PERFORMANCE WORK STATEMENT (PWS) FOR PROVIDING ANNUAL MEDICAL AND DENTAL SCREENINGS TO INCLUDE DENTAL TREATMENT OF DENTAL CLASS III CONDITIONS PART 1 GENERAL INFORMATION 1. GENERAL INFORMATION: 1. General: This is a non-personnel services contract to provide annual medical, hearing, immunization, and dental readiness services. The Government shall not exercise any supervision or control over the contract service providers performing the services herein. Such contract service providers shall be accountable solely to the Contractor who, in turn is responsible to the Government. 1.1 Description of Services/Introduction: The Contractor shall provide all personnel, equipment, supplies, facilities, transportation, tools, materials, supervision, and other items and non-personal services necessary to perform annual medical, hearing, immunization, and dental readiness services as defined in this Performance Work Statement except for those items specified as Government furnished property and services. The Contractor shall perform to the standards in this contract. 1.2 Background: Individual Medical Readiness (IMR) and Fully Medically Ready (FMR) are the basic principles of force-sustainment for Army National Guard (ARNG) forces. Medical and Dental health is vital for force health protection, and failure to achieve a standard of level of medical and dental health could preclude a Soldier from deploying. Medical and Dental Readiness is a command responsibility. The purpose of this PWS is to cover the various components of IMR/FMR, to include, but not be limited to: Medical: Blood Pressure, height & weight, and questionnaire screening, Periodic Health Assessments (PHAs); Specialty Physical Exams such as Chapter 2 (schools), 'Over-40,' Flight, etc., in accordance with AR (Army Regulations) 40-501 (Standards of Medical Fitness); laboratory / phlebotomy work such as sample collection for HIV testing, urine pregnancy testing, pap-smear evaluation, DNA testing, and G6PD and RPR testing; Immunizations required for IMR/FMR and theater specific compliance such as Hepatitis A/B, Influenza, PPD (in some cases, vaccines will be supplied by ARNG), visual acuity and Optometry exams, mobile facility audiometry exams, comprehensive audio evaluations, and SPRINT testing, MEDPROS entry of all applicable and appropriate IMR/FMR functions including completion of the electronic PHA in the MEDPROS online module during an event by providers trained in completing the e-PHA online, and Post Deployment Health Reassessments (PDHRA). Dental: annual dental exams, digital bitewings radiographs, digital panoramic radiographs, DENCLASS data entry of all radiographs and dental records, identification and treatment of all Class 3 Soldiers who are able to be treated in a remote treatment setting and are not projected to require follow up dental treatment procedures. 1.3 Objectives: The purpose is to convert all Soldiers due or identified a needing annual medical, hearing, immunization, and dental readiness services at an event to a medical readiness class of 1 or 2. 1.4 Scope: The objective of this contract is to conduct and complete the requirements of ARNG IMR/FMR medical, hearing, immunization, and dental readiness requirements on all eligible (mobilizing or not) Service Members (SMs) in the ARNG utilizing HIPAA, ADA and OSHA-Compliant contractor set up in Florida National Guard Facilities or mobile health facilities (if mobile facilities are determined to be needed). Medical and dental services shall be performed by Florida licensed professionals or can demonstrate the contractor is authorized by the FL DOH to provide requested services in the state of FL to include physical exams. The contractor shall be held liable and are responsible for ensuring and verifying the appropriate level of Credentialing /Privileging (Licensure, Diploma, background checks, etc.) for all contract providers in support of any ARNG.

1.5 General Information 1.5.1 Quality Control: The Contractor shall develop and maintain an effective quality control program to ensure services are performed in accordance with this PWS. The Contractor shall develop and implement procedures to identify, prevent, and ensure non-recurrence of defective services. The Contractor’s quality control program is the means by which he assures himself that his work complies with the requirement of the contract. After acceptance of the quality control plan the Contractor shall receive the contracting officer’s acceptance in writing of any proposed change to his QC system. 1.5.2 Quality Assurance: The Government shall evaluate the Contractor’s performance under this contract in accordance with the Quality Assurance Surveillance Plan. This plan is primarily focused on what the Government must do to ensure that the Contractor has performed in accordance with the performance standards. It defines how the performance standards will be applied, the frequency of surveillance, and the minimum acceptable defect rate(s). 1.5.3 Hours of Operation: The Contractor is responsible for providing services, between the hours specified in Technical Exhibit 3. The Contractor must at all times maintain an adequate workforce for the uninterrupted performance of all tasks defined within this PWS. When hiring personnel, the Contractor shall keep in mind that the stability and continuity of the workforce are essential. 1.5.4 Place of Performance: The work to be performed under this contract will be performed at government facility (see Technical Exhibit 3). 1.5.5 Security Requirements: Contractors performing work under this contract must maintain a list of all personnel performing services at event for access on government and military facilities. 1.5.6. Physical Security: The Contractor shall be responsible for safeguarding all Government information for Contractor use. At the close of each work period, Government facilities, equipment, and materials shall be secured. Contractor will be responsible for security of equipment and material uses to complete the PWS. 1.5.6. Special Qualifications: HIPAA Training and access MEDPROS and MEDCHART databases. 1.5.7. Post Award Conference/Periodic Progress Meetings: The Contractor shall attend any post award conference convened by the contracting activity or contract administration office in accordance with Federal Acquisition Regulation Subpart 42.5. The contracting officer, Contracting Officers Representative (COR), and other Government personnel, as appropriate, may meet periodically with the Contractor to review the Contractor's performance. At these meetings the contracting officer will apprise the Contractor of how the Government views the Contractor's performance and the Contractor will apprise the Government of problems, if any, being experienced. Appropriate action shall be taken to resolve outstanding issues. These meetings shall be at no additional cost to the Government. 1.5.8. Key Personnel: The follow personnel are considered key personnel by the Government: 1.5.8.1. Contract Manager: The Contractor shall provide a contract manager who shall be responsible for the performance of the work. The name of this person and an alternate who shall act for the Contractor when the manager is absent shall be designated in writing to the contracting officer. The contract manager or alternate shall have full authority to act for the Contractor on all contract matters relating to daily operation of this contract. The contract manager or alternate shall be available between the dates/times specified in Technical Exhibit 3.

1.5.8.2. Physician (General and Family Practice): years of experience in specialty: minimum 1 year practice experience, minimum education: Possess MD or DO from accredited school, certification/license: active unrestricted state medical license, ACLS: preferred, and BCLS: preferred

1.5.8.3. Optometrist: years of experience in specialty: minimum 1 year practice experience, minimum education: Possess OD from accredited school, certification/license: active/unrestricted state licensure required, ACLS: preferred, and BCLS: preferred. 1.5.8.4. Audiologist: years of experience in specialty: minimum 1 year practice experience, minimum education: possess MA or AuD from accredited school certification/license: active/unrestricted state licensure required, ACLS: preferred, and BCLS: preferred. 1.5.8.5. Physician’s Assistant: Years of Experience in Specialty: minimum 1 year experience, minimum education: master’s level degree and accredited PA program, certification/license: licensure required for state employment, BCLS: preferred 1.5.8.6. Behavioral Health Counselor: years of experience in specialty: minimum 1 year experience, minimum education: master’s level degree, certification/license: licensure required for state employment, BCLS: preferred 1.5.8.7. Nurse Practitioner: Years of Experience in Specialty: minimum 1 year experience, minimum education: MSN or Advanced Certification, certification/license: required for state employment, ACLS: preferred, BCLS: required for state employment. 1.5.8.8. Registered Nurse: general years of experience in specialty: minimum 1 year experience, minimum education: RN-AD or diploma, BSN preferred, certification/license: certification preferred, licensed required for state employment, ACLS: preferred, BCLS: required for state employment. 1.5.8.9. Medical Assistant (Certified/Registered): years of experience in specialty: minimum 1 year experience, minimum education: state license and graduate of accredited MA program, certification/license: required/required 1.5.8.10. Hearing Conservationist: years of experience in specialty: minimum 1 year experience, minimum education: DOEHRS Certified, certification: preferred 1.5.8.11. Optometry Technician: years of experience in specialty: NA, minimum education: High School Diploma 1.5.9. Identification of Contractor Employees: All contract personnel attending meetings, answering Government telephones, and working in other situations where their Contractor status is not obvious to third parties are required to identify themselves as such to avoid creating an impression in the minds of members of the public that they are Government officials. They must also ensure that all documents or reports produced by Contractors are suitably marked as Contractor products or that Contractor participation is appropriately disclosed

PART 2 DEFINITIONS & ACRONYMS 2. DEFINITIONS AND ACRONYMS: 2.1. DEFINITIONS: 2.1.1. CONTRACTOR. A supplier or vendor awarded a contract to provide specific supplies or service to the Government. The term used in this contract refers to the prime. 2.1.2. CONTRACTING OFFICER. A person with authority to enter into, administer, and or terminate contracts, and make related determinations and findings on behalf of the Government. Note: The only individual who can legally bind the Government. 2.1.3. CONTRACTING OFFICER'S REPRESENTATIVE (COR). An employee of the U.S. Government appointed by the contracting officer to administer the contract. Such appointment shall be in writing and shall state the scope of authority and limitations. This individual has authority to provide technical direction to the Contractor as long as that direction is within the scope of the contract, does not constitute a change, and has no funding implications. This individual does NOT have authority to change the terms and conditions of the contract. 2.1.4. DEFECTIVE SERVICE. A service output that does not meet the standard of performance associated with the Performance Work Statement. 2.1.5. DELIVERABLE. Anything that can be physically delivered, but may include non-manufactured things such as meeting minutes or reports. 2.1.6. KEY PERSONNEL. Contractor personnel that are evaluated in a source selection process and that may be required to be used in the performance of a contract by the Key Personnel listed in the PWS. When key personnel are used as an evaluation factor in best value procurement, an offer can be rejected if it does not have a firm commitment from the persons that are listed in the proposal. 2.1.7. PHYSICAL SECURITY. Actions that prevent the loss or damage of Government property. 2.1.8. QUALITY ASSURANCE. The Government procedures to verify that services being performed by the Contractor are performed according to acceptable standards. 2.1.9. QUALITY ASSURANCE Surveillance Plan (QASP). An organized written document specifying the surveillance methodology to be used for surveillance of Contractor performance. 2.1.10. QUALITY CONTROL. All necessary measures taken by the Contractor to assure that the quality of an end product or service shall meet contract requirements. 2.1.11. SUBCONTRACTOR. One that enters into a contract with a prime Contractor. The Government does not have privities of contract with the subcontractor. 2.1.12. WORK DAY. The number of hours per day the Contractor provides services in accordance with the contract. 2.2. ACRONYMS:

ADCS ADA ADDR ALARACTS ACOR AFARS AR ARNG CAC CLIA CCE CFR CONUS COR COTR COTS DA DD250 DD254 DENCLASS DENCOM DFARS DMDC DOD DNA DOEHRS DRC DRE DTR FAR FMR G6PD HCG HIPAA HIV HRR IAW IMR ISO KO MEB MEDCOM MEDCHART MEDPROS MMRB MND MWDE MODS MOS MRC NGB

Army Dental Care System American Dental Association Active Duty Dental Repository All Army Activities Alternate Contracting Officer's Representative Army Federal Acquisition Regulation Supplement Army Regulation Army National Guard Common Access Card Clinical Laboratory Improvement Amendments Contracting Center of Excellence Code of Federal Regulations Continental United States (excludes Alaska and Hawaii) Contracting Officer Representative Contracting Officer's Technical Representative Commercial-Off-the-Shelf Department of the Army Department of Defense Form 250 (Receiving Report) Department of Defense Contract Security Requirement List Dental Classification Application Dental Command Defense Federal Acquisition Regulation Supplement Defense Manpower Data Center Department of Defense Deoxyribonucleic Acid Defense Occupations and Environmental Health Readiness System Dental Readiness Classification Digital Rectal Exam Dental Treatment Record Federal Acquisition Regulation Fully Medically Ready Glucose - 6 - Phosphate Dehydrogenate Human Chorionic Gonadotropin Health Insurance Portability and Accountability Act of 1996 Human Immunodeficiency Virus Health Readiness Record In Accordance With Individual Medical Readiness Isolation Contracting Officer Medical Evaluation Board U.S. Army Medical Command Medical Electronic Data (for) Care History and Readiness Tracking Medical Protection System Medical MOS Retention Board Medical Non-deployment Module MEDPROS Wed Data Entry Medical Operational Data System Military Occupational Specialty Medical Readiness Classification National Guard Bureau

OCI OCONUS ODC OSArS OSHA PDHRA PEB PHA PIPO POC PPD PPE PRS PWS QA QAP QASP QC QCP RDA RPR SPRINT SRC SRP STR SOW TE TITMUS TMC

Organizational Conflict of Interest Outside Continental United States (includes Alaska and Hawaii) Other Direct Costs Office of the State Army Surgeon Occupational Safety and Health Administration Post Deployment Health Reassessment Physical Evaluation Board Periodic Health Assessment Phase In/Phase Out Point of Contact Tuberculosis/Tuberculin Skin Test Personal Protective Equipment Performance Requirements Summary Performance Work Statement Quality Assurance Quality Assurance Program Quality Assurance Surveillance Plan Quality Control Quality Control Program Registered Dental Assistant Rapid Plasma Reagin Speech in Noise Recognition Test Soldier Readiness Check Soldier Readiness Processing Soldier Treatment Record Statement of Work Technical Exhibit Vision Testing Equipment Manufacturer’s Name Troop Medical Clinic

PART 3 GOVERNMENT FURNISHED PROPERTY, EQUIPMENT, AND SERVICES 3. GOVERNMENT FURNISHED ITEMS AND SERVICES: 3.1. Services: The Government will provide a pre-event point of contact to coordinate services, an on-site POC to coordinate entry to the facility and assist with providing access to government, provided tables, chairs, and spaces to be used when applicable. 3.2. Facilities: The Government will provide adequate work space for the contactor to complete all requirements in the time designated. A government representative will be designated to provide the contractor access and to secure the facility at the conclusion of each day. 3.3. Utilities: Unless mobile facilities are required, the Government will make available all utilities in the facility for the Contractor’s use in performance of tasks outlined in this PWS. If utilities are furnished, the following is required, the Contractor shall instruct employees in utilities conservation practices. The Contractor shall be responsible for operating under conditions that preclude the waste of utilities, which include turning off the water faucets or valves after using the required amount to accomplish cleaning vehicles and equipment. 3.4. Equipment: The Government will not provide equipment. 3.5. Materials: The government will supply routine adult immunization and packaging and shipping materials for HIV testing.

PART 4 CONTRACTOR FURNISHED ITEMS AND SERVICES 4. CONTRACTOR FURNISHED ITEMS AND RESPONSIBILITIES: 4.1 General: The Contractor shall furnish all supplies, equipment, facilities and services required to perform work under this contract that are not listed under Section 3 of this PWS. 4.2. Materials. The Contractor shall furnish medical and dental service materials and supplies necessary to meet the requirements under this PWS. 4.3. Equipment .The Contractor shall furnish medical and dental equipment to provide the services to meet the requirements under this PWS. Contractor will also provide computer kiosks with CAC card readers and internet access for Soldiers to complete ePHA screening through MEDPROS.

PART 5 SPECIFIC TASKS & REQUIREMENTS 5. SPECIFIC TASKS & REQUIREMENTS: 5.1. Basic Services. The Contractor shall provide services for Individual Medical Readiness IAW with AR 40-501 and DoDI 6025.19. 5.2. Medical Services. 5.2.1. Periodic Health Assessments (PHA): The contractor shall conduct PHAs in accordance with the PHA guidance set forth by AR 40-501 (23 04August 2010 2011RAR) for an undetermined number of Soldiers at undetermined armories and training sites throughout the State. Contractors must have the ability to complete the e-PHA on site via the e-PHA in the applicable MEDPROs module. The contractor must utilize either OSHA-Compliant Mobile Health Practices and/or sites determined by the ARNG. Compliance with OSHA, State & Federal Regulations is mandatory. 5.2.2. Post Deployment Health Re-Assessments (PDHRA): the contractor shall conduct PDHRAs in accordance with AR 40-501 (RAR 003, 08/04/2011) for an undetermined number of Soldiers at undetermined armories and training sites throughout the State. The contractor must utilize either an OSHA & ADA Compliant Mobile Health Practice and/or sites determined by the ARNG. Compliance with OSHA, State & Federal Regulations is mandatory. 5.2.3. Periodic Health Assessments and Physical Exams: the contractor shall conduct Periodic Health Assessments (PHA) and other physical exams (Over-40, Chapter 2, Flight, etc.) in accordance with AR 40-501 (RAR 003, 08/04/2011) for an undetermined number of Soldiers and in undetermined armories throughout the State, which will be identified in each delivery order. The contractor shall conduct physicals in an HIPAA, Privacy Act and OSHA Compliant Mobile Health Vehicle to include visual acuity (Snellan/near vision), on-site laboratory testing for lipids, glucose, urinalysis, HCG, and hemoglobin, a complete physical exam by certified clinician, tonometry, and vital signs, and e-PHA and HRR input. All professionals shall be licensed and adhere to all requirements of OSHA, State & Federal Regulations is mandatory. Contractor will provide computer kiosks with internet access and CAC card readers in order to have Soldiers complete the online ePHA through MEDPROS, the number of kiosk will be based on the total projected number of Soldiers to be screened and the workflow to meet the above requirements. Any counseling conducted during the PHA provider interview will be documented on the electronic PHA survey an on Government provided forms such as a SF 600. Audiometer testing with capability to upload results into ANCI certified and DOEHRS compatible audiometer computer. 5.2.4. Visual Acuity Testing (Snellan/near vision): The contractor shall conduct visual acuity testing in accordance with AR 40-501 (RAR 003, 08/04/2011) for an undetermined number of Soldiers in undetermined armories throughout the State, to be determined in each delivery order. Adherence to OSHA, State & Federal Regulations is mandatory. 5.2.5. DOEHRS Compatible Audiometer Testing: Hearing Conservation and Hearing Readiness tests must be completed in a sound booth. The noise levels within the hearing test environment must not exceed those shown in DA PAM 40-501, Table 7-1. Stationary audiometric test booths must be evaluated on an annual basis using sound level meter equipment conforming to: a. At least the Type 1 requirements of the ANSI Standard S1.4-1983 (R 1997) and S1.4A-1985 Amendment (or latest approved standard).b. The band filter sets shall conform to requirements for Order 3, Type 3-D, extended range as specified by the latest ANSI Standard S1.11. Soldiers will be tested in a sound booth that meets the American National Standards Institute (ANSI) Maximum Permissible Ambient Noise Levels (MPANL) S3.1, 1999 (R 2008)

as measured using a Type 1 Sound Level Meter (SLM) IAW DA Pam 40-501 and will ensure that the USAPHC Audiometric Test Booth Certification Form is posted on the audiometric test booth(s). Noise level measurements must be recorded on the U. S. Army Public Health Command Audiometric Test Booth Certification Form with a copy furnished to the Hearing Program Manager or their representative. The USAPHC Audiometric Test Booth Certification Form is available at: http://phc.amedd.army.mil/PHC%20Resource%20Library/AudiometricTestBoothCertification.pdf. Noise level measurements for mobile audiometric test booths must be evaluated each time they are moved to a new location or at a minimum, annually, if they are never moved and are used as stationary audiometric test booths. Ventilation systems in audiometric test booths must provide adequate air exchange for patient comfort and acceptable sound levels for valid audiometric testing. The contractor shall conduct audiometry in accordance with AR 40-501 (RAR 003, 08/04/2011) for an undetermined number of Soldiers and in undetermined locations throughout the State. Hearing exams will be conducted using the DOEHRS-HC compatible audiometers (Benson) with DOEHRS software. Adherence to all requirements of OSHA, State & Federal Regulations is mandatory. Audiology evaluations and Speech Recognition in Noise Test (SPRINT) testing will be performed IAW all applicable Federal, DOD, MEDCOM, NGB, and State guidelines. SPRINT testing must be available at all events when requested and the results must be available immediately. The contractor shall check that member has DD Form 2215 (baseline Audiogram) recorded in the medical information system (DOERS-HC) and medical record; and if no DD Form 2215 is in the medical record, perform DOEHRS-HC approved audiograms, and all service members with a DD Form 2215 on file have a DD Form 2216 completed. Contractor shall provide a list of personnel who require audiograms. Comprehensive Audio Evaluation (CAE) Testing for ARNG and USAR, the Contractor shall perform CAE testing and diagnostic audio testing, including Pure Tone Air and Pure Tone Bone Tests, and SPRINT testing as indicated by initial screening results and after appropriate unit authorization is obtained. These CAE services may include immittance testing, tympanometry, acoustic reflex, speech reception thresholds, word recognition testing, and otoacoustic emissions. The Contractor shall upload all pure tone audio test results into the DOEHRS-HC database within five (5) working days of completion and shall verify upload. 5.2.6. Immunizations: The contractor shall conduct immunizations in accordance with AR 40-501 (RAR 003, 08/04/2011) for an undetermined number of Soldiers at undetermined locations throughout the State to be determined in each delivery order. Immunizations shall include, but not be limited to Anthrax, Smallpox, Influenza (various), Yellow Fever, Typhoid, Tetanus Diphtheria Pertussis (TDAP), Tuberculosis (TB) skin test, Meningococcal, Hepatitis A, Hepatitis B, Varicella, Rabies, Measles Mumps Rubella (MMR), Japanese Encephalitis and Polio. Adherence to all requirements of the OSHA and all State & Federal Regulations is mandatory. 5.2.7. Phlebotomy/Lab: the contractor shall conduct all laboratory / phlebotomy services such as HIV and G6PD blood draws, pregnancy testing, pap-smear testing, and lipid profiles, as well as flight physical or special forces unique blood draws IAW AR 40-501 (RAR 003, 08/04/2011) for an undetermined number of Soldiers in an undetermined number of armories & training sites throughout the State, to be determined in each delivery order. All HIV specimens will be turned over to the Laboratory that is currently under contract with the ARNG or NGB for testing. The contractor shall utilize the current accepted shipping method and supplies proved by the Center of Disease Detection (CDD) to the National Guard. 5.2.8. DNA Collection: The contractor shall conduct DNA collection in accordance with the AR 40-501 (RAR 003, 08/04/2011) for an undetermined number of Soldiers in an undetermined number of armories throughout the State, to be determined in each delivery order. The contract will utilize the ARNG Medical Detachment for all DNA supplies, shipping supplies, and shipping guidance. Adherence to all requirements of OSHA, State & Federal Regulations is mandatory.

5.2.9. Screening for Immunity: Contractor shall conduct serologic or other tests to identify pre-existing immunity from prior infections or immunizations that may eliminate unnecessary immunizations. Titers for the following immunity or vaccinations will include Measles, Mumps, & Rubella, Varicella, and Polio. 5.3. Dental Examinations 5.3.1. Digital Bitewings, Digital Panoramic Radiographs & Dental Exams: The contractor shall perform required dental examinations to include digital bitewings and digital panoramic radiographs if clinically indicated in support of the annual dental screenings IAW AR 40-501 (RAR 003, 08/04/2011) in an undetermined number of Armories and training sites in the State to be determined in each delivery order. The contractor must use HIPAA, OSHA & ADA Compliant Mobile Dental Practice or Portable Dental equipment. The contractor shall have experience in and capability to upload all exam and digital radiographs into the DENCLASS system. The contractor shall ensure all Soldiers have a current digital Panoramic Radiograph on file and if missing, the contractor shall perform new radiographs. Adherence to all OSHA requirements, State and Federal Regulations are mandatory. Film or 'digitized' radiographs will not be accepted. 5.3.2. Diagnostic Services:      

DOl20-Periodic Oral Evaluation DOl50-Comprehensive Oral Evaluation D0330-Panorarnic Film D0272-Bitewings-Two Films D0274-Bitewings-Four Films D02201D0230- Periapical (limited)

5.3.3. Exam. A periodic oral evaluation shall assess the current state of oral health and risk for future dental disease, as well as assessing general health factors that relate to the treatment of the patient. The following measures are required for each periodic oral evaluation: 5.3.3. 1. Caries risk assessment - Classify Soldiers as low, moderate or high risk for caries as outlined by the American Dental Association's 1995 Special Supplement. This assessment will allow the ADCS to identify those at high risk for future disease and appropriately manage their care. 5.3.3. 2. Periodontal assessment - Periodontal Screening and Recording (PSR), a screening procedure endorsed by the American Dental Association and the American Academy of Periodontology, should be utilized to determine the need for periodontal treatment. 5.3.3. 3. Tobacco risk assessment - Classify Soldiers as a smoker, user of smokeless tobacco or as both. 5.3.3. 4. Oral cancer screening - Perform a thorough oral cancer screening on all beneficiaries as part of all annual examinations. 5.3.3. 5. Digital radiographs should be taken only for clinical reasons according to FDA guidelines as determined by the patient's dentist. Radiographs should be of diagnostic quality, properly identified and dated. A digital panograph is required to be present in dental record and it must be of adequate quality for diagnostic / identification purposes. There is no time requirement on updating pantographic radiographs. However, the digital panographic radiograph must adequately represent the current oral condition of the Soldier. Digital radiographs shall be performed on all service members who do not have a digital

panograph on file in the DENCLASS system, regardless of when the hardcopy pantograph is dated, or at the discretion of the State Dental Officer. 5.3.4. Each exam shall be entered into the DENCLASS reporting system and annotated on the SF 603 (Health Record - Dental) and the DA 5570 (Health Questionnaire for Dental Treatment) of the Soldier's dental records. 5.3.5. Setup of contractor's dental equipment is to be completed by the day prior to event commencement. Setup of contractor's dental equipment is the sole responsibility of the contractor. Breakdown of the contractor's dental equipment is the sole responsibility of the contractor. 5.3.6. As required, provide timely feedback and work progress/ status of number of Dental examinations completed to the Office of the State Army Surgeon's POC (or designated representative) as to timelines or factors that may negatively impact processing 8 Soldier exams per hour per dentist. 5.3.7. Provide completion status to Office of the State Army Surgeon's POC (or designated representative) as to time requirements to complete jobs to insure timely processing. 5.3.8. Contractor must notify the Office of the State Army Surgeon's POC (or designated representative) at the end of the event. 5.3.9. Electronic entry of data into the DENCLASS database is required within 5 days of completion of the Dental Screening mission to include the upload of any radiographs taken during the event. 5.3.10. Contractor shall be licensed on any services rendered and equipment operated during mission. 5.4. Dental Treatment 5.4.1. Based on National Guard Bureau's national statistics, it is estimated that as a result of dental exams, 30% of the alerted & eligible Soldiers will be classified as Classification 3, Non-Deployable without Dental Treatment. This means that an estimated 30% of the population of Soldiers will require dental treatment to be raised to a Class 2 Status, or deployable, before their mobilization. The Contractor shall provide approved dental treatment only within an OSHA & ADA-Compliant Mobile Dental Practice at armories and training sites throughout the State when treatment plan is uploaded and approved in DENCLASS. After each dental examination is complete, the contractor will make a decision based on the authorized dental treatment procedures listed below and convert as many Soldiers with a Dental Readiness Classification (DRC) 3 to DRC 2 or 1 in the event times outlined in Exhibit 3. Contractor will attempt to convert as many DRC 3 during the event to provide a greatest number of medical ready Soldiers. 5.4.2. Authorized dental procedures: Contractor will identify which of the following procedures will not be available for on-site treatment. (a) Restorative Services: D2l40-Amalgam-One Surface D2150-Amalgam-Two Surfaces D2160-Amalgam-Three Surfaces D216I-Amalgam-Four or More Surfaces D2330-Composite-One Surface D2331-Composite-Two Surfaces D2332-Composite-Three Surfaces

(b) Posterior composites: D2335-Composite-Four or More Surfaces D2391-Composite-One Surface D2392-Composite-Two Surfaces D2393-Composite-Three Surfaces D2394-Composite-Four or More Surfaces D2950-Core Buildup, including any pins D2954-Prefabricated Post and Core (c) Endodontic Services: D331O-Anterior Root Canal Therapy D3320-Bicuspid Root Canal Therapy (d) Periodontal Services: Periodontal scaling and root planning is authorized only when a periodontal abscess is present) D4355-Full Mouth Debridement (e) Oral Surgery Services: D7140-Extraction, Erupted Tooth or Exposed Root D72IO-Surgical Removal of Erupted Tooth D7220-Romoval of Impacted Tooth, Soft Tissue D7230-Removal of Impacted Tooth, Partial Bony D7240-Removal of Impacted Tooth, Completely Bony (f) Orthodontic Services: D8680-0rthodontic Retention 5.4.3. The above listings are guides to assist the State Dental Officer or his/her designee in determining treatment to be authorized. The treatment provided by the ARNG is to get the Soldier from a dental class 3 to a dental class 2 only, Comprehensive Treatment (to DENCLASS I) is not authorized. 5.4.4. The State Dental Officer (or designated representative) will review all dental treatment plan for dental care to insure that the above clinical guidelines are met. Exceptions can be made, but they must be coordinated with the State Surgeon. 5.4.5. Prescription Medication Services: 5.4.5.1. Contractor shall set up network & accounts with local pharmacies near event location. 5.4.5.2. Upon need to have dentally treated Soldiers & recommended by licensed dentist, Contractor to arrange for fulfillment of prescription medication for Soldier. 5.4.5.3. Government, Soldier, and/or Contractor are to provide transportation of Soldier to local pharmacy to fill prescription. 5.4.5.4. Contractor shall be invoiced by & submit payment to subcontracted local pharmacy utilized. 5.4.5.5. Local Pharmacy & Contractor to explain prescription medication instructions to ARNG treated Soldier and any other POC at the direction of the Office of the State Army Surgeon. Follow-up

conversations between Contractor and ARNG treated Soldier & Supervisor may be necessary depending on complexity of treatment and prescription medication. 5.4.5.6. All contractor expenses related to prescription medication services & case management related services will be forecasted in the overall amount for dental treatment and the contractors cost should be based on the overall treatment hours listed on Exhibit 3. 5.5. Reporting of Services 5.5.1. Contractor will provide a final report at the completion of medical and dental services that contain a detailed account of all service provide to the individual Service Member and totals of each service provided at the event. Report Summaries can be formatted per the contractors needs but will contain at a minimum all the following information: 5.5.2. Event Summary Report will include at a minimum the total number of Soldiers that:                      

Checked in/out for Dental Exams DRC 1 DRC 2 DRC 3 (3A/3B) Soldiers that received Dental Bitewing X-Rays Dental Panograph X-Rays DD Form 2813 submitted SM Dental Treatments Remaining DRC 3A’s/3B’s SF603 Soldiers checked in/out for Medical Profiles Hearing Exams & Totals for Each Hearing Class) Sprint Tests EKGs Lipid Panels HIV Draws DNA Draws Blood Typing G6PD Each Adult Routine Immunization Immunity Titres

5.5.3. Individual Service Member Report will be a by name roster of each service that individual Service Member received , classification of Medical Readiness Classification (MRC) and Dental Readiness Classification. The report will include at a minimum the following information on each Service Member:     

Name (Last, First, MI) Full SSN Rank Dental Exam Dental Treatment

                          

Dental Treatment Procedure Ending Dental Class after Treatment Dental Readiness Classification (DRC) Dental X-ray (Panograph) Dental X-ray (Bitewing) Dental Notes Dental Prescriptions PHA Vital EKG Lipids HIV Blood Typing G6PD DNA Immunity Titers Pregnancy Hearing Exam Sprint Test Routine Adult Immunizations General Notes on Soldiers Soldier’s Existing Profile Soldier’s New Temp Profile Profile Expiration Date Soldiers New PULHES Case Management Notes Soldier screened for Mental Health

5.6. CONTRACTOR MANPOWER REPORTING (CMR) 5.6.1. The contractor shall report ALL contractor labor hours (including subcontractor labor hours) required for performance of services provided under this contract for the FLARNG via a secure data collection site. The contractor is required to completely fill in all required data fields using the following web address: http://www.ecmra.mil/ 5.6.2. Reporting inputs will be for the labor executed during the period of performance during each Government fiscal year (FY), which runs October 1 through September 30. While inputs may be reported any time during the FY, all data shall be reported no later than October 31 of each calendar year, beginning with 2013. Contractors may direct questions to the help desk at help desk at: http://www.ecmra.mil.

PART 6 APPLICABLE PUBLICATIONS 6. APPLICABLE PUBLICATIONS (CURRENT EDITIONS) 6.1. The Contractor must abide by all applicable regulations, publications, manuals, and local policies and procedures. AR 40-501 (Standards of Medical Fitness) http://www.usapa.army.mil AR 40-35 (Dental Readiness & Community Oral Health Prevention) http://www.usapa.army.mil AR 40-66 (Medical Record Administration and Health Care Documentation) http://www.usapa.army.mil AR 40-562 (Immunizations and Chemoprophylaxis) http://www.usapa.army.mil DoDI 6025.19 (Individual Medical Readiness) http://www.dtic.mil/whs/directives/corres/ Applicable DOD Directives, Instructions, and Publications http://www.dtic.mil/whs/directives/corres/ Applicable Medical & Dental ALARACTS https://www.us.army.mil/suite/page/550282 Applicable MILPER Messages https://perscomnd04.army.mil/milpermsgs.nsf

PART 7 ATTACHMENT/TECHNICAL EXHIBIT LISTING 7.

Attachment/Technical Exhibit List:

7.1. Attachment 1/Technical Exhibit 1 – Performance Requirements Summary 7.2. Attachment 2/Technical Exhibit 2 – Deliverables Schedule 7.3. Attachment 3/Technical Exhibit 3 - Estimated Workload Data

TECHNICAL EXHIBIT 1 Performance Requirements Summary The Contractor service requirements are summarized into performance objectives that relate directly to mission essential items. The performance threshold briefly describes the minimum acceptable levels of service required for each requirement. These thresholds are critical to mission success. The Contractor service requirements are summarized into performance objectives that relate directly to mission essential items. The performance threshold briefly describes the minimum acceptable levels of service required for each requirement. These thresholds are critical to mission success. Performance Standard Performance Method of Objective: Threshold Surveillance PRS # 1: Contactor All immunizations will Zero deviation from A single immunization shall immunize and be updated in standard. report will be run record all required MEDPROS and a using the MEDPROS Adult Routine paper copy on a SF taskforce created for Vaccines required for 600 will be given to each event. A random each Service Member. the individual Service sampling of SM's records will be viewed Member and a copy in HRR to ensure SF will be scanned into 600s were uploaded. HRR during the event. Proper screening and administration will be IAW Military Vaccine protocols. PRS # 2: Contractor Each Service Zero deviation from A PHA report will be shall have a medical Members' ePHA will standard. run using the provider sign the be signed at the event. MEDPROS taskforce ePHA for each Service created for each event. Member. Zero deviation from State Surgeon's Staff PRS # 3: Contactor All SF 600s with standard. or Case shall update vision, vision, vitals, height, Management/Care vitals, height, and weight, and lab results Coordinators will weight. will be updated on the review Service ePHA at the event and Members Records scanned into HRR using the MEDPROS NLT 5 days after the taskforce and HRR event. PRS# 4: Contract All hearing exams will Zero deviation from State Surgeon's Staff shall document and standard. or Case be uploaded into upload hearing exams Management/Care DOEHRS system and and Sprint Test results. all Hearing Coordinators will review Service Exams/SPRINT/CAE Members Records tests will be scanned using the MEDPROS into HRR NLT 5 days taskforce and HRR after the event and shall verify all uploads into DOEHRS and HRR.

PRS# 5: Contract shall update DENCLASS for each Service Member

PRS#6: Contractor will convert all DRC 3 to DRC 2 or 1 within the authorized dental treatment procedures. PRS#7: Contractor shall upload all EKGs.

All Bitewing & Panograph X-rays, DD Form 603, will be upload into DENCLASS during the event unless an alternate timeframe is precoordinated. All Treatment Plans and DRC 3 Conversions will be uploaded into DENCLASS during the event. EKGs will be scanned into HRR

Zero deviation from standard.

Zero deviation from standard.

Zero deviation from standard.

PRS#8: Contract shall upload MEDPROS taskforce.

All Service Members who did not attend the event will be removed by the Contractor so the there are no inconsistency in the rosters or report ran after the event.

Zero deviation from standard.

PRS#9: Contractor shall conduct titers and identify all Medical immunities and negative titers as outlined in ALARACT 255/2014

Upload all medical immunities for Measles, Mumps, and Rubella, Varicella, and Polio results into MEDPROS and HRR NLT 5 days post event. Identify all Soldiers with negative titers and provide the list to State Surgeons Office POC.

Zero deviation from standard.

Case Management/Care Coordinators will review DENCLASS for errors or missing documents.

Case Management/Care Coordinators will review HRR for errors or missing documents. Case Management/Care Coordinators will review HRR for errors or missing documents. State Surgeon's Staff or Case Management/Care Coordinators will review sign in/out rosters with those Service Members in the MEDPROS taskforce. State Surgeon's Staff or Case Management/Care Coordinators will review sign in/out rosters with those Service Members in the MEDPROS taskforce.

TECHNICAL EXHIBIT 2 DELIVERABLES SCHEDULE

Deliverable Contractor will provide at the conclusion of onsite services a report summary of all services provided (see paragraph 5.4.2.) Contractor will provide, at the conclusion of onsite services a report summary of all services provided on each individual Service Member (see paragraph 5.4.3.) Contractor will provide a copy of each Individual Service Member's Standard Form 600, EKG and Laboratory Results, and Department of Army Form 3349 when they receive a focused examination for profiling medical and behavioral issues.

Frequency One report will be generated at the conclusion of the event after all services are complete.

One report will be generated at the conclusion of the event after all services are complete.

Per Individual Service Member

# of Copies 2 copies of the report will be created one for the unit receiving services and the State Surgeon's Representative 2 copies of the report will be created one for the unit receiving services and the State Surgeon's Representative

Medium/Format Submit To Digital or Paper Contracting Copies Officer Representatives or Case Management Staff from the State Surgeon's Office Digital or Paper Contracting Copies Officer Representative or Case Management Staff from the State Surgeon's Office

2 copies of the Standard Form 600 and Department of Army Form 3349 will be generated

Paper Copy

One Copy will be provided to the individual Service Member and the Second will be for the States Surgeon's Office

TECHNICAL EXHIBIT 3 ESTIMATED WORKLOAD DATA ITEM EVENT DATA 1

Place of Performance (Address):

CBJTC SIM Center, 5629 SR 16W, Starke, FL 32091 Start Date/Time

End Date/Time

2

Set Up Date:

08 March 2016

3

Dates of Event :

09 March 2016

10 March 2016

4

Scheduled Times

0730

1530

5

Dental Treatment Times:

0900

1730

6

Number of Soldiers:

MIN: 100

MAX: 120

7

Number of Mobilizing Soldiers:

MIN: 0

MAX: 0

EVENT SCHEDULE Event Day 1

8

Setup

0600

Check in/briefing military/civilian

0645

Blood draws* (over 40)

0730

All stations prepared to receive Soldier (Minus Dental Treatment)

0730

Dental treatment begins

0900

Status report of patient flow and services

1000

Status report of patient flow and services

1300

Contracted PHA/dental exam services complete

1530

Dental treatment complete

1800

Event Day 2

9

Setup

0600

Check in/briefing military/civilian

0645

Dental treatment begins

0700

All other stations prepared to receive Soldiers

0730

Blood draws* (over 40)

0730

Status report of patient flow and services

1000

Contracted PHA/dental exam services complete

1530

Dental treatment complete

1630

*POC for event Set Up or clarification at anytime during the event if the POCs on the ground are unable to assist with an issue please call (numbers to be given upon award of the contract). *POC during event (to be provided after contract is awarded) Services are coordinated through the Florida National Guard Office of the State Surgeon, hosting units are responsible for ship equipment and site set up. INDIVIDUAL SERVICES 11

Male and Female 40 and over Blood draws - All blood draws will be completed at the beginning of the day within the first 2 hours so Soldiers will be able to eat after fasting in a

Total: 15

timely manner 12

Vision: ( to include DD Form 771, *NOSTRA Standard*)

Total: 200

13

Hearing Screenings:

Total: 120

14

Possible Sprint/CAE:

Total: 15

15

Vitals: All stations must be able to conduct vitals to patient traffic flowing EKGs 40 and over: An EKG will be done for all Soldiers over 40 who do not have a base line EKG in their file or who are determined to need an EKG more frequently than every 5 years by a provider. EKGs will be conducted in accordance with guidance from AR 40-501. Civilian provider review for over 40 services. DNA: Contractor ships, military provides supplies

Total: 120

18

HIV(must be within 120 days of mobilization date): Contractor ships, military provides supplies. Military personnel must do quality check to ensure HIV draw and labeling process is being done correctly. Annual HIV draws will be done for all Soldier designated to be on orders for 30 days or more during the year following the event.

Total: 15

19

G6PD:

Total: 5

20

Blood Type:

Total: 15

21

Dental Exams: Including digital panograph and bitewings

Total: 120

22

Dental Treatment Hours:

Total: 48

23

Urine HCG: testing all females receiving immunization with potential of becoming pregnant

Total: 5

24

Laboratory Testing: Varicella Immunity Titre

Total: 15

25

Laboratory Testing: Measles, Mumps, & Rubella Immunity Titre Immunizations as needed: Military will provide immunizations as needed based on MEDPROs task force.

Total: 15

Chlamydia testing: Be prepared to conduct urine Chlamydia testing for up to TBD Behavioral Health Services: All above processes and services will be discussed for clarification Thursday and Friday immediately before the event

Total: 0

16

17

26 27 28

Total: 15

Total: 15

Total: 50

Required

All above processes and services will be discussed for clarification Thursday and Friday immediately before the event Ship all lab results to CW2 Benjamin Reis within a maximum 14 business days after completion of the event, see address below or via coordination of secure fax or encrypted email/email document. P.O. Box Deliveries Office of the State Surgeon ATTN: CW2 Benjamin Reis P.O. Box 1008 St. Augustine, FL 32085

Physical deliveries Office of the State Surgeon ATTN: CW2 Benjamin Reis 2305 State Road 207 St. Augustine, FL 32086