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C2013-197 - 6/11/2013 - Approved
-it"] N owl IoM , E-17FROVISM W14EREAS Contractor has proposed to provide OCCUPATIONAL MEDICAL SERVICES in response to RFP No. BI-0048-13 which is incorporated and attached as Exhibit A; WHEREAS the City has determined Contractor to be the mos! advantageous proposer; NOW, THEREFORE, Contractor and City enter into this Agreement and agree as follows: 1. Services. Contractor will provide OCCUPATIONAL MEDICAL SERVICES in accordance with RFP No. BI-0048-13. 2. Term. This Agreement is for one (1) year commencing on the date signed by the last signatory hereto and continuing for one-year thereafter. The the Contractor and the City Manager. 4. Independent Contractor. Contractor will perform the services hereunder as an independent contractor and will furnish such services in its own manner and method, and under no circumstances Qr conditions may any agent, servant or employee of the Contractor be considered an employee of the City. 2013-197 6/11/13 kLIKI Nuices Emergency Services INDEXED 8. Waiver. No waiver of any breach of any term or condition of this Agreement, or RFP No. BI-0048-13, or the Contractor's proposal in response to RFP No. BI-0048-13 waives any subsequent breach of the same. requirements set forth as part of this Agreement are applicable to all subcontractors and their employees to the same extent as if the Contractor and its employees had performed the services. MMU744#014#11K01; I IMAW P 141 to] I KOL11 a 111,IkE *r, I t4 UNStPA-7101r, 1114 W'ljg # VK4 E&A 4417-M *M�44P Alternatively, the City may terminate this Agreement upon twenty (20" 11 i,ays' written notice to the Contractor. However, the City may terminate this to pay or provide proof of payment of taxes as set out herein. 14. Drug Policy. The Contractor must adopt a Drug Free Workplace policy. 15. Violence Policy. The Contractor must adopt a Violence in the Workplace policy. 16. Notice. Notice may be given by fax, hand delivery or certified mail, postage prepaid, and is received on the day faxed or hand-delivered and on the third day after deposit in the U.S. mail if sent certified mail. Notice shall be sent as follows: IF TO CITY: Attent Director of Human Resourcl P.O. Box 9277 Corpus Christi, Texas 78469-9277 XGRUlWK*" INA M M-113 INV IM41 W j lei 0111.14M oil 1, SIGNEDthis day of,2 Michael MuT, era I .4,ssista,tt]XrectorofFinanerd[Servi,.-,es Incorporated by Reference: Exhibit A: RFP No. BI-0048-13 Exhibit B: Proposer's Proposal Exhibit C: Clarification/Additional Servic* &7u Contractor Title: ?LestA.4 (UtFS Ww" CITY OF CORP©< CHRISTI CITY-WIDE/FIRE t-ND POLICE FORTHE DOT, NON-DOT., CDL EMPLOYEES AND WWII 11A n ga on Igg-101 orn rifel '. ral mi agg 1 Imms -rum willim, 4 - - for the federally approved DOT and NON DOT testing procedures, attached and incorporated as Attachment 11, and in accordance with Fire and Police Department procedures, attached and incorporated as Attachments III and IV. a=. 5. Contractor/Service Provider's Collectors must be specifically trained, or be licensed medical professionals or licensed technicians, who have received specific training from Contractor/Service Provider to carry out drug and alcohol collections following the protocols as specifically set out in the Agreement and incorporated attachments and must perform thes.,.i requirements accurately and consistently. 6. Contractor/Service Provider must provide sufii7xient—stafimg to—alluw- monitored—anti ,iirect observation drug specimen collections (as stated in Attachment III ) by Collectors of the same gender as the Donor for drug tests and to obtain specimens by direct observation if pre- gipproved by the Human Resources Director, Fire Chief, Police Chief, or designee. 9. Contractor/Service Provider must provide Human Resources Director, or designee, with Contractor/Service Provider's courier's written procedure for the transportation of specimens to the laboratory which ensures confidentiality and integrity of the specimen. 10. Contractor/Service Provider must make collections of urine/blood specimens and breath samples, following procedures in the applicable Attachment, using a CCF to ensure the integrity • the specimen from collection to receipt by the laboratory, and maintaining collected specimens in a secured area prior to being picked up by the courier and transported to the laboratory. 17MENEWEVIT41 Is 3n, I=- A In 1. Negative results on initial screen will usually be released to the Contractor/Service Provider's Medical Review Officer ("MRO") within forty-eight (48) hours after receipt of the specimen at Proposer's facility. D]r fit 3. Holidays and weekend work schedules may alter the availability of results as described above. 0 The Contractor/Service Provider must provide all supplies essential to the split-specimen collection (primary and split specimen portions), identification, packaging and transportation of sLf.ecimens to the laboratQjp teqmg site or of a sAit s[ixcimen to a second laboratoi which meets the required certification/accreditation requirements. (e) Chain-of-Custody Form The Medical Review Officer (MRO) for the City of Corpus Christi City-Wide, Fire Department, and Police Department's Alcohol and Drug Policies is required to be a licensed physician with knowledge • drug abuse disorders and certified as an MRO by the American Association of Medical Review Officers. Contractor/Service Provider must provide a physician to perform Medical Review Officer Services as an independent contractor for the City in accordance with the medical services and procedures set out in the attached Attachment VI including but not limited to the following: 2. maintenance of medical records for the drug testing program; provide statistical data reports to the Human Resources Director, Fire Chief, Police Chief, or designee, based on program test results; 4. assessing and state what an employee can and cannot perform for fitness of employees for return-to-duty or applicants' fitness for hire based on drug test results; 5�. providing services, such as legal depositions, courtroom testimony, evaluation of test results and advice about medical matters in relation to drug and alcohol testing, as required by the City Attorney in connection with grievances, arbitrations, claims and lawsuits or other proceedings arising from the City's reliance on such test results. ON-3-W M I DI MUMORS 101111140,11IRMF MW M 41 IMS 11.13129*11 DWI MOVI-N (a) This Agreement shall be for a one-year term with four one-year automatic extension periods. By submission of its proposal, the Proposer agrees that the cost and price information quoted in its proposal is fixed and firm for the duration of the ten-n of this Agreement, provided that upon extension of the Agreement for an additional one-year period(s), the prices for the services to be delivered during the ensuing one-year period(s) may be increased or decreased to (c) If either party fails to comply with any material term of this Agreement, the other party may, at its discretion, declare a default and terminate this Agreement upon thirty (30) days' written notice of its intention to so terminate, unless if within the notice period, the defaulting r!--arty has cured the default. If the City terminates its Contract under the foregoing paragraph, the City shall pay the Contractor for services actually performed prior to such termination, less such payments as have been previously made. Contractor shall not be entitled to any further compensation for work performed by the Contractor or anyone under its control or direction from the date of receipt of -ngoi'---,ZT=-. io-Mer Contractor or any costs related to the electronic transfer of any information including, but not limited to, tape transfers, downloads, uploads, CD, etc. '7Y")MTj=M II III "I'll 1 =ek « 1 tonlrac 3 expense, the Contractor shall provide the City reproducible copies of all work completed or partially completed documents prepared under the Contract — all such documents thereinafter being A- <# 2 property of the City. Before activs can begin under this Agreement, a Certificate of Insurance as proof of ths, required insurance coverage must be delivered to the Human Resources Director or designee, which provides, at a minimum, the amounts of coverage as detailed in Section 2.39 "Insuranec. Provisions" of the RFP. yxf l Proposer's Agent's testimony (specifically including MRO's testimony) both in preparation for any "Proceeding" and at the actual "Proceeding" itself, which concerns any drug and alcohol ki I 4�1111LVIAIM' � � � I � � � I � I � � � 1 � � 12 1113A ON V-43 9 written approval to not appear in person and give live Testimony does not rebut the presumption that the failure to give live Testimony is why the City lost the Proceeding. all applicable federal and state laws and by local, : ©e and federal agencies. Texas, and must be governed and construeld All notices required under this Agreement must be in writing, personally delivered or sent by certified mail, ® receipt requested, addressed to the other party as follows. IF TO CONTRACTOR/SERVICE PROVIDER: Name of Organization: Nueces Emergency Services Name +2I>» G » 9 § Dr. J. Keith Rose, M.D. h r-iffi, M-tre �-� City: Corpus Christi State: T"X Telephone Number: 361-241-1116 Facsimile Number: 361-242-1116 E-mail Address: keithr@doctors-center.com Either party may change its address to which written notice must be sent as provided in this section. d. Waiver NIMMEM11111511111 1111livInIll 111111��11111��j I 1111AITC My STEM rij*u Hur OT AM CAFFEINE UY purYUHIDOXICU UlCrCUI UL ter, nor is City's waiver of any right hereunder at any time, including rights to any payment, a waiver thereof for any other time. e. Non-assignment This Agreement must not be assigned or transferred by Contractor/Service Provider without the prior written consent of the City Manager, or designee. Contractor/Service Provider is at all times solely responsible for the provision ► the drug and alcohol specimen collection, testing, laboratory and MRO services and the competency of services provided hereunder, whether accomplished through its officers and employees or through its agents or subcontractors. f® Sever ability Notwithstanding any other provision to the contrary, if any federal, state, or local law, rule, regulation, or interpretation thereof at any time during the term of this Agreement prohibits, restricts, or in any way materially changes the type of services rendered under this Agreement, then this Agreement may, in good faith, be amended by the parties to provide for payment of compensation in a manner consistent with any such prohibition, restriction, or limitation; Wierwise, this Agreement remains in full force and effect. h. Section Headings Section headings contained in this Agreement are for reference purposes only and do not affect, in any way, the meaning and interpretation of this Agreement. 3MMML423z-M= L�ZBT" M-4 toil nif The Human Resources Director, will promptly notify Ca r/Service Provider of any clai asserted against it for which such indemnification is sought, and will promptly deliver Contractor/Service Provider a true copy of any such claim including, but not limited to, a tr as of any summons or other process, pleading ► notice issued in any lawsuit or oth rproceeding to assert or enforce such claim. t] The City Manager may participate in such investigation, trial and defense of such lawsuit action and any appeal arising therefrom. The City, its officers, employees, agents, representatives will provide full cooperation to the Contractor/Service Provider at all tim _n during the pendency of the claim or lawsuit, including, without limitation, providi Contractor/Service Provider with all available information concerning the claims. I I. Non-Appropriations The continuation of this Agreement after the close of any fiscal year of the City, which fisc year ends on July 31 of each year, will be subject to appropriations and budget approval coveril this Agreement as an expenditure in said budget; however, it is within the sole discretion of Ci Council to determine whether to fund this Agreement. i M. Whole Agreement This Agreement and its Attachments contain all commitments and agreements of the partiQ hereto, superseding any previous agreements between the parties, and no modification of th Agreement may be made except by written amendment executed by the duly authoriz representatives of the parties hereto. I CONTRA TOR L Name: Title: CITY OF CO US T Michael Barrera D t Assistant Director of Financial Services Incorporated by reference: Exhibit A: RFP No. BI-0048-13 Exhibit B: Proposer's Proposal Exhibit C: Clarification/Additional Service t \d Z-47171T."T WUN.-ITTIN PURCHASING DIVISION EXMBIT C The City of Corpus Christi (City) and Nueces Emergency Services d.b.a. The Doctor's Center (referred to as "Contractor") do hereby agree to the following: IN WITNESS WHEREOF, the partie< «:®»» v affixed their signature. CITY OF CORPUS CHRISTI THE DOCTORS' CENTEI p1111111 171111 151\ 1 1111111 C. Trip Mileage Charge is Trip Mileage multiplied by published -.1_ reimbursement 5. Procedure Charge is the standard procedure charge as agreed to between the client and TDC as stated in the contract or agreement in effect at the time of the On Site (Note that any procedure performed at a clinic outside of its normal business hours will also be considered "On Site--for purposes of this policy.) 7. Physician only applies Assistant or Nurse Practitioner is required during the on site visit. This charge is $400.00 per hour. The total on site charge of the Trip Mileage Charge, the Trip Charge, Procedure Charge and the Physician Charge. ly- 2 CL CL LU F cc tv 3 cr N ®� u zi E CL C 91 m 3 C a E SL a as u jE CL ° D • e LU CL m to m u ° � E E CL w 6 E -0 m t E CL 10 CL 0 C ffi C w a mi :E a a c m E .0 m 3 0 E E ® o a C a� C 2 m a. '0 ca g E u � °*� � ae E 0 9u a` 0 Q9 E E a® °C E w u ro c m n c cc c E E E 0 m t �a I c �, .® ® m a- E 2 E m 3 CL E a E �, E u E 9 E , 8a: Ln 2 0 c 3 M E c Wq 9L to 00 pi , " 3: tj cc �q 2 0 $ .11 X �q LA T qr cc cc tn N CL fm -4 c 0 3 Ln sn 8 - j 0 4 9! z W = m 'A to m E .4 4 � : c 4n w kn a m L% %A v w z v q CID IV -01 J= - 2� a > 'Ew a aR E E no 0 0 :a L JOU w 0 M CL -0 E 76 E co '0 ga. 0 r_ ® CL ? 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CL ° � CL Ca., M .0 2 ci 2 W C. u v � } C � N2 w_ s 1d o r, E m - A 2 N _ Ql 0 � a� 6 _ E 4 N -0 r 4d e mm y 62 E Cc, :a L 4 4 Z° 8 2 }, d gi m9 U i w °C 6® Q. 0 ea CD C CL v ° na � cu w cu � �t Pod 2 M E E c N C: w ® u 0. 0 CL R � CD C CL v ° na � cu w cu � �t Pod 2 M E E c N C: w ® u 0. 0 CL w r w '; '. ke »+ �` A. .,. rf. a :_. i '11 1 a J, 9= I M I F Iff I I I I R I I I! Iff I III! I! I! I I! I 1, 11 1111 1 mj- I in �341 1111d, DOT and NON-DOT drug testing; laboratory drug testing services through a laboratory certified by S.A.M.H.S.A. and accredited by C.A.P. for DOT and NON-DOT primary specimens; and medical review officer services with required qualifications: SERVICE PROVIDED EXTENDED PRICE Fee per INITIAL EVIDENTIAL BREATH TEST Fee per CONFIRMATION EVIDENTIAL BREATH TEST ,Fee per INITIAL URINE TEST (5-PANEL DOT) i e. M. r FIRE & POLICE) Fee per INITIAL URINE TEST ( I O O LICE RANDOM , d ' Y ,Maximum fee per request for after-hours testing (This is fee for Derformin test. Fee for actual test in addition to On Site Billing Po Attached '!Fee per Blood Alcohol Test ................................. ........................ !Fee per hour of Expert Witness Testimony from' ACTUAL COST boratory (Includes time actually spent providing', ;testimony as well as time spent waiting in courthouse or at :location of deposition or proceeding to give testimony.� Excl udes any other time inc luding, but not I im ited to, time spent traveling to and from the site where testimony is to be given) SERVICE PROVIDED UNIT PRICE EXTENDED PRICE Fee for Travel of Expert Witness from Laboratory 0 ACTUAL COST (round trip) (includes all travel costs, including, but not limited to-, transportation, lodging, per-diem, parking, tips, etc. to and from site(s) where testimony is required. City requires travel to be by most economical mode [i.e. air versus ground] and byte most economical means within each mode [i.e. coach versus business- or first-class; economy car versus full size or luxury rental]) Fee per hour for Testimony of Pro poser's Collectio 0 $60.00 Personnel (Includes time actually spent providing testimony as well as time spent waiting in a courthouse or at a location of deposition or proceeding to give testimony. Also includes all direct, indirect and incidental travel costs to and from site(s) where testimony is to be provided. Note: The City will not pay any other fee or reimburse any other costs requisite to the provision of testimony provided by personnel of Proposer.) Fee per our for Testimony of Pro poser's Expert 0 $250.00 Personnel (Includes time actually spent providing testimony as well as time spent waiting in a courthouse or at a location of deposition or proceeding to give testimony. Also includes all direct, indirect and incidental travel costs to and from site(s) where testimony is to be provided. Note, The City will not pay any other fee or reimburse any other costs requisite to the provision of testimony provided by personnel of Proposer.) ,Fee per Record Retrieval Request 71 0 JE $60.00= PRICE SHEET Fee per our for ON-CALL, ON-SITE blood alcohol 81 *See Doctor's Center and/or drug specimen collections performed outside the On Site Billing Policy hours of 8 a. m. through 5 p.m., Monday through Friday, Attached as requested by the Director, Fire or Police Chief, or designee, at Proposer's Facility, any City Facility or other location specified to the Proposer in writing by the Director and performed by qualified Proposer's staff. (includes all direct, indirect and incidental travel costs to and from site(s) of collection. Note: The City will not pay any other fee or reimburse any other costs requisite to the provision of this service.) Fee per hour for providing Collection Services during *See Doctor's Center regular work hours, 8 a. m. through 5 p.m., Monday On Site Billing Policy through Friday, at a City designated department (includes Attached all direct, indirect and incidental travel costs to and from site(s) of collection. Note: The City will not pay any other fee or reimburse any other costs requisite to the provision of this service.) Fee for transferring and re-testing of split specimen to $150.00 another S.A.M.H.S.A.-certifled, C.A.P.-accredited laboratory, on timely request to MRO or City applicant or employee. Is to be paid by cash, cashier's check, or money order by the requesting applicant or employee directly to the S.A. M. H. S.A.-certified, C.A.P.- accredited laboratory performing the testing except for split-specimen testing requests for Firefighters which will be paid for by the City (includes all costs requisite and/or incidental to provision of service) Ad-hoc report (per hour) $20.00 Percentage discount if average wait time of 30 minutes If the number of patients who wait longer than 30 minutes exceeds after sign for donors to provide a urine/blood specimen for 10 /0 of the total number of patients in a given month, then a 15% drug testing or provide breath for alcohol testing is not discount will be applied to the patients who waited longer than 30 90% per month (to be deducted from invoice to which minutes. report applies - report is due with invoice). Percentage is to be deducted from the b i I I i ng period to which the report applies and must accompany invoice . **See 3.7 Exceptions` Proposers must quote in a percent forinat showing deduction based on the percentage not met. For example, a deduction of SXXxx for I/z% not met, $XX for I%, $XXxx for I V2%, etc. Note: Any and all costs associated with provision of MRO services described in this RFP shall be included/factored into the fees quoted above. T?%—y—s—Ob—mission o its proposa To &-Vo in its �Vfo�osdl I Ir duration of the initial one-year term of the contact. 2) Proposers are to insert their best price in the "UNIT PRICE"column highlighted in yellow below. 3) In case of discrepancy between UNIT PRICE and EXTENDED PRICE, the unit price will be presumed correct. OCCUPATIONAL MEDICAL SER110ES ----------- Current SERVICE PROVIDED Year Ex,te n-d e'd P ,Audiogram ,"Blood lead Zpp 'Cardiac Risk Assessment ic em20CHD iChem 20 CHD, CBC, UA A 4, 'Chem 2 CHD ----------------------- --------------- - - ,Chest X Ray I-view $660.00 ;Check X-Ray 2-view ,Coast Guard Physical . .. .... ..................... �DIPITET (Tetanus) - - ----- ------------ - -- 'Glucose Fasting (in Center) ; --- - -------------------------------------------- — — ----------------------------------------------------------------------------------------------------------- 'Grip Strength (Dynamometer) ,Haz Mat Physical ENW14 "I, I Hep A Vaccine Hep B Injections Hepatitis B Titer �HIV-1 EIA Screen Hurnan Performance Evaluation Per Hour — ---------------------------- umbar Spine 2 view -- V,njeclio i3Occu It Blood On Site Fee Per Hour – Physician (*See Oil Site flolic�) On Site Fee Per Hour – Registered Nurse On Site Fee Per Hour Licensed Vocational Nurse ,On Site Fee Per Hour Other: Medical Assistant On Site Fee Per Hour – Other: 1 OSHA Respirator Questionnaire IS � Annual 3, ,thysical ',Physical– Pre-placement 011111111107,01, ME ntoux) �,Nmmunjx M1 22:4 Pulmonary Function Test ONNO I'm, ,'Rabies Series- bies Titer X11 11.1 Return to Work Exam !Thyroid Stimulating Hormone (TSH) Dipstick 11 UA Gross Vision Titmus ay Interpretation without B-read $1,000--- er Read reg price W/C contract 'Fee per hour for legal testimony provided by physicia 'Ad-hoe report ( er hour) I *Note: On site fee per hour is paid to Proposer when City ,requests that Proposer perform medical services outside of 'iProposet's facty, during or after Proposer's normal ,operating hours. On site fee per hour are all inclusive of Jany and al I travel costs associated with provision of testimony. ';Percentage discount if average wait of one hour = . 11 ,occupation services be provided and patient be released hour" policy for the following reasons: after sign in is not 90% per month (to be deducted from j I invoice to which report applies - report is due with 1. We are unsure of the list of services included in ."occupational ,invoice). Percentage is to be deducted from the billing medical services" and therefore cannot estimate the treatment time. iperiod to which the report applies and must accompany invoice. Even if the services listed on the price sheet (PIFT, Rabies ;Series, etc.) are all inclusive we know from experience that the Proposers must quote in a percent format showing iprimary factor in determining total treatment time is the ideduction based on the percentage not met. For example, a "'ber of services ordered during one visit. Multiple services ded ucti on of $XX.xx for !/2% not met, $X X.xx for I could very well require total time in the clinic to exceed one i$XX.xx for I Vz%, etc. i hour. I PRICE SHEET If only one collection site, pick-up for occupation services Not Applicable. The Doctor's Center has more than one must be within one hour of Proposer being notified of pick- collection site. up. Proposers must quote in a percent format showing ieduction based on the percentage not met. For example, a ieduction of $XXxx: for V2% not met, $XX.xx for I%, CoNection ► tbc i 3!t!!' ft Wdhi&W to be by examining photo identification or by verifying with a company representative. If the identity cannot be established, the process may not proceed. If the donor being testing requests it, present your identification as well. Brief the donor on i il'•1 process. turn over any i purse ! ii items along i # garment k safekeeping during collection i' i i ! " # :. i i 4 M JI - i i i `,i i t' - i i i r= l f. #:. t. If the individual is unable to provide an adequate amount of urine, the collection she person .Iii the individual to provide : ;; adequate ! i! i. testing should Y discontinued hii the [t■ i notified. �1� -t.t� �' �t�!' 111 �>'' 1 °; AIL ",�-c,t- i <' #I1Iw1'r� ►�" ��� lr� -� ja ! _ 11 1 ! # 1 •" # Js ! 4111: - - 1 M !1.' 1 = be 1, «, mil,, gende-r as the donor. 11.'i.::" ti' 1I Ill.. k } t #'t A : 1 l .; I 1 l i ! ! 1 ! «` 1 t tl ! ':: ! •" t , 11` ;, i !` � ! ! '. ! ! ' 1 I' t x ! lit �+. #? ! '" # ! 1 r ! t ! • t- ti' # ! 1;. page ,'. of these instructions. second t ■-e I! ` 1; is required, make certain :. fresh container used. Discard the original, inadequate specimen and container. Test the specimen for temperature within 4 minutes of urination. The acceptable range is 90-1 degrees I e temperature is outside i r: the driver 1;,+t request ia„ o have his or her # ' temperature taken I counter any suspicion of tampering I # t A # '1 of 1 specimen. Note the per 1e" appropriate on the custody and control form �A UM 071���RA,4110441&#JAM)14 9 r7rro I '5#411,: f.10-14LW4 A4611 il;, � I U j 99 "Will supervisor before collection a second specimen under the direct observation of a site person. An specimens collected must be forwarded to the laboratory. la Keep the specimen in view at aU times prior to sealing and labeling. The specimen must also in view of the test subject. I ► III! M.-F-WWf-MM=,=aMM, MMMI, MRTMHTMTMr,3=,F =-t # ", Ptlij Ik MM. of the form. Tbs inffirmation is not mandatory and should not appear on any other copy of the form if there are problems during i.`. collection, or you have i to believe the individual has adulterated i 1 specimen, check 3 supervisor or 1A i i representative _... .. histructions. Place the i " li .e`.#t in 9)hww*e co 1 designed to ii1 i 1Ai damage, R as specimen ° (m�J,- boxes and/or padded mailers designed this purpose. container enter the date across the .' tape. T; that 1 1 i ^* i! ' documentation sealed inside the container. �' 'i` �! 1 :� ii :ice: 4 ■' 1 CoBection Conection site personnel must be the same gender as the donor when a collection is conducted under direct observation. When a collection is conducted in a public restroom or other facility that does not afford the donor complete privacy, a medical professional or technician of either be the same gender as the donor. collection site personneL er representative r 4 employees. M# Iv' ! # Ss ! Y i3 - it Ii laboratory. Enure proper niount of negimen "r vide make sure that the sample contains at least 30 milliliters of urine. The urine should be poured into a specimen bottles to be sent to the testing # Inspect the sample for color and any sign of contamination of tampering. Note any unusual sips on the custody and controlform. In the case where tampering is suspected, consult with a supervisor befbre collection a second specimen under the direct observation of a site person. All specimens collected must be forwarded to the laboratory. '7 the 7' ! ! is view at all times prior to ":;e #"' and labeling. The specimen must also be m, view if 1`R - -' 1 # ! # • # E ! 1 # i ':! Pn ty "/ ! 11 tf {' t t 4: # f . 1 � '= t / A # ! j • "4# /t 1 i! s[i J `. / of the form. This information not mandatory and should not appear on an other ♦ the form C. enter Place the spech-nen in a shh2ping container designed to minimize dan-mge, such as specimen boxes and/or padded rnafters designed for this purpose. Seal the container securely. Sign the date # the It " tape. ' $ 1 that docurnentatilon sealed imide the container. MMMOMM Initial Lrejjkg-$JeAr. Select or allow the employee to select an individually wrapped mouthpiece. In view of the employee, #y' open the mouthpiece III insert it into the r' adequate amount of breath bas been obtained. f r• R•" QOMM ATF with tamper-evident tape. When the test result is less than 0.02 alcohol concentration, the BAT can linish the test by a N ' and dating ' Step •° the and +• transmitting the result to the designated employer representative in a confidential manner. Step 4 of the ATF is not signed unless the test result was 0.02 or confirmation given. .. +, -4 t a "_ r u#19 1 view of the employee, the BAT must open the mouthpiece 11 insert into the device. The ` and employee must read the unique number on 1" i The employee should blow R R the mouthpiece for least M seconds an adequate amount of breath has been Rk : 1`4.. The BAT must show the employee the test resa displayed i the EBT and the result and test number the EBT prints. 10 11 If the confirmation test result is lower than 0.02, nothing fiwdw is required. If the rest-9 Es 0.02 or higher, f•. must sign and date Step 4 of Liecase.- TX-T4 4 8 6 Home Address: 3120 Oce-an Drive Corpus Cluisti, Texas 78404 (361)888-5375 to of Birth: February 7, 1965 L a emu. Spanish rAI Ucation: Piano Senior ffigh School, 1993 Plano, Texas Summer fnternship- 1987 Marine Biomedical 1ristituto Galveston, Texas Bachelor of Science-1988 Baylor University Waco, Texas DoctorofMedicine, 1992 Univemity of Texas Medical Branch Galveston, Texas Postdoctoral GeAcral. Surgery Trainiw. Upiversity of Texas Southwestem Medical Center Dallas, Texas reuow�wp Pediatric Bu and Rmonstruedon. Shnners RospiUd for Crippled ChUdr--n Galveston, Tcxw Plasdo and RawnsftuctiveSurz=y u.!,.ity of Texas Southwestem Medical Cmte-r Dallas, Texas CU at positio. preddentfCE-0 —Me Doctors' Centce' N Universi(y of Te=s Medical Branch Alpha Omc,-,,a Alpha Honor Societ)- 1992 Honors- Surgery� Interual Medicine, OB/Gyn, Pediatrics-1991 Research: Research Assistant Department of Otolaryngology- 1989 University of Texas Medical Branch Supervisor, ffect Dr. Ray Weiss Subjea E of cigarette smoking as a causative Eactor in 4=0 Laryngeal carcinoma, Grant from American. Cancer Society Research A-ssistant Department of PJastic. Surgery- 190, Uniycrsity of Texas Mp4ical Branch Supervisor, Dr. Martin Robson Qubjm-t: Fascio-canfa=ous flaps; Sheep Model University of Texas Medical Branch Supervisor. Dr. Jon Mader Subject: Fr5Tjerbade oxygen therapy in the treatraent of Perichondritis: Rabbit Modd I Roard Appointments: Medical Quality Review Panel TWCC 2004- presmt American ReA Cress (Coastal l3end Chapter) 2001-200e Corpus Christi Symphony 2002-2004 City of Corpus Cbrisd Crime Control Board 2004 —prcst City of Corpus Christi Charter Revision Committee 200. Cleft Lip/Palate Campaigns Dominican Republic Fal 1 1996 Oxaca, Mexico FaU 1997 Puc4lo Escondido, Mexico Spring 1998 Pue.-to Escondido, Mexico Fall 1998 Puerto Escondido, Mexico Spdn& 1999 Puerto Escondido, Mexico Fall 1999 Pumto Maldonado, Peru Sununer 2001 Moyobarnba, Peru FAU 2002 Moyobamba, Peru Fall 2003 Moyobamba, Peru Summer 2004 Moyobamba, Peru Fall 2004 Lima, Peru Spring 2005 Moyobamba� Peru Summer 2-005 Coastal Bead Surgery Cent Corpus Cliristi, Texas Active Staff I Military: Captain, United States Aimy Mcd Corp (Re=vc,' 1993-2002 ForwardSurgical Team 1-fonevable Disdiarge 12/2002 1. Dowbak- G. Rose IK, Rohrich FJ. A biocitemical and Iiistological national for die (matment of hydrofluoric acid burns vfith calcium -luconate. Y-Burn Cam P,,-cJmbi 1994;15 5. Rose M Desai hfff , Heradon, DN Advances in Bum Care. Advanr= in SurgerY, Cameron ed, Vol 32, October 1996. 6. Rosp Jl�,Hcmdon DN, Advances in tho t=iii t • bums (Accepted- Burn April t996) 7. Rose jK, Desai hq-�, Malmr jK I-lemdonL R is supezior to topical andmicrobials,therapy (TAT) in ffie treabmmt of soald burn in childrm(ADeepted: I Burn Care Rehabil October 19 96) 8. Wb I If SE Rose JIC Ekzai W=Id f, Bamw-, RE, Ifemdon DNr, "SiMY4N-Me of One Hundred It= Child= with Pritaarity Full Thickness Bums over 80% Of dieBody Smives: Lessons LcamodAnn Surg (Accepted: Ana Surg- J'anualY 1997), 9. Rose X Tmy. Rohdch Rj-,,Ihe ancequadjers vein technique: Anew praCdce tw1inique for miemynscular vein repair. (Submitted: J'NficLv Surg- 1\"O'vcmber 1996) 19-Rose JIf, Scale F, Desai K NUakar JK Hemdon IQq. Multiple- barIVOSt POtmdA of limited donorsites in masbively I�uracd dad= (>700% TBSA fulI41ACIMCm). Wound Healing Socictn Boston, hfitssachusWs. May 1996 111LUIZUIZ MU N ll:by PAX J KEITH ROSE MD 3120 OCEAN DR having presented to the Executive Board of the American Association of Medical Review Oflicers satisfactory evidence of prescribed qualifications and having passed an approved examindion before the I IS in accordance with national standards of competency and expertise established for Medical Review Officers, is hereby accredited and designated as a Given and dated this SNA day of Ocb�w. 2.002 Cow#cnignedodscaledwith the Seal of the Ame7ic= Amddfion of Madical Review Officen the day =d date a written CO-Pordle Secrelarg Serio M. Solorzano, g MD P.O. Box 271294 Corpus Christi, Texas 78427 (361) 994-7567 ssolorzanol0f,@sbcglob.?Li,et Objective: To obtain a position Nvith a group or solo practice that provides quality care to those in the community. Education: Residency: Corpus Christi Family Practice Residency (2003—present) Corpus Christi Spohn Memorial Hospital Corpus Christi, Texas Medical School: University of Texas at Houston (1999-2003) Houstor4 Texas Undergraduate: University at Texas at San Antonio (1994-1998) San Antonio, Texas B.S. in Biology Cum Laude Work: Bayside Medical Center Urgent Care Corpus Christi, Texas Physician responsible for urgent careJmin emergency patients presenting to the center. Mysician reVonsibTe lbr patients there for treatment. Radiology Associates (present) Corpus Christi, Texas Responsible for managing allergic reactions t® contrast agents in patients undergoing imaging studies. Tex Scan MRI (pre-sent) Corpus Christi, Texas Responsible for managing allergic reactions to contrast agents in patients undergoing imaging studies. Alameda Imaging Center (present) Corpus Christi, Texas Responsible for managing allergic reactions to contrast agents in patients undergoing imaging studies. Affiliations.- American Medical Association American Academy of Family Practice Nueces County Medical Society Certifications: Basic Life Support Advance Cardiac Life Support Advance Trauma Life Support Pediatric Advance Life Support Neonatal Resuscitation Provider Honors: Golden Key Honor Society Dean's List 1994-1998 Professional Interests: Preventive and sports medicine. . \£f» . in accordance with national standards of competency and eupertk;e established for Medical Review Officers, is hereby accredited and designated as a Fill 'it I I (furcul xwe?<-w juncur.5j 1'Y "urvuff; m.LrEfulmu Una UESIgnalea Wq f" Cturnfiined and seded irim thr,W1 of m Omerliml k"dafilm afPWICO, Revivr CI._,aka _. _r 0-6%yu �UALU COMOV1. Sir, metary 17,-mlifiedle e%II 080 LW.U5 � :������` y�. �~ d� � � .. � / k ® / � / $» /\ t� \ � /\ t / k : \ . j _ � � \ \ \ \ \ \ �� $ � � � \�\ /. \/\ /� \ \ \ \ /� ? .� � � � � � � � � f��� � � THOMAS T. NGTVEN 14838 Highland MW Drive Corpus Christ Texas 78418 M.D. Georgetown University 1 19 9 2 * Washington D.C. B.S. Biological Sciences, Univeristy of California at Irvine 1983-1988 UO Academic Honor Society (Dean's Honor List 7 consecutive quarters) Excellence in Biological Science Research ATE EDUCATION PG-1 The Cleveland Clinic Foundation (Transitional) 1992-1993 U.S. Air Force Aerospace Medicine Clerkship, Brooks AFB Son Antonio, TX 1994 U.S. Naval Aerospace Medicine Clerkship, Pensacola NAS FL 1996-1997 ................. 15 fl Im 4i .. . ........... FA1jrqU*P1f#ff"1 LALODOiel * " 11 MIL LARY & AA� AL EXPERIENCE US. Naval Hight Training, Whiting Field NAS Fl- 1997 USAF General Medical Officer (Captain), Vance AFB OK 1993-1996 U.S. Naval Flight Surgeon (Lt.Commander), Corpus Christ! NAS TX 1997-2004 NASA Search & Rescue Fright Surgeon 1999-2004 E.R. physician (over 9,000 hours) 1997-Present LANGUAGES in accardanu with national standards or competency and expertise MIMI" A4AfRO Regisby of CerfiftedKedimlArview Oft?cgrs OREM .Aimrium AgsarWim of fih�' PKeffi (Offiars in accordance wifh national standards or cumpatenry and experti�e PUBLIC VERIFICATION / PHYSICIAN PROFILE W� 11�10- 21 Date of Birth: 1950 Issuance Date: 02/25/2006 Expiration Date: 08/31/2012 I Disciplinary Status: NONE Licensure Status: NONE all ";MW APIMMAIN4*4111 -W.isciplinary Date: NONE Icensure Date: NONE Education Year of graduation from physician assistant school: 1981 Program: ACADEMY OF HEALTH SCIENCES. FORT SAM HOUSTON Board Action (includes all actions regardless of licenselpermit type) NONE RE�I=A Status Code: AC Description: ACTIVE Status Code- LI Description: LICENSE ISSUA M��» 2 5< W WNRITIMMMM-11 • Resides in: CORPUS CHRISTI TX • Licensefrrack No- 241146 • Recognized tvith IX RN license- • NURSE PRACTITIONER - FAMILY NURSE PRACTITIONER ....... ... verification runction of this website, performs daily updates to the websile and considers the website to be a secure, primary source for I icense verification. Austin, Texas 78701 lit bon. state.tx—u.s1o1v1'apnrsl t, asp 4/1112012 Cum'culum Vitae Oct. 14, 05 15918 Punta 21 ¥> Loop Corpus Christi, ©2 79418 361-949-8860 June 2001 Graduate of University of Texas at Austin School of Nursing. Masters ir Nursing, Family Practice, 11105 to present Micheal Lovoi MD, [riternal Medicine at 13725 NW Blvd, Suite 260,Corpus Christi, TX Currently employed full time. 79 :. 81 Girling Home Health » :f « providing home vi sits, patient teaching, and Hospice Care in Austin area. 11'' ilpli�ilipjiil "KIIEWHRIN Vtfl ism I, I I'm Nancy R. McDovveff 6041 ld�Jlwnd Coijius Chri--,Ei, J'X 78412 W.779,5424 nanc� rose22 t hotmai Lcom To ubtain a position as a Family Nurse Practitioner in as 11olUiCe that enables me to utilize TI(I CnI1,111CC 1-Fly Mirsing skill and IMPPOrtS C()f1tirlUC(.1 clinical growth with µm colon mity to provide holistic health care at the individual. fanitly. and community level, Academic Preparation: 05`201 1 Master ol'Science in Nursing-Family Nurse Practitioner `rexas A&M Corpus Christi 05 1002 Bachelor ofSelence in Nursing Texas A&Nf Corpus Chri�;fi Academic Experience: South 'rexas Family Planning & Health Corporation with Nona Darlene Addison 1Kfenn 0 %Vl-lCNP-BC.' (Intep-rated Clinical, Spring 201 1) 1-niploN ment VNpc.rience: 07,'2002- picscm Corpus Christi Nledical Cmtcr- I he Heart I lospital 09!2011 present Cudia.c Rehahilitatim Corpus Christi Medical Comor SuITRN Cardiac Rehabilitation 41rovide education and suppon of patiews %� ith coronary heal discase �%ho Marc makin fifiestyle changes io prevent %Norsening ofdiseuSe -Monitor patients dUring- physical %% urkow5 ro pre% L:nt overexcnion and /or in' .1urN. Current Licensure and Certifications.- hunih Nursc I'mictitioner American Academ,% ol",�tirs& Practilioners 4'03 12090 Texas ReLtistered Nurse 4689422 Basic I,iI'eSupjN)r1 (BI S) Advanced Cardiac I, ille Support (ACLS) NIH Stroke Scale (N IHSS) Professional Affiliations and Awards: References A-.ailable upon Request Dr. Fabricio /uniga-Acosta MD Corpus Christi HospiLabsts 3315 S. Alameda Street Corpus Christi. I X 78411 .,61.493,1 19 Icell) iii CDOWEI-L, NANCY R 11 559 LEOPARD S T CORPUS CHRISTI, TX 78410-0000-GOO MM2735631 01-31-2016 $731 SCHFMES DISMESSACnVITY msuE OATE MLP-NURSE 1 Mo 3 3N 4,5 oroAt-+I-rinki MCDOWELL, NANCY R 11559 LEOPAkD ST CORPUS CHRISTI, TX 7841 D-NOO CONTROLLED SUBSTANCE REWSTRATION CERnFx:ATE UNITED STATES DEFARTmE NT OF JusTacE DRUG ENFORCEMENT ADMINISTRATION WASHINGTON D C 20537 PAgisfared acthft wALWn sd-mdtk is rasuicted by your mWe Sectim 304 2W 1008 (21 USC 824 and 958) of OM ConClAled Silbstw=s AC1 of 1970, as amekled, Provide that the Atlamey Gerimni may tevcM or suspend a rogizVotion to manufacum. diat-,buts, dsperm, knpan or expart a controlled sL6saarco. THS CERTIRCATE IS NOT TRANSFERABLE ON CRANGE OF OWNERSWIP, CONTROL, LOCATION, OR BUSMESS ACTiVITY, AND IT 13 NOT VAUD AFTER THE EMRATION DATF- I NPIMMI IMINIMM t" NTPOI ";U B", 1 '4"04 ( "UL AT rt) rW1.1, I r"'t C,!K I RA 1,j I I rf M1P CAT C UNH ED PFPARTMENT OF JUSTICE 1,Pur, 0jL09RCP sE,41 1l:NqNISTRAfr1CgN VASHING'ON 0 C 20S37 RoUisfered activity within scheduto is restricted by ycwr sljlo� �"Ccool S !, 1008 ;." U"34' 824 anti 050) 61 'Le Go-ltfolleJ Sut Aanres AQ1 of 1970 as amended Provde ,hall the Ar-orney Gencre may rcv,-ke or -,uspcm, a regisitat,on W s-,,v1ufac:u,e, elmrr,ote, cis punae, avjrvt of export a ccruro �Pd substarwe, TKS CERTIFICATE IS t4 OT TRANSFERABLE ON CHANGE OF OWNERSHM, CONTROL, LOCATION, OR BUFANESS ACTIVITY, AND iT IS NOT VALID AFTER THE EXPIRAMM DATE. REQUESTING MODIFICAPONS TO YOUR REGISTRAT.ON CERTIFICATE TO =ue&l a 08nge ZO your qis1ruet) namp, aaaress L,1w dnrg scht,rduie or I" drug oMes you hanale, please I w&t ='woh Me at dead Warsiomtmdaj-gov - or 2 t,0nurcuslomer Swvice Center at I.4600) GOMM -or 3 sutyrR votir change(s) noritDg lo: Drug EgllomMent Administr-ailov P.0, Box 28083 Washington, DC 20003 Soe -, Ife 21 Ctpje j Fndejj9 rj, .qUl,q,uOetS, Sp-jaon 1301 51 for czrorp eye ktstructotns. You have been rSq�istered to handle the foll emical/drug codes, - - - - - - - - - - - - - - - - - - _ ',Lc�%V�inq_Rh ........... Ashlev lsesiria-GrarCia I a 4 III' bennyvi lie Drr� c. Coq)u- Cluisti, rex as 784 10 Phone: 161. R 13-4593 1 ) , 361_504.40 -i5 1 lion ie.1- Ew.ai I - aah_MODQLL� o Loc,kim- to obtain L N urse Prac� ificyner presit tin in a licaithcare ra cilia y. August 2002- J,uivary 2004 Del "Mar c llege Corpus Chrisd, T6zaq As,-i oc ka tes i n L i be ra I A r ts Janim� 2005- December 2007 Del Mar Codege Corpus Christi. Texas Asso tL�s in NursinL, A Ligust 2(X)B- Nlay 20 `:, lexasA&M Univer irv-CC Corpus Christi. Te%,as Master of Science in NUS ill g. Fwnfly Nurse Practitioner PROFESSIONAL E-KPFRIEI,,,'CE fanuao- 20I 2--i une 2212 Reswrative Rome lfeaPh Cue Corpus Chrj!O, I-exas Pcdialric RN -Provided skilled nursing to %'ented pediatric padents in the co fort l'their home. -Dwies included: assessments, adminisicringni it: afion& intmvenous therapy, provided education to patients and their flarnil ics. ualicens,-d r,'.rsminel vmplicd vilth tredic-are gtandards and completed wt:sis, ra:cr4,q_ discharge,,;, and prov"ding 2ducallon ite patlients. -md their lamdiLs. Janwiry 2t )7- August 2007 Chrislus Spohn Hospital Memorial Corl"m Christi. rexas Student Te0i ai 'Llele&Sjqg unit -Provided io regisLered nw-w- wah patient care tn MvtVSurgical unit. -Duties inG'luded., as5ustjng repstered imrses their patient duties. bathm. fetAings, changillgL and dischwging, PROFESSIONAL CREDEN HALS Rrgistered Nux-self-icemcd 'n the stet e of I'cxas, Advanced Cardiac Life Support, PediaUic Advanced Life ',-,'upwrt, Cnitical Care Nurse Associalion, as Nme Practific',ner Association, Coastal Bend Advanced PraLtice Mirse Asot-)Ciation 'an Ey -14 13 )2 59p ASHLE AMERICAN ACADEMY OFA URSF PRAL I I I I 1 100%145 CERTT FICATION PROGILA M Ashley Antr Posina Garcia, NP-C has i-w- the t mtpirr=ms for nzw kwi.-I. =ifical FAmily Nu-,-.c Pradl orer Carifficado n # F07 Z 2 152 Gramicd fs am July 1,-2017 through June 30, 2017 In- m A m m Cc IZ, rl Lf� Lr) W cz I Ln tj ue pT m u yq cul 41 bbd ry. P114 10 r— :z rj C C) < E dd 0 4-j Co v v Pm( 7 dory C4 CJ cq 0 Cc IZ, rl Lf� Lr) W cz I Ln tj ue pT m 9 I o g8 CL 0 <Mo m 2 10 ID 0 m nr tu= M 0 cc 0 5 2 C= 0 L.L oc: cb U 0 CD CD o 5 E Lo F- 0 U) I o g8 CL 0 <Mo m t4 , . 5 . V V NOM um CO CO u1i LLJ to to kk� " FAlpq I a� a� Ap, I p41 re'VA k m 45 yea 4— L7-4 cz v 14� cz 0 ri ,3 ci E r"MU ft .a. FA,Apmq Af � rw MI's; s r, s 1 s x° co is r: Elm �l 4 .Fee d4 � egP s , r F1 C n. Pr B s*Yn 4 k �p° d F1 C B s*Yn d X 7 iw 9u s imir 'I ST iw 9u s imir iw 9u s F, �1 .................. 2 i i 7" 1� Sol ,w r a w 1*7 L. J G 1 w# 1 4 iii ffl� r. Ea ffi 40, 9 MR 17T- Hmm rm LrM W" at Elm Is01 u ci of 4-4 u cu u C\l I 0-4 0 Q) 0 u to Z-1 < LF,l 0 u 6 z u van ' 2 M ®\ RA <� + > k�� / < / m� } / � � » � ya \<# ��\ ma t Ali ■ Yaw m. I nk Hsi 0 E, rt yyg Yd beA 0 r, o oz pg 1 t-I A a r\ IRI m fiat j A4" ll n, r xa CP. 14 r-rl x. rn vt ll n, r r. 1 i 60 Kol ............ .. . 6523,52 £-12q at an elill usiness work and our company, As a company, we affirm our onpbg commitment to establishing policies and developing effective internal controls that will promote adherence to applicable legal requirements, our standards of business ethics,, our comMiance policies and procedures, and the requirements of federal,-stat-and r) 'v& health care Programs,, Quest DiagnoaticalLcommidedilo n ec n th th and safety of our employees as well as the environmental resources of the communities in which we operale, Laboratory Llcensure & Accred Mlons of Health and Human Services/Substance Abuse and Mental Health Services Administration (HHVSAMHSA) to perform urine drug testing under the Federal program, Additionally, each lab locafion is accredited by the College of American Pathologists Forensic Drug Testing (CAP-FDT) program and licensed by the state where the laboratory is located. Quest Diagnostics'drug-tesfing procedures and laborstodes are also hilly cerfified and a=edite-d by Federal Govemment agencies and professional organizations such &-, Agency fbr Health Care Administration (AHCAI—Flodda and Clinical Laboratory Improvement Amendments (CLIA), Please refer to the Laboratory Licensure, and Certiltications attachments, located in the Appendix, for documentation of Quest Diagnostics'SAMI-ISAcertification, Flease note� the Lenexa, KS laboratory is Wed as LabOne, d&a Quest Diagnostics Incorporafied. Personnel Qualificaflons uest Di nosks also meets all — state and local :ments for all mrs 2c, EXPERIENCE Laboratory Hours of Operation ....................... *,ur clients. anfil 5;00 p.m. Our collection network has the ability to collect all types of specimens for drug testing: * One leafing for drugs of abuse * hair lesSng for d of abuse * breath al o1 testing * on- sae at your workplace) colle6on services WMAM WIN"OWINW-1w ihelffeofthe-instrum- tan to maintain optimurn operating characteristics: unscheduled repair work. fl. QUAUTY CONTROL Aliquot for Screening Test - The specimen container is opened (breaking the seal) and a sr ag rbon of the sample m removed for the initial screening tests. Aliquots may be taken by manual or automated (CV-1000) methods The aliquot is transferred to the testing laboratory and the orlginal specimen is placed in a temporary secured storage All specimen and subsequent aliquot handling is carefully dwumented via intemal COC. Initial Test Description A high-sensifivity Enzyme Immunoassay (EIA) screens for the presence of commonly abused drugs. At this stage, test results equal to or greater than a calibrated immunoassay cutoff concentration iden* presurnisfively-positive speciaws. Each batch contains bO negative and positive quality cDnW samples along with one blind quality control sample that is Inserted into the batch in a random positson. If requIred, confirination testing for specimen validity Is performed by the same or, if avallable, a semnd definitive method that can be utilized to idenfify specimens as adulterated, substituted or invalid. Each confirmation test is performed on a seoond aliquot that is obtained from the original specimen container and all confirmation batches oontain appropriate quality control samples to verify the performance of the procedure, Specimen Valldfty Testing Quest Diagnostics performs specimen validity testing to delterrinine if a One specimen is dilute or has been adulterated or substituted. To report a specimen as dilute, adulterated, or substituted, the Quest Diagnostics laboratory will conduct an Initial validity test (the first test used to determine if a urine specimen is adulterated, dilute, or substituted) and a oonfirmatory validity test (a second test perfo on a different aliquot of the original urines imen to further support a validity last result). Quest Diagnostics' Test Tm offering is a sueenng test for COMMONY Used adulterants, Adulterants defected in urine spedmens include, acids, bases, oyidants — such as, nitrite, chromium (VI), and ha eras — and glutaraldehyde. Candidates may either ingest these foreign substances, sometimes promoted as cleansing aggents, or add them to urhe specimens with the goaI of preventing drug use de don If you request TestSunelll, which is available in all Quest Diagnostics laboratories, every specimen will be screened for the compounds listed Is the folbOng table. If we Identify adulterants. we can confirm their presence using state-of-the-art secondary lesfing methods prior to reporfing the results. Colledon Protocol The collection of a urines `men will be conducted following procedures that allow for individual privacy, These guidelines were dedved from Federal Gov regulations that require Quest Diagnostics to collect the specimen according to the DOT 49CFRparl4O The colie or will follow established protocol to ensure that your spadmen is not adulterated or diluted during the collection procedure. The specimen collection will folfours chain of custody and security procedures. Attention: Director of Human Resources, P.O. Box 9277 Corpus Christi. Texas 78469-9277 IF TO cowRACTOR: Contractor :I- tor*% CAV-k-(X- Contact Address: City. Sta(e. -tanp" 0kcisAlt I-T)c SIGNED this day of AU4k _,20 /3 CITY OF CORPUS CH TJ ("CITr) Michael Barrera Date Assistant Director of Financial Services 2,r. ±1 1� » The continuation of this Agreement after the close of any fiscal year of the City, which fiscal year ends on July 31 of each year, will be subject to appropriatiorff.' and budget approval covering this Agreement as an expenditure in said budget; however, it is within the sole discretion of City Council to determine whether to fund this Agreement 0 ---- - -11, ------ I MRAIWANWROMPY Rim Purpose 2 Policy 2 Scope 3 Y Terms Introduction 1.2 Hazard Vulnerability Analysis 1.3 Hazard fi ation 7 1.4 Risk Assessment 7 1.5 Insurance Coverage 7 1.6 Clinic Emergency Response roles 7 ■ 2 PREPAREDNESS 2.1 Introduction 9 2.2 Emergency Operations Plan (EOP) 9 2.3 Standardized Emergency Management System (SEMS) 9 2.4 Integration with Community-wide Response 10 2.5 Roles / Responsibilities 14 ® Conununications — Notifications 16 ® Continuity of Operations 18 ® Clinic Patient Surge Preparedness 21 2.9 Disaster Medical Resources 23 ® 10 Disaster Mental Health 24 ® Public Information / Risk Cominunications 26 2.12 Training, Exercises and Maintenance 27 3.1 Introduction 31 3.2 Response Priorities 31 3.3 Alert, Warning and Notification 31 3.4 Response Activation and Initial Actions 31 ® Emergency Management Organization 32 ® Emergency Operations Center Operations (EOC) 34 ® Medical Care 35 ® Acquiring Response Resources 38 3.9 Communications 39 3.10 Public Information / Crisis Communications 40 3.11 Security 41 .... ........... The odor's Center 1 Introduction 56 4.2 Documentation 4.3 Inventory a r Loss Lost Revenue through Disruption of Services 57 4.5 Cost / Doss Recovery Sources 5 4.6 Psychological s of atien Restoration of Services 5 4.8 After-Action Repc 5 4.9 Staff Support The odor's Center 1 III&VIIIII 0 ' - The purpose of The Doctor's Center Emergency Operations Plan (EOP) is to establish a basic emergency program to provide timely, integrated, and coordinated response to the vAde range of natural and man made events that may disrupt normal operations and require preplanned response to internal and external disasters. Lam All employees will know and be prepared to fulfill their duties and responsibilities as part of a team effort to provide the best possible emergency care in any situation. Each supervisor at each level of the organization will ensure that employees are aware of their responsibilities. The Doctor's Center will work in close coordination with the Medical Health Operational Area Coordinator (MIFIOAC) and other local emergency officials, k L to disasters. Scope Within the co of plan, disaster overwhelms or threatens to overwhelm the routine capabilities of the clinic. This all-hazards EOP describes an emergency management program designed to respond to natural and man-made disasters, including technological, hazardous #: terrorist Development d implementation of plan co to of JCAHO Environment of Care standards related to emergency preparedness. ,r UMITIMM EMERGENCY OPERATIONS CENTER (EOC) The location at which management can coordinate clinic activities during an emergency. It is managed using the Incident Command System (ICS). The EOC may be established in the primary clinic facility or at an alternate site. EMERGEACTAk'SPOASIE - 7 The Emergency Response Team (ERT) consists of the clinic staff who will fill the core positions of the Emergency Operations Center (EOQ and manage the clinic's emergency response. ESSENTIAL FUNCTIONS (EF) Essential functions and services are those that implement the clinic's core mission and goals. The extended loss of these functions, following an emergency, would create a threat to life/safety, or irreversible damage to the clinic, its staff or its stakeholders. HAZARD AHTIGATION Measures taken by a facty to lessen the severity or impact a potential disaster or emergency may have on its operation. Hazard mitigation can be divided into two categories. Nonstruchn-al Mitigation: Reducing the threat to safety posed by the effects of earthquakes on nonstructuml elements. Examples of nonstructural elements include: light fixtures, gas cylinders, HazMat containers, desktop equipment, unsecured bookcases and other furniture. ELkZARD VULNERABILITY ANALYSIS Hazard vulnerability analysis identifies ways to minimize losses in a disaster considering emergencies that may occur within the facility as well as external to the facility in the surrounding community. INCIDENT COMMAND SYSTEM (ICS) A tern orary management sistem used to mana c and coordinate clinic activities urin IMULTI-HAZARD APPROACH A multi-hazard approach to disaster planning evaluates all threats including the impacts from all natural and man-made disasters, includine technolouical 6reats. w-rwisw_ Irgm, OPERATIONAL AREA (OA) An intermediate level of the State emergency organization, consisting of a county and all political subdons within the county area. Clinics and other health facilities will coordinate their disaster response with the Medical Health Operational Aren Coordinator (MHOAC). The Doctor's Center 4 STANDARD OPERATING PROCEDURES (SOP) Pre-established procedures that guide how an orgmiization and its staff perform certain tasks. An SOP is used routinely for day to day operations and response to emergency situations. An SOP is often presented in the form of checklists orjob action sheets. STANDARDIZED EMERGENCY MANAGEMENT SYSTEM (SEMS) SEMS is the mandatory system established by Goverm-nent. A SEMS incorporates th; use of the Incident Cormnand System. ne Doctor's Center 3 1 MITIGATIO 1.1 Introduction i MTM I-ToD"t' M, The Doctor's Center will conduct a hazard vulnerability analysis to identify hazards and the direct and indirect effect these hazards may have on the clinic. This will provide information needed • the clinic to minimize losses in a disaster and it This Analysis provides a toot for estimating and ranking the probability A occurrence and potential severity of various events. This assessment shoul be performed every three to five years. i The Doctor's Center [,\ d 1 <¥ « y4\++ « Doctor's Center undertake e L Z» mitigation or retrofitting measures J lessen «...= «m or impact =+ifm%} /<asto may have on its operation. Th measures „ are take prior to disasters to minimize ©® damage to the facility. ± M T +±< ± M. The Doctor's CEr Obtain input from clinic staff especially medical and nursing directors, safety officer, and chief operating officer. The Doctor's Center 2.2 Emergency Operations Plan The Doctor's Center Emergency Operations Plan is an "all- hazards" plan that will guide The Doctor's Center response to any type of a disaster or emergency. 2.3 Standardized Emergency Management System (SEMS) 2.3.1 The Doctor"s Center has incorporated the principles of the SEMS into its Emergency Operations Plan to ensure maximurn compatibility with local government response plans and procedures. 2.3.3 These components of the SENIS I ICS are incorporated or referenced in this EOP. BY rM M �_, : r The Doctor's Center 9 FA M \ MIR Manageable Span-of-Control k.h*AW4 I- &, 1� Pill 111 IWITr rgrmm- >¥#«<d*�??� ? Medical deal th Oper-a-b-onal Area Coordinator (AHUAQ who is usually ©<«#«» ° health officer. emergencyTTIpacting clinic operations and will coordinate its response to community-widc disasters with the overall medical and health response of the Operational Area. M-=. I 01=1 WLUI J-IC SCCISIULUkW<UIL ar"tons j)j tile Wjyf«-C aua Omer car«a «2e involved in the response. To ensure coordinatior4 clinic staff will: The Doctor's Center c. Develop reporting and communications procedures to ensure integration with Operational Area response. d. Define procedures for requesting and obtaining medical resources and fR r evacuating / transporting patients, During a response, report the status and resource needs of the clinic and obtain or provide assistance in support of the community-wide response. Note that in some areas, the clinic consortium will coordinate the completion of these tasks while in others, clinics will be responsible for taking the initiative in completing these tasks, F.4.2 Coordination with Emergency Respondem 2.4.2.1 Emergency services availability Fire, EMS and law emergency services may not be able to respond ty. emergencies at the clinic during an area-wide disaster. Clinic personnel will cooperate fully with EMS and law enforcement personnel when they respond to emergencies at the clinic. This may include providing information about the location of hazardous materials or following instructions to evacuate and close the clinic. The Doctor-s Center has identified a recommended location for wc emergency responder command post for coordinating the response to an emergency at the clinic. agreements as reciprocal and will also explore opportunities to providc. support to these facties if conditions allow. ft.4.3.1 Examples of potential disaster related arrangements with nearby hospitals include: Referral / diversion of patients to nearby hospitals, especially patients that require a higher level of care than The Doctor's Center can provide. Acceptance of diverted patients from hospitals to increase their capacity to care for seriously ill and injured. 2.4.3.3 Developing arrangements for receipt or diversion / referral of disaster victims requires careful and detailed planning including: r r, M, "r, IT M • Patient tracking • Contingencies that impact ability of either party to meet the terms of the agreement. WITOWTIMM11111". . The clinic and its clinic consortium will define their emergency resporiss relationship in accordance with the role established by the clini* C 0,; wnti U xv r.. a. In the preparedness phase, the consortium role could include o Strengthening the relationship and coordination between MHOAC and clinics in the county. * Resource acquisition including grant funding, group purchasing and shared equipment * Training and technical assistance. * Coordinated planning. The Doctor's Center 2.4.5 Acquiring Resources fr.4.5.1 The Doctor's Center will develop procedures for augmenting suppli equipment and personnel from a variety of sources. Assistance xnay coordinated through the follouing channals: 13 The Doctor's Ce.,*ter N All f Detemiine disaster response chnical staffing needs in cooperation with the Nursing Director. 2.5.3 Nursing Director The Nursing Director may fill the following roles: a. Serve as a member of the ERT. 2.5.4 Safety Officer The Safety Officer will appoint teams and develop procedures for the following response tasks: mr��� The Doctor's Center 2.5.5 All Clinic Staff All clinic staff have emergency and disaster response responsibilities. The duty statements of all clinic staff will include the following language: "Participates in all safety progrants which may include assignment to an emergency response team." Additional specific response duties may also be included for staff with appropriate skills and responsibilities. rz In addition, ills are required to: a. Familiarize themselves with evacuation procedures and routes for their areas. b. Become familiar with basic emergency response procedures for fire, HAZMAT and other emergencies. c. Understand their roles and responsibilities in The Doctor's Center plans for response to and recovery from disasters. d. Participate in Clinic training and exercises. These exercises are intended to practice emergency response activities and irnprove readiness, Make suggestions to their supervisor or the Emergency Preparedness Committee on how to improve clinic preparedness. b. Prepare family and home for consequences of disasters. The Doctor's Center A 9 In addition to its telephone system, the clinic maintains the following radio communications equipment: �JJWUPI The Doctor's Center 17 the Calallen Clinic Occupational area and is to be used only by trained staffi I WrM 111 t M =.1 •_,,. ,0'342 a. The Doctor's Center will appoint a communications coordinator to maintain and test conununications equipment b. All communications equipment will • tested twice per year. Defective equipment will be repaired or replaced. Batteries will be replaced per manufacturer's recommendation or as required. Spare batteries will be stored with equipment. c. The communications coordinator will ensure copies of operatine instructions, warranties and service agreements for communications equipment are retained both at the clinic and at an offsite location. 1. The communications coordinator will review communications requirements and equipment annually as a part of the review of this overall plan and will make recommendations for equipment upgrades -rjt-- replaceR ent. MHUMELM It is the policy of The Doctor's Center to maintain service delivery or restore services as rapidly as possible following an emergency that disrupts those services. As soon as the safety of patients, visitors, and staff has been assured, the clinic Aill give priority to roviding or ensuring patient access p to health care. The8 Doctor's Center 1 4 - 1 4, 4 - rump-w-StIMM" and public exposure. If the clinic is evacuated, provide security ensure privacy and safety of medical records. I Compile a complete list of equipment serial numbers, dates of purchase and costs. Provide list to the CFO and store a copy offsite. 112rotect computer equipment agiunst theft through use of zecurity devices. f. Relocation of services The Doctor's Center will take the following steps, as feasible and appropriate, to prepare for an event that makes the primary clinic facility unusable. The Doctor's Center will- Identify a back-up facility for continuation of clinic health services, if possible. Establish agreements with nearby health facties to accept referrals of clinic patients. 1,04 1 $0 (41MR; I 1�60 111,V I 18 1#1 t1i 11 7 dentify a back-up site for continuation of clinic busines2 I functions and emergency management activities. Maintain contact list of utility emergencynumbers. Ensure availability of phone and phone line that do not rely ox-, functioning electricity service. Request priority sutus for maintenance and restoration ► telephone service from local telephone service provider. The Doctor-s Center will obtain and install an emergency generator to ensure its ability to continue operations in the event of an emergency that creates power outages. The Doctor's Center will obtain assistance from local utilities or vendors. The Doctor's Center 9�1= : } « Inventory essential equipment and systems that will nee-d continuous power. Run monthly generator start-up tests. 2.8.2 Normal clinic capacity could be exceeded during any type of emergency for reasons that include the following: Events that create patient surge may also reduce clinic resources throuP., exhaustion of supplies and pharmaceuticals and reduced staff availabili Staff may be directly impacted by a2« ergenc . unable to reach the clin or required to meets mi «v2 at other health facilities. The Doctor's Center 2.8.4 The Medical Director and Nursing Director will develop a surveillance process to provide early indications of potential for patient surge that may result from an infectious disease outbreak, bioterrorist attack, or release of a hazardous material. The Doctor's Center clinical staff will monitor: 0XIIETIONCE variations in clinic utilization. .. I . 22 .9te Doctor's Center Clinics may also be able to refer or divert patients to nearby clinics if ThL- Doctor's Center is damaged or overwhelmed, or obtain space and support from other health care providers. 2.9.1.2 The Doctor's Center will also develop a roster of bi-lingual staff language. I 21 The Doctor's Center 2. 9.2 Pharmaceuticals I Medical Supplies / Medical Equipment 2.9.2.2 The Doctor's Center will identify primary and secondary sources of essential medical supplies and pharmaceuticals and develop esfinmtes of the expected time required to resupply in a disaster envirom-nent. = =1 The Doctor's Center r 2.10.2 Responsibilities The scope of r can perform depends in large part on availability of licensed mental health providers at the clinic during the response a. Develop are internal clinic mental health disaster response plan. b. Serve as a member of the Emergency Preparedness Committee and e Emergency Response Team. . - Doctor's h. Work with the clinic PIO to develop information (brochures, PSAs, etc.) that could be used in a response. i. Acquire and maintain the following resources that will be storem with other disaster supplies in a container labeled "Mental Heali supplies": Cell phone or calling cards available for staff to use. Disaster forms to document contacts, Copies of a local resource directory and an agency directory to LO facilitate referrals. Tj -, M I LW T, T., M 2.11.1 The Incident Manager will appoint a Public Information Officer (PIO) to coordinate the release of clinic information internally and externally to media and community. The PIO will develop a Disaster Public Information Plan to guide clinic information dissemination and response to media and community inquiries following the disaster. 2.11.1.2 The plan will define how the following information is gathered, verified, coordinated with the OA PIO, and communicated to communibes served by the clinic and other stakeholders- The Doctor's Center The nature and status of the emergency. Appropriate actions for protection, seeking health care services, and obtaining needed information. 2.11.1.3 It will also include provisions for employee meetings, internal informational publications, press releases and other programs intended to disseminate accurate information regarding the event and its impact as well as deal with misinfonnation. 2.11.2 The Doctor's Center will incorporate disaster preparedness information into its normal communications and education programs for staff and patients including: M Information dissemination channels for these activities include newsletters, pamphlets, health education and in-service education classes, and internet Rostings. M.M,Tj.r, ".3 NUMUMM= ��� All employees will learn the following information from their new Lomployee orientation or subsequent safety training. This checklist will also be used to design facility-wide drills to test clinic emergency response capabilities. Employee essential knowledge and skills include- Location and use of oxygen (licensed staff). Location and use of medical emergency equipment (medic,11 staff and staff trained on AED). The Doctor's Center 27 How emergency codes are called in the clinic and appropriat� initial actions. lig I! �I I I I �� I 111111 111! All employees must attend annual training and updates on emergency preparedness, including elements of this plan. All physician and nursing staff will receive documented training on procedures to treat and respond to patients infected with a bioterrorism agent. Training will include: Recognition of potential epidemic or bioterrorism events. Information about most likely agents, including possible behavioral responses of patients. Infection control practices. I —se—o t P e r s o n I a F hat -ec t I—V c - E aq-uk p —tn e Reporting requirements. I Behavioral responses of patients to biological and chemical agents. NPUMMM c. Clinicians and other staff will receive periodic updates as new inforrnation becornes available. ii, PINIAMETUn- I � 1 mr. M-. - The Doctor's Center Mental health team members will receive training that promotes understanding of the normal human response to disasters. The training for the Mental Health Coordinator and other mental healft professional team members will include delineating the difference between traditional mental health therapy and crisis counseling. 0, Training will also address cultural considerations of the service population and how they are affected by disasters. 2.12.2.2 Exercises should include one or more of the following response issu in their scenarios: i 2.12.2.3 The Doctor's Center will participate in community drills that assess communication, coordination, and the effectiveness of the clinic's and the community's command structures. RFFMMRA�- Of 2.12.3.1 The effectiveness of the administration of this plan will be evaluated following plan activation during actual emergencies or exercises. Staff knowledge and responsibilities will be critiqued by the Emergency Preparedness Committee (EPQ and reported to the clinic Executive Director. !--.12.3.2 Based on the after-action evaluation, the clinic Emergency Preparedne m Committee will develop a Corrective Action Plan that includ l recomm,endations for: rIff-7474= IN97-9 IMR—rorm 3=0=�� 2.12.4.1 The Emergency Preparedness Committee (EIPC) is responsible I coordinating the development and implementation of a comprehensil emergency preparedness program and this plan. 2.12.4.2 A copy of this plan will be provided to the Medical Health Operational Area Coordinator (MBOAC). IP- 12.4.3 The Doctor's Center environment undergoes constant change including remodeling, construction, installation of new equipment, and changes in key personnel. When these events occur, the Emergency Preparedness Committee will review and update The Doctor's Center EOP to ensure: Evacuation routes are reviewed and updated. Emergency response duties are assigned to new personnel, if needed. The locations of key supplies, hazardous materials, etc. are updated. Vendors, repair services and other key information for newi installed equipment are incorporated into the plan. The Doctor's Center Ensure During this phase, The Doctor's Center will mobilize the resources aM take actions required to manage its response to disasters. .. protect of life and provide for L patients, and Contain hazards to facilitate the protection of life, Protect critical infizstructure, facilities, vital records and other Resume the delivery Qf patient care. Support the overall community response. n Restore essential services/ utilities. Provide crisis lic information. Warning 3.3 Alert, 'o Upon v from or other credible sources Doctor's w M : g de supply updating of phone lists, and the inspection of protective equipment and pharmaceutical it for procedures determining if the clinic remains open, closes, or re-opens. If pia T- M, e' #.1 "M The Doctor's Center 31 rf the emergency significantly impacts patient !'" or lib M Y f so 112 137•' 3.5.1 The Incident Manager overseas the command/management ftinction (command at the field level and management at all other levels) is th,; function that provides overall emergency response policy direction, oversight of emergency response planning +1d operations, and coordination responding of i organizational The Doctor's Center who are responsible for coordination with other agencies, and legal counsel may also be added to the management staff. (Management staff is sometimes referred to as the Management or Command Section). 3.5.2 ICS employs four functional sections (operations, planning, logistics, and finance) in its organizational structure. Operations Section — Coordinates all operations in support of the emergency response and implements the incident action plan for a defined operational period. Medical care and mental health services are managed through the Operations Section. Finance and Administration Section — Tracks personnel and other resource costs associated with response and recovery, and provides .7-dininistrative support to response operations. 3.5.3 The Incident Command System has the following additional characteristics: a. Organization Flexibty - Modular Organization Each activated function will have a person in charge of it, but a supervisor may be in charge of more than one fiinctional element. nt Doctor's Center 33 Following are examples of potential position assignments of clinic staff to ICS position. 3.6.1 The 'Emergency Operations Center will be located at The Calallen Clinic due to the structural integrity of the site and the back up generator. 3.6.2 In the event this site is obstructed or inoperable, a new location will be chosen by the Incident Manager and ERT based on environmental conditions. If the primary EOC site is not usable, the EOC will be set up at The Doctor's' Center on SPID. The Doctor's Center 3.6.4 Required supplies include copies oft ? disaster plan, forms for recording and managing information, frequently used telephone numbers, marking y. ?* *r plans, »¥£ yi« <« communications equipment. 3.6 .5 'fle EOC will be deactivated by the Incident Manager when the threat subsides, the response phase ends and recovm activities can be performed at normal work stations. 7= ® v:#- ff #? '�?A22 930UMML= 1 b. Assessing and administering medical attention: A physician or Registered Nurse will assess victims for the need for medical treatment. The medical care team will provide medical services within the clinic's capabilities and resources. The Doctor's Center 6 c. Additional medical carer our m can be requested through pr*cam urez outlined in Section 3.8. q- The Doctor's Center will establish a triage area in the rear parking area of the clinic on SPID that is clearly delineated, secured and with controlled accesses ¥ exit b. If bioterrorism is suspected, all staff in the triage area will wear Personal Protective Equipment (PPE). c. All patients entering the triage area will be tagged and registered. d. Triage converging patients to immediate and delayed treatment categories. c. In response to suspected or verified bioterrorist attack, isolate © ^< f pabents from other patients, especially if suspected agent is human-to- The Doctor's Center —3 M 31 M., A , , " * The Logistics Section should «»«y«© monitor medical supplies and pharmaceuticals and request augmentation of resources from NMOAC at ®« earliest sign that stocks may become depleted. The clinic will wades ». ii; mailable Lasnitals- otker elhics and otYer eyte,-,Tal resource SU 3.8.1.2 The Logistics Section staff in the EOC may turn to external vendors for »<w< m«? or the MHOAC. 3.8.1.3 The MMOAC will seek resources to fill the request from within the OA. If resources cannot i f s und and the request is high priority, it will be submitted to Regional, State, and Federal response levels until the requested resource can be obtained. The Doctor's Center tlffi«l» s�iXAJN JW1 : §»< < «e« if the consortium has a resource acquisition role. 3.9.1 The Incident Manager will appoint a Communications Officer, who may bg, ©e Communications Coordinator, who will work under the Logistics Section and will use the clinic's communications resources to communicate with: fa Telephone service providers and maintenance for the clirlicl; internal telephone «. 2 »» with utties. Staff contact telephone numbers. Disaster response agency contact © «6 »4 «e numbers. The Doctor's Center All incoming messages will be shared with the EOC Planning Section. 3.10.1 During a disaster response, all public information activities must be coordinated with the Operational Area P10. 3.10.2 The Doctor's Center may perform the following public information / crisis communications tasks coordinated by the clinic's Public Information Officer 'E M 3.=4 a mon, � �, I M Coordinating the dissemination of information to clinic stafL community members, patients and other stakeholders. Providing information to the Nueces County Health Department and, where appropriate, coordinating media relations with the consortium. be put into place, If the clinic is'.art of a larger organization the media relations may • handled by the headquarters P10. M "12M Ile Doctor's Center 4 3.10.6 Communications with Patients and Family Members Refer to Section 3.12 of the Emergency Operations Plan (EOP) for Mental Health guidance. 9.10.7 The PIO will ensure that all public releases of information protect patient confidentiality. The Doctor's Center -4T- 43 The Doctor's Center Limit television viewing of terrorist events or other disasters and dispel any misconceptions or misinformation. 316-n. -n", 1141 3.14 Response to Internal Emergencies 3.14.1 An Internal Emergency is an event that causes or threatens to cause physical damage and injury to the clinic, personnel or patients. Examples are fire, explosion, hazardous materials releases, violence or bomb threat. External events may also create internal disasters. Ile folowing procedures provide guidance for initial actions for internal emergencies (refer to The Doctor's Center Fire Emergency Plan for complete infon-nation: C = Contain the smoke/fire by closing all doors to rooms ail corridors, Extinguish the fire if it is safe to do so Evacuate the faciHty if the. im cannot be »<¥# \¥«/ Level a X a»¥ evaluation » determine if the building 2 safe i occup »Le ± ¥w /lam evaluation that will address structural d age <d}} «c Ef <2 « +e » »2§ * \c2 <M w; d» »« w«2« < \ <+ « +± «w The Doctor's Center will maintain V fist of all hazardous ma &? and their MS DS, locations, and procedures for safe handling, containing and • Isolate area of spill and deny entry to building or area. Initiate fl. or hazmat cleanup notifications, as appropriate. • Obtain further instructions from the clinic Executive Director Safety Officer or refer to management guidance maintained at Doctor's' Ce»y»2± ID. I < ;* V XTWTM M44 974MM The clinic may be evacuated due to a fire or other occurrence, threat or order of the clinic Executive Director or designee. Refer to The Doctor's Center Facility Evacuation Plan for complete information. 3.14.4.1 The Doctor's Center will ensure the following instructions are conununicated to staff- a. All available staff members and other able-bodied persons should do everything possible to assist personnel at the location of the ©m or emergency in ©© removal of patients. The Doctor's Center 46 ne Doctor's Center 47 h. If the enviromnent is safe, station staff at clinic entrance to answer patient questions and make referrals. Tbe Doctor's Center i. Implement business recovery operations. Refer to Section 2.5, above, a. Close and secure the clinic until after the disaster has occurred. Ensure patients and visitors can return home safely. b. Allow clinic to remain fully or partially operational. Review plans and procedures. Update contact information. The Doctor's Center -A LI An External Disaster is an event that occurs in ®e community. Examples include earthquakes, floods, f i r e s , hazardous materials releases o r e rrorist events. An external disaster may directly impact the clinic, facility and its ability to operate. M » « «£ WJ W, WL M =#' I I a 177 M- 7 =0, 1. MV� lqlwt ItOT-frioPMEVI IM" The Doctor's Center relatively unaffected and remain viable options for sending assistance or receiving patients from the disaster area, In widespread emergencies, nearby medical resources are likely to be AMsTMIS My a-so % eriespoILKE pnontj' 1.L.0 cilics and other response assistance. 3.15.2 Weapons of Mass Destruction (WMD) If staff suspects an event involving CBRNE weapons has occurred, they should: Remain calm and isolate the victims to prevent further contaminatiR n within the facility. Contact the Medical Director, Nursing Director, or other appropriate clinician- � Comfort the victims. Contact appropriate Operational Area authorities, Terrorist use of Weapons of Mass Destruction may result in the release of radiation, hazardous materials and biological agents in proximity to the clinic. Shelter-In-Place may be the best strategy to minimize risk of exposure to these agents, 0=.-. The Doctor's Center TF 3.15-3.1 The Doctor's ►t bioterrorism incident ma I s Director rMedical Director due to- initiated clinic's ;� Government official notification of an outbreak within or near d1i Presentation of a patient with a suspected exposure to a bioterrorist agent. In case of presentation by a patient with suspected exposure to a bioterrorist agent, The Doctor's Center will follow current CDC response guidelines- ► l . i. R . . ! f & Sudden increase in the following non-specific illnesses: + Pneumonia, i or s o, Bleeding disorders. .w o Unexplained rashes, and mucosal or skin irritation, particularly in adults. • Neuromuscular illness, like muscle weakness and paralysis. !F Diarrhea. Simultaneous disease outbreaks in human and animal or bird populations. Unusual temporal or geographic clustering of illness (for example, patients who attended the same public event, live in the same part of town, -3.15.3.3 Infection Control Practices for Patient Management The Doctor's Center will use Standard Precautions to manage all patients, including symptomatic patients with suspected or coriffimett' The Doctor's Center Used patient-care equipment soiled or potentially contaminated with blood, dy fluids, secretions, or excretions \ handled in _ manner that prevents exposures to skin and mucous membranes, avoids contamination of clothing, an minimizes the likelihood #\ transfer of microbes er patients a«de«« «#?m The Doctor's Center has policies in lace 4 <» ®w that reusable equipment is not used for the care o another patient ^ until it has been appropriately dea¥T¥ and reprocessed, and to ensue that single-use patient items are appropriately s 4>» Sterilization a «§ required for al instruments or equipment that enter normally © ©je tissues *< through which blood flows. Contaminated «as « is sorted and discarded in accordance wi federal, state and local regulations. Policies < the prevention of occupational injury to exposure a blood o m « pathogens in accordance with Standard f< autiom ;» ¥1 :« ©rsa Precautions 4y in plat! : <, M / > « <Ar� b. Evidence to be collected could include clothing, suspicious packages, or other items that could contain evidence of contamination. At a minimum: The Doctor's Center has a supply of plastic bags, marking peas, and ties to secure the bags. Each individual evidence bag wilI be labeled with the patient's name, date of birth, medical record number, date of collection and site +/« /} § *m The Doctor's Center 54 The Doctor's Center *9tj& 4 t This phase includes activities taken to assess, manage and coordinate the recovery from an event as the situation returns to normal. These activities include: To continue providing the same cfficient service as was provided prior to the incident, The Doctor's Center will immediately begin gathering complete documentation including photographs. Depending on the event, it may be necessary to expedite resumption of health care services to address unmet community medical needs. :� .- M M-MMM, Ent-M-3-Mage IT osses. oi equipment using a current and complete list of equipment serial numbers, costs, and dates of inventory. One copy will be filed with the CFO and another copy in a secure offshe location. The Doctor's Center 56 The CFO will work with the Finance Section to document al. expenses incurred from the disaster. An audit trail will be developed to assist with qualifying for any Federal reimbursement or assistance available for costs and losses incurred by the clinic «<I result of the disaster. M= • prc-disaster design • pre-disas3 °« «?*« 3�< w= 2« Insurance Carriers - The Doctor's Center will file claims with its insurance companies for damage to the clinic. The clinic will not receive federal reimbursement for costs or losses that are reimbursed by the insurance carrier. Eligible costs not covered by the insurance carrier such as the © <? !ce deductible may be reimbursable. The Doctor's Center 4.6 Psychological Needs of Staff and Patients Mental health needs of patients and staff are likely to continue during the recovery phase. The Mental Health Coordinator will continue to monitor for and respond to the mental health needs of clinic staff and patients. 7= The Doctor's Center will take the fbilowing steps to restore services as rapidly as possible: a. If necessary, repair clinic facility or relocate services to a new or temRorary facility. b. Replace or repair damaged medical equipmenL c. Expedite structural and licensing inspections required to re-ope 3 d. Facilitate the return of medical care and other clinic staTtoaj SNME� , �,� The clinic recognizes that clinic staff and their fames are impacted by conununity-wide disasters. The clinic will assist staff in their recovery efforts to the extent possible. The Doctor's Center H. Collection S,te Name. THE DOCTOR'S CENTER Collection Site Code Address: 4637 VID Calleclor Phone No City. State and Zlpn CORPUS CHRISTI TX 78411 Collector Fax No,, SPECIMEN BOTTLEfS) RELEASED70- OQuem Diagnosticai Courier OredEx C3 Other NECEIVED AT LAB: X S,gno'sirl af WrrrW Accpstromr % Nano, lFem M1, Lsm) Dow Wo ID-W, r'.";ry owl I poa-dvo nw dow'i"Uo In me, 4~0,: the I ha« nor rdwaff,rowd q any mannv,- each NW&7wn bork. Uspamg Ph a janvw gm "IV p n040,t she 'Ind P. a. this xi and�: gh, LN000 ash —d 1. W.Ch grad ~ teffi. 4 > , X signmuff of OWN WANT) Donors Name 01fo M.: X41,, Otte lmo ,Ujv-� ow— pho� No be,4.0 phto. No Mato of Mob I mo k -4 top, ml gig u, ,!Pg,gL YES a1. NO LOCAL SMALL BUSINESS (LSB) ..... . . . . . ................. ............. igillillil lw I lomn f) aji WO I oi-SA-Au'a Roft) AR R74 COMPANY NAME. Id2le—m- - P. 0. BOX: STREETADDRESS, J4(P39 STID FIRM IS: 1. Co Azoration 2. Partnership 3. Sole Owner 4. ciation 5, Other 0 Name 11 21W.W..", RAT—TaxintheRbOV name Name Title 3. State the names of each "board member," of die City of Corpus Christi having an "ownership interese" constituting 3% or more orthe ownership in the above named Name 4. State the names of each employee or officer of a "consultant" ror the City of Corpus Christi who worked on any matter related to the subject of this contract and has an "ownership interest-7 conAtuting 3% or more of the ownership in the above named Name IA I'StIRIZffat 1DR I W the matter is apparent. The disclosure shall also be made in a signed writing filed with the City Secretary. [Ethics Ordinance Section 21-349 (d)] a. "Board member." A member of any board! commission, or committee appointed by the City Council of Ole City of Corpus Christi, Texas. b. "Lconomic benefit". An action that is likely to affect an economic interest if it is likely to have an effect on thw) interest that is distinguishable from its effect on members of the public in general or a substantial segment thereof.