-Ray Category: 94874-50 Unit of Measure: Each Unit Price: 5 656,. 00 Line: 1.4 Number of Units: 5 Total: h 30e . 00 Description: Additional/Optional Examination Components: Chest X-Ray Category: 94874-50 Unit of Measure: Each Unit Price: 5 1-1.0. 00 Number of Units: 50 Total: 5 e2100c'-00 Page4 of41 Line: 1.5 Description: Additional/Optional Examination Components: EI{C (12 lead) Category: 94874-50 Unit of Measure: Each Unil Price: $ 35'.00 Line: 1.6 Number of Units: 425 Total: $ I A-.) Sy 15 ,i)0 Description: Additional/Optional Examination Components: Rubella Titer Cateeory: 94874-50 Uni( of Measurer Each Unit Price: $ a5 0U Line: 1.7 Number of Units: 5 Total: $ I d- 0 0 Description: Additional/Optional Examination Components: Rubella Immunization Category: 94874-50 Unit of Measure: Each Unit Price: $ Line: 1.8 Number of Units: 5 Total: $ Description: Additional/Optional Examination Components: Review of Miscellaneous Medical Records Category:.94874-50 Unit of Measure: Each Unit Price: $ 15,00 Number of Units: 5 Total: $ 76 -0 0 Page 5 of 4 1 G«•r�- r a.,.) r c<L- LC�A� Line: 1.9 Description: Additional/Optional Examination Components: Hepatitis A, 13, and C Screening Category: 94874-50 Unit of Measure: Each Unit Price: S Line: 1.10 Number of Units: 25 Total: $ 1 o00'00 Description: Additional/Optional Examination Components: HIV Testing & Counseling - ELISA - Test Category: 94874-50 Unit of Measure: Each Unit Price: $a ,0 0 Line: 1.11 Number of Units: 25 Total: $ (nay • DZ' Description: Additional/Optional Examination Components: HIV Testing & Counseling - Western Blot Category: 94874-50 Unit of Measure: Each Unit Price: $ V Line: 1.12 Number of Units: 25 Total: $ iv -S . 0 0 Description: Additional/Optional Examination Components: HIV Testing & Counseling - Pre Counseling .. Category:.9.48.74-50 Unit of Measure: Each Unit Price: $_ Number of Units: 25 Total: $ Page 6 of 41 Line: 1.13 Description: Additional/Optional Examination Components: HIV Testing & Counseling - Post Counseling Category: 94874-50 Unit of Measure: E+'ach unit Price: . ,l Line: 1.14 Number of Units: 25 Total: Description: Additional/Optional Examination Components: HIV Testing & Counseling - Measles, Mumps, Rubella Immunization Category: 94874-50 Unit of lvleasure: Each Unit Price: $ Line: 1.15 Number of Units: 5 Total: $ 3c ,CSC' Description: Additional/Optional Examination Components: HIV Testing & Counseling - Tetanus Vaccine Category: 94874-50 Unit of Measure: Each Unit Pricc:.5 3d . Gt`a Line: 2 Number of Units: 5 Total: 5 i 5-0 ' 00 Description: Employment Physical Examinations for Firefighters (Examination shall be conducted pursuant to current NFPA 1582 Guidelines and City of Miami Medical Protocols) Line: 2.1 Description: Basic Physical Examination (including lab work, visual exam, and audiological exam) Category: 94874-50 Unit of Measure: Each Page 7 of 41 Unit Price: $ V • pc' Line: 2.2 Number of Units: 60 Total: $ 4, 00.00 Description: Additional/Optional Examination Components: Chest X-Ray Category: 94874-50 Unit of Measure: Each Unit Pricc: $ qi , o 0 Line:.2.3 Number of Units: 60 Total: 5 .2, Our od Description: Additional/Optional Examination Components: EKG Category: 94874-50 Unit of Measure: Each Unit Pricc: $ 35 .c 0 Line: 2.4 Number of Units: 60 Total: $ „2, r000 C: Description: Additional/Optional Examination Components: Back X-Ray Category: 94874-50 Unit of Measure: Each Unit Price: $ (,0 up Line: 2.5 Number of Units: 1 Total: $ (c 0 ' 00 Description: Additional/Optional Examination Components: Cardiovascular Stress Test Category: 94874-50 Unit of Measure: Each Unit Price: sb0o Number of Units: 60 Total: $ tJ Ct00.0 0 Page 8 of 4 I Line: 2.6 Description: Additional/Optional Examination Components: }IIV Testing & Counseling - EL!SA Test Category: 94874-50 Unir of ibleasure: Each Unit Price: $ <S • 0 0 Linc: 2.7 Number of Units: 60 Tota $ 1;500,00 Description: Additional/Optional Examination Components: HIV Testing & Counseling - Western Blot Category: 94874-50 Unit of Measure: Each Unit Price: 00 Line: 2.8 Number of Units: 60 Total: $ I, 5-00.0 D Description: Additional/Optional Examination Components: HIV Testing & Counseling - Pre Counseling Category: 94874-50 Unit of Measure: Each Unit Price: $ j3 Number of Units: 60 Total: $ Line: 2.9 __Description: Additional/Optional Examination Components: HIV Testing & Counseling - Post Counseling Category: 94874-50 Unit of Measure: Each Unit Price: $ Number of Units: 60 Total: $ /11 Page 9of41 Line: 2.10 . Description.: Additional/Optional Examination Components: PPD Test Category: 94874-50 Unit of Measure: Each Unit Price: S Line:.2,1 1 Number of Units: 60 Total: $ 3L>C 00 Description: Additional/Optional Examination Components: Hepatitis A, B and C Screening Category: 94874-50 Unit of Measure: Each Unit Price $ `f0' • 000 Line: 3 Number of Units: 60 Total: $ 2, L{OC),O( Description: Employment Physical Examinations for Police Officers (Examination shall be conducted pursuant to current California Peace Officer Standards and City of Miami Protocol) Line: 3.1 Description: Basic Physical Examination (including lab work, visual exam, and audiological exam) Category: 94874-50 Unit of Measure: Each Unit Price: $ SD ie 0 Line: 3.2 Number of Units: 60 Total: S 4-) SZ)0 . D L? Description: Additional/Optional Examination Components: Chest X-Ray Category: 94874-50 Page 10 of 41 Unit of pleasure: Each Unit Price: $ Lt-0,00 Line: 3.3 Number of Units: 60 Total : S, L/_l p . OL% Description: Additional/Optional Examination Components: EKG Category: 94874-50 Unit of Measure: Each Unit Price: $ .00 Line: 3,4 Number of Units: 60 Total: $ e2 r l00.0 c Description: Additional/Optional Examination Components: Cardiovascular Stress Test Category: 94874-50 Unit of Measure: Each Unit Price: dSD , Ct 0 Number of Units: 60 Total: $ I S (i00 -OD Line: 3.5 Description: Additional/Optional Examination Components: Back X-Ray Category: 94874-50 Unit of Measure: Each Unit Price: $ ivtl , cro Line: 3.6 Number of Units: 1 Total: 5 Description: Additional/Optional-Examination-Components: Hepatitis A, B, and -C-Screcning- Category: 94874-50 Unit of Measure: Each Unit Price: $ OZ) Number of Units: 60 Total: $ , t y.00,19L7 Page 1 1 of 41 Line: 3.7 Description: Additional/Optional Examination Components: PPD Test Category: 94874-50 Unit of Measure: Each Unit Price: $ 5. 00 Line: 3.8 Number of Units: 60 Total: $ ?..)0 0 • C' t} Description: Additional/Optional Examination Components: Pulmonary Function Category: 94874-50 Unit of Measure: Each Unit Price: $ 2 S , 0 U Line: 3.9 Number of Units: l Total:$ Description: Additional/Optional Examination Components: Blood Type & Rh Typing Category: 94874-50 Unit of Measure: Each Unit Price: $ 2 9-.0 0 Line: 3.10 Number of Units: 1 Total: $ 2• 0 0 Description: Additional/Optional Examination Components: Rubella Titer Category: 94874-50 Unit of Measure: Each Unit Price: $ a 4,0 0 Number of Units: 1 Total: $ a-4.'0° Page 12 of 41 Line: 3.11 Description: Additional/Optional Examination Components: Rubella Immunization Cateeorv: 94874-50 Unit of Measure: Each Unit Price: $ Number of Units: 1 Total: $ (!t{ttA(,l Line: 3.12 Description: Additional/Optional Examination Components: Review & Provide Written Interpretation of Medical Records Category: 94874-50 Unit of Measure: Each Unit Price: $ 25.0 D Line: 4 Number of Units: l Total: $ 21 •O 0 Description: Return to Work Physical Examinations for all Classifications Line: 4.1 Description: Return to Work Physical Examinations Category: 94874-50 Unit of Measure: Each Unit Price: $ 3L u0 Number of Units: 400 Total: $ /0?i ()DLL611) I'age 13 of 41 tf SA Mount Sinai MEDICAL CENTER Table of Contents A. Executive Summary. page 1 B. Professional Experience .................... 'C. Occupational Health Staffing... ..... ....................................... page 3 Occupational Health Staffing (cont'd)page 4 Occupational Health Staffing (cont'd)............. page 5 Resume, Curriculum Vitae, Certificates, Licenses....... ........... Attachment A D. HIPPA - Privacy Notice of Privacy Practices - Policy & Procedures Attachment B E. Proposer's Clients List.............................................................. page 6 Proposer's Clients List (cont'd)....... ...page 7 Proposer's Clients List (cont'd).... F. Proposer's Facility and Location..................................................page 9 Fee Proposal...................................... ........... ............. ..... Attachment C Campus Map of Mount Sinai Medical Center......... ........ ..............Attachment D Departmental Brochure..........................................................Attachment E Mount ". nai MEDICAL CENTER Executive Summary Mount Sinai Medical Center of Florida, Inc. located at 4300 Alton Road Miami Beach, Florida 33140 is South Florida's largest not -for -profit organization. The Medical Center facilities include acute care, diagnostic, treatment, teaching and research facilities with approximately a 935- licensed bed capability. Mount Sinai Medical Center has over 50 years of Professional Experience providing acute care, diagnostic and treatment services within the facility. Mount Sinai's mission is to provide quality healthcare to every patient regardless of race, religion, ethnic background, gender or national origin. The Occupational Health Department at Mount Sinai Medical Center located in the Lowenstein Building first Floor and has been prodding services to numerous accounts and municipalities for over 29 years. Mount Sinai is especially proud of the occupational health services it provides to Miami -Dade County. We look forward .to provide the City of Miami with quality services. The Scope -of services provided by this department includes: Pre -employment Physicals, Promotional Physical Examinations, Return to Work Physical Examination, Vaccinations and any additional services requested. The Occupational Health Center has been regularly engaged in providing high stress, standard preemployment fitness for duty physical examinations/return _to work, FMLA, Worker's Compensation, Executive Physicals, Immunization, Employee Health Services, drug and alcohol testing and Emergency Department 24-hours, 7 days a week (urine and alcohol collections, including weekends and - holidays), to the County for the past 29 years. This department is committed to providing quality Health Care Services with integrity and continues to set high standards of excellence in all of its activities. -1- Mount Sinai MEDICAL CENTER PROFESSIONAL EXPERIENCE The Occupational Health Center at Mount Sinai Medical Center opened its doors in 1981 and has been providing services to numerous accounts and municipalities for over 29 years. The Occupational Health Department employees the following dedicated and qualified personnel to perform the services outlined in this contract: Program Manager, two Medical Review Officers (MROs), Medical Director/M.D., Medical Doctors (one female), Cardiologists, Psychiatrists, Radiologists, and LPN (DOT certified), five Medical Assistants/BAT two Patient Representatives/Reception and one Medical Records personnel. -2- Mount Sinai MEDICAL CFNTER OCCUPATIONAL HEALTH STAFFING The Occupational Health Center will staff sufficiently to supply all services stated in the Scope of Services and the Agreement. The OHC will increase staffing if necessary to fully comply with what has been stated in the Scope of Services. Linda Arama, Director, Project Manager Approximately 28 years experience with Miami -Dade County as .Director of OHC Kenneth Kaplan, M.D. Medical Director of Occupational Health Department, Medical Review Office, Board Certified in Internal Medicine, Certified in Workers Compensation Joshua M. Trabin, M.D. Certified in Internal Medicine, Medical Review Officer. SAP Gerardo Jose Minsal-Ballester, M.D. Certified in Internal Medicine Samira Habibnejad, M.D. Certified in Internal Medicine Orlando Santana, M.D. Board Certified Cardiologist Philip Samet, M.D. Board Certified Cardiologist Jeffrey D. Neitlich, M.D. Board Certified Radiologist Jenny Audain, Superviosr Certified Intoximeters Breath Alcohol Instructor (Intoximeters Model Aicomonitor CC), Certified DOT Drug Screening Technician, , Drug Screening Coordinator Lucy._Castellanos,_ARNP _ Board Certified Advanced Registered Nurse Practitioner Sabrina Moore -Maras, ARNP Board Certified Advanced Registered Nurse Practitioner Deborah R. Wilcox Board Certified Advanced Registered Nurse Practitioner - 3 - Mount Sinai MEDICAL CENTER OCCUPATIONAL HEALTH STAFFING (Contd.) Patricia Wilson, LPN Occupational Health Certification Drug/Alcohol Screening, DOT, BAT Lourdes Campos Medical Assistant Certified DOT Drug Screening Technician, Certified Breath Alcohol Technician (BAT), Pulmonary Testing, HearingNision Testing Linda Diejuste Medical Assistant Certified DOT Drug Screening Technician, Certified Breath Alcohol Technician (BAT), Pulmonary Testing, HearingNision Testing Rolande Jean -Joseph Medical Assistant Certified DOT Drug Screening Technician, Certified Breath Alcohol Technician (BAT), Pulmonary Testing, HearingNision Testing Bonnie Lawson Medical Assistant Certified .DOT Drug Screening Technician, Certified Breath Alcohol Technician (BAT), Pulmonary Testing, HearingNision Testing Dianelys Serrano Medical Assistant Certified DOT Drug Screening Technician, Certified Breath Alcohol Technician (BAT), Pulmonary Testing, HearingNision Testing Maria Garcia Patient Representative / Medical Assistant Registration Certified DOT Drug Screening Technician, Certified Breath Alcohol Technician (BAT), Pulmonary Testing, HearingNision Testing Toledo Murray Patient Representative Registration -4- Mount Sinai MEDICAL CENTER OCCUPATIONAL HEALTH STAFFING (Contd.) Meredith R. Portee Patient Representative / Medical Assistant / Medical Records Registration, Certified DOT Drug Screening Technician, Certified Breath Alcohol Technician (BAT), Pulmonary Testing, HearingNision Testing Linda Ivory Patient Representative Registration / Medical Records Clerk -5- Attachment A Credentials Resumes, Curriculum Vitae, Certificates, Licenses KENNETH J. KAPLAN, M.H. 12300 NE Miami Court North Miami, FL 3316] PERSONAL DATA: Place of Birth —New London, CT Date of Birth — December 23, 1959 Personal and Professional References upon Request CERITIFICATION AND LICENSURE: Board Certified Internal Medicine ] 999 Medical License — Commonwealth of iMass. 1988-1995 Medical License — State of Florida 1994-present Certified Medical Review Officer by AAMRO 2001-present Certified Substance Abuse Professional 2003-present EDUCATION: Medical Doctor: Tufts University School of Medicine Boston, Massachusetts B.S.M.E.: Tufts University College of Engineering Medford, Massachusetts Suma Cum Laude Graduate of New London High School New London, Connecticut Valedictorian HONORS: Tau Beta Pi Engineering Honor Society Tufts University — Medford, Massachusetts POST GRADUATE TRAINING: Residency in Internal Medicine, Faulkner Hospital 1985-1988 /associate Institution of Tufts University School of Medicine Boston, Massachusetts ChiefResidency in Ambulatory Medicine Faulkner Hospital Boston, Massachusetts 1988-1989 STATE OFFLOR1DA DEPARTMENTtOF .HEALTH DIVISION QF MEDICAL. QUAL4TY.A. SURANCF 7.:�'DATE-_.. t CENSE NO"::': 1;; -OO ITROL (N30. 12i1912029 ME 66b52 303t31 Mt_tMCAL DQCTOR bebvr bias rnet aft requiraments of and rules of tha state of EbriOa. ra ion Date: JANUARY 31, 2012 NETWJOSF�N t(API AN IO HE fliAM1 CT. tTI MtAMI, FL, 33181 `Chats G:fist GDVERF4CQR QUAWFICATION(S):... DISPEWING PRAC71i1DNER at i%a M. Viarnr,nl ;ROS, ty4;t3:; M:P..�i. STATE SURC•tON 6FNERAL ❑SSPLAY 1F. REOtX1RED !3`( U>W Personal Information: Date of birth: Citizenship: Marital Status: Languages: Education: Graduate: Post graduate: Positions held : Oct 2003- Present June 1999-July 2000 Dec 1998-May 1999 SAMIRA M. HABIBNEJAD, M.D 1431 SW, 171 Terrace Pembroke Pines, FL. 33027 Home: (954) 499-5923 shabibnejad@yahoo.com February 18,1969 USA Married English, Farsi 1987-1995 Iran University of Medical Sciences Tehran, Iran Medical Doctor degree 2002-2003 Mount Sinai Medical Center Miami Beach, FL. Internal Medicine Residency 2000-2002 Easton Hospital Easton, PA. Internal Medicine Residency Medical staff and Internal Medicine Attending for Out patient department at Mount Sinai medical center. Member of Utilization Review Committee at Mount Sinai and Miami Heart Institute. Fellow of Special Immunology University of Miami School of Medicine Jackson Memorial Hospital Miami ,FL Observer , department of Medicine Jackson Memorial Hospital Miami, FL. June 1998-Nov 1998 July 1995-Mar 1997 Research: Medical Licensure: Certifications: Presentation: Society Membership: References: Research coordinator Interventional Cardiology Cedars Medical Center Miami, FL. General physician Public Health Center Bandar Abbas, Iran Double blind study to determine safety and efficacy of anti platelet agents in post PTCA patients. Cedars Medical Center, Miami, FL. State of Florida, ME88214 (Expires on 1/31/2005) (Certificate No. 0-579-896-2) American Board of Internal Medicine ECFMG -Certified Jan.29,1999 " Chryseobactrium meningosepticum cellulitis following Jet ski accident."a case report. Pennsylvania Coalition for Internal Medicine ACP/ ASIM. ( Pittsburgh, PA. Nov. 2001) American College of Physicians American Medical Association Pennsylvania Medical society 2001 - Present 2002 - Present 2000 — Present Gloria Weinberg, M.D, F.A.C.P. Program Director of Internal medicine Mount Sinai Medical Center, Miami Beach, FL. (305)674-2053 D. Allen Young M.D. Associate program Director of Internal Medicine Mount Sinai Medical Center, Miami Beach , FL. (305)674-2438 Wesley Kozinn, M.D, F.A.C.P. Director of Medical Education Easton Hospital , Easton, PA (610)250-4906 David Kemp, M.D, F.A.C.P. Program Director of Internal Medicine Easton Hospital, Easton, PA. (610)250-4515 Stephen Symes, M.D. Associate Program Director of Internal Medicine University of Miami School of Medicine Jackson Memorial Hospital, Miami. FL. (305)243-4598 STATE Dr FLORIDA DE?ARTMENT OF HEALTH DIVISION OF MEDICAL DUAL Ii}.ASSURANCE AC- 3214036 DATE LICENSE NO. CONTROL NO. 11/25/2008 I ME 8821E i 263402 The MEDICAL. DOCTOR named beiJw hey mei +eauCemeO!5 of UIC IewS and NIe0 of the Stele of Flohda. E pi ion Dale: JANLIARY 3i, 2011 SAMIRA MAHMOUDI FIAWEINEJAD 016-j VI0/900 d 927-1 -006d AYS0:80 OIOZ-91-1flf Vert fication of Physicians cer atioti erican Board nternal Ivleciicirie H )me l Search Results Paec I or I Search Results Verify Another Physician's Certification: by... Dr, Samira Manmoudy Habibnejad Certification Area Certification Certification History Status Certified Internal Medicine End of fist Certified 05/24/2004, Certificate valid through 12/31 /2014 For more details about ABIM Certification, see below: Reporting Certification Status Board Eligibility Representation of Certification Status Suspension and Revocation of Certification Name A91df 10 NPI Comments *ABIM's website serves as primary source verification. '"Certification status is updated to this system within 5 days of notification to physicians. Data elements. such as name changes, are updated in ABIM's records within 24 hours of being processed by ABIM. "'All ABIM certifications issued in 1990 (19887 for critical care medicine, and 1988 for geriatric medicine) and thereafter are valid for 10 years. Dates of validity are noted on the certificates. To remain valid, these certifications must be renewed through ABIM's Maintenance of Certification program. Certifications issued before these dates are valid Indefinitely, although ABIM strongly recommends such certificate holders to renew as well. © 2004 - 2010 American Board of Internal Medicine, All rights reserved, i The ABIM logo is a registered trademark of the American Board of Internal Medicine. El8-1 PCO/EOO d 12V-1 VIJ d llY2E:60 0102-91-117 Joshua M. Trabin, M.D. 2951. South Bayshore Drive, 4311 Miami F1. 33I33 (305) 924-5221 faculty Appointment Mount Sinai Medical Center (July, 2008-Present) Miami Beach, Florida -Associate Program Director of the Internal Medicine Residency -Part of a traditional infernal medicine group practice that is involved in teaching residents and medical students -Faculty and supervising attending for the resident outpatient clinic Committee Membership Mount Sinai Medical Center Miarni Beach, Florida Academic Affairs Committee (July, 2007-Present) Medical Management Advisory Committee (July, 2008-Present) Medical Review Committee (JUIv, 2007-Present) Residency Interview Committee (December, 2007—Present) Residency Management Team (July, 2007-Present) Post -Graduate Training Mount Sinai Medical Center Miami Beach, Florida Internal Medicine Chief Resident Internal Medicine Resident Internal Medicine Intern North Shore University Hospital -Manhasset; New York Obstetrics and Gynecology Intern (J uly, 2007-July, 2008) (July, 2005-.rune, 2007) (June, 2004-June, 2005) (July, 2003-May, 2004) 016-d V10/E00 d RV-1 -VIOad VIV90,80 OIOZ-9l—afar Education Doctor of Medicine University of Miami School of Medicine Miami, Florida Bachelor of Science, Biology Major University of Miami Coral Gables, Florida Honors and Leadership Residency Mount Sinai Medical Center Howard Kane Resident of the Year Award Mount Sinai Medical Center Department of Medicine Chief Resident Award American College of Physicians Chief Resident Award Association of Program Directors in Internal Medicine Chief Resident Conference Florida Chapter American College of Physicians Tallahassee Visitation Trip Selected Chief Resident for the Academic year of 2007-08 (May, 2003) (May, 2000) (.June, 2008) (June, 200S) (September, 2007) (April, 2007) (March, 2006) (September, 2005) Medical School Cushing Academic Society Community Service Director (2002-2003) AssistantActivities Coordinator (2001-2002) Maimonides Society Vice President (1999-2000) Jewish Leadership Institute (July. 1999) Undergraduate Graduated Cum Laude Honors Student ,Association Beta Beta Beta (Biology Honor Society) Golden KevNational Honor Society National Honor Society of Phi Kappa Phi Dean's List x4 Provost's Honor Ro11 x2 Alpha Epsilon Delta (Premedical Honor Society) Honors Program in Medical Education 0t0-d Pto/P0 d 9 V-1 -vtoad lr/30 60 o1o2-9L-1nr Post -Graduate Research and Academic Projects Lecture: Updates in Cervical Cancer ScreeninU 11 Lecture: Auscultation of }lean Soruids Lecture: Updates in Cervical Cancer Screening Lecture: Iv}1CU Conference: Sepsis Lecture: ilvlorbidity and Mortality Conference: Pneumocystis jirovecii pneumonia Lecture: Clinical Vignette: Pancreatic Endocrine Tumor Lecture: Chronic Pancreatitis Lecture: Clinical Vignette: SC Disease Lecture: Cervical Cancer Screening Lecture: Renal Disease and Pregnancy Case Renort: .A patient with GI manifestations of amyloidosis (unpublished) Professional Society Affiliations _American College of Physicians Member American Medical Association Member Association of Program Directors in Internal Medicine Member License Florida: ME r 100162 DEA;`i FT0579257 L'xanzinations American Board of Internal Medicine: Passed in August, 2008 USMLE Step 3: Passed in May, 2005 USMLE Step 2: Passed in May, 2003 USMLE Step 1: Passed in June, 2001 (June, 2008) (October, 2007) (June, 2007) (February, 2007) (January, 2007) (November, 2006) (May, 2006) (November, 2005) (August, 2005) (April, 2005) (October, 2005) Ol6-d Vl0/500 d 92P-1 -M08d 4V'V50:90 OIOZ-91-1(lf 7SC ST. OF FLORIDA DEPARTMENT OF HEALTH DIVISION OF MEDICAL QUALITY ASSURANCE DATE LICi7N.S.E NO CONTROL NO 01/20/2010 ME 100162 309972 • MED CA _ DOCTOR led be ow as me( all recluffeme.nts or laws -and riles of the state or Florida. .iration Dat_: JANUARY 31, 2012 •HUA MICH EL TRABIN ) ALTON R AD VENSTEIN. UILDING MI BEACH, FL' 33140 FED STATS Charlie Crisl GOVERNOR Ana IM. Viamonte Ros, M.D., STATE SURGEON GENERAL DISPLAY IF REQUIRED BY LAW Li) uJ Cr) 3 a C_) E Ow 0 2 tu ° < Cr COOROL I ICE 1.15E HO. w o w ;; JOSHUA MICHAEL TRABIN EXPIRATION DATE JANUARY 31, 2012 icense numb r is RIE 100162, please U9C it In all correspondence v4L, your lions,' Jr.nuncii. Eor.h liccri.soc it, :lois Iv ron,pOnSitlIC for notifying kir depaeLmencte liCcri5CC5 Cu root rnoilirlF, Oddrcon and praculic loos -Won oddro58, If you 11,o, not receivoll your ronowal tiny, prior o thc oxpinadon date sbon.r, e,pac call (BSC) 48B-0595. ii5 3cCfloe te eponn,rn,. r.hAfiFc. Name oOanEo.:: require IeJ docurnc niauon uhuwine_ 61, mono char2n. Pluunc pho:ocopy of no, Of Zhz. C010,,of. panics this 5 rrrO roayrInEr. liccTISC, n divOrt.c. Ocosoc or a C01:r . ord cr. A tirivtr9 liCOOSe or social 9ecurity card is no: considered legal docomornutloa. Quality As turance offers you the convenience of acycrol online services. These service; give you the ability lc r-no, your license, update 0rpraectee tn addresses update your profile information. Cto to .vwvellhealthsonrec.eom 3. Click on Liccnscc/Provider 3. Click on Practitioner Louie Seice, your profession -5 Enter le =taunt ID and per:sword that was providod to you on your license rind click on 'Login". O. t.f you do not know your account IS rind pas3iYord. click on eGci Login tir.it, or 0011 our Comrr COI -Wick Center or ce5ni 4:4.8.0595 for as.:,...Stanec, TO: DEPA DIVISK LICEN P.C. B TALLA TMENT OF .HEALTI-I N OF MEDICAL QUALITY ASSURANCE ING AND AUDITING SERVICES UNIT X 6320 ASSEE, FLORIDA 22314-6320 'IAME CHA GE (ATTACH LEGAL DoCIJMENTATIO(41. LAST FIRST MIDDLE LAST 103. 5/99 016-H FIRST MIDDLE ZOO d 9Z1?-1. -008d IPIY50:80 oLoz-91-ini V eri (ication Of Physicians cer ration American Board of rntemal Medicine' H7me i Search Results 1'aec 1 0l 1 Search Results Verify Another Physician's Certifi t by... Dr. Joshua M Trabin Certification Arca Certification States Internal Medicine Certified Certified 03/19/2008, Certificate valid through 12/31/2018 End of list ra ron: Name n57M tU NPI Certification History Comments For more details about ABIM Certification, see below Reporting Certification States Board Eligibility Representation of Certification Status Suspension and Revocation of Certification •AP?M's website serves as primary source verification. "Certification status is updated to this system within 5 days of notification to physicians. Data elements, such as name changes, are updated in ABIM's records within 24 hours of being processed by ABIM. -••All ABIM certifications issued in 1990 (1987 for critical care medicine and 1988 for geriatric medicine) and thereafter are valid for 10 years. Dates of validity are noted on the certificates. To remain valid, these certifications must be renewed through ABIM's Maintenance of Certification program. Certifications issued before these dates are valid indefinitely, although ABIM strongly recommends such certificate holders to renew as well. GJ 2004 - 2010 American Board of Internal Medicine. AN rights reserved. I The ABIM lcgc ,s a registered trademark of ttfie American Board of Internal Medicine. EI6-4 P00/Z0O d 12P-1 -1/063 VY72E:60 0102-91-101 JUL -1b-1010 u9:t2A61 rKUM- AAMRO ifin 4Te THIS IS TO CERTIFY THAT ttTbirL7)1 7-c . having presented to the Executive Board of the American Association of Medical Review Officers satisfactory evidence of prescribed qualifications and hawing passed an approved examination before the Amrican cksaariatilm rtf a1 Ufficcri in accordance with national standards of competency and expertise established for Medical Review Officers, is hereby accredited and designated as CI Tr.rtififb 4f[&ita1 Piikt @ffiter and by order of the AAMRO Board has been entered as such in the AAMRO Registry of Certified Medical Review Officers Given and dated this Counter.;icmed dad sealed with the Sec( the itnecteati Association of -Medical Rcuicu• of irers the clap and dote above written - h) day of � 1-1z, o9 + t L Corpora lc Secretary Chairman Certificate Number 0 0 6i1,-z.1-. t NAME: ADDRESS: PHONE: EDUCATION AND TRAINING: CURRICULUM VITAE Gerardo Mirisal, N.D. 4491 Fortail Ln Weston, El 33331 Ph: (786) 797-9699 Beeper: (305) 839-2248 E-mail: GMINSAL@hotmail_cow, 1978 Graduated - La Piedad High 5choo], Puerto Rico. 1979 University of Puerto Rico, Rio Piedras Campus, Puerto Rico. 1983 Doctor of Medicine, Unive_sidad Central del Este, School of Medicine, San Pedro de Macoris, Dominican Republic_ 1987-88 1988-91 1991-93 XAMINATIONS: Internship, Caguas Regional Hospital, Caguas, Puerto Rico. Internal Medicine, Caguas Regional Hospital, Caguas, Puerto Rico. Geriatric Medicine, University of Hawaii at 5anoa, Rca}.ini Medical Center, Honolulu, Hawaii 984 Educational Commission for Foreign Medical Graduates. ]987 Puerto Pico Board of Medicine 1992 FLEX 1996 American 5oa_d of Internal Medicine 1999 Certification of Added Qualification in Geriatrics 016-d V10/010"d 92V-1 -VIM 8V90 30 0(02-9I-ii1r PROFESSIONAL EXPERIENCE: Dec. 1998-present: Staff Geriatrician, Mount Sinai Medical Center of Greater Miami, 4300 Alton Rd, Miami Beach, Florida. 33140 Jan. 1995- Nov 1998: Associate Director, Life Care Nursing Home, Crossing Blvd, Orange Park, Fl. Nov. 1995-- Nov 1998: Medical Director, Medwise Center at two locations, 5500 °landing Blvd. i! 1, Jacksonville, FL and 3199 u5 Hwy ]7, Green Cove Springs, FL. Nov. 1996-July 1998: Medical Director, Oak Terrace Nursing Home, Green Cove Springs, FL. Nov. 1996-Nov 1998: ACLS Medical. Course Director, Heart Start, Orange Park, Florida. 1996-1998: Utilization Committee, Member_ Orange Par}: Medical Center, Orange ?ark, 71. ept.-Oct 1995: Medical Director, Le Posada Nursing Home, Miami, FL. _993- May 1995: Director of Geriatric and Family Consultation Services, Division of Geriatrics, Department of Medicine, John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii. ug 1993-Jun.1995: Assistant Professor of Medicine, Division of Geriatrics, Department of Medicine, John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii. Aug 1993-Jun 1995: Director of Medical Students, Division of Geriatrics, Department of Medicine, John A. Burns School of Medicine, University of Hawaii , Honolulu. Hawaii. 92-1995: Advance Cardiac Life Support Instructor, Queen's Medical Center, Honolulu, Hawaii Ol6-d G10/l10 d 92Y-1 -41(na MO 88 OIOZ-91—inc ILITARY EXPERIENCE: 1988-1991: Puerto Rico Amoy National Guard, Juana Diaz, Puerto Rico !991-May 1995: Hawaii Army National Guard, Honolulu, E,3waii Officer in charge of the Cardio-Vancula` Screening Program. April 1997-present: Medical Officer, Florida Aid National Guard, Camp Blanding, P1. THER PROFESSIONAL, EXPERIENCE: 1991-1995: Physician Consultant, Honolulu Heart Program, KuaY.ini Medical Centex, Honolulu, Rawaii, 1iNORS AND AWARDS: Ay Commendation Medal, Puerto Rico Army National Guard, 1990 Sate Active Duty, Hawaii Army National Guard, 1993. Hurricane IniJi relief .ssion . G axo Travel Grant 1993 DICAL LICENSURE: Florida: ME0069508 SSIONAI. ORGANIZATIONS: Am rican Medical .Association AMrican Geriatrics Society Florida Medical Association • Am:rican College of Physicians American Medical Directors Association 016-d P10/210 d 92P-1 -v108j WOO 90 0102-91-1nr C 'MMUNIT:' AND STATE ORGANIZATIONS: 1-93-1995 Member, Immunization Task Force, Department of Health, Honolulu, H wail LECTED RESEARCH: Principal Investigator, Suicide: The Honolulu Study, Poster Presentation at the American Geriatrics Society. A study to investigate the suicide frequency in a multi -ethnic community. 016-d Ol0/El0 d 9dV-1 V�O�d 6Vh'90'90 0102-91-1lf vitai 2003 1991-1995: Physician Consultant, Honolulu Heart Program, Kual<ini Medical Center, Honolulu, Hawaii. -IONORS AND AWARDS: army Commendation Medal, Puerto Rico Army National Guard, 1990 tate Active Duty, Hawaii Army National Guard, 1993_ Hurricane Ini ci relief mission. laxo Travel Grant 1993 EDICAL LICENSURE: -lorida: ME0064508 PROFESSIONAL ORGANIZATIONS: American Medical Association American Geriatrics Society llorida Medical Association American college of Physicians merican Medical Directors Association OMMUNITY AND STATE ORGANIZATIONS: 993 1995 Member, Immunization Task Force, Department of --Health, H nolulu, Hawaii ELECTED RESEARCH: Page 4 016-d MVP LO d 9iV-1 -008d VW90 80 Ol0?-91-111r IU1-D1-2DID 11:2GAM FROM - AC 7 6 2 0 3 STATE OF FLORIDA DEPARTMENT OF HEALTH DIVISION OF MEDICAL QUALITY ASSURANCE I-i 3 r.uuvuui r-uvu DATE LICENSE NO. CONTROL NO. 01/21/2010 ME 64508 310345 The MEDICAL DOCTOR named below has met all requirements of the laws -and rules or the state of Florida. Expiration Date JANUARY 31, 2012 GERARDO JOSE MINSAL-SALLESTER OPDILOWENSTEINS BLDG 1ST FL. 4300 ALTON ROAD MIAMI BEACH, FL 33140 UNITED STATES Charlie Crist Ana M. Viamon1e Ros, M.D,,, M.P.H. GOVERNOR STATE SURGEON GENERAL DISPLAY IF• REQUIRED BY LAW Veri cation of Physicians certi ;lion Page; 1 of 1 American Board of Internal Medicine Hcrne Search Results Search Results Verify Another Physici an's Certification: by... Name Candidate: hat Dr. Gerardo Jose Minsal Certification Area Certification Certification History Comments Status Intemal Medicine Certified Certified 08/21/1996, Certificate valid through 12/31/2006 Geriatric Medicine Not Certified End of list Certified 05/15/2007, Certificate valid through 12/31/2017 Certified 11/04/199S, Certificate valid through 12/31/2008 Diplomates may choose to renew only those certificates most relevant to their practice. 2004 - 2009 American Board of Internal Medicine i 51 D Walnut Street, Suite 1700, Philadelphia, P.4 19106 EI6-d V00/VOO d /2P-1 VIOSd ViVUE 60 0102-91-1f1r CLIZ CUL Uhl VITAE KEY D. INEITLICII, CURRENT TIME: Chairman and Residency Program Director Department of Radiology Mouni Sinai Medical Center Iviiami Beach, Fl 3314C) (305) 674-2680 BOWIE ADDRESS: 2800 Regatta Ave Miami Beach, Fl 33140 cell (305) 213-1430 BIRTBDATE: SPECIALTY L 17,1ai,171/77 January 28, 1963 Unite e States BOard 01:1ad1ology Dates Institution Die;=ree LW11erreUf lite-191-atUS 1981 — 191.'1,5 Clark TiiveLsiiy, Worcestet, 1eJJ. in Biology 1 — 19E9 Harvard iviedical School, Boston, MA 1989 — 1990. The Faulkner Hospital Internship Internal iviedicine 1990 — 1.994 Yale New Haven Hospital Radiology Residency New T-Taven, Li 1"..y93 — 1994 Yale New Haven Hospital II • r-,1" /T TrI Irk ITT r ,"."!/LJtiYird CA RiilER: Dates 7/94 — 1/98 7/96 — 1/98 7/97 — 1/98 Position Assistant Professor, Dept of Diagnostic Imaging Yale University School of Medicine Co -Director, Abdominal Imaging Fellowship Prograrn Dept ofDiagmostic Imaging, Yale 'University School of Medicine Associate Direc,tor, Radiology Residency Training Program Dept ofDiagnostic Imagiiig, Yale University School of Medicine 1/98 — 1/7007 Attending Radiologist, Flovital of St. Raphael 7/98 — 1/2005 Director, Radiology Residency Training Program . • Dept of Diagnostic imaging, Hospital of Saint Raphael 7/98 — 117007 • Assistant Professor, Vale University School ofiviedicin, 7/00 — 1/2007 Section Chief Body Imaging Section Dept of Diagnostic Imaging, Hospital of Saint Raphael 2/2007- present Chairman, Department of Radiology Mount Sinai Me„di cal Center, -Miami Beach 5/2007-10/2008 Program Director, Radioiog-y Residency Mount Sinai Ivieclical Center 11/2009 present Program Director, Radiology Residency Mount Sinai iviedical Center PROFESSIONAL AFFILIATIONS: American -College of Radiology (ACR) Society of Uroradiology (SUR) Society of Gastrointestinal Radiologists (SGR) Yale University Center for Swallowing -Disorders Radiology Society of North America CRS.NA) Connecticut State Medical Society American irviedical Association Exanthier Awlerican Board of -Radiology 2007 — present !aONOF S AND A WARTS Cambridge Who's Who Global Who's 7008 2007 Top Radiologists in Eimer ioa 201E Hospital of St. Raphael 2003/2004 Teacher of the Year Radiology Residency Prooram Hospital of St. Raphael 1998/99 Teacher of the Year Radiology Residency Program Yale New -1. ven Hospital r. w. Clark University R O�.S N @ _;.¢; 1994/9l Teacher of the Year 1985 Summa Cum Laude 1985 Honors Biology 1985 David Potter Prize (Excellence to Dioiog ) 1984 Jefferson Fellow general Academic Achievement) 1984 Junior Phi Beta Kappa TIT TM Ie AT ONS (ORTaiLNAL e CNARCF0 Tyler Neitlich, M.D.. Jeffrey D. NeitIich M.D. The Imaging Evaluation of Cholelithiesis in the Obese patient- Ultrasound vs CT Cholecystograrmy: Our experience with the Bariatric Surgery Population, J Obes Surg, Feb, 2009 Tyler M Stockrnann M.D., Elmer \'alin M.D.. Jeffrey D. Neitlich M.D. CT cholecystography for the evaluation of gallstones in the pre -operative assessment of patients for Bariatric Surgery - a comparison with ultrasound. Society of Crastrointestinai Radiology, June 2006 Levine JA, Neitlich JD, Smith RC. The value of prone scanning to distinguish ureterovesical junction stones from ureteral stones that have, passed Into the bladder: Leave no stone 'unturned. .A.1R 1999 i.7"• 7 7_981 Traubicci J. Neitlich JD, Smith RC. Comparison of Plain Films and Unenhanced Helical CT in Evaluating Phleboliths: Is there a Lucent Center? AIR 1999; i 7i: 11-1 ?. Neitlich JD Foster HE, Glickman MG, Smith RC. Detection of Urethral Diverticuia Using a High Resolution Fast Spin Echo Technique: Comparison with Double Balloon Urethrography, Journal of Urology 1998; 159:408-410. Steinlauf AF, Traube M, Neitiich JD, Cooney EL. Clostridium difficiie colitis: a possible cause of unexplained elevation ofse nn alkaline phosphatase levels in patients with AIDS. Clin Infect Dis. 1998 May;26(5):1248-9. Smith RC, Dalrymple NC, Neitlich JD. Noncontrast Helical CT in the Evaluation of Acute Flank Pain, Abdominal Imaging, 1998; 23:10-16. Neitlich JD Topazian MD, Smith RC, Burrell M, Gupta AG, Rosenfield AT. Non -Contrast Helical CT for the Detection of Common Bile Duct Calculi: A comparison with ERCP, Radiology 1997; 203:753-757. Levine JA, Neitlich JD, Verga .M, Dalrymple NC, Smith RC. Identification of Ureteral Calculi on Plain Radiographs in Patients with Flank Pain: Correlation with Helical CT. Radiology 1997; 204:27-31. PUBLICATIONS (CHAP I'ERS/REVIEW ARTICLES) Levine JA, Neitlich JD, Verga M., Dalrymple ND, Smith RC. Identification of Ureteral Calculi on Plain Radiographs in Patients with Flank Pain: Correlation with Helical CT Yearbook of Radiology 1998. Neitlich JD, Burrell MB, Drug, induced disorders of the small intestine, Abdominal imaging, 1997 Neitlich JD, Burrell MB, Drug Lnduced Disorders Of The Colon, Abdominal Imaging, 1997 Neitlich JD, Scoutt L, Transabdominal and Transoperative Ultrasound, Hepatobiiiary and Pancreatic Surgery: Imaging Strategies and Surgical Decision Making, Wiley 1997 Neitlich JD, Smith RC, Rosenfield AT, Urologic Frontiers in Helical CT, Contemporary Urology, October, 1995. SCIENTIFICPRESENTATIONS/ABSTRACTS Tyler Neitlich, MD., Jefirey-D.-Neitlich- MD., Comparison of 2D/3D and Virtual -CT with IVP for the detection nfTTroepithelial lesions ofthe kidneys ureters and hladder, ST TRTESCrAR �008 Tyler Neitlich M.D., Jeffrey D. Neitlich. M.D., Preoperative Detection of Gallstones in Bariatric Surgery Patients: CT or Ultrasound? Scientific Session, RSNA 2007 Steven Zell M.D., Jeffrey D. Neitlich, M.D. Neoplasia or infection? The mutual mimickers in the GU tract, Computer Presentation RSNA 2007 Tyler M Stockmann M.D., Elmer Valin M.D., Jeffi-ey D. Neitlich M.D. CT cholecystography for the evaluation of gallstones in the pre -operative assessment of patients for Bariatric Surgery - a comparison with ultrasound. Society of Gastrointestinal Radiology, June 2006. Neitlich ID, Acute Flank Pain, Evaluation with Multidetector CT, ARRS Vancouver, May 2006 Truman S, Neitlich ID, Hodges L, Rosenfield AT, Smith RC. Accuracy of Determining the Size of Ureteral Stones using Unenhanced Helical CT. Annual Meeting of the American Roentgen Ray Society, New Orleans, LA, May, 1999. Levine J, Neitlich JD, Smith RC. The Value of Prone Scanning to Distinguish TJ J Stones from Passed Stones: Leave No Stone Unturned. 84-th Scientific Assembly and Annual Meeting of the Radiological Society of North America, Chicago, IL, December 1998. Levine JA, Neitlich JD, Smith RC. Distinguishing IJVJ Stones from Bladder Stones: The Value of Prone Scanning With Unenhanced Helical CT, Annual Meeting of the Society of Uroradiology (Poster Presentation) Bermuda, June, 1998. Traubicci, J, Neitlich JD, Fields J, Smith RC. Unenhanced CT in the Evaluation of Acute Flank Pain in the Pediatric Patient. Annual Meeting of the American Roentgen Ray Society, San Francisco, CA, April, 1998. Nolten A, Neitlich ID, Brown J, Filippi C, Smith RC. The Accuracy of Plain Radiography in the Diagnosis of Facial Trauma. Annual Meeting of the American Roentgen Ray Society, San Francisco, CA, April, 1998. Traubicci J, Neitlich ID, Smith RC. Comparison of Plain Films and Unenhanced Helical CT in Evaluating Phleboliths: Is there a Lucent Center? 83-d Scientific Assembly and Aimual Meeting of the Radiological Society of North America, Chicago, IL, December, 1997. Levine JA, Neitlich JD, Verga M, Dalrymple NC, Smith RC. Identification of Ureteral Calculi On Plain Radiographs in Patients with Flank Pain: Correlation with Helical CT, 83-d Scientific Assembly and Annual Meeting of the Radiological Society of North America, Chicago, IL, December 1997. Neitlich ID, Rosenfield -Darling ML, Smith RC, Comparison of Unenhanced Helical CT Scanning andd-Pulsed Doppler Ultrasound -in -the Evaluation -of Acute Renal Obstruction, 83-d Scientific Assembly and Annual Meeting of the Radiological Society of North America, Chicago, IL, December 1997. Kaplan D, Neitlich JD, Verga J, Dalrymple D, Rosenfield AT, Smith RC. Hematuria Testing In Patients With Acute Flank Pain and Suspected Ureterolithiasis Why Bother? Annual Meeting of the Society ofUroradiology, Sante Fe, New Mexico, June, 1997. Neitlich JD, Hodges L, Barish M, Dalrymple N, Smith RC, The Accuracy of Unenhanced Helical CT In Determining Renal Stone Size and Volume, Annual Meeting of the Society of Uroradiology, Sante Fe, New Mexico, June, 1997 Dickey KW, Hsia HC, Egglin TK, Neitlich JD, Belcher DJ, Rosenfield AT, Helical CT Angiography of the Abdominal Aorta: The Value of th 3-D Image for Branch Detection and Stenosis, SCVIR 1996. Neitlich JD, Topazian M, Smith RC, Gupta AG, Burrell M, Rosenfield AT, Non -Contrast Helical CT versus ERCP in the Evaluation of Choledocholithiasis, Society of Gastrointestinal Radiology, Annual ivieeting, March 1996. Smith RC, Verga M, Rosenfield AT, Neitlich JD, Glickman MG, Non -Contrast Helical CT in the Evaluation of Flank Pain: Diagnostic Criteria and Results, SUR, June 1994 Neitlich JD, Hitzig B, The Evaluation of pH Regulation in the CNS Using NMR Spectroscopy Massachusetts General Hospital Warren Laboratory, MIT, 1984. Neitlich JD, Curtis J, Regulation of Cortico-steroid Production in the Adrenal Cortex, Clark University Press, June 1985 ONGOING RESEARCH Neitlich TM, Neitlich JD, CT Virtual Colonoscopy, a combined approach with flexible sigmoidoscopy, work in progress, IRB approved. Neitlich TM, Neitlich JD, CT Urography- a 3D and virtual approach to evaluating the ureters, work in progress, IRB approved. Neitlich TM, Neitlich JD, Virtual Cystoscopy, comparison of CT and MRJ techniques, work in progress. Neitlich TM, Neitlich JD, 3D Ureterography and Cystography in the evaluation of Hematuria, a comparison with JVP and Endoscopy, Hospital of St Raphael Department of Radiology, IRB approved. Neitlich TM, Neitlich JD, The efficacy of CT angiography as a first line imaging technique for lower Gastrointestinal bleeding, IRB approved Neitlich TM, Neitlich JD -- CT Cholecystography As Part Of The Pre -Op Evaluation in Bariatric Surgery, IRE approved COMMJTTEES Mount Sinai Medical Center, Academic Affairs Committee 2007 — present Mount Sinai Medical Center, Cancer Committee 2007 — present Mount Sinai Medical Center, Resident Selection Committee 2007 — present Hospital of St. Raphael Graduate Medical Education Committee l 998 — 2005 Hospital of St. Raphael, Diagnostic Imaging, Customer Satisfaction Committee 1998 — 2003 Yale Diagnostic Imaging Residency Selection Committee 1995 — 1997 Yale Diagnostic Imaging Abdominal Imaging Fellowship Selection Committee 1995 — 1997 Yale Emergency Department/Diagnostic Imaging Quality Improvement Team 1996 —1997 Yale -New Haven Hospital Curriculum Committees: Laparoscopic Choiecystectomy Pancreatitis 1995 1996 bell p.r Firth: Place c>'f R.i rth: Mari Lc' I SLeitus: Address: FORMAL EDUC:E'.T I ota CURFA;.tlLlUM V FHII 1c S;MET. New Yori♦, N.Y. Married.- three ci,i 1dr:;n -"ji r.11:i:ri; lioad. Miami iiaac.): Florida ;,jltii) F.f... - Juna ?9i 2 New York Lowerv1IC:1?' Ar:s ifr i' PUrc S:..ien._- New ,'crrk . , tz N.D. - Jane, l9 7 New Yori: tin i very i t , Col lede NSW York C1Ly ADDITIONAL T RnI N 1 N: - MEDICAL See i _ i ne int'rnsi-fl, - Mount Sinai hospital, New Yori. - July, 1947 - Jude, 194E FFe> i den: - Internal .Medicine - b-ony. li `. rags Hoso i ;:a i , New 'York - Ju iy.,'19 -June, J a5O; Resident - Internal Medicine - ?Mount fif:'ci Homer; .cl, New York. - July,195DD - June, 1,5;_. F+ss . ...,en;.'ine Phy:.i-ciah - Irv;ngr n House Follow;:p Cerdiac Clinic for Patients with Rheumatic Heart Disease: Fr. Arthur DeLraFf, ChieF, 19117-19;F Research Fellow - Cardiopulmonary Lahr-ratory - Bel ievue Hospital (Cr es't Service and Tirst Me.d i cv ) Division - COurribia anti:. College of Physicians and Surgeons) under fir. A.L.. Cournene and D.r. D.W. Richard, Jr, .iu iy, t9 i - June, 19 3 Senior Ass': Surgeon - U.S. .0 lc Health Service. HospFtel, Manna: an beacn, 1953 - June, 1955 UKIV RSIT1' APPOINTMENTS Urduer;l±_y of Miami School of Medicine, Coral Gales, Florida Instru:tor, Dept of Phvs inlo ry - Ass'4 Profes3or of Physiology - 1956-19.57 Asoc.iaie " " - I9 7-present Ass-'t •Pre}Tes :,r of Medicine A==.SO:irt.:. er Professor of l':c.''ici:, CERTIFICATIONS fr.. orc: Ic,. -1r;7. American Board of Lncernal Medicine: Cent. N. 129Si3 May 5,, is 5 Subspecialty Board of Cardiovascular Disease Cert. No. 12093 December 12, 11;59 Fellow - American College of cardiology Associate Fellow - American College of Physicians 1:95.9 Fellow - American College of Physicians 19E4 - page. LICE1E ie3.0 Januar-y HOHDLAR1ES Phi Beta Kappa Albha Omega Alpha HOSPITAL APPDI-MTMENTS Attending in Medicine ftendinp Physician Devi-, Internal Medicine Senior Attendinc, Physiciah, Dept. of Internal Medicine JacLson Memorial HospiLal Mountin Medical EIiflBeach, Florida Mount Sinai Medical Lenter, miam! Beach, riorida Director, Cardipnulmonary Mount Sinal Medical Lenter, Laboratory Beach, Florida Chic-F., Division of Cardiology, Dept. of ini:ernal Medicine SOCIETY MEMBERSH)Pli Moon!, Sinai Medical Center miami Beach. Florida 1956 - presen - 1964 - resent' 1955 - present 194 - orebehl American Medical Associacion American College of Physiciam American College of Chest Phybi-clans AmerIcan College of Cartlic,logy American Heart Association Heart Association of GreaCer Miami American AssociaTion of Universi:y Professors American Physicians Fellowship, ihc. 'for the la-rael Medical As.sociation The Biomedical Enciineerine Socie:y Alpha Omeoa Alpha Honor Medical Society American Asa:la:ion for the Advancemen-t of Science American Society for [Unica; Pharmacology Therapeutics American Medical WritErs Associa-tion American Society of internal Medicine Nation,a1 Rehabilitation Association American Phytiological Society Florida Heort F]or),Sa Soc;e:'y fttemzil McIdizivie American Federation for Clinical Research International Study Crap for Research in Cardiac Met.a.00lism C - _pap tf. 3 - OTHL PP 0 I VIKENTi; Editorial board - FACE Editorial board - CatheterizaUon and Clardiovaular Formerly Editorial board - American journal of CardioloclY Formerly Editorial Board - Circelation Formerly Chairman, Committee in lCardiovacular Prryiolum - Amer-lc:an Colleye of Chest PhysicLans Formerly Proilram CommiLtte - Amrican Ne-art Association Editorial Board - Mounl Cinai Journal of Medicine Editorial board - Journal of %le. Amr7,...ricnn Colleoe of Cardiclopy RS :gz #569C« POST GR Di1ATF TR AwR !rl: gmD BOARD CPR mA2J+ C)riando 6770 InaiailCreel; arivc, vim isaa.d. zsG! D y S§l6! Married RmmG:a:Q:. m lldr w « ac : S.S. 5OG-17-5461 bm . % A£Shoolof ed w. C.oral GAke d aa(.119 7 26: DmeGEJIi y Coral Gables. Florida Hmml4y w a3. Universily r :Loyola mCia /1.979-14@ .41.LIOLISIZIDECo SummcSchool iS%3«9? studied Spanish Civilizalion itnr.1CuUe Cardiology Fellowship, QcumSi iwei C 6iiBeach, Florida R7G199: Residency, Internal hikdicjn.M w: M dic CerneJ, Miami amidi; Fluridu d9&71993 MedicalLicense: State of Florida, November I 9E9 s:Q DEA: 47.EiSl9335 9 internal Iliedicine, Sept:miller 12, .1990 Cardioloey. November. 1993 fiuii.Rzscarcii - Un-n'ersilorn�i 15;11;5 7:0Sc r hr on - 71'liversir,of. lviiam. 19 Ci ^.1,V'`°.1R,i,iS: NVani d "C)utsIirnditie Felinw G)1 he }.."fir' nit dical residents laid [h: Department of Inicrnad I-k;ledicinr.. ' 991-1 c 2. PRE itiT4TiOrN : Omstantiinn Fellow of the `:`ear-i..t;;p :zn1 n cif I�ictsiciti; l i)cj_-1993 "Thromiinaytopcnia a_rrsocia led with L.enlrspirosis", Clutstandinc Presentation, hioun: Sinai 1:4edical Center, Miami Bach, Floricia-ivlarah 1 9131- ''Thirombo;-ytop_nia as:;Clciritvd wit3Y Leptaspirosir, C)utstandrne .presentation at Regional - 1CF 1vieetinr ?arnpr_ I ;oricit,-Oc_. I E1i~E. M tiical jeopardy ContestraniNeleeting,. 1vlair: h I9E9-Winner. Medical 'jeopardy Cnnt_stani-,1C P Ivivetin . November I c) Second Place in State of -Florian i 4::ciir:ai Jeopardy Gone ,tans r CP title' in= +ytarcli ! 99.0-Winnt:"r t;4edi;:al Jeopardy Corit stint-s.`.CP trlectin October 1941)- Si:conc ?'lace in State of Florida. Resident Lectuie Series, 1'Mtiount Sinai j;li;:dsCtlt-Cantor. tv�iami Beacii. flc+ridlu. "Tr iarniento del Inlaria reatmcnt at Acute Myocardial Infarction) -Latin A:nieritan Conference. Nov. 1991-1+.lount Sinai i.i::iica t cart r. tvfian:ii B ach. Florida. "i�4treric Subita" (Sudden Death). Latin rnerican Coi i ien _e NON'. 1992-Mouni Sintti Medical Center.:iy4ianii lieuch. Florida. ' 1J it Clinic.-o dv1.:E o e-rar, :..,....> _ L'Sr'_nrl_I_F`,'4 1.aiinArnerican.Ccin:ferencc•-1t1t. Sinai 111edi. Cltr.-Nov. F 7! ! 9 "Tqi gmm i nm uoL Miocardio yi pi ,c w aora r m! of acute' E t 3 m w4 ur . tear Am: t ,Cmi m».&ec 3-2:ym;%di IC nL arni Bauch. Florida. St. FranciF Hospital. M.ianiiBw South Mia Hospital -Miami. Flo:- H 2 Can Physician, y:Sinai H7/&.M amia:.:aW,2c d- ab1 l:tkay 3 9. Private P lit L. 4 - m Chici of r g«ycur Clinic 2+ smu fmT93E% Cnuc Case.Pathway forAci:E R edm:a mmi . yT#C .aOCTF' y Physic.thiris &mom =J College Cardiolocy Florida Society of ;Internal Qc:_cii=i National Society fif 'National S \ of internal G6 ar Dude u 1Q Gib meaam PERK < .ININTERESTS: Taai ,r QaE cyclint, tcnnis. 19 IBLic“IONS: Santana 0. Salirstein S. Vii1im D, Machack) I-1. .Agraston AS..Nr.ininvasive clocumenlation of rupture of Mt' interventricular sapunn due It, .subacute bacacrial andocarditis. lo Journal of Echocarclioaraphy 2:Nn '1;26-1.1T. 992. 2. Agatston A.S. Santana 0: .Doppier Echocardiography. CuiTent Opinion in Rilai0102V. AllnUSI 1992, liAV, 15-22. ;Santana (.1"). N7ivas.11).. Rarnos A, Safirstein S. Agatslon.AS. iuJUpIc niyaloma.involvim2 the pericardium associated with cardiac tamponade :Ind constrictive pericarditi!i. A11107 lit:art .1 '1993; 'Vol 126: 737-740. 4. Guarra OR. Santana 0. Saiirstir 5. AqilLSI011 AS. Drattnosis localizad cardiac tamponade following cardiat- swgcry: Tile role of transe.sophageal achocardicutraoliv, Video Journal of Echocardlorraphy; Vol 2145-14E: Ocl. '1992. 5. Santana O. Guerra DR. Vivu 1. Rani t:”. A. Anatsmn AS. Multipic.. myeloma inv.()) V ill!: thc p.r...ricariiurn associated with cardiac tamponatie and constrictive Rericarditis. -Vidc..o Journal of Eehocardir.igraphy. T ht publishad. 6. SEIT11111121 (). VivinsP. Trattuniento il Infurio Agudo tie! tviloc.:artlio (Treatment of Acm IVIyocarchnl Infarction). 'Madico Interamaricann, -Fab. 1992, 4.9-5E, 7. .S'antatia 0. ViV;Z Tratarniento ini-artn P.!..TLIdt) razI, Miarth (Traatrnem fA2Ulf: Myozarclial infarction). I'viedico latcrarnericann, ,Mar. ! 993, 42-50. E. Saratria O. Fantlino-Sende I', Viva!: II'. ivluerte Sublui (Suddan Dcatrii, Medico Interarncticano, M.ay 1993. 45-52. 9. F•;antanti 0 Campo C. Vivm. Aantston AS. Lane Vantricuiar'tirombus in an ;...11-7,ympLonia1ir. Man -A easc rcport. To ix.• submimta. J O. 5.aniang_Q, Franco M. Vivas P. Guerra OR. Aaatston AS. Spindle cal sarcoma prcsentina us right ventricular outflow tract Obstruction. Video Journal Of Echocardiography. 1993 Vol. 3; 67-70. Civarra OR.1.-;antana 0, \'LIF Pi-1. Vianola ,PA, .A.uatston AS. Transesopliaaeal Echo- cardiography in percutaneous.mitral baIkan v vuopay. 711idat-1 Journal of.Echocar- diograPhY, 1993; Vol. 12. Willens 1-1. 5antarni O. Vuoto T. Cluc:n7t, Agaiston AS. Diagno/ns ol IntradorLit: by trantitsoijitageal echocardiography in i patient with dial isthmzi. \ride° journal of Ecthocarclraphy. April 1 993, 11n1 3, 'No 2, 46-49. 13. T71-ancri k4. Cicara R._ Santana0. Viv115: P..indicacioner. pan mareapaso:: ell aCiutIOS (indi- cations for.pacernakers in adults). hiledito Interarnericano. :lune 59-66. 14. .Franco .114, CicLtr lt. Santant:. r). Vs I'. Incii;:acionts:para 1 Implante de CIardiocierfi- briladores Autornaticos•del -Corazon (i-ndientions for Ai CD). Medico Interamericano, Nov. 1993, 15- I 8. .115. Jaraki AR, Santana O. Fandino-Sencie 1. Ayaision.AS. ,Asymptomatic Sinus of Vnisaiva aneu7sirf c)mpressirg; the left main coronary artery. Video journai of 1.'„,chocarcliog.raphy; 1993: Vol. 3: 71-72. 16. Ceara 1,1.1v1. Santana C): El uso clinic° del Ecc Transtsoil4ico (Clinical Me of TEE). lviedico Interamcricano. Aug. 1993: 117-24. 17, Gtara RM.Santana a La ..E.:coaardiograila Trunsesofae,ic.a (Transcsoriliaaeal Eeno cardiourapliy). CardicliouiL Intercontinental, \To] 3, 1No 1, Jan -April 1994, 58-6). 1E. A2atston AS. Junowitz, \VR, Genre 1.1,1\1, antnw 0.Tornoarafia c.ornputarkr.ada rapidri part,. visualizar 1a arteriaF corona.rins. (Ultra -fast Ct visualize the coronaries) Carclibioaia tritercomincmal 2.„ 92. Iv:lay-August 1993., 56-59. 19. Audtstor, S. Janowil2„ Cicara RM. Santana O. Visu izion dc las coronarias pt)r rneciio del Imatror: tile.ctronarits by 'the I matron). tvledico Internmcricano. July 1993. Vol. 7 35-28. 20. Safirstein 5.:11anuma 0.AualS1.011 AS. Thyrotoxicosis assoziated with a reversible .Dilatecl Cardiornyopatlw. Amer 1-leart J. Sept. 1994. 61 6-6.17. 21. Urcna P. Taveras 111 J1V1. Santana 0, Crespo F. Coronary Artery Dissection. To be published -Resident It Staff Physizian. 22. Taverns 11.1 .110, f.,.antarm 0. Urena P, Crespo 9. Mancjo moderno del pacierne con cui-dio- rniopatia hiperirofica (Manageincnt ofpatients with .1-lypenrophic Cardioniyopathy). Medico Interarnericand, 'Feb. 1994, 71-72. 3. Sencic!jfvlF. Samaria RIVI. f--antlinii O. Viva!: P. Senat..• FP: Diatmosticodi rnciai dias taquiearciius de comple.io QRS arnplio (Din Dial.:Lnusi::: of Vide Conipit: Tachycardia), IVIeclico Interanierizano. Scrit. 1992i, ?:::-L37, 24. Gearn R.4S'aniEtrw 0: 1:'-evision rk lOs esLudiosd rnortaiidild n iaUc curdiaco contestivo. (Review of Mortality Stuiie,„;on Ct)ngestive Hean Fai)ure). lvieciieu I meranyerieario, 1994, 22 I -223. 25 Gezira R. Sitntano (:: Revision cie toi.; estudius de roonalidnd d1c earcliaco cones-v. (Review of iVioruilil.y in CHF). To ;lc publisiled-Cardiciloaia Intercontinemal 1994. 26. .1): El uso dc :Betli-bloqueatiores on pacicnits•zon insuficiericiL card iacp.. fU of beta-blockers in Canuegtive '.Heart Failure). To be published-ivittlicolraerarnericano, Nov. 1994. 7. $antanit 0: El use k lielL-bloqueatiores en paciernes eon insuncienciv, curdiaea. (Bow- blockers in CHF). To be publisheri-Cardiologin Intercontinernal, 1994. Attachment B Privacy Notice of Privacy Practices Policy and Procedures Ol,(11t Sinai Department: Organization Wide Poliey 'Number: Subject 2.3.0.036 Privacy:'Notice of Privacy Practices or: ; Administrative Approval: Senior VP and Chief .Finan4iicer Effective Date: April 1-4, i P.olic-y Drigina 2003 Privacy Officer Review Date: Feb 05; 12/05;5/07; 10/08; 7/09 Revise Date: PURPOSE: Compliance with HIPAA Privacy Rule, 4:5'CER,§ 1.64.520 —Notice of Privacy Practices for Protected Health Information (PHI,) The purpose of the Notice is to explain how -the 'Medical Center will use 'and:disclose the individuals protected health information (PHI)and to state the individual's rights and the Medical Center's legal duties with :respect to PHI. it SCOPE: The policy -applies 'to .311:patients who have a direct:treatment relationship with -the facility. III. POLICY: tt-is.the policy of Mount Sinai Itiled.icai Center to promote the individual's unoerstanding of the .facility's privacy:pra.ctices. A..component of tacilitatinc the understanding of privacy practices is to provide a notice of privacy practices to our patients. IV PROCEDURE: A. A "Notice of Privacy Practices "will be provided to individuals no later than the date of first service delivery::and-to.any:member ofthe priblic upon request. B. As a covered direct treatment provider, Mount Sinai Medical' Center will make good faith•effort to obtain -the individual's written acknowledgment of -receipt of the notice. Patient acknowledgment will be documented in .the "Authorization and .Ceneral'Consent" form.:in circumstances :that do not allow for written ackn:owledgemeritto be Obtained, a reason for not -obtaining the acknowledgement.vvill be documented. For emergency situations, in orderto not:impede an individual's timely .access to quality:health care, delivery of the Notice and acknowledgement by the patient will be delayed until reaso„ably'practicable after the emergency situation. as specified in 4-5 CFR ::§164.520(c)(2)(i)(B) and 46 CFR §:164.520 1,c) (2) (ii) D. The information, referred to as the individual's health or medical record serves as a: • Basis for planning patient care and treatment • Means of communication among the health professionals Who contribute tothe patient's care • Legal document:describing the care the. patient. receives Means:b.y which the patient ore -third party payer can verify that services billed were actually provided • A tool in educating health professionals • A source of data' for medical research • A source of 'information for public health officials charged with improving the health of the nation • .A source _of.data for facility.planning and marketing • A tool with which we can assessand continually work to improve the care we render and the outcomes weachieve E. Patients have the righto: • Request.a.restriction on certain uses and disclosures of information as provided by 45 CFR § 1:64.522 • -Be provided with -the "Notice of Privacy Practices" • Inspect and copy their health -record as .provided -for in 45 CFR .S 1.64,524 • Request amendment(s) to their health record as provided in 45 CFR § 164.528 Obtain an -accounting of disclosure :of healthinformmation .as provided in 45 CFR. fi 1:64.528 • Requestcommunications health information by alternative meansor at alternative.locations • Revoke their,authorization-to use or disclose-health:information-except to the extent that action has already Peen taken in relianceon'their authorization F. Mount Sinai Medical Center is required 10: • Maintain -the privacy of patient`health information • Provide -the .patient with a notice as to our -legal duties:and-privacy practices with respect to information we collect and'rrmaintain about the patient • Abide by the terms of.the.Privacy Notice • Notify -the patient if we are unable to agree to a requested restriction or amendment • Accommodate reasonable:requests that the patient may make to have health information communicated_ by-alternative.means or at alternative locations G. Mount Sinai Medical Center reserves .the right to change our, practices and to make the new provisions effective for all protected health information we maintain. H. Revisions made to the "Notice of.Privacy Practices" will:be posted on the Medical Center's web site. Patient health information will not be disclosed without:author,ization except as described in this policy. For all other requests for disclosure refer to Privacy: Release of Protected Health Information policy and procedure J. Patients who believe _their privacy rights have been violated may contact the Privacy Officer of Mount Sinai .Medical Center at 305-674-2722. Further complaints may be made to the -Secretary of Health and:Human Services, Office of Civil Rights. V. REFERENCES: 45 CFR 164.520 ("Notice .of Privacy Practices for Protected Health Information") 45 CFR 164.522.("Rights to Request Privacy Protection for Protected Health Information") 45 CFR 1.64.524 ("Access of Individualslo Protected Health Information") 45 CFR 164.528 ("Accounting of:Disolosures.of Protected. .Health Information") MSMC Policy 2.30.021 ("Patient RequestforRestriction:anrd;Confidential Communication of -Protected Health information') MSMC Policy2.30:024 (';Patient Access and Amendment to Health Records") MSMC Policy 2.3'0.045 ("Filing A Health Information Privacy Complaint") Mount Sinai MEDICAL CENTER Proposer's Occupational. Health Clients List (cont'cl) City of Surmise Fire Department Contact Person: Chief James Dixon Telephone No. 954-746-3400 E-Mail: Jdixon(Ocitvofsunrise.com Work Performed: Hazmat Physicals Comprehensive Health Services Contact Person: Tammy Simonson Telephone No. 1-800-638-8083 E-Mail: Tsimonson@CHSmedical.com Worked Performed: Pre -employment and Annual Physicals and Drug and Alcohol Screening Miami Dade County Public Schools -Police Department Contact Person: Joey Diaz Telephone No. 305-757-7708 Work Performed: Pre -employment and Annual Police Physicals Miami Parking Systems Contact Person: Socorro Perez Telephone No. 305-373-6789 E-Mail: Sperez@miaminarking.com Work Performed: Preemployment and Annuals and Drug and Alcohol Screenin g Village of Bay Harbor Islands Police Department Contact Person: Assistant Chief Duncan Young Telephone No. 305-866-6242 Worked Performed: Pre -employment and Annual Physicals and Drug and Alcohol Screening Village of Pinecrest Fire Department Contact Person: Mayra Sauleda Telephone No. 305-234-2121 Work Performed: Pre -employment Physical City and Police and Drug and Alcohol Screening -7- Mount Sinai MEDICAL CENTER Proposer's Occupational Health Clients List (cont'd) Village of Key Biscayne Fire Department Contact Person: Chief Eric Lang Telephone No. 305-365-8989 Work Performed: Pre -employment and Annual Physicals and Drug and Alcohol Screenin g Village of Key Biscayne Police Department Contact Person: Chief Jose Monteagudo Telephone No. 305-365-8989 Work Performed: Pre -employment and Annual Physicals and Drug Screening Village of Pinecrest Contact person: Peter Lombardi Telephone No. (305)234-2121 Worked Performed: Pre -employment /Annual Physical /Standard Physical and Drug and Alcohol Screening Ecology& Environment, Inc. Contact Person: Paul Jonmaire Telephone No. 716-684-8060 Worked Performed: Pre -employment and Annual Physicals and Drug Alcohol Screening Intercredit Bank Contact Person: Nadia Avelar Telephone No. 305-375-8442 E-Mail: Navelar@intercredit.com Work Performed: Drug and Alcohol Screening Lloyds Bank Contact Person: Carol Ann Loo Telephone No. 305-5.79-8905 Work Performed: Drug and Alcohol Screening -8- Mount Sinai MEDICAL CENTER Facility and Location Mount Sinai Medical Center is located at 4300 Alton Road Miami Beach, Florida 33140. The Occupational Health Department at Mount Sinai is located on the first floor of the Lowenstein Building with adjacent 30 free parking spaces for the City of Miami employees. The Occupational Health Department has approximately 8,000 sq. ft. dedicated to the waiting area that is designed to hold a maximum capacity of 60 persons at one given time. Hours of operation are Monday through Friday, 8:00 am to 5:00 p.m. (Hours are flexible). The designated area is comprised of: 5 Diagnostic exam rooms -• 4 Physical Examination rooms The following equipment is used to perform services: • Audiology testing booths that meet OSHA standards with testing capabilities from 500 to 8000 Hz Visual Screening instruments for visual acuity, muscle balance (horizontal and vertical phoria), depth perception, color perception, and binocular vision 14 and 24 plate Ishihara and 15D-Farnsworth tests for color deficiency Diagnostic Spirometry Testing using a Fleisch-Type Pneumotachometer with computer graphics and interpretation. •• Handheld non -contact tonometer for glaucoma measurements 12 Lead EKG machines electronically connected to Board Certified Cardiologists for interpretation. • Complete phlebotomy and comprehensive radiology services on site. • US DOT approved ALCOMonitor for breath alcohol testing The Occupational Health Department has back-up equipment on premises. Mount Sinai Medical Center is conveniently located next to the Julia Tuttle Causeway, 1-95 Expressway; exit Alton Road North, 5 miles away from City of Miami. Metro Dade public transportation buses have regular scheduled stops at the Main entrance of Mount Sinai Medical Center, De Hirsch Meyer Building, and a short distance to the Occupational Health Department and are handicap accessible. 9