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HomeMy WebLinkAboutExhibit 4 (2)Attachment C Fee Proposal Line: 1 Description: Entploymenl and Promotional Physical Examinations for Non Sworn Classifications Line: 1.1 Description: Basic Physical Examination (including lab work, visual exam, and audiological exam) Categoiy: 94874-50 Unit of Measure: Each Unit Price: $ S•{) • 0 0 Line: 1.2 Number of Units: 425 Total: $ 3 000: DD Description: Additional/Optional Examination Components: PPD Test Category: 94874-50 Unit of Measurer Each Unit Price: $ 7 OU Line: 1.3 Number of Units: 600 Total: $ 3 °op . Un Description: Additional/Optional Examination Components: Back X-Ray Category: 94874-50 Unit of Measure: Each Unit Price: $ 0 0 Line: 1.4 Number of Units: 5 Total: $ 300 . c0C7 Description: Additional/Optional Examination Cotponents: Chest X-Ray Category: 94874-50 Unit of Measure: Each Unit Price: $ 40. 0O Number of Units: 50 Total. $ d1Cc C , 00 Page 4 of 41 Line: 1.5 Description: Additional/Optional Examination Components: EKG (12 lead) Category: 94874-50 Unit of Measure: Each Unit Price: $ Line: 1.( Number of Units: 425 Total: $ 1 A-) "15 MO Description: Additional/Optional Examination Components: Rubella Titer Category: 94874-50 Unit of Measure: Each Unit Price: $ t.5.00 Line: 1.7 Number of Units: 5 Total. $ 00 Description: Additional/Optional Examination Components: Rubella Immunization Category: 94874-50 Unit of Measure: Each Unit Price: $ — Number of Units: 5 Total: $ — ?•/ t Line: 1.8 Description: Additional/Optional Examination Components: Review of Miscellaneous Medical Records Category: 94874-50 Unit of Measure: Each Unit Price: $ 15.00a Number of Units: 5 Total: $ 75 , U 0 Page 5 of 41 Line: 1.9 Description: Additional/Optional Examination Components: Hepatitis A, B, and C Screening Category: 94874-50 Unit of Measure: Each Lim. Price: $ lip •00 Line: 1.10 Number of Units: 25 Total: $ 'I, c'CV •ts)() Description: Additional/Optional Examination Components: HIV Testing & Counseling - EL1SA Test Category: 94874-50 Unit of Measure: Each Unit Price: $ . $ •0 0 Line: 1.11 Number of Units: 25 Total: $ 5 • D-? Description: Additional/Optional Examination Components: F11V Testing & Counseling - Western Blot Category: 94874-50 Unit of Measure::Each Unit Price: $ < •0 t' Line: 1.12 Number of Units: 25 Total: $ . C 0 Description: Additional/Optional Examination Components: HIV Testing & Counseling - Pre Counseling Category: 94874-50 Unit of Measure: Each Unit Price: $ Number of Units: 25 Total: 5 Page 6 of 41 Line: 1.13 Description: Additional/Optional Examination Components: HIV Testing & Counseling - Post Counseling Cateeory: 94874-50 Unit of lvle,sure: Each Unii T'rice: $ Line: 1.14 ;ET Number of Units: 25 Total: $ Description: Additional/Optional Examination Components: HIV Testing & Counseling - Measles, Mumps, Rubella immunization Category: 94874-50 Unit ofMeasure: Each Unit Price: $ bp: 00 Line: 1.15 Number of Units: 5 Total: $ 3DO (00 Description: Additional/Optional Examination Components: HIV Testing & Counseling - Tetanus Vaccine Category: 94874-50 Unit of Measure: Each Unit Price: 5 3tl . f)C) Line: 2 Number of Units; 5 Total: $ i Si) • UC) 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 Unil Price: c'c' Line: 2.2 Number of Units: 60 Total: $ 4, '0D 06) Description: Additional/Optional Examination Components: Chest X-Ray Category: 94874-50 Unit or Measure: Each Unit Price: S y-,o 0 Line: 2.3 Number of Units: 60 Tota Description: Additional/Optional Examination Components: EKG Category 94874-50 Unit of Measure: Each Unit Price: S ,3; .0 0 Line: 2.4 $ ,2,4cr.o6 Number of Units: 60 Total: $ '00 O L> Description: Additional/Optional Examination Components: Back X-Ray Category: 94874-50 Unit of Mcasure: Each Unit Price: $ (0, UD Line: 2.5 Number of Units: ] Total: $ (C' ' 00 Description: Additional/Optional Examination Components: Cardiovascular Stress Test Category: 94874-50 Unit of Measure: Each Unit Price: 55 D ,G 0 Number of Units: 60 Total: $ LS— C)0,00 Page 8 of 4 1 Line: 2.6 Description: Additional/Optional Examination Components: HIV Testing & Counseling - ELISA Test Category: 94874-50 Unit of Measure: Each Unit Price: $ • 0 Line: 2.7 Number of Units: 60 Total: $ ;5oc .OG Description: Additional/Optional Examination Components: HIV Testing & Counseling - Western Blot Category: 94874-50 Unit of Measure: Each Unit Price: $ Line: 2.8 Number of Units: 60 Total: $ I, 50C) , D 0 Description: Additional/Optional Examination Components: HIV Testing & Counseling - Pre Counseling Category: 94874-50 Unit of Measure: Each Unit Price: $ Line: 2.9 Number of Units: 60 Total: $ Description: Additional/Optional Examination Components: HIV Testing & Counseling - Post Counseling Category: 94874-50 Unit of -Measure: Each Unit Price: $ Number of Units: 60 Total: $ A47 Page 9 of 41 Line: 2.10 Description: Additional/Optional Examination Components: PPD Test Category: 94874-50 Unit of Measure: Each Unit Price: $ 5.00 Line: 2.11 Number of Units: 60 Total:S 3OE,0 Description: Additional/Optional Examination Components: Hepatitis A, B and C Screening Category: 94874-50 Unit of Measure: Each Unit Price: '0c) Line: 3 Number of Units: 60 Total: S r LI 00.00 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: S go ec Line: 3.2 Number of Units: 60 Total: $ 4-) .c-Do. OD Description: Additional/Optional Examination Components: Chest X-Ray Category: 94874-50 Page 10 of 41 Unit of Measure: Each Unit Price: $ Like ,00 Line: 3.3 Number of Units: 60 Total: $;),C`4L Description: Additional/Optional Examination Components: EKG Category: 94874-50 Unit of Measure: Each 11nii ]'rice: $ Line: 3.4 Number of Units: 60 Total: $ a ,100 00 Description: Additional/Optional Examination Components: Cardiovascular Stress Test Category: 94874-50 Unit of Measure: Each Unit Price: 5 0 Line: 3.5 Number of Units: 60 Total: $ 1$ / 000.0 0 Description: Additional/Optional Examination Components: Back X-Ray Category: 94874-50 Unit of Measure: Each Unit Price: $ (vtl u17 Line: 3.6 Number of Units: 1 Total: $ 00 Description: Additional/Optional Examination Components: Hepatitis A, B, and C Screening Category: 94874-50 Unii of Measure: Each Unit Price: 5 tW , Number of Units: 60 Total: $ ,Q t yrl(; •L7f% 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: $ 00 • 0 L� Description: Additional/Optional Examination Components: Pulmonary Function Category: 94874-50 Unit of Measure: Each Unit Price: $ 2 5 0 C) Line: 3.9 Number of Units: 1 Total: $ 0 Description: Additional/Optional Examination Components: Blood Type & Rh Typing Category: 94874-50 Unit of Measure: Each Unit Price: $ 9.0 0 Line: 3.10 Number of Units: 1 Total: $ 2 el. 0 t) Description: Additional/Optional Examination Components: Rubella Titer Category: 94874-50 Unit of -Measure: Each Unit Price: $ ,214.,0 D. Number of Units: 1 Total: $ 4.0 0 Page 12 of 41 Line: 3.1 1 Description: Additional/Optional Examination Components: Rubella Immunization Category: 94874-50 Unil of Measure: Each Unit Price: S Number of Units: 1 Line: 3.12 Total:/`(rkm t�2e 824..'ret-C" Description: Additional/Optional Examination Components: Review & Provide Written Interpretation of Medical Records Category: 94874-50 Unit or Measure: Each Unit Price: 5 2 S .0 0 Linc: 4 Number of Units: I Total: $ 01 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: $ 3t .60 Number of Units: 400 Total: 5 /,?j l?otl - c U Page 13 o141 Attachment D Facility Map GUMENICK AMBULATORY SURGICAL CENTER Occupational Health Located in the Lowenstein Building (Part Lot B) Mount Siriai t E D I c_: :a I. CENTER DE IURSC11 MEYER ''.TOWER. , 4308 GOLDEN MEDICAL `' OFFICE BUILDING 4302 SIMON MEDICAL OFFICE BUILDING Attachment E Departmental Brochure Mount Sinai MEDICAL CENTER Occupational Health Services Offered: 0 Pre -Employment Physicals O Drug & Alcohol Test Program 0 Executive Physicals 0 Workers' Compensation O Immunization Program Cl Wellness Program O Fitness for Duty / Return to work Programs O 24-hour Emergency Department O Employee Health Rapid Response Service include: O 24-hour Emergency Department with Drug Testing Occupational Health: Hours of Operation — Same day or next day appointments Medical Evaluations Results — reported to the Human Resources Representative within 48 hours from time applicant is seen Strong Physician Experience: Kenneth Kaplan, M.D. — Medical Director of Occupational Health, SAP. Cert. in Workers Compensation Joshua Trabin, M.D. — Medical Review Officer. SAP Gerardo Minsal, M.D. Clinicians: A team consisting of 11 individuals, comprised of Advance Registered Nurse Practitioner (ARNP), Licensed Practitioner Nurse (LPN), certified DOT drug screening technicians, certified breath alcohol technicians, and medical assistants Management Staff Linda Arama, Director Occupational Health Services Jenny Audain, Supervisor Occupational Health Services • Occupational Health Services Facility • Facility: 5 Diagnostic exam rooms and 3 physical exam rooms • Location, Location, Location: • Occupational Health Services is conveniently located at Mount Sinai Medical Center, Lowenstein Building (4304 Alton Road) • Parking — Easy Access, provided free of charge in the Lowenstein Parking Lot "B" Directio:ns to Mount Si.n.ai From Miami International Airport/West Dade County Follow the airport signs to State Road 112 east. After you exit the State Road 112 tollbooth, take Interstate 195 east to Miami Beach. Signs will direct you to "Alton Road/Hospitals." Mount Sinai Medical Center is on the left. From Southwest Dade Take State Road 836 east to Interstate 95 north to Interstate 195 east to Miami Beach. Signs will direct you to "Alton Road/Hospitals." Mount Sinai Medical Center is on the left. From North Dade, Broward and Palm Beach Counties Take Interstate 95 south to Interstate 195 east,to Miami Beach. Signs will direct you'to "Alton Road/ Hospitals." Mount Sinai Medical Center is on the left. From West Broward Take Interstate 595 east to Interstate 95 south to Interstate 195 east to Miami Beach. Signs will direct you to "Alton Road/Hospitals:" Mount Sinai Medical Center is on the left. tsviclunt Sinai M E D I C A 1. CENTER Location Mount Sinai Medical Center Campus Lowenstein Building 4304 Alton Road Miami Beach, FL 33140 Parking available in the Lowenstein Parking Lot B HLo_v-11'I—Z,_.11U • 0f Miami Page: 0.4 LARRY M. `['RING (I-n•, 4i,1%moo i;'(IcL' Ms. Linda Aroma Moor Sinai Medical Cenfe 4300 Alton Roar1. Lawenst in Building MIimi Peach. FL 33140 1'1D1'i . I—H 1 1 tJN 1 M.,t;CSti tgittj .ref 4affimi August 5, 2010 SENT VIA EMAIL. AND FAX RE: Response to RFP 22 240 Physical Examination Services Dear Ms. Aroma; CARLOS A. tvHGUYA Cith mare,: The Cite of Miami is in Eh process. of evaluating your proposal response to RFP 220240 for Physical Examination Services. 17 u cer to assist us in the evaluation process, we need additional information and documentation regarding yIur response. Pu-suant to Section 4.1(4) ), SUBMISSION REQUIREMENTS, the following requirement is reflected: cj Submit a copy s) of credentials for all physicians performing examinations, including Cardiologist, and R=•iofogist. include copies of State of Florida license and copies of Board Certification in intern.' Medicine or Femily Practice for physicians performing examinations. Specify whether any of the • ysicians, to be assigned to the City's account, have ever had any complaints filed against them. If o, disclose and discuss. Your proposal response, wever, failed to include "copies of Board Cer►ificalian in Internal Medicine or family Practice for physic ns performing examinations". Therefore, al this lime please submi: conies of Board Certification in inter al Medicine or Family Practice for the physicians listed below: • Kenneth Kapl , M.D. • Joshua M. Tra■in, M.Q. • Gerardo Jose 1Ainsal-Ballester, M.O. • Samira Habib ejad, M,D. Addllionally, although resu es for the Cardiologists and Radiologists listed below were included in your proposals, the City is her by requesting that other credentials such as copies of Board Certficat:on in i-Zadiolugy and Cardiology ,nd copies of State of Florida license be submitted at this time. • Orlando Santa a, M.D. Cardiolooist • Philip Somet, Cardiologist • Jeffrey D. Neil ich, M.D. Radiologist Hui,-1U-1.51U :fir,:.fib ri�i"P._ t'H ltl`! I HIJ._tb.`, Date: tiffs/GVIV tiMG. ✓: r + .V. Of- Miami Page: 005 Ms. Linda Aroma August 5, 2.010 Page 2 _Mir, ��,r7ew r.e�aiati Furthermore, Special Cordlion, Section 2.17, Compensation Proposal, states the lollowing requirement: "Each Proposers tall use the Lines section of this RFP to subrr.0 all fees and costs tc provide the required services es listed herein.. Proposer may also detail any additional tees that are necessary to meet the terms of this RFP and provide all services as detailed in Section 3 Scope of Work. The City reserves the right -to add or delete any service, at any time. Should the City determine to add gn additional service for which pricing was not previously secured, the City shall seek the Successful Proposer to provide reasonable cost(s) for same. Should the City determine' the pricing unrest onabie, the City reserves the right to negotiate cost(s) or seal( another vendor for the provision of said service(s). Failure to sutra it compensation proposal as required shall disqualify Proposer from consideration." Your proposal response, however, failed to Include "all toes and costs to provide the re.quired services as listed herein" For example, Line 1.7 - Additional/Optional Examination Components: Rubella Immunization and Line 311 - Additional/Optional Examination Components: Rubella Immunization, of your proposal response included the fallowing comment: "Manufacturer cannot supply in USA" Al this lime, please clarify by selecting a response below, if the City is to interpret your comment cited above as meaning that vlount Sinai Medical Center is unable to provide the City of Miami with the goods/services requested in Line 1.7 and Line 3,11 of the RFP: Correct, Mount Sinai Medical Center is unable to provide the City of Miami with the "Rubella Immunization for the reason stated In Lines 1.7 and 3.11 of the Proposal response. [ ] Incorrect, the City is to interpret Mount Sinai Medical Center's comment as follows: Additionally, your proposal response indicated what appears to be a "zero" dollar amount in the "Unit Price" and "Total" sections of the following line items: Line 1.12 - Additional/Optional Examination Components: HIV Testing & Counseling - Pre Counseling: Line 1.13 - Additional/Optional Examination Components: HIV Testing & Counseling - Post Cou �seling; Linz 2.8 - Addtionat/Optional Examination Components: HIV Testing & Counseling - Pre Counseling; Line 2.9 - Addrtional/Optional Examination Components: HIV Testing & Counseling - Post Counseling At this time, please c;arify by selecting a response below. what is meant by your response for the above cited line items: (Xj Mount Sinai Medical Center is proposing toprovide these services at "no -charge" to the City of Miami. ger- 4r- Co �'Sw.E, en pO t V per C-00 n Sal ri l j 1 Mount Sinai Uedicai Center is unable to provide these services to the City of Miami, HUU-I J-GU L U vlr ..� r 1lQLC U/ U/ g.vty Of Miami Page: ►0 Ms. Linde Amnia Auglist 5, 2010 Page H I 1 CIA I HV-�CSD Please sip below to cant rm your response made on the previous page: Print Nance Title Signs i + , R 1 t� Date f „A:JD r ,u4 r . E',Iy/ A response to this let r must be submitted to the attention of Yusbel Gonzalez. via email: y_gonzalez@miamigovco or fax: 305-400-5104, by no later than Tuosdav, August 10, 2010, at 2:00 P.M Failure to respond by the-tlputated date and time may deem your bid non -responsive. Thank you for your coope etion. Sinr, rely ring Ctfief Financial Officer LS:LP.:yg TOTAL F'.1J4 ABMS Board Cmiiloatlon Credentials Prafte ABMS® Board Certification Credentials Profile A 5ervKC P,Pymed oy me Amenoan hoa1P al ncavlSpecialneo Pnw Search p 509129 P000555 1 0.5000ce I Save Physician I Pnn, Kenneth Joe,nh Kaplan (ABMSUID - G21822) V,ewed00/2010 9:42:21 ALI CST DOB: 122111959 Sbala' AM. LenMiumm� Arneneen Da. al Medicine internal Medicine- General Status: (writhed pan.rlmilad PareMM1mmn 155I12009 • 12A112019 EerueE �imimnlm imUdl Cendealgn OBRe/1996- tYl1f4009 Edutenvn 1085 LC ...Prof M0(Palno) cm Direct Wf Connect - MIvp 71•177 um actenuns artySian,eemaob.ed e Lewema,nla Pngnanaew lea OM. ane .esoalm,eovralleen[s'or aca�gwelreu set 0l JCA1m. near. WU: e,m aaer eroSu,gepwee'Mw a tie ABMS 0nyeoene9ee0,y cennunan eau women ny L0[FACT9OmMeggaMeuw am moyA udw Me 200P.an 0pae POMednai sosoenml I0.0M5L1 ono sugec 10 Inc ,ne'vemo, gopem uwe or me U1ved Pp. e A91J5. AL PN1m Hvv.a0 or ADM 1.177ec1 Conn. em A0M5 Dami nmwy Apw, e9u e.e ,wisem Uaaeman_. of n,e 'uneaten mem nl Meow ticeco mes. h¢psJISOI3V.evllifx:ts.orp,�d1/DGReoort.asp xtabm5wd=62/022 8N912t118 • .., A.,.."1...• Sar..--,..-. ' . - A. • I1;51- ' ' ): " F .i...--C-..- • ' , • I- - . ' " - - , . .. -* . , ,..,41 : :T.,: • ' . : 7 t.14.ci.4 1 • 114t1.•,,,l'E'Cir ' ; •:, :.'-',. . 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'-1 .:•.'.'':-..-:, • 7, ':.:-:',:f.-.;::_...4...-.-..-,.. -.....j.L...',,,:....,; •,:. - -,, _ ..,,, e,.._ ' 1 !' :,- ,.: • -,7 . ioos. ., •,•. . ...— ... -1)0AIRD OF 1NCORPUliA7 ED 1936 ATTESTS THAT tWtw Z.1Jtit oat HAS MET THE REQUIREMENTS OF THIS BOARD AND IS HEREBY CERTIFIED FOR THE PERIOD 2007 THROUGH 2017 AS A DIPLOMATE 1N INTERNAL MEDICINE cc. t fLi-a e�tit tlECT 1ar_cLEI.-TT' �v!i.intn 1.,3G0 7 Lau, JGar.50... ��k�ot'd— ✓' 2007 a onmow HAS MET THE R CERTIFIE INT A.RD OF .I INCORPORATED 19J6 ATTESTS THAT ra Ealpnaubgabihnijt TE EQUIREMENTS OF THIS BOARD AND iS H^R.EBY D FOR THE PERIOD 2004 THROUGH 2014 AS A DIPLOIvIATE IN ERNAL MEDICINE 6f ._-„� n ree 4 4 �4 .1tn^ •�• d y l'� p � c� . /4- ,218476 ` / % )1i Ai jter 2664 STATE OF FORIDA DEPAkTMENT-OF-HE-AL-TH DIVISION OF MEDICAL QUALITY ASSURANCE' AC# : . DATE LICENSE NO. CONTROL NO. 1--- 10i1512009 ME 55387 J 2119131 .The twpicAi. DOCTOR named below -has met all requirements of the laws and-rutes of the state of Florida. Expiration Date:. - JANUARY 31, 2012 ORLANDO SANTANA LICENSEE SIGNATURE 1 HUU—U`�—!IJ1N lr-I• rnI icrr ABMS® ,Board Certification Credentials Profile 4 service provided by the American Board of Medical Specialties New Search 1 Search Results I Ftit+_dbdreM. i Sue Physician ( Print Orlando Santana (ABMSUID - 27108 ) Viewed:3/9/2010 9:47:32 AM CST DOE 12/11 StatusAlive Gerttncation 1961 American Board of internal MadiGino Interne uodie/ General Expired i irii •I -inure l Inn ai Coral' atop Cujlavascular Disease - Subs acidity Active Time -Limited Recertification 84.orrctl funs-t imrled lnihal C rtiliCatiOn Education Status: Nct.Cerrtlfed Di4112r1144 - 12 31:2000 Status: Certified 09l09i2003 - 12f31r2013 - 1987 MD (Dock Lo=ation r of Mediorne) Pr•vate Corsi Gables, FL 531/16-1928 (United States) Naito: It IS up to t sought. The information as yeidtition requtrrlrr The ABMS physiaa gmerti,.an Board of 2DG6• ABMS, Ail Ric e,tr Pored by Direct Conn e user to Determine i the Dhyslaan record obtamee Iron this Service is hat rot the physiraan being pre.5enled by this servigri IS approval 1Dr busing.$ ube an0 i5 valid to meet the primary seuroe erns for uettentierrng es set by J .I-$O, rr1COA. URA: and other accrediting agendas. speclaity certi(Ica t (t 00ta provlded by CefliFACTS On•Line tS proprietary and cooyrignW by the 14�lcui Spe::;aIt IABMSe'i and subit:01 t0 the inteliestual property laws of the United States.' nts Reserved. Tne Powered by ApMS LtrreL1 Connect am: A MS Otfrvial D:sot y Agewn logos are repisterecr newt:arvs of ;mt., Arreri,ran Board 01 lle0rmi $pP_watires +' V, -cent i-act5.ore 1c DCReport.asp:'atlmsuid-"1US ;'9 1010 xuMncn -72 INCORPORATED ID AMERICAN COLLEGE OF�PHYSICIANS um02x, �racciea,/ ✓LtecZuft1114 AMERICAN MEDICAL ASSOCIATION PItth9 Sant* Airibmer.,r,0;&er u ntd,,I d; ,oalzrrmi Cnriiavasrular Dispnsp � � aF gar '-�2- DAYL�t).rces rif2�'V6f) oi' .eE+o9.�a A MS® Board Certification Credentials Profile A service provided by the American Board of Medical Specialties flo.po Search Search Results J Feodback Scrvi" Physl[lan I Print Philip Samet A.BMSUID - 259330 ) Viewed:31912010 9:45:40 AM CST DOB: 01130i Status: Alive Certification 922 American Board of Internal Medicine Internal Medicln - General Active Lit©lim Cardiovascular raoasc - Subspecialty Adave Litetim Education 1947 MD (Doder of Medicine) Location Initial Certification Initial Cerlifl alion Status: Certif+ed 10117'1955 - Status: Certified 01/0111959 - 4300 Alton Rd x 203 Miami Beach, FL 3140-2a00 {United States) Notice: I! iw up to sought. Tne Information an veriti:dtiDn rC4urle The ABMS physic American Board or 200. ABMS, Ali P., The Powered by Arr:enn Spero c: https: WAN w -crti1.3cts.or2 peweree Qy Direct Connect - usor to determine a the physician record oo!erne^ hum tuts service is that of the physical') being presented oy Mis service is approved for t,ur;in s use and is valid Io meet the primary source eve, for credeniiaiing as set by JCAHO. NCOA, URAC and airier accrediting agencies. n specraty carlificalSan data provided by CFrI,FACT5 On -Line 4 pt00rietary and copyrightec by the Medical Specialties tABMSel and suplect !o the ntBNectuni properly laws of the United So mrs. ins Reserve 9P S Direct Connect and ABMS Official Display Agent togas are registered Ifaderrrarics of the eoi:at Soo; ratites tdr•DCR port.aspx?sin1:IGrsuli=truecL:, Insuid=2592,;U 9 �t:110 AC# STATIO FLOnIEJA pep/011011MT OF VIMALTH DIVISIQN CIF PIROIcAl,(104WitASPRAticti LATE LICEMSV Nt). rnaLIo oven:me ME The liEDICALOQC:fpn named bele* has Trikil frityeenegIts died frifee ei the steel c4 Florbin Flovi,n-Dgcx----00U4tANY 1721PWUP tVO ?L'117.111rigAtl DOPY; hOtf ITIKAMOI AP14 Y UtrEU MIAMI ki44/1, it PIO alkItS CrtiOTI4 Ott G-DleRNtik 1.414e4, Ana M.Nikermr!te Roe, STATE SURGEON G:14/Folki_ CY.SPLAY iF REOIJIRFU SY LAW F.XPIFtik-rt.-A CA1E: JANUARY 11 ZI1a , •, or• r L51111: ot...4•4.1,c4 I:rt.:1..70J 01,14 i.rr.,1;21..47 1.1c :* whir ter Aoirrt.tg „ ! SIIST,fs • 1.-fr la7.1J114 pr-'1r.tta tfAri.:11 h4411 U}r. N11, fr'rr,k1.4 %.0 rd t-elser 951dq ., eirs.trIt.: asIr 11.,• t-.4:6;t,•AA4 0.581 ':.• 1; Iran 1r noptit. 0,1.4 ftjlpittli rt.1,4er 7,g.,...1.1^....TX,1•11.1;4111111,11m 110, $511.11tv.uoii 41,4 ft :1 Wird/1,V -1.•hs-t 11Cter.4 tVri syrissik, sow& Is ael 4.-klk114,114-1 Ftftsmict.ti"..4cro.. k cl.atr,%1 rff3,3! prr, 4111r 1,1-.1 tV4 71 Ur:Pr 11c1r:trri qrlr ri-ros tir 1 ITte11/4, pq, i,d.1-4..er T.03 kt,thlDtkm L 5V2.11WitAtite*M1P1 qt, ttra11to.rit2P4,14./Orr S: r1;11 q,, rtec.SortWi .5.1.11,11 1,1ri "Jvot# S .•^, 4r..s.I 11,14411, "6: V,V•VIL,• I so* ,7,1,0, 1•14, WV, I. to . , T.I5pj • • . • tr.., • •.,4 c Li 1 .aotaixtrieet4 .461,,ffrel-,Wiez6st AletrinktA,amel as ree r�-- / at diaa inch bug � of jute; 1994 AC#3 2 36289 STATE OF FLORIDA DEPARTMENT OF HEALTH DIVISION OF MEDICAL QUALITY ASSURANCE DATE LICENSE Nb. CONTROL NC). 12/11!2008 ME 98014 266702 The MED CAL DOCTOR named be ow has met all requirements of the laws aid rules of the state of Florida. Expiration Date: JANUARY 31, 2011 JEFFREY II AVID:NEITUCH MOUNT SI Al MEDICAL CENTER 4300 AL .. N AVE MIAMI BE • CH, FL 33141 Charlie Grist GOVERNOR 7114,4_ ire:.40h,444 AnaM.'Viamonte.Ros, 4,4:11 0L}?.ii STATE Sf1RG_Q GE1." t ": DISPLAY IF RE QUJR D'SY LAW TOTAL F. ATTACHMENT "A" SCOPE OF SERVICE 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. g• Urinalysis (Microscopic) 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) 3. 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 Examination 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, 50.0 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,) C'it of Miami. Florida Physical Examination 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. 2. 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 y of Miami. FloridaPhysical Examination RFP 223226'' Cir 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 of results from a Radiologist. 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. ATTACHMENT "B" COMPENSATION Line: 1 Description: Employment and Promotional Physical Examinations for Nun Sworn Classifications Line: 1.1 Description: Basic Physical Examination (including lab work, visual exam, and audiological exam) Category: 94874-50 Unit of Measure: Each .Unit Price: $ 0•00 Line: 1.2 Number of Units: 425 Total: $ 3+)0i95 00 Description: Additional/Optional Examination Components: PPD Test Category: 94874-50 Unit of Measure: Each Unit Price: $ 5.00 Line; 1.3 Number of Units: 600 Total: $ 3, UD0 . did Description: Additional/Optional Examination Components: Back X-Ray Category: 94874-50 Unit of Measure: Each Unit Price: $ 60• 0 Line: 1.4 Number of Units: 5 Total: $ 300 , PO Description: Additional/Optional Examination Components: Chest X-Ray Category: 94874-50 Unit of Measure: Bach Unit Price: $ 1{-0.00 Number of Units: 50 Total: $ 100r) , 0 0 Page 4 of 41 Line: 1.5 Description: Additional/Optional Examination Components: EKG (12 lend) Category: 94874-50 Unit of Measure: Each Unit Price: $ 3�•UV Line: 1.6 Number of Units: 425 Total: $ f 4-) 015 ,00 Description: Additional/Optional Examination Components: Rubella Titer - Category: 94874-50 Unit of Measure: Each Unit Price: $ 1 S . 00 Number of Units: 5 Line: 1.7 Total: $ , 1 aS . 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 D 0 Page 5 of 41 Line: 1.9 Description: Additional/Optional Examination Components: Hepatitis A, B, and C Screening Category: 94874-50 Unit of Measure: Each Unit Price: $ r110 .00 Line: 1.10 Number of Units: 25 Total: $ 1,000.00 Description: Additional/Optional Examination Components: HIV Testing & Counseling - ELTSA Test Category: 94874-50 Unit of Measure: Each Unit Price: $ a5.0 Line: 1.11 Number of Units: 25 Total: $ tuP.5.0D Description: Additional/Optional Examination Components: HIV Testing & Counseling - Western Blot Category: 94874-50 Unit of Measure: Each Unit Price: $ •0 0 Line: 1.12 Number of Units: 25 Total: $ to S . 0 C) Description: Additional/Optional Examination Components: HIV Testing & Counseling - Pre Counseling Category: 94874-50 Unit of Measure: Each Unit Price: $ Number of Units: 25 Total: $ Page6of41 Line: 1.13 Description: Additional/Optional Examination Components: HIV Testing & Counseling - Post Counseling Category: 94874-50 Unit of Measure: Each Unit Price: Number of Units: 25 Total: $ Line: 1.14 Description: Additional/Optional Examination Components: HIV Testing & Counseling - Measles, Mumps, Rubella Immunization Category: 94874-50 Unit of Measure: Each Unit Price: $ (00,00 Line: 1.15 Number of Units: 5 Total: $ 300 + L00 Description: Additional/Optional Examination Components: HIV Testing & Counseling -Tetanus Vaccine Category: 94874-50 Unit of Measure: Each Unit Price: $ 30 Line: 2 Number ofUnits:5 Total: $ i5D • OD 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: $ $n o0 Line: 2.2 Number of Units: 60 Total: $ ci , ;©r?• 00 Description: Additional/Optional Examination Components: Chest X-Ray Category: 94874-50 Unit of Measure: Each Unit Price: $ 11:0 ; o .0 Number of Units: 60 Total: $ .a, . ov• 0 D Line:.2.3 Description: Additional/Optional Examination Components: EKG Categoiy: 94874-50 Unit of Measure: Each Unit Price: $ 3 5 . o D Line: 2.4 Number of Units: 60 Total: $ .21100.V 0 Description: Additional/Optional Examination Components: Back X-Ray Category: 94874-50 Unit of Measure: Each Unit Price: $ (,0, 0t7 Line: 2.5 Number of Units: 1 Total: $ (0 0 QO Description: Additional/Optional Examination Components: Cardiovascular Stress Test Category: 94874-50 Unit of Measure: Each Unit Price: $ i0 (1 Number of Units: 60 Total: $ ) /000.©0 Page 8 of 41 Line: 2,10 Description: Additional/Optional Examination Components: PPD Test Category: 94874-50 Unit of Measure: Each Unit Price: $ 5.00 Line: 2.11 Number of Units: 60 Total: $ 3D .0r) Description: Additional/Optional Examination Components: Hepatitis A, B and C Screening Category: 94874-50 Unit of Measure: Each Unit Price: $ 9'D ' 0U Line: 3 Number of Units: 60 Total: ? L/OO,2C) Description: Employment Physical Examinations for Police Officers (Examination shall be conducted purs6ant to current California Peace Officer Standards and City of Miami Protoco)) Line: 3.1 Description: Basic Physical Examination (including lab work, visual exam, and audiological exam) Category: 94874-50 Unit of Measure: Each Unit Price: $ go , cJ U Line: 3.2 Number of Units: 60 Total: ED{t . P D Description: Additional/Optional Examination Components: Chest X-Ray Category: 94874-50 Page 10 of 41 Line: 2.6 Description: Additional/Optional Examination Components: HIV Testing & Counseling - ELISA Test Category: 94874-50 Unit of Measure: Each Unit Price: $0 Line: 2.7 Number of Units: 60 Total: $ 1 506'00 Description: Additional/Optional Examination Components: HIV Testing & Counseling - Western Blot Category: 94874-50 Unit of Measure: Each Unit Price: $ Line: 2.8 Number of Units: 60 Total: $ 1, 500 ,0 Description: Additional/Optional Examination Components: HIV Testing & Counseling - Pre Counseling Category: 94874-50 Unit of Measure: Each Unit Price: $ Qj Line: 2.9 Number of Units: 60 Total: $ Description: Additional/Optional Examination Components: HIV Testing & Counseling - Post Counseling Category: 94874-50 Unit of Measure: Each Unit Price: $ t% Number of Units: 60 Total: $ Page 9 of 41 Unit of Measure: Each Unit Price: $ ,00 Line: 3.3 Number of Units: 60 Total: $ 1 Ey,, L 00 Description: Additional/Optional Examination Components: EKG Category: 94874-50 Unit of Measure: Each Unit Price: $ 3•:; D0 Line: 3.4 Number of Units: 60 Total: $ o2 0,06 Description: Additional/Optional Examination Components: Cardiovascular Stress Test Category: 94874-50 Unit of Measure: Each Unit Price: $ aSD,O (J Line: 3.5' Number of Units: 60 Total: $ I5 /00C .0 Description: Additional/Optional Examination Components: Back X-Ray Category: 94874-50 Unit of Measure: Each Unit Price: $ iva 613 Line: 3.6 Number of Units: 1 Total: $ Lot , 0 0 Description: Additional/Optional Examination Components: Hepatitis A, B, and C Screening Category: 94874-50 Unit of Measure: Each Unit Price: $ , OD Number of Units: 60 Total: $ '� 1490,90 Page 11 of 41 Line: 3.7 Description: Additional/Optional Examination Components: PPD Test Category: 94874-50 Unit of Measure: Each Unit Price: $ . , OO Line:3.8 - Number of Units: 60 Total: $ 30 0• 0 0 Description: Additional/Optional Examination Components: Pulmonary Function Category: 94874-50 Unit of Measure: Each Unit Price: $ 25 • O D Line: 3.9 Number of Units: 1 Total: $ o,)S • 0 D Description: Additional/Optional Examination Components: Blood Type & Rh Typing Category: 94874-50 • -Unit of Measure: Each Unit Price: $ Z 4'•° 0 Line: 3.10 Number of Units: 1 Total: $ Z i/ . 0 0 Description: Additional/Optional Examination Components: Rubella Titer Category: 94874-50 - Unit of Measure: Each Unil Price: $ D Number of Units: 1 Total: $ r7 'f ,0D Page 12 of4l Lim: 3.11 Description: Additional/Optional Examination Components: Rubella Immunization Category: 94874-50 Unit of Measure: Each Unit Price: $ Number of Units: 1 Total: $ e .h Lr.SA) Line: 3.12 Description: Additional/Optional Examination Components: Review & Provide Written Interpretation of Medical -Records Category: 94874-50 Unit of Measure: Each Unit Price: $ 2S •0 0 Line: 4 Number of Units: 1 Total: $ .2.1 .: 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: $ gp . �d Number of Units: 400 Total: $ /' I ODD' 0D Page 13 of 41