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INTERGOVERNMENTAL AGREEMENT
BETWEEN
THE CITY OF PHOENIX
AND
THE CITY OF CHANDLER
FOR FIREFIGHTER HEALTH SERVICES AT THE PHOENIX FIRE DEPARTMENT
HEALTH CENTER
AGREEMENT NO.
This Intergovernmental Agreement (“IGA”) is entered into this QU. day of .
2020 (“Effective Date”), by and between the City of Phoenix, for and on behalf of the
Phoenix Fire Department (“the City”), and the City of Chandler, an Arizona municipal
corporation (“the Customer’). Throughout this Agreement, the City and the Customer
individually may be referred to as “Party” and may be referred to collectively as “Parties”
to this Agreement.
RECITALS
WHEREAS, the City Manager of Phoenix, is authorized and empowered by provisions of
the City Charter to execute contracts; and,
WHEREAS, the City is authorized and empowered to enter into intergovernmental
agreements for the provision of services or for joint or cooperative action pursuant to
Arizona Revised Statutes (A.R.S.) §11-952. The City is also authorized and empowered
pursuant to Chapter 2, Section 2 (i), of the Charter of the City of Phoenix; and,
WHEREAS, agreements for mutual assistance and intergovernmental cooperation in
public safety areas, including operations and management of fire and police, or the public
safety related agencies have existed between municipalities and governmental
jurisdictions; and,
WHEREAS, it is the desire of the municipalities, governmental jurisdictions, agencies and
fire districts participating in this Agreement, to work together for mutual benefit of the
public, Customer’s community and all of the Customer's personnel; and,
WHEREAS, the Customer desires to participate in the firefighter health services offered
at the Phoenix Fire Department Health Center (the “Health Center’); and,
WHEREAS, the City has entered into an Agreement with a Medical/Occupational and
Wellness Health Services vendor to furnish services and operate the Health Center
including, but not limited to, annual firefighter physical examinations; and,
WHEREAS, the City desires the participation of the Customer to more effectively provide
annual firefighter medical examinations for sworn personnel as required by (i) federal and
Last revised: April 30, 2020
state law and/or national fire service standards; and (ii) regulations as deemed necessary
by the Fire Chiefs of their respective fire departments; and,
WHEREAS, Ordinance No. S-45006 dated September 19, 2018 authorized the City to
enter into an agreement with the City of Chandler for the Health Center to provide services
to Chandler firefighters and police officers.
AGREEMENT
NOW THEREFORE, in consideration of the mutual promises, inducements, covenants,
agreements, conditions and other good and valuable consideration, the receipt and
sufficiency which is acknowledged, the Parties agree as follows:
ARTICLE I. PURPOSE
1. The purpose of this Agreement is to define the delivery of health services that will be
provided by the Health Center to the Customer. These services include physical
examinations, immunizations, return to work evaluations, and exposure management.
2. The Customer will reimburse the City for all services performed. In addition, the
provision of services to other jurisdictions will not negatively impact the City’s public
safety personnel.
ARTICLE I. STATEMENT OF SERVICES
1. The Customer's personnel may participate in the selected health services and
programs, as listed in Exhibit A— IGA Services Menu, and Exhibit B — IGA Services
Menu Infection Control for Law Enforcement Agencies, provided by the Health Center
and any other such employee health and safety programs the Health Center may have
to offer. If any other such employee health and safety programs that the Health Center
may offer are to be utilized by Customer personnel, all such health and safety
programs will only be made available and provided after written contract amendment
to this Agreement. Services are to be provided at the Health Center or such other
location designated by the City.
ARTICLE Ifl. TERM OF THE AGREEMENT
1. Term:
This Agreement shall commence on the Effective Date referenced above, regardless
of the date of recordation with the Maricopa County Recorder’s Office, and shall
continue in force for five (5) years, or until terminated by formal act of the Parties.
Last revised: April 30, 2020
2. Termination:
Pursuant to the provisions of A.R.S § 38-511, either party may terminate this
Agreement at any time by providing thirty days (30) written notice to the other parties
Fire Chief. Termination can be with, or without, cause.
ARTICLE IV. GENERAL TERMS AND CONDITIONS
1. Governing Law; Forum; Venue:
This Agreement is executed and delivered in the State of Arizona, and the substantive
laws of the State of Arizona (without reference to choice of law principles) will govern
their interpretation and enforcement. Any action brought to interpret or enforce any
provision of this Agreement that cannot be administratively resolved, or otherwise
related to or arising from this Agreement, will be commenced and maintained in the
state or federal courts of the State of Arizona, Maricopa County, and each of the
Parties, to the extent permitted by law, consents to jurisdiction and venue in such
courts for such purposes.
2. Implied Contract Terms:
Each and every provision of law and any clause required by law to be in this Contract
shall be read and enforced as though it were included herein, and, if through mistake
or otherwise, any such provision is not inserted, or is not correctly inserted, then upon
the application of either Party, the Contract shall be physically amended to make such
insertion or correction.
3. Parol Evidence:
This Contract is intended by the undersigned Parties as the final expression of their
agreement and is intended to be the complete and exclusive statement of the terms
of the agreement between the Parties. No course of prior dealings between the
Parties and no usage in the trade shall be relevant to supplement or explain any term
used in this Contract. Acceptance or acquiescence in a course of performance
rendered under this Contract shall not be relevant to determine the meaning of this
Contract even though the accepting or acquiescing Party has knowledge of the nature
of the performance and the opportunity to object.
4. Confidentiality and Data Security:
4.1 All data, regardless of form, including originals, images and reproductions,
prepared by, obtained by, or transmitted to the Customer in connection with this
Agreement is confidential, proprietary information owned by the City. Except as
specifically provided in this Agreement, the Customer will not disclose data
generated in the performance of the Services to any third person without the prior
written consent of the City Manager, or his/her designee.
4.2 Personal identifying information, financial account information, or restricted City
information, whether electronic format or hard copy, must be secured and
protected at all times to avoid unauthorized access. At a minimum, Customer
Last revised: April 30, 2020
must encrypt and/or password protect electronic files. This includes data saved
to laptop computers, computerized devices or removable storage devices. When
personal identifying information, financial account information, or restricted City
information, regardless of its format, is no longer necessary, the information must
be redacted or destroyed through appropriate and secure methods that ensure
the information cannot be viewed, accessed, or reconstructed.
4.3 In the event that data collected or obtained by the Customer in connection with
this Agreement is believed to have been compromised, Customer will notify the
City Privacy Officer immediately. Customer agrees to reimburse the City for any
costs incurred by the City to investigate potential breaches of this data and,
where applicable, the cost of notifying individuals who may be impacted by the
breach.
4.4 Customer agrees that the requirements of this Section will be incorporated into
all subcontractor/sub consultant agreements entered into by the Customer. It is
further agreed that a violation of this Section will be deemed to cause irreparable
harm that justifies injunctive relief in court. A violation of this Section may result
in immediate termination of this Agreement without notice.
4.5 The obligations of Customer under this Section will survive the termination of this
Agreement.
. Health Insurance Portability and Accountability Act (HIPPA) of 1996:
The Parties certify that each is familiar with the requirements of HIPAA, as amended
by the Health Information Technology for Economic and Clinical Health Act (HITECH
Act) of 2009, and accompanying regulations and will comply with all applicable HIPAA
requirements in the course of this Agreement. The Parties warrant that each will
cooperate in the course of performance of the Agreement so that the Parties will be in
compliance with HIPAA.
. Third-Party Beneficiary Clause:
The Parties expressly agree that this Agreement is neither intended by any of its
provisions to create any right of the public or any member thereof as a third party
beneficiary, nor to authorize anyone not a Party to this Agreement to maintain a suit
for personal injuries or property damage pursuant to the terms or provisions of this
Agreement.
. Contract Cancellation:
All Parties acknowledge that this Contract is subject to cancellation by the City
pursuant to the provisions of A.R.S. § 38-511.
. Fund Appropriation Contingency:
The Parties understand that the continuation of this Agreement is subject to the budget
of the Parties providing for the contract item as an expenditure. The Parties cannot
Last revised: April 30, 2020 J 4
assure that the budget item for funding this Agreement will be approved in the future.
In such event, either Party may terminate this Agreement.
. No Joint Venture:
No term or provision in this Agreement is intended to create a partnership, joint venture
or agency arrangement between any of the Parties.
10.Assignment and Delegation:
11
Neither this Agreement, nor any of its rights or obligations, may be transferred or
assigned by either party without the prior written consent of both Parties. Any attempt
to assign this Agreement without prior written consent will be void and may result in
penalties up to and including termination of the Agreement.
.Entire Contract; Amendment, No Oral Modification:
This Agreement constitutes the complete agreement of the Parties. It supersedes all
previous representations, understandings, and agreements, written or oral, relating to
the subject matter of this Agreement. This Agreement and its terms may not be
modified or changed except in writing signed by both Parties.
12. Invalidity of Any Provisions:
This Agreement will remain in effect even if one or more of its terms or provisions have
been held to be invalid or unenforceable. Such a holding will result in the offending
term or provision being ineffective to the extent of this Agreement, which would
subsequently be construed as though the invalid or unenforceable term or provision
never existed. Upon discovery by either Party of invalid terms or provisions, written
notice will be given to the other party within ten (10) business days.
13.Independent Contractor Status:
The Parties agree that neither party shall be deemed to be an employee or agent of
the other Party to this Agreement and that the relationship created by this Agreement
is that of independent contractors. Neither Customer nor any of Customer's agents,
employees or helpers will be deemed to be the employee, agent, or servant of the
City. Customer, its employees and subcontractors are not entitled to worker's
compensation benefits from the City.
14.Workers’ Compensation:
The Parties agree that itis the responsibility of each Party to ensure that its employees
are notified in accordance with the provision of Arizona Workers’ Compensation Law,
specifically, A.R.S. § 23-1022, or any amendment thereto, and that all such notices,
as required by such laws, shall be posted accordingly. That by signing this Agreement
and to ensure compliance with the notice posting requirements, each Party grants
consent to all other Parties to inspect that Party’s respective premises and work places
upon request of any of the other Parties. However, nothing in this Agreement should
be construed as imposing a duty to inspect another Party's respective premises and
Last revised: April 30, 2020
work places, and this agreement does not create a joint or employer/employee
relationship between a Party and another Party’s employees.
15. Severability:
The provisions of this Contract are severable to the extent that any provision or
application held to be invalid shall not affect any other provision or application of the
Contract which shall remain in effect without the invalid provision or application.
16.Non-Waiver:
Any City delay or failure to exercise or enforce any right, power, privilege, or remedy
under this Agreement may not be deemed a waiver, release, or modification of the
requirements of this Agreement or any of its terms or provisions.
17.Compliance with Laws:
The Customer will comply with all existing and subsequently enacted federal, state
and local laws, ordinances, codes, and regulations that are, or become applicable to
this Agreement. If a subsequently enacted law imposes substantial additional costs,
a request for an amendment may be submitted pursuant to this Agreement.
18.Transactional Conflict of Interest:
The Parties acknowledge that this Agreement is subject to cancellation provisions
pursuant to Arizona Revised Statutes (A.R.S.) §38-511, the provision of which are
incorporated herein and made a part hereof.
19. Compliance with Non-Discrimination Laws:
The Parties agree to comply with all applicable state and federal laws, rules,
regulations and executive orders governing equal employment opportunity, non-
discrimination and affirmative action.
20. Equal Employment Opportunity and Equal Pay:
In order to do business with the City, the Customer must comply with Phoenix City
Code, 1969, Chapter 18, Article V, as amended, Equal Employment Opportunity
Requirements. Contractor will direct any questions in regard to these requirements to
the Equal Opportunity Department, (602) 262-6790.
21.Drug Free Workplace:
The Parties will comply with the Drug Free Workplace Act of 1988 and will permit
inspection of its personnel records to verify such compliance. A Party's breach of the
above-mentioned warranty shall be deemed a material breach of the Agreement and
may result in the termination of the Agreement.
22. immigration Requirements:
The Parties will comply with the Immigration Reform and Control Act of 1986 (“IRCA”)
and will permit inspection of its personnel records to verify such compliance. To the
extent applicable under A.R.S. § 41-4401, each Party warrants compliance with all
Last revised: April 30, 2020 | os
federal immigration laws and regulations that relate to its employees and compliance
with the E-verify requirements under A.R.S. § 23-214(A). Each Party has the right to
inspect the papers of the other Parties participating in this Agreement to ensure
compliance with this paragraph. A Party’s breach of the above-mentioned warranty
shall be deemed a material breach of the Agreement and may resultin the termination
of the Agreement.
23. Legal Worker Requirements:
The City is prohibited by Arizona Revised Statutes § 41-4401 from awarding an
agreement to any organization who fails, or whose subcontractors fail, to comply with
Arizona Revised Statutes § 23-214(A). Therefore, the Customer agrees that:
23.1 Each subcontractor the Customer uses warrants their compliance with all federal
immigration laws and regulations that relate to their employees and their
compliance with Arizona Revised Statutes § 23-214,
23.2 A breach of warranty will be deemed a material breach of the Agreement and is
subject to penalties up to and including termination of the Agreement.
23.3 Only through an audit with.the Customer, will the City retain the legal right to
inspect the papers of the Customer or subcontractor employee(s) who work(s)
on this Agreement to ensure that the Customer or subcontractor is complying
with the warranty.
24.Lawful Presence Requirement:
Pursuant to A.R.S. §§ 1-501 and 1-502, the City of Phoenix is prohibited from
awarding a contract to any natural person who cannot establish that such person is
lawfully present in the United States. To establish lawful presence, a person must
produce qualifying identification and sign a City-provided affidavit affirming that the
identification provided is genuine. This requirement will be imposed at the time of
contract award. This requirement does not apply to business organizations such as
corporations, partnerships or limited liability companies.
25.No Israel Boycott:
By entering into this Contract, the Contractor/Contractor certifies that itis not currently
engaged in, and agrees for the duration of the Contract to not engage in, a boycott of
Israel.
26. Arbitration:
In accordance with A.R.S. § 12-1518, where applicable, the Parties agree to resolve
all disputes arising out of or relating to this Agreement through arbitration as required
by AR.S. § 12-133.
Last revised: April 30, 2020
ARTICLE Vil. NOTICES
4. Any notice, consent, or other communication (“notice”) required or permitted under
this Agreement must be in writing and either delivered in person, sent by facsimile
transmission, deposited in the United States mail, postage prepaid, registered or
certified mail, return receipt requested, or deposited with any commercial air courier
or express service addressed as follows:
If to CITY: if to CUSTOMER:
City of Phoenix Fire Department City of Chandler Fire Department
150 South 12th Street 151 East Boston Street
Phoenix, AZ 85034 Chandler, AZ 85225
Attn: Kristen Dunham Attn: Eric Kemp
Fire Administration City of Chandler Fire Department
Telephone: (602) 534-3539 Telephone: (480) 782-2137
Fax: (602) 262-4429 Fax: (480)
Notice will be deemed received at the time it is personally served or, on the day itis
sent by facsimile transmission or, upon deposit with any commercial air courier or
express service or, if mailed, ten (10) days after the notice is deposited in the United
States mail as provided above. Either Party may change its mailing address, fax
number, or the contact information for the person to receive notice by notifying the
other Party as provided herein. Notice sent by facsimile transmission must also be
sent by regular mail to the recipient at the above address. This requirement for
duplicate notice is not intended to change the effective date of the notice sent by
facsimile transmission.
Last revised: April 30, 2020 | |
IN WITNESS WHEREOF, this Agreement is executed as provided below. Further, in
signing this Agreement, the signatories below affirm and attest that they are authorized
to execute this Agreement on behalf of their respective Party.
CITY OF PHOENIX, a municipal corporation
, City Manager
City Clerk, City of Phoenix aug 17, 2020
APPROVED AS TO FORM:
Julie a a “Ff 16:36 PDT)
City Attorney, City of Phoenix LIN.
CITY OF CHANDLER, a municipal
corporation
By: 20 gE ——
Tom Dwiggins
Fire Chief
ATTEST:
City Clerk, City of Chandler
APPROVED AS TO FORM:
Wn 4)
City Attorney, City of Chandlet}z¥,,
Last revised: April 30, 2020
Phoenix Fire Department
IGA Services Menu
Health & Wellness Center (Exhibit A)
150 S. 12" Street
Phoenix, AZ 85034
Description Each
Firefighter - Physical Examinations to include:
e Health Survey $718.00
e Blood testing and analysis consisting of: Chem 18/Lipid
Panel/CBC/Uric Acid, UA/Micro - (New Hires/New Patients &
Annually for all FF’s)
e Hepatitis-B Antibodies — (New Hires/New Patients only)
e Hepatitis-C Antibodies — (New Hires/New Patients only)
° Prostate Specific Antigen (PSA) - (New Hires & Annually for
N Males age 45 and older only)
F Varicella Titer — (New Hires/New Patients only)
P Hearing Conservation Program - Hearing Testing and Evaluation
A (assessed in an ANSI-approved soundproof audiometric booth)
« Visual Acuity, Color & Depth Perception Testing & Evaluation.
P e Vital Signs (temperature, pulse, and respiratory rate, and blood
H pressure)
Y e Spirometry/Pulmonary Function Test & Evaluation
Ss * EKG Stress Test (treadmill)
| (New Hire Recruits perform a MAX Treadmill, a Sub-max is
c performed annually thereafter unless otherwise determined by a
A Health Center Clinician. Non-Sworn New Hires perform resting
L EKG only)
e Chest X-Ray
(New Hires and every 5 years thereafter, unless Health Center
Clinician deems it necessary)
¢ Skin fold measurement by calipers, body weight, & height
e Immunization history screening and review
e Uptoa 30-minute consult with physician or physician
assistant to discuss physical examination
N/A | Firefighters- SCBA Fit Testing N/A NIA
Firefighter - TIER Program Participation
The Tier 4 Health Assessment is a program that places members in a category or xl OPT IN | OPT OUT
tier based on their annual physical assessment. Historically, we have recommended TIER TIER
T removing people from active duty if we saw something during their physical that was Pp P
{ unhealthy, dangerous, or physically limiting. These not-fit-for-duty members were rogram rogram
E prescribed rehabilitation methods with the goal of returning them back to active duty
R as soon as possible. This program is rehabilitative, not punitive.
P “Opting in’ to our Tier Program requires that the participating agency cover the costs
R of Tier follow ups, lab testing, and treadmill testing for their members. Peer Fitness
° Trainer Support or resources should be made available through the participating
G agency to assist their employees in wellness improvement. The PFD Health &
Wellness Center's role is to identify the employee's Tier status. Management of
R employee's progress regarding follow-ups and testing, shall be the employer's
A responsibility. (See attached: Tier Program Defined document)
m TIER Follow-Up $75.00 $0.00
TIER Follow-Up with Treadmill $200.00 $0.00
HWC-IGAServicesMenu Exhibit A - R2020.doc Page 1 of 4 Last update: 4/29/2020:clk
TIER Lab Draw (Repeat Atc Lab retesting) $37.00 $0.00
Firefiqhter- Immunizations
“Opting in” to the immunization program assures that we will provide C1 oPT IN | ff] OPT OUT
vaccinations to your department members. Immunizations will only be Immunizations } |mmunizations
administered if it is deemed necessary by Health & Wellness Center
1 Medical Team. Your department will only be billed for the immunizations
M given to your members. Every effort will be made to provide the most cost
M effective immunization series that is medically necessary to protect the
U member.
‘ Tdap (Tetanus/Diphtheria/Pertussis) 7 shot $60.00 x 1 $0.00
Zz
A Tetanus/Diphtheria 7 shot $40.00 x 1 $0.00
T
., $60.00 x 2
4 MMR (Measles/Mumps/Rubella) 2 shot series (8120.00/series) $0.00
x Hepatitis-A (Havrix) 2 shot series Priore $0.00
Hepatitis-B (Engerix) 3 shot series $60.00 x3 $0.00
(+ blood draw to check antibodies after completed series) ($180.00/series) :
Twinrix (Hep A and B Combo) 3 shot series $100.00 x 3 $0.00
(+ blood draw to check Hep-B antibodies after completed series) ($300.00/series) :
Firefighter - TB Testing
T | By “opting in’ for the T-Spot TB blood testing you agree that your [x] OPT IN | [] OPT OUT
B department will pay for the Phoenix Fire Department Health & Wellness T-Spot TB T-Spot TB
T center to perform T-Spot TB blood testing for all your new hire fire fighter Testing Testing
E recruits to establish a baseline and then on any of your sworn members
s should a TB exposure occur while on duty.
T
]
N T-Spot TB Blood Test (new hires and following TB exposure only) $85.00 $0.00
G
Firefighter - Return to Work Evaluations
Occasionally, your department may request that an employee be evaluated Xl OPT IN | [] OPT OUT
at the PFD Health & Wellness Center regarding a return to work evaluation. Return to Return to
These evaluations take place after a release to full duty by employee's Work Evals Work Evals
treating surgeon or physician for an injury or illness.
Costs associated with a return to work evaluation may vary depending on
what is needed. Below are the base costs. Choosing to “opt in” for this
service will allow your members to be seen at the Health & Wellness Center
for these types of visits. Your department will only be billed for the services
R | provided at the time of the visit.
T Return to Work Evaluation Assessment
w (Clinician’s review of all notes and work release information related to Return to $100.00 $0.00
Work injury or illness)
E $100.00
v (minimum)
A Return to Work Physical Exam by Clinician $0.00
L (Clinicians physical exam of patient related to Return to Work injury or illness) $105.00 / hr. .
s (after first hour
with Clinician)
X-Ray per view if required :
(cost varies based on the location and complexity of the injury) $70.50-200.00 $0.00
Resting EKG $67.00 $0.00
Bloodwork Testing if required Per Test $0.00
HWC-IGAServicesMenu Exhibit A - R2020.doc Page 2 of 4 Last update: 4/29/2020:clk
Infection Control Program and ICO Assistance (opt In | OPT OUT
(This program is available to both Fire and Law Enforcement Infection Infection
Agencies) ; Control Control
Please note: Geographically, we are limited on the distance that this service Program Program
can be provided. Therefore, this option is only available to agencies within
the Phoenix Metropolitan area.
For agencies within the Phoenix Metropolitan area, choosing to “opt in’ for
the Infection Control Program, we will provide your members with Infection
Control Officer assistance based on the following objectives and
responsibilities. Pricing details for this service are listed below.
Major Objectives:
e Toensure quatity of care of patients and department members.
« To provide a liaison between medical facilities, the medical examiner and
the state’s public health office
1 e Toassist your department ensuring compliance with federal, state and
N local laws and regulations.
FE e To develop and institute a comprehensive program for exposure
E notification and medical follow-up.
e To monitor compliance with department's infection control
c practices/procedures.
T « To update exposure control program to include T.B. control.
I PFD Infection Control Officer Responsibilities:
ie) e Work with administration, risk management and safety on infection control
N and related compliance issues.
¢ Establish and maintain records on employee exposures, medical follow-up
Cc and personnel health.
oO e Will ensure reporting and documentation of exposures, medical follow-up,
N confidentiality and record keeping.
T e Work with medical facility representatives to ensure timely exposure
R notification, testing and reporting.
O ¢ — Will interview and assist exposed department personnel.
L e Assist in evaluation of new products and equipment relating to infection
control —- OSHA compliance.
e Assist with the development of new infection control policies and
P procedures for your department.
R e Work with medical examiner regarding exposures involving deceased
8 persons.
Annual Per Member Fee
nN (active members only) $66.00 $0.00
M
If participating in the Infection Control program, the fees listed below apply and will only be billed to your :
department if an exposure occurs and testing or treatment is required. Please note: This contract does not
include or cover prophylaxis. Prophylaxis charges received by Phoenix Fire will be passed-along to the
participating-agency.
Exposure Consult with Health & Wellness Center Clinician $75.00 $0.00
Hepatitis C Antibody (lab draw) $44.00 $0.00
Hepatitis C Confirmatory (lab draw) $100.00 $0.00
HIV Antibody (lab draw) $25.00 $0.00
Hepatitis A Vaccine (Havrix) 2 shot series $50.00 x 2
($100.00/series) $0.00
Tetanus/Diphtheria Vaccine 7 shot $40.00 $0.00
Tdap Vaccine (Tetanus/Diphtheria/Pertussis) 7 shot $60.00 $0.00
Activation of Post Exposure Prophylaxis (PEP) Line $250.00 $0.00
HWC-IGAServicesMenu Exhibit A - R2020.doc Page 3 of 4 Last update: 4/29/2020:clk
Firefighter Physical Exam Scheduling:
We will provide all participating fire departments with the appropriate number of designated appointment
dates and time slots for your member's physical exams (new hire recruits, new patients, and annual
physicals). Once the dates and times have been provided, it will be up to your department's liaison to
provide our scheduler with the individual names of the members that will be occupying the time slots. For
new patients, the Patient Health Review packet will need to be completed as a “new” patient and received at
the PFD Health & Wellness Center at least 5 business days prior to the appointment date to create an
Electronic Health Record, medical chart, and prepare the appropriate paperwork that will be needed at the
time of the visit. Not providing the requested packet in the requested time frame, may result in the release of
the scheduled physical exam appointment.
All other appointment types (i.e., Exposure Consults & Return to Work Evaluations) will be scheduled on an
individual basis.
Firefighter Bloodwork/Lab Draws:
New Hire Recruits/New Patients:
All bloodwork required for pre-hire or new patient physical exams shall be drawn at the PFD Health and
Wellness Center located at 150 S. 12" St., Phoenix, AZ. This is a fasting lab draw. No food eight (8) hours
prior to lab draw, only black coffee and water are permissible during the eight (8) hour fasting period. The
fasting lab draw should be completed at least 48 hours prior to the scheduled physical exam. The Patient
Health Review Packet information must be provided to the Health & Wellness Center prior to lab work being
drawn. An Electronic Health Record must be established in advance to link the lab work to the patient
record.
Annual Physical Bloodwork/Lab Draws:
Once the initial (pre-hire or new patient) lab draw is completed at the Health & Wellness Center, entities may
continue to utilize the Health & Wellness Center for all annual physical lab work, or they may have lab work
done ata lab location through the contracted lab vendor with the Phoenix Fire Department Health &
Wellness Center. No internal blood draws within your department will be permitted, unless facilitated with
Phoenix Fire Health & Wellness Center staff. All participating agencies shall work with the PFD Health &
Wellness Center staff to coordinate the bloodwork required for your department, confirm contracted lab
vendor and locations, and ensure the correct lab slips are provided to the lab at the time of the blood draws.
The Phoenix Fire Department's contract agreement with our laboratory services vendor does not include “on
site” phlebotomy services for wellness fairs or events held at individual fire departments. Services rendered
for “on site” phlebotomy will need to be arranged with the lab separately and all “on site” phlebotomy service
charges will be the responsibility of the fire department requesting these services.
Cancellations, No Shows, and Unused Reserved Appointments:
Life is busy, and we understand that unforeseen circumstances can take place preventing members from
making their scheduled appointments. We would appreciate a minimum 24-hour notice for cancellations.
We will work with your department's liaison, or with the individual, to reschedule an appointment due to
unavoidable circumstances. However, a no show with no call to notify our department, or reserved
appointment slots that are unused, may result in a charge to your department. We want to be respectful of
your time and would ask for the same courtesy in return.
HWC-IGAServicesMenu Exhibit A - R2020.doc Page 4 of 4 Last update: 4/29/2020:clk
Phoenix Fire Department
Health & Wellness Center
IGA Services Menu
Infection Control for Law Enforcement Agencies
Zrwmnonv rowmAZzooN 20-HAomMTNZ-—
150 S. 12" Street (Exhibit B)
Phoenix, AZ 85034
Infection Control Program and ICO Assistance CJ opt in | (4 opt out
(This program is available to both Fire and Law Enforcement Infection Infection
Agencies) ; Control Control
Please note: Geographically, we are limited on the distance that this service Program Program
can be provided. Therefore, this option is only available to agencies within
the Phoenix Metropolitan area.
For agencies within the Phoenix Metropolitan area, choosing to “opt in’ for
the Infection Control Program, we will provide your members with Infection
Control Officer assistance based on the following objectives and
responsibilities. Pricing details for this service are listed below.
Major Objectives:
e« To ensure quality of care of patients and department members.
e To provide a liaison between medical facilities, the medical
examiner and the state’s public health office.
e To assist your department ensuring compliance with federal, state
and local laws and regulations.
e To develop and institute a comprehensive program for exposure
notification and medical follow-up.
e To monitor compliance with department's infection control
practices/procedures.
“To.update exposure contro! program to include T.B. control.
‘Infection Control Officer Responsibilities:
e Work with administration, risk management and safety on infection
control and related compliance issues.
e Establish and maintain records on employee exposures, medical
follow-up and personnel health.
e Will ensure reporting and documentation of exposures, medical
follow-up, confidentiality and record keeping.
e Work with medical facility representatives to ensure timely
exposure notification, testing and reporting.
e Will interview and assist exposed department personnel.
e Assist in evaluation of new products and equipment relating to
infection control - OSHA compliance.
e Assist with the development of new infection control policies and
procedures for your department.
e Work with medical examiner regarding exposures involving
deceased persons,
Please see Breakdown of Infection Control Program Services Fees
on page 2.
HWC-IGAServicesMenu Exhibit B - R2020.doc Page 1 of 2
Last update: 4/29/2020:clk
Breakdown of Infection Control Program Services Fees
Annual per member fee
(active members only) $66.00 $0.00
If participating in the Infection Control program, :the fees listed below apply and will only be billed to your
department if an exposure occurs and testing or treatment is required. Please note: This contract does not
include or cover prophylaxis. Prophylaxis charges received by Phoenix Fire.will be passed along to the
participating agency. : :
Exposure Consult with Health & Wellness Center Clinician $75.00 $0.00
Hepatitis C Antibody (lab draw) $44.00 $0.00
Hepatitis C Confirmatory (lab draw) $100.00 $0.00
HIV Antibody (lab draw) $25.00 $0.00
Hepatitis A Vaccine (Havrix) 2 shot series $50.00 x2
($100.00/series)_| $0.00
Tetanus/Diphtheria Vaccine 7 shot $40.00 $0.00
Tdap Vaccine (Tetanus/Diphtheria/Pertussis) 7 shot $60.00 $0.00
Activation of Post Exposure Prophylaxis (PEP) Line $250.00 $0.00
HWC-IGAServicesMenu Exhibit B - R2020.doc Page 2 of 2 Last update: 4/29/2020:clk