HomeMy WebLinkAboutExhibit 6Metro -Dade Firefighters
Wellness Center
(Third -highest ranked firm)
WELLNESS
CENTER
REQUEST FOR PRO_POSA►L. FOR
PHYSICAL EXAMINATION SERVICES
TO THE CITY OF M►IAMI
July 28, 2010
MDFF WELLNESS CENTER
City of Miami Request for Proposal
Cover Page
Proposer's Name:
Contact Person for the Contract:
Firm's Liaison for the Contract:
Primary Office Address/
Facility Location:
Local Business Address
Business Phone:
Business Fax:
E-Mail Address:
Title of RFP:
RFP Number:
Federal Employer ID:
Metro Dade Firefighters Wellness Center
Veronica M. Salom
Veronica M. Salom
8000 NW 21st Street, Suite 200
Dora!, FL 33122
Same as Primary Office Address
305-499-8900
305-499-8901
vsalomamiamidade.00v
Request for Proposals for Physical
Examination Services
220240
22-3887060
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MDFF WELLNESS CENTER
City of Miami Request for Proposal
Table of Contents
Executive Summary 4
Professional Experience and Qualifications 6
Center Staffing 6
Annual Medical Examination 8
Proposer's Facility and Location 14
Fee Proposal 16
Attachment 1 28
HIV Informed Consent Form 28
Attachment 2 29
Hepatitis A, B, C Screening Informed Consent Forms 29
Attachment 3-A 30
Dalisla Soto Curriculum Vitae 30
Attachment 3-B 34
Dalisla Soto State of Florida License 34
Attachment 3-C 35
Dalisla Soto .Board Certification 35
Attachment 4-A 36
Michele Grundstein Curriculum Vitae 36
Attachment 4-B 38
Michele Grundstein State of Florida License 38
Attachment 4-C 39
Michele Grundstein Board Certification 39
Attachment 5-A 40
Alan Roberts Curriculum Vitae 40
Attachment 5-B 42
Alan Roberts State of Florida License 42
Attachment 5-C 43
Alan Roberts Board Certification 43
Attachment 6-A 44
Donald Rosenberg Curriculum Vitae 44
Attachment 6-3 51
Donald Rosenberg State of Florida License 51
Attachment 6-C 52
Donald Rosenberg Soto Board Certification 52
Attachment 7-A 53
Germaine Rodriguez Curriculum Vitae 53
Attachment 7-B 56
Germaine Rodriguez State of Florida License 56
Attachment 7-C 57
Germaine Rodriguez Board Certification 57
Attachment 8 58
HIPAA Patient Notice 58
Attachment 9 60
Release of Medical Records to the City of Miami 60
Attachment 10 61
Employee HIPAA Training Certificates 61
Attachment 11 70
--Excerpts-from-SOP-for-Medical Records —.. ._._ _..-.-....._ _ __70_.
Medical Records 70
Attachment 12 71
Receipt of Medical Records Acknowledgement 71
Attachment 13 72
Miami -Dade County Occupational License 72
Attachment 14 73
Pictures of Center Facility 73
3
MDFF WELLNESS CENTER
City of Miami Request for Proposal
Executive Summary
On December 16, 2002, the Metro -Dade Firefighters (MDFF) Wellness Center, a
501(c) 9 not -for -profit organization, was created as part of the Fire Service Joint Labor
Management Wellness -Fitness initiative, to improve the quality of life of all uniformed
fire personnel. The Center is a unique partnership between the Miami -Dade Fire
Rescue (MDFR) Department and the International Association of Firefighters (IAFF)
Union, Chapter 1403. The Center was specifically created to provide medical services
to firefighters and their families. The MDFF Wellness Center has provided annual
physical examinations, return -to -work evaluations, drug testing, occupational health,
vaccination administration, x-ray services, worker's compensation, and cardiovascular
stress testing for Miami -Dade County employees,_. particularly Fire -Rescue for the_past.9
years. The Center conducts Miami -Dade Fire Rescue pre -employment and annual
physicals pursuant to the NFPA 1582 Guidelines, and with the potential to expand
services to other public service employees and agencies.
. Over the years, we have expanded our medical services to other public safety and
government agencies. Currently, we conduct in-service medical physicals for the City of
Key West Fire Department, United States Air Force Homestead Fire Department, Drug
Enforcement Agency, and Urban Search and Rescue Team. Most recently, we entered
into a partnership with the Fire Department of New York (FDNY) to conduct medical
evaluations on their retirees. After two years of logistical planning, we participated with
the FDNY Bureau of Health Services in the World Trade Center Medical Monitoring and
Treatment Program, as funded by the National Institute of Occupational Safety and
Health (NIOSH). MDFF Wellness Center staff worked very closely with FDNY to
become a satellite office, and provide local FDNY retirees deployed to the World Trade
Center disaster site medical examinations and follow-up care. During five days in May,
we welcomed 75 retirees to the Wellness Center and provided quality medical care for
exposure -associated physical and health conditions.
The Center is staffed with one professional manager and 3 certified Family
Practice physicians through a service agreement with the University of Miami. These
independent physicians are highly knowledgeable on the working conditions and
hazards faced by public safety employees, such as first responder employees of the
police and fire departments. The specialized knowledge of our physicians in the field of
occupational health, allow for an enhanced level of care for our patients. Ms. Veronica
Salom, our professional manager, has a Masters of Science degree from The Florida
State University and has over 15 years of professional, administrative experience. She
has dedicated the last 4 years to administering the Center. The Center's Medical
Director, Dr. Dalisla Soto, has been working with public safety and governmental
employees since 2003 when she joined the Center. She received her medical degree
from the University of Panama and completed her Family Medicine residency at the
--University of -Miami; -Jackson -Memorial Hospital. Dr.- Michele-Grundstein—has dedicated - -
her career to the health and wellness of public safety employees, since joining the
Center in 2001. She graduated from SUNY Stony Brook School of Medicine in New
York State. She completed her residency from the University of Florida and is certified
by the American Board of Family Practice since 1999. Dr. Alan Roberts joined the
1
Veronica M. Salom
Wellness Center Manager
-i-a$• LDID
Date
4
MDFF WELLNESS CENTER
City of Miami Request for Proposal
Executive Summary
) Center in March of 2009. He received his medical degree from Jefferson Medical
College, Thomas Jefferson University and became Chief Resident of Family Practice in
1977 at St. Margaret Memorial Hospital. Dr. Roberts has been Board Certified in Family
Medicine since June of 1978 and practicing occupational medicine since June of 2003.
Our physicians have significant expertise in occupational health and medicine since
dedicating their careers to performing medical examinations, pre -employment physicals,
return -to -work evaluations, and worker's compensation examinations.
The MDFF Wellness Center is a licensed medical facility located at 8000 NW 21st
Street, Suite 200, Doral, FL 33122. The MDFF Wellness Center is approximately 3
miles from the City of Miami's corporate limits and easily accessible from Florida State
. Road 836, Dolphin Expressway and Florida. State Road 826,._Palmetto _Expressway....
The hours of operation is Monday through Friday 7:00 am to 5:00 pm, excluding legal
Holidays. Our business number is (305) 49.9-8900 and our contact person is Ms.
Veronica Salom, Center Manager.
The Center is approximately 5,500 square feet and is equipped with state-of-the-
art equipment. The Center contains five (5) exam rooms, stress testing room,
audiometry, vision and spirometry area, a laboratory area with an adjacent bathroom
equipped for drug testing services, an X-ray suite, and EKG rooms. We also have a
204 square foot waiting room which seats approximately 15 patients and a lounge area
with freshly brewed coffee, which seats 6. additional patients. The building provides
ample parking with over 125 individual spaces. Parking is adjacent to the building and at
no cost. There is sufficient space for oversized emergency vehicles such as fire
suppression trucks, battalion vehicles and rescues. There are multiple handicap spaces
available as well and a front door drop off area.
The MDFF Wellness Center is requesting consideration to perform physical
examination services for the City of Miami to include pre -employment, promotional,
employment, and retum-to-work physical examination services of its employees both in
sworn and non -sworn classifications. The Center recognizes that services include
general physical examinations for employees or prospective employees referred and
authorized by the City of Miami Department of Employee Relations. The physical
examination services include a complete family and personal medical history, laboratory
work -up (blood, urine, hearing, EKG, vision, etc.) and a thorough physical examination
by a physician. We provide quality employer physicals at competitive prices. As per the
included Fee Proposal, the basic physical examination fee for non -sworn classifications
is $120, and for sworn classifications (fire, police, etc.) is $150 each. Fees for additional
examinations are as follows: PPD test-$10, Chest X-ray-$80, Back X-ray-$70, EKG (12
lead)-$50, Rubella Titer-$35, Rubella Immunization-$55, Review of Medical Records-
$20, Hepatitis A, B & C Screening-$45, HIV Testing Eliza-$45, HIV Testing Western
Blot-$50, HIV Pre Counseling-$15, HIV Post Counseling-$15, MMR Immunization-$55,
-Tetanus=$15,— Cardiovascular —Stress Testing=$375; -Pulmonary—Function Test=$110 -
Blood Type/Rh Typing-$12, Rubella Titer-$55, Rubella Immunization-$55, Review and
provide written interpretation of medical records-$25, Return -to -Work Examinations-
$50.
Veronica M. Salom
Wellness Center Manager
a2•aolb
Date
5
MDFF WELLNESS CENTER
City of Miami Request for Proposal
Professional Experience and Qualifications
a) On December 16, 2002, the Metro -Dade Firefighters (MDFF) Wellness Center is
a 501 (c) 9 not -for -profit organization that was created as part of the Fire Service Joint
Labor Management Wellness -Fitness Initiative. The purpose of the Fire Service Joint
Labor Management Wellness -Fitness Initiative was to improve the quality of life of all
uniformed fire personnel through comprehensive medical screenings and preventative
physicals. The Center is a unique partnership between the Miami -Dade Fire Rescue
(MDFR) Department and the International Association of Firefighters (IAFF) Union,
Chapter 1403. The Center was specifically created to provide medical services to
firefighters and their families.
The preliminary work- on the -Wellness Center concept began in 2001 as key
personnel from MDFR, IAFF Local 1403, and the Metro Dade Fire Fighter's Health
Project participated on Task Force and Technical subcommittees of the Fire Service
Joint Labor Management Wellness Fitness Initiative. The charge of these committees
was to devise a comprehensive wellness and fitness program within fire -rescue
departments.
Over the years, we have expanded our medical practice to other public safety and
government agencies. Our mission continues to be to provide comprehensive medical,
occupational health, and rehabilitative services for the prevention of disease and injury
among our patients through state-of-the-art health education techniques, the delivery of
prevention -oriented health care, and the delivery of job -specific rehabilitative services.
The Center has specialized knowledge of the treatment and monitoring of workplace
exposures. Since our inception, MDFF Wellness Center offers our patients these broad
service components:
➢ Medical, by administering pre -employment physicals to applicants, annual
physicals to employees, and medical care to patients injured during on-the-job
activities while serving as a primary care center
Serves as an authorized care center for Workers' Compensation Center
➢ Fitness Efforts including fitness sessions, nutritional services, educational
seminars, and weight management course
Center Staffing
The MDFF Wellness Center is staffed by a professional manager, one supervisor,
two full-time and one part-time physician, two medical assistants, one exercise
physiologist and other ancillary staff. All our medical staff is CPR -certified,
ertifi d, five (5) staff
merribers are Advanced..Ca iliac Life -Support (ACLS)=certified, and_our two (2) medical
•
assistants are certified phlebotomists and certified medical assistants. We have a
certified X-ray operator on staff as well. Additionally, we contract for services to other
licensed, board certified physicians for the interpretation of x-rays and administration of
cardiac stress testing.
6
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MDFF WELLNESS CENTER
City of Miami Request for Proposal
Professional Experience and Qualifications
Ms. Veronica Salom has a Masters of Science degree from The Florida State
University and has over 15 years of professional, administrative experience. She has
dedicated the last 4 years to providing quality, professional administration to the Center.
She is trained in both OSHA compliance and HIPAA compliance for medical practices.
Our three physicians are independent physicians hired through a contract with the
University of Miami. Our physicians are highly knowledgeable on the working
conditions and hazards faced by members of the fire and police service. The
specialized knowledge of our physicians in the field of occupational health, allow for an
enhanced level of care for our patients. Our physicians have extensive experience in
reviewing job classifications to determine an employee's ability to perform these tasks.
The Center's Medical Director, Dr. Dalisle Soto, has been working with the .public.
safety and governmental employees since 2003 when she joined the Center. She has
over 12 years of occupational health medicine experience. She received her medical
degree from the University of Panama and completed her Family Medicine residency at
the University of Miami, Jackson Memorial Hospital. She completed a mini -residency in
Occupational Medicine and also trained in Diving Medicine with the US Navy at Panama
City, Florida. She is certified by the American Board of Family Medicine since 1992.
Dr. Soto had 5 years experience in Occupational Medicine prior to joining the Wellness
Center. She serves as our Medical Review Officer when reviewing employer -required
drug tests. Dr. Soto serves as a clinical instructor for an occupational medicine rotation
for the University of Miami Department of Family Medicine residency program, and she
volunteers her time at the St. Juan Bosco Community Clinic.
Dr. Michele Grundstein, has dedicated her career to the health and wellness of
firefighters and other public safety employees, since joining the Center in 2001. She
graduated from the University of Massachusetts with a Bachelor of Science in Exercise
Science. Her undergraduate work led to her to SUNY Stony Brook School of Medicine
in New York State where she graduated in 1996. She completed her residency from the
University of Florida and is certified by the American Board of Family Practice since
1999. Dr. Grundstein also serves as a clinical instructor for the occupational medicine
rotation for the University of Miami Department of Family Medicine residency program.
Her special interests include sports medicine and the incorporation of functional
medicine in family practice medicine.
Dr. Alan Roberts joined the Center in March of 2009. He received his medical
degree from Jefferson Medical College, Thomas Jefferson University and completed
Chief Resident of Family Practice in 1977 at St. Margaret Memorial Hospital. Dr.
Roberts has been Board Certified in Family Medicine since June of 1978 and
Occupational Medicine since June of 2003. Dr. Roberts is recognized as an expert in
travel medicine and is a renowned speaker on vaccine -related subject matter. He is
also certified Senior Federal Aviation Administration Flight Examiner, a federally-
- certified -Medical -Review -Officer, -and -a -certified -Drug -Free -Workplace- Medical Advisor. The MDFF Wellness Center is submitting this proposal to conduct physical
examinations for the City of Miami pre -employment, promotional, and return -to -work
physical examination services. These services include general physical examinations
for employees or prospective employees referred and authorized by the City of Miami's
Department of Employee Relations. Return -to -work examinations will be
accommodated as walk-in patients without a prior scheduled appointment.
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MDFF WELLNESS CENTER
City of Miami Request for Proposal
Professional Experience and Qualifications
Annual Medical Examination
The annual medical examination is divided into two (2) phases. Phase 1 of the
physical examination includes completion of a comprehensive medical history, the
collection of blood and urine, vision, hearing and other diagnostics tests.
1. Medical History Collection: The MDFF Wellness Center will obtain a complete and
thorough family and personal medical history from the examinee, to be reviewed by
the physician with the patient at the time of the physical examination which includes
the following:
2. Laboratory Work -Up
a. Compiete Blood Count (CBC) with Differential
b. Comprehensive Metabolic Panel (22 requisite blood tests)
c. Complete Lipid Profile with Ratios
d. TSH
e. RPR
f. Urinalysis (Microscopic)
• Albumin • Ketone Bodies er. Bilirubin
• Protein Leukocyte • Nitrite
• 'pH esterase • Specific Gravity
• Blood .. Urobilinogen
g•
Electrocardiogram (EKG): a 12=lead EKG with rhythm strip is done in a resting
state; results interpreted by a' cardiologist certified by the American Board of
Internal Medicine.
h. Cardiovascular Stress Test: Treadmill stress test is performed by a board -
certified cardiologist that is available for the Center for such services, when
necessary. This test will establish police officer, police auxiliary/reserve,
detention officer and firefighter's ability to perform under the added stress
conditions of chemical protective clothing, as well as identifying any cardio-
vascular potential problem.
3. PPD Skin Test/Chest X-ray: PPD will be performed by the Mantoux Method
required. If PPD results are positive, a Chest X-ray will be performed with standard
size posterior and anterior views. Chest X-ray results are interpreted by a licensed
radiologist that is contracted by the Center for services.
4:-- Eye —Test: ---The acuity-test--screens-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 will be performed with and without corrective lenses. The Wellness
Center will ensure specific requirements for eye tests are maintained.
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MDFF WELLNESS CENTER
City of Miami Request for Proposal
Professional Experience and Qualifications
Police Officer, Police Auxiliary/Reserve, Detention Officer, and Public Service
Aid (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. Audiogram Test (Hearing): Audiometric testing will be conducted in the frequencies
of 500, 1000, 2000, 3000, 4000 HERTZ. It will be accomplished in a soundproof
booth with a certified and calibrated audiometer. Written interpretation of results is
provided for each physical.
Phase 2 includes a comprehensive physical examination by a board -certified physician
who has an intimate understanding of occupational medicine. Phase 2 of the annual
medical examination will include a thorough review of all medical records, testing, and
available exposure records. Based on the results of medical tests, the medical physical
examination, and review of medical history and exposure records, our physicians may
require additional tests to ensure the health of personnel, which approval will be sought
by the City of Miami prior to administering.
A. Physical Examination
o Vital Signs
oBlood Pressure (Both Arms) oPulse oRespiration oTemperature
o Height
o Weight
• General Appearance
o Head, Scalp, Face
• Neck: palpation of the thyroid, trachea, iymphs, vessels, and neck for masses
and nodules.
o Endocrine System
o Eye: examination of eye movements and focus, pupils (equality and reaction),
sclera, opthalmaloscopic examination of fundus, ocular motility.
o Ears: examination of external ears; otoscopic examination of ear canal and
eardrum -for -perforations -.-
• Nose: speculum examination of interior nose and sinuses to include nares.
o Mouth; visual inspection of mouth, tongue, teeth, gums, floor and roof of mouth,
manual palpation of any abnormal masses.
o Throat: visual examination of tonsils, uvula, check for abnormal growths.
9
MDFF WELLNESS CENTER
City of Miami Request for Proposal
Professional Experience and Qualifications
• Lungs and Chest: inspection of the chest; auscultation of lungs with stethoscope.
• Optional -Breast: Physician will offer to perform examination which will include
visual inspection and palpation of the breast and nipples. During this
examination, instruction in self-examination of the breast will be included
• Heart: palpation of chest wall for heartbeat and abnormalities (thrust and size);
auscultation of heart with stethoscope for abnormal sounds and murmurs(rhythm
and sounds)
• Abdomen: visual inspection of abdominal wall; palpation and percussion of
abdomen for masses and abdominal organs, auscultation of abdomen for bowel
sounds and bruits, examination for hernias_.
• External Genitalia- visual inspection, palpation, percussion and auscultation.
• Anus and Rectum -visual inspection for hemorrhoid and fissures
• Upper Extremities -strength and range of motion
• Lower Extremities -strength and range of motion
• Vascular System: visual inspection for deformity and cervical and lumbo-sacral
range of motion, palpation of the vertebral bodies and paraspinal muscles and
musculoskeletal
• Skin for rashes and scars; lymphatic
•• 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
1. Chest X-Ray (Sworn Police and Fire): Anterior/posterior and lateral views,
with written interpretation of result provided to Department of Employee
Relations within 72 hours.
2. HIV Testing/Counseling required for Firefighter, Crime Scene Investigator
and Property Specialist applicants/employees (Applicants and Employees
can decline HIV testing) will be conducted and the requisite consent form
will be provided at the time of the physical (Attachment 1). All results will
be delivered to the City of Miami, Department of Employee Relations in a
sealed envelope marked CONFIDENTIAL.
3. Hepatitis A, B, and C Screening required for Firefighter, Police Officer,
Crime Scene_Investigator_and__P_ro.per_ty_Specialist..applicants/employees.._
(Applicants and Employees can decline Hepatitis testing) will be
conducted and the requisite consent form will be provided at the time of
the physical (Attachment 2). All results will be delivered to the City of
Miami, Department of Employee Relations in a sealed envelope marked
CONFIDENTIAL.
10
MDFF WELLNESS CENTER
City of Miami Request for Proposal
Professional Experience and Qualifications
OPTIONAL (Testing requested by the City as needed)
1. Back X-ray: two views of the back; Iumbo-sacral spine and pelvis and
interpreted by a board certified radiologist
2. Pulmonary Function Test (Vital Lung Capacity): a spirometer test, which
measures at what capacity an individual, can expel a volume of air
following full inspiration. Three (3) valid tracings of a forced vital
capacity from which a Forced Expiratory Volume in one (1) second can
be delivered
3. Blood Type and Rh Typing
4. Rubella Titer
5. Rubella Immunization
6. Tetanus Vaccine
7. Written interpretation and/or medical resume to be reviewed and
provided of an employee/applicant medical records from another agency
a) The City of Miami has not had any formal agreements with the MDFF Wellness
Center. However, in late 2003, the City of Miami used the Center for overflow physicals
for its public safety personnel.
b) The MDFF Wellness Center Board of Directors is composed of seven voluntary
members. There are three members from the International Association of Firefighters
(IAFF) union, three members from the Miami -Dade Fire Rescue Department
administration, and one risk management expert. The Board of Directors are as follows:
MDFR Chief Herminio Lorenzo; MDFR Assistant Director Scott Mendelsberg; Captain
Maria Chin; Miami -Dade County Director of Risk Management Marsha Pasqual; Local
1403 President Dominick Barbera; Firefighter Denise Paganacci; and Local 1403
Treasurer Steve Jessup.
c) Credentials of our three staff physicians and specialists are attached.
(Attachment 3-Dr. Dalisla Soto, Attachment 4-Dr. Michele Grundstein, Attachment 5, Dr.
Alan Roberts, Attachment 6-Dr. Donald Rosenberg, Attachment 7-Germain Rodriguez)
The Center contracts with Doral Medical Imaging to provide professional radiological
interpretation of all our X-rays by a certified radiologist. Additionally, the Center has
available the world renowned Dr. Donald Rosenberg, a board -certified cardiologist, to
provide the EKG interpretation and administers the cardiovascular exercise stress test.
To our knowledge, none of the professionals have had any complaints filed against
- — - - -them.
d) As an entity that performs or assists the City of Miami with the function or activity
involving the use or disclosure of "individually identifiable health information (IIHI)
and/or Protected Health Information (PHI), the Center will comply with the Health
Insurance Portability and Accountability Act (HIPAA) of 1996 and the City of Miami
Privacy Standards. The Center complies with all HIPAA related matters and ensures
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MDFF WELLNESS CENTER
City of Miami Request for Proposal
Professional Experience and Qualifications
compliance with the protected patient information is maintained but understands that
the City of Miami, as the employer must obtain PHI when required. The Center will
make the PHI available to the City of Miami for accounting of disclosures or for
compliance audits, and will report non -permitted disclosures immediately. The Center
recognizes that information gathered is only for performing services required for the
City of Miami or as required by law.
The Center believes the maintenance of patient/doctor confidentiality is
paramount to developing a positive patient -physician relationship. The Center
provides its patients written notice of its privacy information practices including
specifically, a description of the types of uses and disclosures that would be made
- with protected -health information. Attachment 8 is the HIPAA Patient Notice provided
to all our patients. Attachment 9 is a specific medical release form allowing the
Center to release information to the City of Miami. which also .-reiterates that
information garnered in the physical is released to their employer.
The Center staff is highly cognizant of HIPAA mandates for privacy, security
and electronic transfer standards. As this is one of our priorities, all Center staff
received 8 hour in-service training on Medical Records Law in January 2009.
Attachment 10 contains certificates of completion of the course. Medical records will
be maintained and managed by the MDFF Wellness Center. Our commitment to
patient privacy is also further elaborated in the MDFF Wellness Center Policies and
Procedures. Attachment 11 is an excerpt of the relevant section.
The City of Miami Employee Relations Department will receive a written report,
compliant with the HIPAA act of 1996, of each medical examination indicating whether
their employee is fit -for -duty, restricted duty, and unfit for duty as related to. the
employee's occupational duties within 24 hours of completion of the examination.
Verbal results will also be provided the day the examination is completed to the
appropriate City of Miami personnel, upon request. A copy of the entire medical
examination will be delivered to the employer and provided to each patient upon
completion of the physician's examination. Attachment 12 is copy of the Receipt of
Medical Records Acknowledgement that each patient will sign upon receipt of their
records. The Center will make available all medical records and files maintained on
the City of Miami's behalf during the contract period and at least five (5) subsequent
years thereafter.
e) Due to our unique expertise in providing occupational health physicals particularly
for public safety personnel, other governmental agencies have selected our Center for
their employee's physicals. The Center meets the unique needs of each governmental
organization by complying with their medical physical parameters and reporting
—Standards-.—The-Center strives to maintain -the confidentially of -each of our —Patients --
while providing their employers the required medical documentation. The
Center provides each organization with a specific written release for use by its
employees to ensure HIPAA compliance requirements are maintained.
12
MDFF WELLNESS CENTER
City of Miami Request for Proposal
Professional Experience and Qualifications
Currently, the Center has the following clients that utilize our facility for various services
that range from annual physical examinations, worker's compensation, laboratory
services, and drug testing:
Key West Fire Department
Chief Mike Davila
PO Box 1409
Key West, FL 33041
(305) 292-8179
mdavila(a kevwestcitv.com
Value of Contract: $10,000
Fire Department of New York
Ms. Spencer Carroll
9 Metro Tech Center
Room 8s10, Brooklyn, NY 11201
(718) 999-1935
ca rrols(Nfdny. nyc. gov
Value of Contract: $45,000
Miami Dade County
Human Resources Department
Mike Edwards ,
111 NW 1 Street, #2010
Miami, FL 33128
(305) 375-2479
mxx@miamidade.aov
Value of Contract: $500,000+
United States Air Force
Homestead Fire Department
Chief Raymond Bradshaw
Homestead Air Reserve Base
Homestead, FL 33039
Raymond. bradshaw(u�hom estead. af.mil
Value of Contract: $25,000
Logistics Health Inc.
U.S. Drug Enforcement Agency
Morgan Menezes
328 Front Street South
La Crosse, Wl, 54601
(800) 666-2833
mmenezes(cr�loaistichealth. com
Value of Contract: $5,000-$10,000
f) At this time, there are no clients that have discontinued use of our services within
the past three (3) years.
13
(D
MDFF WELLNESS CENTER
City of Miami Request for Proposal
Proposer's Facility and Location
a) The primary work will be performed at the MDFF Wellness Center which is
centrally located in the heart of Miami. The MDFF Wellness Center is a licensed facility
located at 8000 NW 21st Street, Suite 200, Dora!, FL 33122. (Attachment 13) The
Center is approximately 3 miles from the City of Miami's corporate limits. The Center is
very easily accessible from Florida State Road 836, Dolphin Expressway and Florida
State Road 826, Palmetto Expressway. The hours of operation is Monday through
Friday 7:00 am to 5:00 pm excluding legal holidays. Our business number is (305) 499-
8900 and our contact person is Veronica Salom, Center Manager.
Figure 1. Map of Facility Location
b) The Center is approximately 5,500 square feet and is equipped with state of the
art equipment. The Center contains five (5) exam rooms, stress testing room,
audiometry, vision and spirometry area, a laboratory area with an adjacent bathroom
equipped to conduct drug testing, an X-ray suite, and EKG rooms. We also have a 204
square foot waiting room which seats approximately 15 patients and a lounge area with
freshly brewed coffee, which seats 6 additional patients. Additionally, the Center has a
large work-out/rehabilitation area and a secured medical records room.
c) The building where the MDFF Wellness Center is located provides an ample
parking lot of with over 125 individual spaces. Parking is adjacent to the building and at
no cost to our patients. There is sufficient space for oversized emergency vehicles such
as fire trucks, battalion vehicles and rescues. There are multiple handicap spaces
available and a front area where patients can be dropped off with a covered entrance.
14 '
MDFF WELLNESS CENTER
City of Miami Request for Proposal
Proposer's Facility and Location
d) The reception area is approximately 12 feet by 17 feet and can seat
approximately 15 individuals at any time. It is tiled, air-conditioned with satellite
television and recreational magazines are available. An additional lounge, available
with fresh coffee, juices, and snacks, serves as another waiting area holding 6-8
individuals during various portions of medical examinations. Attachment 14 includes
pictures of our facility.
e) The MDFF Wellness Center is equipped with the necessary medical equipment to
perform the physical examination services for the City of Miami. The Center has the
following:
• Fischer X-Ray Machine
-• Eckoustic Audiometric Booth
• Earscan MP Pure Tone Audiometer Data Output
• Titmus i500 Vision Tester
• Burdick Eclipse LE II EKG
• Burdick Atria 3100 EKG
• Easyone Diagnostic Spirometer
• Quinton Q Stress Cardiac Stress Testing System
The MDFF Wellness Center has an equipment maintenance plan to ensure all
medical and diagnostic machines have been properly maintained. Spirometry and
audiometric hearing equipment are calibrated daily and receive a full -service inspection
annually. The X-ray machine is maintained every other week and is serviced as
needed. Yearly inspections of the X-ray machine are performed by the State of Florida.
The Center's Exercise Stress Testing machine is serviced annually or more frequently
as needed.
The Center strives to ensure all equipment is functioning properly and takes
immediate action to remediate problems with the equipment within 48 hours. The
Center has agreements with vendors to provide redundancy in the event equipment
failure cannot be immediately resolved at the Center. Doral Medical Imaging, which is
within 1/2 mile of the Center, serves as our back-up X-ray site. The cardiovascular
stress testing can be performed at a contracted. facility (Gables Diagnostic Center) on
the same -day of appointment. The Snellen Wall chart can be utilized if Titmus i500
Vision Tester becomes inoperable. EKG testing can be performed on our 2 EKG
machines or as a redundancy measure on the Lifepak.12 and Quinton Stress Testing
system which are EKG compatible. Any required repeat tests are conducted at no cost
to the City of Miami.
15
MDFF WELLNESS CENTER
Certification Statement City of Miami Request for Proposal
Fee Proposal
Please quote on this form, if applicable, act 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 (I) 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 (I) agree to abide by all terms and
conditions of this solicitation and certify that 1 am authorized to sign this submission for the submitter.
Please print the following and sign your name:
SUPPLIER NAME: Metro -Dade Firefighters Wellness Center, inc.
ADDRESS- 8000 Northwest 21 Street, Suite 200
PHONE: 305.499.8900 FAX 305.499.8901
EMAIL: vsalom@miamidade.gov
SIGNED BY- v 1`' ah`
BEEPER'
TITLE: Wellness Manager DATE• July 28, 2010
FAILURE TO COMPLETE. SIGN. AND RETURN THIS FORM SHALL DISQUALIFY THIS BID.
16
Page 2 of 41
MDFF WELLNESS CENTER
City of Miami Request for Proposal
Pg&tlig F813MaI
Legal Name of Firm:
Metro -Dade Firefighters Wellness Center, Inc.
Entity Type: Partnership, Sole Proprietorship, Corporation, etc.
501 (c) 9 Not for Profit Corporation
Year Established:
2002
Office Location: City of Miami, Miami -Dade County, or Other
8000 Northwest 21 Street, Suite 200, Miami, Florida 33122
Occupational License Number:
499826-7
Occupational License Issuing Agency:
Miami -Dade County
Occupational License Expiration Date:
July 27, 2010 (Renewal has been sent to Tax Collector)
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.": (Yes or No)
Yes
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)
No
In the event your answer to question above is yes, how many new positions would you create to
perform this work?
Not Applicable
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.
Not Applicable
17
Page 3 of 41
Line: 1
MDFF WELLNESS CENTER
City of Miami Request for Proposal
Fee Proposal
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: 94874-50
Unit of Measure: Each
Unit Price: $ 120.00
Line: 1.2
Number of Units: 425 Total: $ 51, 000.00
Description: Additional/Optional Examination Components: PPD Test
Category: 94874-50
Unit of Measure: Each
Unit Price: $ 10.00
Line: 1.3
Number of Units: 600
Total: $ 6,000.00
Description: Additional/Optional Examination Components: Back X-Ray
Category: 94874-50
Unit of Measure: Each
Unit Price: $ 70.00
Line: 1.4
Number of Units: 5 Total: $ 350.00
Description: Additional/Optional Examination Components: Chest X-Ray
Category: 94874-50
Unit of Measure: Each
Unit Price: $ 80.00 Number of Units: 50
Total: $ 4,000.00
MDFF WELLNESS CENTER
City of Miami Request for Proposal
Fee Proposal
Line: 1.5
Description: Additional/Optional Examination Components: EKG (12 lead)
Category: 94874-50
Unit of Measure: Each
Unit Price: $ 50.00 Number of Units: 425 Total: $ 21,250.00
- • Line:1.6 •
Description: Additional/Optional Examination Components: Rubella Titer
Category: 94874-50
Unit of Measure: Each
Unit Price: $ 35.00
Line: 1.7
Number of Units: 5 Total: $ 175.00
Description: Additional/Optional Examination Components: Rubella Immunization
Category: 94874-50
Unit of Measure: Each
Unit Price: $ 55.00
Line: 1.8
Number of Units: 5 Total: $ 275.00
Description: Additional/Optional Examination Components: Review of Miscellaneous Medical
Records
Category: 94874-50
- Unit of Measure: Each -
Unit Price: $ 20.00
l
Number of Units: 5 Total: $ 100.00
Page 5 of 41
19
Line: 1.9
MDFF WELLNESS CENTER
City of Miami Request for Proposal
Fee Proposal
Description: Additional/Optional Examination Components: Hepatitis A, B, and C Screening
Category: 94874-50
Unit of Measure: Each
Unit Price: $ 45.00
Line: 1.10
Number of Units: 25 Total: $ 1,125.00
Description: Additional/Optional Examination Components: HIV Testing & Counseling- ELISA
Test
Category: 94874-50
Unit of Measure: Each
Unit Price: $ 45.00
Line: 1.11
Number of Units: 25 Total: $ 1,125.00
Description: Additional/Optional Examination Components: HIV Testing & Counseling - Western
Blot
Category: 94874-50
Unit of Measure: Each
Unit Price: $ 50.00
Line: 1.12
Number of Units: 25
Total: $1,250.00
Description: Additional/Optional Examination Components: HIV Testing & Counseling - Pre
Counseling
Category: 94874-50
- Unit.of Measure: Each -
Unit Price: $ 15.00
Number of Units: 25 Total: S 375.00
Page 6 of 41
20
Line: 1.13
MDFF WELLNESS CENTER
City of Miami Request for Proposal
Fee Proposal
Description: Additional/Optional Examination Components: HIV Testing & Counseling - Post
Counseling
Category: 94874-50
Unit of Measure: Each
Unit Price: $ 15.00
Line: 1.14
Number of Units: 25 Total: $ 375.00
Description: Additional/Optional Examination Components: HIV Testing & Counseling - Measles,
Mumps, Rubella Immunization
Category: 94874-50
Unit of Measure: Each
Unit Price: $ 55.00
Line: .1.15
Number of Units: 5
Total: $ 275.00
Description: Additional/OptionaI Examination Components: HIV Testing & Counseling - Tetanus
Vaccine
Category: 94874-50
Unit of Measure: Each
Unit Price: $ 15.00
Line: 2
Number of Units: 5 Total: $ 75.00
Description: Employment Physical Examinations for Firefighters (Examination shall be
conducted pursuant to current NFPA 1582 Guidelines and City of Miami Medical Protocols)
- -Line: 21 -
Description: Basic Physical Examination (including lab work, visual exam, and audiological exam)
Category: 94874-50
Unit of Measure: Each
Page 7 of 41
21
Unit Price: $ 150.00
Line: 22
MDFF WELLNESS CENTER
City of MiamimRequest for Proposal
Number ofl9 tS:er6Qp®Sal Total: $ 9,000.00
Description: Additional/Optional Examination Components:. Chest X-Ray
Category: 94874-50
Unit of Measure: Each
Unit Price: $ 80.00
Line: 2.3
Number of Units: 60 Total: $ 4,800.00
Description: Additional/Optional Examination Components: EKG
Category: 94874-50
Unit of Measure: Each
Unit Price: $ 50,00
Line: 2.4
Number of Units: 60 Total: $ 3,000.00
Description: Additional/Optional Examination Components: Back X-Ray
Category: 94874-50
Unit of Measure: Each
Unit Price: $ 70.00
Line: 2.5
Number of Units: 1 Total: $ 70.00
Description: Additional/Optional Examination Components: Cardiovascular Stress Test
Category: 94874-50
Unit of Measure: Each
Unit Price: $ 375.00
Number of Units: 60 Total: $ 22,500.00
Page 8of4l
22
MDFF WELLNESS CENTER
City of Miami Request for Proposal
Fee Proposal
(
} Line: 2.6
Description: Additional/Optional Examination Components: HIV Testing & Counseling - ELISA
Test
Category: 94874-50
Unit of Measure: Each
Unit Price: $ 45.00
Line: 2.7
Number of Units: 60 Total: $ 2,700.00
Description: Additional/Optional Examination Components: HIV Testing & Counseling - Western
Blot
Category: 94874-50
Unit of Measure: Each
Unit Price: $ 50.00
Line: 2.8
Number of Units: 60 Total: $ 3,000.00
Description: Additional/Optional Examination Components: HIV Testing & Counseling - Pre
Counseling
Category: 94874-50
Unit of Measure: Each
Unit Price: S 15.00
Line: 2.9
Number of Units: 60 Total: $ 900.00
Description: Additional/Optional Examination Components: HTV Testing & Counseling - Post
-Counseling
Category: 94874-50
Unit of Measure: Each
Unit Price: $ 15.00
Number of Units: 60
Total: $ 900.00
Page 9 of 41
23
MDFF WELLNESS CENTER
City of Miami Request for Proposal
Fee Proposal
Line: 2.10
Description: Additional/Optional Examination Components: PPD Test
Category: 94874-50
Unit of Measure: Each
Unit Price: $10.00 Number of Units: 60 Total: $ 600.00
Line: 2.11
Description: Additional/Optional Examination Components: Hepatitis A, B and C Screening
Category: 94874-50
Unit of Measure: Each
Unit Price: $ 45.00
Line: 3
Number of Units: 60 Total: $ 2,700.00
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 Iab work, visual exam, and audiological exam)
Category: 94874-50
Unit of Measure: Each
Unit Price: $ 150.00
Line: 3.2
Number of Units: 60 Total: $ 9,000.00
Description: Additional/Optional Examination Components: Chest X-Ray
Category: 94874-50
Page 10 of 41
24
Unit of Measure: Each
Unit Price: $ 80.00
Line: 3.3
MDFF WELLNESS CENTER
City of Miami Request for Proposal
Fee Proposal
Number of Units: 60 Total: $ 4,800.00
Description: Additional/Optional Examination Components: EKG
Category: 94874-50
Unit of Measure: Each
Unit Price: $ 50.00
Line: 3.4
- Number of Units: 60 Total: $ 3,000.00
Description: Additional/Optional Examination Components: Cardiovascular Stress Test
Category: 94874-50
Unit of Measure: Each
Unit Price: $ 375.00 Number of Units: 60 Total: $ 22,500.00
Line: 3.5
Description: Additional/Optional Examination Components: Back X-Ray
Category: 94874-50
Unit of Measure: Each
Unit Price: $ 70.00
Line: 3.6
Number of Units: 1 Total: $ 70.00
_ _ Description: _Additional/Optional Examination Components: Hepatitis A, B,.and C Screening
Category: 94874-50
Unit of Measure: Each
Unit Price: $ 45.00 Number of Units: 60 Total: $ 2,700.00
Page 11 of 41
25
MDFF WELLNESS CENTER
City of Miami Request for Proposal
Fee Proposal
Line: 3.7
Description: Additional/Optional Examination Components: PPD Test
Category: 94874-50
Unit of Measure: Each
Unit Price: $ 10.00
Line: 3.8
Number of Units: 60
Total: $ 600.00
Description: Additional/Optional Examination Components: Pulmonary Function
Category: 94874-50
Unit of Measure: Each
Unit Price: $ 110.00
Line: 3.9
Number of Units: 1 Total: $ 110.00
Description: Additional/Optional Examination Components: Blood Type Rh Typing
Category: 94874-50
Unit of Measure: Each
Unit Price: $ 12.00
Line: 3.10
Number of units: 1 Total: $ 12.00
Description: Additional/Optional Examination Components: Rubella Titer
Category:_ 9.487.4-50.
Unit of Measure: Each
Unit Price: $ 55.00
Number of Units: 1 Total: $ 55.00
Page 12 of 41
26
Line: 3.11
MDFF WELLNESS CENTER
City of Miami Request for Proposal
Fee Proposal
Description: Additional/Optional Examination Components: Rubella Immunization
Category: 94874-50
Unit of Measure: Each
Unit Price: $ 55.00
Line: 3.12
Number of Units: 1 Total: $ 55.00
Description: AdditionallOptional Examination Components: Review & Provide Written
Interpretation of Medical Records
Category: 94874-50
Unit of Measure: Each
Unit Price: $ 25.00
Line: 4
Number of Units: 1 Total: $ 25.00
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: $ 50.00
Number of Units: 400 Total: $ 20,000.00
Page 13 of 41
27
n
MDFF WELLNESS CENTER
City of Miami Request for Proposal
Attachment 1
HIV Informed Consent Form
Patient
Elam
Date @ ❑pm
Classification: Firefighters ❑Police Officer DCrime Scene Investigator ❑Property Specialist
The test for Human Immunodeficiency Virus is a simple blood test that detects the presence of antibodies produced by the body
following infection with the virus that causes AIDS. This is not a test for the disease AIDS. The test does not tell you if you have
AIDS. The HIV test is not 100% accurate. This test involves the withdrawal by needle of a small amount of blood for laboratory
testing. When the blood is drawn, you may have some discomfort at the site of the needle entry and a small bruise and slight
soreness may develop. Otherwise, there is a minimal risk of physical injury. If you consent to have the HIV test done, it is
important for your health care that the test results be placed in your medical record so that persons involved in your health care
will have that information.
The HIV test results are considered confidential and are not subject to disclosure without your authorization except to
persons_and..entities allowed access. by law.and for. purposes permitted by law. The Metro -Dade .Firefighters Wellness -
Center has stringent policies and procedures designed to protect the confidentiality of medical records and laboratory test
results. The possibility of unauthorized disclosure, however always exists. The test results will be disclosed to you on a face-to-
face basis and you will have the opportunity to obtain further information and counseling regarding the meaning of the test
results.
PATIENT ACKNOWLEDGEMENT AND CONSENT
I acknowledge the need for, and the nature of, the HIV test. It has been explained to me by Metro -Dade Firefighters Wellness
Center.
1 HAVE READ THE ABOVE AND 1 ACKNOWLEDGE RECEIVING FROM METRO-DADE FIREFIGHTERS WELLNESS
_ CENTER OTHER INFORMATION ABOUT THE TEST FOR HIV AND ABOUT AIDS, AND I HAVE BEEN GIVEN THE
I\ PPORTUNITY TO ASK QUESTIONS, AND MY QUESTIONS HAVE BEEN ANSWERED.
The test for HIV has been explained to me, including its purpose, potential use, limitations and the meaning of its results. I
understand the benefits and risks, and I request that this HIV test be performed as requested by my employer the City of Miami.
I acknowledge that the disclosure of information contained in my medical records relating to my HIV test is restricted in
accordance with Florida and Federal law and that my employer, the City of Miami, will receive the HIV results.
I do /do not
and/or other third party payors.
authorize the release and disclosure of my HIV test results to my insurance company
Signature of Patient or Authorized Person Witness
Relationship to Patient Date
ATTESTATION OF PHYSICIAN
I have explained to the above patient the need for, and the nature of, the HIV test. I have explained, in layman's terms, the
possible risks, hazards, complications and consequences, which are associated With the test. The patient has indicated his/her
understanding and has consented to the test being performed.
❑ As a physician, I will provide pre- and post test counseling
0 Request that a certified HIV counselor see patient
\ —Physician
28
MDFF WELLNESS CENTER
City of Miami Request for Proposal
Attachment 2
Hepatitis A, B, C Screening Informed Consent Forms
Patient Date
Classification: ❑Firefighters ❑Police Officer DCrime Scene Investigator ❑Property Specialist
❑am
❑pm
Hepatitis means liver inflammation and is caused by a virus. Several different viruses cause hepatitis: Hepatitis A,
Hepatitis B and Hepatitis C. Viral hepatitis infection can be acute (short-term) or chronic (lifetime). Chronic hepatitis can
cause severe liver damage and liver cancer, therefore, screening is important as a preventative measure.
Hepatitis A Virus (HAV) is spread by eating food or drinking water contaminated with feces, or the bowel movement
(BM) from a person infected with the Hepatitis A Virus. It can also be caused by anal -oral contact. Adults who become
infected with HAV usually have symptoms for several weeks. There is a vaccine to prevent Hepatitis A. People who travel
to areas with poor sanitation, illicit drug users, men who have sex with men, and people with liver disease should be
vaccinated.. ... — - ...
Hepatitis B Virus (HBV) is spread through contact with infected blood, through sex with an infected person, and from
mother -to -child during childbirth. It is the most common hepatitis viral infection. Most adults who become infected will
recover from HBV after a few months and become immune to being infected again. However, chronic HBV can lead to a
scarring of the liver, called cirrhosis (sir-o-sis) and liver cancer. There is a vaccine to prevent Hepatitis B. People who are
exposed to blood and/or body fluids through sexual, household or occupational contact, illicit drug users, as well as
people with HIV or liver disease, should be vaccinated.
Hepatitis C Virus (HCV) is spread mostly from contact with infected blood, such as a blood transfusion (before 1992),
kidney dialysis, or through injecting drug use. It is rarely sexually transmitted, although sex with multiple partners or a
/'history of sexually transmitted diseases can increase risk. The virus can enter the body through minor cuts or scrapes by
_,.razors, toothbrushes or on needles used for tattooing, body piercing or through drug paraphernalia. Most infected people
go on to develop chronic HCV, a silent and progressive disease that can lead to cirrhosis and liver cancer, which is why
testing is so important.
PATIENT ACKNOWLEDGEMENT AND CONSENT
• I acknowledge that the City of Miami requires the screening of Hepatitis A, B, and C during my annual medical
physical.
• I acknowledge that the test results of my Hepatitis A,B, and C screening will be provided to the City of Miami in a
confidential manner.
• The above benefits of having the Hepatitis A, B and C screenings have been explained to me.
I recognize that I have the right to refuse the Hepatitis A, B, and C screening.
I acknowledge that the disclosure of information contained in my medical records relating to my Hepatitis A, B and C
screening tests is restricted in accordance with Florida and Federal law and that my employer, the City of Miami, will
receive these results.
1 consent to the HAV, HBV, and HCV testing and to the release of this information to the City of Miami.
I refuse to consent to the HAV, HBV and HCV testing.
Signature of Patient or Authorized Person Witness
1)
29
Attachment 3-A
Dalisla Soto Curriculum Vitae
DALISLA C. SOTO, M.D., F.A.A.F.P.
Home Office
10568 NW 51st Terrace 8000 NW 21st Street
Miami, FL 33178-3210 Miami, Florida 33122
(305) 591-8330 (305) 499-8900
EDUCATION
04/2005 Medical Review Officer (MRO) Course
-American Academy of Occupational & Environmental Medicine
Washington, D.C.
02/2004 Fitness for Diving Certification Course
Underwater & Hyperbaric Medical Society (OHMS)
New Orleans, Louisiana
09/2002 Stress EKG Course
The National Procedures Institute
Myrtle Beach, South Carolina
1989-1992
Residency in Family Medicine
Jackson Memorial Hospital
University of Miami School of Medicine
1986 Diving Medical Officer Course
Naval Diving and Training Center
Panama City, Florida
1986 Mini -Residency in Occupational Medicine
Post -Graduate School of Medicine
University of Cincinnati, Ohio
1982-1983 Pathology Rotation, Social Security Hospital
Panama, Republic of Panama
1974-1978 Doctor of Medicine, School of Medicine
University of Panama, Republic of Panama
1972-1974 Pre -Medicine Studies, School of Natural Science and Pharmacy
University of Panama, Republic of Panama
30
Curriculum Vitae
DALISLA C. SOTO, M.D., F.A.A.F.P.
PROFESSIONAL EXPERIENCE
Family Practice/Occupational Med. Physician 9/2003-present
University of Miami - Department of Family Medicine
& Community Health/Metro-Dade Firefighter Wellness Center
Family Practice Physician
Volunteer, St. John Bosco Clinic
Personal Leave
Family Practice Physician
Miami Medical Consultants
▪ Private practice performing
clinical outpatient medicine
including skin biopsies,
suturing, joint injections and
Stress Tests
Family Practice Physician
MCCI, Hialeah Medical Center
• Outpatient Managed Care Setting
FPA Medical Management
Medical Director, Hialeah Medical Center
South Florida Regional Medical Director
Clinical Medical Director, Tri-County
Family Practice Physician
PCA Medical Centers
Physician -in -Charge, Atlantic District
Occupational Health Division
Panama Canal Commission
U.S, Federal Agency
Emergency Room Physician
Social Security Hospital
- -Panama, Republic of Panama
General Medical Officer
ER and Outpatient Clinic
5/2003-9/2003
3/2003-5/2003
- 3/2002-2/2003
1999-2/2002
1998-1999
1997-1998
1996-1997
1992-1996
1984-1988
1983-1984
31
Curriculum Vitae
DALISLA C. SOTO, M.D., F.A.A.F.P.
Coco Solo U.S. Army Hospital
Republic Of Panama 1980-1982
Two Year Rotating Internship
Republic of Panama 1978-1980
CERTIFICATIONS AND AWARDS
Approved Diving Medical Examiner
Undersea and Hyperbaric Medical Society 2004-2007
Medical Review Officer (MRO)
-Medical Review Officer Certification Council (MROCC) 2005-2011 -
Listed in "Guide to America's Top Family Doctors" 2002-2003
2004-2005
BCLS/ACLS Provider Re -Certification 2005
Fellow, American Academy of Family Physicians 1997
Diplomat, American Academy of Family Physicians 1992
Recertification-1998; Recertification-2004
Chief Resident, Department of Family Practice
University of Miami Jackson Memorial Hospital • 1991-1992
FLEX Certification 1991
Sustained Superior Job Performance Award 1988
Panama Canal Commission, U.S. Federal Agency
Republic of Panama
Special Service Award
Panama Canal Commission, U.S. Federal Agency
Republic of Panama
1988
Special Achievement Award for Superior Job Performance 1987
Panama Canal Commission, U.S. Federal Agency
Republic of Panama
ECFMG 1980
32
Curriculum Vitae
DALISLA C. SOTO, M.D., F.A.A.F.P.
PROFESSIONAL ACHIEVEMENTS
South Florida Regional Medical Director
F.P.A. Medical Management, Miami, Florida
1997-1998
Clinical Medical Director, F.P.A. Medical Management 1996-1997
Physician -in -Charge Atlantic District
Occupational Health Division
Panama Canal Commission
Chairman, Dive Safety Committee
Panama Canal Commission
1984-1988
1986-1988
PUBLICATIONS
• Dive Safety Manual (1987), Panama Canal Commission Diving Program
PROFESSIONAL SOCIETIES
• American Academy of Family Physicians (AAFP)
• Society of Teachers of Family Medicine (STFM)
• American College of Occupational and Environmental Medicine (ACOEM)
• Underwater and Hyperbaric Medical Society (UHMS)
LANGUAGES
• Fluent in English and Spanish
MISCELLANEOUS
• UPIN #: F25660
• PIN #: 14759
• Citizenship: USA
33
MDFF WELLNESS CENTER
City of Miami Request for Proposal
Attachment 3-B
Dalisia Soto State of Florida License
STATE OF t7:{7R1..
DEPARTM f .,CAEtf>EALTH
DMSTON OF MEDt AL QUALITY ASSURANCE
AC#
LICENSE NO.
NTROLN
ME 59438
DECAL DOCTOR
`t ai r iovu E3as ;all reg4ice rents cf
`�he':Eays and mies'if the State of Florida.
icat on D a s :::°; :.. iiANE..UARY 3i,. 2011
DALUSLA :CAS T RELLON SOTO
•
LICENSEE SIGNATURE
3
34
MDFF WELLNESS CENTER
City of Miami Request for Proposal
Attachment 3-C
Dalisla Soto Board Certification
'13 o di it
� I�t (ttEf441mti fit, I�1,
is a Diplomats of this Board and
having met its continuing requirements is hereby
itoreptirtth
as a
2004-201
MDFF WELLNESS CENTER
City of Miami Request for Proposal
Attachment 4-A
Michele Grundstein Curriculum Vitae
EDUCATION
University of Vermont, Burlington, VT Aug 1987-June1988
University of Massachusetts, Amherst, MA Jan 1989-May 1991
Bachelor of Science in Exercise Science — Valedictorian in major 3.80/4.00
Honors: Cum Laude, Phi Eta Sigma, Phi Kappa Phi and Golden Key Honor Societies
SUNY Stony Brook School of Medicine, Stony Brook, NY
Doctor of Medicine
University of Florida North Broward Hospital District
Family Practice Residency, Coral Springs, FL
July 1992- May 1996
July 1996- June 1999
CERTIFICATIONS
National Board of Medical Examiners Certificate
State Medical License for Florida, 1997 #0074252
Drug Enforcement Agency, 1998
Board Certified - American Board of Family Practice 1999/ Re -certified 2005 - 2012
ACLS 2006
Functional Medicine — AFMCP 2004
MEMBERSHIPS
American Academy of Family Physicians
Florida Academy of Family Physicians
Southeastern Lipid Association
Institute of Functional Medicine
COMMUNITY PROJECTS
Team Physician, United States Olympic Committee, Olympic Soccer Games, FL. 1996
Team Physician, Douglas High School, Coral Springs, FL. 1998-1999
Physician, The Big Red- Professional Red Clay Tennis Tournament, Coral Springs, FL.
1997/1998
Physician, Honda Classic Golf Championship, Coral Springs, FL. 1997
Physician, US Snowboarding Championships, Stratton Mountain, VT. 1996
Sports Physicals. Broward County School District, FL. 1996-1998
Physician, National Depression Screening, Coral Springs, FL. 1997/1998
Physician, National Eating Disorder Awareness and Screening, Coral Springs, FL. 1998
School Physician, Ely High School, Pompano Beach, FL. 1998-1999
Aids Community Teaching, Suffolk County, NY. 1991-1993
Volunteers for Israel, Hartsfeld Hospital, Gedera, Israel. 1991
Delta Zeta Sorority Fundraising Chairperson — won New Precedence Award, Amherst, MA.
1990
RESEARCH AND PRESENTATIONS
Grundstein, MA. The Need to Promote Exercise as Medicine. Florida Family Physician, Winter
1997:47(1),23-24 - Winning essay of the FAFP Essay Award.
"Exercise is Medicine". North Broward Hospital District Star Walkers, Plantation FL. February
1998
"Exercise for Weight Loss". Community Symposium on Weight Loss. Coral Springs, FL 1997
36
MDFF WELLNESS CENTER
City of Miami Request for Proposal
"Practice Guidelines for Anxiety". Coral Springs Medical Center Resident Conference. July
1996/1998
"Exercise and Pregnancy". Winthrop Hospital OB/GYN Conference. Mineola, NY. June 1995
"Physician Counseling on Exercise". Coral Springs Medical Center Noon Conference. March
1999
WORK EXPERIENCE
University of Miami, Miller School of Medicine Feb 2003-present
Assistant Professor of Clinical Medicine -Dept of Family Medicine and Community Health
Physician, Metro -Dade Fire Fighters Wellness Center, Miami, FL
Fire Fighter Health and Wellness Center, Miami, FL.
Medical Director Aug 2001-Feb 2003
Q.- Sole physician overseeing a comprehensive occupational health and wellness program,
including physical therapy, exercise physiology and nutrition for fire fighters, their
families and Miami Dade executives. includes : executive physicals, work related
injuries, urgent and primary care, international vaccines for the Urban Search and
Rescue Team (Yellow Fever vaccine status), advanced lipid screening, cardiac risk
factor and lifestyle modification, low back prevention
Holy Cross Medical Group, Ft. Lauderdale, FL
Family Physician — Primary Care Medicine and
Holy Cross Emergency Room Minor Care
North Beach Medical Group
A subsidiary of Cleveland Clinic Florida, Ft. Lauderdale, FL
Family Physician — Primary and Urgent Care Medicine
Oakridge Medical Group, Ft Lauderdale, FL
Family Physician
Sept 2000-July 2001
Oct 1999-Aug 2000
Aug 1999-Oct 1999
American Express Health & Fitness Program, New York, NY 1988-1992 intermittent
(Full Time during Educational Gap)
Health and Fitness Specialist/Exercise Physiologist Sept 1988-Jan 1999
Received Q1 — "Quality' Award for outstanding contributions and employee excellence.
Central Queens YM & YWHA, Forest Hills, NY 1985-1996 intermittent
(Part time)
PERSONAL
Born in Forest Hills, New York- 4/12/69
Skiing, Golf, Tennis, Astanga Yoga, Writing
Former highly competitive gymnast, completed several triathlons.
uJ
37
MDFF WELLNESS CENTER
City of Miami Request for Proposal
Attachment 4-B
Michele Grundstein State of Florida License
DEP THE T OF: E l°EALTH
DIUISIc N OF MEDICAL QUALITY 11• , U��AN_GE
.;DATE
s
- E ENSE NO
=CON . N`O TROL.
01/2812010 f
ME 74252
312619
The MED'IGALDGCjTOIt
named``fie ow`'tias mel- all're {uirernents of
tfie tAi$4.6d :Eules;or �tIje 'state of Florida.
:
1 p 'atiea Date' JANUARY 31, 20 t2
MlGfiELE'AMY aiR.UN'DSTEIN
8000 NW 21 STR *ET, STD., 200
MIAML FL; 331•22 '
UNI T ED'S.'.TAtt.S
I,a11ie�rist
VRNDR
QUALIFICATION(.4; :<,
DISPENSING PRACTrt1c 14Ek -
Priafirt. Viamontex3,o„tv1:Di M.
�`TPTC- SURIaEOW DUKE
iIICP`Lctki� tF: F..(SI i:tr4i=ll::ak VAVI/
38
MDFF WELLNESS CENTER
City of Miami Request for Proposal
Attachment 4-C
Michele Grundstein Board Certification
:ANovi' mity,
*fr A M GrItabateirt, .�.
is a Dit lomate of this Board and
having met its continuing requirements is hereby
Reatifith
BileitP
2005--20 1 2
:24r/-4-
39
MDFF WELLNESS CENTER
City of Miami Request for Proposal
Attachment 5-A
Alan Roberts Curriculum Vitae
CURRICULUM VITAE
ALAN K. ROBERTS, M.D.
71NDERGRAD! TATF,
B.S. Biology - Bucknell University — September1966- June 1970
Lewisburg, Pennsylvania
CUM LAUDE GRADUATE - June 1970
MRTNCAT,
Jefferson Medical College
Thomas -Jefferson -University
Philadelphia, Pennsylvania
September 1970 -June 1974
FAMI( Y PR ACTT(1F
Residency Program - St. Margaret Memorial Hospital
Pittsburgh, Pennsylvania
July 1974- June 1977
Chief -Resident Family Practice -June 1976- Ju1y1977
Pennsylvania - June1976
Florida — July 1977 — present License Number 30398
F41Y1TT YPRACTICF.
Founder and medical director of Sunshine Medical Centers with three locations in South Florida.
SMC evolved into a three location medical practice providing primary care, urgent care, and a variety
of medical services to the employees of international corporations, cruise lines and
airlines based in South Florida. SMC also provided Travel Medical services to an extensive
private and corporate -affiliated population. July 1977 —November 2007
South Miami Port of Miami Downtown Ft. Lauderdale
6341 Sunset Drive 907 S. America Way 1347 S. Andrews Avenue
South Miami, FL 33143 Miami, FL 33129 Ft. Lauderdale, FL 33315
. The practices were acquired by a national medical services provider.
May 2001— CEO — Vaccine Express -In this position, Dr. Roberts became a "Recognized
expert in the field of travel medicine and renowned spokesman on vaccine -related subject matter. VXP specializes in the
prevention of travel -related and vaccine -preventable illnesses. VaccineXpress employees have provided thousands of
individuals and corporate employeeswith proper immunizations for travel to foreign countries for protection against
vaccine preventable disease for nearly 30 years.")
MEMBERST-ITPS
Board Certification Family Practice —June 1978
Recertification Family Practice -June 2010
40
MDFF WELLNESS CENTER
City of Miami Request for Proposal
American Medical Association current
American Academy of Family Practice May 1978- present
American Occupational Medical Association June 2003 - present
American Society of Tropical Medicine & hygiene May 1999 - present
International Society of Travel Medicine May 2000 - present
Dade County Medical Society July 1978 - present
Florida Medical Society July 1978 - present
American Board of Holistic Medicine - certified 2008
AFFILTATiONS
Assistant Professor, Department of Family Medicine, Voluntary Faculty
University. of Miami December2002..._.._.
Clinical Instructor, Department of Family Medicine and Community Health, University
of Miami, December 2009 to present.
-Sr. Flight Examiner = Capman Airways April 1-990=June 1994
Sr. Flight Examiner — Major airlines — United States July 1985 - present
Medical Examiner —Various Cruise and cargo Lines Apri11985- November 2007
Medical Examiner - Coast Guard exams April 1986 —November 2007
Medical Consultant— City of Coral Gables May1994-November 2007
Medical Consultant— City of Ivliami May 2002-April2005
Medical Consultant — City of Miami Beach May 1999 -May 2004
GlaxoSmithKline — Corporate Hepatitis Preven]ionAdvisory Board January 2005 -
present
GlaxoSmithKline— Vaccine Preventable Hepatitis Speakers Force January 2005- present
GlaxoSmithKline - Cervarix - Advisory Board 2010
Merck —Adult Vaccine Advisory Board March2005 - present
Salix — Principal examiner Travelers' Diarrhea Prevention Study January2006-
Seetember 2006
Merck — Speakers forum — Human Papillomavirus Virus (HPV)March 2005 —
November 2007
Merck — Speakers forum — Herpes Zoster Prevention January2005- present
Sanofi Pasteur —Adult Vaccine Advisory Board February2006 -present
AAUCM (American Academy of Urgent Care Medicine) Symposium presentation
Travel Medicine May, 2008
South Miami Hospital Courtesy staff privileges August 1977- November 2007
Coral Reef HospitaUJackson South Courtesy staff privileges September 1994 —
November 2007 converted to honorary staff privileges
CERTIFICATES:
Drug -Free Workplace Medical Advisor January1998 - present
Federal Certified MRO - Medical Review Officer March1998 - present
Senior Federal Aviation Administration Flight Examiner February1986 - present
Travel Health Certified — The Int'l Society of Travel Medicine May 2000 - present
ACLS Certified August2005-August2011 ..
MFDIA & PUBLIC TV INTERVIEWS
Over the years, Dr. Roberts has been interviewed by The Wall Street Journal, USA Today and local
public television (WLRN) on a variety of Travel Medicine topics.March 1998-May 2006
PUBLICATIONS: Safety of Typhim Vi Vaccine in a Post -marketing Observational Study
Published in the Journal of Travel Medicine, Volume 14, Issue 6 2007, 386-391
41
MDFF WELLNESS CENTER
City of Miami Request for Proposal
Attachment 5-B
Alan Roberts State of Florida License
STATE OF FLORIDA
DEPARTMENT OF HEALTH
DIVISION OF MEDICAL QUALITY ASSURANCE
DATE 1 LICENSE NO, CONTROL NO.
10/15/2009 I ME 30398 L 288568
AC# 3
The MEDICAL DOCTOR
— named below has met all requirements of
the laws and rules of the state of Florida.
Expiration Date: JANUARY 31, 2012
cLMtfii
LICENSEE SIGN TURE
42
MDFF WELLNESS CENTER
City of Miami Request for Proposal
Attachment 5-C
Alan Roberts Board Certification
4
orb dJrnniijj
Alan 3Kennwfh Krherts AO.
is a Diplomate of this Board and
having met its continuing requirements is hereby
tri
nr
43
MDFF WELLNESS CENTER
City of Miami Request for Proposal
Attachment 6-A
Donald Rosenberg Curriculum Vitae
UNIVERSITY OF M3AMI SCHOOL OF MEDICINE
Curriculum Vitae
1. Date:
P1RSONA7
2, Donald G. Rosenberg, M.D.
3. Home Phone: (305) 891-0114
4. Mice Phone: 305) 243-7242 Fax:
October 20Oi23
5. Home Address: 12885 Hickory Road
North Miami, Florida 33181
(
5) 243-7244
6. Current Academic Rank: Professor of Clinical Medicine, Division of Cardiology
Department of Medicine
Medical Director, Miami -Dade County Fire Rescue
7. Primary Department: Department of Medicine, Division of Cardiology
8. Secondary Jolnt Appointments: None
9. Citizenship: U.S.A.
10. Vioa Type: WA
HIGHER EDUCATION
11. institutional: Emory University, Atlanta, GA July 1949-June 1952
Emory University, Atlanta, OA
School afMedicine
Medical Degree July 1952-Sun; 1953
12. Non-lnatituttonat:
University of Miami School of Medicine/
Jackson Memorial Hospital Medical Center
Rotating Internship
Grady Memorial Hospital
Residency — Internal Medicine
July 1956-June 1957
July 1957-June 1959
44
MDFF WELLNESS CENTER
City of Miami Request for Proposal
.D'anild Q Rosenberg,
Curriculum Vitae Page 2
Emory University July 1959-June 1960
Fellowship — Cardiology
13. Certification, licensures, boards:
American Board of Internal Medicine February 6, 1964
American Board of internal Medicine
Recertification October 26, 1974
American Board of Cardiology October 19, 1977
- - - - Florida State Board of Medical Examiners August 15, 1956 . _.
Licensed M.D.
Georgia State Board of Medical Examiners July 06, 1956
Licensed M.D.
EXPERIENCE
14. Academic:
University of Miami School of Medicine Clinical Instructor July 1971-June 1974
of Medicine
University ofMiami School of Medicine Clinical Assistant Professor July 1974-June 1978
of Medicine
University of Miami School of Medicine Clinical Associate Professor July 1979-June 1983
ofMedieine
University of Miami School of Medicine Clinical Professor July 1984-June 1988
of Medicine
University of Miami School of Medicine Director, EMS Training July 198o-Itme 1994
Programs, Div. of Card.
University of Miami School of Medicine Director, ACLS Training July 1994-lone 1995
Program, Div. of Card.
University of Miami School of Medicine Associate Professor July 1988-June 1997
of Clinical Medicine
Metro -Dade Fire Rescue Medical Director January1996-Present
University of Miami School of Medicine Professor of Clinical Med, July 1997 Present
45
MDFF WELLNESS CENTER
City of Miami Request for Proposal
Vonald G. Rosmbarg. M.D., F.ACC.
15. Hospital Appointments
Jackson Memorial Hospital
North Miami -General Hospital
Jackson Memorial Hospital -.
Parkway Regional Medical Center
North Miami General Hospital
North Miami General Hospital
Jackson Memorial Hospital
Parkway Regional Medical Center
Parkway Regional Medical Center
Jackson Memorial Hospital
American Heart Association of
Greater Miami
American Heart Association
Florida Affiliate
American Heart Association
Florida Affiliate
16. Military: None
CLrriculum Vitae Page ]
• Courtesy Staff July 1960-June 1963
Senior Attending, Internal
Medicine, Cardiology July 1961-June 1962
Active Staff July 1963-June 1971
Sr. Attending, Dept, ofMed, July 1966-June I967
Cardiology
Chairman, Audit Committee
Chairman, CICU Committee
Courtesy Staff
• Chief of Staff
Board of Directors
Active Staff
July 1971-June 1972
July 1971-tune 1973
July L971-June 1988
July 1979-June 1980
July 1980-June 1985
Ju1y1988-Present
Chairman, CPR-ECC Comm. July 1990-June 1994
Member Affiliate Faculty July 1994-June 2001
Member; ACTS Subcomm July 1994-June 2001
PUBLICATIONS
17. Books, chapters in books, and monographs published:
Myerburg RJ, Velez M, Fenster J, Rosenberg D, Castellanos A. The role of automated external
defibrillators for out -of -hospital cardiac arrest. In Santini M, ed. Non Phannacological
Treatment of Sudden Death. Rome, Italy, 2003; 1-22.
Myetburg RJ, Elliott S, Rosenberg DG, Interian A, Jr., Castellanos A. New developments in
46
Erma le G. Rosenberg, M.D..
MDFF WELLNESS CENTER
City of Miami Request for Proposal
Curriculum Vitae Page 4
out -of -hospital cardiac defibrillation: evaluation ofAED strategies. In: Paul J. Wang. New
Arrhythmia Technologies, Blackwell. Futura, Massachusetts; 2005; 11: 95-108
I>I, Juried or refereed journal articles;'
1. Rosenberg DG, Galambos JT. Yellow spinal fluid: American Journal of Digestive Disease.
1960; Vol. #7: 32-48,
2. Rosenberg DG, Rape WC, Rubble L, Jr. Journal of Parenteral Methylphenidate HCL in
Barbiturate Poisoning: Medical Association of Georgia, January 1959; Vol. #7: 19-21.
3. Rosenberg DG. Use of Allopurinol in Gout, Hypenuicemia and Urie Acid Lithiasis: Southern
Medical Journal, Birmingham, AL, Feb., 1967; Vol 4:215-218.
4. Levin E, Botnoniria E, Rosenberg Da, et al. Ethnic Differences in Return of Spontaneous
Circulation after Bystander Cardiopulmonary Resuscitation in Witnessed Out -of -Hospital
Cardiac Arrest: Circulation Supplement, Vol, 94, Number 8, October 15, 1996.
Morrow DA., Antrnan Ei+2, Sayan A, Schuhwerk KC., Giugiiano RP., deLemos JA., Wailer
M., Cohen SA., Rosenberg DG., Cutler SS., McCabe CH., Walls RM., and Braunwald E.
Evaluation of the Time Saved by Pre -hospital Initiation of Retavase for ST Elevation MI:
Results of the Bar1y Retavase (ER) —TE8lI 19 Trial. J Am Coll Cardin' 2002; Vol #40:71-77.
6. Rosenberg DG., Levin E., Lausell A., Brown A., Gardner J_, Perez E., Veennedaal M., Ong
YSC., and GurmM. Feasability and Timing of Prehospital Administration ofRetavase in
Patients with Acute Myocardial infarction. Accepted for publication in the Journal of
Thmmbosisand Thrombolysis. Journal of Thrombosis and Thrombolysis 13(3), 147-153,
2002.
7, MyerburgRJ., Fenster I., Mauricio V., Rosenberg DG., Lai S., Kuriansky P., Newton S, Knox
M., and Castellanos A. "Impact of Community -Wide Police Car Deployment of Automated
External Defibrillators on Survival from Out -of -Hospital Cardiac Arrest." AMA Circulation
2002;106:1058-1064.
8. Myerburg,RJ, Velez, M, Fenster, 1, Rosenberg, DG, and Castellanos, A. "Community -Based
Responses to Impending or Actual Cardiac Arrest and Advances in Post -Cardiac Arrest Care"
Journal of Interventional Cardiac Electrohysiology 9, 189-202, 2003
19. Other works, publications and abstracts:
Schrank KS, ILittrell KA, Farber P, Rosenberg DG. Prehospital Paramedic Interpretation of 12-
Lead Electrocardiograms for Myocardial Ischemia and Infarction, Ann Emerg Med 1993; 22
(5);174.
2_ Algona P, Altus P, Camibba C, Rosenberg Da, et. al. Frehospital Actions by Health -Care
Providers and Physicians. JFloridaMedAssoc, February, 1995. Vol 82(2): 100-107.
3. Rosenberg DG, Levin £,. Brown A, et "al. Prehospital Administration of Reteptase in Patients
47
MDFF WELLNESS CENTER
City of Miami Request for Proposal
. beanie 0. Rosenberg, M.O., F.A.C.C.
Curriculum Vitec Pagt5
with Acute Myocardial Infarction. Ann E,nerg Med. October, 1999. Suppl 40; 34(4): p-pp.
4. Rosenberg DO, et al..A mnemonic for the recall of causes of Electromechanical Dissociation
(EMD). Resuscitation. 40(1):57. .
5, Newman MM,Mossesso VN Jr, Omato JP, Paris PM, Andersen L, Brimfield K, Dunnavant GR,
Frederick J, Groh WJ, Johnston S, Lerner EE, Murphy G, Myerburg RJ, Rosenberg DG, Savino
M, Sayre MR, Sciammarella J, Schoen V, Vargo P, van Alem A, White RD. Law Enforcement
agency defibrillation (LEA-D): position statement and best practices.precotnmendations from
the National Center far Early Defibrillation. Prehosp Emer Care 6:346-347, 2002.
6. 1Vfyerburg RJ, Velez M, Rosenberg DG, Fenster J, Castellanos A. "Automatic external
defibrillators for prevention of out -of -hospital sudden death; effectiveness of the automatic
. _.__ -- external -defibrillator. JCardiovascElectrophysio12003(suppi):14:S108-S116.
20. Other works accepted for publication:
1. Cardiology Patient Simulator (Supplement). From the Medical Training and Simulation
Laboratory, Division of Research in Medical Education and Division of Cardiology,
'Department ofMedicine.
PROFESSIONAL
21. Funded research grants received within the last Five yearn (*currently active):
Boehringer Mannheim Corporation: Multicenter, Open, Pilot Trial to Determine the Feasioility
and Timing of Field Administration of Retavase in
Patients with Acute Myocardial Infarction.
January, 1998 —Present (Ongoing)
Principal Investigator: Donald G. Rosenberg, M.D.
22, Editoriat responsibilities: None
23. Professional and honorary organisations:
American heart Association of Greater Miami
Vice President
American Heart Association of Greater Miami
President
American Medical Association
July 1977-June 1978
July 1980-June 1981
July 1971- Present
Florida Medical Association July 1971- Present
48
MDFF WELLNESS CENTER
City of Miami Request for Proposal
Gunatd. G. Ftnscitherg, Mi,P.A.C.C.
Dade County Medical Association
Alpha Omega Alpha
24. Honors and awards:
Curriculum Vitae
Past 6
July 1971 - ?resent
My 1955 - Present
07/09/1998 Recipient of the "Raymond H. Alexander, M.D., EMS Medical Director Of the year for
the State of Florida, Award for 1998'.Presented by the Florida Department of Health,
Bureau of Emergency Medical Services, during the State EMS Advisory Council
Meeting. Tampa, Florida
06/06/1998 Recipient of the "Roy M. Baker, MD., Award for Outstanding Leadership in the State of
Florida in the Emergency Provision of Medical Services by a Physician or Layperson.”
Presented by the Florida Medical Association._ Miami, Florida -
05/14/1989 Completed continuing medical education program, "Medical Risk Management"
sponsored by the University of South Florida, for seven hours in Category I for the
Physicians Recognition Award.
05/21/1989 Completed the American Heart Association Advanced Cardiac Life Support Instructor
Course.for 24 hours of CME credit. Card expires Jun e 2003.
05/14/1989 Completed continuing medical education program, "AIDS Education," sponsored by the
University of South Florida, for three hours in Category I for the Physicians
Recognition Awards.
. June 1993 Made a romnbm• of ACLS Affiliate Faculty of the American Heart Association, Florida.
Affiliate.
25. Post -Doctoral Fellowships: None
26. Other professional activities (papers presented; conferences; seminars; etc.)1
National and International Scientific Meetings:
Annual Teaching Conference in Clinical Cardiology July 1982-June 1996
University of IvliatniflEial Harbour, FL
Professional Cholesterol Education Program April 29, 1989
American Heart Association
Capitol Medical Society - Invited Lectureship Nov 9-10, 1988
Attended many National Meetings ofthe American
Heart Asaociation and American College of Cardiology over the years.
27. 'Teaching:
49
MDFF WELLNESS CENTER
City of Miami Request for Proposal
isonalt G. Rosenberg, M.D., F.A.C".C.
Currictilum Vitae Page 7
a) Teaching awards received: See #24
Medical -Pathology Seminar Lecture Series
"Physician Management of The Patient with Coronary Artery Disease"
Nov 15, 2004
Eighth Annual Pacesetters 2004 presented by the Fire Chiefs' Association of
Broward Regional EMS Council
"An Afternoon with Ffarvey" May 14, 2004
37s' Teaching Conference in Clinical Cardiology and Neurology Jan 28-29, 2005
b) Current teaching responsibilities: N/A
20. Teaching specialization;
Numerous ACLS Courses
Medical Training Laboratory
University ofMiatni
Senior Student Cardiology Teaching Program
University of Miami
29. Thesis and dissertation advising:.
None
SERVICE
30. University comnuilee and administrative responsibilities: N/A
July 1971-June 1999
July 1971-June 2002
31. Community Activities:
University of Miami Hospital & Ciinic/Syivester Cancer Center Environmental - Care
Comrmttee
Award for Distinguished Community Service far the Florida Chapter — American College of
Physicians, American Society of internal Medicine 33rd Scientific Meeting Renaissance Vinoy
Resort. October 5, 2001
50
MDFF WELLNESS CENTER
City of Miami Request for Proposal
Attachment 6-B
Donald Rosenberg State of Florida License
STATE QF L 3RID `` ACtr
aEr l�;C1VI 1 T:_ F NEALTI•1
D10SI0I OF tufEOICAL QUALITY ASSURANCE
==-
_
LICENSE NO.
'-01,R6f2OO9 it 7175 l -_
X
ltitit.:ir
;�2 e - T i.CA.L=DOCTOR
>namec e� -fsas tn' f all requ;rem.6nts of
t hy_- owsrand -nf'es:=tithe sta.e of Florida.
Exjicgtio t,D to > : <<:__ JANUARY 31, 2011
:;r: :: • i �i r
LlC l\SEE SIGNATUR- E'.
1'.
75577,-:�
•
•
51
MDFF WELLNESS CENTER
City of Miami Request for Proposal
Attachment 6-C
Donald Rosenberg Soto Board Certification
HAS NIET TH .It.EQUiOMENTS-OF•TN S ElDAR14 j.ND lti •
HEEVESY. DESIONATErfr A- D1E'1.(7M:AT CEILT1FIz;D IN
.T E-SU$SPECIALTY aC, • ,._
CARDIOVASCULAR •- DIM'SE• .. 4,
453
nnm. ay....1. mmc A10001pm/ P u.O"c.F . un ••. a..a..-v ci
RRf,E r T ]tali» c CAE»lnvwl'CutM Nt^.(y •
o�fr�
d. e. 09 m 14441
w..' 24744.
U
"" OCTOBER 19.1977
Fc.11 701a-17
52
MDFF WELLNESS CENTER
City of Miami Request for Proposal
Attachment 7-A
Germaine Rodriguez Curriculum Vitae
CURRICULUtvi VITAE
GERMANE RODRIGUEZ, M.D.
HOME ADDRESS:
EDUCATION:
Jan -Feb 2002
1997— 1998
1996-- 1997
1993 _1997
Miami Beach, FL
90 Alton Road P113310
Miami Beach, Florida 33139
(305)532 4514
Mini -Fellowship, Musculoskeietal NMI Pro -Scan MRI
Cinneinnxri, Ohio
Fellowship, Body Imaging (MPJ', CT and U/S)
Brigham and Womcn's Hospital / Harvard Medical School
Boston, MA.
Chief Resident
Mount Sinai Medical Center
Miami Beach, FL
Resident, Diagnostic Radiology Mount Sinai Medical Center
1989 _1993 Doctor in Medicine, Honors
Universidad Central del Caribe Medical School
Bayamon, Puerto Rico
1987 —1989 Bachelors in Science, Honors
Interamerican University of Puerto Rico
San (lennan, Puerto Rico
1985-1987 University ofPuerto Rico
Mayaguez, Puerto Rico
MDFF WELLNESS CENTER
City of Miami Request for Proposal
SPECIALTY 1 CERTIFICATIONS;
Florida
Massachusetts
Pennsylvania
American Board of Radiology
National Board of Medical Examiners
WORK E) RIENCE:
March 2002 - Present Diagnostic Radiology and Medical Director __
OMI MR1 Network
Weston, Florida
Mar. 1999 - Feb. 2002
Jul. 1993 - Feb. 1999
Dec. 1997 - Jun. 1998
Radiologist, Body Imaging
Specialists in Diagnostic imaging, PA.
Miami, Florida
Diagnostic Radiologist
HealthSouth Doctors' Hospital
Coral Gables, Florida
Diagnostic Radiologist Jordan Hospital
Plymouth, Massachusetts
Jul. 1996 - Jun. 1997 Diagnostic Radiologist Homestead Hospital
Homestead, Florida
Jan. 1995 - jun. 1997
Diagnostic Radiologist
Miami Children's Hospital
Miami, Florida
PROFESSTIONAL ORGANIZATIONS:
Clinical Magnetic Resonance Society
Radiological Society of North America
Florida Medical Association.
Dade County Medical Association.
54
HONORS:
1999 - 2000
1989 -1993
1987 -1989
MDFF WELLNESS CENTER
City of Miami Request for Proposal
Who's Who in Health Care and Medicine
Cum Laude Graduate
Universidad Central del Caribe Medical School
Alpha Omega Alpha Honor Society
Janet M. Glasgow Memorial Achievement Award
from the American Women's Medical Association.
Magna Cuin Lauda
Interamerican University of Puerto Rico
LANGUAGES: English, Spanish
55
MDFF WELLNESS CENTER
City of Miami Request for Proposal
Attachment 7-B
Germaine Rodriguez State of Florida License
nedei 'er -fi
matawa
'L iv i' .
T1I •?4 C -• mow•
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rigAsv
24 - ;ST
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Qe( / r
bd% C (% 6� / 6 C O �{
pocictf o F fArs brfri74er
56
MDFF WELLNESS CENTER
City of Miami Request for Proposal
Attachment 7-C
Germaine Rodriguez Board Certification
57
MDFF WELLNESS CENTER
City of Miami Request for Proposal
Attachment 8
HIPAA Patient Notice
METRO-DADE FIREFIGHTERS WELLNESS CENTER
8000 N.W. 21 Street, Suite 200
Miami, FI 33122
(305) 499-8900 Office• (305) 499-8901 Fax
MDFRWELLNESS@MIAMIDADE.GOV
THIS NOTICE DESCRIBES HOW HEALTH INFORMATION ABOUT YOU MAY BE USED AND
DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW
CAREFULLY.
Applicable federal and state laws require our practice, to maintain the privacy of your health information.
These laws also require us to provide you with this Notice of our privacy practices, and to inform you of your
rights, and or obligations, concerning your health information. We are required to follow the privacy practices
--described below -while -this -Notice - is in.effect This Notice -is-effective-of April-1a-2003--and -will remain -in -. -'
effect until we replace it,
CHANGES TO NOTICE:
We reserve the right to change this Notice and the privacy practices described below et any time in
accordance with applicable law. Prior to making significant changes to our privacy practices, we will alter this
. Notice to reflect the changes, and make the revised Notice available to you on request. Any changes we
make to our privacy practices and/or this Notice may be applicable to health information created or received
by us prior to the date of the changes. You may request a copy of our Notice at anytime. For more information
about our privacy practices, or for additional copies of this Notice, please contact us using the information
listed at the end of this Notice.
PERMITTED USES AND DISCLOSURES OF HEALTH INFORMATION:
A. TREATMENT, PAYMENT, and HEALTH CARE OPERATIONS: You should be aware that during the
course of our relationship with you we would likely use and disclose health information about you for
treatment, payment, and healthcare operations. Examples of these activities are as follows:
• Treatment: We may use or disclose health information to a physician or other healthcare provider providing
treatment to you.
• Payment: We may use and disclose your health information to obtain payment for services we provide to you.
• Healthcare Operations: We may use and disclose your health information in connection with out healthcare
operations. Healthcare operations include quality assessment and improvement activities, reviewing the competence
or qualifications of healthcare professionals. evaluating practitioner and provider performance, and other business
operations.
B. AUTHORIZATIONS: You may specifically authorize us to use your health information for any purpose or to
disclose your health information to anyone, by submitting such an authorization in writing. Upon receiving an
authorization from you in writing we may use or disclose your health information in accordance with that
authorization. You may revoke an authorization at anytime by notifying us in writing. Your revocation will not
affect any use or disclosures permitted by your authonzation while it was in effect. Unless you give us a
written authorization, we cannot use or disclose your health information for any reason except those permitted
by this Notice.
C. DISCLOSURES TO FAMILY AND PERSONAL REPRESENTATIVES: We must disclose your health
information to you, as described in the Patient Rights section of this Notice. Such disclosures will be made to
any of your personal representatives appropriately authorized to have access and control of your health
information. We may disclose your health information to a family member, friend or other person to the extent
necessary to help with your healthcare or with payment for your healthcare only if authorized to do so. In the
event of your incapacity or in emergency circumstances, we wit disclose health information based on a
determination using our professional judgment disclosing only health information that is directly relevant to the
person's involvement in your healthcare.
D. MARKETING: We will not use your health information for marketing communications without your written
authorization.
E. USES OR DISCLOSURES REQUIRED BY LAW: We may use or disclose your health information when
we are required to do so by law, including for public health reasons (e.g., disease reporting). In some
1 of 2
0
58
MDFF WELLNESS CENTER
City of Miami Request for Proposal
METRO-DADE FIREFIGHTERS WELLNESS CENTER
8000 N,W, 21 Street, Suite 200
Miami, FI 33122
(305) 499-8900 Office • (305) 499-8901 Fax
MDFRWELLNESS@MIAMIDADE.GOV
appropriate authorities if we reasonably believe that you are a possible victim of abuse, neglect, or domestic
violence or the possible victim of other crimes.
F. PATIENT AND THIRD PARTY PROTECTION: Only as permitted by law, we may disclose your health
information to the extent necessary to avert a serious threat to your health or safety or others.
G. LAW ENFORCEMENT/NATIONAL SECURITY: Under certain circumstances we may disclose health
information relating to members of the Armed Forces to military authorities. Under certain circumstances we
May also disclose -health 'information relating to inmates or patients to correctional institutions or law
enforcement personnel having lawful custody of those individuals. We may disclose health information in
response to judicial proceedings and law enforcement inquiries as permitted by law and to authorized federal
_officials -health _information ..required_for -lawful- -intelligence,-counterintelligence,-and • other- national - security
activities.
H. APPOINTMENT REMINDERS: We may use or disclose your health information to provide you with
appointment reminders (such as votcemail messages, postcards, or letter).
PATIENT RIGHTS:
A. ACCESS TO RECORDS: Upon submission of a written request to us, you have the right to review or
receive copies of your health information, with limited exceptions. You may obtain a form to request
access by using the contact information listed at the end of this Notice. You may request that we provide
copies in a format other than photocopies and we will use the format you request if it is readily available.
B. RESTRICTIONS AND ALTERNATIVE COMMUNICATIONS: You have the right to request that we place
additional restrictions on our use or disclosure of your health information for treatment, payment and
healthcare operations purposes. Depending on the circumstances of your request we may, or may not
agree to those restrictions. If we do agree to your requested restrictions we must abide by those
restrictions, except in emergency treatment scenarios. You have the right to request that we
communicate with you about your health information by alternative means or to alternative locations (e.g.,
at your place of business rather than at your home). Such requests must be made in writing, must specify
the altemative means or locations, and must provide satisfactory explanation how payments will be
handled under the alternative means or location you request.
C. AMENDMENTS TO RECORDS: You have the right to request that we amend your health information.
Such requests must be in writing, and must explain why the information should be amended. We may
deny your request under certain circumstances.
QUESTIONS AND COMPLAINTS
If you would like more information regarding our privacy practices or have questions or concerns, please
contact us. If you are concemed that we may have violated your privacy rights, or you disagree with a
decision we made regarding disclosure or access to your health information, please forward concerns in
writing to the above address. We support your right to the privacy of your health information.
PATIENT ACKNOWLEDGMENT OF THE NOTICE OF PRIVACY PRACTICES AND CONSENT TO USE
AND DISCLOSE HEALTH INFORMATION
I hereby consent to the use and disclosure of my health information, for the purposes and activities permitted
under the Federal Privacy Law, which are described in the MDFF Wellness Center Notice of Privacy
Practices.
Print Name
Signature Date
2 of 2
59
Th
MDFF WELLNESS CENTER
City of Miami Request for Proposal
Attachment 9
Release of Medical Records to the City of Miami
, hereby authorize Metro -Dade Firefighters Wellness
Center to release all medical records including HIV Test and Hepatitis A Hepatitis B and
Hepatitis C Results, if applicable, concerning my physical examination as contracted by
the City of Miami for its personnel to the City of Miami, Employee Relations Department
or any physician or attorney representing this agency.
Employee Name (Please Print)
Employee Signature Date
60
CD
D
DALISLA SOTO
This Is to certify attendance at the "Medical Records Law" seminar presented January 30, 2009 in Miami, FL.
Keeping You Cunent
.D11CATION'Str2VICE9 Helpingl'ouSulceed°
A DIVISION OF LOIIMAN BUSINESS CENTER, INC
2510 ALPINE ROAD • P.O. BOX 509 • EAU CLAIRE, WI 54702
PHONE: 866-352-9539. • FAX: 715-833-3944
www.lorman.corn • customerservice@lorman.com
SittpluAL
Michelle L. Shepherd
CE cool°Inolor
384642
(5)
Employee H1PAA Training Certificates
01. ;uaunyoa}3.v
City of Miami Request for Proposa
IRENE SALVI
This is to certify attendance at the "Medical Records Law" seminar presented January 30, 2009 in Miami, FL.
LORMAN
OO
KeepingYoUCurrent.
buclitimsIhvif s Helping You Succeed:
A DIVISION OF lDM8 BUNIE55 CENIENINC.
2510 ALPINE ROAD • P.U. BOX 509 • EAU CLAIRE, WI 54702
PHONE: 866-352-9539• FAX: 715-833-3944
www.lorman corn • customerservice@lorman.com
-Made, g Sktpitg ,,
Michelle L. Shepherd
CE Coo,Oinatar
384642
City of Miami Request for Proposal
This is to certify attendance at the "Medical Records Law" seminar presented January 30 2009 in Miami, FL.
L� R
AN®
Keeping YouCurrent
'E_eut;AwR A8uE PtVIt €s: HelpingYauSucceed:
A DIVISION Or LOMMM BUSINESS CHER, UIC
2510 ALPINE ROAD • P.O. BOX 509 • EAU CLAIRE, WI 54702
PHONE: 866-352-9539 • FAX: 715-833-3944
www.lorman.com • customerservice@lorman.com
1/L ci,rn, �i SILtplgiV_,
Michelle L. Shepherd
CE Coordinator
384642
City of Miami Request for Proposal
MICHELLE GRUNDSTEIN
This is to certify attendance at the "Medical Records Law" seminar presented January 30, 2009 in Miami, FL.
LORIVIItN®KeepingYouCu►ient
EbUCAttt N`SERVIC€s HelpingYouSucceed°
A DIVISION OF LORMAN BUSINESS CENTEB,INC.
2510 ALPINE ROAD • P.O. BOX 509 • EAU CLAIRE, WI 54702
PHONE: 866-352-9539 • FAX: 715-833-3944
www.lorman.com • custornerservice@lorman.com
clto S444.
Michelle L. Shepherd
CE Coo,dloolot
384642
City of Miami Request for Proposal
VERONICA SALOM
This is to certify attendance at the "Medical Records Law" seminar presented January 30, 2009 in Miami, FL.
LOR
AN®
€tfUCAtION SEIIVlc i Helping You Succeed.'
A DIVISION OF LORMAN BUSINESS CENTER, INC,
2510 ALPINE ROAD • P.O. BOX 509 • EAU CLAIRE, WI 54702
PHONE: 866-352-9539 • FAX: 715-833-3944
www.lorrnan.com • customerservice@lorman.corn
Keeping You Current
11oFPi, c3 . srr ireiL,
Michelle L. Shepherd
CE Coordinator
384642
City of Miami Request for Proposal
KENIA JAIMES
This is to certify attendance at the "Medical Records Law" seminar presented January 30, 2009 in Miami, FL.
AN®
Keeping YouCunent
tb cATIbN'StkIllC S.
A DIVISION OF LORMP N BUSINESS CENTER, INC
2510 ALPINE ROAD • P.O. BOX 509 • EAU CLAIRE, WI 54702
PHONE: 866-352-9539 • FAX: 715-833-3944
www.lorman.corn • customerservice@lorman.com
Michelle L. Shepherd
CE Coordinator
384642
City of Miami Request for Proposal
JENNIFER GALAGARZA
This is to certify attendance at the "Medical Records Law" seminar presented January 30, 2009 in Miami, FL.
LOR
Aikr
KeepingYouCurrent
EbUCATIOWStRVIt s Hel in YouSucceed°
ADIMSIONOFEORMANBUSINESS CENTER,INC p 9
2510 ALPINE ROAD • P.O. BOX 509 • EAU CLAIRE, WI 54702
PHONE: 866-352-9539 • FAX: 715-833-3944
www.lorman.com • customerservice@lorman.com
Michelle L. Shepherd
CE Coordinator
384642
City of Miami Request for Proposal
ALESAILEC FIGUEROLA
This is to certify attendance at the "Medical Records Law" seminar presented January 30, 2009 in Miami, FL.
AN®
Keeping YouCunent
€bUCdtItiN!set Vtc65'.
A DIVISION OF IORMN BUSINESS CENTER, INC
Helping YouSucceed:
2510 ALPINE ROAD • P.O. BOX 509 • EAU CLAIRE, WI 54702
PHONE: 866-352-9539. • FAX: 715-833-3944
www.lorman.com • customerservice@lorman.com
Michelle L. Shepherd
CE Coo:dlwwr
384642
City of Miami Request for Proposal
HILDA IRIS CHAYT
This, is to certify attendance at the "Medical Records Law" seminar presented January 30, 2009 in Miami, FL.
LOR
AN® Keeping You Current.
tbUGiFIION`S IWIttS HelpingYouSucceed•
A DIVISION OF LORMAN BUSINESS (EMIR INC
2510 ALPINE ROAD • P.O. BOX 509 • EAU CLAIRE, WI 54702
PHONE: 866-352-9539 • FAX: 715-833-3944
www.lorman.com • customerservice@lorman.com
yVCr�i�pr,. �° Slrp ,L
Michelle L. Shepherd
CE Coordinator
384642
City of Miami Request tor Proposal
MDFF WELLNESS CENTER
City of Miami Request for Proposal
Attachment 11
Excerpts from Metro -Dade Firefighters Wellness Center
Standard Operating Procedure for Medical Records
Purpose
The purpose is to assure proper documentation, maintenance, security, and confidentiality of the patient medical
record and to define the rights of the health care provider and the patient regarding ownership of the medical record.
Medical Records Access and Maintenance Procedures
Patient medical records are the property of the MDFF Wellness Center and maintained in a manner that assures
availability to authorized staff and confidentially of their contents.
1. Scope of Services -Medical record services shall include the maintenance of the individual patient medical
record to include the confidentially, security and integrity of the data and/or information contained within.
2. Hours of Operation/Access-Access to the medical record is available during routine operating hours of the
facility. Access to the medical record at times other than normal operating hours is restricted to physicians
and designated administrative staff.
3. Release of Medical Records and/or Medical Information -Information from a medical record shall be released
only upon written authorization from the patient, legal guardian, or upon receipt of a subpoena or court
order, or as otherwise permitted by law. The patient has a right to the information contained within the
medical record.
4. Filing System -A formalized system shall be used to file medical records alphabetically by the last name.
5. Completion -The physician shall be responsible for entries made into the medical record including the
history, subject and objective findings, assessment and diagnosis and plan of care. The physician shall
assume responsibility for assuring completion of the medical record at the conclusion of the patient
encounter.
6, Standard Content -The medical record shall contain sufficient information to identify the patient clearly, to
justify the diagnosis and treatment, and to document the results accurately.
7. Removal of Records -Patient medical records are the property of the MDFF Wellness Center. Removal of
medical records from the premises is strictly prohibited without approval of the Wellness Manager and/or by
court order. Original records shall not be removed from the Center except pursuant to appropriate court
process. information released from the medical record shall be upon written consent of the patient. The
facility shall be responsible for safeguarding the medical record of the patient making the record available
only to those who are properly authorized. Pursuant to the State of Florida, the patient has no physical
ownership rights of the original medical record.
8. Center Employees and family members with Medical Records must sign a medical release form filed in the
Medical Record in order to have any access to it.
Retention of Medical Records
Medical Records will be retained by the MDFF Wellness Center for 14 years. Files kept at the Center will be patients
that have a last date of service at the Center within three years. Any file that is older than three years will be sent to
a contracted off -site medical records secured storage facility. Any file that is older than 14 years since the last visit to
the Center will be properly discarded. Phone message books which contain copies of air messages will also be kept
for 14 years and follow the same guidelines from the patient medical records from above.
Medical records retention policy for employer based physicals will be pursuant to appropriate entity.
70
MDFF WELLNESS CENTER
City of Miami Request for Proposal
Attachment 12
Receipt of Medical Records Acknowledgement
MDFF Wellness Center performs pre -employment, in-service, return -to -work physicals
on behalf of the City of Miami. We have been authorized by the City of Miami's
Employee Relations Department to provide one complimentary copy of your Annual
Physical
acknowledge that I read the above
information and that l received my complimentary copy of my City of Miami Annual
Physical
Signature Date
71
MIAMI DADEaCOUN
TAX COLLECTOR'
1'40.W UAGL
1st FLOORS ri
MIAMI, EL 33730�'x
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0061101
3`357;2;2:D:M
MDFF WELLNESS CENTER
City of Miami Request for Proposal
Attachment 13
Miami -Dade County Occupational License
OCATION
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(COUNTY :DR CLUES •NO•
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'PAYlIENT'fl!CEIVf
IAMIAADEjCOUiCOLEECTCX
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SEE OTHER SIDE
DO NOT FORWARD
METRO DADE FIRE FIGHTERS
WELLNESS CENTER INC
STAN HILLS, PRES
8000 NW 21 ST 200
MIAMI FL 33122
Figure 2. Main Parking Lot
'J
MDFF WELLNESS CENTER
City of Miami Request for Proposal
Attachment 14
Pictures of Center Facility
73
t
IVMDFF WELLNESS CENTER
City of Miami Request for Proposal
Figure 3. Overflow Parking Lot
74
MDFF WELLNESS CENTER
City of Miami Request for Proposal
Figure 4. Reception Area
75
MDFF WELLNESS CENTER
City of Miami Request for Proposal
Figure 5. Lounge
76
MDFF WELLNESS CENTER
City of Miami Request for Proposal
Figure 6. Medical Examination Room -View 1
77
MDFF WELLNESS CENTER
City of Miami Request for Proposal
Figure 7. Medical Examination Room -View 2
78
MDFF WELLNESS CENTER
City of Miami Request for Proposal
Figure 8. X-Ray Machine
79
LARRY M. SPRING
Chief Financial Officer
August 5, 2010
Ms. Veronica m. Salom
Metro Dade Firefighters Wellness Center
8000 NW 215i Street, Suite 200
Dora' 'FL 33122
RE: Response to RFP 220240 Physical Examination Services
Dear Ms. Salom,
CARLOS A. MIGOYA
City Manager
SENT VIA EMAIL AND FAX
The City of Miami is in the process of evaluating your proposal response to RFP 220240 for Physical
Examination Services. Pursuant to Section 1.4, Addenda, of the Request for Proposal, the following
requirement is stated:
"It is the bidder's/proposer's responsibility to ensure receipt of all Addenda. Addenda are
available at the Citys website at:httpi/www.ci.miamLfLuslprocurement"
Within your response, however, there was no indication that you acknowledged receipt of Addendum No.
1. At this time, please sign and date below to acknowledge receipt of Addendum No. 1. Failure to
acknowledge receipt of addenda, may cause for the City to reject your response, as stipulated in Section
1.34, Evaluation of Responses.
Print Name Signature
Title Date
A response to this letter must be submitted to the attention of Yusbel Gonzalez, via email:
V4onzalezta?.miamioov.com or fax: 305-400-5104, by no later than Tuesday. August 10, 2010, at 2:00 P.M
Failure to respond by the stipulated date and time may deem your bid non -responsive.
Thank you for your cooperation.
g
Chief Financial Officer
LS:LR:yg
Cc: RFP File
Enclosure: Addendum No. 1
Healthcare Practitioner License Printer Friendly Detail Information Display Page 1 of 1
License Verification
Data As Of 8/2/2010
GERMAINE RODRIGUEZ-FERRER
LICENSE NUMBER: ME70893
Profession
MEDICAL DOCTOR
License/Activity Status
License Expiration Date
License Original Issue Date
07/10/1996
Discipline on File Public Complaint
NO NO
Address of Record
90 ALTON ROAD
PH3310
MIAMI BEACH, FL 33139
UNITED STATES
The information on this page is a secure, primary source for license
verification provided by The Florida Department of Health, Division of
Medical Quality Assurance. This website is maintained by Division staff
and is updated immediately upon a change to our licensing and
enforcement database.
http://ww2.doh.state. fl.us/irm00PRAES/prasindi_print_report. asp?LicId=61768&Pro fNBR... 8/2/2010