Providence Occupational Medical Group ~ C160047 City of Tigard- Contract Summary Form
(Form must accompany every contract
Contract Title: C" "�. �,�r�€) Number
Contractor: Providence Occupational Medical Group Contract Total: $ 5,000.00
Summary Overview: Providence to provide pre-employment physical capacities testing for specfied
Positions.
Initial Risk Level: ❑ Extreme ❑ High ❑ Moderate ❑ Low
Risk Reduction Steps:
Risk Comments:
Risk Approval:
Contract Mgr: Brandi Leos Ext: 2407 Dept: Human Resources
Type: ❑ Purchase Agreement ❑ Personal Service 59 General Service ❑ Public Improvement
❑ IGA ❑ Other: Start: 3/17/2016 End: 12/31/2016
Firm Amount/Score
Quotes/Bids/Proposals:
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Account String Fund-Division-Account Work Order-Activity Type Amount
Year 1 Do not encumber �.�CA-
Year
A Year 2 T J
Year 3
Year 4
Year 5
Approvals LCRB Date
Department Comments:
Department Signature: ()//slz>z-�
Contracting Comments:
Contracting Signatur
City Manager Comments: r
City Manager Signature:
Contract `7
CITY OF TIGARD,OREGON
AGREEMENT FOR SERVICES RELATED TO
OCCUPATIONAL MEDICINE SERVICES
THIS AGREEMENT made and entered into this 22"d day of March, 2016 by and between the City
of Tigard, a municipal corporation of the State of Oregon, hereinafter called "City", and Providence
Occupational Medical Group,hereinafter called"Contractor",collectively known as the"Parties."
RECITALS
WHEREAS,Contractor has submitted a bid or proposal to City to provide specific services;and
WHEREAS, Contractor is in the business of providing specific services and is aware of the
purposes for which City requires the services; and
WHEREAS, City and Contractor wish to enter into a contract under which City shall purchase the
services described in Contractor's bid or proposal;
THEREFORE,The Parties agree as follows:
1. SERVICES TO BE PROVIDED
Contractor agrees to provide services related to pre-employment testing as detailed in Exhibit
A—Scope of Services and by this reference made a part hereof.
2. EFFECTIVE DATE AND DURATION
Contractor shall initiate services upon receipt of City's notice to proceed, together with an
executed copy of this Agreement. This Agreement shall become effective upon the date of
execution and shall expire, unless otherwise terminated or extended, on December 31, 2016.
All services shall be completed prior to the expiration of this Agreement.
3. COMPENSATION
City agrees to pay Contractor an amount not exceeding Five Thousand and No/100 dollars
($5,000.00) for performance of those services described herein, which payment shall be based
upon the following applicable terms:
A. Payment will be made in installments based on Contractor's invoice, subject to the
approval by the City, and not more frequently than monthly. Payment shall be made
only for work actually completed as of the date of invoice.
B. Payment by City shall release City from any further obligation for payment to
Contractor, for services performed or expenses incurred as of the date of the invoice.
Payment shall not be considered acceptance or approval of any work or waiver of any
defects therein.
C. Contractor shall make payments promptly, as due, to all persons supplying labor or
materials for the prosecution of this work.
D. Contractor shall not permit any lien or claim to be filed or prosecuted against the City on
any account of any labor or material furnished.
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E. Contractor shall pay to the Department of Revenue all sums withheld from employees
pursuant to ORS 316.167.
F. If Contractor fails,neglects or refuses to make prompt payment of any claim for labor or
services furnished to Contractor or a subcontractor by any person as such claim
becomes due, City may pay such claim and charge the amount of the payment against
funds due or to become due the Contractor. The payment of the claim in this manner
shall not relieve Contractor or their surety from obligation with respect to any unpaid
claims.
G. Contractor shall pay employees at least time and a half pay for all overtime worked in
excess of 40 hours in any one work week except for individuals under the contract who
are excluded under ORS 653.010 to 653.261 or under 29 USC sections 201 to 209 from
receiving overtime.
H. Contractor shall promptly, as due, make payment to any person, co-partnership,
association or corporation, furnishing medical, surgical, hospital care or other needed
care and attention incident to sickness or injury to the employees of Contractor or all
sums which Contractor agrees to pay for such services and all moneys and sums which
Contractor collected or deducted from the wages of employees pursuant to any law,
contract or agreement for the purpose of providing or paying for such service.
I. The City certifies that sufficient funds are available and authorized for expenditure to
finance costs of this contract during the current fiscal year. Appropriations for future fiscal
years shall be subject to budget approval by the City Council.
4. ASSIGNMENT/DELEGATION
Neither party shall assign or transfer any interest in or duty under this Agreement without the
written consent of the other and any attempted assignment or transfer without the written
consent of the other party shall be invalid.
5. SUBMITTING BILLS AND MAKING PAYMENTS
All notices and bills shall be made in writing and may be given by personal delivery,mail or fax.
Payments may be made by personal delivery, mail, or electronic transfer. The following
addresses shall be used to transmit notices,bills,payments,and other information:
CI-n-OF TIG9RD PROVIDENCE OCCUPATIONAL MED.GRP
Attn:Brandi Leos Attn: Laura Cook
Address: 13125 SW Hall Boulevard Address: 4035 SW Mercantile Dr Ste 108
Tigard, Oregon 97223 Lake Oswego, OR 97035
Phone: (503) 718-2407 Phone: (503) 216-7930
Fax: (503) 639-6795 Fax: (503) 216-7915
Email: brands ci),tigard-onggv Email: laura.cook(cr)pro-,Jdence.or
6. TERMINATION
The parties agree that any decision by either party to terminate this Agreement before the
31" day of December, 2016 shall be accompanied by thirty (30) days written notice to the
other party prior to the date termination would take effect. There shall be no penalty for
early termination. If City terminates the contract pursuant to this paragraph, it shall pay
Contractor for services rendered prorated to the date of termination.
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7. ACCESS TO RECORDS
City shall have access to such books, documents, papers and records of Contractor as are
directly pertinent to this Agreement for the purpose of making audit,examination, excerpts and
transcripts.
8. FORCE MMEURE
Neither City nor Contractor shall be considered in default because of any delays in completion
and responsibilities hereunder due to causes beyond the control and without fault or negligence
on the part of the parties so disenabled, including but not restricted to, natural disaster, war,
civil unrest, volcano, earthquake, fire, flood, epidemic, quarantine restriction, area-wide strike,
freight embargo, unusually severe weather or delay of subcontractor or supplies due to such
cause; provided that the parties so disenabled shall within ten (10) days from the beginning of
such delay,notify the other party in writing of the cause of delay and its probable extent. Such
notification shall not be the basis for a claim for additional compensation. Each party shall,
however,make all reasonable efforts to remove or eliminate such a cause of delay or default and
shall, upon cessation of the cause, diligently pursue performance of its obligation under the
Agreement.
9. NON-DISCRIMINATION
Contractor agrees to comply with all applicable requirements of federal and state civil rights and
rehabilitation statues, rules, and regulations. Contractor also shall comply with the Americans
with Disabilities Act of 1990, ORS 659A.142, and all regulations and administrative rules
established pursuant to those laws.
10. INDEMNITY
Contractor agrees to and shall defend, indemnify and hold harmless City, City's officers,
employees, agents and representatives from and against all liability, claims, costs, demands,
judgments, penalties, and causes of action of any kind or character, or other costs or
expenses incidental to the investigation and defense thereof, of whatever nature, resulting
from or arising out of the activities of the Contractor or its subcontractors, agents, or
employees in performance of this contract, except, however, that the foregoing shall not
apply to liability that arises out of the City's, its officers, employees, agents and
representatives sole negligence. If any aspect of this indemnity shall be found to be illegal or
invalid for any reason whatsoever, such illegality or invalidity shall not affect the remainder
of this indemnification.
11. INSURANCE
Contractor shall maintain insurance acceptable to City in full force and effect throughout the
term of this contract. Such insurance shall cover risks arising directly or indirectly out of
Contractor's activities or work hereunder.
The policy or policies of insurance maintained by the Contractor shall provide at least the
following limits and coverages:
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A. Commercial General Liability Insurance
Contractor shall obtain, at contractor's expense, and keep in effect during the term of
this contract, Comprehensive General Liability Insurance covering Bodily Injury and
Property Damage on an "occurrence" form (CG 2010 1185 or equivalent). This
coverage shall include Contractual Liability insurance for the indemnity provided under
this contract. The following insurance will be carried:
Coverage Limit
General Aggregate 3,000,000
Products-Completed Operations Aggregate 2,000,000
Personal&Advertising Injury 1,000,000
Each Occurrence 2,000,000
Fire Damage (any one fire) 50,000
B. Commercial Automobile Insurance
Contractor shall also obtain, at contractor's expense, and keep in effect during the term of
the contract, Commercial Automobile Liability coverage including coverage for all owned,
hired, and non-owned vehicles on an "occurrence" form. The Combined Single Limit per
occurrence shall not be less than$2,000,000.
If Contractor uses a personally-owned vehicle for business use under this contract, the
Contractor shall obtain, at Contractor's expense, and keep in effect during the term of the
contract, business automobile liability coverage for all owned vehicles on an "occurrence"
form. The Combined Single Limit per occurrence shall not be less than $2,000,000.
C. Workers' Compensation Insurance
The contractor, its Subcontractors, if any, and all employers providing work, labor, or
materials under this Contract that are subject employers under the Oregon Workers'
Compensation Law shall comply with ORS 656.017, which requires them to provide
workers' compensation coverage that satisfies Oregon law for all their subject workers.
Out-of-state employers must provide Oregon workers' compensation coverage for their
workers who work at a single location within Oregon for more than 30 days in a
calendar year. Contractors who perform work without the assistance or labor of any
employee need not obtain workers' compensation coverage. All non-exempt employers
shall provide Employer's Liability Insurance with coverage limits of not less than
$1,000,000 each accident.
D. Additional Insured Provision
All policies aforementioned, other than Workers' Compensation and Professional
Liability, shall include the City its officers, employees, agents and representatives as
additional insureds with respect to this contract.
E. Insurance Carrier Rating
Coverages provided by the Contractor must be underwritten by an insurance company
deemed acceptable by the City. All policies of insurance must be written by companies
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having an A.M. Best rating of "A-VII" or better, or equivalent. The City reserves the
right to reject all or any insurance carrier(s)with an unacceptable financial rating.
F. Self-Insurance
The City understands that some Contractors may self-insure for business risks and the
City will consider whether such self-insurance is acceptable if it meets the minimum
insurance requirements for the type of coverage required. If the Contractor is self-
insured for commercial general liability or automobile liability insurance the Contractor
must provide evidence of such self-insurance. The Contractor must provide a Certificate
of Insurance showing evidence of the coverage amounts on a form acceptable to the
City. The City reserves the right in its sole discretion to determine whether self-
insurance is adequate.
G. Certificates of Insurance
As evidence of the insurance coverage required by the contract, the Contractor shall
furnish a Certificate of Insurance to the City. No contract shall be effective until the
required Certificates of Insurance have been received and approved by the City. The
certificate will specify and document all provisions within this contract and include a
copy of Additional Insured Endorsement. A renewal certificate will be sent to the below
address prior to coverage expiration.
H. Independent Contractor Status
The service or services to be rendered under this contract are those of an independent
contractor. Contractor is not an officer, employee or agent of the City as those terms are
used in ORS 30.265.
I. Primary Coverage Clarification
The parties agree that Contractor's coverage shall be primary to the extent permitted by law.
The parties further agree that other insurance maintained by the City is excess and not
contributory insurance with the insurance required in this section.
J. Cross-Liability Clause
A cross-liability clause or separation of insureds clause will be included in all general liability,
professional liability,pollution and errors and omissions policies required by this contract.
A certificate in form satisfactory to the City certifying to the issuance of such insurance will be
forwarded to:
City of Tigard
Attn: Contracts and Purchasing Office
13125 SW Hall Blvd.
Tigard,Oregon 97223
At the discretion of the City, a copy of each insurance policy, certified as a true copy by an
authorized representative of the issuing insurance company may be required to be forwarded to
the above address.
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Such policies or certificates must be delivered prior to commencement of the work. The
procuring of such required insurance shall not be construed to limit contractor's liability
hereunder. Notwithstanding said insurance, Contractor shall be obligated for the total amount
of any damage,injury,or loss caused by negligence or neglect connected with this contract.
12. ATTORNEY'S FEES
In case suit or action is instituted to enforce the provisions of this contract, the parties agree
that the losing party shall pay such sum as the court may adjudge reasonable attorney fees and
court costs, including witness fees (expert and non-expert), attorney's fees and court costs on
appeal.
13. COMPLIANCE WITH STATE AND FEDERAL LAWS/RULES
Contractor shall comply with all applicable federal, state and local laws,rules and regulations,
including, but not limited to, the requirements concerning working hours, overtime, medical
care, workers compensation insurance, health care payments, payments to employees and
subcontractors and income tax withholding contained in ORS Chapters 279A, 279B, and
279C,the provisions of which are hereby made a part of this agreement.
14. CITY OF TIGARD BUSINESS LICENSE
Contractor shall obtain,prior to the execution of any performance under this Agreement,a City
of Tigard Business License. The Tigard Business License is based on a calendar year with a
December 31st expiration date. New businesses operating in Tigard after June 30th of the
current year will pay a pro-rated fee though the end of the calendar year.
15. CONFLICT BETWEEN TERMS
It is further expressly agreed by and between the parties hereto that should there be any conflict
between the terms of this instrument in the proposal of the contract, this instrument shall
control and nothing herein shall be considered as an acceptance of the terms of proposal
conflicting herewith.
16. SEVERABILITY
In the event any provision or portion of this Agreement is held to be unenforceable or invalid
by any court of competent jurisdiction, the validity of the remaining terms and provisions shall
not be affected to the extent that it did not materially affect the intent of the parties when they
entered into the agreement.
17. REPRESENTATIONS AND WARRANTIES
Contractor represents and warrants to the City that:
A. Contractor has the power and authority to enter into and perform this Agreement.
B. This Agreement, when executed and delivered, is a valid and binding obligation of
Contractor,enforceable in accordance with its terms.
C. Contractor (to the best of Contractor's knowledge, after due inquiry), for a period of no
fewer than six calendar years (or since the firm's inception if less than that) preceding the
effective date of this Agreement, faithfully has complied with:
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1) All tax laws of this state, including but not limited to ORS 305.620 and ORS
chapters 316, 317,and 318;
2) Any tax provisions imposed by a political subdivision of this state that applied to
Contractor, to Contractor's property, operations, receipts, or income, or to
Contractor's performance of or compensation for any work performed by
Contractor;
3) Any tax provisions imposed by a political subdivision of this state that applied to
Contractor, or to goods, services, or property, whether tangible or intangible,
provided by Contractor; and
4) Any rules, regulations, charter provisions, or ordinances that implemented or
enforced any of the foregoing tax laws or provisions.
D. Any intellectual property rights or such delivered to the City under this Agreement, and
Contractor's services rendered in the performance of Contractor's obligations under this
Agreement, shall be provided to the City free and clear of any and all restrictions on or
conditions of use, transfer, modification, or assignment, and shall be free and clear of
any and all liens, claims, mortgages, security interests, liabilities, charges, and
encumbrances of any kind.
18. COMPLIANCE WITH TAX LAWS
A. Contractor must, throughout the duration of this Agreement and any extensions, comply
with all tax laws of this state and all applicable tax laws of any political subdivision of the
State of Oregon. For the purposes of this Section, "tax laws" includes all the provisions
described in subsection 25.C. 1) through 4) of this Agreement.
B. Any violation of subsection A of this section shall constitute a material breach of this
Agreement. Further, any violation of Contractor's warranty, in subsection 25.0 of this
Agreement that the Contractor has complied with the tax laws of the State of Oregon and
the applicable tax laws of any political subdivision of this state also shall constitute a
material breach of this Agreement. Any violation shall entitle the City to terminate this
Agreement, to pursue and recover any and all damages that arise from the breach and the
termination of this Agreement, and to pursue any or all of the remedies available under
this Agreement,at law,or in equity,including but not limited to:
1) Termination of this Agreement,in whole or in part;
2) Exercise of the right of setoff, and withholding of amounts otherwise due and owing
to Contractor,in an amount equal to State's setoff right,without penalty;and
3) Initiation of an action or proceeding for damages, specific performance, declaratory
or injunctive relief. The City shall be entitled to recover any and all damages
suffered as the result of Contractor's breach of this Agreement, including but not
limited to direct, indirect, incidental and consequential damages, costs of cure, and
costs incurred in securing a replacement Contractor.
These remedies are cumulative to the extent the remedies are not inconsistent, and the City
may pursue any remedy or remedies singly, collectively, successively, or in any order
whatsoever.
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19. COMPLETE AGREEMENT
This Agreement,including the exhibits,is intended both as a final expression of the Agreement
between the Parties and as a complete and exclusive statement of the terms. In the event of an
inconsistency between a provision in the main body of the Agreement and a provision in the
Exhibits, the provision in the main body of the Agreement shall control. In the event of an
inconsistency between Exhibit A and Exhibit B,Exhibit A shall control.
No waiver, consent,modification,or change of terms of this Agreement shall bind either party
unless in writing and signed by both parties. Such waiver, consent, modification, or change if
made, shall be effective only in specific instances and for the specific purpose given. There are
no understandings, agreements, or representations, oral or written, not specified herein
regarding this Agreement. Contractor,by the signature of its authorized representative,hereby
acknowledges that he/she has read this Agreement, understands it and agrees to be bound by
its terms and conditions.
IN WITNESS WHEREOF, City has caused this Agreement to be executed by its duly authorized
undersigned officer and Contractor has executed this Agreement on the date hereinabove first written.
CITY OF,�IGARD PROVIDENCE OCCUPATIONAL MED GRP
By:Authorized City Representative y: David Golda,Program Director
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Date Date
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EXHIBIT A
SCOPE OF SERVICES
Test Administration
Scheduling Appointments
The candidate/examinee shall:
1. Contact the Consultant Agency by calling 503-216-7960 within three business days to arrange
an appointment at a desired clinic location.
Administering the Test
The consultant shall adhere to the following process:
1. Upon arrival at the clinic, the candidate/examinee is registered by the front desk staff and
directed to complete any required forms.
2. After registration, the candidate/examinee is then escorted to the back office where any
necessary ancillary services are performed by a certified Medical Assistant or Technicians (i.e.
height, weight, blood pressure, vision screens, hearing tests, lung function tests, etc.). A
qualified medial provider will complete the additional aspects of the pre-screen medial
evaluation,including administering a drug test and other medical tests as may be necessary.
3. After the pre-screen medical evaluation with the medical provider, the examinee is escorted to
the to the physical capacity room where the remainder of the examination will be performed
by a certified Medical Assistant.
4. The process typically takes 45 minutes to one hour.
5. Upon completion of the appointment the front desk staff assists the examinee in "checking
out".
Reporting Examination Results
The consultant shall:
1. Following test completion, process records and reports and send results to the identified City
of Tigard Human Resources designee.
2. Certify and provide results from the examination/evaluation to the City within two (2)
business days or when lab and ancillary results are available.
3. Provide results to the City of Tigard in a one page report which indicates one of the following:
a) Pre-screen medical and baseline test results:
I. The individual may perform the job without restrictions.
II. Limitations are identified in this individual's ability to perform the job: (limitations
noted)
b) PCE test results:
I. The examinee is cleared to perform the job without restriction/accommodations; or,
II. Identification of limitations and accommodation(s); or,
c) Determination Pending review of requested medical records
Further evaluation is necessary,which may include additional testing, or review of
requested medical records.
4. Restrict protected health information from the report provided to the City of Tigard.
5. NOT provide examinees a copy of the report, nor give information about the results, unless
special instructions to do so are provided by the City of Tigard.
6. Make available providers and staff to answer questions the City of Tigard contact may have
regarding the examinations,within the allowances of HIPPA.
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Time Commitments
The consultant shall:
1. Complete the conditional post-offer evaluation in one visit unless, based on a specific
examinee's medical history,additional medical information is needed.
2. Obtain the necessary release from the examinee and request records as appropriate.
3. Review records within one to two business days of receipt, and issue a final report of findings
within two business day of review OR when required contact candidate/examinee to return to
complete final testing phases.
Records Administration
The consultant shall:
1. Maintain physical custody of all medical records and retain all records relating to Tigard
business for at least 5 years after termination or cancellation of the Agreement or,if later,until
any related pending proceeding or litigation has been closed.
2. Archive records per the State's record retention schedule. (Medical records may be maintained
by the consultant electronically,provided the consultant has confirmed the format conforms
to specifications required by City of Tigard for transfer of records.)
3. Warranty that consultant is knowledgeable of HIPAA and the protection of health
information obtained, created,or exchanged as a part of a contract with the City,and shall
abide by and implement HIPAA's statutory requirements.
4. Assist the City,when requested,in responding to claims/appeals that may be filed as a result
of disqualification or conditional pass of an applicant/employee, including but not limited to:
administrative hearings, courts of competent jurisdiction,quasi-legal,and quasi-judicial
hearings.
Other On-Site Services
The consultant may:
1. Provide on-site training as requested by the city in areas such as wellness program training and
support, ergonomics,etc.
2. Provide other services such as ergonomic evaluations, or other related services as agreed upon
by the consultant and the City of Tigard.
Fee Schedule
The city shall remunerate the consultant agency as follows:
DOT Medical Exams—New DOT Medical Exams—Recertifications
DOT Medical Exam-$85.00 DOT Medical Exam-$85.00
Audiogram-$25.00 Audiogram-$25.00
Accucheck-$15.00 Accucheck-$15.00
ECG-$65.00 ECG-$65.00
Record Review Brief-$25.00 Record Review Brief-$25.00
Record Review Extended-$50.00 Record Review Extended-$50.00
Exam Brief Follow-Up-$55.00 Exam Brief Follow-Up-$55.00
No Show DOT Exam Fee-$85.00 No Show DOT Exam Fee-$85.00
Customer Service Field Worker FBI Candidate Exam
Pre-placement Exam-$70.00 Pre-placement Exam-$70.00
NON DOT Drug Screen Collection—this is billed TB Skin Test-$28.00
directly to BioMed ECG-$65.00
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Record Review Brief-$25.00 ECG Stress Treadmill-$250.00
Record Review Extended-$50.00 Company Forms 1-5 pages-$15.00
Exam Brief Follow-Up-$55.00 Record Review Brief-$25.00
No Show Pre-placement Exam Fee-$70.00 Record Review Extended-$50.00
Exam Brief Follow-Up-$55.00
No Show Pre-placement Exam Fee-$70.00
Utility Worker-Parks Utility Worker-All Other
Pre-placement Exam-$70.00 Pre-placement Exam-$70.00
PCT Standard-$63.00 PCT Standard-$63.00
Audiogram-$25.00 Audiogram-$25.00
DOT Qualification-$25.00 DOT Qualification-$25.00
DOT Drug Screen Collection-this is billed directly to DOT Drug Screen Collection-this is billed directly to
BioMed BioMed
Accucheck-$15.00 Accucheck-$15.00
ECG-$65.00 ECG-$65.00
Record Review Brief-$25.00 Record Review Brief-$25.00
Record Review Extended-$50.00 Record Review Extended-$50.00
Exam Brief Follow-Up-$55.00 Exam Brief Follow-Up-$55.00
No Show Pre-placement Exam Fee-$70.00 No Show Pre-placement Exam Fee-$70.00
Seasonal Worker Pre-placement Police Exam-DPSST
Pre-placement Exam-$70.00 Exam DPSST-$80.00
NON DOT Drug Screen Collection-this is billed Audiogram-$25.00
directly to BioMed Spirometry-$36.00
Audiogram-$25.00 Titmus-$25.00
Record Review Brief-$25.00 Ishihara-$10.00
Record Review Extended-$50.00 NON DOT Drug Screen Collection-this is billed
Exam Brief Follow-Up-$55.00 directly to BioMed
No Show Pre-placement Exam Fee-$70.00 Venipuncture-$15.00
Comprehensive Metabolic Panel-$33.00
Blood Count-$22.00
Blood Typing ABO-$25.00
UA Dip-$15.00
UA Dip w/Micro-$20.00
Chest X-Ray-$95.00
Record Review Brief-$25.00
Record Review Extended-$50.00
Exam Brief Follow-Up-$55.00
No Show DPSST Exam Fee-$80.00
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Invoicing
The consultant shall:
1. Not transmit invoices or test results,which have date of birth and partial social security
number,via electronic systems.
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