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HomeMy WebLinkAboutExhibit 4ount Sinai MEDICAL CENTER November 10, 2010 City of Miami — City Clerk % 3500 Pan American Drive Miami, Florida 33133 Re: RFP NO. 243229 — Annual Physical Examination Services for First Responders Mount Sinai Medical Center, Occupational Health Center located at 4300 Alton Road, Lowenstein Building, Miami Beach, FL 33140, Telephone Number (305) 674-2312, Fax Number (305) 674-2413, Federal Employer Identification Number 59-262442 is formally responding to your Request for Proposal No. 243229 Request for Annual Physical Examination Services for First Responders for Various Medical Services that may be necessary or required by the City of Miami, Local, State, and Federal Laws: The Proposer is appointing Ms. Linda Arama as the primary contact person for this RFP; she can be reached at (305) 674-3910 (office) and 305-535-7904 (fax), e-mail address is Larama(a,msmc.com. Should you have any questions concerning the above, please do not hesitate to contact the undersigned. Sincerely, Linda Arama Director Occupational Health Center 1 Mount Sinai MEDICAL CENTER Table of Contents A. Executive Summary ............................................................ .page 1 B. Professional Experience............................................................page 2 C. Occupational Health Staffing page 3 Occupational Health Staffing (cont'd)............................................page 4 Occupational Health Staffing (cont'd)............................................page 5 Resume, Curriculum Vitae, Certificates, Licenses .Attachment A D. HIPPA - Privacy Notice of Privacy Practices - Policy & Procedures Attachment B E. Proposer's Clients List ........................... page 6 Proposer's Clients List(cont'd)....................................................page 7 Proposer's Clients List(cont'd).....................................................page 8 F. Proposer's Facility and Location................................. ...... ...........page 9 FeeProposal............... ...... ............... ....... ............................ Attachment C Campus Map of Mount Sinai Medical CenterAttachment D Departmental Brochure..........................................................Attachment E Mount Sinai MEDICAL CENTER Executive Summary Mount Sinai Medical Center of Florida, Inc. located at 4300 Alton Road Miami Beach, Florida 33140 is South Florida's largest not -for -profit organization. The Medical Center facilities include acute care, diagnostic, treatment, teaching and research facilities with approximately a 935- licensed bed capability. Mount Sinai Medical Center has over 50 years of Professional Experience providing acute care, diagnostic and treatment services within the facility. Mount Sinai's mission is to provide quality healthcare to every patient regardless of race, religion, ethnic background, gender or national origin. The Occupational Health Department at Mount Sinai Medical Center located in the Lowenstein Building first Floor and has been providing services to numerous accounts and municipalities for over 29 years. Mount Sinai is especially proud of the occupational health services it provides to Miami -Dade County. We look forward to provide the City of Miami with quality services. The Scope of services provided by this department includes: Pre -employment Physicals, Promotional Physical Examinations, Return to Work Physical Examination, Vaccinations and any additional services requested. The Occupational Health Center has been regularly engaged in providing high stress, standard pre -employment fitness for duty physical examinations/return to work, FMLA, Worker's Compensation, Executive Physicals, Immunization, Employee Health Services, drug and alcohol testing and Emergency Department 24-hours, 7 days a. week (urine and alcohol collections, including weekends and holidays), to the County for the past 29 years. This department is committed to providing quality Health Care Services with integrity and continues to set high standards of excellence in all of its activities. -1- Certification Statement Please quote on this form, if applicable, net prices for the item(s) listed. Return signed original and retain a copy for your files. Prices should include all costs, including transportation to destination. The City reserves the right to accept or reject all or any part of this submission. Prices should be firm for a minimum of 120 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, form or person submitting a submission for the same materials, supplies, equipment, or services, 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 I am authorized to -sign this submission for the submitter. Please print the following and sign your name: SUPPLIER NAME: Mount Sinai Medical Center of Florida , Inc. ADDRESS: 4300 Alton Road, Miami Beach, Florida 33140 PHONE: 305-674-2662 FAX: 305-674-2007 EMAIL: Wchutkan@msmc.com BEEPER: 305-674-3910 SIGNED BY: (W \...,-/V- ` TITLE: Vice President, Finance DATE: FAILURE TO COMPLETE. SIGN AND RETURN THIS FORM SHALL DISQUALIFY THIS BID Page 2 of 54 Certifications Legal Name of Firm: MOUNT SINAI MEDICAL CENTER OF FLORIDA. INC Entity Type: Partnership, Sole Proprietorship, Corporation, etc. CORPORATION Year Established: 1948 Office Location: City of Miami, Miami -Dade County, or Other MIAMI BEACH, FLORIDA 33140 Occupational License / Business Tax Receipt Number: 182347-6 Occupational License / Business Tax Receipt Issuing Agency: Miami Dade County Tax Collector Occupational License / Business Tax Receipt Expiration Date: 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": Y , 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? N/A Please list the title, rate of pay, summary of duties, number of positions, and expected length or duration of all mew positions which might be created as a result of this award of a Contract. N/A Please list and acknowledge all addendum/addenda received. List the addendum/addenda number and date of receipt (i.e. Addendum No. 1, 7/1/07). If no addendum/addenda was/were issued, please insert N/A. Page 3 of 54 Mount Sinai MEDICAL CENTER PROFESSIONAL EXPERIENCE The Occupational Health Center at Mount Sinai Medical Center opened its doors in 1981 and has been providing services to numerous accounts and municipalities for over 29 years. The Occupational. Health. Department employees the following dedicated and qualified personnel to perform the services outlined in this contract: Program Manager, two Medical Review Officers (MROs), Medical Director/M.D., Medical Doctors (one female), Cardiologists, Psychiatrists, Radiologists, Audiologist and LPN (BAT and DOT certified), five Medical Assistants(BAT and DOT certified) two Patient Representatives/Reception and one Medical Records personnel. Mount Sinai MEDICAL CENTER OCCUPATIONAL HEALTH STAFFING The Occupational Health Center will staff sufficiently to supply all services stated in the Scope of Services and the Agreement. The OHC will increase staffing if necessary to fully comply with what has been stated in the Scope of Services. Linda Arama, Director, Project Manager Approximately 28 years experience with Miami -Dade County as Director of OHC Kenneth Kaplan, M.D. Medical Director of Occupational Health Department, Medical Review Office, Board Certified in Internal Medicine, Certified in Workers Compensation, SAP Joshua M. Trabin, M.D. Certified in Internal Medicine, Medical Review Officer Gerardo Jose Minsal-Ballester, M.D. Certified in Internal Medicine Samira Habibnejad, M.D. Certified in Internal Medicine Orlando Santana, M.D. Board Certified Cardiologist Philip Samet, M.D. Board Certified Cardiologist Jeffrey D. Neitlich, M.D. Board Certified Radiologist Susan Rae Roth Board Certified Audiologist Jenny Audain, Supervisor Certified Intoximeters Breath Alcohol Instructor (Intoximeters Model Alcomonitor CC), Certified DOT Drug Screening Technician, Drug Screening Coordinator Lucy Castellanos, ARNP Board Certified Advanced Registered Nurse Practitioner Sabrina Moore -Maros, ARNP Board Certified Advanced Registered Nurse Practitioner Deborah R. Wilcox Board Certified Advanced Registered Nurse Practitioner -3- Mount Sinai MEDICAL CENTER Patricia Wilson, LPN Occupational Health Certification Drug/Alcohol Screening, DOT, BAT Lourdes Campos Medical Assistant Certified DOT Drug Screening Technician, Certified Breath Alcohol Technician (BAT), Pulmonary Testing, HearingNision Testing Linda Diejuste Medical Assistant. Certified DOT Drug Screening Technician, Certified Breath Alcohol Technician (BAT), Pulmonary Testing, HearingNision Testing Rolande Jean -Joseph Medical Assistant Certified DOT Drug Screening Technician, Certified Breath Alcohol Technician (BAT), Pulmonary Testing, HearingNision Testing Bonnie Lawson Medical Assistant Certified DOT Drug Screening Technician, Certified Breath Alcohol Technician (BAT), Pulmonary Testing, HearingNision Testing Dianelys Serrano Medical Assistant Certified DOT Drug Screening Technician, Certifi Pulmonary Testing, HearingNision Testing Breath Alcohol Technician (BAT), Maria Garcia Patient Representative / Medical Assistant Registration Certified DOT Drug Screening Technician, Certified Breath Alcohol Technician (BAT), Pulmonary Testing, HearingNision Testing Toledo Murray Patient Representative Registration Meredith R. Portee Patient Representative / Medical Assistant / Medical Records Registration, Certified DOT Drug Screening Technician, Certified Breath Alcohol Technician (BAT), Pulmonary Testing, HearingNision Testing Linda Ivory Patient Representative Registration / Medical Records Clerk -4- Mount Sinai MEDICAL CENTER Occupational Health Clients List Occupational Health Department at Mount Sinai Medical Center provides Physical Examination Services to the following contracts. All of the following contracts follows our Privacy Notice of Privacy Practices (see attachment c) Miami -Dade County Contact Person: Michael Edwards Telephone No. 305-375-2643 E-Mail: mxx@iniamidade.gov Work Performed: Pre -employment and Annual Physicals OSHA, Exposures, Drug and Alcohol Screening, including DOT, Immunization, Fitness for Duty/ Return to Work and Executive Physicals City of Hialeah Contact Person: Capt. Clifford Charlock Telephone No. 305-824-5717 E-Mail: Ccharlok@hialeahfl.gov Worked Performed: Fire Fighters Hazmat Physicals City of Miami Beach Contact Person: Sam Yarily Telephone No. 305-673-7000 E-Mail: Yarilysam@miainibeachfl.ffov Worked Performed: Preemployment and Annual Physicals OSHA, Exposures, Drug and Alcohol Screening, including DOT City of North Bay Village Contact Person: Janice Rosado, Human Resources Telephone No. 305-756-7171 E-Mail: Jrosado@NBVillage.com Worked Performed: Preemployment and Annual Physicals, City including Police and Drug and Alcohol Screening City of Opa-Locka Police Contact person: Ezekiel Orji Telephone No.(305)953-2815 E-Mail: Gruiznicolas@onalockafl.gov Worked Performed: Annual Physical / Pre -Employment / Drug and Alcohol Screening -5- Mount Sinai MEDICAL CENTER Proposer's Occupational Health Clients List (cont'd) City of Sunnylsles-Beach Contact Person: Yael Y. Londoiio, PHR 18070 Collins Avenue Sunny Isles Beach, Florida 33160 Telephone No. 305-792-1809 E-Mail: Ylondono@sibfl.net Work Performed: Pre -employment and Annual Physicals and Drug and Alcohol Screening City of Sunrise Fire Department Contact Person: Chief James Dixon Telephone No. 954-746-3400 E-Mail: Jdixon@citvofsunrise.com Work Performed: Hazmat Physicals Comprehensive Health Services Contact Person: Tammy Simonson Telephone No. 1-800-638-8083 E-Mail: Tsimonson@CHSmedical.com Worked Performed: Pre -employment and Annual Physicals and Drug and Alcohol Screening Miami Dade County Public Schools -Police Department Contact Person: Joey Diaz Telephone No. 305-757-7708 E-mail: Jdiaz@dadeschools.net Work Performed: Pre -employment and Annual Police Physicals Miami Parking Systems Contact Person: Socorro Perez Telephone No. 305-3 73-6789 E-Mail: Sperez@miamiparking.com Work Performed: Pre -employment and Annuals and Drug and Alcohol Screening Village of Bay Harbor Islands Police Department Contact Person: Assistant Chief Duncan Young Telephone No. 305-866-6242 E-Mail: Dyoung@BayHarborIslands.net -6- Mount Sinai MEDICAL CENTER Proposer's Occupational Health Clients List (cont'd) Village of Pinecrest Contact Person: Mayra Sauleda Telephone No. 305-234-2121 E-Mail: Saulecla@pinecrest-fl.gov Work Performed: Pre -employment Physical City and Police and Drug and Alcohol Screening Village of Key Biscayne Fire Department Contact Person: Chief Eric Lang Telephone No. 305-365-8989 E-Mail: Elang@kevbiscayne.fl.gov Work Performed: Preemployment and Annual Physicals and Drug and Alcohol Screening Village of Key Biscayne Police Department Contact Person: Chief Jose Monteagudo Telephone No. 305-365-8989 E-Mai1: Jmonteagudo@keybiscayne.fl.gov Work Performed: Pre -employment and Annual Physicals and Drug Screening Ecology& Environment, Inc. Contact Person: Paul Jonmaire Telephone No. 716-684-8060 Worked Performed: Pre -employment and Annual Physicals and Drug Alcohol Screening Intercredit Bank Contact Person: Nadia Avelar Telephone No. 305-375-8442 E-Mail: Navelar@intercreclit.com Work Performed: Drug and Alcohol Screening Lloyds Bank Contact Person: Carol Ann Loo Telephone No. 305-579-8905 Work Performed: Drug and Alcohol Screening -7- Mount Sinai MEDICAL CENTER Facility and Location Mount Sinai Medical- Center is located at 4300 Alton Road Miami Beach, Florida 33140. The Occupational Health Department at Mount Sinai is located on the first floor of the Lowenstein Building with adjacent free parking spaces for the City of Miami employees. The Occupational Health Department has approximately 8,000 sq. ft. dedicated to the waiting area that is designed to hold a maximum capacity of 60 persons at one given time. Hours of operation are Monday through Friday, 7:00 am to 5:00 p.m. (Hours are flexible). The designated area is comprised,of. • 5 Diagnostic exam rooms • 4 Physical Examination rooms The following equipment is used to perform services: • Audiology testing booths that meet OSHA standards with testing capabilities from 500 to 8000 Hz • Visual Screening instruments for visual acuity, muscle balance (horizontal and vertical phoria), depth perception, color perception, and binocular vision • 14 and 24 plate Ishihara and 15D-Famsworth tests for color deficiency • Diagnostic Spirometry Testing using a Fleisch-Type Pneumotachometer with computer graphics and interpretation. • Handheld non -contact tonometer for glaucoma measurements • 12 Lead EKG machines electronically connected to Board Certified Cardiologists for interpretation. • Complete phlebotomy and comprehensive radiology services on site. • US DOT approved ALCOMonitor for breath alcohol testing The Occupational Health Department has back-up equipment on premises. Mount Sinai Medical Center is conveniently located next to the Julia Tuttle Causeway, I-95 Expressway; exit Alton Road North, 5 miles away from City of Miami. Metro Dade public transportation buses have regular scheduled stops at the Main entrance of Mount Sinai Medical Center, De Hirsch Meyer Building, and a short distance to the Occupational Health Department and are handicap accessible. 8 Attachment A Credentials Resumes, Curriculum Vitae, Certificates, Licenses KENNETH J. KAPLAN, M.D. 12300 NE Miami Court North Miami, FL 33161 PERSONAL DATA: Place of Birth —New London, CT Date of Birth — December 23, 1959 Personal and Professional References upon Request CERITIFICATION AND LICENSURE: Board Certified Internal Medicine Medical License — Commonwealth of Mass. Medical License — State of Florida Certified Medical Review Officer by AAMRO Certified Substance Abuse Professional EDUCATION: Medical Doctor: B.S.M.E.: Graduate of New 1999 1988-1995 1994-present 2001-present 2003-present Tufts University School of Medicine Boston, Massachusetts Tufts University College of Engineering Medford, Massachusetts Suma Cum Laude London High School New London, Connecticut Valedictorian HONORS: Tau Beta Pi Engineering Honor Society Tufts University — Medford, Massachusetts POST GRADUATE TRAINING: Residency Medicine, Hospital 1985-1988 /assciate Institution of fts University School of Medicine Boston, Massachusetts Chief Residency in Ambulatory Medicine 1988-1989 Faulkner Hospital Boston, Massachusetts CL. rtN i CD ' STATE LORLDA N 'A - `1) DO)ARril_E.,NT;bF,.114ALTH OP•Oti011/41 pF ME.13.1tAL Q4ALATY.Aqsq1ANc 0 .- iris/2mi : Ach21 , . NPE 14662 303131 The NFEINCAL Q.00TO. . . named' beloW tias rrret all requ-wernents crf a, the taws and rules of Via state of Florida. Exp)raiiOn Dat4-. JANUARY 31, 2012 o KENNitH•JOSEPH KAFTAN 123o0 HE IMAM! CT. , , NORTHt'31 IT I t.r) ••••• :•L . • a. 0 .GOVERNOR QUALIFICATIONtS): CarE.NstmG P RACTiptICIER -- Z.: .:Aiio 1.4. Viamont6RoOtteEtAO. M P-•• DIEPLAY RETi BY LAW a i UJ ABMS® Board Certification Credentials Profile A service provided by the American Board of Medical Specialties iK. 4 S=.zarcft ! Se -;arch Results ! Feedback ! Save Physician j Print Kenneth Joseph Kaplan (ABMSUID - 621822) Viewed:8/9/2010 9:43:21 AM CST DOB: 12/23/1959 Status: Alive Certification American Board of Internal Medicine Internal Medicine - Genera! Status: Certified Active Time -Limited Recertification 12/07/2009 - 12/31/2019 Expired Time -Limited Initial Certification 08/24/1999 - 12/31/2009 Education 1985 MD (Doctorof Medicine) Location Private powered by Direct I Connect Notice: It is up to the user to determine if the physician record obtained from this service is that of the physician being sought. The information as presented by this service is approved for business use and is valid to meet the primary source verification requirements for credentialing as set by JCAHO, NCQA, URAC and other accrediting agencies. . The ABMS physician specialty certification data provided by CertiFACTS On -Line is proprietary and copyrighted by the American Board of Medical Specialties (ABMS®) and subject to the intellectual property laws of the United States. 2006, ABMS, All Rights Reserved. The Powered by ABMS Direct Connect and ABMS Official Display Agent logos are registered trademarks of the American Board of Medical Specialties. acny9ahmsuid=621822 8/9/2010 ..N.. 4%,. -,. �C " Vi— > r, itfi W1...- A. `^ui^+�4:ti.�ao r ,,r.,.sw+<�^udtome_ wtTo_..`tin =m.;�o"^tt vn nln? nx: a„^?q YW.;17:?I(i .MITSn?mm N?, n l,) Q__ Certificate of Completion This certifies that on February 18, 2008 Kenneth Kaplan successfully completed the curriculum specified by the Department of Transportation (DOT) and curriculum specified by Intoximeters, Inc. for certification as a Breath Alcohol Technician (BAT) and Factory Authorized Calibration Technician The curriculum presented corresponds with the DOT's BAT model curriculum established pursuant to 49 CFR Part 40 Procedures. It also corresponds with Intoximeters, Inc.'s proficiency in the use of the Evidential Breath Testing (EBT) curriculum which includes a review of the Evidential Breath Test device's Quality Assurance Plan, and requires demonstration of proficiency in conducting calibrations, calibration checks and the operation of the: ALCOMONITOR CC The course curriculum was approved by Intoximeters, Inc., the manufacturer of the Evidential Breath Test Device, and complies with the manufacturer's standards for the operation of the instrument. Intoximeters, Inc. Expires: February / 2013 iil"Gikt Y '4>:v aY4'iYi'IuL LU+u•i�.vi�u` it tr•.u+Ii�ui iuv a�.wiiSS M Greg Clark, Instructor 13318 _ -4s--4e4 1 `ISitg 11 :.,.,...?^'^nR_...... „R;ra?m . :.!m'. !... C ,Prr,Ynmrrryrrp, wenr.47,1 iKl r 9:0.Fs y n ..!!. > Certificate of Completion This certificate is awarded to Kenneth Kaplan for successful completion of the in -taximeters Instructor Course held on February 19 - February 20, 2008 and authorizes the participant to train Factory Authorized Calibration Technicians in accordance with requirements outlined under the Intoximeters Factory Authorization Agreement for Calibration Technician Trainers. For the Intoximeters Model ALCOMONITOR CC ir £ Expires: February / 2009 In -taximeters, Inc_ Greg Clark, Instructor Certification Number: 11972 24x., lkar HAS SUCCESSFULLY COMPI ETED SAPAA'S SUBSTANCE ABUSE PROFESSIONAL QUALIFICATION TRAINING COURSE AND EXAMINA- TION AND IF ALL OTHER QUALIFICATION REQUIREMENTS ARE MET (SEE NOTE) MAY PERFORM ALL SAP DUTIES STIPULATED BY DOT REGULATIONS. Note_ This ceruTitmte a valid only if the pervon is a licensed physirian (Doctor of Meriiglrse or Ostcopadry}; or a lie nsed or certified Social WorNrr; or a licensed or certified Psychologist; or a licensed or certified Employee Azslaance Profesisional; or an Alcohol and Drug Abux Counselor r.n tined by the National gaSoaation of Alcoholism and Drug Abuse Coutselas CsArtlfiettion Commission or by the Inter- national Certification Rccir„ „sty Consort orntAkotrol and otter Dug abuse (tCRC), or by the National Board tor Certified Counselors, Inc. and Affiliates NBCC). specific-aRy NriCC's Master Addictions Counselor (MAXI; or State-Iirensed or certi- fied Marriage and Family 1 heraaests. SAPAA makes no srai..so Ly as to ectueari onai qualification or best pra,.tu-r of the Substance Abuse Profrssion:4. Approval of Professional Development Hours: 16 LACCApproval Number: SASONLND9Z5-309 Qualification Instruction & Exam Mary Hines Crate SAPAA President September 16, 2C114 Substance Abuse Program Administrators Association has successfully completed training as a Professional Collector, Instructor and is Proficient in Specimen Collections Proficient in 49 CFR Part 40 Procedures Joshua M. Trabin, M.D. 2951. South Bayshore Drive, #311 Miami, FL 33133 (305) 924-5221 Faculty Appointment Mount Sinai Medical Center (July, 2003-Present) Miami Beach, Florida -Associate Program Director of the Internal Medicine Residency -Part of a traditional internal medicine group practice that is involved in teaching residents and medical students -Faculty and supervising attending for the resident outpatient clinic Committee 1yMemherslrip Mount Sinai Medical Center Miami Beach, Florida Academic Affairs Committee Medical Management Advisory Medical Review Committee Residency Interview Committee Residency Management Team Post -Graduate Training (July, 2007-Present) Committee (July, 2008-Present) (July, 2007-Present) (December, 2007—Present) (July, 2007-Present) Mount Sinai Medical Center Miami Beach, Florida Internal Medicine Chief Resident Internal Medicine Resident Internal Medicine .intern North Shore University. Hospital Manhasset, New York Obstetrics and Gynecology Intern (July, 2007-July, 2008) (July, 2005-June, 2007) (June, 2004-June, 2005) (July, 2003-May, 2004) Education Doctor of Medicine University of Miami School of Medicine Miami, Florida Bachelor of Science, Biology 1vfa.jor University of Miami Coral Gables. Florida Honors and Leadership Residency Mount Sinai Medical Center Howard Kane Resident of the Year Award Mount Sinai Medical Center Department of Medicine Chief Resident Award American College of Physicians Chief Resident Award Association of Program Directors in Internal Medicine Chief Resident Conference Florida Chapter American College of Physicians Tallahassee Visitation Trip Selected Chief Resident for the Academic year of 2007-08 (May, 2003) (May, 2000) (June, 2008) (June, 2008) (September, 2007) (April, 2007) (ivlarch, 2006) (September, 2005) Medical School Cushing Academic Society Community Service Director (2002-2003) Assistant Activities Coordinator (2001-2002) Maimanides Society Vice President (1999-2000) Jewish Leadership Institute (July, 1999) Undergraduate Graduated Cum Laude Honors Student Association Beta Beta Beta (Biology Honor Society) Golden Key National Honor Society National Honor Society of Phi Kappa Phi Dean's List x4 Provost's Honor Roll x2 Alpha Epsilon Delta (Premedical Honor Society) Honors Program in Medical Education Post -Graduate Research and Acadernie Projects Lecture: Updates in Cervical Cancer Screening Il Lecture: Auscultation of Heart Sounds Lecture: Updates in Cervical Cancer Screening Lecture: MICU Conference: Sepsis Lecture: Morbidity and Mortality Conference: Pneumocystis jirovecii pneumonia Lecture: Clinical Vignette: Pancreatic Endocrine Tumor Lecture: Chronic Pancreatitis Lecture: Clinical Vignette: SC Disease Lecture: Cervical Cancer Screening Lecture: Renal Disease and Pregnancy Case Report: A patient with GI manifestations of amyloidosis (unpublished) Professional Society Affiliations American College of Physicians Member American Medical Association Member Association of Program Directors in Internal Medicine Member License Florida: ME # 100162 DEA# FT0579257 Examinations American Board of Internal Medicine : Passed in August, 2008 USMLE Step 3: Passed in May, USMLE Step 2: Passed in May. 2003 USMLE Step 1: Passed in June, 2001 (June, 2008) (October, 2007) (June, 2007) (February, 2007) (January, 2007) (November, 2006) (May, 2006) (November, 2005) (August, 2005) (April, 2005) (October, 2005) O 0 7, 8 1 STATE OF FLORIDA DEPARTMENT OF HEALTH DIVISION OF MEDICAL QUALITY ASSURANCE DATE LUCENS_ NO. CONTROL NO. 01/20/2010 ME 100162 3099�2 "he MEDICADOCTOR . 'timed below 'las met art requirements of ie lanes -and r ilea or the state of Florida. .piration Date: •• JANUARY 31, 2012 OSHUA MICHAEL TRAIN 300 ALTON RDAO DWENSTEIN BUILDING IAMI BEACH, FL 33140 NITED STATaS . Charlie Crist - GOVERNOR Lxie. Ana M. Viamonte Ros, M.O.. M.P.FI- STATE SURGEON GENERAL DISPLAY IF REQUIRED BY LAW w C'`i cl G U vi 4�a 0ul o `zu. wq wm� tam 7 N 0 0 :Oul 2uL Ng) r C N w U1 .o w w 01 A 0 0 JOSHUA MICHAEL TRABIN EXPIRATION DATE JANUARY 31, 2012 tr license numb r is ty0: 100162, please use it In all correspondence NIL, your booed/council. lyarh linen ee io .sale if re.sponsible for notifying the deai.raen::n he licensee's current mailing :,ddresa and prat UCe laentian ;ddres8. If you have not received your renewal notice 90 days prior tu the expiration date ebea-on nsc, plea3c call (850) 488-0595. this aeCtlan to report name chant. Name chooser: require legal d0Cum0ntll:on showing the name chant•e. Plaoae m.tke cure china phmfCOpy clone or the roDoxialg a mpafllca this 1 rml a marriage IicenSc, a divorce decree nr a court order. A driver's liceo3e at social security cud Is sot coesldcled legal dun 'minas. licit Qualify As nuance offers you the convenience of several online services. These services give you tilt ability to rgnew your license, update you: tnailioe p:-.aaxc Rion addre4sc3 and update your profile information. 1. Co to w wwJIhcalthaonrCe.com 2. Click on Licensee/Provider 3. Click on Practitioner Login 4. Scicci.your profession -5. Enter Ile account ID and pan: wort) that was provided to yea no your initial license and elicit on "Login". h. If you rid, not know your account ID and password. click on ^Get Login tidy" nr call nor Cuaamer Canino CCeler ar (83614. -0505 for aSOiS;artee. L TO: DEPARTMENT OF HEALTH DIVISION OF MEDICAL QUALITY ASSURANCE LICENSING AND AUDITING SERVICES UNIT P.O. 80X 6320 TALLA-fASSEE, FLORIDA 32314-6320 NAME CHANGE (ATTACH LEGAL DOCUMENTATION) )M' LAST .. . _ FIRST • fsMIDOLE • LAST FIRST MIDDLE 2103. 5/98 T-423 P 002/002 F-�15 JUL-IS-2010 09:52AM RGM- AAMRa tc�itm th c��t THIS IS TO CERTIFY THAT Vatithi ui), having presented to the Executive Board of the American A� qualificationand n of Medical Review Officers satisfactory evidence of prescribed qua i having passed an approved examination before the az-t ,Assticiatitm.rif AYral Pii6,3 (1fficr in accordance with national standards 'of competency and expertise established for Medical Review Officers, is hereby accredited and designated as a Divert and dated this Crtificb Vital itttl (1ff is r and by order of the 1A.MRO Board has been entered as such in the AAMRO Registry of Certified Medical Review Officers lint , a) i Coun tersip7ed and sealed with the Sea( of the. American Association of Medical Review Ofrirarc the day and dale above Written !ri vnire AA/I4 Chairman rnmorate Secretary Cerrifzcare Number 01 0 6i4'z it Verification of Physicians certification American Board of Internal Medicine -t me I Search Results Search Results Verify Another Physician's CcrtifiCation: by... Dr. Joshua M Trabin Certification History Certification Certification Area Status Certified Certified 0811912008, Internal Medicine Certificate valid through 12/31/2018 Pattr 1 vl 1 Name ?81na IQ NPI End of list For more details about ABIM Certification, see below: Reporting Certification Status Board Eligibility Representation of Certification Status Suspension and Revocation of Certification 'ABIM's website serves as primary source verification. s of notification to physicians. Data elements, such as —Certification status is .reupdated updatedto this system withinc5 day physicians. by ABIM. 4 urs of ing such as name changes. are in ABIM^sfo critical care medicines within 2and e1988 for geriatric medicine) and To remain valid, these there ABIM validcertifications f r 1 issues in Dates f validity p of Certification program ainva,thCertifications issued thereafter aressfor en weds. rougof stMaintena noted on the cercation p.certificate holders u although ABIM strongly recommends such . -rt certifications must be renewed throng to before these dates are valid indefinitely, 9 renew as well• g o The ABM Icgo is a registered trademark °` �1e American Board or tnternat Medicine. © 20Da - 2010 American Board or Internal Medicine. All rights reserved. NAME: ADDRESS: CURRItCJLUM VITAE Gerardo Minsal, M.D. 4491 Foxtail Ln Weston, Fl 33331 PHONE: Ph: (786) 797-9699 Beeper: (305) 839-2248 E-mail: GMINSAL@hotnail-coz. EDUCATION AND TRAING: 1978 Graduated - La Piedad High School Puerto Rico. 1979 University of Puerto Rico, Rio Piedras Campus, Puerto Rico. 1983 Doctor of Medicine, Universidad Central dial Este, School of. Medicine, San Pedro de Macoris, Dominican Republic. 1987-88 Internship, Caguas Regional Hospital, Caguas, Puerto Rico. 1988-91 Internal Medicine, Caguas Regional Hospital, Caguas, Puerto Rico. 1991-93 Geriatric Medicine, University of Hawaii at Manoa, Xuakini Medical Center, Honolulu, Hawaii :XAMINATIONS: 984 Educational Commission for Foreign Medical Graduates. 987 Puerto Rico Board of Medicine 992 FLEX 1996 American Board of Internal Medicine 1998 Certification of Added Qualification in Geriatrics °ROFESs oN?L EX-FER_-ENCE: Dec. 1998-present: Staff Geriatrician, Mount Sinai iecical Center of Greater Miami, 4300 Alton Rd, Miami Beach, Florida. 33140 Jan. 1998- Nov 1998: Associate Director, Life Care Nursing Home, Crossing Blvd, Orange Park, F1. Nov. 1995- Nov 1998: Medical Director, Medwise Center at two locations, 5500 Blanding Blvd. # 1, Jacksonville, FL and 3189 G5 Hwy 17, Green Cove Springs, FL. Nov. 1996-July 1998: Medical Director, Oak Terrace Nursing Home, Green Cove Springs, FL. Nov 1996-Nov 1998: ACLS Medical Course Director, Heart Start, Orange Park, Florida. 1996-1998: Utilization Committee, Member. orange Park Medical Center, Orange Park, F1. ept.-Oct 1995: Medical Director, La Posada Nursing Home, Miami, FL. 993- May 1995: Director of Geriatric and Family Consultation Services, Division of Geriatrics, Department of Medicine, John A. Burns School of Medicine, University of Hawaii. Honolulu, Hawaii. ug 1993-Jun.1995: Assistant Professor of Medicine, Division of Geriatrics, Department of Medicine, John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii. g 1993-Jun 1995: Director of Medical Students, Division of Geriatrics, Department of Medicine, John A. Burns School of Medicine, University of Hawaii , Honolulu, Hawaii. 1.92-1995: Advance Cardiac Life Support Instructor, Queen's Medical Center, Honolulu, Hawaii ILIT.LRY EXPERIENCE: 1988-1991: Puerto Rico Army National Guard, Juana Diaz,. Puerto Rico d, Honolulu, R.Iwaii !991-May 1995: Hawaii Officer Ainycharge nof the al iCardiowancula }Screening Program. April 1997-present: Medical Officer, Florida Air National Guard, Camp Blanding, F1. THER PROFESSIONAL EXPERIENCE: 1991-1995: Physician Consultant, Honolulu Heart Program, Kuakini Medical Center, Honolulu, Hawaii. H,NORS AND AWARDS; A y Cotmnendation Medal, Puerto Rico Army National Guard, 1990 S.ate Active Duty, Hawaii Army National Guard, 1993. Hurricane Iniki relief .ssion. G axo Travel Grant 1993 DICAL LICENSURE: F orida: ME0069508 PROFESSIONAL ORGANIZATIONS: Am rican Medical Association Am'rican Geriatrics Society Florida Medical Association Am;rican College of Physicians American Medical Direct0r3 Association MMUNIT: AND STATE ORGANIZATIONS: 1993-1995 Member, Immunization Task Force, Department of Health, Honolulu, H waii SELECTED RESEARCH: Principal Investigator, Suicide: The Honolulu Study, Poster Presentation at the Am-rican Geriatrics Society. A study to investigate the suicide frequency in a mu ti-ethnic community. :UL-0I-20I0 II:NAM FrcC11- ACM76?703 T-I95 P 001/09I F-045 STATE OF FLORIDA DEPARTMENT OF HEALTH OF MEDICAL QUALITY ASSURANCE DATE LICENSE NO. CONTROL NO. 0112112010 ME 64508 310345 The MEDICAL DOCTOR named below has met all requirements of the laws and rules of the state of Florida. Expiration Date! JANUARY 31, 2012 GERARDO JOSE MINSAL-9ALLESTER OPDILOWENSTEINS BLDG 1ST FL. 4300 ALTON ROAD MIAt41I BEACH, FL 33140 UNITED STATES (2,AZ47‘.. Charlie Crist GOVERNOR Ana-M. Viamonte Ros, M.D.,.M.P.H. STATE SURGEON GENERAL DISPLAY IF REQUIRED BY LAW RD OF I INCORPORATED 1936 ATTESTS THAT Gerarbo illinsat HAS MET THE REQUIREMENTS OF THIS BOARD AND IS HEREBY CERTIFIED FOR THE PERIOD 2007 THROUGH 2017 AS A DIPLOMATE IN INTERNAL MEDICINE 148-mt i--E-4.44& CI IINI,ELECT Zacj.cy,r, SEC P 1UPER NUM PEK 136087 Verification of Physicians certification ,Ameritin Boy; of internal Medicine H_ me I Search Results earch Results Verify Another Physician's Dr. Gerardo Jose Minsal Certific Certification Area Stet Certification: ation Certification History us internal Medicine Certified Geriatric Medicine Not Certified End"of llst © 2004 - 2009 Ame riCan Board of Internal Medicine ► 510 Walnut Street,Su1te 1700, Philadelphia, PA 19106 Certified 08/21/1996, Certificate valid through 12131 /2006 Certified 05115/2007, Certificate valid through 12/31/2017 Certified 11104/1998, Certificate valid through 12/3112008 Pagc l of 1 Name Caneidate s NPI Comments Diplomates may choose to renew only those certificates most relevant to their practice. Personal Information: Date of birth: Citizenship: Marital Status: Languages: Education: Graduate: Post graduate: Positions held : Oct 2003- Present June 1999-July 2000 Dec 1998-May 1999 SAMIRA M. HABIBNEJAD, M.D 1431 SW, 171 Terrace Pembroke Pines, FL. 33027 Horne: (954) 499-5923 shabibnejad@yahoo.com February 18,1969 USA Married English, Farsi 1987-1995 Iran University of Medical Sciences Tehran, Iran Medical Doctor degree 2002-2003 Mount Sinai Medical Center Miami Beach, FL. Internal Medicine Residency 2000-2002 Easton Hospital Easton, PA. Internal Medicine Residency Medical staff and Internal Medicine Attending for Out patient department at Mount Sinai medical center. Member of Utilization Review Committee at Mount Sinai and Miami Heart Institute. Fellow of Special Immunology University of Miami School of Medicine Jackson Memorial Hospital Miami , FL. Observer , department of Medicine Jackson Memorial Hospital Miami, FL. June 1998-Nov 1998 July 1995-Mar 1997 Research: Medical Licensure: Certifications: Presentation: Society Membership: References: Research coordinator Interventional Cardiology Cedars Medical Center Miami, FL. General physician Public Health Center Bandar Abbas, Iran Double blind study to determine safety and efficacy of anti platelet agents in post PTCA patients. Cedars Medical Center, Miami, FL. State of Florida, ME88214 (Expires on 1/31/2005) (Certificate No. 0-579-896-2) American Board of Internal Medicine ECFMG -Certified Jan.29,1999 " Chryseobactrium meningosepticum cellulitis following Jet ski accident."a case report. Pennsylvania Coalition for Internal Medicine ACP/ ASIM. ( Pittsburgh, PA. Nov. 2001) American College of Physicians American Medical Association Pennsylvania Medical society 2001 - Present. 2002 - Present 2000 — Present Gloria Weinberg, M.D, F.A.C.P. Program Director of Internal medicine Mount Sinai Medical Center, Miami Beach, FL. (305)674-2053 D. Allen Young M.D. Associate program Director of Internal Medicine Mount Sinai Medical Center, Miami Beach , FL. (305)674-2438 Wesley Kozinn, M.D, F.A.C.P. Director of Medical Education Easton Hospital , Easton, PA (610)250-4906 David Kemp, M.D, F.A.C.P. Program Director of Internal Medicine Easton Hospital, Easton, PA. (610)250-4515 Stephen Symes, M.D. Associate Program Director of Internal Medicine University of Miami School of Medicine Jackson Memorial Hospital, Miami. FL. (305)243-4598 AC3 2 STATE OF FLORIDA DEPARTMENT OF HEALTH DIVISION OF MEDICAL QUALITY. ASSURANCE DATE LICENSE NO CONTROL NO. 11125/2008 ME 88214 263402 The MEDICAL DOCTOR named beloWhas met all requirements of fhe.lawsand rules of the state of Florida. Expiration Date:` JANUARY 31, `2011 SAMIRA MAHMOUDI HABIBNEJAD MOUNT SINAI HOSPITAL, OUT PA.TI.` 4304 ALTON ROAD GREENSRAN . MIAMI BEACH, FL, 33140 UNITED STATES Charlie Crist GOVERNOR Ana.M. Viamonte.Ros, M;D:, M.P.H. STATE SURGEON GENERAL;; DISPLAY IF REQUIRED BY LAW -02 eNESIOENr Nye utCE PRE. N usuM 218476 ARD OF INTE INCORPORATED 1936 ATTESTS THAT SAmira fiialinuntbg Babibnz hh HAS MET THE REQUIREMENTS OF THIS BOARD AND IS HEREBY CERTIFIED FOR THE PERIOD 2004 THROUGH 2014 AS A DIPLOMATE IN INTERNAL MEDICINE Aiy.4- 2004 Vcri Cleat on of Physicians certification American Board of internal Medicine H7mz Search Results Search Results Verify Another Physician's Certification: by.. Dr. Samira Mahmoudy Habibnejad Certification Area Certification Certification History Status Internal Medicine . Certified Certified 08/24/2004. Certificate valid through 12/31/2014 End of list p:l .c 1 0l 1 Ndme. ASINIID NFI Comments For more details about ABIM Certification,. see below:. Reporting Certification Status Board Eligibility Representation of Certification Status Suspension and Revocation of Certification •ABIM's website serves as primary source verification. "Certification status is updated to this system within 5 days of notification to physic aPss Baba elemeABIM nts. such as name changes, are updated in ABIM's records within 24 hours of being p "'All ABIM.certifications issued in ofva8d ty7 raretical care medicine and noted on the certificates. To rema88 for in varic lid. these of and thereafter aresvalid for 10 years. bcefore these must renewed through Bthough ABIM strongly IM's Maintenance of e recommends such certificate ram. lfications issued holders to before these dates are validIndefinitely. renew as well. a - 2010 American Board of Internal Mediane, All rights reserved. I The ABIM logo is a registered trademark o` Me 200 American Board of Internal Medicine. PEP SnNAL.: .51)11.,ICADON: POSTGRAINJATE HCENSURE: II3C.1ARD n ry r oN Orlando Santana. MD 6.770 Indian Creek Drive. 8-D Miami Beach. El. 33141 D.OB. 12/11-.16 l Married to Ro G cam. M.D. no children U.S. citizen 560-17-5461 University of Miami School of Medicine. Coral tlithles. Florida (1983-1987'1 Degree-. M.D. Lint vcrsity of Miami, Coral Gables..florida (198'0-1983'1 Degree: B.S. i:,17 Loyola. at Chicato. 1.1979- 1()go) Augustarm 0olIet...2c, Summer School in Spain-1978 studied Spanish Civilization and Culture Cardiology Fellowship, Mourn Sinai Medical CIenicr. Miami Roach: Florida (1900-19931_ Residency, Internal 1V1(.41n:inc. Mown Sinai N-ledical Colter. Nifiaini Beach. Florida (1987-1'400). Licenw: State of Florida, November 1til) i!ti 51;47 D *. rS 1 9 3 5 internal lytedicinc. September 12. 1990 (Iardioloty, Niov-inhe.r. 1993 RFSFARCH: Pain Research - University of Miami 191i5 Research on Suicide - University' of iMiann 1986 A \VAR Named "Outstanding Fellow of the Year" by the medical residents and die Department of Internal Niledicine,, 1991 -1q9-2. Outstanding Fellow of the Ylear-Departmein of Medicine 1992i-1993 PRESENTATIONSi "Thromboeytopertia associated with Leptospirosis", Outstanding. Presentation, Mount Sinai N4,edical Center, Miami Beach. Florida-N:411rd) 198.S. 'Thromhoeytopcnia associated with Leptospirosis". Otastandine presentation at Regional ACP iMeeting- lampa.Florida-Ocr,. Medical Jeopardy Contestant-ACP Mein. March I 99-tViiiriier: Mr:afield Jeopardy Conie5tant.-ACP Miun November I 980- St-q,:ond Placc: in State of Florida, Medical Je pard:y Cantetat ti-ACP MeeimiL. March 1990-Witmer. Medical Jeopardy Contestant-ACP Meeting. October Second Place in State of Florida. Resident Lecture Series,. Mount Sinai Medical Center. Miami Beach., Florida: "Tratamiento' del Infarto Agitdo del Miocardio" (Treatment or Acute Myocardial Inthrction)-1..atin American Conference. Nov. 1.99 -Mount. Sinai Medical Ceniet% Miami Beach, Florida. "Muerte Subita" (Sudden Death), Latin Americim Ccmference Nov. 1992-Ivlount Sinai Medical Center. Miami Beach. Florida, "Uso Clinica del Feu Fransesolligico" use of 1 1 atin American ConFerence-N,11. Sinai Med. Or. -Nov. 1oq3. PRESENTATIONSi al PI ,OY?_iizili:NT: 'Tratamiento del Infant' Agudo d Miocardiu primcra 24 horas" (Treatment or acute MI in the. first 24 hours). Latin Ainerican Conference, Nov. I 904-Nl 1. N4ed iL (_Lruu Miami Beach. Florida. St. Francis Hospi -al. Nlinini Beach. Florida -House Physician -vot South. Miami. FlospitaLMiaini, Florida -Critical. Care Physician.. M. Sinai Hospital. Miami Beach.. Flo, rkla-CardiologY Attending, 7193.--4,194. Private Practice Cardiology -Miami. Florida. 4194-presenr. Chief Cardiolotty-Pasteur 2194-present. COMMITIT•IES: Critical Carc. Pathway rur Acut",7 I\41. IvIedic_al Resident Search Committee. M1H,DICAI, SOCIETIES: American Colkige or Physietany. American Coliei4.." or Cardiology Honda Society or Internal Medicine. National Society of lvleclical Residents National Society of:Internal 'Medicine (1)(1de County N,tedienl. Association PERSONAL, INTERESTS,. Truvelint, readint,2.,,cyclint,„, tennis.. .PliBLICATIONS;. 1. Saniana 0 St:ifirstein S. Williams I). Machado H. .ATinston AS, Noninvasive documentation of rupture cif the interventricular septum due tel subacute bacterial crtdocarditis.- Video-Jo-urn:a-Lot' EchocardingTaphy"Voi 2:No I:26-28,-Jan- I 992. 2. Agatston AS. Santana 0: Doppler Felweardiovriphv Current Opinion in RAdioloov AAJUUSL 1992. 4:1V. 1 52)). Santana 0, Vivits P. Ramos A. Salirstein S, Agarsvon AS. N4ultiple inycionia involving the pericardium associated with cardiac tamp wade and constrictive pericarditis. Amer Htairi .1 1993: Vol I 26: 737-740, Guerra OR. Santana O. Salirstein S. Agatston AS. Diagnosis ot localized cardiac ti.unporiade following cardiac surgery: The role cif transesonhilgettl cehocirilliographv. Video Journal oCEchoeardiography.. Vol 2.145-148; Oct 1992. SlifltD110 O. Guerra (DR, Vivas P, Ramos A. ,A4atston.AS. Multipletnycloina Imo ving tie porieardium associated tvith cardiac tamponade and constrictive pericarditis. Video lournal of Echocardiography. 'Io be published. 6. Santana 0, Vivas II Tratamiento Id infarto Agudo dol N4incardio (Treatment of Acute N-41:,orardial Infarction). 'Medici:1 Interamericann. Feb, 1993. 49-58. 7. Santana 0„Vivas P. Tratruniento del Ittlrto Agudo del NItocardio I -cannel -it of Acute MveSelrdiaHrthretton't Medico Intertmericano Wu- 1993412-50 8. Santana 0 Fandirm-Sende F. Vivas P. Muerte Subita (Sudden Dcathl. Medico lateramericano. Ma 1993. 45-5'2. 9 Santtma.0, Camp C. Vivas P, Agatston A!".. Large Ventricular thrombus in an asymptomatic man -A casc report. To be submitted, SantimS2. Franco N.1. Vi vas P. Guerra OR. Agatston AS. Spindle cell sarcoma presenting as rightventricular outflow tract obstrucdon. Video Journa.1 011:1,ehcicardiot_.traphr, 1q9.1 Vol. 3; 67-70. Guerra OR,. Sanmna vivas pA. Agittston jx.s, Transesophagea I F.:eh°. cardiography in: percutaricous mitral balloon valvuloplasty, Video Journal of Echocar- diot4rapnv, 1993, Vol. 3, NO 2.41-45, -Y) 2.. Wiliens H. Santana O. Vuoto T. Citte.rra OR. Agarsmn AS. Dianosis or intraaortic Debris transesophageal cchocardicTraphy in a patient with digital ischetnia. Video Journal or Aarii 1993.. VOI 3. NO 2.46-49, 13. Franco M. Gezira R. Santana_0, Vivas1), Indieaciones para mareapasos en adu hos Indi- cations for pacemakers in adults). Medico Inn:Tarnericano, June 1993. 59-66. lit. Franco IV. Ocara R. Santana (3. Vivas 1'. indicaciones para cl Implante de Cardioderi- britadores Automaticos del Corazon (Indications for AJCD). Medico I nterarnericano. Nov. 1992. I 5-18. 15. Jaraki AR. Sat-Mtn:la Frindino-Sende 1. Agatsion AS. .Asymmomatic Sinus or Valszdra anct.irysm compressing the left imiin coronary artcr\. Video journal or Fehoctirdiography: 1993.. Vol. 3: 71-72, 16. Genra M. Santana 0; El uso climcn del Eco 'Fransesoral.iico ((linical use: ol-TEE). Medico Interamerienno. Au. 1993: I 7-24. i7 Cleara Simtrana 0:1„a Leocardiogralia Transesolagica (1ransesophageal Ech card.Mgraphy), Cardiologia intoreonnnent:Al, Vol 3. No 094. 58-61, Agnrston AS. Jr.tnowitz WR, (5earli Simtano a Tornografia computarizt-ala ultra- rapich parrs visualizar ifiti arterias coronarins. (Ultra -last r.It to visualize the coronaries) Cardiologia Intercontinental Vol. 2, 61. Ivlay-Auanst 1.9071, 56-59. 19. Agbtston. AS, frinowitz Geara RM. Santana 0_, Visualizacion de las eoronarias por medic) del [matron- (\risualization oldie c.:6ronaries by the Imatron). Medico Interamericano. July 1991. Vol, 7. 35-38. 20, StifirsIcin S, Santana 0 Agatston AS. Thyrotoxieosis associated with a reverstbie Cardiornyopathy. Amer Heart .1. Sept. 1994. 616-o 1 7. 21. (irenn P. Taveras 111 Jivl.Santana O. Crespo F CoronitrY Artery Dissection. To hu. publishcci-Resicica & StartPhysticinn. Taverns III .1v1, Sornttnn I...Irk:1111 P. CreSpO1,Ivlanejo modern° del pm:sterile eon cardio- mi-opatia nipertri,dica CIVIaliagement or patients with Hypertrophie Cardiornyopathvt. iVledico Interamerienno. Fel), 1994. 71-72. Sande MI', Santana RM. Santana 0. \lives P, Scnde Diagnitstico di rerencial de lis taquierirdias de eornplejo ()RS iiupUu Di CR:rant:la] Diagnosis of Wide Complex. Taellyeardi4. Medico Interarnericano. Sept. 1903. 33-37 24. Cieara R. Santana 0: Revision de los esti:It:hos de inortalidad en rail() cardiac() congas ivo (Review' of Mortality Studies on Congestive [(cart Failure) Medico Interarnericano. April I 904, 221-2.23. 25 Cleara R. SaitC1.111) Revision de los estudios de mortalidad entidio cardiac() eongestivo. (Review alMortality in CETE). To be published-Carciiologia Intercontinental, 1094. 26, Santana. 0: El nso de Beta-bloctealores en pacientes con insuliciencia cardiaca. (Use of ban-Mockersn Congestive Heart Failure). d'i•t he published -Medico Interainericano, Nov, 1994. 27. Santana 0: El uso de 3eta,bloquendores en pacienteS eon insuricienria cardiacti. (Beta- block-arsin Cb117). To be publishecl7Carditalottia Intercontinental. 1004. • . . . ..... ... .. DEPAF TMENT OF HEALTH DJVI Io =OF MEDICAL QUALITY ASSURANCE STATE OF F. It A... AC# LICENSE NO.5 . 00,E I; 7 . Io Ikr ulre rttoa the st�t:►1'Irid: . x i t :: ";:_ J N '.` 1 p 1 :. R.1401.0, SANTANA .... LICENSEE SIGNATURE 434 . NTR 'Nct: ABMS@ Board Certification Credentials Profile i service provided by the American Board or Medical Specialties 1-;1-ch Search Moults 1 Feedback, Save Physician j Print Orlando Santana (ABMSUID - 27108 ) Viewed:3/9/2010 9:4732 AM CST DOS- 12J1111915 CortifIcation American Board of Internal Medicine Internal Medicine • General r::..tror,,.1 I lino imiteJ C.1.11fiCaliOrl Status: Not Certified 12/ fliNJ - 1"2:131/217?00 Cardiovascular Disease - Subspecialty Status: Certified ,Active Time -Limited Recertification 09/09/2003 - 12/31/2013 E,;:,trod 11 OA 12[31 i2f.'ff:i:f Education I997 MO (Doctor 01 Medcinel Location CPiral Gables. FL 33146-1928 (United States) d by Direct if Connect Notice: tt ei tip lathe user 10 dok-ealine it the physiclan recerd °Wailed from this service is that 01 Ole physician being sal:ght, The infornatir_In as presented by this service is approved for business use and is wild to meet the .prirnary source vefoolori renotrernents for crc,rfeniiaiing as SeI by JCAHO. NCOA, LJRAC and other accrediting agencies The. AF3MS physician so-et:taffy neihrication data provided by CertiFACTS On -Line tS proprietary and copyrighted by the Arn,Thcan Beard .af Mecical Seeciaes (ABNIS4) and subject to the inieeeciiial property laws of the Untied States 2006. ABMS, AS Rights Reseriieo rhe Priwereo ray ARMS Direct Cnneect ana rXBMS OO2a Orsptay 0f7f-ynt logo0 are niNistereir tradernarirs or ihe rtriairi Kihaical Specialties 1\ C. C1111:1ctssurt:: do L)(2Repi)rt.-asp.N.111rivincl"2-11.)S l'() 'OH Di e of B rub.: Place OF Birth: AddTess:. FORMAL EDUCAT I ON CUPPIC11 t U.M V ITA.E. . •— • - • PHILIP SAM1-1, 'ID. 1/30i22 New York, N.Y. Mar r Ved - t.hro.e. chi Idren 5951 Al too Road, Mfa Reach I To r TJa 33140- . - Jusr. 1942 Nw York i veT ty Co 1 1 e:ge o f Art:s and Pure Sc I eases New York City June., 1947 New York Unl va rs ty Colle(p c i ne New York C i ty ADD IT ONAI TRAINING - ME C 1 sternsh o Mount Sisa Hopi t-a , New, Yorl, July , 1947 - Juse 1948 Res i den t - Irna I Medic ine - Bronx Veterans Hosnl ta 1 , New York - Jul,, 1948-Jusa , 1950 Res i den t - Internal Medi c ine - Mount S inai Host) ta 1 , New or - July ,I550 - jure 1551 Ass t Attend i.ng Physic i am - 1 ru 1nn House Fo 1 1 owuo Cardiac CI in i c for Pa/ i ergs WV th Rheumat lc Hart D Vsease: Dr Arthur DeGra f , Chi ef 1947-1955 Research Fe 1 low - Card i opu Ii4onary LaboraUory - Be I 1 evue Hospi cal (Chest Service and First Medic.al Division - Columbia Univ. Col lege of Phys I ci ans and Surgeons) under Dr. A.C.Cournand and Or. D.W. Richard, Jr, July, 1951 - June, 1953 Sen i or ASS t Surgeon - U. S. Pub I i c Hea I th Se ry i ce Hospi ca 1 , Manhar:as Beach July, 1953 - June, 1955 UN iVERSITY APPOINTMENTS UrljVers 1 cy of Miami School of medicine, Coral Gables , Florida 1 as.tr..eL Lor , Dept. of Phyr1y- 1955-1956 As S' t EY0e's s or of Ph7s 1-0 1 0 gy - 1-956-195.7 Assoc i a ye " 1957-oresen r Aa t Pro for OF A551,3c i ate " Professor of- Ve:T!ici, CERTiFICATIONS 195'6 -195'3 l'1444:1-197,4, 1 ':1.40- pres•xr American Bard of lnterr,uF Medclne Cert. No. 12093 May 5, 1955 SUbspec 1 ty Board of Ca-rdia4.4asctj 1 a r Dlsease Cart:. No. 12093 December 12, 1959 Fe - Amer [ czn Col lege. of Cardiology Assoc i al:re Fe t - Amer i can Collet -le of Physicians 4959 Fe I low - Amer i can Ca I 1 ecie of Phys i c 1 ars 1984 CV - page. 2 STATE LICENSE Florida 63i January 15, 1St55 HONORARIES Phi Beta Kappa Atpha OMega Alpha HOSPITAL ARPOINTMENTS Attendlng in Medtcitia Jackson Memorial Ho Attending Physician Mount Sinai Medical Center, Dept. InteTnal Medicine Miami Beach, Florida Senior Attendini; Physician, Dept. of internal Medicine Director, Cardiopulmonary Laboratory Mbunt Sinai Medical Center, Mlami Beach, Florida Mount Sinai Medical Center, miami Beach, Florida Chief, Division of Modnv Sinai Medical Center Cardi'ology, Dept. of Miami Beach, F or da I rc:erna 1 Med i c ine SOCIETY MEMBERSHIPS American Medicaj Assooiation American College of Physicians American College of Chest Physicians American College of Cardlotogy American Heart ASSOCiaCtOn Heart Assoc1atton Of Greater 8i.ami American Assiociatton of University Professors American Physicians Fellowship, Inc. for the Israel Medical Association The Biomedical Engineering Society Alpha Omeia Alpha Honor Medical Society American Association for the Advancement of Science American Society for Clinical Pharmacology & Therapeutics American Medi.cal Writers Assocition American Society or Internal Medicine 1956 - presenz. 1957 - 1564 1964 - present. 1955 - present 1964 - oresenz National Rehabilitation 1=ssociation American Physiological Sit Florida Heart Asoola,Hor Florida Society. n-f Internal KeUicife:t American Federation For Clinical Peaearch International Study Group for Research in Cardiac Metabolism CV - page 3 OTHER A PO I NTMEN TS Editorial Board - PACE Editorial Board - Catheterization and Cardiova%i.ular Diagnosis Formerly Editorial Board - American Journal of Cardiology Formerly Editorial Board - Circulation Formerly Chairman, CommitttJ.e in Cardiovascular Physiology - American of Chest Physicians Formerly Program Committee - American Heart Msociation Editorial Board - Mount 1 1 Journal of Medicine Editorial Board - Journal of' :he AnrIc,n Colleoe of Cardiology College AC : 5TATTi OF FLORMA DEPARTMENT Of IAA! - DIVIWON c)F felvtDICA41. QUALITY ARSURANCF: DATE 0.110712010 — ' LICENSE NO. CQt4TTiOL, t•to 6143.0 3-4)5.3a TI f4801chi. 00cTazgi nRITICA bda& has ITO al.)qti e.1 irte lawsnd n4 f lha ;31-0Vi. (4 Rivkin El,p1mViart pate; 4ANUARY 31, 2:012 p4t1p SAMET.T, 4100 ALTOti'OPAII DEPT, 00 EL01113-Q.CARDIGIIRAPHY Mi„,x40J 45 Akt 11, It 13444 utwrco sults GOVE.RI,I0iz! Ag.,tig? 414/1044, egli e, M. Viaffifiptii140, STATE SACitirgi aINERAL 1:Y6-PLAN' eif LAW 13 L3 EPRAVON £AI .14,111JA.11.Y. 31, CO:. txr.tql, tillit..' '474 tityill.vir4 a4, I ',.,7ac7::,1 -• •;:ss.s,.! • •-....;..rvs:t ?.., .taaa, a^ti ‘aa,P.at la4rdata ITI4t7 L°11: •‘,•, rta.:{aea'a +ha- 1.tve Pisssr. 4.'1'4 a tlet,..1r4...,20 01:;,aTIZ V`Stt t:tia,aat,,aaZ t,' r al a fit.:::14 ctlis.4 4 ustillsi scsras14d I ca-al.iiiskol I %/Jul eitqvg=tv?.10.- 1.a=a:W.tf'a al117/ :4'4%2 .41r tj ft 7 14 tszr?u'r.,:ei r yt,r, 47,4, ta, “; laaa rut fazir',„;q1"tu ut„:0 plan, a, 74Uattia sy,tsrr• pssz. cs..tir. lat C1,7.4 tizt..tiM.,•PrtYitirr ‘71:5-it rfir.r nilai`X. L.a.,,•at.d. , O'Nkarri'="a a 171,V, q%,, Itirta,v 1.4,rd ;60 %Pad ra,,ag ati ssai "Latta"' e, tra ati 1-%;..t.: , I tt,ZaLl • ;, .s 1..r" ty*,41,3 1.4 1 ij7'.',1. 4,4e t - t, wt... et -• tta ans, CT.* INCORPORATED 1936 AMERICAN COLLEGE OF PHYSICIANS AMERICAN MEDICAL ASSOCIATION Vhusae Cartiiavasrular DISPnSP '- !UI ILLJLLT ITAE CURRENT TITLE: Chairman and Residency Program Director Dep:art.Ile'.tt o rTadiology Mount Sinai Medical Center Miami Beach, Fi 33140 (305) 674-2680 HOME ADDRESS: 2800 Regatta Ave Miami Beach, Fl 33140 coil 305) 213-1430 30 BIRTHDA II.: January 28, 1963 CT I iLEiNSHJP: United States SPECIALTY �r-rFIC TIONy B . rT+ . 1 . %�fTaisi'ii,r�li�:!�. 'June 1994 Aiilel`I[:III.i'iL'tI'CI(_titilClLUIi};_.'.y ,DUCAIION: Dates 3.213t1tt!>:Uil D gree Coliierreii;Titie/Stalks (l1 1985 1 J \t). f:, i�9v 1 — Li_%t!i University, Worcester, �VI ^ BS iI: Biology 1985 — 1989 Harvard Medical School, Boston, M "{i M.D. 1989 — 1990 The Faulkner Hospital Internship Internal Medicine 1990 — 1994 Yale New Haven Hospital Radiology Residency New Haven, CT 1993 — 1994 Yale New Haven nospiiil Fellow In CTVSiNR CM/1E E R: Dates 7/94— 1/98 7/96 — 1/98 7/97 —1/98 Position Assistant Professor, Dept of Diagnostic Imaging Yale University School of Medicine Co -Director, Abdominal Imaging Fellowship Program Dept ofDiagnostic Imaging, Yale University School of Medicine Associate Director, Radiology Residency Training Program Dept of Diagnostic Imaging, Yale University School of Medicine 1/98 1/2007 Attending Radiologist, Hospital: of St. Raphael 7/98 — 1/2005 . 7.'r 98 — 1 f_'JLI 7 Director, Radiology Residency Training Program Dept of Diagnostic Imaging, Hospital of Saint Raphael Assistant Clinical Professor, Yale university School of Medicine 7/00 - 1/2007 Section Chief, Body Imaging Section Dept of Diagnostic imaging, Hospital_ of Saint Raphael 2/2007- present Chairman, Department of Radiology Mount Sinai Medical Center, Miami Beach 5/2007-10/2008 Program Director, Radiology Residency Mount Sinai Medical Center 1 1/2009 present Program Director, Radiology Residency Mount Sinai Medical Center PROFESSIONAL. AFI, ILIATIONS: American College of Radiology (ACR) Society ofUroradiology (SUR) Society of Gastrointestinal Radiologists (SGR) Yale University Center for Swallowing Disorders Radiology Society of North America (RSNA) Connecticut State Medical Society American Medical Association Examiner ,American Board of -Radiology 2007 — present HONORS AND AWARDS Cambridge Who's Who Global Who's Who Top Radiologists in America Hospital of St. Raphael Radiology Residency Program Hospital of St. Raphael 1998/99 Teacher of the Year Radiology Residency Program Yale New Haven Hospital Clark University RESEARCH ?nno 2007 7006 2003/2004 Teacher of the Year 1994/95 Teacher of the Year 1985 Summa Cum Laude 1985 Honors Biology 1985 David Potter Prize. (Excellence in Biology) 1984 Jefferson Fellow (General Academic Achievement) 1984 Junior Phi Beta Kappa PUBLICATIONS (ORIGINAL RESEARCH) Tyler Neitlich, M.D., Jeffrey D. Neitlich M.D.-The Imaging Evaluation of Cholelithiasis in the Obese patient- Ultrasound vs CT Cholecystography: Our experience with the Bariatric Surgery Population, J Obes Surg, Feb, 2009 Tyler M Stockmann M.D., Elmer Valin M.D., Jeffrey D. Neitlich M.D. CT cholecystography for the evaluation of gallstones in the pre -operative assessment of patients for Bariatric Surgery - a comparison with ultrasound. Society of Gastrointestinal Radiology, June 2006. Levine JA, Neitlich JD, Smith RC. The value of prone scanning to distinguish ureterovesical junction stones from ureteral stones that have passed into the bladder: Leave no stone unturned. AJR 1999; 172:977-981. Traubicci J. Neitlich JD, Smith RC. Comparison of Plain Films and Unenhanced Helical CT in Evaluating Phleboliths: Is there a Lucent Center? AJR 1999; 172:13-17. Neitlich JD Foster HE, Glickman MG, Smith RC. Detection of Urethral Diverticula Using a High Resolution Fast Spin Echo Technique: Comparison with Double Balloon Urethrography, Journal of Urology 1998; 159:408-410. Steinlauf AF, Traube M,..Neitlich_JD,. Cooney EL.. Clostridium difficiie colitis: a possible cause of unexplained elevation of serum alkaline phosphatase levels in patients with AIDS. Clin Infect Dis. 1998 May;26(5):1248-9. Smith RC, Dalrymple NC, Neitlich JD. Noncontrast Helical CT in the Evaluation of Acute Flank Pain, Abdominal Imaging, 1998; 23:10-16. Neitlich JD, Topazian MD, Smith RC, Burrell M, Gupta AG, Rosenfield AT. Non -Contrast Helical CT for the Detection of Common Bile Duct Calculi: A comparison with ERCP, Radiology 1997; 203.753-757. Levine JA, Neitlich JD, Verga M, Dalrymple NC, Smith RC. Identification of Ureteral Calculi on Plain Radiographs in Patients with Flank Pain: Correlation with Helical CT. Radiology 1997; 204:27-31. PUBLICATIONS (CHAPTERS/REVIEW ARTICLES) Levine JA, Neitlich JD, Verga M, Dalrymple ND, Smith RC. Identification of Ureteral Calculi on Plain Radiographs in Patients with Flank Pain: Correlation with Helical CT Yearbook of Radiology 1998. Neitlich JD, Burrell MB, Drug induced disorders of the small intestine, Abdominal Imaging, 1997 Neitlich JD, Burrell MB, Drug Induced Disorders Of The Colon, Abdominal Imaging, 1997 Neitlich JD, Scoutt L, Transabdominal and Transoperative Ultrasound, Hepatobiliary and Pancreatic Surgery: Imaging Strategies and Surgical Decision Making, Wiley 1997 Neitlich JD, Smith RC, Rosenfield AT, Urologic Frontiers in Helical CT, Contemporary Urology, October, 1995. SCIENTIFIC PRESENTATIONS/ABSTRACTS Tyler Neitlich, M.D., Jeffrey D. Neitlich, M.D., Comparison of 2D/3D and Virtual CT with IVP for the detection of Uroepithelial lesions of the kidneys, ureters and bladder, SUR/ESGTAR 2008 Tyler Neitlich M.D., Jeffrey D. Neitlich, M.D., Preoperative Detection of Gallstones in Bariatric Surgery Patients: CT or Ultrasound? Scientific Session, RSNA 2007 Steven Zell M.D., Jeffrey D. Neitlich, M.D., Neoplasia or infection? The mutual mimickers in the GU tract, Computer Presentation, RSNA 2007 Tyler M Stockmann MD., Elmer Valin M.D., Jeffrey D. Neitlich M.D. CT cholecystography for the evaluation of gallstones in the pre -operative assessment of patients for Bariatric Surgery - a comparison with ultrasound: Society of Gastrointestinal Radiology June 200 Neitlich JD, Acute Flank Pain, Evaluation with Multidetector CT, ARRS Vancouver, May 2006 Truman S, Neitlich JD, Hodges L, Rosenfield AT, Smith RC. Accuracy of Determining the Size of Ureteral Stones using Unenhanced Helical CT. Annual Meeting of the American Roentgen Ray Society, New Orleans, LA, May, 1999. Levine J, Neitlich JD, Smith RC. The Value of Prone Scanning to Distinguish UVJ Stones from Passed Stones: Leave No Stone Unturned. 84-th Scientific Assembly and Annual Meeting of the Radiological Society of North America, Chicago, IL, December 1998. Levine JA, Neitlich JD, Smith RC. Distinguishing UVJ Stories from Bladder Stones: The Value of Prone Scanning With Unenhanced Helical CT. Annual Meeting of the Society of Uroradiology (Poster Presentation) Bermuda, June, 1998. Traubicci, J, Neitlich JD, Fields J, Smith RC. Unenhanced CT in the Evaluation of Acute Flank Pain in the Pediatric Patient. Annual Meeting of the American Roentgen Ray Society, San Francisco, CA, April, 1998. Nolten A, Neitlich JD, Brown J, Filippi C, Smith RC. The Accuracy of Plain Radiography in the Diagnosis of Facial Trauma. Annual Meeting of the American Roentgen Ray Society, San Francisco, CA, April, 1998. Traubicci J, Neitlich ID, Smith RC. Comparison of Plain Films and Unenhanced Helical CT in Evaluating Phleboliths: Is there a Lucent Center? 83-d Scientific Assembly and Annual Meeting of the Radiological Society of North America, Chicago, IL, December, 1997. Levine JA, Neitlich JD, Verga M, Dalrymple NC, Smith RC. Identification of Ureteral Calculi On Plain Radiographs in Patients with Flank Pain: Correlation with Helical CT, 83-d Scientific Assembly and Annual Meeting of the Radiological Society of North America, Chicago, IL, December 1997. Neitlich JD, Rosenfield -Darling ML, Smith RC, Comparison of Unenhanced Helical CT Scanning and Pulsed Doppler Ultrasound in the Evaluation of Acute Renal Obstruction, 83-d Scientific Assembly and Annual Meeting of the Radiological Society of North America, Chicago, IL, December 1997. Kaplan D, Neitlich JD, Verga J, Dalrymple D, Rosenfield AT, Smith RC. Hernaturia Testing In Patients With Acute Flank Pain and Suspected Ureterolithiasis—Why Bother? Annual Meeting of the Society of Uroradiology, Sante Fe, New Mexico, June, 1997. Neitlich JD, Hodges L, Barish M, Dalrymple N, Smith RC, The Accuracy of Unenhanced Helical CT In Determining Renal Stone Size and Volume, AnnualMeetingof the Society of Uroradiology, Sante Fe, New Mexico, June, 1997 Dickey KW, Hsia HC, Egglin TK, Neitlich JD, Belcher DJ, Rosenfield AT, Helical CT Angiography of the Abdominal Aorta: The Value ofth 3-D Image for Branch Detection and Stenosis, SCV1R 1996. Neitlich JD, Topazian M, Smith RC, Gupta AG, Burrell MI, Rosenfield AT, Non -Contrast Helical CT versus ERCP in the Evaluation of Choledocholithiasis, Society of Gastrointestinal Radiology, Annual Meeting, March 1996. Smith RC, Verga M, Rosenfield AT, Neitlich JD, Glickman MG, Non -Contrast Helical CT in the Evaluation of Flank Pain: Diagnostic Criteria and Results, SUR, June 1994 Neitlich JD, Hitzig B, The Evaluation of pH Regulation in the CNS Using NMR Spectroscopy Massachusetts General Hospital Warren Laboratory, MIT, 1984. Neitlich JD, Curtis J, Regulation of Cortico-steroid Production in the Adrenal Cortex, Clark University Press, June 1985 ONGOING RESEARCH Neitlich TM, NeitIich JD, CT Virtual Colonoscopy, a combined approach with flexible sigmoidoscopy, work in progress, IRB approved. Neitlich TM, Neitlich JD, CT Urography- a 3D and virtual approach to evaluating the ureters, work in progress, IRB approved. Neitlich TIVI, Neitlich JD, Virtual Cystoscopy, comparison of CT and MRI techniques, work in progress. Neitlich TM, Neitlich JD 3D Ureterography and Cystography in the evaluation ofHematuria, a comparison with IVP and Endoscopy, Hospital of St Raphael Department of Radiology, IRB approved. Neitlich TM, Neitlich JD, The efficacy of CT angiography as a first line imaging technique for lower Gastrointestinal bleeding, IRB approved Neitlich TM, Neitlich JD -- CT Cholecystography As Part Of The Pre -Op Evaluation in Bariatric Surgery, IRB approved COMMITTEES Mount Sinai Medical Center, Academic Affairs Committee 2007 — present Mount Sinai Medical Center, Cancer Committee 2007 — present Mount Sinai Medical Center, Resident Selection Committee 2007 — present Hospital of St. Raphael Graduate Medical Education Committee 1998 — 2005 Hospital of St. Raphael, Diagnostic Imaging, Customer Satisfaction Committee 1998 — 2003 Yale Diagnostic Imaging Residency Selection Committee 1995 —1997 Yale Diagnostic Imaging Abdominal Imaging Fellowship Selection Committee 1995 —1997 Yale Emergency Department/Diagnostic Imaging Quality Improvement Team Yale -New Haven Hospital Curriculum Committees: Laparoscopic Cholecystectomy Pancreatitis 1995 1996 AC#3 2 3 G 2 8 STATE OF FLORIDA DEPARTMENT OF HEALTH DIVISION OF MEDICAL QUALITY ASSURANCE DATE LICENSE NO. CONTROLNO. 12/11/2008 ME 98014 266702 The MEDICAL DOCTOR named below has met all requirements of the laws and rules of; the state of Florida. Expiration Date: , 'ANUARY 31, 2011 JEFFREY DAVID NEITLICH MOUNT SINAI MEDICAL CENTER 4300 ALTON AVE MIAMI BEACH, FL 33141 Charlie Crist GOVERNOR glis,atietAM' AnaM.'Viamonte Ros, STATE SURGEON GENERAL= DISPLAY IF REQUIRED BY LAW 4...4 1,1°2‘ g4 r &yaw"- eeld _coo/zeta/J:092,1/4 @Vmew;cei/w,W4e..1.thifyiy;, „de @Vmetiaz.n. Mwilizerw, e9te,ceeok, @.gmeacezaz, X7-€11:14711, TecalWoceee/7 .14 6/2!ec e9bOfl :ezfe.:64,4t, CiOntete:ca,9z, eCeetacezi@Vidocialio-n, Z.4 @VmetZcavz, (0:: Egiezayfeeelie 2:eLZ. ,a9ld &Wed 4:1;.• @Wriot9CleZ4.11-91, le;ve.J+-ez-wd@9;zzetectz9z, @_,ViAzic477.1e7b.1 Z:zz 6-Wedicine- ce:.‘-e: y,ezzi Affirm Davila &Midi eXdiAtemaed,a9r, acceAleelxviwele ,erfeadizak Akeicv ez,-)ze ledReeezZae-4.4 ..12€74, ,cettezz:N, Jia9izzievedl. ,a,71‘ 19142471Caae0.941 -aNzi Azd /ad-dee/ ../‘ -eraziazt-izah:o-wel .eayukcialw-91(4t.,del weed;-)-e& ce.4 6._Zezte-/ ODti this ninth hag of 'Mune, 1994 C6Utee,,a(ezintwzak.a4;91, Ja - d a e reeziged:k. a:ce 4feci.:44 V2 pitigunstir litabirring Jenny Audain 17561NE5`hAve North Miami Beach, FL 33162 Ce11 (305)761-9014 Home (305) 493-4395 Email: jenjen0378@ao1.com OBJECTIVE Serves as the Supervisor for Mount Sinai Medical Center Occupational Health Department SUMMARY OF QUALIFICATIONS • Communicate with all levels of management and staff positively and effectively • Recommends positive changes, and assist management in identifying opportunities for improvement that builds morale • Develops and monitors quality and performance measurements to maintain optimal delivery of care in the areas of responsibility outcomes • Excels at handling multiple tasks in fast paced environment • Possesses comprehensive knowledge of public health issues • Seven years experience in hospital Inpatient, Outpatient, Emergency Department, Employee Health and Occupational Health settings EDUCATION Master in Public Health / Health Service Administration, Expected December 2011 Barry University, Miami Shores, FL Bachelor of Science in Health Service Administration, July 2005 Barry University, Miami Shores, FL Associates Degree in Accounting, May 2000 Miami- Dade College, Miami, FL WORK EXPERIENCE Occupational Health Supervisor, January 2007- Present Mount Sinai Medical Center, Miami Beach, FL • Provides supervision, guidance and direction to assigned staff • Reviews and revises current department policies contracts and procedures • Develops and monitors quality and performance measurements • Conducts internal auditing and monitoring of registration and billing • Helps improve the departments customer service satisfaction • Train employees for DOT drug and alcohol collection Patient Access Representative Team Leader, February 2006 - January 2007 Mount Sinai Medical Center, Miami Beach, FL Patient Access Representative, January 2002- February 2006 Mount Sinai Medical Center, Miami Beach, FL Customer Service Representative, January 1999- December 2001 Precision Response Corporation, Miami, FL Accounts Payable, August 1997- January 1999 Service Merchandise, Hollywood, FL Certification: Certified Instructor for DOT specimen Professional Collectors and Breath Alcohol Technician This is to certify that .Jenny Audain has successfully completed training as a Professional Collector Instructor and is Proficient in Specimen Collections Proficient in 49 CFR Part 40 Procedures Greg Clark A]coPro, Inc. February 18, 2008 ��t►�'�I.11►�.���11t1�'''1111Fi �� DIVIS STATE OE FLORIDA DEPARTMENT OF HEALTH ON OF MEDICAL QUALITY, ASSURANCE UAE . LICENSE NO CONTROL NO 12/19/2009 AY.740 . _ 5351. The AUDIOLOGIST .':. . named below has mei all requirements. of. -.the-laws and-rales-of`ttte`state -al Florida. Expii`atioin Date: DECEMBE R 31, 2011 SUSAN RAERO'f H • 4302 ALTON ROAD SUITE 650, MIANN SEAL}{, EL 33140 UNITED STATES' Charlie Cris{ GOVERNOR AN) M. Vi:t nonte Ras, STATE SURGEON) GENERAL- F:REQUIRED. BY LAW CC Attachment B Privacy Notice of Privacy Practices Policy and Procedures • Mount Sinai _ . Departmerit: Organization Wide Effective Date April 14 2003 Privacy Officer Review Date; Feb 0:5: 12/05,5/07; 10/08. 7/09 Revise Date. { Policy Number': ; Subject 2.30:036 i PtNacy:Notice of Privacy I i 1 Practices Policy Originator, I Adinft7rit-trative ApproVal: ; Senior VP_ and chief I fficer PURPOSE. Compliance With. HIPAA;Privaey; Rule, 45 CFR § 164;520—Notice of Privacy Practices for Protected Health-liirerlfnatiOn (PHI) Thepurpose Of the Notice is to:explain how the Medidat.Center willf:uSeand•disClOse,the individual's protettc-d health informatien (-PEityandlo.State.the indiVidLiars• rights and the Medical Center's legal'•dutiet With reSpect40.,pRI. 11, SCOPE: The r..‘elidyabblieS to aff:patientS:WIICF•have edited tre'atment relationship with the facility. PO;LICY: tt poky ofAldunt:-,Sinaiff.fledicalCeriter to.promote the .. . ndivduars understandingg of the facility's..privacy practites. A component of facilitating the understanding of,otivacy practices is- to provide a notice of privacy practices to our patients. IV PROCEDURE: A. A "Notice of Privacy Practicet will he providednO later than the • date of first service,deliverTandito..artyJhertiber olthe-pribliouport:reduest. B. As a covered direct-treatnient•provider:MOUnt•SinaiMedital,Center will make good faith effort to Obtain the•-individuat'S•Written acknowledgment of receipt of the noticE,=, Patient-acknowiedgqient will-'bedocoMented in the "Authorization and General,Consent'. fOrrnAn-eircuri1Stances,that do not .allOw for a v.fritten ACKhoWledgeinentto;.4e;obtained,t; reatOn.for not. itb.Oining the C, For emergency situations. -6iideellerio(inioede.‘anindiYidUarS tiir•dly .actess 'to quality health,:eare, detiver)e dithey'Nefite end' acknOWledgeMent by the .patienhvill he delayed UntilreaSOnabilYsiptecticableafter the emergency situation. as .snecified in 45 CFR §-164.5"20I,c)(2)'(VB) and 45 'CFR §164 520 D. The information, referred'to as the individual's health or- medical record serves as a: • Basis for planning patient care and treatment • Means of communication among.the Health professionals who contribute to the patient's -care' • Legal docurnent.deseribing,the care the patient receives' • Means by which -the patieri o;r athird-party payer can' verify that:servi"ces billed were actuallyprovided'. • A tool in educating health professionals • A source•of data. for medical research • A source of information for public health officials charged with improving the health of the nation • A source of data for'facility plan. ning and marketing. • A tool with which we can assess and continually work.t'o irriprovefhe care we render and the outcomes we, achieve E. Patients have the rightle: • Requesta restriction certain uses and disclostires.of info'mation as provided by 45 CFR ti 164.522. • Be provided with the "Notice of Privacy Practices" • Inspect -and copy-their:health record as provided for in 45 CIFR § 1'64.524 • Request amendrnent(s)-to theirhealth record as provided- in45.CF.R . 1164..528 • Obtain an -accounting -of discIosures of health information as provided in 45 CFR, 164.528 • Request cornrnunications Of health information by alternative means. or at alternative Iocations • Revoke their authorization to_use or disclose -health information except to the extent that action has already been taken in reliance on -their authorization F. Mount Sinai Medical Center is required. to; • Maintain the privacy of patient health -information • Provide the patient with a notice as to our legal deities.and privacy practices with respect to information we collect and Maintain about the patient • Abide by the terms of the Privacy Notice: • Notify the patient ifwe unable to agree':to a requester restriction or amendment • Accornrriodate reasonable requests that the p:atient':rnay make to have health information communicated by alternative means -or at alternative locations G. Mount Sinai Medial Center reserves right to change our practices and to Make- the new proviion8 effective for all protected health information we maintain. H. Revisions Made to the "Notice of Privacy Practices"will be pOStedon the, Mclical Centers -web site. I. Patient health information wH n@t be disclosed withbut,'authotiZatiOn exCept as described in thisipocy, For ail other requests for disclosure -refer to Privacy. Release Of,PridtecteeiHealth.lniforMatiOn.-pelicy.and procedure J. Patients who believe their privacy rights have been viblated may contact the Privacy Officer of Mount ,Sinai Medical Center at 305-61,:4;2722. Further coniplaitits may be made to the SeCretary of'Flealithand:HUmen Services, Office of Civil V; REFERENCES 45 CFR 164.52,0 45 CFR 164.522 Information") 45 CFR 164.524 45 CFR 164.528 (Notice. of FriVaey Practices fOr Protected Health,triformatien") ("Rights,to RequeStPriVacy Protection for Protected Health CAccess.of. IndiVidUalsilb- Protected Health Information) (Accountingibt DiSClosureSeProtetted Health infOrmatiorii") MSMC Policy 2.30021,-(" pationt-Rouqgt-fot.:RetttietiOn iiand•Genfidential Communication of Protected Health Information") MSMC Policy 2.30..024.("Patient Access and AmendMentto Health Records") MSMC Policy 2 30_045 ("Filing A Health Inforrnatton Privacy Complaint") Attachment C Fee Proposal Line: 1 Description: GROUP 1 - TIRE -RESCUE ANNUAL PHYSICAL EXAMINATION SERVICES, INCLUDING HEPATITIS A and B PROGRAM. Line: 1.1 Description: Basic Physical Category: 94874-50 Unit of Measure: Each Unit Price: $ L' )•C)0 Number of Units: 400 Total: $ ikiS) opn4ftO Line: 1.2 Description: Additional/Optional Exams: Speculum and Bi-Manual Exam including Pap Smear Category: 94874-50 Unit of Measure: Each Unit Price: $ '6 S . CO Line: 1.3 Number of Units: 50 • Total: $ Description: Additional/Optional Exams: Mammogram Category: 94874-50 Unit of Measure: Each Unit Price: $ T S •0 U Number of Units: 50 Total: $ 00 Line: 1.4 Description: Additional/Optional Exams: Comprehensive Hearing Test Category: 94874-50 Unit of Measure: Each Unit Price: $ ItSU 00 Number of Units: 20 Total: $ 3 , z'r.G,n O0 Page 5 of 54 Line: 1.5 Description: Additional/Optional Exams: Echocardiogram Category: 94874-50- Unit of Measure: Each Unit Price: $ 3'Ctt ' 0 Line: 1.6 Number of Units: 200 Total: $ 'Or [20e)• G") Description: Additional/Optional Exams: Thallium Stress Test Category: 94874-50 Unit of Measure: Each Unit Price: $ 1 , t 00 00 Number of Units: 50 Total: S t 4,40 Line: 1.7 Description: Additional/Optional Exams: Exercise Muga Stress Test Category: 94874-50 Unit of Measure: Each Unit Price: $0 0 Number of Units: 10 Total: $ Line: 1.8 Description: Additional/Optional Exams: Hepatitis A and B Screening Category: 94874-50 - Unit of Measure: Each Unit Price: $ ) ?.00% Number of Units: 200 Total: $ ' 006). DO Page 6 of 54 Line: 1.9 Description: Additional/Optional Exams: Tetanus Toxoid Immunization Category: 94874-50 Unit of Measure: Each Urrrt P"rice: $" t IO.. `'' Line: 1.10 Number of-Units:-50- Total: .$ Cic- Description: Additional/Optional Exams: Tetanus Booster Category: 94874-50 Unit of Measure: Each Unit Price: $ . ,.0O Number of Units: 75 Total: $ 1, n •S.: 0 Line: 1.11 Description: Additional/Optional Exams: Pulmonary Function Test - Flow Volume Loop Category: 94874-50 Unit of Measure: Each Unit Price: $ ik:y.o 0 Number of Units: 50 Total: $ rg,coi., iT)e.' Line: 1.12 Description: Additional/Optional Exams: Pulmonary Function Test- Post Bronchodilatory Study Category: 94874-50 Unit of Measure: Each Unit Price: $ joo,00 Line: 1.13 Number of Units: 50 Total: $ uo 0 0 Description: Additional/Optional Exams: Radiological Evaluation Page 7 of 54 Category: 94874-50 Unit oflvleasure: Each Unit Price: $ }' Line: 1.14 Number of Units: 200 Total: $ v, 00c 01 Description: Additional/Optional Exams: Flexible Sigmoidoscopy Category: 94874-50 Unit of Measure: Each Unit Price: $ 6,+01C 00 Line: 1.15 Number of Units: 10 Total: $ 6/ c do 0 () Description: Additional/Optional Exams: Colonoscopy Category: 94874-50 Unit of Measure: Each Unit Price: $ i) 5)0,00 Line: 1.16 Number of Units: 10 Total: S ' ,i)De) 00 Description: Additional/Optional Exams: RPR Category: 94874-50 Unit of Measure: Each Unit Price: $ i0.0 0 Number of Units: 1 Total: $ I 0 0 0 Line: 1.17 Description: Additional/Optional Exams: 24 Hour Halter Monitor Category: 94874-50 Unit of Measure: Each Page 8 of 54 Unit Price: $ .3 7-5.O 0 Line: 1.18 Number of Units: 15 Total: $ Ji (. '�.0 f_? Description: Additional/Optional _Exams: .Mantoux Test Category: 94874-50 Unit of Measure: Each Unit Price: $ G- 0 0 Line: 1.19 Number of Units: 550 Total: $ ? "2 50 Description: Additional/Optional Exams: Flu Shot Category: 94874-50 Unit of Measure: Each Unit Price: $ • 0 t Number of Units: 700 Total: $ I'! ,I?lir1,(i Line: 1.20 Description: Additional/Optional Exams: Hazardous Material Team, Dive Team, TRT Physical Category: 94874-50 Unit of Measure: Each Unit Price: $ i ;;.00 Number of Units: 170 Total: $ 3!,1-50 (W Line: 1.21 Description: Additional/Optional Exams: Bilirubin Direct and Toral Category: 94874-50 Unit of Measure: Each Unit Price: $ t t; 0 c' Number of Units: 170 Total: $ i, rt%c' _r'c7 Page 9 of 54 Line: 1.22 Description: Additional/Optional Exams: Cholinesterase Category:-94874=50 Unit of Measure: Each Unit Price: $ -';, 0 Number of Units: 170 Total: $ ,& I) 00 Line: 1,23 Description: Additional/Optional Exams: Heavy Metal Screening Quantitative for Pb (Lead), As (Arsenic), Hg (Mercury) Category: 94874-50 'Unit of Measure: Each Unit Price: $ .S CO Line: 1.24 Number of Units: 170 Total: $ U1.b0 0 Description: Additional/Optional Exams: Tonometry Category: 94874-50 Unit of Measure: Each Unit Price: $ 1 ti 0 0 Line: 1.25 Number of Units: 170 Total: $ 1,100 , Description: Hepatitis A Immunizations - First Injection _._. In accordance with specifications Category: 94874-50 Unit of Measure: Each Unit Price: $ (u. J C' Number of Units: 50 Total: $ -5/<Z13)`" Page 10 of 54 Line: 1.26 Description: Hepatitis A Immunizations - Second Injection Category: 94874-50 Unit of Measure: Each Unit Price: $ !o`.5-f-'0 Line: 1.27 Number of Units: 50 Total: $7).0Q Description: Hepatitis B Immunizations - First Injection In accordance with specifications Category: 94874-50 Unit of Measure: Each Unit Price: $ ''1 0 0 Line: 1.28 Number of Units: 50 Total: $ L2:.�--W 0 0 Description: Hepatitis B Immunizations - Second Injection In accordance with specifications Category: 94874-50 Unit of Measure: Each Unit Price: $ 5).0 0 Line: 1.29 Number of Units: 50 Total: $ :., 5'D . 0 G) Description: Hepatitis B Immunizations - Third Injection In accordance with specifications Category: 94874-50 Unit of Measure: Each Unit Price: $ ' 0 CI Line: 1.30 Number of Units: 50 Total: $ �t-'7J11.Q 0 Page 11 of 54 Description: Hepatitis A and B Combined (TWINRIX) - First Injection In accordance with specifications Category: 94874-50 Unit of Measure: Each Unit Price: S g() Number of Units: 50 Total: $ ; .. To ,0t1 Line: 1.31 Description: Hepatitis A and B Combined (TWINRIX) - Second Injection In accordance with specifications Category: 94874-50 Unit of Measure: Each Unit Price: $ !) , 00 Number of Units: 50 Total: $ 376 , 0 Line: 1.32 Description: Hepatitis A and B Combined (TWINRIX) - Third Injection In accordance with specifications Category: 94874-50 Unit of Measure: Each Unit Price: $ �t) , 0 u Number of Units: 50 Total: $ 1f /-5W,0 Line: 1.33 Description: Additional/Optional Exams: Cardiovascular Stress Test Category: 94874-50 Unit of Measure: Each Unit Price: $ a5-1) , t30 Number of Units: 40 - ota1: $-'I@t}/t0 '-.pJC) __.._._._. Line: 2 Description: GROUP 2 - POLICE ANNUAL PHYSICAL EXAMINATION SERVICES, INCLUDING HEPATITIS A and B PROGRAM. Page 12 of 54 Line: 2.1 Description: Basic Physical (including lab work, visual exam, and Audiological Exam) Category: 94874-50 Unit of Measure: Each Unit Price: $ PO. 0 ° Line: 2.2 Number of Units: 1,100 Total: $ i j 000 0 Description: Pulmonary Function Test Category: 94874-50 Unit of Measure: Each Unit Price: $ .0 0 Line: 2.3 Number of Units: 50 Total: $ 11 �50 Description: Electrocardiogram (EKG) Category: 94874-50 Unit of Measure: Each Unit Price: $ 3.1 -00 Line: 2.4 Number of Units: 1,100 Total: $ & &e .O 0 Description: PPD Skin Test (Mantoux) Category: 94874-50 Unit of Measure: Each Unit Price: $ .0 0 Line: 2.5 Number of Units: 1,100 Total: $ ..9) 0 0 Page 13 of 54 Description: Additional/Optional Exams: Radiological Evaluation Category: 94874-50 Unit of Measure: Each Unit Price: $ '%' 0 L) Line: 2.6 Number of Units: 800 Total: S 6)60;1:0 Description: Additional/Optional Exams: Cardiovascular Stress Test Category: 94874-50 Unit of Measure: Each Unit Price: $ 9.50 CD Line: 2.7 Number of Units: 100. Total: $ 0 Description: Additional/Optional Exams: Echocardiogram Category: 94874-50 Unit of Measure: Each Unit Price: $ 300 Er 0 Line: 2.8 Number of Units: 100 Total: $ .E40,000 0 Description: Additional/Optional Exams: Thallium Stress Test Category: 94874-50 Unit of Measure: Each —UnifPrice: $ 1 ( D0 ;vC3 Line: 2.9 Number of Units: 75. Total. $ `3), Sou Description: Additional/Optional Exams: Exercise Muga Stress Test Page 14 of 54 Category: 94874-50 Unit of :Measure: Each Unit Price: $ G J :0 0 Number of Units: 1 Total: $ 5, 0 Line:.2.10 ._ Description: Additional/Optional Exams: Stool Hematest for Occult Blood Category: 94874-50 Unit of Measure: Each Unit Price: $ 5.0 0 Line: 2.11 < p 0 Number of Units: 1 Total: $ Description: Additional/Optional Exams: Pap Smear Category: 94874-50 Unit of Measure: Each Unit Price: $ :0 L Line: 2.12 Number of Units: 10 Total: $ 35o .pc� Description: Additional/Optional Exams: Mammogram Category: 94874-50 Unit of Measure: Each Unit Price: $ 1-1 S . G 50,00 Number of Units: 50 Total: $ Line: 2.13 Description: Additional/Optional Exams: CA 125 Category: 94874-50 Unit of Measure: Each Page 15 of 54 Unit Price: $ Line: 2.14 Number of Units: 1 Total: $ -� ( Ci Description: Additional/Optional Exams: PSA Category: 94874-50 Unit of Measure: Each Unit Price: $ tt; .0 0 Line: 2.15 Number of Units: 600 Total: $ 6,4OL) • 4,0 Description: Additional/Optional Exams: Comprehensive Hearing Test Category: 94874-50 Unit of Measure: Each Unit Price: $ VS0 e' L• Line: 2.16 Number of Units: 10 Total: $ QC) Description: Additional/Optional Exams: 24 Hour Holter Monitor Category: 94874-50 Unit of Measure: Each Unit Price: $ . 7-,S . o o Line: 2.17 Number of Units: 50 Total: $ f �S, 51.52) .1)D Description: Additional/Optional Exams: HBSAB Titer Category: 94874-50 Unit of Measure: Each Unit Price: $ 2i) , f7 0 Number of Units: 1 Total: $ 0 a Page 16 of 54 Line: 2.18 Description: Additional/Optional Exams: Flexible sigmoidoscopy Category: 94874-50 Unit --of Measure: Each - Unit Price: $ (LQU ,C' 0 Line: 2.19 Number of Units: 1 Total: $ 1:=00; 0 0 Description: Additional/Optional Exams: Tetanus Booster Category: 94874-50 Unit of Measure: Each • Unit Price: $,00 Line: 2.20 Number of Units: 150 Total: $ 3,450.00 Description: Additional/Optional Exams: Bilirubin Direct and Total Category: 94874-50 Unit of Measure: Each Unit Price: $ 10 • 0 Line: 2.21 Number of Units: 1 Total: $ I t , Ci 0 Description: Additional/Optional Exams: Cholinesterase Category: 94874-50 Unit of Measure: Each Unit Price: $ 5.0 t) Line: 2.22 Number of Units: 1 Total: $ 4�S -J O Page 17 of 54 Description: Additional/Optional Exams: Heavy Metal Screening Quantitatative for Pb (Lead), As (Arsenic), Hg (Mercury) Category: 94874-50 Unit of Measure: Each Unit Price: $ `27.0 -t-' Line: 2.23 Number .of..Units :_1_ .... Total: $ ,2 :3 0 Description: Additional/Optional Exams: Tonometry Category: 94874-50 Unit of Measure: Each Unit Price: $ i'tO, , 0 C) Line: 2.24 Number of Units: 1 Total: $ Description: Additional/Optional Exams: RPR Category: 94874-50 Unit of Measure: Each Unit Price: $ IS•O Line: 2.25 Numbcr of Units: 1 Total: $ l g • O 0 Description: Additional/Optional Exams: Blood Type Category: 94874-50 Unit-ofMeasure:-Ea ch Unit Price: $ `` • r' 0 Line: 2.26 Number of Units: 1 Total: $ 0 Description: Hepatitis A Immunizations - First Injection Page 18 of 54 In accordance with Specifications Category: 94874-50 Unit of Measure: Each Unit Price: $ Line: 2.27 Number of Units: 75 Description: Hepatitis A Immunizations - Second Injection In accordance with Specifications Category: 94874-50 Unit of Measure: Each Unit Price: $ (,5 D 0 Line: 2.28 Total: $ 4, :r . 00 Number of Units: 75 Total: $ 1: C 5-- 0 o Description: Hepatitis B Immunizations - First Injection In accordance with Specifications Category: 94874-50 Unit of Measure: Each Unit Price: $ 60 ` U i✓� Number of Units: 75 Total: $ 3; ? 0 .tea Line: 2.29 Description: Hepatitis B Immunizations - Second Injection In accordance with Specifications Category: 94874-50 Unit of Measure: Each Unit Price: $ 5-0 ,0 C.; Number of Units: 75 Total: $ 3,7 50,61 o Line: 2.30 Description: Hepatitis B Immunizations - Third Injection In accordance with Specifications Category: 94874-50 Page 19 of 54 Unit of Measure: Each Unit Price: $ bar ' 60 Line: 2.31 Number of Units: 75. Total: $ 3 -75-0 ' .0 O Description: Hepatitis B Immunizations -Third"Injectton In accordance with Specifications Category: 94874-50 Unit of Measure: Each Unit Price: $ 50.0 (� Number of Units: 75 Total: $ 3, 7 `5-0 , to J Line: 2.32 Description: Hepatitis A and B Combined (TWINRIX) - First Injection In accordance with Specifications Category: 94874-50 Unit of Measure: Each Unit Price: $ )t) , ;: 0 Number of Units: 75 Total: $ 6,750 : 0 D Line: 2.33 Description: Hepatitis A and B Combined (TWINRIX) - Second Injection In accordance with Specifications Category: 94874-50 Unit of Measure: Each Unit Price: $ 90 .0 0 Number of Units: 75 Total: $ ; 751) 'd 41 Line: 2.34 Description: Hepatitis A and B Combined (TWINRIX) - Third Injection In accordance with Specifications Category: 94874-50 Unit of Measure: Each Unit Price: $ 0 ( 0 0 Number of Units: 75 Total: $ ' ) "9u ' L Page 20 of 54 fJ(7"(ot)6(f �P�rCt' Gonzalez, Yusbel From: Diaz -Warshaw, Lillian Sent: Friday, April 08, 2011 1:31 PM To: Gonzalez, Yusbel Subject: FW: Calvin Ellis - additional lab request Yusbel, I am forwarding Linda's e-mail. Let know if you have any questions. Thank you, City of Miami Department of Employee Relations 444 SW Second Avenue, 7th Floor Miami, Florida 33130 Direct: (305) 416-2008 • Fax: (305) 416-2115 email: Idiaz-wa rsh aw Pmiamiaov.com Please consider the environment before printing this e-mail Inc From: Linda Arama [mailto:Linda.Arama@msmc.com] Sent: Friday, April 08, 2011 1:16 PM To: Diaz -Warshaw, Lillian Subject: Calvin Ellis-01:ditional�' el b e- q For the test protocol for the thQotingrange.%frearmlinstructo"rs; the additional charge for Tin and Zinc is $156.00t. Tttej eavy Metals'{lead,:Arsenic'Mercuriocoppen;>Tln, Zin) will<be1$211 007total Linda Arama Director Patient Access/Employee Health Occupational Health Department Outpatient Department Tel: 305-674-3910 Cell: 305-588-8033 Fax: 305-535-7904 larama@msmc.com Help support Mount Sinai's lifesaving mission. Text SHARE to 27722 and donate $10 to Mount Sinai. *message & data rates may apply Confidentiality Notice: This e-mail message, including any attachments, is for the sole use of the intended recipient(s) and may contain CONFIDENTIAL or PRIVILEGED information. Any unauthorized review, use, Attachment D Campus Map PEARLMAN; RESEARCH ''FACIL�TY.�' "COMP„REHENSIVE 'C ANCER. CENTER BISCAYLVE ?B GUMENICK-- AMBULATORY `.SURGICAL CENTER,. GREENE PAVILION .eA,. BUILDING Occupational Health Located in the Lowenstein Building (Park Lot B) cunt Sinai MFDICAL CENTER OROVITz : EMERGENCY BUILDING;:'; '4382 SIMON MEDICM OFFICE'BUILDING:, OE HIRSCI-1MEYER �i'GREENSPAN ;:;TOWERd ;, ,+',{° ,-PAVILION.; 43O8'GOLDENEDICAL :i�' OFFICE: BUILDING.,i.P Directions t® Mount Sinai From. Miami International Airport/West Dade County Follow the airport signs to State Road 112 east. After you exit the State Road 112 tollbooth, take Interstate 195 east to Miami Beach. Signs will direct you to "Alton Road/Hospitals." Mount Sinai Medical Center is on the left From Southwest Dade Take State Road 836 east to Interstate 95 north to Interstate 195 east to Miami Beach. Signs will direct you to "Alton Road/Hospitals." Mount Sinai Medical Center is on the left. From North Dade, Broward and Palm Beach Counties Take Interstate 95 south to Interstate 195 east to Miami Beach. Signs will direct you to "Alton Road/ Hospitals." Mount Sinai Medical Center is on the left. From West Broward Take Interstate 595 east to Interstate 95 south to Interstate 195 east to Miami Beach. Signs will direct you to "Alton Road/Hospitals." Mount Sinai Medical Center is on the left. -Aittwr,Godfie R /svicount Sinai MEDICAL CENTER Location Mount Sinai Medical Center Campus Lowenstein Building 4304 Alton Road Miami Beach, FL 33140 Parking available in the Lowenstein Parking Lot B Attachment E Departmental Brochure Mount Sinai MEDICAL CENTER Occupational Health Services, Offered: ❑ Pre -Employment Physicals ❑ Drug & Alcohol Test Program ❑ Executive Physicals ❑ Workers' Compensation ❑ Immunization Program ❑ Wellness Program ® Fitness for Duty / Return to work Programs ❑ 24-hour Emergency Department ❑ Employee Health Rapid Response Service include: ❑ 24-hour Emergency Department with Drug Testing ❑ Occupational Health: Hours of Operation — Same day or next day appointments ❑ Medical Evaluations Results — reported to the Human Resources Representative within 48 hours from time applicant is seen Strong .Physician Experience: Kenneth Kaplan, M.D. — Medical Director of Occupational Health, SAP. Cert. in Workers Compensation Joshua Trabin, M.D. — Medical Review Officer Gerardo Minsal, M.D. Clinicians: A team consisting of 11 individuals, comprised of Advance Registered Nurse Practitioner (ARNP), Licensed Practitioner Nurse (LPN), certified DOT drug screening technicians, certified breath alcohol technicians, and medical assistants Management Staff Linda Arama, Director Occupational Health Services Jenny Audain, Supervisor Occupational Health Services • Occupational Health Services Facility • Facility: 5 Diagnostic exam rooms and 4-physical exam rooms • Location, Location, Location: • Occupational Health Services is conveniently located at Mount Sinai Medical Center, Lowenstein Building (4304 Alton Road) • Parking — Easy Access, provided free of charge in the Lowenstein Parking Lot "B" ,�;:x,'uxa?' ;,.rt`�;; q'�`':"�'W••,,. ry �N''�ir„�";r�q 'J-i .C'V' =+r?r. P .jn . �Y., •.wb'c� ,y ^, r; wiw 4. . 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'L.,.'S-z��'�„fiir nr?x' `'.nK�R.-��'f�,=,�'ry?�.��!iv 7' IN�y'r��3" ��r.G '�:$ �� � C•5�, � y .5.. . `4:'J'b, t`i4, ,, ' .�..i," r�M1. 5 �is : ' n-d.., F, f - r� lfrr , 'Y. ��{�y'Y�•?'7E' T�'; F .�'',t, .'iF"A 1� Hs",n'.•'..':-{'rli'wi,+:'( y,..�,.F y� �i � '`w-re'"�. ..� .�rk� "�'ti .i i1' �,i :ti" '"e �r4"L`.t=� �`if'tiP; +, 3,u4-f1'-r'";.Fn l'n i , Y.,)-. ,�%T l;'t,-�Seai.°`A) .tK 4,'�x J'si.'�,73. a'��' .�},^�^'.2 + te 'y '{'4Y 3' '�'1�' . ,-10' �F�,*��,. �', !1'�y. .d. ,�,,,y � �:yrph9 R;•: '�� .{s•, M `� "P�u :�E'�'`� 4i`A-y;�,�-(''1,..�i= .��,a �nY" �'S�� R5✓, w`(:.,t�I�r;�, +nit „�'� ,IS, A..,t�i t."! ''�C �f.$b.�C'"".'."te: �{a �h:.�`^ vR'3ts�i.. i! ii.�, C]"�r .', ..itf3�+s!}�rns.lw .;3i'.";re.:.,, -(•z�''.��} Ah.., 'i�„ 'xTs! �n'h,4^>.;.,.+ia .4 , b!�'M:, +k. is�;Yu �o ki L'Gvr.Y '7✓, ,. . �„�,;a4 8fan,, "u',"' ', 4:; �' i�{ i✓',., -�@. i`W'� �4 '3" �' �;' ,'•,x9.a .`.s:,:i�/ 1. art✓' v b ,u'�•� ' � mot, ,7�h i P, � t`S'4, Y',h 'c :y�' �;, '�' .'pe;�� 1. �.�`,s`.� � � {.v�� 1 L,�tJ. Jate: 12/13/3010 Time: 4:4t5 PM ro:JUnDJOr:1U4 ty of Miami Page: 004 KENNETH ROBERTSON Chief Procurement Officer Ms. Linda Arama Mount Sinai Medical-Centerof Florida; lnc- 4300 Alton Road, Lowenstein Building Miami Beach, FL 33140 arrri December 8, 2010 CARLOS A. MIGOYA City Manager SENT VIA EMAIL AND FAX RE: Response to RFP 243229 Annual Physical Examination Services for First Responders Dear Ms.Arama, The City of Miami is in the process of evaluating your proposal response to RFP 243229 for Annual Physical Examination Services for First Responders. In order to assist us in the evaluation process, we need additional information and documentation regarding your response. • Pursuant to Section 4, Submission Reouirements, subsection 4, Professional Experience and Qualifications, the following requirement is stated: d) Specify whether any or the physicians, cardiologists, radiologists, audiologists, and medical professional staff, to be assigned to the City's account, have ever had any complaints filed against them. if so, disclose and discuss. Upon review of your proposal response, we were unable to locate where you addressed the above stated requirement. Therefore, in an effort to complete the evaluation of your proposal response, please utilize the space provided to "Specify whether any of the physicians, cardiologists, radiologists, audiologists, and medical professional staff, to be assigned to the City's account, have ever had any complaints filed against them. If so, disclose and discuss." Al o COr / , fn-{ S i 1 <-' CL�c� � )n5'�I � L 21�� , Please-sign-and_date-below..to_certifyyouur_resp0nse --bone ln�%t� Print Name T--�rY-- I le i cA,-YvtCA. Signature Date 1 Ms. Linda Arama December 8, 2010 Page 2 Additionally, subsection 4c) of Section 4, Submission Reauirements, of the RFP solicitation document, states, in part, the following requirement: Submit a copy(s) of credentials and State of Florida license for the following individuals: -Medical Professional Staff. • Registered nurse and/or licensed medical professional providing Hepatitis A and B immunization. Certified medical personnel administering Hepatitis A and B tests. We were unable to locate, within your proposal response, the credentials and State of Florida license for the Medical Professional Staff that will be providing Hepatitis A and B immunization and tests. Therefore, at this time, please submit the credentials (such as qualifications, education diplomas, and/or resumes) and State of Florida license for the Registered Nurse and/or licensed medical professional that will be providing Hepatitis A and B immunization and the certified personnel that will be administering Hepatitis A and B tests. A response to this letter, along with all documentation requested herein, must be submitted to the attention of Yusbel Gonzalez, via email: Vaonzalez(cr�miamiaov.com or fax: 305-400-5104, by no later than. December 21. 2010. at 5:00 P.M. Failure to respond by the stipulated date and time may deem your proposal non -responsive. Thank you for your cooperation. KR:yg Cc: RFP file Sincerely, Kenneth Robertson Purchasing Director/Chief Procurement Officer