Service Agreement - Public Safety Medical - 2018 Firefighters Annual Physicals

Home Browse Search

Assignability Th,isAgnement is not assignable, Right to Receive Notice of Breach As required by the Health Insurance Portability and Accountability Act (HIPAA), PSM will provide a written notice to all South Bond Fire Department employees in the event we learn ofany unauthorized uuqmisibun, use or disclosure ofyour personal health information (PH|)as aresult nfnot being properly secured merequired byH|PAA. We will notify employees of the breach as soon as possible but no later than sixty (60) days after the breach has been discovered. PBN1 will incur aUU expenses for notification and actions necessary to correct breach. Policy on Additional Testing |nthe event that PSPNfinds hnecessary at South Bend Fire Department expense and etthe request of the medical director, the South Bend Fire Department representative wflI be notified in advance. Policy oVRepeat Testing [nthe event that P8kHfinds itnecessary toretestapatient due hmmpositive test result urthe recommendation mf the PSPNmedical director, the cost incurred will be billed to South Bend Fire Department if the retest was not based upon anerror onthe original test. The South Bend Fire Department representative will benotified in advance, If the retest is due to an error by PSM or a contracted laboratory or other representative, PSM will absorb any additional retest costs. No recommended actions will be made to South Bend Fire Department until PSM has received accurate retest information. Policy on Reporting Results PSM will provide a medical/respirator clearance letter for every patient. The letter will state whether or not the employeeis medicallyU d for duty, representative without the written consent of the patient unless reguired by law (ie. OSHA). If during the medical evaluation, findings are such that the patient cannot be medicalIy-cleared for duty, the patient will be counseled aatothe medical concerns and the need tolimit duty assignment. The designated South Bend Fire Department nspnmuanhaUve will be notified, in general tenny, of the need for duty restriction and any safety - sensitive responsibilities, It will also be recommended that the patient be re-evaluated by PS[N^ after appropriate medical treatment, to provide final clearance of return to full duty after a release is first made bythe patient's treating physician. P5[N will assist the employee with, providing related medical information and their job requirements hzthe treating physician to omoiot in their care. Dates and Location of Services Chief Initial BLOOD DRAWS Dates: July 18m' uly20m&July24tu-Ju|y20m Location: 1222South Michigan South Bend, |N40081 EXAMS Dates: Aug2Om-24m& September 100-14m&Nov121h_16m Location: 1222Soum Michigan South Bend. |m46601 Departmental Information Contact person: Name: ToddGkwanxan Ti'ltke Chief Phwnw:(574)235-A25? E-mail: tskwama@aouthbexdim.gov Address: 1222South Michigan South Bend, |N488O1 Number ofPersonnel: 3516 Chief of Dept: Chief Steve Cox Price Increases Price increases for the following year will bemade known byend iof April ofthe current year. Pricing reflected above iavalid through December 31.2O1B. F: marketing/GoMmine templates 2of4