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HomeMy WebLinkAbout25A - COMPREHENSIVE PHYSICAL EVALUATIONS (2)REQUEST FOR COUNCIL ACTION CITY COUNCIL MEETING DATE: AUGUST 3, 2009 TITLE: AGREEMENT FOR COMPREHENSIVE PHYSICAL EVALUATIONS, HEALTH SCREENING AND VACCINATIONS ~; ~ ~~ CITY MANAGER RECOMMENDED ACTION CLERK OF COUNCIL USE ONLY: APPROVED ^ As Recommended ^ As Amended ^ Ordinance on 1 S` Reading ^ Ordinance on 2"d Reading ^ Implementing Resolution ^ Set Public Hearing For_ CONTINUED TO FILE NUMBER Authorize the City Manager and Clerk of the Council to execute the attached agreement with Tustin-Irvine Medical Group, subject to non- substantive changes approved by the City Manager and City Attorney, in an amount not to exceed $70,000. DISCUSSION The City requires annual comprehensive physical evaluations for the Fire Department's sworn personnel and the Police Department offers the service to their personnel on a voluntary basis. The program provides one-on-one feedback, including recommended programs for physical improvements, methods to assist in the early detection and treatment of illnesses or injuries and to assist in minimizing time lost from them. The Tustin-Irvine Medical Group has provided these services for several years (Medical Center of Santa Ana merged operations with Tustin-Irvine during FY 2008/09). Additionally, the Personnel Services Agency, Risk Management Division, uses Tustin-Irvine Medical Group to evaluate and treat employees who may be exposed to communicable diseases. Also included in this agreement are annual low cost flu vaccinations for City employees, provided by the Personnel Services Agency, Employee Benefits Section. 25A-1 Agreement for Physical Examinations August 3, 2009 Page 2 FISCAL IMPACT Funds are budgeted in the fiscal year 2009-10 Fire Department, Fire Suppression, Other Contractual Services account (account no. 11-323- 6291, $55,000) and the Personnel Services, Risk Management, Other Personal Services (082-178-6191•; $10,000; and Employee Group Benefits, Benefit Payments Wellness account (account no. 81-177-6527, $5,000). APPROVED AS TO FUNDS AND ACCOUNTS: Gt/~dt~ C ~(/~ Marc Martin Fire Chief Fire Department -~~ Kathie Gonzalez Executive Director Personnel Services Agency Francisco Gutierrez Executive Director Finance & Management Services Agency _~ ~~ ~~. 25A-2 CONSUL'I'AV1' AGREEMF,NT 1-f-lIS AGREEMIN'I-, madc and entered into this ~`~ day of .August, 2009 by and between l ustin Irvine Medical Group, a professional corporation (hcreinatter'`Consultant"), and the Cl l~l` Ot--~ SA'~1T:~ AtiA. a charter city and municipal corporation organized and existing under the Constitution and lace s of the State of California (hereinafter "City"). RF.('1"1'A1.~ :'1. The City desires to retain a consultant having special skill and knowledge in the field of health services to provide comprehensive physical evaluations and communicable disease prevention. I3. Consultant represents that Consultant is able and w~illin~ to provide such services to the City. C. In undertakin~~ the perfom~ance ol•this .Agreement. Consultant represents that it is knoeelcdgcahlc in its field and that an}~ services performed by Consultant under this :1~~recment eeill be performed in compliance evith such standards as may reasonably be expected from a professional consulting tit-m in the field. ~O~V TII!';Rh,FORE. in consideration of-the mutual and respective promises, and subject to the terms and conditions hereinafter set forth, the parties agree as folloe~ s: SCOPF, OF SERVICES Consultant shall provide comprehensive physical examinations for all Fire sworn personnel and for those Police s~~-orn personnel ~~~ho elect to see Consultant as part of the annual evellness pro~~ram. as set forth in Exhibit .A. attached hereto and incorporated by this reference. ~~dditionalle. Consultant shall treat City personnel echo may be exposed to communicable diseases in their employment, as set forth in Exhibit E3, attached hereto and incorporated by this reference. Consultant eeill also provide an annual flu vaccination clinic for City employees. a. City a~~rees to pay, and Consultant agrees to accept as total payment for its services, the rates and charges identified in Exhibit A. The total sum to be expended under this Agreement shall not exceed X70.000.00 during the term of this Agreement. b. Payment by City shall be madc within thirty (3U) days following receipt of proper invoice cvicfencing eeurk performed. subject to City accounting procedures. Payment need nut be made for evork evhich tails to meet the standards of performance set forth in the Recitals which may reasonable be expected by Cite. 25~-3 ^I his agreement shall commence on July 1, 2009 and terminate on June 30, 2010, unless terminated earlier in accordance ~~ith Section 12. below. The term of this Agreement ma.' be extended upon a writing executed by the Firc Chief and the City Attorne~~. -1•. 1`UIi:YE\UH:1'1' CO'\'rIZACTOR Consultant shall. during the entire term oCthis Agrcemcnt, be construed to be an independent contractor and not an cmplo}~ce of the City. ~l"his Agreement is not intended nor shall it be construed to create an employer-employee relationship. a joint venture relationship, or to allow the City to exercise discretion or control over the professional manner in which Consultant perlorms the services which are the subject matter of this Agreement; however, the services to be provided by Consultant shall be pro ided in a manner consistent with all applicable standards and regulations go~crning such services. Consultant shall pay all salaries and ~~a~~cs. employer's social security taxes. unemployment insurance and similar taxes relating to employees and shall be responsible for all applicable withholding taxes. ~. INS[; i2,=ONCE Prior to undertaking performance of work under this .Agrcemcnt. Consultant shall maintain and shall require its subcontractors, if any. to obtain and maintain insurance as described below: a. Conunercial General Liability insurance. Consultant shall maintain commercial ~~eneral liahility insurance ~~hich shall include. but not be limited to protection against claims allsln`~ from bodily and personal injur}. including death resulting therefrom and damage to property . resultin~~ i~rorn anv act or occurrence arising out of Consultant's operations in the performance oC this Agreement. including. without limitation. acts im~olving vehicles. The amounts of" insurance shall be not less than the following: single limit coverage applying to bodily and personal injury, including death resulting therefrom, and property damage, in the total amount of $1.000.000 per occurrence, $2,000.000 in the aggregate. Such insurance shall (a) name the City, its oi~ticcrs. employees, agents, volunteers and representatives as additional insured(s): (b) be primary with respect to insurance or self=insurance programs maintained by the City: and (c) contain standard separation of insureds provisions. h. 13usincss automobile liability insurance, or equivalent form, «ith a combined single limit of not less than S 1.000.000 per occurrence. Such insurance shall include coverage for o~~ ned. hired and nun-owned automobiles. c. ~~'orker's Compensation Insurance. In accordance with the provisions of Section 3300 ofthc labor Code. Consultant. if Consultant has anv employees. is required to be insured against liability for ~~orker-s compensation or to undertake self=insurance. Prior to commencin~z the performance of the ~~ork under this ~'lgreement, Consultant agrees to obtain and maintain am~ ernplo.cr's liability insurance ~yith limits not less than SI.000,000 per accident. d. Professional liability (errors and omissions) insurance. with a combined single limit of not less than S 1.000,000 per claim. 2 5~-4 e. I he iollo~ying requirements apply to the insurance to be provided by Consultant pursuant to this section: (i) Consultant shall maintain all insurance required above in full force and effect for the entire period covered by this Agreement. (ii) Certificates of insurance shall be furnished to the City upon execution of this A~recment and shall be approved in form by the City Attorney. (iii) Certificates and policies shall state that the policies shall not be canceled or reduced in coverage or changed in any other material aspect without thirty (30) days prior ~yritten notice to the City. f. I1~Consultant lads or refuses to produce or maintain the insurance required by this section or lads or refuses to (~urnish the City with required proof that insurance has been procured and is in force and paid ior. the City shall hayc the right, at the City's election. to forthwith terminate this :~~zrecment. Such termination shall not effect Consultant's ri~~ht to be paid for its time and materials expended prior to notification of termination. Consultant waives the right to receive compensation and agrees to indemnil~} the City for any work performed prior to approval of insurance b~~ the Cite. 6. IVUENINIFIC~ITION Consultant agrees to and shall indemnii~~ and hold harmless the City. its officers. agents. employees, consultants, special counsel. and representatives Isom liability: (1) for personal injury. damagcs,.just compensation, restitution, judicial or equitable relief arising out of claims for personal injury. including health, and claims for property damage. which may arise from the direct or indirect operations of the Consultant or its contractors, subcontractors, agents. employees. or other persons acting on their behalf ~~hich relates to the services described in section 1 ol~this :`lgreement: and (2) Isom am claim that personal injury, damages. .just compensation. restitution. judicial or equitable relief is due by reason ol'the terms oi'or effects arisin~~ from this A~~reement. This indemnity and hold harmless agreement applies to all claims for damages. just compensation, restitution, judicial or cquitablc relief sui~fcred. or alleged to hay e been sul~lcred, h} reason oi'the events referred to in this Section or by reason of the terms ul~. or eliects. arisin~~ li-om this Agreement. The Consultant further agrees to indemnify. hold harmless. and pa~~ all costs for the defense of the City, including fees and costs for special counsel to be selected by the C: ity, regarding am action by a third party challenging the validity ol'this Agreement. or asserting that personal injury. damages. just compensation. restitution. judicial or cquitablc relief due to personal or property rights arises by reason of the terms ol; or effects arising from this :agreement. City may make all reasonable decisions with respect to its representation in am~ legal proceeding. 7. CO~VFIUh.NTIALITY Consultant shall conform to all HIPPA requirements regarding examinations performed by Consultant. I f Consultant receives from the Ciri~ information which due to the nature of such inlormation is reasonably understood to be confidential and/or proprietary. Consultant agrees Mat ll Shall nol use Ur disclose such information except in the performance of this Agreement. and i'urther a~~rees to exercise the; same degree of care it uses to protect its o~~m inlormation of~ 25i~-5 like importance. but in no event less than reasonable care. "Confidential Infiormation'~ shall include all nonpublic inlormation. Confidential information includes not only ~-ritten information. but also information transferred orally, ~ isuallti, electronically. or by other means. Confidential inlormation disclosed to either party by° any subsidiary and/or agent of the other party is covered by this A~reemcnt. "I~he foregoing obligations of non-use and nondisclosure shall not apply to any inl-ormation that (a} has been disclosed in publicly a~~ailablc sources; (b) is. throu~ah no fault of~ the Consultant disclosed in a publicly available source: (c) is in rightful possession oC the Consultant without an obligation of confidentiality; (d) is required to be disclosed b~ operation of law_ or (e) is independently developed by the Consultant without reference to inlormation disclosed by the City. CONFLICT OF INTEREST CLAUSE Consultant covenants that it presently has no interests and shall not have interests, direct or indirect. which would conflict in any manner with performance of services specitied under this A~rccmcnt. 9. NO'1'ICI? And notice. tender, demand. delivery. or other communication pursuant to this \~recment shall be in ~~ritin`~ and shall be deemed to be properly given if delivered in person or mailed b~ first class or certified mail. postaoc prepaid, or sent by tclcfacsimile or other telegraphic communication in the manner provided in this Section, to the follo~~~ing persons: fo Cite: Clerk of the City Council C`it~~ of Santa Ana 20 Civic Center Plaza (M-30) P.U. I3ox 1988 Santa Ana, C: A 92702-1988 telelacsimile (714) 647-6956 ~~~ith courtes~~ copies to: and l=ire Chief City of Santa Ana 1439 S. Broad~~av (M-80) Santa Ana. California 92702 tclcfacsimile (714) 647-779 Personnel Services Agency Risk !~'Ianagcment Division C'it~ of Santa Ana 20 Civic Center Plaza (1~~1-28) 1'.U. I3ox 1988 Santa ;~na. California 92702 tc;l~facsimile (714) 6~7-~31 I Chief of Police City of Santa Ana 60 Civic Center Plaza Santa Ana, California 92702 (714) 24~-8007 25A-6 I~o Consultant: Tustin Irvine Medical C3roup S00 ~~~. Tustin lvenuc, ~:A Santa :~na. California 9?70~ ~l~clcfacsimile (714) 28~-0400 1ttn: lZose Barrio A party may change its address b~ giving notice in ~~riting to the other party. Thereafter, anv communication shall be addressed and transmitted to the nevi address. If sent b~~ mail, cunununicatiun shall be elective or deemed to have been given three (i) days alter it has been deposited in the l;nited States mail, duly registered or certified, with postage prepaid, and addressed as set forth above. If sent by telefacsimilc, communication shall be effective or deemed to ha~c bccn given t~~cnt}-four (24j hours after the time set forth on the transmission report issued b~ the transmitting facsimile machine, addressed as set forth above. for purposes oi'calculatin` these time frames. ~~eekends. federal, state, County or Cite holidays shall be excluded. ~ , 10. I~:XCLI~SIVITI' :1ND :1VIENUME'.VT This :~greemcnt represents the complete and exclusive statement between the City and Consultant. and supersedes anv and all other a~recmcnts, oral or written. between the parties. In the event of a conflict bct~~~ecn the terms ol• this Agreement and any attachments hereto, the terms of this :agreement shall prevail. This Agreement may not be modified except by written instrument signed h~~ the (`ih~ and by an authorized representative of Consultant. 1~he parties agree that anv terms or conditions of any purchase order or other instrument that arc inconsistent ~~ith. ur in addition to. the terms and conditions hereof. shall not bind or obligate Consultant nor the C'it~. I~:ach party to this .1~recment ackno~~•Icdges that no representations. inducements. promises or a~~rrcmrnts. orally or other~~isc. hay c bccn made b_v an_v party. or anyone acting on behalf of any party .which are not embodied herein. 1 1. :15S1(;X Vl>4:\"I' lnasnwch as tlus Agreement is intended to secure the specialized services of Consultant, Consultant may not assign. transfer, delegate. ur subcontract any interest herein ~~~ithout the prior written consent of the City and any such assignment, transfer, delegation or subcontract ~~~ithout the City's prior ~~ritten consent shall be considered null and void.'~othing in this Agreement shall be construed to limit the City's ability to have any of the services which are the subject to this Agreement performed b~~ City personnel or by other consultants retained by City. 12. TI~:Iti\~IIX.aTI01\ This :1~~rcement n1a~~ be terminated by the City upon thirty (30) days written notice of termination. In such e~ cnt. Consultant shall be entitled to recciyc and the City shall pay Consultant compensation for all services performed b~ C'onsultant prior to receipt of-such notice of ternlination. subject to the tollo~~in~~ conditions: a. :~s a condition ofsuch pa~nlent. the F-:xecutive Director may require Consultant to deliver to the City all ~~~urk product completed as of such date. and in such case such work product shall be the propcrt~ uCthe City unless prohibited b~ la~~, and Consultant consents to the City's use thereof for Such purposes as the City deems appropriate. 25A-7 h. I?avmcnt need not be made for +vork which fails to meet the standard of performance specified in the Recitals of this ~1~~reement. 13. llISCI2IMIVA'I'101~ Cunsultarlt shall not discriminate because of race, color, creed, religion, sex, marital status. sexual orientation. aye. national oriy~in, ancestry, or disability, as defined and prohibited by applicable la+v. in the recruitment, selection, training, utilization, promotion, termination or other employment related activities. Consultant atfrms that it is an equal opportunity employer and shall comply +yith all applicable federal, state and local laws and regulations. 1-I. JURISDIC"1'lOV - ~'I~.NUE This :~~~rccment 11as been executed and delivered in the State of California and the validity. interpretation. performance. and enforcement of am of the clauses of this !lgreement shall be determined and ~zoverned by the laws of the State of California. Both parties further agree that Orange Count. California. shall be the venue for any action or proceeding that may be brou~~ht or arise out of. in connection ++~ith or by reason of this Agreement. 15. YI20FI:SS101\~V. LICF,NSES Consultant shall, throughout the term of this Agreement, maintain all necessary licenses. permits. approvals. waivers, and exemptions necessary for the provision of the services hereunder and required b+ the laws and regulations of the United States. the State of California. the City ol• Santa :~na and all other governmental agencies. Consultant shall notify the City immediately and in writing of its inability to obtain or maintain such permits, licenses, approvals. +yaivers. and exemptions. Said inability shall be cause for termination of this Agreement. 16. ~1ISCELLA'~EOI:S I'ItOVISIO'.VS a. }~:ach undersigned represents and +yarrants that its signature hereinbelow has the power, authority and ri~~ht to hind their respective parties to each of the terms of this Agreement. and shall inderrn~i(~ City liill+. includin~~ reasonable costs and attorney's lees, for any injuries or dama~~es to City in thr event that such authority or po++cr is not, in fact. held by the signatory or is withdra+tin. b. .~I1 I~:xhihits referenced herein and attached hereto shall be incorporated as if fully set torth in the bod+ of~this ~grccment. 25A-8 IN WITNESS WHEREOF, the parties hereto have executed this Agreement the date and year first above written. ATTEST: CITY OF SANTA ANA PATRICIA E. HEALY DAVID N. REAM Clerk of the Council City Manager APPROVED AS TO FORM: JOSEPH ~~'. FLETCHER City Attortley Bv: Teresa Judd Deputy City Attorney TUSTIN IRVINE MEDICAL GROUP -~ - ,• ` `., ~ lr J / //NAMEI / ~ ~ ' ~ > . l / i~~...f J? J ~ ., Lam. ~,/.~` ,r ,~....=~ t ~.._!..=~ L / ~~ (Title) ~-~ .. -- ~~, -" ~ ,r_ < 25A-9 EXHIBIT A I-lS"1"1~ 11Z~'INt: '\-1t-;DICr~I. G1tOUP shall provide comprehensive physical evaluations and additional tests as necessary. for all Santa Ana Fire Department sworn personnel as part of the annual ~yc(h~ess program. and for those Santa Ana Police Department sworn personnel who choose Medical Comer of"Santa :~na to perform the physical as part of the voluntary annual ~ycllnoss program'. as l~~llo~is: Comprehcnsi~~e Phi steal Evaluations that include: • Reyic~y the results oCthe Santa Ana College fitness assessment • Re~~ic~1 of employee-s detailed medical history • Rc~ ic~~ of the t~~elyc-]cad F.CG from ~radcd treadmill exercise test • I loi~~ht and wci~~ht measurements • Blood pressure and heart rate measurements • Roy icw of the screening procedures (listed below) • Roy icy o1" the body's medical systems. including cardiovascular, respiratory, gastrointestinal, genitourinary. endocrine, hematology and musculoskeletal Proposed Bid: $40.00 Screenint; Procedures include: • l'rinalysis • Ilcmocult • 1 loavy Metal Scrccnin~~ (blood~~orm) • ~f13 tort • Vision test • I learin~,~ lost • Chest X-Ra}~ (t~~o yic~~ys) • I~1tG reading b}~ cardiologist • Complete exam. which includes all components necessary in order to satisfy the DMV Conuncrcial Driyer~s License Class A Proposed 13id $1 10.00 Additional Testing • 1-1o~ible Si~~moidoscopy or Colonoscopy • "Treadmill -refer to Cardiologist • 1~ lu ~-'accinc (optional at omployer•s site) • 1'1'1 • "I otanus toxoid • 1 lopatitis 13 Surlace Antibodies (blood work) $200.00 i.A $20.00 $1.00 $20.00 $20.00 *Medical Center of Santa _~~na will not commence any evaluations of Police personnel tiles until it 1'CCeI~ l;5 nohee from the individual that he/she will be undergoing the physical at the Medical Ccntcr ot• Santa ;~na. s 25A-10 EXHIBIT B SCOPE: OF SF.RVICF,S l•l'S1 I\ 1R~'1\1 V1EllICAI. GROLIP shall perform communicable disease exposure services, includiny~ the following. for City of Santa Ana personnel as requested by the Executive Director of Personnel Services or his designee: Evalt-ation Ollicc Visit (follow Up Visits as neccssar_v) Respirator Exams Pulmonar~~ ]unction ~l~cst I:KG L~ ;1 (Culture c'~, Sensitivity if•ncccssarv) Post l~:xhusure ~f13 SCl'eCn (including any necessar` x-rays) Post i-:~hosur~ I3(ood Screens (including HIV, Hepatitis A ! B / C) I lea~~~ ;A~lctal ~festin~ Blood Lead I.e~ el Rubella Titer Ruhcola l~itcr Varicella Titer Wound Culture & Sensitivity Vaccines (as required) -ledications (as required) CO'\'I P1_~:'~ S ~VI 101\ Consultant shall he compensated for all services rendered as set forth in the Schedule of Pees (I:XHII31~1 I3)* 9 25A-11 LXHIBI"1' B I''EE SCI-II:DULE ~o 25A-12 Protocol: EXPOSURE S 99000 LABC&H COLLECTION AND HANDLING 20.00 93000 TSEKG EKG W/Interpretation 50.00 99205 OVNPComp* OV COMPREHENSIVE, NEW 186.73 99215 93 OVComp/Inter OV COMPREHN,EST/INTERPET 103.86 99204 OVNPExt* OV EXTENDED, NEW 146.12 99202 OVNPLim* OV LIlVIITED, NEW 70.19. '~~, : ~ 87340-C LAB3416 -LAB IMP A8cB PANEL #3416~:*3~- 58.00 83655 LABS99* LAB BLOOD LEAD#599 QUESTLAB 37.00 86787 LAB4439 LAB VARICELLA*TITER IgG#443912008 48.00 86762 LAB802 LAB RUBELLA IGG AB*TTTER#802/2008 25.05 86703-1 LAB19728 LAB HIV 1/2 AB W/RFIS#19728* 37.05 82300 3460 LAB CADMIUM BLD#3470 PACTOX 60.00 Employer 82495 3470 LAB CHROMIUM BLD#3470 PACTOX 45.00 82495-A LAB3080 LAB CHROMIUM URINE(PACTOX)~ 115.00 87086 LABCuIUrine LAB CULTURE & SENSTf(ITRINE) 43,65 86765 LAB964 LAB MEASL/RUBEO*TI'I~R#964/2008 28.00 83825 LABMercuryBl LAB MERCURY BLOOD 180.00 Employer 83825 LABMcrcuryUr LAB MERCURY URINE 21.44 84202 LABZZP LAB ZZP-ZINC PROTOPRPH BLD LAB 82.00 85025 LA136399 LAB CBC (DIFF/PLT) #6399* 15.00 80053 LAB 10231 LAB COMP METABOLIC PANEL 25.00 86709 LAB86709P LAB HEP A IgM ANTIBODY#S12*P 26.50 86705 LAB4848P LAB HEP B CORE IGM AB#4848*P 30.00 87340 LAB498P LAB HEP BSURF ANTG W/CONF#49$*P 17.32 86803 LAB8472P LAB HEP C VIRUS AntiBod #8472*P 27.30 90658 VXFIu FLU VACCINE (3 Yrs & Above) 20A0 90707 V'XMMIZ MMR VACCINE 76.00 90704 V~vlumps MUMPS VIRUS VACCINE, LIVE 30.00 99070/13 MSRespQues Respiratory Questionnaire 20.00 94010 TSSpirometry SPIROMETRY 20.00 86580 TBPPDintrad TB Test Intraderrmal (PPD) 12,00 25A-13 Date 03/23/09 s' ~-c ~'..~ 4; c~,m~~y: I'~ ~ i i n Ir~~i,ic ?<'lcdicalGroup C. TY OP SANTA ANA - EXPOSURES/LYNN HWE P.O. IsOX i 988, M-~1 SANTA ANA, CA 92702 Protocol: .EXPOSURE S Page 2 9G713-A 90718-,~ Tetanus & Diptheria AbsorbedlAduit WC 40.00 90716 VXVaricella VARICELLA/Chicken Pox Vaccine 135.00 1'~52G0 O~: ~V;;u~,cCinr WOUND CLEANSER, ANY TYPE 20.00 31 GO1 1. ~~ '' `::' i !- URINALYSIS WITH MICRO 1fl.00 71(?ZO X::.:..~:;:?~,~ XIZ CI•IEST2 VIEWS 60.00 Bill To Name: CITY OF SANTA ANA -EXPOSURES :1r':i~ess: LYNN IIWANG P.O. BOX 1988, M-41 S: `.:~Tf'~ ANA, CA 92702 ]'ax:• ;~;} t,:,7_~994 LIIWANGLSANTA-ANA.ORG Crntact: L1`Niti' HWANG BACK OFFICE: FOR B L:. C~ll130RNI:1':'~. " `_)G E'~ EXPOSURES ALWAYS DO BLOODWORIt THIS SHOULD INCLUDE A CI :r '; CHIP, HIiP ,1., ' :, A:~~;) I.11v. it WITHIN THE GOLDENHOUR AND DOCTOR WANTS TO DTSi'i;\SE COMBI~-'I .Z, YC)U MAY GIVE THE EXPOSED EMPLOYEE ONE OR TWO PILLS. TI~IF,Rr~'.• ^~' -"`' ~r ~'•P TIT,'" ~Eli~_'S TO BE CALLED INTO THE PHARMACY. MEI)ICATTO.NS: W liTity C'_LL1NG IN T,i I:1>! t:AT1ON TRY 1'0 USE RTI'E-AID , SAV-ON OR WALGREENS. MAT<lw :'1 '•:OTfi OP THE 1': i:~IZ.vIAGY NUMBER IN TIC PATIENTS FILE AND ON THE FRONT SCREEN OI~ 'I'I1 i "C1?.4PLUTE FC Z FCs'Ct. RE tiSE. ALSO GET THE PI~ARMACY'S FAX NUMBER SOTHAT DEil-l;~G?2t1PHICS AN D B ILLING/CLAIM INFORMATION CAN BE FAXED TO THEM. 25A-14 Other: Eax: Speeiai Instructions: FYtONT OFFICE: FAX MSU (14ARKL•'D 1~;•:!'USL`RE) AND OTHEIZPAPERWORKTO LYNNHWANG AT ABOVE NUMBER. '1'11i>>1 E-MAIL Ll'N' : 1I~'~%:~IQG WI"1'H INFORMATION ABOUT THE EXPOSURE.