Exhibit 10.11
Public Works and Government Services
Canada
Purchasing Office
Science Directorate
11CI.PhaseIII
Place du Portage
▇▇ ▇▇▇▇▇▇▇ ▇▇.
▇▇▇▇. Quebec KIAOS5
DRAFT
CONTRACT
THIS CONTRACT CONTAINS SECURITY
REQUIREMENTS
Canada
TITLE: 'Civilian Health Care Services for in-▇▇▇▇▇▇▇▇ Support for the Canadian
Forces'
CONDITIONS RESPECTING THE SECURITY REQUIREMENTS
1. Notwithstanding the Security Requirements Clause set out below, the
Contractor will have a period of 3 months from the effective date to have
the security clearances described in Section 1, 2 and 3 of the Security
Requirements clause below granted to it or approved by the Canadian and
International Industrial Security Directorate (CIISD) of Public Works and
Government Services Canada, if such are not already in place. In the event
the Contractor fails to obtain the required clearances listed below within
the said three (3) months, the Minister shall be entitled to terminate the
contract for default pursuant to the General Conditions of the Contract.
2. At all times during the period of contract, including the time during which
security clearances are not in place, the Contractor acknowledges that
Canada is subject to the provisions of the Privacy Act (R.S.C.. c. P-21)
with regard to the collection, retention, use and handling of any "personal
information" as defined therein. Notwithstanding anything else contained
herein, if the Work under any Call-Up issued under the Contract involves
the collection, creation or handling of any such personal information, the
Contractor shall keep confidential any such personal information, and shall
not collect, retain, use or disclose it other than in accordance with the
terms of the Contract and the provisions of the Privacy Act. Except for the
information collected under article 3.16.2 of the Statement of Work. The
Contractor shall deliver to Canada all such personal information in
whatever form. Upon the completion or termination of the Contract or at
such earlier time as the Minister may request.
3. Security clearances required for the individual Health Care Service
Providers are the responsibility of the Contractor.
SECURITY REQUIREMENTS
- The Contractor shall within 3 months from contract award, hold a valid
Designated Organization Screening (DOS), with approved Document
Safeguarding at the level of PROTECTED B, issued by the Canadian and
International Industrial Security Directorate (CIISD) of the Department of
Public Works and Government Services Canada.
- Contractor personnel who require access to DESIGNATED information, assets
or sensitive work sites shall EACH hold a valid ENHANCED RELIABILITY
screening, granted or approved by CIISD.
- The Contractor SHALL NOT perform any DESIGNATED Automatic/Electronic Data
Processing and/or Production until CIISD has issued written approval. After
approval has been granted, these tasks may be performed at the level of
PROTECTED B.
4. The Contractor shall comply with the provisions of:
a) the Security Requirements Check List (SRCL), attached at Annex "F'
(which includes the "Security Guide for Contract W2203-9-CA02").
b) The Industrial Security Manual (June 1992).
STANDARD INSTRUCTIONS AND CONDITIONS
1. Standard Acquisition Clauses and Conditions Manual
All instructions, general terms, conditions and clauses identified herein by
title, number and date are set out in the Standard Acquisition Clauses and
Conditions (SACC) Manual, issued by Public Works and Government Services Canada
(PWGSC), bearing Catalogue No. P60-4/1-1998E and revised as of 12 May 2000.
A hard copy of the SACC Manual may be obtained from: Canadian Government
Publishing. An electronic version may also be viewed at the following PWGSC
internet address: ▇▇▇▇://▇▇▇.▇▇▇▇▇.▇▇.▇▇/▇▇▇▇.
2. Terms and Conditions of the Contract
Pursuant to the Department of Public Works and Government Services Act, S.C.
1996, C.I 6,
(a) the general terms, conditions and clauses identified herein by title,
number and date. are hereby incorporated by reference into and form
part of this Contract, as though expressly set outherein, subject to
any other express terms and conditions herein contained.
(b) the Conditions set out In part B of the Standard Instructions and
Conditions DSS-MAS 9403-5(1999/06/21) set out in the SACC Manual are
hereby incorporated by reference into and form part of this Contract.
GENERAL CONDITIONS
General Conditions - Services, DSS-MAS 9676 (2000/05/12) apply to and form part
of this contract.
FINANCIAL AGREEMENT
As a further assurance that funds will be available to complete the Work
according to the terms of the Contract, the Contractor shall, within 30 working
days after the date of this contract, furnish the Contracting Authority with a
certified copy of a duly executing Line of Credit from an approved lendor in the
agreed upon amount.
In the event that the Contractor does not provide such a certified copy within
the said 30 day period. Canada may terminate this Contract for default under the
"Default by the Contractor" section as set out in the General Conditions.
STATEMENT OF WORK
The Contractor shall perform the Work and provide the deliverables in accordance
with and as set out in the Statement of Work attached hereto as Annex 'A" and
forming part of this contract, and, generally in accordance with the
Contractor's proposal referenced herein at "Priority of Documents'.
The Contractor is advised that DND will not sign the Contractor's Internal
Standard Operating Procedure Manual (described in Contractor's proposal as a
Policy Manual and later clarified by the Contractor as being a procedure
manual). Non-signature by DND shall not modify or reduce the Contractor's
obligations under the Contract.
PERIOD OF CONTRACT
From date of contract award through March 31.2004. See Article 3.18 of ▇▇▇▇▇ "A"
- Statement of Work
OPTION TO EXTEND PERIOD OF CONTRACT
No later than six (6) months prior to the expiry date of the contract, the Crown
has the irrevocable option to extend the period of the contract by one period of
36 months.
The option shall be exercised under the same terms and conditions of the
contract and in accordance with the rates accepted and listed in the contract
for the option period. The exercise of the option shall be evidenced in writing
by the Contracting Authority.
PRIORITY OF DOCUMENTS
The documents specified below form part of and are incorporated into the
Contract. If there is a discrepancy between the wording of any documents which
appear on the list, the wording of the document which first appears shall
prevail over the wording of any document which subsequently appears on the list.
1) these articles of Agreement
2) General Conditions 9676 referenced herein
3) Annex "A"- Statement of Work
4) Annex'B"- Basis of Payment
5) Annex "E" - Schedule of Milestones
6) Annex "C" - Treasuiy Board Travel and Living Guidelines
7) Annex "D(degree)- Insurance Requirements
8) Annex "F" - Security Requirements Checklist and its Security Guide
9) Contractor's correspondence to PWGSC concerning its proposal at 10) below, as
follows:
9.1 Proposal Clarification No. 7 dated January 16,2001
9.2 Proposal Clarification No. 6 dated January 9,2001
9.3 Proposal Clarification No. 5 dated December 18, 2000 titled "Response
to Request - "Financial Assessment"
9.4 Proposal Clarification No. 4 dated November 30, 2000
9.5 Proposal Clarification No. 3 dated November 22.2000
9.6 Proposal Clarification No. C dated November 10.2000 titled "Re: Request
No. 2 for Information"
9.7 Proposal Clarification No. B dated Novembers, 2000 titled "Re: Request
for information'
9.8 Proposal Clarification No. A dated October 27,2000 titled
'Re: Solicitation No. W2203-99CA02/B" containing Interim Financial
Statements
9.9 Proposal Clarification No. 1.2 dated October 11.2000 titled
"Clarification to Technical and Management Proposal"
9.10 Proposal Clarification No. 1 dated October 4, 2000 titled "Technical and
Management Proposal and a separate letter of the same date titled
"Financial Proposal".
10) Contractor's proposal dated September 14.2000 titled "Civilian Health Care
Services for In-▇▇▇▇▇▇▇▇ Support for the Canadian Forces'.
APPLICABLE LAWS
This Contract shall be Interpreted and governed, and the relations between the
Parties determined, by the laws in force in the province of Ontario.
INTERNATIONAL SANCTIONS
1. Persons and companies in Canada are bound by economic sanctions imposed by
Canada by regulations passed pursuant to the United Nations Act, R.S.C.
1985, o. U-2. the Special Economic Measures Act. S.C. 1992. c. 17, or the
Export and import Permits Act, R.S.C. 1985, c. E-19. As a result, the
Government of Canada cannot accept delivery of goods or services that
originate, either directly or indirectly, from the countries subject to
economic sanctions. At the time of contract award, the following
regulations implement economic sanctions:
(a) United Nations Iraq Regulations;
(b) United Nations Libya Regulations;
(c) United Nations Federal Republic of Yugoslavia (Serbia and Montenegro)
Regulations.
2. It is a condition of this Contract that the Contractor not supply to the
Government of Canada any goods or services which are subject to economic
sanctions as described in paragraph 1. above.
3. During the performance of the Contract should the addition of a country to
the list of sanctioned countries or the additions of a good or service to
the list of sanctioned goods or services cause an impossibility of
performance for the Contractor, the situation will be treated by the
Parties as a force majeure. The Contractor shall forthwith inform Canada of
the situation: the procedures applicable to force majeure shall then apply.
INSURANCE REQUIREMENTS
The Contractor shall carry the insurance requirements set out in Annex 'D".
NO PARTNERSHIP OR DELEGATION
Canada and the Contractor expressly disclaim any intention to create a
partnership, employer/employee relationship, joint venture or joint enterprise.
Nothing contained in this Contract nor any acts of Canada or the Contractor
shall constitute or be deemed to constitute Canada and the Contractor as
partners, employer and employee, joint venturers or principal and agent in any
way for any purpose. The Contractor shall not represent or hold itself out to be
an agent of Canada and shall not use any symbol, mark or words that could convey
the sense that the Contractor Is acting as an agent of Canada.
For greater certainty, neither this Contract nor any other document which may be
necessary or desirable for purposes of completing any transaction contemplated
by this Contract shall constitute or be deemed as a delegation by the Minister
or the Canadian Forces to the Contractor of any of their powers, duties or
functions.
TECHNICAL AUTHORITY
LCdr ▇▇▇▇▇▇▇ ▇▇▇▇▇▇▇
Department of National Defence
Canadian Forces Medical Group Headquarters
Project Management Office Rx2000
Health Services Delivery and Accreditation
▇▇▇▇ ▇▇▇▇ ▇▇▇▇▇ ▇▇▇▇▇
▇▇▇▇▇▇. Ontario K1A OK6
TELEPHONE: (▇▇▇) ▇▇▇-▇▇▇▇
FACSIMILE: (▇▇▇) ▇▇▇-▇▇▇▇
The Technical Authority, or his/her authorized representative, is responsible
for all matters concerning the technical content of the Work under this
requirement. Any proposed changes to the scope of the Work are to be discussed
with the Technical Authority, but any resulting change can only be confirmed by
a contract amendment issued by the Contracting Authority.
In the case of the Technical Authority issuing a Service Request Form, it is
understood that in the Statement of Work where "acceptance by the local health
authority at a CF site" is mentioned, the "Technical Authority" is interpreted
instead.
CONTRACTING AUTHORITY
▇▇▇▇▇ ▇▇▇▇▇▇▇
Science, Informatics and Professional Services Sector
Science Directorate
Public Works and Government Services Canada
Place du Portage. Phase III, ▇▇▇▇
▇▇ ▇▇▇▇▇▇▇ ▇▇▇▇▇▇ TELEPHONE: (▇▇▇) ▇▇▇-▇▇▇▇
Hull, Quebec. CANADA K1A OS5 FACSIMILE: (▇▇▇) ▇▇▇-▇▇▇▇
The Contracting Authority is responsible for the management of this Contract.
Any changes to the Contract must be authorized in writing by the Contracting
Authority. The Contractor is not to perform work in excess of or outside the
scope of this Contract based on verbal or written requests or instructions from
any government personnel other than the aforementioned officer.
INSPECTION/ACCEPTANCE
All the work performed under this contract shall be to the satisfaction of and
subject to inspection by the Technical Authority or his/her designated
representative, prior to acceptance. Should a deliverable or any portion thereof
not be in accordance with the requirements of the contract, the Technical
Authority or his/her designated representative shall have the right to reject it
or require its correction. Inspection or
acceptance shall not relieve the Contractor from responsibility for failure to
meet the requirements of the contract.
BASIS OF PAYMENT
The Contractor shall be paid as set out in Annex "B" - Basis of Payment attached
hereto and forming part of the contract.
GOODS & SERVICES TAX (GST)/HARMONIZED SALES TAX (HST)
All prices and amounts of money in the Contract are exclusive of Goods and
Services Tax (GST) or Harmonized Sales Tax (HS7), as applicable, unless
otherwise indicated. The GST or HST, whichever is applicable, is extra to the
price herein and will be paid by Canada.
The estimated GST or HST is included in the total estimated cost on page one of
the Contract. GST or HST. To the extent applicable, will be incorporated into
all invoices and progress claims and shown as a separate item on invoices and
progress claims. All items that are zero-rated, exempt or to which the GST or
HST does not apply, are to be identified as such on all invoices. The Contractor
agrees to remit to Canada Customs and Revenue Agency any amounts of GST and HST
paid or due.
METHOD OF PAYMENT
1. For Basis of Payment Article 1. "Implementation/Start-Up Costs": The
Contractor will be paid in accordance with the Schedule of Milestones
attached as Annex "E", for the amounts listed in Annex "B", and in
accordance with articles 5 and 6 below, on the following condition:
a. the Milestone Report for the milestone claimed has been received and
accepted by the Technical Authority.
2. For Basis of Payment Article 2 "Base Rate": The Contractor will be paid the
firm monthly rate for the Management, Operation and Maintenance Services
provided, as described therein, in accordance with articles 5 and 6 below.
3. For Basis of Payment Article 3 "Incremental Rate": The Contractor will be
paid the firm monthly rate for the Management, Operation and Maintenance
Services provided. SHOULD THE RATE BE CHARGEABLE, as described therein, in
accordance with articles 5 and 6 below.
4. For Basis of Payment Article 4 "Health Care Services by Service Providers -
Cost Reimbursable Items": The Contractor will be paid for services
completed by the Health Care Providers in accordance with articles 5 and 6
below.
- Payment by Canada to the Contractor for the Work shall be made within:
(a) thirty (30) days following the date on which all of the Work has been
delivered at the location(s) specified in the Contract and all other
Work required to be performed by the Contractor under the terms of the
Contract has been completed; or
(b) thirty (30) days following the date on which an invoice and
substantiating documentation are received according to the terms of the
Contract;
whichever date is the later.
6. If Canada has any objection to the form of the invoice or the
substantiating documentation, within fifteen (15) days of its receipt,
Canada shall notify the Contractor of the nature of the objection. "Form of
the invoice" means an invoice which contains or is accompanied by such
substantiating documentation as Canada requires. Failure by Canada to act
within fifteen (15) days will only result in the date specified In
paragraph 1 of this clause to apply for the sole purpose of calculating
interest on overdue accounts.
LIMITATION OF EXPENDITURE - Cost Reimbursable to a Limitation of Expenditure
Canada's total liability under this contract shall not exceed $86,381,894.00
Goods and Services Tax/Harmonized Sales Tax extra.
No increase in the total liability of Canada or in the price of Work resulting
from any design changes, modifications or interpretations of specifications,
made by the Contractor, will be authorized or paid to the Contractor unless such
changes, modifications or interpretations, have been approved, in writing, by
the Contracting Authority, prior to their incorporation into the Work. The
Contractor shall not be obliged to perform any work or provide any service that
would cause the total liability of Canada to be exceeded without the prior
written approval of the Contracting Authority. The Contractor shall notify the
Contracting Authority in writing as to the adequacy of this sum when:
(a) it is 75 percent committed, or
(b) four (4) months prior to the Contract expiry date. or
(c) if the Contractor considers the funds provided are inadequate for
the completion of the Work, whichever comes first.
In the event that the notification refers to inadequate funds, the Contractor
shall provide to the Contracting Authority, in writing, an estimate for the
additional funds required. Provision of such notification and estimate for the
additional funds does not increase Canada's liability.
INVOICING
Canada will only make payment upon receipt of a satisfactory invoice duly
supported by specified release documents and any other documents called for
under the Contract.
The Contractor shall submit invoices on its own form and shall detail:
o the Contractor's name and address:
o PWGSC File Number, Contract Serial Number, Financial Code. and, the
Client Reference Number if applicable;
* Goods and Services Tax or Harmonized Sales Tax, as applicable.
o the items listed in subarticle 1. below
Invoices shall not be submitted prior to delivery of the services to which the
invoice relates.
The Contractor shall submit:
4 to the Technical Authority:
a. a single monthly invoice for:
-the Implementation/Start Costs Milestone Fee, as applicable;
-Base Rate and, if applicable, the Incremental Rate;
b. a bi-weekly(every two weeks) invoice for all Provider Costs, which must
be supported by the report listed herein under the article titled
"Reporting"-subarticle 1.A therein. These invoices should be provided
on the 1st and the 15th of each month.
Copies of receipts, vouchers, completed service provider billing and time sheets
signed by the LHA. etc. to support the costs invoiced must accompany the
invoice. Providers who are engaged pursuant to a call-up but not active during
the billing period will also be listed and no provider costs billed unless there
is a provision in the call-up for payment of non-active duty, such as 'on-call
services or the like, in accordance with the terms of the contract.
2. to the PWGSC Contracting Authority, on a tri-monthly basis: one copy of all
invoices.
REPORTING
The Contractor shall provide reports as follows:
1. Rendered Health Services
A. to the Technical Authority:
- a report must accompany the bi-weekly invoice for Provider Costs
shall detail:
o costs by CF site and then by provider type (using service code)
* costs in accordance with the Basis of Payment, including
identification of the rate(s) listed in the service delivery
option(s) selected and accepted by the Crown;
* details on the formula used to establish the rate for any personnel
and/or subcontractors who are not at arm's length of the Contractor.
▇.▇▇ the Local Health Authority at each individual CF site receiving
services under this contract:
- a bi-weekly detailed report including as a minimum.
* the provider type (using service code)
* provider name;
* type of service by service code:
* dates and hours of service;
o basis of payment as applicable
* copies of receipts, vouchers, signed
billing sheets, etc. to support: authorized travel and living,
training and/or orientation charges, and the total charge being
invoiced to the Technical Authority for that provider.
▇.▇▇ the PWGSC Contracting Authority.
- if requested by the Contracting Authority, a copy of the report
provided in 'Reporting I .A." above which shall be delivered within
two weeks of the request.
AUDITS
1. C0705C (1998/06/15) -Audit
2. Compliance with contract terms. The Minister has the right to conduct
quarterly (or other periodic) reviews of all rates, payments made,
invoices, reports, and other documentation, as deemed necessary by the
Minister, to determine whether the Contractor is carrying out the Contract
in accordance with its terms. Such reviews shall be carried out in
consultation with representatives of the Department of National Defence,
and the Contractor shall cooperate fully with the Minister during such
reviews and promptly furnish all information required by the Minister for
such reviews. Without prejudice to Canada's other rights and remedies, the
Contractor shall promptly remedy any instances of non-compliance with the
Contract identified by Minister at any time during the Contract
3. Evaluate effectiveness of contract and identify elements of work
requiring improvement-
3.1. In order to evaluate the effectiveness of this contract, and to
identify elements of the Work requiring improvement, formal contract
audits may take place at the direction of the Crown. Some specific
items that may be audited include the accuracy of charges made to the
Crown, the adequacy of internal control structures (both detective
and preventive), and the level of compliance with the contract
requirements.
3.2. The Crown may undertake more formal audits of this program and the
Auditor's evaluation will furnish the Technical Authority with
analyses, recommendations, counsel, and information concerning the
activities examined.
The foregoing audits do not change, nor restrict, the audit provisions contained
in the General Conditions of the contract.
PAYMENTS
All payments shall be regarded as interim payments only and Canada shall have
the right to conduct interim cost/time verifications or audits and to make
adjustments from time to time during the performance of the Work. Any
overpayments resulting from such payments or otherwise shall be refunded
promptly to Canada.
T4A SUPPLEMENTARY SLIP REQUIREMENT
Pursuant to paragraph 221 (1)(d) of the Income Tax Act. payments made by
departments and agencies to contractors under applicable services contracts
(including contracts involving a mix of goods and services) must be reported on
a T4A Supplementary slip. To enable client departments and agencies to comply
with this requirement, contractors are required to provide information as to
their legal name and status, business number, and/or Social Insurance Number or
other identifying supplier information as applicable, along with a certification
as to the completeness and accuracy of the Information.
T4A INFORMATION- DIRECT REQUEST BY CLIENT DEPARTMENT
Contractors are required to provide Canada Customs and Revenue Agency the
identifying information referred to in clause *T4A Supplementary Slip
Requirement", as
and when requested by the client department. (These requests may take the form
of a general call-letter to suppliers or individual contact, in writing or by
telephone).
EDUCATION AND EXPERIENCE
The Contractor certifies that all statements made with regard to the education
and the experience of individuals proposed for completing the subject Work are
accurate and factual, and the Contractor agrees that the Minister reserves the
right to verify any information provided in this regard and that untrue
statements may result in the Contract being terminated for default pursuant to
the terms of the general conditions forming part of this Contract.
CERTIFICATIONS
Compliance with the Certifications the Contractor has provided Canada in its
proposal is subject to discretionary audit In the event that it is determined
that any certification made by the Contractor is untrue, whether made knowingly
or unknowingly, any contract entered into pursuant to those certifications may
be determined to be in default and the Minister shall be entitled, pursuant to
the provisions of the contract, to terminate for default.
SITE REGULATIONS
The Contractor undertakes and agrees to comply with all standing orders or other
regulations, in force on the sites where the work is to be performed, relating
to the safety of persons on the sites or the protection of property against loss
or damage from any and all causes including fire.
WORK FORCE REDUCTION PROGRAMS
1. It is a term of this contract:
(a) that the Contractor has declared to the Contracting Authority whether the
Contractor has received a lump sum payment made pursuant to any work force
reduction program, including but not limited to the Work Force Adjustment
Directive, the Early Departure Incentive Program, the Early Retirement
Incentive Program or the Executive Employment Transition Program, which has
been implemented to reduce the public service;
(b) that the Contractor has informed the Contracting Authority of the terms and
conditions of that work force reduction program, pursuant to which the
Contractor was made a lump sum payment, including the termination date, the
amount of the lump sum payment and the rate of pay on which the lump sum
payment was based: and
(c) that the Contractor has informed the Contracting Authority of any exemption
in respect of the abatement of a contract fee received by the Contractor
under the Early Departure Incentive Program Order or paragraph 4 of Policy
Notice 1995-8, of July 28,1995.
2. The Contractor represents and warrants that the information submitted with
its bid is accurate and complete. The Contractor acknowledges that the
Minister has relied
upon such representation to enter into this Contract Such representation
may be verified in such manner as the Minister may reasonably require.
3. The Contractor acknowledges that in the event of a breach of such covenant,
the Minister shall have the right to rescind the Contract.
4. Nothing in this clause shall be interpreted as limiting the rights and
remedies which Canada or the Minister may otherwise have in relation to or
pursuant to this Contract.
CANADIAN CONTENT CERTIFICATION
1. The Contractor represents and warrants that the certification of Canadian
Content submitted with its bid is accurate and complete, and that the goods
and services to be provided to Canada pursuant to this Contract will be in
accordance with the said certification. The Contractor acknowledges that
the Minister has relied upon such representation and warranty to enter into
this Contract. Such representation and warranty may be verified in such
manner as the Minister may reasonably require.
2. The Contractor acknowledges that in the event of a breach of such covenant,
the Minister shall have the right to treat the Contract as being in default
in accordance with the default provisions of the Contract.
3. The Contractor shall keep proper records and documentation relating to the
origin of the goods and services provided to Canada. The Contractor shall
not. without the prior written consent of the Minister, dispose of any such
records or documentation until the expiration of six (6) years after final
payment under this Contract, or until settlement of all outstanding claims
and disputes, whichever is later. All such records and documentation shall
at all times during the aforementioned retention period be open to audit,
inspection and examination by the authorized representatives of the
Minister, who may make copies and take extracts thereof. The Contractor
shall provide all facilities for such audits, inspections and examinations,
and shall furnish all such information as the representatives of the
Minister may from time to time require with respect to such records and
documentation.
4. Nothing in this clause shall be interpreted as limiting the rights and
remedies which Canada or the Minister may otherwise have in relation to or
pursuant to this Contract.
ANNEX "A" - STATEMENT OF WORK
TABLE OF CONTENTS
1.0 PROJECT SCOPE
1.1 Background
1.2 Purpose
1.3 Scope
1.4 Terminology
1.5 General Instructions
2.0 APPLICABLE DOCUMENTS
2.1 CF Spectrum of Care
2.2 CF Drug Benefit List
3.0 SERVICE REQUIREMENTS
3.1 Regular Requests
3.2 Language of Services
3.3 Requests for Service Providers
3.4 Advertisement of Need for Health Care Provider Services
3.5 Choice of Health Care Providers for Options
3.6 Response to Requests for Services
3.7 Coordination with Local Health Authorities
3.8 Health Care Service Provider Terms and Conditions
3.9 Provider Costs
3.10 Non-Regular Requests
3.11 Health Information
3.12 Provider Qualifications
3.13 Liability
3.14 Invoicing and its Reporting
3.15 Grievances and Complaints (Dispute Resolution)
3.16 Security and Privacy
3.17 Quality Assurance
3.18 Contract Duration and Implementation Phases
3.19 Project Performance Measurement
4.0 RESPONSIBILITIES and AUTHORITIES
4.1 Local Health Authorities
4.2. Technical Authority
5.0 PROJECT MANAGEMENT
5.1 General
5.2 Project Manager
5.3 Progress Reporting
APPENDICES
Appendix 1 - Range of Services
Appendix 2 - Use of Locations and Sizes of Service Delivery
Appendix 3 - Summary of Health Care Providers (Military & Civilian)
1.0. PROJECT SCOPE
1.1. Background
I.I.I. The responsibility for health care to Canadian Forces (CF) members rests
with the CF as outlined in the National Defence Act. Within the CF, health care
services are managed by the Director General Health Services (DGHS).
1.1.2. The CF maintains medical and dental units as the primary point of care
for CF members. These CF health organizations, consisting of base clinics and
small hospitals, are geographically co-located with major military
installations. Within these CF health facilities, a varying range of health
services are offered depending on the population served and the CF resources
available. Military medical and dental personnel augmented by civilian personnel
undertake the on-base (on-site) delivery and administration of health care to CF
members. The balance of health services are purchased from civilian providers
off-site. Most ambulatory care services and occupational health services are
provided on Base while most specialist and in-patient services are purchased
from local civilian communities.
1.1.3. The CF Is completing a period of extensive re-engineering that involves
re-aligning CF health services to more fully meet operational and training
commitments. This re-alignment has resulted in short-term (temporary) and
long-term (permanent) gaps in the availability of military health service
providers at CF health facility sites increasing the need for civilian providers
both on and off Base. In particular, short to medium term requirements
frequently result from operational taskings and the rapid removal of essential
medical and dental staff from base health facilities. Without adequate
replacement of services, the resultant shortfalls impact negatively on patient
care.
1.1.4. On-Base Services. As part of the emphasis on increasing the use of
civilian versus uniformed health care providers, the CF will be establishing a
core team of civilian providers at each CF Base clinic. These civilians will be
augmented by military medical and dental personnel to completely staff the CF
clinics to provide a range of services.
1.1.5. Off-Base For off-Base, Fee-for-Service Providers the CF maintains a
National Provider Network (NPN) of health care providers. The NPN is a formal
list of all civilian health care providers who have agreed to see CF patients
and invoice for their services through the current claims administrator.
1.1.6. Currently, numerous problems exist at the local level that are negatively
affecting the ability of local CP health authorities to source and contract
civilian health care providers to augment the services provided by uniformed
military providers. Most importantly, the local health authorities have limited
time, resources, expertise, and necessary contacts to source, contract and
manage large numbers of civilian providers. The CF requires a prime contractor
who understands health care providers, will provide their services to the CF,
and can manage them while they are delivering service to the CF as part of the
overall care team.
1.1.7. The CF believes that a contractor (herein referred to as the Contracted
Provider/ Administrator `[CPA]) is needed to act as a centre) CP-wide resource
in support of Base local health authorities to provide and manage civilian
provider services in support of the CF health services. The CPA must work
closely with local CF health authorities at the Base level. The CPA must respond
to the needs of local CF health authorities by obtaining and providing specific
civilian health care services to support military health care services to CF
members. This contract will be used, primarily, to provide on-site services in
support of CF health resources. However, in certain cases, this contract may be
used to provide off-site (non fee-for-service) services.
1.2. Purpose. The purpose of this contract is to establish and engage a
Contracted Provider/Administrator (CPA) to provide civilian health care services
to the CF for the CF Health Services. This contract is not intended to establish
all off-base fee-for-service arrangements since the NPN referred to at 1.1.5 has
already been established and comprises a reasonably complete network of off-site
fee-for-service civilian providers. A CPA is required, primarily, to establish
and/or improve on current on-Base services and to make additional off base
arrangements for services, as the needs arise.
1.3. Scope.
1.3.1. This contract is required to support CF health services at various CF
locations across Canada providing health services. The range of services that
may be requested through this contract are outlined at Appendix 1 to this SOW.
The locations for which services may be requested are outlined at Appendix 2.
The Technical Authority shall provide the Contractor with the addresses, contact
name and communication numbers for each of the locations.
1.3.2. The number of required service providers over the contract period and its
optional extension period is difficult to predict accurately. The only
information available to the Contractor for service usage estimation purposes is
the information provided in Appendix 3. For this reason, the resulting health
services will be requested on an "as and when" requested basis only. Information
gathered under a previous contract for services, which was undertaken to trial
this concept, indicates that the CPA can expect to establish and manage 300-400
service providers CF-wide.
The Contractor should expect to provide all civilian services currently listed
in Appendix 3. Additionally, it is expected that a portion (25%) of military
health care providers will be replaced with civilian health care providers under
the contract. The Contractor is advised however, that these figures are provided
only for initial planning purposes only - DND may use this contract more or less
extensively. The estimated quantity, level and type of services specified herein
are only an approximation of requirements given in good faith by Canada. The
issuance of this contract shall not constitute an agreement by Canada to order
all of the said services.
1.3.3. This contract is intended to cover arrangements for services for
primarily on-site services and limited off-site providers. These services could
be provided by subcontractors or by employees of the CPA. Provider payment
arrangements could be varied and might include sessional, per diem, monthly
reimbursement rates, on-call. The majority of off-site providers currently used
by the CF are fee-for-service, are registered as part of the CF NPN as
fee-for-service providers and are paid by the health care
claims administrator. The CPA under the proposed contract is not expected to
provide administration or action related to these established fee-for-service
provider arrangements.
1.3.4. The contractor shall not provide services outside of the Canadian border.
1.4. Terminology
1.4.1. Local Health Authority (LHA): The senior CF medical or dental officer at
a CF location responsible for the provision and administration of either medical
or dental care to a specified catchment population of CF members. The local
health authority for medical services is referred to as the Health Care
Coordinator (HCC), or as the Base or Wing Surgeon. The local health authority
for dental services is referred to as the Dental Detachment Commander (DDC), or
as the Base or Wing Dental Officer.
1.4.2. Director General Health Services (DGHS): The senior CF officer in charge
of providing and managing health care services for all CF members. The DGHS is
assisted in his/her responsibilities by a headquarters staff (Canadian Forces
Medical Group, HQ).
1.4.3 Health Care Coordinator [HCC] (Base / Wing Surgeon): The local CF health
authority for medical services to a specific catchment population of CF members.
1.4.4. Dental Detachment Commander [DDC] (Base/Wing Dental Officer): The local
CF health authority for dental services to a specific catchment population of CF
members.
1.4.5. Health Care Services: All professional, technical, and related functions
performed by health providers including (but not restricted to): general and
specialist medical care, general and specialist dental care, nursing care,
medical laboratory services, diagnostic imaging services, pharmacy services,
physiotherapy services, occupational health services, environmental health
services, health education and training, physiotherapy services, mental health
services including counseling.
1.4.6. In-▇▇▇▇▇▇▇▇ Care Services: All on-base (on-site) and off-base (off-site)
health encounters provided to non-deployed CF members.
1.4.7. On-Site (On Base) Health Services: Health care that is provided within
the confines of a DND organization.
1.4.8. Off-Site (Off Base) Health Services: Health care that is provided outside
the confines of a DND organization.
1.4.9. Functional (area) Headquarters: Refers to the next higher level of
Command above the local CF health authority. This is an intermediate level of
command and control between the Base level (local) and the DGHS staff.
1.4.10. Technical Authority: Refer to the project management office at the
Canadian Forces Medical Group Headquarters (CFMGHQ) located in Ottawa, ON and
will be a single point of contact for the Contractor.
1.4.11. Standard of Care: Standard of care may be measured by parameters such as
access (time to treatment), qualifications of providers, cleanliness and
maintenance of premises and equipment, accurate charting, the delivery of
appropriate care, adherence to pre-defined practice standards and guidelines and
patient satisfaction.
1.4.12. Engaged Providers versus Performing Providers: A provider is considered
engaged (by the Contractor) if there has been a formal request from the CF (a
Service Request Form) for services and a Service Delivery Option has been
accepted bv the LHA for which a "call-up" exists. Engaged does not necessarily
mean that a provider will supply services full-time (active), however, the CF
may want the provider to remain available (and on the books as necessary) for
services as and when requested, e.q. "on-call. There may or may not be a fee
chargeable for maintaining a provider who is not active on a full-time basis
(eg. "on-call*), depending on the service. In fact there may be months when an
engaged provider does not provide services, however, they will still be
considered engaged for the purposes of ascertaining the number of engaged
providers. Excluded are providers available from the Contractor's pool of
resources or any inventory list of qualified providers. or the like. who may be
awaiting the Contractor's request for engagement of their services. A provider
"performing' services is an engaged provider who has in the past month performed
services for which a Provider Cost is incurred and invoiced by the CPA to DND.
1.5. General
1.5.1, CF facilities, equipment and material cited herein as supplied to the
Contractor are supplied as Government Property and shall be treated as such. The
Contractor shall notreplace used consumables.
1.5.2. Unless otherwise specified, "days" expressed herein are "calendar*.
1.5.3. The Contractor is reminded the Contractor is engaged as an independent
Contractor for the sole purpose of performing the Work. Neither the Contractor
nor any of its personnel or subcontractors are engaged as an employee, servant
or agent of Canada. The Contractor is responsible for all deductions and
remittances required by law in relation to its employees including those
required for Canada or Quebec Pension Plans, unemployment insurance, workers'
compensation, or income tax. Further, the Contractor shall comply with the
'Sub-contracting" provisions of the General Conditions and the relationship
between the Contractor and subcontractor concerning the provisions in the
preceding paragraph.
1.5.4. The terms 'call-up' or 'agreement' herein refer to the Service Delivery
Option selected and presented by the Contractor, accepted by the LHA. and for
which the Contractor has made final selection and shall arrange for the services
to commence pursuant to the terms of this contract.
1.5.5. Except for obvious inapplicability, the terms and conditions cited herein
for 'on-site' services apply with equal force and offered to "off-site"
services.
1.5.6. The term "service provider(s)", "health care provider(s)" includes
individuals, Contractor's personnel providing the health care services, as well
as any contracted firm or organization or individual providing its health
services and/or service providers. The terms 'service package" and "service
delivery option" have the meaning given to them in article 3.5 herein.
1.5.7 The term "Provider Costs" means the costs directly related to the health
service provision (not management, maintenance and operation of the contract),
are pass through charges, and are detailed in the Basis of Payment article of
the Contract.
2.0. APPLICABLE DOCUMENTS
2.1. The CF Spectrum of Care document is available from the Technical Authority.
This document outlines the health care benefits that are provided to CF members.
2.2. CF Drug Benefit List This is a part of the CF Spectrum of Care document.
Both documents, in existing version and as may be periodically updated during
the term of the contract, apply to the contract.
3.0. SERVICE REQUIREMENTS
The Contractor (CPA) shall work closely with the Technical Authority and local
hearth authorities to provide various health services in support of in-▇▇▇▇▇▇▇▇
health care services. Services shall be provided primarily on-site, however, the
Contractor will also be required to develop arrangements for off-site services
(non fee-for-service) where and when on-site service delivery is not the best
option.
It is expected that two types of providers will be engaged by the Contractor: 1)
personnel of the Contractor; and 2) providers who have been subcontracted by the
Contractor. Various arrangements for reimbursing providers may be considered
including but not limited to on-site fee for services (when no other alternative
exists), salaried, per diem, sessional, on call.
To provide ease of reading this Statement of Work. following is a brief outline
(only) of the Service Request and Engagement Process:
o the LHA initiates a request for sarvices through a Service Request Form (SDF):
o the Contractor selects appropriate services and responds to the SDF by
presenting a service package proposal in a Service Delivery Option (SDO):
o the LHA reviews the SDO and will provide written notice of its acceptance
or rejection of the SDO: the Contractor then makes final selection of the
appropriate services from the accepted SDOs. From these 'final selected"
SDOs. the Contractor makes arrangement between the Contractor and the
provider for the delivery of the health services to DND:
o the final SDO selected by the Contractor from which the Contractor shall
deliver health services is considered the "call-up" between the Crown and
the Contractor
o providers are engaged for delivery of services only if a "call-up"
exists: all in accordance with the terms of this contract.
Specifically:
3.1. REGULAR Requests. Local health care authorities [or the Technical
Authority in cases where a CF-wide service is being requested] will
request services against this contract on an as and when requested by
the Local Health Authority or Technical Authority basis. The Contractor
shall supply service providers in response to these stated requirements
within 60 days following a request (which time excludes the time taken
by DND to review and respond to the presented Options). NO services
shall commence until the Local Health Authority or the Technical
Authority has provided written notice to this effect.
3.1.1. The Contractor shall be responsible for supplying service
providers and ensuring that applicable terms and conditions,
as set out in this SOW and in the contract, are met.
3.1.2. While the requirement may be identified by LHAs for greater
period, DND shall be limited in their obligation to call-ups
with the Contractor for health services that do not run past
the end-date of the contract period or its extension thereof,
including any option period exercised. Any contract period
extensions will be evidenced in writing by the Contracting
Authority. The Contractor will not be required to provide
services which will extend beyond the contract period.
3.1.3. Option to extend period of contract. The Contractor shall
provide the same contract services throughout the option
period detailed in the 'Option to Extend Period of Contract*
article of the Contract.
3.1.4. For each Service Delivery Option presented to the LHA by the
Contractor, which has a total estimated value of $25.000.00
(GST/HST included) or more. The Contractor shall have
considered, and will present at least two potential sources
when at least two potential resources can provide the same
services.
In this case, the process of finding and selecting health care
providers) shall be based on obtaining the best value for the
Crown. Best value is defined as meeting DND's requirement
while obtaining a fair and reasonable price in accordance with
the Basis of Payment articles of this Contract.
If only one source is recommended by the Contractor, the
Contractor shall substantiate the reason(s). DND retains the
right to act in the best interest of satisfying Canada's
needs, which could include, but not be limited to, refusal of
the sole source and/or having the Contractor conduct a further
search to find additional options.
3.1.5. The Contractor shall advertise in accordance with article 3.4
herein.
3.2. LANGUAGE of Services.
2.2.1 Project Management (Contracted Provider Administrator (CPA)
The Contractor shall deliver all services, including all reports but
excluding the services provided by health care providers, to the local
health authority, in the local health authority's official language of
choice.
3.2.2. Services of Health Care Service Providers. Unless otherwise agreed
to by the local health authority, Health Care Service Providers shall
conduct the contract services in the official language of the base.
3.3. REQUESTS for Services. The Contract shall work with the Technical Authority
to develop an acceptable Service Request Form (SRF) to be used by local
health authorities to detail the service requirement and to request health
services from the Contractor. As a minimum, the SRF shall detail the
following:
3.3.1. a description of services to be provided, start-date, end-date or
duration of requirement, location of service delivery, language of service
delivery and, hours of service delivery including any after-hours call or
call-back requirements;
3.3.2. an indication of whether options for either on or off-site services are
required (mandatory or preferred):
3.3.3. the type of CF facilities, equipment, materials and support available to
the service provider;
3.3.4. service provider requirements in addition to those listed in this
contract including work experience and qualifications;
3.3.5. any specific performance standards that must be met by a service provider
for the particular work to be undertaken that may not be stipulated herein, as
well as any quality assurance programs a provider would be expected to
participate in:
3.3.6. any CF specific training or orientation that a health care provider must
agree to take:
3.3.7, any other details unique to the specific requirement.
3.4. ADVERTISEMENT of Need for Health Care Provider Services. The Contractor
shall advertise DND requirement for Health Care Provider Services which
shall meet the Advertising Objectives listed below and will inventory
potential suppliers onto a list.
3.4.1 Advertising Objective: To establish wide awareness of DND requirements for
health care provider services as a means to maximizing the quantity of capable
potential health care providers to fulfill this contract.
3.4.2. Advertising Frequency: Contractor shall advertise frequently enough to
achieve the advertising objective outlined in this article 3.4. However, as a
minimum, the Contractor shall advertise at least once every 12 months during the
period of the contract and any extension thereof.
Advertising is a general requirement, meaning the Contractor is not expected to
advertise each and every request for service providers.
3.4.3 Advertising Forum or Medium: The forum or medium are the discretion of the
Contractor and must attract the attention of the various provider categories.
Quantity and
type of forums or mediums shall be reasonable and sufficient in quantity so as
to achieve the advertisement objective. In any advertisement the Contractor
shall indicate that it is an independent contractor acting on its own behalf and
that it does not represent the Government of Canada or the Department of
National Defence.
3.4.4 Advertising Location: Advertisements shall be based on national,
provincial, and/or local coverage, depending on what is appropriate for the
occupation being advertised and the known availability of providers. Ideally,
long term service periods should be advertised provincially and/or nationally,
whereas short term service periods could be limited to provincial and/or local
coverage.
3.4.5. List of Potential Health Care Providers. Using the names of providers who
have approached the Contractor and who meet the requirements for the provider
categories, the Contractor shall develop and maintain a list of potential health
care providers throughout the period of contract and any extension thereof. The
Contractor shall consider this list and other sources of information when
actionning an SRF.
The Contractor shall provide this list to the Crown, at no cost to the Crown, at
any time during the contract period and/or shortly after expiration or
termination of the contract period, upon request of the Technical Authority.
3.4.6. Information in Advertisement. While ensuring the advertising meets the
objective of advertisement, the Contractor shall, as a minimum, disseminate the
following information:
- The periods during which health care service providers may be needed and that
the individuals may be placed onto a list of interested service providers:
- Indication of what 'pertinent" information the Contractor requires.
3.4.7 The Contractor shall not, at any time, indicate that Canada guarantees
engagement of services.
3.5. Choice of Health Care Providers for Options. The service packages presented
by the Contractor in response to the SRF is termed Service Delivery Option(s)
(SDO('s)]. In the Contractor's determination of the SDO to present to DND. the
Contractor shall consider the List of Potential Health Care Providers and other
sources of information. Choice of Service Providers for the SDO(s) shall be made
on the basis of Best Value to the Crown as defined in article 3.1.4 herein.
3.6. Response to Requests for Service. The Contractor shall respond to local
health authorities within 30 calender days after receiving the
requirement details (SRF).
3.6.1. The Contractor shall present one (1) or more, as required, reasonable
Service Delivery Options which shall include:
3.6.1.1. Identification of proposed service providers, confirmation of hours
and any other conditions proposed;
3.6.1.2. Required facilities, equipment and material to be provided by the CF
for each option:
3.6.1.3. The proposed Provider Costs and method (such as sessional, on-call,
etc.), and any other allowable direct costs related to the service provision',
3.6.1.4. The rate applicable for any unforecasted work as outlined in article
3.10.1
herein;
3.6.1.5. Confirmation of appropriate licensure and liability coverage for each
option presented;
3.6.1.6. Written confirmation by the service provider(s) named that the option
is acceptable to them.
3.6.1.7. Indication of:
- The number (qty) of providers considered;
- The source(s) from which the option(s) was (were) selected (i.e. Health Care
Provider List or otherwise);
- The preferred option(s) and the reasons for recommending it (them).
3.6.1.8. When applicable, identification the service providers is not at an
arm's length relationship of the Contractor and the Contractor shall provide the
following certification:
Certification of a "non arm's length relationship":
"I hereby certify that the service delivery option(s) selected herein is
personnal or employees of the Contractor, or, is a subcontract to this Party-the
Contractor which is not at arm's-length of the Contractor."
3.6.3 Following the local health authority's acceptance of a Service Delivery
Option, the Contractor shall make a final selection from the accepted SDOs and
then shall arrange for the accepted services to begin within 30 days of the
local health authority's notice of acceptance.
3.6.4. Non-acceptance of Service Delivery Option. Selection of a service
provider is the responsibility of the Contractor. The local health authority
will be consulted prior to final selection by the Contractor being made for the
purpose of acceptance of the presented SDO. Reasons for non-acceptance of any
SDO selected by the Contractor may include, but not be limited to: the reasons
cited in article 3.1.5 herein (paragraph 3 in particular), previous poor
performance of service or previous failure to conduct business in accordance
with CF requirements, inadequate qualifications or experience in a required
service area, reasons of conflict or interest or an appearance of a conflict of
interest, or the provisions of articles 3.4, 3.5 of the SOW, or the Basis of
Payment of the Contract, not being followed. Notwithstanding the foregoing,
nothing in this contract requires Canada to accept any Service Delivery Option
presented, and the acceptance of such SDO at the sole discretion of the LHA.
3.6.5. In every case that a service provider is rejected, the local health
authority shall indicate why In writing to the Contractor with a copy to each of
the Technical Authority and the Contracting Authority.
3.6.6. At time of Contractor's presentation of SDO(s) to the Crown and
throughout the life of the contract, the Contractor shall ensure all health
service provider's are:
a) licensed, registered or certified in accordance with Canadian provincial
regulations governing their health care specialty, as per Appendix 1 herein:
b) in good standing with provincial licensing bodies; and
c) maintain expertise through appropriate educational training.
Coordination with Local Health Authorities. The Contractor is expected to
establish an excellent response and support system that responds to Base and
regional requirements. The Contractor must ensure that there are adequate
Contracted Provider
Administrator staff available to support all Base requirements simultaneously,
particularly during the implementation phase of this contract which is expected
to be quite busy. The Contractor shall liaise at lease monthly with local CF
health authorities and the Technical Authority to ensure that the provision of
civilian health services arranged through this contract are being met in
accordance with the terms of the contract.
3.8. Health Care Service Provider Terms and Conditions. The Contractor shall
respect the principle of continuity of health services by avoiding
unnecessary changes in health services providers.
3.8.1. The Contractor will ensure that prior to service providers beginning with
the CF, they are made aware of, and agree to abide by standards for professional
services as set out by DND. These may include, but are not limited to, the CF
Spectrum of Care, the CF Drug Benefit List and other health policies and/or
updates of all such documents, as expressed by the Technical Authority
throughout the contract period or its extension(s) thereof.
3.8.2. The Contractor shall ensure that the service providers will coordinate
their service provision schedules with local health authorities so as to
collaborate with the care team and not disrupt continuity of service to CF
members.
3.8.3. As integral health care team members, service providers working at CF
locations may be required to participate in regular coordination meetings,
orientation, training and briefings, and. to conduct their business using
CF-approved forms and other health information tools for reporting and recording
encounters (and they shall do so).
3.8.4. The capabilities to be delivered under this contract are very important
for the health care services provided to CF members. At all times service
providers will, within reason, be treated with respect and as part of the care
team.
3.8.5. Service providers will not intentionally disrupt patient care and will
respect the culture and organization of the CF at all times. Any disruption of
services caused by the service providers will be the responsibility of the
Contractor to remedy immediately, even if it means replacing a provider. The
Contractor shall provide immediate notice of an occurred disruption and advance
notice of imminent disruption of services.
3.8.6. Service providers must familiarize themselves with any Government
Furnished Equipment they are to use, prior to its use.
3.9. PROVIDER COSTS. See Basis of Payment of the Contract.
3.10. NON-REGULAR Requests.
3.10.1. Peak Workload Periods - Unforecasted Work. Increasing the level of
services provided during peak workload periods may be required. (The highest
probability is extended hours of work. In some cases, additional providers may
be required.) These situations may arise quickly, and unexpectedly, as a result
of CF units deploying. The Contractor is expected to cooperate with local health
authorities in providing increased services during these periods. As much notice
as possible will be provided to the Contractor.
3.11. Health Information. Health information related to all medical and dental
encounters by CF members is considered essential to maintaining a complete
patient health record. All health care providers delivering services to CF
members must return relevant encounter information to the local health
authorities. On occasion, CF members may request access to medical records and
information related to their medical care. They have this express right under
Access to Information laws. The Contractor shall provide information requested
under these situations within the statutory limits.
3.12. Provider Qualifications. Health care providers must meet the
qualifications and any licensure requirements as outlined at Appendix 1 to this
SOW. The Contractor shall ensure that all service providers are in good standing
with provincial/federal associations and not under investigation. The Contractor
shall be responsible for conducting credential verifications on all service
providers, prior to and periodically during their conducting work under the
contract. The Contractor shall immediately notify the Technical Authority of the
need to remove any of the service providers for not meeting the foregoing
requisites.
3.13. Liability, The Contractor Is responsible for ensuring that service
providers (individuals, companies, etc.) hold adequate liability insurance
either through an individual licensing organization (CMPA) or the Contractor
will provide adequate liability coverage for them. It is recognized that some
liability coverage(s) may not be available for certain provider groups, such as
medical administration support. Annex "D" of this contract details the Insurance
Requirements. In the case of subcontractors, the Contractor shall flow the
coverage to the subcontractor, if required, but without reducing nor limiting
the Contractor's liability requirements.
3.14. Invoicing and its Reporting. DND will provide the Contractor with unique
billing codes. These codes correspond to specific provider services and CF sites
(the client) and will allow DND to combine these with off-site fee-for-service
providers, in order to get a complete picture of costs. Refer to the "Invoicing"
and "Reporting" articles in contract for further requirements.
3.15. Grievances and Complaints (Dispute Resolution). The Contractor shall agree
to the following dispute resolution mechanisms to ensure that both parties
attempt to first settle conflicts outside of the judicial system. The Contractor
and the Technical Authority shall work towards ensuring that problems and
contract issues get resolved at the lowest possible level. In general, the
Contractor will try to resolve issues firstly with the local health authority.
For clarification of contract requirements, and for issues that cannot be
resolved at the local level, the CPA will meet with the Technical Authority to
resolve matters and clarify requirements. If the Technical Authority and the
Contractor cannot reach an agreement, then either party will approach the PWGSC
Contracting Authority for interpretation of the contract requirements.
3.15.1. It is expected that each party will cooperate and make every attempt to
resolve complaints concerning the services provided, however, the local heath
authority is not to handle a problem or complaint without discussion with the
Contractor.
3.15.2. The Contractor shall make every attempt to resolve problems. Either the
Contractor or the local health authority may choose to inform the Technical
Authority of the situation at this point, however, this step will be dictated by
the situation and those involved.
3.15.3. When the Technical Authority receives a complaint from the local health
authority (further to the preceding articles) that cannot be resolved at a lower
level, the Technical Authority will immediately ensure that the Contractor is
made aware of the problem, in writing, if not already notified by the Technical
Authority. The Technical Authority and the Contractor shall attempt to resolve
the situation. If no acceptable solution can be reached, the PWGSC Contracting
Authority shall be approached to interpret the obligations of all parties
concerned. A remedy could include terminating the service provider.
3.15.4. Where the Contractor has a complaint about the treatment of a service
provider, the Contractor shall immediately contact the local health authority
and attempt to resolve the issue. The Contractor will either resolve the issue
directly with the local health authority or engage the assistance of the
Technical Authority.
3.15.5. Written records of complaints and responses assist all parties should a
problem continue. The Contractor shall, therefore, keep a written record of all
complaints made and action taken. The local health authority, or the Technical
Authority as appropriate, will do the same.
3.15.6. Termination of Call-Ups for Reason of Lapse in Need. The local health
authority will provide written notification to the Contractor of a lapse in
need for call-ups. The notification shall be given in advance, on a
reasonable efforts basis, as follows:
o where the call-up is for a period of 12 months or longer: no less than 60
days before the services are no longer required;
o where the services under an call-up is for a period of between 6 to 12
months : no less than 30 days before the services are no longer required:
o where the call-up for services is for a period of less than 6 months: no
less than 15 days before the services are no longer required.
Termination of services shall be without penalty to the Crown. Payment for
service providers' work shall cease upon the termination of their Work under the
contract.
3.16. Security and Privacy. Maintaining the privacy of individual CF members and
the confidentiality of medical information is paramount to the CF. The
Contractor will ensure that all service providers, whether servicing the CF
on-site or through off-site facilities, are aware of the requirement to
appropriately safeguard medical information and conduct their business to
safeguard CF member privacy and medical information confidentiality.
3.16.1 On-site providers. Service providers who conduct business at CF sites
must be cleared to at least enhanced reliability status. Medical information
produced as a result of on-site visits to providers is the property of DND and
will be safeguarded in accordance with DND security regulations for Protected B
material. (General Conditions of this contract and the Security Requirements
CheckList also apply). No health information shall be removed from CF sites, nor
used for other than its intended purpose without the express written permission
of local health authorities. Nothing in this contract prevents the providers
from accessing medical Information for insurance or legal purposes and provided
all such access requests shall be directed to the Technical Authority and/or the
local health authority.
3.16.2. Off-site providers. Medical information produced as a result of off-site
visits to providers for services under this contract is, by law, considered the
property of the service provider organization. Service providers who conduct
business under this
contract not at CF sites (off-site) must, as a minimum, safeguard medical
information in accordance with all relevant federal and provincial laws and
regulations and always in a manner to protect the privacy of the individuals
involved. No health information generated from off-site visits of CF members
will be used for other than its intended purpose without the express written
permission of local health authorities and the CF member.
3.16.3. In addition to 3.16.1 and 3.16.2, at all times during the period of
contract, including the time during which security clearances are not in place,
the Contractor acknowledges that Canada is subject to the provisions of the
Privacy Act (R.S.C., c. P-21) with regard to the collection, retention, use and
handling of any "personal information as defined therein. Notwithstanding
anything else contained herein, if the Work under any Call-Up issued under the
Contract involves the collection, creation or handling of any such personal
information, the Contractor shall keep confidential any such personal
information, and shall not collect, retain, use or disclose it other than in
accordance with the terms of the Contract and the provisions of the Privacy Act.
Except for the information collected under article 3.16.2 herein, the Contractor
shall deliver to Canada all such personal information in whatever form, upon the
completion or termination of the Contract or at such earlier time as the
Minister may request.
3.17. Quality Assurance and Accreditation. CF medical facilities may be
accredited during the term of the contract. Providers must participate in and/or
observe the accreditation process. Providers participation will be at no
additional cost to Crown. Local health authorities and the Director General
Health Services are responsible to ensure an acceptable standard of care to CF
members. In order to monitor the standard of care being provided to members by
service providers under this contract, audits by DGHS take place regularly.
These audits may include service providers under this contract and occur with
the following conditions:
3.17.1. Given at least 10 working days written notice, the Contractor (including
service providers) will allow the Director General Health Services staff access
to the Contractor's service premises (includes off-site locations providing
services) for audit purposes.
3.17.2. The written notice will outline what elements of the service will be
audited; for example chart reviews, premises inspections, equipment/supplies,
prescriptions. The Director General Health Services or local health authorities
may include any DND or civilian members on an audit team, as deemed appropriate
by the Technical Authority. The Contractor may be present for any audit visit.
3.17.3. The Contractor will have 14 days to review and respond in writing to any
findings and recommendations.
3.17.4. The Contractor shall correct any unsatisfactory conditions to
satisfactory or better conditions. If the Contractor's corrective action
anticipated or undertaken is considered, by the Technical Authority, to be
inadequate, the Contractor shall improve its corrective action to the
satisfaction of the Technical Authority.
3.17.5. All CF Health Clinics monitor quality through regular Quality Assurance
programs. Providers shall participate and cooperate in these programs as
requested by DND.
3.18. Contract Duration and Implementation Phases. Total contract period
(implementation & operational periods) shall be from date of contract award
through March 31,2004. The Contractor shall commence work from date of contract
award.
It is felt the CF will require an estimated 400 providers and will take about 12
months to reach a steady state (otherwise considered implemented).
While some providers will be required before 15 July 2001, the remaining
providers will be phased in over the remaining period of the initial 12 months
(approximately)
It is believed there will be a relatively large workload during the first 12
months of the contract, with less work required during the on-going operational
phase.
The Contractor shall have the following service structure established by 15 July
2001, understanding the remainder of the estimated 400 providers will be
phased-in (as applicable) through the remaining initial contract period.
Minimum Service Structure:
Reporting including the response and support system to CF sites, invoicing
development of request forms, progress meetings having already started, initial
discussions with all sites to identify start-up requirements, initial providers
identified or in-place.
During the initial period but before 14 July 2001 the Contractor shall approach
all bases and discuss immediate and expected future requirements. Bases at
Halifax and Greenwood will be approached and assisted as a priority. Beyond
those two sites, DND would prefer that larger bases be provided services as a
priority before smaller sites.
3.19 Project Performance Measurement. In addition to the "Inspection and
Acceptance of the Work" provisions in the contract, the Contractor's project
performance and services are subject to the Technical Authority's acceptance.
The Technical Authority shall assess such and the following performance measures
will be used:
3.19.1. Response to LHA requests for SDOs is given within 30 days from date
of SRF and the services have started within 30 days from date of acceptance
by the LHA of the service option presented:
3.19.2. SDOs presented by Contractor are satisfactory to the local health
authority;
3.19.3. Services provided under this contract, and in particular the adequacy
of the continuity of the Health Care Providers (both management and actual
providers) are satisfactory to the Technical Authority, local health
authorities and his/her clients.
3.19.4. Compliance with other terms and conditions of this contract such as
security, reporting, advertising, etc.
4.0. RESPONSIBILITIES and AUTHORITIES
4.1. Local Health Authorities shall be responsible to:
4.1.1. Identify to the Contractor the detailed service requirements and
respond to questions from the Contractor;
4.1.2. Report regularly to the Contractor on services being provided through
this contract and report any dissatisfaction;
4.1.3. At no time is the local authority to intentionally discuss Provider
Costs, including benefits or other terms and conditions directly with
service providers:
4.1.4. Endeavor to ensure that service providers and other staff treat one
another with
mutual respect and in a cooperative manner at all times;
4.1.5. Ensure he/she is requesting services only and not individual providers
(by name).
The LHA will have an opportunity to accept or not accept any SDO
presented by the Contractor. Such non-acceptance should only be used for
substantial reasons (as outlined in the SOW and contract) which will be recorded
and provided in writing to both the Contractor and the Technical Authority.
4.1.6. Provide, maintain and replace those facilities, equipment and supplies as
set out in the call-up and which belong to the Crown.
4.1.7. Advise the Contractor of their intention to renew a call-up at least 30
days before the end of the call-up period.
4.1.8. Advise the Contractor of LHA's intention to terminate a call-up, for
reason of lapse in need (not including termination for cause), in accordance
with the timelines listed in article 3.15.8 herein.
4.2. The Technical Authority shall be responsible to:
4.2.1. provide technical expertise to this contract;
4.2.2. reimburse the Contractor, in accordance with the terms of this contract,
for both management charges and Provider Costs plus any other allowable charges
accepted and set out in the contract.
4.2.3. work with both the local health authorities and the Contractor to resolve
any disputes at the lowest level possible;
4.2.4. conduct or arrange for audits to be conducted to ensure that the terms of
this contract are being met.
5.0. PROJECT MANAGEMENT
5.1. General. The Contractor shall implement project management to the extent
necessary to establish and validate management of this contract The Contractor
shall be responsible for providing efficient organization, effective control
systems, reporting procedures and to report on how the work is being
accomplished and scheduled.
5.1.1. In addition to the project controls detailed herein, the Contractor is
responsible for implementing additional controls, as necessary, to ensure that
all requirements as specified in this SOW and the contract are satisfied.
5.2. Project Manager. The Contractor shall appoint a single Project Manager
(PM) by name, to act as the Point of Contact with the Crown. The PM must be
vested with sufficient authority within the Contractor's organization to make
and communicate to the Crown all decisions related to the work, and shall
provide the planning control for all aspects of the work.
5.3. Progress and Milestone Reporting. The Contractor shall convene and
provide data and personnel for the efficient conduct of Progress Review
Meetings at the Technical Authority location in Ottawa. These meetings will
occur monthly during the start-up phase and quarterly thereafter. The
Contractor will be responsible for co-chairing the Progress Review Meetings
with the Technical Authority or his/her designate.
5.3.1 The first meeting will be scheduled for a date two weeks after contract
award.
5.3.2. The Contractor will be responsible for recording and submitting
minutes of each meeting to all attendees.
5.3.3. The Contractor will be required to produce monthly progress reports and
distribute them to the Technical Authority and other Meeting attendees along
with the agenda at least one week prior to the scheduled Progress Review
Meeting. These
reports shall be in a format selected by the Contractor and shall provide
complete and correct visibility of the progress of the work.
5.3.4. Specifically, for the Implementation/Start-Up Period, the Contractor
shall prepare and submit a Milestone Report, in single COPY to the Technical
Authority. One copy of the report shall also be forwarded to the Contracting
Authority. This report must be submitted for each milestone listed in the
"Schedule of Milestones" attached as Annex "E". Each report shall consist of
a narrative which shall contain, as a minimum:
a) a description of the Work completed under the milestone;
b) any problems encountered or foreseen (relating to time or technical
matters); and
c) the certifications for purchase of items and of work, as requested in
Annex E
APPENDIX 1 to ANNEX "A" - RANGE OF SERVICES
CIVILIAN PROVIDER SERVICES THAT
MAY BE REQUIRED UNDER THIS CONTRACT
General: For each of the occupation groups listed below, any individual supplied
under this contract to provide services to DND must be qualified in accordance
with the guidelines below and currently in good standing with their professional
body.
A. Medical Doctors. As a general rule, a medical doctor must hold a current and
valid licence to practise medicine in the province in which he or she will be
engaged by DND. However, the medical care of military personnel at a DND unit is
an over-riding factor. In circumstances when the unit cannot obtain this care,
except by engaging a civilian medical doctor registered in another province,
such engagement may be authorized by the local HCC.
B. Dentists. As a general rule, a dentist must hold a current and valid licence
to practise dentistry in the province in which he or she is to be engaged by
DND. However, the dental care of military personnel at a DND unit Is an
over-riding factor. In circumstances when the unit cannot obtain this care,
except by engaging a civilian dentist registered in another province, such
engagement may be authorized by the local dental detachment commander. In
addition, a dentist must have recently demonstrated through practice the ability
to provide comprehensive dentistry including restorative treatment, oral
surgery, periodontics, endodontics, and prosthodontics (unless to be engaged for
a specialty service).
C. Nurses (includes Nurse Practitioners). To be eligible for engagement as a
registered nurse, as a Nurse Practitioner or a registered specialist nurse, a
nurse must be currently registered in a province or territory of Canada. Nurse
Practitioners must be graduates of a nurse practioner program recognized by the
Canadian Nursing Association. DND may have requirements for specialty nursing
areas such as community health, operating room trained or critical care. These
nurses must be duly qualified in the required nursing specialty area.
D. Optometrists. Optometrists are licensed to practise on a provincial basis,
although there is informal provincial reciprocity in some areas in Canada.
Optometrists engaged by DND must be licensed in the province in which they are
engaged unless reciprocity exists.
E. Ophthalmic Technicians. To be eligible for engagement, an ophthalmic
technician must be licensed in the province in which he/she will be engaged
and have at least 1 year of experience in a clinical setting.
F. Physiotherapists. To be eligible for engagement, a physiotherapist must be
licensed in a province in Canada and be eligible for membership in the Canadian
Physiotherapy Association. If a physiotherapist is working in sole charge they
require a minimum of 5 years of practice. Physiotherapists working on CF clients
should have knowledge and experience in orthopedics and sports medicine.
G. Occupational Therapists. To be eligible for engagement, an occupational
therapist must have current registration or be eligible for membership in the
Canadian Association of Occupational Therapists. Occupational therapists trained
to meet World Federation of Occupational Therapists' standards are acceptable to
the Canadian Association of Occupational Therapists.
H. Pharmacists. To be eligible for engagement, a pharmacist must hold a current
and valid licence to practise pharmacy in a province or territory of Canada.
I. Pharmacy Technicians. To be eligible for engagement, a pharmacy technician
must be a graduate of a recognized technical school in the field of pharmacy
technician.
J. Psychologists. To be eligible for engagement, psychologists must be a
registered or certified psychologist. The certification must be in the area of
clinical psychology.
▇. ▇▇▇▇▇▇▇▇▇▇. To be eligible for engagement a dietitian must be eligible for
membership in the Dietitian of Canada and adequately trained or experienced in
the clinical dietetics field.
L. Registered Nursing Assistants, Certified Nursing Assistants, Licensed or
Registered Practical Nurses. To be eligible for engagement, registered nursing
assistants, certified nursing assistants, and licensed or registered practical
nurses must be eligible for registration in a province or territory of Canada.
Ex-Military Service medical assistants who were qualified at the TQ5 level or
above may be considered so long as the Contractor can satisfy article 3.13
herein as well as all other terms and conditions of this Contract.
M. Physician's Assistants. To be eligible for engagement, a physician's
assistant must be trained to the TQ6B military level or to a civilian equivalent
standard.
N. Diagnostic Imaging Technologists. To be eligible for engagement, civilian
X-ray technicians must be in possession of a registration certificate from the
Canadian Society of Radiological Technicians (CSRT). Ex-Military Service
technicians who were qualified at TQ5B or above may be considered so long as the
Contractor can satisfy article 3.13 herein as well as all other terms and
conditions of this Contract.
0. Laboratory Technologists. To be eligible for engagement, civilian laboratory
technicians must possess current registration in the Canadian Society of
Laboratory Technologists (CSLT).The British Institute of Medical Laboratory
Technologists (IMLT), the American Society of Medical Technologists (ASMT).
Ex-Military Service technicians
who were qualified at TQ6A or above may be considered so long as the Contractor
can satisfy article 3.13 herein as well as all other terms and conditions of
this Contract.
P. Medical Social Workers. To be eligible for engagement, a medical social
worker must have a Master of Social Work or a Bachelor of Social Work (dependent
on the requirements) degree from a recognized school of social work and be
eligible for membership in the Canadian Association of Social Work.
Q. Medical Administration. To be eligible for engagement, medical administration
individuals must be adequately qualified and have relevant experience to perform
the particular medical administration job outlined by the CF. Administration
work may include but not be limited to the following tasks: medical records,
clinic administration, medical appointments, medical transcription. Further
qualifications will be set out by the local health authorities as the particular
needs arise.
APPENDIX 2 TO ANNEX A - LIST OF LOCATIONS AN SIZES OF SERVICE DELIVERY
The contractor shall consult with the Technical Authority for instruction
concerning the Local Health Authority names, communication numbers and location
addresses.
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CANADIAN FORCES FULL TIME CF SIZE OF CF GEOGRAPHIC NEAREST POPULATED
BASE/STATION/UNIT POPULATION MEDICAL SUPPORT LOCATION CENTRES
(AS AT CONTRACT UNIT
ISSUE)
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CFB Bagotville 1220 Medium Alouette, PQ Bagotville, Chicoutimi,
La Baie, Jonquiere PQ
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CFB ▇▇▇▇▇▇ 2142 Medium ▇▇▇▇▇▇, ON Barrie/Alliston ON
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Calgary Detachment 300 Small Calgary, AB Calgary, AB
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CFB Cold Lake 2600 Medium Grand Centre, AB Grand Centre, Bonneyville,
AB
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CFB Comox 1200 Medium ▇▇▇▇▇▇▇▇, ▇▇ ▇▇▇▇▇▇▇▇, Nanaimo,
Victoria, BC
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CFB Edmonton 4524 Medium Edmonton, AB Edmonton, AB
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CFB Esquimalt 3500 Large Victoria, BC Victoria, BC
---------------------------------------------------------------------------------------------------------------------------------
CFB Gagetown 3206 Large Gagetown, NB Fredricton, NB
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CFB Gander 200 Small Gander, NF St John's NF
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CFB Goose Bay 91 Small Happy Valley, St John's NF
Labrador
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CFB Greenwood 2166 Medium Greenwood, NS Kentville, NS
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CFB Halifax 6730 Large Halifax, NS Halifax, NS
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CFB Kingston 4600 Medium Kingston, ON Kingston, ON
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London Detachment 500 Small London, ON London, ON
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Meaford Detachment 181 Small Meaford, ON ▇▇▇▇ Sound, ON
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Moncton Detachment 839 Small Moncton, NB Moncton, NB
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CFB Montreal 700 Small Montreal, PQ Montreal, PQ
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CFB Moose Jaw 400 Small Moose Jaw, SA Regina, SA
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CFB North Bay 623 Small-Medium North Bay, ON North Bay, ON
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CFB Ottawa 7000 Large Ottawa, ON Ottawa, ON
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CFB Petawawa 5064 Medium Petawawa, On Pembroke, ON
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Shearwater 908 Medium Shearwater, NS Halifax, NS
Detachment
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CFB Shilo 773 Medium ▇▇▇▇▇, MA ▇▇▇▇▇▇▇, MA
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CFB St. ▇▇▇▇ ▇▇▇ ▇▇▇▇▇▇ ▇▇. ▇▇▇▇, ▇▇ ▇▇▇▇▇▇▇▇, PQ
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CFB St. John's 163 Small St. John's, NF St. John's NF
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CFB Suffield 100 Small Suffield, AB Medicine Hat, AB
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CFB Toronto 750 Medium Toronto, ON Toronto, ON
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CFB Trenton 2900 Medium Trenton, ON Belleville, ON
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CFB Valcartier 5668 Large Valcartier, PQ Quebec City, PQ
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▇▇▇▇▇▇▇▇▇▇ 270 Small ▇▇▇▇▇▇▇▇▇▇, ▇▇ Edmonton, AB
Detachment
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CFB Winnipeg 2437 Medium Winnipeg, MA Winnipeg, MA
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CFRC Calgary 0 CFRC Calgary, AB Calgary, AB
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CFRC Edmonton 0 CFRC Edmonton, AB Edmonton, AB
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CFRC Gagetown 0 CFRC Gagetown, NB Gagetown, NB
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CFRC Halifax 0 CFRC Halifax, NS Halifax, NS
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CFRC Kingston 0 CFRC Kingston, ON Kingston, ON
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CFRC London 0 CFRC London, ON London, ON
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CFRC Montreal 0 CFRC Montreal, PQ Montreal, PQ
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CFRC Ottawa-Hull 0 CFRC Ottawa, ON Ottawa, ON
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CANADIAN FORCES FULL TIME CF SIZE OF CF GEOGRAPHIC NEAREST POPULATED
BASE/STATION/UNIT POPULATION MEDICAL SUPPORT LOCATION CENTRES
(AS AT CONTRACT UNIT
ISSUE)
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CFRC Quebec City 0 CFRC Quebec City, PQ Quebec City, PQ
---------------------------------------------------------------------------------------------------------------------------------
CFRC Regina 0 CFRC Regina, SA Regina, SA
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CFRC Rimouski 0 CFRC Rimouski, PQ Rimouski, PQ
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CFRC Sherbrooke 0 CFRC Sherbrooke, PQ Sherbrooke, PQ
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CFRC St John's NF 0 CFRC St. John's, NF St. John's NF
---------------------------------------------------------------------------------------------------------------------------------
CFRC Toronto 0 CFRC Toronto, ON Toronto, ON
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CFRC Trois Riviere 0 CFRC Trois Riviere, PQ Trois Riviere, PQ
---------------------------------------------------------------------------------------------------------------------------------
CFRC Vancouver 0 CFRC Vancouver, BC Vancouver, BC
---------------------------------------------------------------------------------------------------------------------------------
CFRC Victoria 0 CFRC Victoria, BC Victoria, BC
---------------------------------------------------------------------------------------------------------------------------------
CFRC Winnipeg 0 CFRC Winnipeg, MA Winnipeg, MA
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Small Medical Support Unit: Very limited services offered on site. Most services
referred out, including ambulatory care. Some occupational health (health
examinations) offered on-site, health care coordinator refers members to
civilian national Provider Network (NPN) and authorizes services. Normally sites
with small regular force populations and dispersed reserve (part-time) members.
All medical records kept on catchment population of regular and reserve force
members
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Medium-Sized Medical Support Unit: Ambulatory care services including
diagnostics, pharmacy and limited treatments. Triage and limited emergency care.
Generally, 2-3 physicians and regular working hours. Most specialist services
off-site and all surgery and complex treatments and care referred out. Varying
amounts of physio, pharmacy. Lab, x-ray on-site. All medical records kept on
catchment population of regular and reserve force members.
--------------------------------------------------------------------------------
Large Medical Support Unit: Comprehensive care provided including all ambulatory
care services, triage and limited emergency care, and limited surgical services.
Specialist services. Some in-patient care. All medical records kept on catchment
population of regular and reserve force members.
--------------------------------------------------------------------------------
Canadian Forces Recruiting Centres (CFRC): Small units across Canada Whose role
is to screen and enroll CF members. Medical examinations are part of the normal
screening process. This service is normally provided by a single medical
assistant at the Warrant Officer (WO) or Sergeant.
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APPENDIX 3 TO ANNEX "A" - HEALTH CARE PROVIDERS (MILITARY & CIVILIAN) BY CF SITE SUMMARY
CF Base: (as at June 2000)
Military population served: 60813
(includes satellite units supported)
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Total # of Total # of Military Total # of Full-time Total # of Part-time
providers working providers working civilians working civilians working
PROVIDER CATEGORY in support of in support of in support of in support of
in-▇▇▇▇▇▇▇▇ in-▇▇▇▇▇▇▇▇ in-▇▇▇▇▇▇▇▇ in-▇▇▇▇▇▇▇▇
services services services services
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MEDICAL PROVIDERS
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General Duty (G.P) Doctors 115 82 12 21
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PHYSICIAN SPECIALIST
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ANESTHETISTS 7 7 0 0
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GENERAL SURGEON 5 5 0 0
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PSYCHIATRIST 9 5 1 3
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GENERAL INTERNAL MEDICINE 8 7 0 1
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ORTHOPEDIC SURGEON 7 4 1 2
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Diagnostic Imaging Technologist 27 21 2 4
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Dietician 5 0 0 5
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Health Care administrator 27 26 1 0
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Laboratory Technician 41 33 4 4
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Licenced Practical Nurse 1 0 1 0
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REGISTERED NURSES
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GENERAL DUTY 129 121 1 7
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OPERATING ROOM TRAINED 16 15 0 1
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COMMUNITY HEALTH 22 22 0 0
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CRITICAL CARE 19 16 0 3
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Optical Technicians 12 4 2 6
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Pharmacists 37 21 5 11
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Physiotherapists 33 15 11 7
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Social Workers 41 23 17 1
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Psychologists 6 0 3 3
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Operating Room Technicians 11 11 0 0
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Medical Assistants (all levels) 219 208 5 6
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Others 14 9 5 0
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TOTAL MEDICAL 811 655 71 85
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DENTAL PROVIDERS
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General Dentists 57 40 12 5
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Dental Hygienists 176 92 76 8
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Dental Assistants 21 0 19 2
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TOTAL DENTAL 254 132 107 15
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