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Agreement with Mount Sinai Medical Center of Florida DocuSign Envelope ID: 192DD89C-A3C5-4226-BF99-1A23E2A1F635 Contract No. 20-144-01 2oLCo - 3)393 PROFESSIONAL SERVICES AGREEMENT BETWEEN THE CITY OF MIAMI BEACH AND MOUNT SINAI MEDICAL CENTER OF FLORIDA, INC. FOR MEDICAL SERVICES FOR PRE & POST EMPLOYMENT SERVICES, PURSUANT TO RFI-2020-144-JC This Professional Services Agreement ("Agreement") is entered into this 28 day of , 207.1 ("Effective Date"), between the CITY OF MIAMI BEACH, FLORIDA, a municipal corporation organized and existing under the laws of the State of Florida, having its principal offices at 1700 Convention Center Drive, Miami Beach, Florida, 33139 (the "City"), and MOUNT SINAI MEDICAL CENTER OF FLORIDA, INC., a Florida not for profit corporation, whose address is 4300 Alton Road, Miami Beach FL, 33140 ("Consultant"). SECTION 1 DEFINITIONS Agreement: This Agreement between the City and Consultant, including any exhibits and amendments thereto. City Manager: The chief administrative officer of the City. City Manager's Designee: The City staff member who is designated by the City Manager to administer this Agreement on behalf of the City. The City Manager's designee shall be Sonia Bridges, Division Director, Risk Management & Benefits, Human Resources Department. Consultant: For the purposes of this Agreement, Consultant shall be deemed to be an independent contractor, and not an agent or employee of the City. Services: Al! services, work and actions by the Consultant performed or undertaken pursuant to the Agreement. Fee: Amount paid to the Consultant as compensation for Services Proposal Documents: Proposal Documents shall mean City of Miami Beach RFI, No. 2020-144- JC for Medical Services together with all amendments thereto, issued by the City in contemplation of this Agreement (the RFI), and the Consultant's proposal in response thereto ("Proposal"), ail of which are hereby incorporated and made a part hereof as Attachment A; provided, however, that in the event of an express conflict between the Proposal Documents and this Agreement, the following order of precedent shall prevail: this Agreement; the RFI, and the Proposal. 1 DocuSign Envelope ID: 192DD89C-A3C5-4226-BF99-1 A23E2A1 F635 Risk Manager: The Risk Manager of the City, with offices at 1700 Convention Center Drive, Third Floor, Miami Beach, Florida 33139; telephone number (305) 673-7000, Ext. 6515; and fax number(305)673-7023. SECTION 2 SCOPE OF SERVICES 2.1 In consideration of the Fee to be paid to Consultant by the City, Consultant, through the Occupational Health Center, shall provide the work and services described in Exhibit 'A" hereto (the "Services"). Although Consultant may be provided with a schedule of the available hours to provide its Services, the City shall not control nor have the right to control the hours of the Services performed by the Consultant; where the Services are performed (although the City will provide Consultant with the appropriate location to perform the Services); when the Services are performed, including how many days a week the Services are performed; how the Services are performed, or any other aspect of the actual manner and means of accomplishing the Services provided. Notwithstanding the foregoing, all Services provided by the Consultant shall be performed in accordance with the terms and conditions set forth in Exhibit "A" and to the reasonable satisfaction of the City Manager. If there are any questions regarding the Services to be performed, Consultant should contact the following person. Sonia Bridges Division Director, Risk Management& Benefits Human Resources Department soniabridgesgmiamibeachfl.gov Ph: 305-673-7524 2.2 Consultant's Services, and any deliverables incident thereto, shall be completed in accordance with the timeline and/or schedule in Exhibit "A" hereto. SECTION 3 TERM 3.1 The term of this Agreement ("Term") shall commence upon execution of this Agreement by all parties hereto (the Effective Date set forth on p. 1 hereof), and shall have an initial term of two (2) years, with three (3) one year renewal terms, to be exercised at the City Manager's sole option and discretion, by providing Consultant with written notice of same no less than thirty (30) days prior to the expiration of the initial term. The initial term and each approved renewal term shall be collectively referred to herein as the "Term". 3.2 OPTION TO RENEW WITH PRICE ADJUSTMENT The initial contract prices shall prevail for a period of two (2) years from the Effective Date. Prior to, or upon completion of, that initial term, the City shall have the option to renew this Agreement annually for an additional three (3) one (1) year renewal terms. Prior to completion of each exercised renewal term, the City may consider an adjustment to price of 2.0% annually. It is the Consultant's responsibility to request any pricing adjustment under this provision. For any adjustment to commence on the first day of any exercised renewal term, the Consultant's request for adjustment should be submitted ninety (90) days prior to expiration of the then 2 DocuSign Envelope ID: 192DD89C-A3C5-4226-BF99-1A23E2A1 F635 current Term. The Consultant's adjustment request shall not be in excess of 2.0%. If no adjustment request is received from the Consultant, the City will assume that the Consultant has agreed that the optional renewal term may be exercised without pricing adjustment. Any adjustment request received after the commencement of a new renewal term may not be considered. The City reserves the right to negotiate lower pricing for the additional Term(s) based on market research information or other factors that influence price. The City reserves the right to apply any reduction in pricing for the additional Term(s) based on the downward movement of the applicable Consumer Price Index for All Urban Consumers; U.S. City average (1982-84=100), as established by the United States Bureau of Labor Statistics ("CPI"). The City will notify the Consultant of any reduction in pricing ninety (90) days prior to the expiration of each additional renewal term. The Consultant reserves the right to reject any reduction in pricing and may terminate the Agreement within sixty (60) days from receipt of the City's notification by written notice to the City. Such termination shall not constitute an event of default by the Consultant if notice is made timely in accordance with the termination provision set forth therein. The City reserves the right to reject any price adjustments submitted by the Consultant and/or to not approve any otherwise available renewal terms based on such price adjustments. Continuation of the Agreement beyond the initial term, and any option subsequently exercised, is a City prerogative, and not a right of the Consultant. This prerogative will be exercised only when such continuation is clearly in the best interest of the City. Should the City reject any price adjustments submitted by the Consultant, within sixty (60) days from receipt of notification from Consultant, the Consultant reserves the right to terminate the Agreement within thirty (30) days from receipt of the notification from the City by written notice to the City. Such termination shall not constitute an event of default by the Consultant if notice is made timely in accordance with the termination provision set forth therein. Should the Consultant decline the City's right to exercise the option to renew the Agreement after granting any adjustments in pricing, the City may consider the Consultant in default. 3.3 Notwithstanding the Term provided herein, Consultant shall adhere to any specific timelines, schedules, dates, and/or performance milestones for completion and delivery of the Services, as same is/are set forth in the timeline and/or scope referenced in Exhibit "A" hereto. SECTION 4 FEE 4.1 In consideration of the Services to be provided, Consultant shall be compensated in accordance with the fees listed in Exhibit "B" attached hereto, subject to any modifications approved pursuant to Section 3 2. 4.2 INVOICING The Consultant, through the Occupational Health Center, shall submit monthly invoices reflecting fees for all exams and tests for the previous month. Upon receipt of an acceptable and approved invoice, payment(s) shall be made within forty-five (45) days for that portion (or those portions) of the Services satisfactorily rendered (and referenced in the particular invoice). 3 DocuSign Envelope ID: 192DD89C-A3C5-4226-BF99-1 A23E2A1 F635 Invoices shall include a detailed description of the Services (or portions thereof) provided, itemize pricing on ail invoices, test date, type of exam conducted, name of the applicant tested and shall be submitted to the City at the following address: Accounts Payable: Payablesm iamibeachfl.gov SECTION 5 TERMINATION 5.1 TERMINATION FOR CAUSE If the Consultant shall fail to fulfill in a timely manner, or otherwise violates, any of the covenants, agreements, or stipulations material to this Agreement, the City, through its City Manager, shall thereupon have the right to terminate this Agreement for cause. Prior to exercising its option to terminate for cause, the City shall notify the Consultant of its violation of the particular term(s) of this Agreement and shall grant Consultant ten (10) days to cure such default. If such default remains uncured after ten (10) days, the City may terminate this Agreement without further notice to Consultant. Upon termination, the City shall be fully discharged from any and all liabilities, duties, and terms arising out of, or by virtue of, this Agreement. Notwithstanding the above, the Consultant shall not be relieved of liability to the City for damages sustained by the City by any breach of the Agreement by the Consultant. The City, at its sole option and discretion, shall be entitled to bring any and all legal/equitable actions that it deems to be in its best interest in order to enforce the City's rights and remedies against Consultant. The City shall be entitled to recover all costs of such actions, including reasonable attorneys' fees. 5.2 TERMINATION FOR CONVENIENCE OF THE CITY THE CITY MAY ALSO, THROUGH ITS CITY MANAGER, AND FOR ITS CONVENIENCE AND WITHOUT CAUSE, TERMINATE THE AGREEMENT AT ANY TIME DURING THE TERM BY GIVING WRITTEN NOTICE TO CONSULTANT OF SUCH TERMINATION; WHICH SHALL BECOME EFFECTIVE WITHIN THIRTY (30) DAYS FOLLOWING RECEIPT BY THE CONSULTANT OF SUCH NOTICE. ADDITIONALLY, IN THE EVENT OF A PUBLIC HEALTH, WELFARE OR SAFETY CONCERN, AS DETERMINED BY THE CITY MANAGER, IN THE CITY MANAGER'S SOLE DISCRETION, THE CITY MANAGER, PURSUANT TO A VERBAL OR WRITTEN NOTIFICATION TO CONSULTANT, MAY IMMEDIATELY SUSPEND THE SERVICES UNDER THIS AGREEMENT FOR A TIME CERTAIN, OR IN THE ALTERNATIVE, TERMINATE THIS AGREEMENT ON A GIVEN DATE. IF THE AGREEMENT IS TERMINATED FOR CONVENIENCE BY THE CITY, CONSULTANT SHALL BE PAID FOR ANY SERVICES SATISFACTORILY PERFORMED UP TO THE DATE OF TERMINATION; FOLLOWING WHICH THE CITY SHALL BE DISCHARGED FROM ANY AND ALL LIABILITIES, DUTIES, AND TERMS ARISING OUT OF, OR BY VIRTUE OF, THIS AGREEMENT. 4 DocuSign Envelope ID: 192DD89C-A3C5-4226-BF99-1 A23E2A1 F635 5.3 TERMINATION FOR INSOLVENCY The City also reserves the right to terminate the Agreement in the event the Consultant is placed either in voluntary or involuntary bankruptcy or makes an assignment for the benefit of creditors. In such event, the right and obligations for the parties shall be the same as provided for in Section 5.2. 5.4 TERMINATION NON-PAYMENT BY CITY If, following submittal of an invoice by Consultant pursuant to Section 4.2 hereof, the City shall fail to make timely payment to Consultant for Services (of for portions of the Services) satisfactorily rendered, the Consultant shall provide written notice of such non-payment to the City Manager, and the City shall have thirty (30) days from receipt of such notice (including notification that if payment is not made within said period, Consultant intends to terminate the Agreement) to make payment to Consultant. If such payment is not made within such thirty (30) day period, then Consultant may terminate the Agreement without providing additional written notice to the City, and Consultant shall be entitled to bring such legal and/or equitable actions as it deems necessary in order to collect the unpaid amounts due to it under this Agreement; provided, however, that in no event shall the City's liability or money damages exceed the amount referenced in Section 8 hereof; nor shall the City be liable to Consultant for any loss profits indirect and/or consequential damages. In the event the Consultant prevails in its action for non-payment against the City, it shall be entitled to recover all costs of such action, including reasonable attorney's fees. SECTION 6 INDEMNIFICATION AND INSURANCE REQUIREMENTS 6.1 INDEMNIFICATION Consultant agrees to defend, indemnify and hold harmless the City of Miami Beach and its officers, employees, agents, and contractors, from and against any and all actions (whether at law or in equity), claims, liabilities, losses, and expenses, including, but not limited to, attorneys' fees and costs, for personal, economic or bodily injury, wrongful death, loss of or damage to property, which may arise or be alleged to have arisen from the negligent acts, errors, omissions or other wrongful conduct of the Consultant, its officers, employees, agents, contractors, or any other person or entity acting under Consultant's control or supervision, in connection with, related to, or as a result of the Consultant's performance of the Services pursuant to this Agreement. To that extent, the Consultant shall pay all such claims and losses and shall pay all such costs and judgments which may issue from any lawsuit arising from such claims and losses and shall pay all costs and attorneys' fees expended by the City in the defense of such claims and losses, including appeals. The Consultant expressly understands and agrees that any insurance protection required by this Agreement or otherwise provided by the Consultant shall in no way limit the Consultant's responsibility to indemnify, keep and save harmless and defend the City or its officers, employees, agents and instrumentalities as herein provided. The parties agree that one percent (1%) of the total compensation to Consultant for performance of the Services under this Agreement is the specific consideration from the City to the Consultant for the Consultant's indemnity agreement. The provisions of this Section 6.1 and of this indemnification shall survive termination or expiration of this Agreement. 5 DocuSign Envelope ID: 192DD89C-A3C5-4226-BF99-1A23E2A1F635 6.2 INSURANCE REQUIREMENTS (A) The Consultant shall maintain the below required insurance in effect prior to awarding the agreement and for the duration of the Agreement. The maintenance of proper insurance coverage is a material element of the agreement and failure to maintain or renew coverage may be treated as a material breach of the Agreement, which could result in withholding of payments or termination of the Agreement. 1. Genera! Liability, in the amount of $1,000,000 combined single limit, for bodily injury and property damage. The City of Miami Beach must be endorsed as an Additional Insured as their interest may appear. 2. Consultant Professional Liability, in the amount of$1,000,000; and 3. Workers Compensation & Employers Liability, as required pursuant to Chapter 440, Florida Statutes. A waiver of subrogation endorsement must be provided. (B) Additional Insured — City of Miami Beach must be included by endorsement as an additional insured with respect to all liability policies (except Professional Liability and Workers' Compensation) arising out of work or operations performed on behalf of the Consultant including materials, parts, or equipment furnished in connection with such work or operations and automobiles owned, leased, hired or borrowed in the form of an endorsement to the Consultant's insurance. (C) Notice of Cancellation — Each insurance policy required above shall provide that coverage shall not be cancelled, except with notice to the City of Miami Beach c/o EXIGIS Insurance Compliance Services. (D) Waiver of Subrogation — Consultant agrees to obtain any endorsement that may be necessary to affect the waiver of subrogation on the coverages required. However, this provision applies regardless of whether the City has received a waiver of subrogation endorsement from the insurer. (E) Acceptability of Insurers — Insurance must be placed with insurers with a current A.M. Best rating of A:VII or higher. If not rated, exceptions may be made for members of the Florida Insurance Funds (i.e. FWCIGA, FAJUA). Carriers may also be considered if they are licensed and authorized to do insurance business in the State of Florida. (F) Verification of Coverage — Consultant shall furnish the City with original certificates and amendatory endorsements, or copies of the applicable insurance language, effecting coverage required by this contract. All certificates and endorsements are to be received and approved by the City before work commences However, failure to obtain the required documents prior to the work beginning shall not waive the Consultant's obligation to provide them. The City reserves the right to require complete, certified copies of all required insurance policies, including endorsements required by these specifications, at any time CERTIFICATE HOLDER MUST READ: CITY OF MIAMI BEACH c/o EXIGIS Insurance Compliance Services P.O. Box 947 Murrieta, CA 92564 6 DocuSign Envelope ID: 192DD89C-A3C5-4226-BF99-1A23E2A1F635 Kindly submit all certificates of insurance, endorsements, exemption letters to our servicing agent, EXIGIS, at: Certificates-miam ibeachriskworks.com (G) Special Risks or Circumstances — The City of Miami Beach reserves the right to modify these requirements, including limits, based on the nature of the risk, prior experience, insurer, coverage, or other special circumstances. Compliance with the foregoing requirements shall not relieve the vendor of his liability and obligation under this section or under any other section of this agreement. SECTION 7 LITIGATION JURISDICTION/VENUE/JURY TRIAL WAIVER This Agreement shall be construed in accordance with the laws of the State of Florida. This Agreement shall be enforceable in Miami-Dade County, Florida, and if legal action is necessary by either party with respect to the enforcement of any or all of the terms or conditions herein, exclusive venue for the enforcement of same shall lie in Miami-Dade County, Florida. By entering into this Agreement, Consultant and the City expressly waive any rights either party may have to a trial by jury of any civil litigation related to or arising out of this Agreement. SECTION 8 LIMITATION OF CITY'S LIABILITY The City desires to enter into this Agreement only if in so doing the City can place a limit on the City's liability for any cause of action, for money damages due to an alleged breach by the City of this Agreement, so that its liability for any such breach never exceeds the sum of $10,000. Consultant hereby expresses its willingness to enter into this Agreement with Consultant's recovery from the City for any damage action for breach of contract to be limited to a maximum amount of$10,000. Accordingly, and notwithstanding any other term or condition of this Agreement, Consultant hereby agrees that the City shall not be liable to the Consultant for damages in an amount in excess of $10,000 for any action or claim for breach of contract arising out of the performance or non-performance of any obligations imposed upon the City by this Agreement. Nothing contained in this section or elsewhere in this Agreement is in any way intended to be a waiver of the limitation placed upon the City's liability, as set forth in Section 768.28, Florida Statutes. SECTION 9 DUTY OF CARE/COMPLIANCE WITH APPLICABLE LAWS/PATENT RIGHTS; COPYRIGHT; AND CONFIDENTIAL FINDINGS 9.1 DUTY OF CARE With respect to the performance of the Services contemplated herein, Consultant shall exercise that degree of skill, care, efficiency and diligence normally exercised by reasonable persons 7 DocuSign Envelope ID: 192DD89C-A3C5-4226-BF99-1 A23E2A1 F635 and/or recognized professionals with respect to the performance of comparable work and/or services. 9.2 COMPLIANCE WITH APPLICABLE LAWS In its performance of the Services, Consultant shall comply with all applicable laws, ordinances, and regulations of the City, Miami-Dade County, the State of Florida, and the federal government, as applicable. 9.3 PATENT RIGHTS; COPYRIGHT; CONFIDENTIAL FINDINGS Any work product arising out of this Agreement, as well as all information specifications, processes, data and findings, are intended to be the property of the City and shall not otherwise be made public and/or disseminated by Consultant, without the prior written consent of the City Manager, excepting any information, records etc. which are required to be disclosed pursuant to Court Order and/or Florida Public Records Law. All reports, documents, articles, devices, and/or work produced in whole or in part under this Agreement are intended to be the sole and exclusive property of the City, and shall not be subject to any application for copyright or patent by or on behalf of the Consultant or its employees or sub-consultants, without the prior written consent of the City Manager. SECTION 10 GENERAL PROVISIONS 10.1 AUDIT AND INSPECTIONS Upon reasonable verbal or written notice to Consultant, and at any time during normal business hours (i.e. 9AM — 5PM, Monday through Fridays, excluding nationally recognized holidays), and as often as the City Manager may, in his/her reasonable discretion and judgment, deem necessary, there shall be made available to the City Manager, and/or such representatives as the City Manager may deem to act on the City's behalf, to audit, examine, and! or inspect, any and all other documents and/or records relating to all matters covered by this Agreement. Consultant shall maintain any and all such records at its place of business at the address set forth in the "Notices" section of this Agreement. 10.2 INSPECTOR GENERAL AUDIT RIGHTS (A) Pursuant to Section 2-256 of the Code of the City of Miami Beach, the City has established the Office of the Inspector General which may, on a random basis, perform reviews, audits, inspections and investigations on all City contracts, throughout the duration of said contracts. This random audit is separate and distinct from any other audit performed by or on behalf of the City. (B) The Office of the Inspector General is authorized to investigate City affairs and empowered to review past, present and proposed City programs, accounts, records, contracts and transactions. In addition, the Inspector General has the power to subpoena witnesses, administer oaths, require the production of witnesses and monitor City projects and programs. Monitoring of an existing City project or program may 8 DocuSign Envelope ID: 192DD89C-A3C5-4226-BF99-1 A23E2A1 F635 include a report concerning whether the project is on time, within budget and in conformance with the contract documents and applicable law. The Inspector General shall have the power to audit, investigate, monitor, oversee, inspect and review operations, activities, performance and procurement process including but not limited to project design, bid specifications, (bid/proposal) submittals, activities of the Consultant, its officers, agents and employees, lobbyists, City staff and elected officials to ensure compliance with the contract documents and to detect fraud and corruption. Pursuant to Section 2-378 of the City Code, the City is allocating a percentage of its overall annual contract expenditures to fund the activities and operations of the Office of Inspector General. (C) Upon ten (10) days written notice to the Consultant, the Consultant shall make all requested records and documents available to the Inspector General for inspection and copying. The Inspector General is empowered to retain the services of independent private sector auditors to audit, investigate, monitor, oversee, inspect and review operations activities, performance and procurement process including but not limited to project design, bid specifications, (bid/proposal) submittals, activities of the Consultant its officers, agents and employees, lobbyists, City staff and elected officials to ensure compliance with the contract documents and to detect fraud and corruption. (D) The Inspector General shall have the right to inspect and copy all documents and records in the Consultant's possession, custody or control which in the Inspector General's sole judgment, pertain to performance of the contract, including, but not limited to original estimate files, change order estimate files, worksheets, proposals and agreements from and with successful subcontractors and suppliers, all project-related correspondence, memoranda, instructions, financial documents, construction documents, (bid/proposal) and contract documents, back-change documents, all documents and records which involve cash, trade or volume discounts, insurance proceeds, rebates, or dividends received, payroll and personnel records and supporting documentation for the aforesaid documents and records. (E) The Consultant shall make available at its office at all reasonable times the records, materials, and other evidence regarding the acquisition (bid preparation) and performance of this Agreement, for examination, audit, or reproduction, until three (3) years after final payment under this Agreement or for any longer period required by statute or by other clauses of this Agreement. In addition: (1) If this Agreement is completely or partially terminated, the Consultant shall make available records relating to the work terminated until three (3) years after any resulting final termination settlement; and (2) The Consultant shall make available records relating to appeals or to litigation or the settlement of claims arising under or relating to this Agreement until such appeals, litigation, or claims are finally resolved. 9 DocuSign Envelope ID: 192DD89C-A3C5-4226-BF99-1 A23E2A1 F635 (F) The provisions in this section shall apply to the Consultant, its officers, agents, employees, subcontractors and suppliers. The Consultant shall incorporate the provisions in this section in all subcontracts and all other agreements executed by the Consultant in connection with the performance of this Agreement. (G)Nothing in this section shall impair any independent right to the City to conduct audits or investigative activities. The provisions of this section are neither intended nor shall they be construed to impose any liability on the City by the Consultant or third parties. 10.3 ASSIGNMENT, TRANSFER OR SUBCONSULTING Consultant shall not subcontract, assign, or transfer all or any portion of any work and/or service under this Agreement without the prior written consent of the City Manager, which consent, if given at all, shall be in the Manager's sole judgment and discretion. Neither this Agreement, nor any term or provision hereof, or right hereunder, shall be assignable unless as approved pursuant to this Section, and any attempt to make such assignment (unless approved)shall be void. 10.4 PUBLIC ENTITY CRIMES Prior to commencement of the Services, the Consultant shall file a State of Florida Form PUR 7068, Sworn Statement under Section 287.133(3)(a) Florida Statute on Public Entity Crimes with the City's Procurement Division. 10.5 NO DISCRIMINATION In connection with the performance of the Services, the Consultant shall not exclude from participation in, deny the benefits of, or subject to discrimination anyone on the grounds of race, color, national origin, sex, age, disability, religion, income or family status. Additionally, Consultant shall comply fully with the City of Miami Beach Human Rights Ordinance, codified in Chapter 62 of the City Code, as may be amended from time to time, prohibiting discrimination in employment, housing, public accommodations, and public services on account of actual or perceived race, color, national origin, religion, sex, intersexuality, gender identity, sexual orientation, marital and familial status, age, disability, ancestry, height, weight, domestic partner status, labor organization membership, familial situation, or political affiliation. 10.6 CONFLICT OF INTEREST Consultant herein agrees to adhere to and be governed by all applicable Miami-Dade County Conflict of Interest Ordinances and Ethics provisions, as set forth in the Miami-Dade County Code, as may be amended from time to time; and by the City of Miami Beach Charter and Code, as may be amended from time to time; both of which are incorporated by reference as if fully set forth herein. Consultant covenants that it presently has no interest and shall not acquire any interest, directly or indirectly, which could conflict in any manner or degree with the performance of the Services. Consultant further covenants that in the performance of this Agreement, Consultant shall not employ any person having any such interest. No member of or delegate to the 10 DocuSign Envelope ID: 192DD89C-A3C5-4226-BF99-1A23E2A1F635 Congress of the United States shall be admitted to any share or part of this Agreement or to any benefits arising therefrom. 10,7 CONSULTANT'S COMPLIANCE WITH FLORIDA PUBLIC RECORDS LAW (A) Consultant shall comply with Florida Public Records law under Chapter 119, Florida Statutes, as may be amended from time to time. (B) The term "public records" shall have the meaning set forth in Section 119.011(12), which means all documents, papers, letters, maps, books, tapes, photographs, films, sound recordings, data processing software, or other material, regardless of the physical form, characteristics, or means of transmission, made or received pursuant to law or ordinance or in connection with the transaction of official business of the City. (C) Pursuant to Section 119.0701 of the Florida Statutes, if the Consultant meets the definition of"Contractor" as defined in Section 119.0701(1)(a), the Consultant shall: (1) Keep and maintain public records required by the City to perform the service; (2) Upon request from the City's custodian of public records, provide the City with a copy of the requested records or allow the records to be inspected or copied within a reasonable time at a cost that does not exceed the cost provided in Chapter 119, Florida Statutes or as otherwise provided by law; (3) Ensure that public records that are exempt or confidential and exempt from public records disclosure requirements are not disclosed, except as authorized by law, for the duration of the contract term and following completion of the Agreement if the Consultant does not transfer the records to the City; (4) Upon completion of the Agreement, transfer, at no cost to the City, all public records in possession of the Consultant or keep and maintain public records required by the City to perform the service. if the Consultant transfers all public records to the City upon completion of the Agreement, the Consultant shall destroy any duplicate public records that are exempt or confidential and exempt from public records disclosure requirements. If the Consultant keeps and maintains public records upon completion of the Agreement, the Consultant shall meet all applicable requirements for retaining public records. All records stored electronically must be provided to the City, upon request from the City's custodian of public records, in a format that is compatible with the information technology systems of the City. (D) REQUEST FOR RECORDS; NONCOMPLIANCE. (1) A request to inspect or copy public records relating to the City's contract for services must be made directly to the City. If the City does not possess the requested records, the City shall immediately notify the Consultant of the request, and the Consultant must provide the records to the City or allow the records to be inspected or copied within a reasonable time. (2) Consultant's failure to comply with the City's request for records shall constitute a breach of this Agreement, and the City, at its sole discretion, may: (1) unilaterally terminate the Agreement; (2) avail itself of the remedies set forth under the Agreement; and/or(3)avail itself of any available remedies at law or in equity. (3) A Consultant who fails to provide the public records to the City within a reasonable time may be subject to penalties under s. 119.10. (E) CIVIL ACTION. 11 DocuSign Envelope ID: 192DD89C-A3C5-4226-BF99-1A23E2A1 F635 (1) If a civil action is filed against a Consultant to compel production of public records relating to the City's contract for services, the court shall assess and award against the Consultant the reasonable costs of enforcement, including reasonable attorneys' fees, if: a. The court determines that the Consultant unlawfully refused to comply with the public records request within a reasonable time; and b. At least 8 business days before filing the action, the plaintiff provided written notice of the public records request, including a statement that the Consultant has not complied with the request, to the City and to the Consultant. (2) A notice complies with subparagraph (1)(b) if it is sent to the City's custodian of public records and to the Consultant at the Consultant's address listed on its contract with the City or to the Consultant's registered agent. Such notices must be sent by common carrier delivery service or by registered, Global Express Guaranteed, or certified mail, with postage or shipping paid by the sender and with evidence of delivery, which may be in an electronic format. (3) A Consultant who complies with a public records request within 8 business days after the notice is sent is not liable for the reasonable costs of enforcement. (F) IF THE CONSULTANT HAS QUESTIONS REGARDING THE APPLICATION OF CHAPTER 119, FLORIDA STATUTES, TO THE CONSULTANT'S DUTY TO PROVIDE PUBLIC RECORDS RELATING TO THIS AGREEMENT, CONTACT THE CUSTODIAN OF PUBLIC RECORDS AT: CITY OF MIAMI BEACH ATTENTION: RAFAEL E. GRANADO, CITY CLERK 1700 CONVENTION CENTER DRIVE MIAMI BEACH, FLORIDA 33139 E-MAIL: RAFAELGRANADO@MIAMIBEACHFL.GOV PHONE: 305-673-7411 10.8 FORCE MAJEURE (A) A "Force Majeure" event is an event that (i) in fact causes a delay in the performance of the Consultant or the City's obligations under the Agreement, and (ii) is beyond the reasonable control of such party unable to perform the obligation, and (iii) is not due to an intentional act, error, omission, or negligence of such party, and (iv) could not have reasonably been foreseen and prepared for by such party at any time prior to the occurrence of the event. Subject to the foregoing criteria, Force Majeure may include events such as war, civil insurrection, riot, fires, epidemics, pandemics, terrorism, sabotage, explosions, embargo restrictions, quarantine restrictions, transportation accidents, strikes, strong hurricanes or tornadoes, earthquakes, or other acts of God which prevent performance. Force Majeure shall not include technological impossibility, inclement weather, or failure to secure any of the required permits pursuant to the Agreement. 12 DocuSign Envelope ID: 192DD89C-A3C5-4226-BF99-1 A23E2A1 F635 (B) If the City or Consultant's performance of its contractual obligations is prevented or delayed by an event believed by to be Force Majeure, such party shall immediately, upon learning of the occurrence of the event or of the commencement of any such delay, but in any case within fifteen (15) business days thereof, provide notice: (i) of the occurrence of event of Force Majeure, (ii) of the nature of the event and the cause thereof, (iii) of the anticipated impact on the Agreement, (iv) of the anticipated period of the delay, and (v) of what course of action such party plans to take in order to mitigate the detrimental effects of the event. The timely delivery of the notice of the occurrence of a Force Majeure event is a condition precedent to allowance of any relief pursuant to this section; however, receipt of such notice shall not constitute acceptance that the event claimed to be a Force Majeure event is in fact Force Majeure, and the burden of proof of the occurrence of a Force Majeure event shall be on the requesting party. (C) No party hereto shall be liable for its failure to carry out its obligations under the Agreement during a period when such party is rendered unable, in whole or in part, by Force Majeure to carry out such obligations. The suspension of any of the obligations under this Agreement due to a Force Majeure event shall be of no greater scope and no longer duration than is required. The party shall use its reasonable best efforts to continue to perform its obligations hereunder to the extent such obligations are not affected or are only partially affected by the Force Majeure event, and to correct or cure the event or condition excusing performance and otherwise to remedy its inability to perform to the extent its inability to perform is the direct result of the Force Majeure event with all reasonable dispatch. (D) Obligations pursuant to the Agreement that arose before the occurrence of a Force Majeure event, causing the suspension of performance, shall not be excused as a result of such occurrence unless such occurrence makes such performance not reasonably possible. The obligation to pay money in a timely manner for obligations and liabilities which matured prior to the occurrence of a Force Majeure event shall not be subject to the Force Majeure provisions. (E) Notwithstanding any other provision to the contrary herein, in the event of a Force Majeure occurrence, the City may, at the sole discretion of the City Manager, suspend the City's payment obligations under the Agreement, and may take such action without regard to the notice requirements herein. Additionally, in the event that an event of Force Majeure delays a party's performance under the Agreement for a time period greater than thirty (30) days, the City may, at the sole discretion of the City Manager, terminate the Agreement on a given date, by giving written notice to Consultant of such termination. If the Agreement is terminated pursuant to this section, Consultant shall be paid for any Services satisfactorily performed up to the date of termination; following which the City shall be discharged from any and all liabilities, duties, and terms arising out of, or by virtue of, this Agreement. In no event will any condition of Force Majeure extend this Agreement beyond its stated term. 10.9 E-VERIFY (A) Consultant shall comply with Section 448.095, Florida Statutes, "Employment Eligibility" ("E-Verify Statute"), as may be amended from time to time. Pursuant to the E-Verify Statute, commencing on January 1; 2021, Consultant shall register with and use the E- Verify system to verify the work authorization status of all newly hired employees during the Term of the Agreement. Additionally, Consultant shall expressly require any 13 DocuSign Envelope ID: 192DD89C-A3C5-4226-BF99-1 A23E2A1 F635 subconsultant performing work or providing services pursuant to the Agreement to likewise utilize the U.S. Department of Homeland Security's E-Verify system to verify the employment eligibility of all new employees hired by the subconsultant during the contract Term. If Consultant enters into a contract with an approved subconsultant, the subconsultant must provide the Consultant with an affidavit stating that the subconsultant does not employ, contract with, or subcontract with an unauthorized alien. Consultant shall maintain a copy of such affidavit for the duration of the Agreement or such other extended period as may be required under this Agreement. (B) TERMINATION RIGHTS. (1) If the City has a good faith belief that Consultant has knowingly violated Section 448.09(1), Florida Statutes, the City shall terminate this Agreement with Consultant for cause, and the City shall thereafter have or owe no further obligation or liability to Consultant. (2) If the City has a good faith belief that a subconsultant has knowingly violated the foregoing Subsection 10.9(A), but the Consultant otherwise complied with such subsection, the City will promptly notify the Consultant and order the Consultant to immediately terminate the agreement with the subconsultant. Consultant's failure to terminate a subconsultant shall be an event of default under this Agreement, entitling City to terminate the Consultant's Agreement for cause. (3) A contract terminated under the foregoing Subsection (B)(1) or (B)(2) is not in breach of contract and may not be considered as such. (4) The City or Consultant or a subconsultant may file an action with the Circuit or County Court to challenge a termination under the foregoing Subsection (B)(1) or (B)(2) no later than 20 calendar days after the date on which the contract was terminated. (5) If the City terminates the Agreement with Consultant under the foregoing Subsection (BX 1), Consultant may not be awarded a public contract for at least 1 year after the date of termination of this Agreement. (6) Consultant is liable for any additional costs incurred by the City as a result of the termination of this Agreement under this Section 10,9. SECTION 11 NOTICES Until changed by notice, in writing, all such notices and communications shall be addressed as follows: TO CONSULTANT: Mount Sinai Medical Center of Florida, Inc. 4300 Alton Road Miami Beach, FL 33140 Attn: Diana Garcia Email: diana.garcia(c�msmc.com TO CITY: 'City of Miami Beach Human Resources Department 1700 Convention Center Drive, 3'd floor Miami Beach, FL 33139 Attn. Sonia Bridges, Division Director Risk Management Email: soniabridges( miamibeachfl.gov 14 DocuSign Envelope ID: 192DD89C-A3C5-4226-BF99-1A23E2A1F635 All notices mailed electronically to either party shall be deemed to be sufficiently transmitted. SECTION 12 MISCELLANEOUS PROVISIONS 12.1 CHANGES AND ADDITIONS This Agreement cannot be modified or amended without the express written consent of the parties. No modification, amendment, or alteration of the terms or conditions contained herein shall be effective unless contained in a written document executed with the same formality and of equal dignity herewith. 12.2 SEVERABILITY If any term or provision of this Agreement is held invalid or unenforceable, the remainder of this Agreement shall not be affected, and every other term and provision of this Agreement shall be valid and be enforced to the fullest extent permitted by law. 12.3 WAIVER OF BREACH A party's failure to enforce any provision of this Agreement shall not be deemed a waiver of such provision or modification of this Agreement. A party's waiver of any breach of a provision of this Agreement shall not be deemed a waiver of any subsequent breach and shall not be construed to be a modification of the terms of this Agreement. 12.4 JOINT PREPARATION The parties hereto acknowledge that they have sought and received whatever competent advice and counsel as was necessary for them to form a full and complete understanding of all rights and obligations herein and that the preparation of this Agreement has been a joint effort of the parties, the language has been agreed to by parties to express their mutual intent and the resulting document shall not, solely as a matter of judicial construction, be construed more severely against one of the parties than the other. 12.5 ENTIRETY OF AGREEMENT The City and Consultant agree that this is the entire agreement between the parties. This Agreement supersedes all prior negotiations, correspondence, conversations, agreements or understandings applicable to the matters contained herein, and there are no commitments, agreements or understandings concerning the subject matter of this Agreement that are not contained in this document. Title and paragraph headings are for convenient reference and are not intended to confer any rights or obligations upon the parties to this Agreement. [Remainder of Page Intentionally Left Blank] 15 DocuSign Envelope ID: 192DD89C-A3C5-4226-BF99-1A23E2A1F635 IN WITNESS WHEREOF, the parties hereto have caused this Agreement to be executed by their appropriate officials, as of the date first entered above. FOR CITY: CITY OF MIAMI BEACH, FLORIDA ATTEST: DocuSigned by: rafat t %Vaanade By. CITY CLER MAYOR 6/1/2021 13:17 EDT Date: FOR CONSULTANT MOUNT SINAI MEDICAL CENTER OF FLORIDA, INC. ATTEST: By / ILLLAtt as By: 02 IT the 1 ornash As&tsiwit Vi cP lets is e)t D t Gt,V1Gt E)a✓c( Print Name and Title Print Name and Title ay?c.g.eV' po- Date: 2e, zo2.1 APPROVED AS TO FORM & LANGUAGE & FOR EXECUTION 16 ��ityAttome La DocuSign Envelope ID: 192DD89C-A3C5-4226-BF99-1 A23E2A1 F635 EXHIBIT A SCOPE OF SERVICES A. FACILITY SERVICES AND HOURS OF OPERATION Consultant's Occupational Health Center will provide the medical services for pre and post-employment services, as more particularly delineated herein, based upon the price schedule set forth in Exhibit B to the Agreement. The Occupational Health Center will conduct and review laboratory results, x-rays. and other medical reports; evaluate reports and makes appropriate recommendations as needed; review special medical problems such as but not limited to contagious disease cases, return from sick leave, on-duty injuries , disability , and other medical issues as required provide reports and medical opinions when applicable; counsel personnel and job applicants about medical conditions and findings, and refer to appropriate follow-up care, when indicated. Mount Sinai Medical Center is located at 4304 Alton Road, Miami Beach, Florida 33140. The Occupational Health Center at Mount Sinai is located on the first floor of the Samuel Jacobson Building with adjacent free parking for the City of Miami Beach employees. Hours of operations are Monday thru Friday. 7:00 a.m. to 5.00 p.m. (Hours are flexible). Drug and alcohol test services will be available (7) days a week. twenty- four (24) hours a day. The City will have the ability to schedule same day or next day appointments with the Occupational Health Center for all'services if necessary. The Occupational Health Center will provide convenient parking adjacent to the Samuel Jacobson Building at no cost to applicants, employees, and the City for individuals referred. B. DESIGNATED LIAISON The Occupational Health Center will supply the City of Miami Beach with a Project Manager/primary contact, which will be Diana Garcia, Manager, Occupational Health. which will be assigned to address all questions and concerns of the City. Diana Garcia will be available for any issues during business hours. and after hours if needed. Luz Perez, Program Billing Coordinator, Occupational Health will be the alternate contact person in the event the Project Manager is unavailable. Luz Perez is fully informed in all areas. All other staff providing services under this contract will be properly informed and trained on procedures. forms, changes and requirements. Any special instructions will be communicated to all staff. C. EXAMINATION RESULTS All medical evaluation results will be reported to the Human Resources Department within forty- eight (48) hours from the time the applicant and/or employee is first seen. 17 DocuSign Envelope ID: 192DD89C-A3C5-4226-BF99-1 A23E2A1 F635 With the assistance of the City's Information Technology Department, the Occupational Health Center will set up and utilize an electronic mail system compatible with the City. If requested by the City, all reports and other necessary communication will be utilized through this system. Occupational Health Center also offers to work with the city to provide any other electronic services. The Occupational Health Center will assure that instructions, changes, and transfer of information and documents will be only with those individuals or firms designated by the Human Resources Director. Immediate notification will be made to designated City staff of "no-shows" or any problems with an individual's cooperation or compliance. The Occupational Health Center will provide applicant deadlines for follow-up as needed, as determined by the City's policy. The Occupational Health Center is and will maintain compliance with HIPAA throughout the duration of contact. The following email addresses should be used to send medical evaluation results to the Human Resources Department: Pre-Employment Physicals and Promotional Physicals: HRRecruitment(c�miamibeachfl.gov Reasonable Suspicion/Random and Post-Accident Drug Testing: HRER(a�miamibeachfl.gov Fitness for Duty/Return-to-Work Evaluations: HRER@miamibeachfl.gov Workers' Compensation related Evaluations: RiskMgmtRequests(a�miamibeachfl.gov Hepatitis B Series: RiskMgmtRequests(c�miamibeachfl.gov D. SUPPLY AND EQUIPMENT The designated area is comprised of: • 4 Diagnostic exam rooms: Vision, Pulmonary, Hearing and EKG testing • 4 Physical examination rooms • 2 Laboratory • 1 Drug and Alcohol testing area prepared to conduct three testing at the time. The following equipment is used to perform services: • Audiology testing booths that meets OSHA standards with testing capabilities from 500 to 8000 Hz. • Visual Screening instruments for visual acuity, muscle balance(horizontal and vertical phoria), depth perception, color perception, and binocular vision. • 14 and 24 plate Ishihara and 15 D-Famsworth tests for color deficiency. 18 DocuSign Envelope ID: 192DD89C-A3C5-4226-BF99-1A23E2A1F635 • Diagnostic Spirometry Testing using a Fleish-Type Pneumotachometer with computer graphics and interpretation. • Handheld non-contract tonometer for glaucoma measurements • 12 Lead EKG machines electronically connected to Board Certified Cardiologists for interpretation. • Completed phlebotomy and comprehensive services. • US DOT approved ALCO Monitor for breath alcohol testing. The Occupational Health Center has back up equipment on premises. E. MEDICAL RECORDS The Occupational Health Center must maintain health files for all City employees and/or applicants. These files will include medical records regarding injuries and accidents related to employees in accordance with all state and federal laws. Upon request of the Human Resources Director or their designee, the Occupational Health Center's Director or their designee Diana Garcia, will provide medical records regarding Workers' Compensation claims within twenty-four (24) hours of request Records shall be faxed to the City's Third Party Administrator (TPA) for Workers' Compensation at (866) 434-2475 or mail to 14055 Riveredge Drive, Tampa, Florida 33637. Medical records may only be released to the Human Resources Director, Risk Management Director, or their designee. All requests and designee's assignments must be made and accepted in writing only (e-mail is acceptable). During a City employee's visit to the Emergency Room, the treating physician shall complete form DFS-F5-DWC-25 to request authorization for a medical treatment plan. to communicate to the TPA an injured employee's medical status, to document the injured employee's date of Maximum Medical Improvement (MMI date), and to document a Permanent Impairment Rating (PI Rating).The DFS-F5-DWC-25 form must be given to the City employee upon release from the hospital. F. PHYSICAL EXAMINATIONS FOR PRE-EMPLOYMENT AND PROMOTIONAL Based on the physical requirements of the job description provided by the City, the Occupational Health Center will conduct physical examinations and drug/alcohol testing, as required for pre- employment and promotional applicants The results of the pre-employment and promotional physical examinations will be reported to the Human Resources Director's designee within forty-eight (48) hours from the time the applicant is first seen. The Occupational Health Center will provide capacity for up to twenty (20) appointments per day from the City. Occupational Health Center is flexible of all scheduling that is required by the City of Miami Beach. The City will have the ability to schedule same day or next day appointments for pre- 19 DocuSign Envelope ID: 192DD89C-A3C5-4226-BF99-1A23E2A1 F635 employment and promotional examinations. Tuberculosis testing will be performed using the Quantiferon - Gold Blood Test. Positive results will be handled by the Occupational Health Center Medical Director and will not be referred to the Department of Health or other facility unless agreed to in writing by the City. In any case, there will be no additional charge to the applicant for this service. Police Officer and Firefighter applicant physical examinations will include tests for heart disease, AIDS or HIV, Hepatitis, Pulmonary Tuberculosis, or Meningococcal Meningitis. Mount Sinai Medical Center, Occupational Health Center provides private and isolation rooms for all applications and employees providing urine specimens and provide cloth gowns for all patients. Mount Sinai Medical Center - Emergency Department 24-hours, 7 days a week (urine and alcohol collection including after hours, weekends and holidays). G. PSYCHIATRIC SERVICES The Occupational Health Center will be able, upon request, by the City, to conduct psychological or psychiatric consultations with general City employees, and to prepare appropriate summary and recommendation reports. The Occupational Health Center will be able, upon request, to review and research psychological factors relating to personnel, especially public safety. The Occupational Health Center will be able, upon request. to conduct stress-reduction meeting with spouses of Police personnel and other employees referred by the City. H. EXPOSURE /IMMUNIZATION PROGRAM The Occupational Health Center recommends Quantiferon Blood test for Tuberculosis screening, this blood test enables one visit instead of 2 to 4 visits. If the Quantiferon - Gold Blood test is positive. a screening chest x-ray will be provided. The Occupational Health Center will administer a Tetanus Toxoid Booster Immunization for Police Officers, Firefighters, Waste Collectors and Parks personnel. This may include other occupations depending on the job specification and/or individual requirements. The Occupational Health Center will administer a complete series of three (3) Hepatitis B and Hepatitis A & B vaccines for those City employees with a potential risk exposure to infected blood or body fluids, as determined by the City. The Occupational Health Center will administer other vaccines that may be required such as measles, mumps and rubella vaccine, or any additional immunizations, tests, vaccines, as required by local, state, or federal requirements, or by industry recommendations or guidelines. 20 DocuSign Envelope ID: 192DD89C-A3C5-4226-BF99-1A23E2A1F635 The Occupational Health Center will administer and make available, a one (1) day supply of anti-viral medications against the AIDS virus for emergency responders according to current federal guidelines. These medications will be given within two hours of a significant exposure to the AIDS virus. The City's employees will have access to the administration of anti-viral medications for the AIDS virus on a twenty- four (24) hour basis. The Occupational Health Center will administer HIV/AIDS baseline tests to sworn Fire Department employees and perform other tests requested by the City to comply with future union contracts. I. DRUG & ALCOHOL TEST PROGRAM The Occupational Health Center will conduct a Drug and Alcohol Test Program as required by local, state and federal law and regulations. This will include a certified Substance Abuse Professional (SAP), Breath Alcohol Technician (BAT) and Medical Review Officer (MRO) as defined by the U.S. Department of Transportation (DOT), Title 49 Code of Federal Regulations (CFR), Part 40. The Occupational Health Center will conduct pre-employment drug and alcohol testing on all applicants, as well as conduct promotional drug and alcohol testing to all safety sensitive applicants before they actually perform safety sensitive functions for the first time. The Occupational Health Center will conduct random testing on all City employees and the safety sensitive employees who drive vehicles that require Commercial Driver Licenses in accordance with Title 49 CFR, Part 40. The Occupational Health Center conducts all alcohol and drug tests in compliance with procedures spelled out in 49 CFR, Part 40. The Occupational Health Center will conduct post-accident drug and alcohol drug testing as determined by the City. Testing will be available twenty-four (24) hours a day, seven (7) days a week at either the Occupational Health Center or the ER. The Occupational Health Center will conduct testing on employees when the City observes behavior or appearance that is characteristic of drug use or abuse or alcohol use or misuse. The Occupational Health Center will conduct return-to-duty and follow-up drug and alcohol testing for employees who violate the City's drug free workplace standards at intervals and frequently determined solely by the City. The Occupational Health Center will provide drug and alcohol testing services with licensed and certified personnel and laboratories as required by local, state, and federal law. The Occupational Health Center drug and alcohol testing services will be overseen by the Medical Review Officer (MRO). 21 DocuSign Envelope ID: 192DD89C-A3C5-4226-BF99-1 A23E2A1 F635 The Occupational Health Center will insure proper and documented chain of custody during and after sample collection and testing. The Occupational Health Center has appropriate private facilities to conduct these tests, including a locked, secured box for private articles and police weapons. Individuals referred to Occupational Health Center for reasonable suspicion or post- accident alcohol and/or drug testing should not have a waiting time that exceeds 30 minutes. J. FITNESS FOR DUTY AND RETURN TO WORK EVALUATIONS The Occupational Health Center will evaluate employees' ability to continue employment in their current capacity and to assess and recommend reasonable accommodation for other job opportunities for which they may be qualified. This may include a physical examination. return to work evaluation, psychological and/or psychiatric evaluation, and/or any reports to be completed as requested by the City for fitness for duty. The Occupational Health Center will complete evaluations within two (2) working days of the request and on the same day in case of an emergency. A status report and recommendations will be forwarded to the City within twenty-four (24) hours of the appointment or receipt of test results, if any. The Occupational Health Center shall assist the City in the evaluation and verification of questionable Family Medical Leave requests as needed. K. COMMUNICATION With the assistance of the City's Information Technology Department, the Occupational Health Center(OHC) will set up and utilize an electronic mail system compatible with the City. All reports and other necessary communication will be utilized through this system. Any and all associated costs with the set up will be absorbed by the Occupational Health Center. The Occupational Health Center also offers to work with the City of Miami Beach to provide any other electronic services. The Occupational Health Center will have qualified personnel available during all business hours to supply all services including final physician sign-off for pre-employment examinations. All test results under the Scope of Services and the Agreement will be communicated only to the Human Resources Director, or his/her designees. The Occupational Health Center's designee for resolving and/or escalating billing errors shall be Diana Garcia. In the event that a City employee receives a bill for medical services, the Human Resources Director or its designee shall contact Luz Perez at 305- 674-2085. Billing errors shall be resolved 10 days from the date stated on the bill. 22 DocuSign Envelope ID: 192DD89C-A3C5-4226-BF99-1A23E2A1 F635 EXHIBIT B MEDICAL SERVICES FOR PRE AND POST-EMPLOYMENT SERVICES FEES RFI 2020-144-JC Description Unit Price Standard Pre-Employment Physical Including: $ 115.00 Review of medical history/Physician examination and consultation Breath Alcohol Test Urine Drug Screen-12 Panel(Amphetamines.Barbiturates.Benzodaizepiles Cocaine Metabolites,Methaqualone, Hatluc nogens of any kind.Manjuana Metabol les,Methadone.Methytenedroxyamphetamne Analogues(MDA),Opiates, Phencyclidine.and Propoxyphene Hearing Screen/Whisper Vision Screen OuantFeron-TB Gold Test(Tuberculosis test) Description Unit Price Police,Firefighter Pre-Employment Physical Including: $ 285.00 Review of medical history/Physician examination and consultation Breath Alcohol Test Urine Drug Screen- 12 Panel(Amphetamines Barbiturates,Benzodaizepunes,Cocaine Metabolites,Memaqualone. Hallucinogens of any knd,Marquana Metabolites,Methadone.Memyfenednoxyamphetamne Analogues 1MDA),Opiates. Phencycildne and Propoxyphene Comprehensive Blood Cell Counts Comprehensive Blood Chemistry Comprehensive Lipid Panel Comprehensive Urinalysis HIV/AIDS-Elisa TestWestem Bolt Hepatitis B Titer Hepatitis C Titer Hem Cult(40 years&older) Visual Exam(NFP Guidelines&California Standards) Glaucoma(40 years and older) Comprehensive Pulmonary Function Test Cuantiferon TB Gold Test(Tuberculosis test) OSHA Compliant PA and LAT(If medically indicated) Chest PA&LAT with Radiologist Interpretation Electrocardiogram(EKG) [CONTINUED ON NEXT PAGE] 23 DocuSign Envelope ID: 192DD89C-A3C5-4226-BF99-1 A23E2A1 F635 EXHIBIT B MEDICAL SERVICES FOR PRE AND POST-EMPLOYMENT SERVICES FEES Description Unit Price Immunization Services Tdap(Tetanus.Diptheria. Pertussisi S 40.00 Hepatitis B Vaccine(series of 3) b 140.00 Hepatitis A&B Vaccine(series of 3) $ 335.00 Measles. Mumps and Rubella(MMR) 5 90.00 Anti Viral Medication for HIV/AIDS (1 day supply) $ 75.00 Description Unit Price Additional Services Stress Test $ 265.00 Electrocardiogram(EKG) $ 40.00 Chest PA di LAT with Radiologist Interpretation $ 40.00 Fitness for Duty Evaluations $ 135.00 Psychiatric Services $ 185 00 Drug/Alcohol Testing for Random.Reasonable Suspicion, Return to work and Post-Accident and Alcohol Testing Including Consultation with Medical Review Officer and Evaluation by the Substance Abuse Professional Pursuant to DOT requirements. $ 40.00 Respirator Review and Clearance $ 65.00 On-Site Tech(Nurse or Physician Assistant) S 65.00 After Hours Medical Personnel $ 160.00 After Hours Drug/Alcohol Testing Tech $ 30.00 Drug Testing for Phencyclidedine.Ketamine.LSD,Mescaline.Dinthyltryptamine. Belladonna Price as Incurred alkaloids.Dextromethorphan.and Salvia Dlvinorum. Mobile Unit(VAN) $ 900.00 Value Added Services by Proposer Description ,j Unit Price • CDL Physical S 143.85 Review of medical history/Physician examination and consultation Unne Dipstick.specific,gravity,blood,protein and glucose Visual Exam Whisper lest Blood Alcohol S 26.25 Pregnancy Test S 20.00 Tetanus and Diphtheria and Pertussis(T-dap)Vaccine S 40.00 Hep A Titter 5 33.60 QuantiFeron Blood Test(Tuberculosis test) S 45 00 An alternative to traditional TB skin test One patient visit requirement,instead of 2 to 4 visits. Measles,Mumps and Rubella(MMR) S 50.00 Workers'Compensantion Services Available 24 DocuSign Envelope ID: 192DD89C-A3C5-4226-BF99-1A23E2A1F635 ATTACHMENT A RESOLUTION AND COMMISSION AWARD DocuSign Envelope ID 192DD89C-A3C5-4226-BF99-1A23E2A1F635 RESOLUTION NO. 2020-31393 A RESOLUTION OF THE MAYOR AND CITY COMMISSIONERS OF THE CITY OF MIAMI BEACH, FLORIDA, ACCEPTING THE RECOMMENDATION OF THE CITY MANAGER AND AUTHORIZING THE ADMINISTRATION TO ENTER INTO NEGOTIATIONS, PURSUANT TO REQUEST FOR INFORMATION (RFI) NO. 2020-144- JC, FOR PRE AND POST-EMPLOYMENT MEDICAL SERVICES, WITH MOUNT SINAI MEDICAL CENTER OF FLORIDA,INC., FOR AN INITIAL PERIOD OF THREE (3) YEARS, WITH TWO (2) ONE (1) YEAR RENEWAL OPTIONS AT THE SOLE DISCRETION OF THE CITY MANAGER, NOT TO EXCEED THE AMOUNT APPROPRIATED ANNUALLY FOR THESE SERVICES THROUGH THE CITY'S BUDGETING PROCESS; AND FURTHER, AUTHORIZING THE MAYOR AND CITY CLERK TO EXECUTE AN AGREEMENT UPON CONCLUSION OF SUCCESSFUL NEGOTIATIONS BY THE ADMINISTRATION. WHEREAS, the City utilizes medical services provider(s) to perform pre-employment physical examinations, drug and alcohol testing, fitness for duty evaluations, return-to-work evaluations, infectious disease exposure services, and administer vaccinations to City employees; and WHEREAS, the City has an operational need to maintain local pre and post-employment medical services on a 24-hours a day, 365-days a year basis; and WHEREAS, the current contract for pre and post-employment medical services with Mount Sinai Medical Center of Florida, Inc. (Mount Sinai), expired on February 15, 2020; and WHEREAS, in anticipation of the expiring agreement, on January 15, 2020, the City Commission approved an extension of the agreement with Mount Sinai, on a month-to-month basis; and WHEREAS, in consideration of the expiring agreement, the Administration considered options for procuring future pre and post-employment medical services; and WHEREAS, the Administration is aware that the City may exercise its discretion to procure medical services by way of the exemption of health services provided under Florida Statutes 287.057; and WHEREAS,the Administration has determined that it is in the City's best interest to solicit information from firms providing pre and post-employment medical services; and WHEREAS, in an effort to reveal available market options, Request for Information No. 2020-144-JC (the RFI) was issued on February 21, 2020, with an opening date of July 2, 2020; and WHEREAS, the City received a total of three (3) responses to the RFI from the following firms: Mount Sinai Medical Center of Florida, Inc.; Occupational Health Centers of the Southwest, PA dba Concentra Medical Centers; and Occupational Medical Centers of America; and DocuSign Envelope ID. 192DD89C-A3C5-4226-BF99-1A23E2A1F635 WHEREAS, Mount Sinai is the only respondent with facilities on Miami Beach; and WHEREAS, Mount Sinai is the only respondent capable of meeting the City's local services needs operating on a 24-hours a day, 365-days a year basis; and WHEREAS, the Administration has consistently rated Mount Sinai as highly satisfactory in the services provided to the City; and WHEREAS, after reviewing the submissions, the City Manager is recommending that the Mayor and City Commission approve this Resolution, authorizing the Administration to enter into negotiations with Mount Sinai Medical Center of Florida, Inc., as the firm most able to provide the pre and post-employment medical services, meeting the City's best interests. NOW, THEREFORE, BE IT DULY RESOLVED BY THE MAYOR AND CITY COMMISSION OF THE CITY OF MIAMI BEACH, FLORIDA, that the Mayor and City Commission hereby accept the recommendation of the City Manager, and authorize the Administration to enter into negotiations, pursuant to Request for Information (RFI) No. 2020-144- JC, for Pre and Post-employment Medical Services, with Mount Sinai Medical Center of Florida, Inc., for an initial period of three (3) years, with two (2) one (1) year renewal options, at the sole discretion of the City Manager, not to exceed the amount appropriated annually for these services through the City's budgeting process; and authorizing the Mayor and City Clerk to execute an agreement upon conclusion of successful negotiations by the Administration. PASSED AND ADOPTED this ��/ day of Seprnee2020. ATTEST: Dan Gelber, Mayor 2 Rafael E. Gran:do, City Clerk Yi� e 1 1:1 ........... _ =-y UvUI�� UrIA T-�,(1 )' �' '• APPROVED AS TO Y-'\‘'••• e ? .... FORM &LANGUAGE n! &FOR EXECUTION • -2 r'[,,/'by City Attorney Date DocuSign Envelope ID: 192DD89C-A3C5-4226-BF99-1A23E2A1F635 Resolutions-C7 O MIAMI BEACH COMMISSION MEMORANDUM TO: Honorable Mayor and Members of the City Commission FROM: Jimmy L. Morales, City Manager DATE: September 16, 2020 SUBJECT:A RESOLUTION OF THE MAYOR AND CITY COMMISSION OF THE CITY OF MIAMI BEACH, FLORIDA, ACCEPTING THE RECOMMENDATION OF THE CITY MANAGER AND AUTHORIZING THE ADMINISTRATION TO ENTER INTO NEGOTIATIONS, PURSUANT TO REQUEST FOR INFORMATION (RFI) NO. 2020-144-JC, FOR PRE AND POST- EMPLOYMENT MEDICAL SERVICES, WITH MOUNT SINAI MEDICAL CENTER OF FLORIDA, INC., FOR AN INITIAL PERIOD OF THREE (3) YEARS, WITH TWO (2) ONE (1)YEAR RENEWAL OPTIONS AT THE SOLE DISCRETION OF THE CITY MANAGER, NOT TO EXCEED THE AMOUNT APPROPRIATED ANNUALLY FOR THESE SERVICES THROUGH THE CITY'S BUDGETING PROCESS; AND FURTHER, AUTHORIZING THE MAYOR AND CITY CLERK TO EXECUTE AN AGREEMENT UPON CONCLUSION OF SUCCESSFUL NEGOTIATIONS BY THE ADMINISTRATION. RECOMMENDATION In careful consideration of the aforementioned reasons, it is the recommendation of the City Manager that the Administration be authorized to enter into negotiations, pursuant to Request for Information (RFI) No. 2020-144-JC, for Pre and Post-employment Medical Services, with Mount Sinai Medical Center of Florida, Inc., for an initial period of three (3) years, with two (2) one (1) year renewal options at the sole discretion of the City Manager, not to exceed the amount appropriated annually for these services through the City's budgeting process; and further authorizing the Mayor and City Clerk to execute an agreement upon conclusion of successful negotiations by the Administration. BACKGROUND/HISTORY The City utilizes medical services provider(s) to perform pre-employment physical examinations, drug and alcohol testing, fitness for duty evaluations, return-to-work evaluations, infectious disease exposure services, and administer vaccinations to City employees. . These services are critical to the daily ongoing operations to departments citywide. The City of Miami Beach currently has an agreement with Mount Sinai Medical Center of Florida, Inc. ("Mount Sinai")to provide medical services. Page 362 of 1855 DocuSign Envelope ID. 192DD89C-A3C5-4226-BF99-1 A23E2A1 F635 Mount Sinai has the largest physical presence of any healthcare provider within Miami Beach and have provided these occupational medical services for the City for the past five (5) years, as well as many years in the past.The City administration has consistently rated Mount Sinai as highly satisfactory in the services provided. Mount Sinai has an Occupational Health Center which has operated for over thirty-nine years.Additionally, Mount Sinai provides similar occupational medical services to other governmental entities throughout Miami-Dade and Broward Counties. The Mayor and City Commission approved a contract with Mount Sinai pursuant to RFP 2014- 127-LR which became effective February 15, 2015.The contract with Mount Sinai was set to expire on February 15, 2020. In advance of the expiration, on January 15, 2020, the Mayor and City Commission approved an extension of the agreement with Mount Sinai, on a month-to- month basis. RFI PROCESS Although the City may exercise its discretion to procure medical services by way of the exemption of health services provided under Florida Statutes 287.057, the Administration sought to solicit information from companies providing these services, as being in the best interest of the City.Therefore, the Administration developed a Request for Information (RFI) in order to solicit interest from prospective firms. On February 21, 2020, the RFI was issued. Over 7,000 firms were notified of the RFI via BidSync. 118 firms accessed the RFI documents. The City received three (3) responses to the RFI. Proposals were received from the following firms: • Mount Sinai Medical Center of Florida, Inc.; • Occupational Health Centers of the Southwest, PA dba Concentra Medical Centers;and • Occupational Medical Centers of America. In conducting its due diligence, the Administration found that Mount Sinai is the only proposer with facilities on Miami Beach, which is critically important to the ongoing human resources needs of the City. Equally important is the fact that Mount Sinai is the only firm with available business operations on a 24-hours a day, 365-days a year basis on Miami Beach. Therefore,for the reasons listed above, the Administration would like to continue its successful relationship for medical services with Mount Sinai, the most qualified proposer to the City's needs Applicable Area Citywide Is this a"Residents Right Does this item utilize G.O. to Know" iternpursuant to Bond Funds? City Code Section 2-14? Yes No Legislative Tracking Page 363 of 1855 DocuSign Envelope ID: 192DD89C-A3C5-4226-BF99-1 A23E2A1 F635 Human Resources ATTACHMENTS: Description o Resolution Page 364 of 1855 DocuSign Envelope ID: 192DD89C-A3C5-4226-BF99-1 A23E2A1 F635 ATTACHMENT B ADDENDA AND RFI SOLICITATION DocuSign Envelope ID: 192DD89C-A3C5-4226-BF99-1A23E2A1F635 PROCUREMENT DEPARTMENT tJ\ I A M I B E AC I-I 1755 Meridian Avenue,3rd Floor Miami Beach,Florida 33139 www.miamibeachfl.gov ADDENDUM NO.9 REQUEST FOR INFORMATION (RFI)2020-144-JC FOR MEDICAL SERVICES FOR PRE AND POST-EMPLOYMENT SERVICES June 25, 2020 This Addendum to the above-referenced RFI is issued in response to questions from prospective proposers, or other clarifications and revisions issued by the City. The RFI is amended in the following particulars only (deletions are shown by strikethrough and additions are underlined). I. MODIFICATIONS. RFI DUE DATE AND TIME.The deadline for the receipt of proposals is extended until 3:00 p.m.,on Thursday,July 2,2020. II. RESPONSES TO QUESTIONS RECEIVED. Q1: I have a question regarding the Addendum 7. On question#2,the question was who was going to be tested for the hallucinogen.The answer was"All employees,except Police and Fire", now on page 5 of the addendum, point "b"Police Firefighter Pre-Employment,#3, all the hallucinogen tests are listed. Is this an error? Please clarify. Al: Drugs that Police and Fire are tested for: 1. Amphetamine, 2. Barbiturates, 3. Benzodiazepines, 4. Cocaine Metabolites, 5. Marijuana Metabolites, 6. Methadone, 7. Methaqualone, 8. Methylenedioxyamphetamine(MDA)Analogues,9.Opiates, 10. Phencyclidine,and 11. Propoxyphene. Q2: The Pre-Employment Physical for Police and Firefighter includes the drug test. Do you want that to change? A2: No. THE DEADLINE FOR QUESTIONS HAS PASSED AND NO FURTHER QUESTIONS WILL BE CONSIDERED. Any questions regarding this Addendum should be submitted in writing to the Procurement Department to the attention of the individual named below: Procurement Contact: Telephone: Email: Jason Crouch 305-673-7000,ext.26694 JasonCrouch@miamibeachfl.gov Proposers are reminded to acknowledge receipt of this addendum as part of your RFI submission. -rely, i lex Flit i s Proc ent Director i ADDENDUM NO.9 REQUEST FOR INFORMATION(RFI)2020-144-JC OR MEDICAL SERVICES FOR PRE AND POST-EMPLOYMENT SERVICES DocuSign Envelope ID: 192DD89C-A3C5-4226-BF99-1A23E2A1F635 PROCUREMENT DEPARTMENT MIAMI BEACH 1755 Meridian Avenue,3rd Floor Miami Beach, Florida 33139 www.miamibeachfl.gov ADDENDUM NO. 8 REQUEST FOR INFORMATION (RFI) 2020-144-JC FOR MEDICAL SERVICES FOR PRE AND POST-EMPLOYMENT SERVICES June 17, 2020 This Addendum to the above-referenced RFI is issued in response to questions from prospective proposers, or other clarifications and revisions issued by the City. The RFI is amended in the following particulars only(deletions are shown by strikethrough and additions are underlined). IMPORTANT NOTICE The City of Miami Beach in order to comply with the Centers for Disease Control (CDC) requirements, pursuant to COVID-19, will until further notice, only accept electronic RFI submittals. Therefore, all RFI responses must be submitted via email,with a corresponding PDF attachment containing the proposal item(s), to Jason Crouch, jasoncrouchmiamibeachfl.qov , prior to 3:00 PM, Friday, June 26, 2020. RFI responses will not be accepted in-person or via BidSync. I. RFI DUE DATE AND TIME. The deadline for the receipt of proposals is extended until 3:00 p.m., on Friday, June 26, 2020. Late proposals will not be accepted. Proposers are cautioned to plan sufficient time to allow for email delivery of the proposal documents .• . : : • . ,for which the Proposer is solely responsible. A forthcomin' addendum will be issued to BidS nc with res•onses to all •uestions received. Any questions regarding this Addendum should be submitted in writing to the Procurement Department to the attention of the individual named below, with a copy to the City Clerk's Office at RafaelGranado@miamibeachfl.gov Procurement Contact: Telephone: Email: Jason Crouch 305-673-7000, ext.26694 JasonCrouch@miamibeachfl.gov Proposers are reminded to acknowledge receipt of this addendum as part of your RFI submission. Si cer ly, le Denis I a* 'rocureme' • rector DocuSign Envelope ID: 192DD89C-A3C5-4226-BF99-1A23E2A1F635 PROCUREMENT DEPARTMENT 1\/\ I A M I B E AC H 1755 Meridian Avenue,3rd Floor Miami Beach,Florida 33139 www.miamibeachfl.gov ADDENDUM NO. 7 REQUEST FOR INFORMATION (RFI) 2020-144-JC FOR MEDICAL SERVICES FOR PRE AND POST-EMPLOYMENT SERVICES June 5, 2020 This Addendum to the above-referenced RFI is issued in response to questions from prospective proposers, or other clarifications and revisions issued by the City. The RFI is amended in the following particulars only(deletions are shown by strikethrough and additions are underlined). ATTACHMENT(S) Exhibit A: FY19 Testing Volume II. RESPONSES TO QUESTIONS RECEIVED. Q1: We did not see the pages where we can enter the fees for the services? Al: Please provide your fees on a separate document attached to your RFI response. Format should be in PDF or Excel. Q2: Pertaining hallucinogen of any kind will this be included for every employee that needs lab work? Please specify who will be tested? A2: All employees, except Police and Fire. Q3: For hallucinogens, beside Phencyclidine (aka angel dust); do you want to include the more rarely abused? Ketamine (aka special K), LSD, Mescaline (peyote,mushrooms), Dimthyltryptamine, Belladonna alkaloids, Dextromethorphan (aka red devils); Salvia Divinorum (aka: ska)? A3: Yes. Q4: Do you want an EKG for pre-employment police and firefighter? A4: All sworn police and fire staff. Q5: What departments are currently being tested? A5: Testing is done for multiple departments depending on the issue and language in collective bargaining agreements. For instance, post-accident drug and alcohol testing is required of all employees after a vehicle accident, except police&fire. ADDENDUM NO.7 REQUEST FOR INFORMATION(RFI)2020-144-JC FOR MEDICAL SERVICES FOR PRE AND POST-EMPLOYMENT SERVICES DocuSign Envelope ID: 192DD89C-A3C5-4226-BF99-1A23E2A1 F635 Q6 What services and what expectations do you have regarding"mobile services"? A6: Mobile services for post-accident drug testing and random drug testing as an option. Q7: How many employees does the City of Miami Beach have? A7: 2,279. Q8: Comprehensive HIV/AIDS(currently not part of NFPA guidelines,but is it preferred because of pension protocol)? A8: HIV/AIDS testing is preferred. Testing is required if a first responder or field worker has been exposed to a positive individual. 09: Comprehensive Hepatitis B and C titer(Hep B antibody quantitative) (Hepatitis C testing- preferred because of pension protocol)? A9: Standard medically accepted tests that fail to indicate the presence of Hep B and C is required. Q10: Nasal Swab Culture(Why a nasal swab culture? Need more information to when this would completed. This is not a common test for our standards.) A10: Nasal Swab Culture is not required. Q11: Hema Cult(Confirming if this is 40 years and over or part of a sperate fitness test) rectal for colon cancer? All: Confirmed this test is for 40 years and older as part of a fitness exam, not pre-employment physical. Q12:Visual Exam, (Confirming complexity of vision testing-acuity+depth+color+visual fields)? Al2: Yes, use NFP Guidelines and California Standard. Q13:Glaucoma Screen (Is this being completed with a tonometer and can you confirm over 40 years old)? A13: Glaucoma screening for Police and Fire over the age of 40. Q14:Tuberculin Skin Test(1 step of 2 step, do we need to do blood testing)? A14: Would prefer Interferon Gamma Release Assay Testing (IGRA) instead of TB Skin test. Either of the two FDA approved IGRA tests are acceptable(QuantiFeron®-TB Gold In-Tube and T-Spot®). Q15: OSHA compliant PA and LAT(assuming this is done if medically indicated)? A15: Not aware of any OSHA testing that is required. Q16: Chest X-ray with Cardiologic Interpretation(There is no difference here from the chest Xray 2 view,need clarity)? A16: Chest X-ray to show if lungs are clear, evidence of fluid or consolidation, placement of trachea and mediastinum,the condition of bony thorax and diaphragm. ADDENDUM NO.7 REQUEST FOR INFORMATION(RFI)2020-144-JC FOR MEDICAL SERVICES FOR PRE AND POST-EMPLOYMENT SERVICES DocuSign Envelope ID: 192DD89C-A3C5-4226-BF99-1A23E2A1F635 Q17: Tetanus Toxoid Booster(We normally recommend TDAP instead of Tetanus only,would this be ok)? A17: Prefer the TDAP instead of Tetanus only. Q18:Anti-viral medication for HIV/AIDS exposure (Do we need to carry a 3-day supply) (this is reserved for post exposure prophylaxis,when would this be administered assuming if medically appropriate?) A18: A 3-day supply should be available to administer for post exposure cases of first responders or field workers. Q19:Would you please provide an approximate number of physicals expected to be requested by the city on a monthly basis? A19:We had an average of 438 physicals in 2019(including police and fire). Q20: Item G -We have the ability to facilitate on-site physicals. Would our bid be disqualified if we do not have a "mobile unit"? A20: No. Any questions regarding this Addendum should be submitted in writing to the Procurement Department to the attention of the individual named below: Procurement Contact: Telephone: Email: Jason Crouch 305-673-7000,ext.26694 JasonCrouch@miamibeachfl.gov 1 Proposers are reminded to acknowledge receipt of this addendum as part of your RFI submission. Sincerely 2Ale1ienis Procurement Director -+ ADDENDUM NO.7 REQUEST FOR INFORMATION(RFI)2020-144-JC FOR MEDICAL SERVICES FOR PRE AND POST-EMPLOYMENT SERVICES DocuSign Envelope ID: 192DD89C-A3C5-4226-BF99-1A23E2A1F635 Exhibit A: FY19 Testing Volume �._. �,..S 1 ADDENDUM NO.7 REQUEST FOR INFORMATION(RFI)2020-144-JC FOR MEDICAL SERVICES FOR PRE AND POST-EMPLOYMENT SERVICES DocuSign Envelope ID: 192DD89C-A3C5-4226-BF99-1 A23E2A1 F635 The City's responses are bolded and underlined below. a. Standard Pre-Employment Physical including: 363 conducted 1. Review of medical history/physical examination and consultation 2. Breath Alcohol Test 3. Urine Drug Screen—12 Panel 4. Hearing Screen/Whisper 5. Vision Screen 6. Tuberculin Skin Test b. Police, Firefighter Pre-Employment Physical including: 75 conducted 1. Review of medical history/physical examination and consultation 2. Breath Alcohol Test 3. Urine Drug Screen 12-Panel (test panels include Amphetamines, Barbiturates, Benzodiazepines, Cocaine Metabolites, Methaqualone, Hallucinogens of any kind, Marijuana Metabolites, Methadone, Methaqualone, Methylenedioxyamphetamine (MDA) Analogues, Opiates, Phencyclidine, Methadone, and Propoxyphene.) 4. Comprehensive Blood Cell counts 5. Comprehensive Blood Chemistries 6. Comprehensive Lipid Panel 7. Comprehensive HIV/AIDS 8. Comprehensive Hepatitis B and C titer 9. Comprehensive Urinalysis 10. Nasal Swab Culture 11. Hem Cult (40 years and over) 12. Visual Exam, (acuity+depth+color+visual fields) 13. Glaucoma Screen (40 years and older) 14. Comprehensive Pulmonary Function Test ADDENDUM NO.7 REQUEST FOR INFORMATION(RFI)2020-144-JC FOR MEDICAL SERVICES FOR PRE AND POST-EMPLOYMENT SERVICES DocuSign Envelope ID: 192DD89C-A3C5-4226-BF99-1A23E2A1F635 15. Tuberculin Skin Test 16. OSHA compliant PA and LAT(if medically indicated) 17. Chest X-ray with Cardiologic Interpretation c. Immunization Services to include: 350 conducted 1. Tetanus Toxoid Booster 2. Hepatitis B Vaccination (complete series of 3) 3. Hepatitis A&B Vaccination (complete series of 3) 4. Measles, Mumps and Rubella 5. Anti-viral medication for HIV/AIDS exposure (3-day supply) d. EKG (5) EKG to be conducted on all sworn police and fire personnel e. Random, Reasonable Suspicion, Return to Work and Post-Accident Drug and Alcohol Testing Including Consultation with the Medical Review Officer and Evaluation by the Substance Abuse Professional Pursuant to DOT Requirements 750 conducted f. Respirator Review and Clearance 5 conducted g. Mobile Unit 4 conducted ti ADDENDUM NO.7 REQUEST FOR INFORMATION(RFI)2020-144-JC FOR MEDICAL SERVICES FOR PRE AND POST-EMPLOYMENT SERVICES DocuSign Envelope ID: 192DD89C-A3C5-4226-BF99-1A23E2A1 F635 PROCUREMENT DEPARTMENT MIAMI BEACH 1755 Meridian Avenue,3��Floor Miami Beach, Florida 33139 www.miamibeachfl.gov ADDENDUM NO. 6 REQUEST FOR INFORMATION (RFI) 2020-144-JC FOR MEDICAL SERVICES FOR PRE AND POST-EMPLOYMENT SERVICES May 29, 2020 This Addendum to the above-referenced RFI is issued in response to questions from prospective proposers, or other clarifications and revisions issued by the City. The RFI is amended in the following particulars only(deletions are shown by strikethrough and additions are underlined). IMPORTANT NOTICE The City of Miami Beach in order to comply with the Centers for Disease Control (CDC) requirements, pursuant to COVID-19, will until further notice, only accept electronic RFI submittals. Therefore, all RFI responses must be submitted via email,with a corresponding PDF attachment containing the proposal item(s), to Jason Crouch, jasoncrouchmiamibeachfl.qov , prior to 3:0.0 PM, Friday, June 19, 2020. RFI responses will not be accepted in-person or via BidSync. I. RFI DUE DATE AND TIME. The deadline for the receipt of proposals is extended until 3:00 p.m., on Friday, June 19,2020. Late proposals will not be accepted. Proposers are cautioned to plan sufficient time to allow for email delivery of the proposal documents traffic or other delays, for which the Proposer is solely responsible. A forthcomin• addendum will be issued to BidS nc with responses to all •uestions received. Any questions regarding this Addendum should be submitted in writing to the Procurement Department to the attention of the individual named below, with a copy to the City Clerk's Office at RafaelGranado@miamibeachfl.gov Procurement Contact: Telephone: Email: Jason Crouch 305-673-7000, ext.26694 JasonCrouch@miamibeachfl.gov Proposers are reminded to acknowledge receipt of this addendum as part of your RFI submission. Sincerely, Alex Denis Procurement Director DocuSign Envelope ID: 192DD89C-A3C5-4226-BF99-1A23E2A1F635 DEPARTMENT M 1 AMI B E AC I-IPROCUREMENT 1755 Meridian Avenue,3�tl Floor Miami Beach, Florida 33139 www.miamibeachfl.gov ADDENDUM NO. 5 REQUEST FOR INFORMATION (RFI) 2020-144-JC FOR MEDICAL SERVICES FOR PRE AND POST-EMPLOYMENT SERVICES May 21, 2020 This Addendum to the above-referenced RFI is issued in response to questions from prospective proposers, or other clarifications and revisions issued by the City. The RFI is amended in the following particulars only(deletions are shown by strikethrough and additions are underlined). IMPORTANT NOTICE The City of Miami Beach in order to comply with the Centers for Disease Control (CDC) requirements, pursuant to COVID-19, will until further notice, only accept electronic RFI submittals. Therefore, all RFI responses must be submitted via email,with a corresponding PDF attachment containing the proposal item(s),to Jason Crouch,jasoncrouch@miamibeachfl.gov, prior to 3:00 PM, Friday, June 5, 2020. RFI responses will not be accepted in-person or via BidSync. I. RFI DUE DATE AND TIME. The deadline for the receipt of proposals is extended until 3:00 p.m., on Friday,June 5,2020. City-of-Miami-beach Procurement Department Miami Beach, FL 33139. Late proposals will not be accepted. Proposers are cautioned to plan sufficient time to allow for email delivery of the proposal documents traffic or other delays, for which the Proposer is solely responsible. A forthcomin• addendum will be issued to BidS nc with res•onses to all •uestions received. Any questions regarding this Addendum should be submitted in writing to the Procurement Department to the attention of the individual named below, with a copy to the City Clerk's Office at RafaelGranado@miamibeachfl.gov Procurement Contact: Telephone: Email: Jason Crouch 305-673-7000, ext.26694 JasonCrouch@miamibeachfl.gov Proposers are reminded to acknowledge receipt of this addendum as part of your RFI submission. Eki erely, Alex Denis Procurem n Director DocuSign Envelope ID: 192DD89C-A3C5-4226-BF99-1A23E2A1F635 PROCUREMENT DEPARTMENT MIAMI BEAC H 1755 Meridian Avenue,3rd Floor Miami Beach,Florida 33139 www.miamibeachfl.gov ADDENDUM NO.4 REQUEST FOR INFORMATION (RFI) 2020-144-JC FOR MEDICAL SERVICES FOR PRE AND POST-EMPLOYMENT SERVICES April 22, 2020 This Addendum to the above-referenced RFI is issued in response to questions from prospective proposers, or other clarifications and revisions issued by the City. The RFI is amended in the following particulars only(deletions are shown by strikethrough and additions are underlined). I. RFI DUE DATE AND TIME. The deadline for the receipt of proposals is extended until 3:00 p.m., on Friday, May 29, 2020. City of Miami Beach Procurement Department 1755 Meridian Ave, 3rd Floor Miami Beach, FL 33139. Late proposals will not be accepted. Proposers are cautioned to plan sufficient time to allow for traffic or other delays, for which the Proposer is solely responsible. Any questions regarding this Addendum should be submitted in writing to the Procurement Department to the attention of the individual named below, with a copy to the City Clerk's Office at RafaelGranado@miamibeachfl.gov Procurement Contact: Telephone: Email: Jason Crouch 305-673-7000, ext.26694 JasonCrouch@miamibeachfl.gov Proposers are reminded to acknowledge receipt of this addendum as part of your RFI submission. g±..i erely, Alex Denis Procurem n Director DocuSign Envelope ID: 192D089C-A3C5-4226-BF99-1A23E2A1 F635 DEPARTMENT MIAMI B E AC I-•IPROCUREMENT 1755 Meridian Avenue,3rd Floor Miami Beach, Florida 33139 www.miamibeachfl.gov ADDENDUM NO. 3 REQUEST FOR INFORMATION (RFI) 2020-144-JC FOR MEDICAL SERVICES FOR PRE AND POST-EMPLOYMENT SERVICES March 31, 2020 This Addendum to the above-referenced RFI is issued in response to questions from prospective proposers, or other clarifications and revisions issued by the City. The RFI is amended in the following particulars only(deletions are shown by strikethrough and additions are underlined). I. RFI DUE DATE AND TIME. The deadline for the receipt of proposals is extended until 3:00 p.m., on Friday, May 8, 2020. City of Miami Beach Procurement Department 1755 Meridian Ave, 3rd Floor Miami Beach, FL 33139. Late proposals will not be accepted. Proposers are cautioned to plan sufficient time to allow for traffic or other delays, for which the Proposer is solely responsible. Any questions regarding this Addendum should be submitted in writing to the Procurement Department to the attention of the individual named below, with a copy to the City Clerk's Office at RafaelGranado@miamibeachfl.gov Procurement Contact: Telephone: Email: Jason Crouch 305-673-7000, ext.26694 JasonCrouch@miamibeachfl.gov Proposers are reminded to acknowledge receipt of this addendum as part of your RFI submission. g...±. i erely, Alex Denis Procurem n Director DocuSign Envelope ID: 192DD89C-A3C5-4226-BF99-1 A23E2A1 F635 PROCUREMENT DEPARTMENT t\'\ I A M I B E1 \C I-I 1755Meridian Avenue, 3ra Floor Miami Beach,Florida 33139 www.miamibeachfl.gov ADDENDUM NO. 2 REQUEST FOR INFORMATION (RFI) 2020-144-JC FOR MEDICAL SERVICES FOR PRE AND POST-EMPLOYMENT SERVICES March 27, 2020 This Addendum to the above-referenced RFI is issued in response to questions from prospective proposers, or other clarifications and revisions issued by the City.The RFI is amended in the following particulars only(deletions are shown by strikethrough and additions are underlined). I. RFI DUE DATE AND TIME. The deadline for the receipt of proposals is extended until 3:00 p.m., on Friday,April 17, 2020. City of Miami Beach Procurement Department 1755 Meridian Ave, 3rd Floor Miami Beach, FL 33139. Late proposals will not be accepted. Proposers are cautioned to plan sufficient time to allow for traffic or other delays, for which the Proposer is solely responsible. Any questions regarding this Addendum should be submitted in writing to the Procurement Department to the attention of the individual named below, with a copy to the City Clerk's Office at RafaelGranado@miamibeachfl.gov Procurement Contact: Telephone: Email: Jason Crouch 305-673-7000, ext.26694 JasonCrouch@miamibeachfl.gov Proposers are reminded to acknowledge receipt of this addendum as part of your RFI submission. c ely, lex Deni rocure Director DocuSign Envelope ID: 192DD89C-A3C5-4226-BF99-1A23E2A1F635 PROCUREMENT DEPARTMENT MIAMI BEACH 1755 Meridian Avenue, 3rd Floor Miami Beach, Florida 33139 www.miamibeachfl.gov ADDENDUM NO. 1 REQUEST FOR INFORMATION (RFI) 2020-144-JC FOR MEDICAL SERVICES FOR PRE AND POST-EMPLOYMENT SERVICES March 13, 2020 This Addendum to the above-referenced RFI is issued in response to questions from prospective proposers, or other clarifications and revisions issued by the City. The RFI is amended in the following particulars only(deletions are shown by strikethrough and additions are underlined). I. RFI DUE DATE AND TIME. The deadline for the receipt of proposals is extended until 3:00 p.m., on Friday, April 3,2020. City of Miami Beach Procurement Department 1755 Meridian Ave, 3rd Floor Miami Beach, FL 33139. Late proposals will not be accepted. Proposers are cautioned to plan sufficient time to allow for traffic or other delays, for which the Proposer is solely responsible. Any questions regarding this Addendum should be submitted in writing to the Procurement Department to the attention of the individual named below, with a copy to the City Clerk's Office at RafaelGranado@miamibeachfl.gov Procurement Contact: Telephone: Email: Jason Crouch 305-673-7000, ext.26694 JasonCrouch@miamibeachfl.gov Propo s are reminded to acknowledge receipt of this addendum as part of your RFI submission. 7Zer ly ';''' '-i Ale benis )/c.Pr cure - Director 1 J ADDENDUM NO. 1 W � RFI 2020-144-JC DocuSign Envelope ID: 192DD89C-A3C5-4226-BF99-1A23E2A1 F635 RFI 2020-144-JC Medical Services for Pre and Post-Employment Services REQUEST FOR MIAMI BEACH INFORMATION (RFI) 2020-144-JC, Procurement Department MEDICAL SERVICES FOR PRE 1755 Meridian Ave., 3rd Floor AND POST-EMPLOYMENT Miami Beach, Florida 33139 SERVICES SECTION 0100 1. Background. The City utilizes medical services provider(s) to perform pre-employment physical examinations, drug and alcohol testing, fitness for duty evaluations, return-to-work evaluations, infectious disease exposure services, and administer vaccinations to current and prospective City employees. The City has an operational need to establish an agreement with a medical services provider(s) to perform pre-employment physical examinations,drug and alcohol testing,fitness for duty evaluations,return-to-work evaluations,infectious disease exposure services,and administer vaccinations.The City seeks to retain the highest quality of services available. The City anticipates selecting one (1) services provider to perform the requested services. However, the City reserves the right to select additional providers if it is deemed to be in the best interest of the City. 2. Scope of Services. The City of Miami Beach, Florida (hereinafter referred to as the "City") is soliciting this Request for Information ("RFI") from qualified healthcare providers that are able to provide medical services for pre and post-employment services,as identified in Attachment A. 3. Submittals. Interested parties should submit responses in accordance with requirements below. The City will consider responses based upon the provider's qualifications and demonstrated experience in providing similar services. Submit three(3) hard copy"original" proposals marked as such, and one (1) electronic copy (USB flash drive or CD-ROM,) of the proposal. In keeping with the City's sustainability program, RFI hard copies should be printed when possible on paper containing a high level of post-consumer recycled content. 4. Submittal Deadline: Friday,March 20,2020 at 3:00 p.m.Responses to the RFI are to be submitted to: City of Miami Beach Procurement Department 1755 Meridian Avenue, 3rd Floor Miami Beach, Florida 33139 Electronic submittals will not be accepted.Additionally,submittals received after the due date and time will not be considered. 4.1. QuestionlAnswer Deadline.Tuesday, March 10, 2020 at 5:00 p.m. [REMAINDER OF PAGE INTENTIONALLY LEFT BLANK] DocuSign Envelope ID: 192DD89C-A3C5-4226-BF99-1 A23E2A1 F635 RFI 2020-144-JC Medical Services for Pre and Post-Employment Services Submittals should conform to the following response format: TAB 1 Cover Letter&Minimum Qualifications Requirements. 1.1 Table of Contents. The table of contents should indicate the tabs, sections with tabs and page numbers to facilitate the evaluation committee's review. 1.2 Cover Letter. A cover letter to indicate name and contact information for the submitting provider and primary account representative,to include: addresses, primary telephone numbers and email addresses. TAB 2 Project Team Qualifications. 2.1 Organizational Chart: An organizational chart to include executive leadership, physicians, nurses and administrative personnel of each involved in the project. 2.2 Relevant Experience of Prime Proposer: Summarize projects where the Proposer and/or its principals have provided services similar to those described herein. For each project provide the following: a. project name and scope of services provided; b. name of individuals that worked on the referenced project that have been included in Section 2.1 above; c. client; d. client project manager and contact information;and e. annual contract value of the services provided. TAB 3 Approach and Methodology. Submit detailed information on the approach and methodology that the Proposer and its team has used in past in engagements in providing the services described herein with a focus on the following,at a minimum: 3.1 The City requests that respondents submit responses to the following services categories. In sufficient detail,please describe your firm's approach,process,and organizational capacity in response to the items below: • Facility Services and Hours of Operation; • Designated Liaison; • Licensend Physician/Medical Review Officer Certification; • Examination Results; • Supplies/Equipment; • Record Keeping and Retention of Records; • Pre-Employment and Promotional Exams; • Psychiatric Services; • Exposure/Immunization Program; • Drug&Alcohol Testing Program; • Fitness for Duty and Return-To-Work Evaluations; • Communication with the City;and • Staffing. 3.2 Provide a minimum of two(2)examples of medical services current or previous contracts for pre and post-employment testing similar to those requested herein; 3.3 Describe capacity of the organization to accommodate the City's business volume; 3.4 Provide hours of operation; 3.5 Describe any value-added services; and 3.6 Provide three(3)references for the above referenced contracts. TAB 4 Fees for Medical Services. Submit detailed fees for medical services referenced in Attachment A of the RFI DocuSign Envelope ID:192DD89C-A3C5-4226-BF99-1A23E2A1F635 RFI 2020-144-JC Medical Services for Pre and Post-Employment Services 5. Evaluation of Responses. The City shall evaluate all information received based upon the Proposer's qualifications and the extent to which the proposed services meet the City's needs and concerns, are of high quality and adhere to best practice standards and are economically feasible. Following its receipt and review of the responses submitted to this RFI, the City reserves the right to contact such firm (or firms) as the City, in its sole discretion and determination, may wish to interview, in further determining the most qualified firm (or firms) to perform the required professional services solicited pursuant to this process. 6. Result of RFI.The City is not required to act upon any information obtained through this RFI. However, the City reserves the right to negotiate an agreement or issue a Purchase Order pursuant to this RFI to the Proposer deemed to be in the best interest of the City. 7. Procurement Contact.Any questions or clarifications concerning this solicitation shall be submitted to the Procurement Contact noted below: Contact: Telephone: Email: Jason Crouch 305-673-7490 Ext.26694 jasoncrouchAmiamibeachfl.gov All responses to questions/clarifications will be sent to all prospective Proposers in the form of an addendum posted to BidSync. (REMAINDER OF PAGE INTENTIONALLY LEFT BLANK) DocuSign Envelope ID: 192DD89C-A3C5-4226-BF99-1A23E2A1 F635 RFI 2020-144-JC Medical Services for Pre and Post-Employment Services ATTACHMENT A: MEDICAL SERVICES FOR PRE AND POST-EMPLOYMENT SERVICES FEES Pursuant to Tab 4,the respondent must submit its fees for the following medical services: a. Standard Pre-Employment Physical including: 1. Review of medical history/physical examination and consultation 2. Breath Alcohol Test 3. Urine Drug Screen—12 Panel 4. Hearing Screen/Whisper 5. Vision Screen 6. Tuberculin Skin Test b. Police, Firefighter Pre-Employment Physical including: 1. Review of medical history/physical examination and consultation 2. Breath Alcohol Test 3. Urine Drug Screen 12-Panel (test panels include Amphetamines. Barbiturates, Benzodiazepines, Cocaine Metabolites, Methaqualone, Hallucinogens of any kind, Marijuana Metabolites, Methadone, Methaqualone, Methylenedioxyamphetamine (MDA) Analogues, Opiates, Phencyclidine, Methadone, and Propoxyphene.) 4. Comprehensive Blood Cell counts 5. Comprehensive Blood Chemistries 6. Comprehensive Lipid Panel 7. Comprehensive HIV/AIDS 8. Comprehensive Hepatitis B and C titer 9. Comprehensive Urinalysis 10. Nasal Swab Culture 11. Hem Cult(40 years and over) 12. Visual Exam, (acuity+depth+color+visual fields) 13. Glaucoma Screen (40 years and older) 14. Comprehensive Pulmonary Function Test 15. Tuberculin Skin Test 16. OSHA compliant PA and LAT(if medically indicated) 17. Chest X-ray with Cardiologic Interpretation c. Immunization Services to include: 1. Tetanus Toxoid Booster 2. Hepatitis B Vaccination (complete series of 3) 3. Hepatitis A&B Vaccination (complete series of 3) 4. Measles, Mumps and Rubella 5. Anti-viral medication for HIV/AIDS exposure(3-day supply) d. EKG e. Random, Reasonable Suspicion, Return to Work and Post-Accident Drug and Alcohol Testing Including Consultation with the Medical Review Officer and Evaluation by the Substance Abuse Professional Pursuant to DOT Requirements f. Respirator Review and Clearance g. Mobile Unit DocuSign Envelope ID: 192DD89C-A3C5-4226-BF99-1A23E2A1 F635 ATTACHMENT C SUNBIZ & PROPOSAL RESPONSE TO RFI DocuSign Envelope ID: 192DD89C-A3C5-4226-BF99-1A23E2A1 F635 Detail by Entity Name DIVISION OF CORPORATIONS 4411C IDP/151011 Of t r .org t0.p_.PDlsmDrtf; an official state of Florida IveLsitr Department of State / Division of Corporations / Search Records / Search by Entity Name / Detail by Entity Name Florida Not For Profit Corporation MOUNT SINAI MEDICAL CENTER OF FLORIDA, INC. Filing Information Document Number 710931 FEI/EIN Number 59-0624424 Date Filed 05/23/1966 State FL Status ACTIVE Last Event AMENDMENT Event Date Filed 05/25/2012 Event Effective Date NONE Principal Address 4300 ALTON ROAD MIAMI BEACH, FL 33140 Mailing Address 4300 ALTON ROAD 5TH FLOOR, WARNER BUILDING MIAMI BEACH, FL 33140 Changed: 06/10/2010 Registered Agent Name&Address FRIEDLAND, PRISCILLA 4300 ALTON ROAD MIAMI BCH, FL 33140 Name Changed: 07/12/2000 Address Changed: 01/27/1998 Officer/Director Detail Name &Address Title PCEO SONENREICH, STEVEN D 4300 ALTON ROAD MIAMI BEACH, FL 33140 search.sunbiz.org/Inquiry/CorporationSearch/SearchResultDetail?inquirytype=EntityName&directionType=Initial&searchNameOrder=MOUNTSINAIM... 1/3 DocuSign Envelope ID: 192DD89C-A3C5-4226-BF99-1A23E2A1 F635 Detail by Entity Name Title SENIOR VP& GENERAL COUNSEL JAFFEE, ARNOLD 4300 ALTON RD MIAMI BEACH, FL 33140 Title EXECUTIVE VP OF OPERATIONS &CFO MENDEZ, ALEX 4300 ALTON RD. MIAMI BEACH, FL 33140 Title CHAIRMAN BOARD OF TRUSTEES HILDEBRANDT, MARK H 4300 ALTON RD. MIAMI BEACH, FL 33140 Annual Reports Report Year Filed Date 2018 02/05/2018 2019 04/04/2019 2020 02/03/2020 Document Images 02/03/2020--ANNUAL REPORT View image in PDF format 04/04/2019--ANNUAL REPORT View image in PDF format 02/05/2018—ANNUAL REPORT View image in PDF format 01/16/2017—ANNUAL REPORT View image in PDF format 03/07/2016--ANNUAL REPORT View image in PDF format 02/19/2015--ANNUAL REPORT View image in PDF format 01/21/2014--ANNUAL REPORT View image in PDF format J 07/19/2013--AMENDED ANNUAL REPORT View image in PDF format 02/25/2013—ANNUAL REPORT View image in PDF format 05/25/2012—Amendment View image in PDF format 01/25/2012--ANNUAL REPORT View image in PDF format 02/03/2011--ANNUAL REPORT View image in PDF format 06/10/2010--ANNUAL REPORT View image in PDF format 01/12/2010--ANNUAL REPORT View image in PDF format 01/28/2009--ANNUAL REPORT View image in PDF format 01/28/2008—ANNUAL REPORT View image in PDF format 02/22/2007--ANNUAL REPORT View image in PDF format 0 /14/2006--ANNUAL REPORT View image in PDF format 01/28/2005--ANNUAL REPORT View image in PDF format 03/15/2004--ANNUAL REPORT View image in PDF format J 02/14/2003--ANNUAL REPORT View image in PDF format 04/07/2002--ANNUAL REPORT View image in PDF format 02/12/2001 --ANNUAL REPORT View image in PDF format search.sunbiz.org/Inquiry/CorporationSearch/SearchResultDetail?inquirytype=EntityName&directionType=Initial&searchNameOrder=MOUNTSINAIM... 2/3 DocuSign Envelope ID: 192DD89C-A3C5-4226-BF99-1A23E2A1F635 Detail by Entity Name 12/11/2000--Amended and Restated Articles View image in PDF format 07/26/2000--Amendment View image in PDF format 07/12/2000--Reg.Agent Change View image in PDF format 03/07/2000--ANNUAL REPORT View image in PDF format J 03/03/1999--ANNUAL REPORT View image in PDF format _I 05/04/1998--Name Change View image in PDF format I 01/27/1998--ANNUAL REPORT View image in PDF format 01/30/1997--ANNUAL REPORT View image in PDF format I 05/01/1996--ANNUAL REPORT View image in PDF format I 05/01/1995—ANNUAL REPORT View image in PDF format search.sunbiz.org/Inquiry/CorporationSearch/SearchResultDetail?inquirytype=EntityName&directionType=Initial&searchNameOrder=MOUNTSI NAIM... 3/3 DocuSign Envelope ID: 192DD89C-A3C5-4226-BF99-1 A23E2A1 F635 Mount Sinai MEDICAL CENTER • 1' r li +'1 • f 4 • . _ SMACK AL TGW SURGICAL R 1 , • riL RESPONSE TO RFI RFI NO. 2020-144-JC MEDICAL SERVICES FOR PRE AND POST-EMPLOYMENT SERVICES FOR CITY OF MIAMI BEACH DocuSign Envelope ID: 192DD89C-A3C5-4226-BF99-1 A23E2A1 F635 INTENTIONALLY LEFT BLANK DocuSign Envelope ID: 192DD89C-A3C5-4226-BF99-1A23E2A1F635 Mount Sinai Medical Ce- nter w LT ti IN THIS SECTION: Cover Letter a n d Minimum w , Qualification s N '� � H a g R o At ww w • 1 .1 Table of Contents r C • 1 .2 Cover Letter O �..> poi C • 1 .3 Minimum Qualification � w a � Requirements tw0al Ca) o � w DocuSign Envelope ID: 192DD89C-A3C5-4226-BF99-1A23E2A1 F635 Mount Sinai MEDICAL CENTER TAB 1 1 . 1 TABLE OF CONTENTS 1 DocuSign Envelope ID: 192DD89C-A3C5-4226-BF99-1 A23E2A1 F635 Table of Contents TAB 1 —Table of Contents, Cover Letter& Minimum Qualification Requirements 1.1 Table of Contents 1 Table of Contents (cont'd) 2 1.2 Cover Letter 3 1.3 Minimum Qualification Requirements 4 TAB 2- Organizational Chart& Relevant Experience of Prime Proposer 2.1 Organizational Chart 5 2.2 Relevant Experience of Prime Proposer 6 Experience (cont'd) 7 Experience(cont'd) 8 TAB 3—Approach and Methodology, Similar Services, Capacity of the Organization to Accommodate the City's Business Volume,Hours of Operation,Value Added Services,References,Addendum 3.1 Approach and Methodology 9 Approach and Methodology(cont'd) 10 Approach and Methodology(cont'd) 11 Approach and Methodology(cont'd) 12 Approach and Methodology(cont'd) 13 Approach and Methodology(cont'd) 14 Approach and Methodology(cont'd) 15 Approach and Methodology(cont'd) 16 Approach and Methodology(cont'd) 17 3.2 Similar Services 18 3.3 Capacity of the Organization to Accommodate the City's Business Volume 19 3.4 Hours of Operation 20 3.5 Value-Added Services 21 3.6 References 22 3.7 Addendum 23 1 DocuSign Envelope ID: 192DD89C-A3C5-4226-BF99-1A23E2A1F635 TAB 4- ATTACHMENT A Fees for Medical Services &Value-Added Services TAB 5—ATTACHMENT B,ATTACHMENT C, &ATTACHMENT D ATTACHMENT B Curriculum Vitae/Resume, Certificates, Licenses of Mount Sinai Medical Center Personnel ATTACHMENT C Subcontractor's Curriculum Vitae/Resume, Certificates, Licenses (Quest Diagnostic) ATTACHMENT D Local Business Tax Receipt 2 DocuSign Envelope ID: 192DD89C-A3C5-4226-BF99-1A23E2A1 F635 Mount Sinai MEDICAL CENTER TAB 1 1 .2 COVER LETTER DocuSign Envelope ID: 192DD89C-A3C5-4226-BF99-1A23E2A1 F635 Mount Sinai MEDICAL CENTER June 16,2020 City of Miami Beach Procurement Department 1755 Meridian Avenue, 3rd Floor Miami Beach,Florida 33139 Re: RFI NO. 2020-144-JC Medical Services for Pre and Post-Employment Services Mount Sinai Medical Center,Occupational Health Center(The"Proposer") located at 4304 Alton Road, Samuel Jacobson Healthcare Center, 1st Floor,Miami Beach, FL 33140,Telephone Number(305)674-2312,Fax Number(305)674-2527, Tax Identification Number 59-262442 is formally responding to your Request for Proposal No. 2020-144-JC, Medical Services for Pre and Post-Employment Services that may be required by the City of Miami Beach,and other Local, State,and Federal Laws. The Proposer is appointing Dr. Doris Danko MD, MA, MPH, as the primary account representative for this RFI; she can be reached out at(305) 674-2347(office),via e-mail at doris.danko@msmc.com, and via fax at(305)674-2385. Should you have any questions concerning the above,please do not hesitate to contact the undersigned. Sincerely, N(1 . C,64 kl Dr. Doris Danko MD, MA, MPH Program Director DocuSign Envelope ID: 192DD89C-A3C5-4226-BF99-1A23E2A1F635 Mount Sinai MEDICAL CENTER TAB 1 1 .3 MINIMUM QUALIFICATION REQUIREMENTS DocuSign Envelope ID: 192DD89C-A3C5-4226-BF99-1A23E2A1F635 Mount Sinai MEDICAL CENTER MINIMUM QUALIFICATION REQUIREMENTS Mount Sinai Medical Center is South Florida's largest not-for-profit organization. We are an opportunity employer and do not discriminate on the basis of race,creed, color national origin, sex,religion,veteran status,disability or any other characteristic prohibit by law. The Medical Center facilities include acute care,diagnostic,treatment,teaching and research facilities with approximately a 935-licensed bed capability. Mount Sinai Medical Center has over 71 years of Professional Experience providing acute care,diagnostic and treatment services within the facility. The Occupational Health Center at Mount Sinai Medical Center is located in the Samuel Jacobson Building, first Floor and has been providing services to numerous accounts and municipalities for over 39 years. Mount Sinai is especially proud of the occupational health services it provides to the City of Miami and provided to Miami-Dade County. We look forward to continue to provide the City of Miami Beach with quality services. The Scope of services provided by this department includes:pre-employment physical examinations,drug and alcohol testing, fitness for duty evaluations, infectious disease exposure services,administer vaccinations, FMLA, Worker's Compensation, Executive Physicals, Employee Health Services,and Emergency Department 24-hours, 7 days a week 365 days a year (urine and alcohol collections, including weekends and holidays). This department is committed to providing quality Health Care Services with integrity and continues to set high standards of excellence in all of its activities,our board certified medical doctors/MRO are licensed to practice in the State of Florida,and board certified Radiologists and Cardiologists,also licensed by the State of Florida. 0 0 0 C 0) 7 Response to RFINo.2020- 144-J 4 .7 o MEDICAL SERVICES FOR PRE AN � '-' = N ID EMPLOYMENT SERVICES '' ;'' e--t, FOR CITY OF MIAMI BEAC ' ' V) ci'N Z P F�. N • • � W N N Z m N N j0 rn -� 4 W xo CD To vCLA m Mn N' D OED E L. C7 M X o rnmom zo :1)v CD (T) Non 0 0 C) ^ vl 1 a) C') --1„ a o = 13 > r-t- o mill cr) o 0 0 ZDs(1) (In Z gel_ DocuSign Envelope ID: 192DD89C-A3C5-4226-BF99-1A23E2A1F635 Mount Sinai MEDICAL CENTER TAB 2 2. 1 ORGANIZATIONAL CHART 0 0 C) c CD cn C) m C) Organizational Chart o Occupational Health Center o 4300 Alton Road Miami Beach, Florida 33140 Monday— Friday 7:00 am — 5:00 pm (24 HR ER Drug Testing) Doris Danko, M.D., M.A,MPH. Luz Perez Program Director Program Billing Coordinator co Physicians W Specialists Doris Danko, M.D.,MA,MPH. -71 Medical Director of Occupational Health, Board Certified in Occupational Christos Mihos, MD Board Certified Cardiologist and Preventive Medicine, MRO, SAP, and Worker's Comp Alfonso Tolentino, MD Board Certified Cardiologist Chetan Rajadhyaksha, MD Board Certified Radiologist Larissa Hernandez, M.D. Steven Resnick, MD Board Certified Neurologist Board Certified in Internal Medicine, Medical Doctor of Occupational Yanko Enamorado, MD Board Certified Psychiatrist Health, MRO, Worker's Comp. Marc Umlas, MD Board Certified Orthopedist Elizabeth Kury Perez, M.D. Board Certified in Internal Medicine, Medical Doctor of Occupational Health, Worker's Comp. Medical Assistants Clerical Staff APRN &LPN Meredith Portee,Supervisor of Scheduling, Lourdes Campos, CMA & DOT Certified Registration, Billing and Elyana Mitchell, MSN, APRN Linda Dieujuste, CMA & DOT Certified Medical Records Sylvana Saintiche, MSN, APRN Gorvens Sene , CMA & DOT Certified Linda Ivory,Patient Representative, (Medical monitoring&exposure testing of Lisbeth Moharam, CMA & DOT Certified Scheduling, Registration,and Medical hazardous materials and safety issues: Records Specialist mask fitting;ADA;FMLA,ACLS) Erika Wright Patricia Wilson, LPN, DOT Certified, Mask Patient Representative,Scheduling,and Registration Fitting, Exposure Testing DocuSign Envelope ID: 192DD89C-A3C5-4226-BF99-1A23E2A1F635 Mount Sinai MEDICAL CENTER TAB 2 2.2 RELEVANT EXPERIENCE OF PRIME PROPOSER DocuSign Envelope ID: 192DD89C-A3C5-4226-BF99-1A23E2A1 F635 Mount Sinai MEDICAL CENTER RELEVANT EXPERIENCE Mount Sinai Medical Center Occupational Health Center provides professional medical and health care services for ongoing and completed contracts similar to the scope of services for City of Miami Beach.A detail description of the services Mount Sinai Medical Center Occupational Health Center is provided in chart below: Project Name Project Name Project Name Project Name The Client City of Miami Beach Miami Beach Miami Dade County City of Miami Fraternal Order Health Trust Scope of Service Provide professional Provide professional Provide professional Provide professional medical and health care medical and health care medical and health care medical and health services program services program for all services program for all care services program for all Classification Classification Classification for all Classification -Annual and -Physical evaluation -Pre-Employment and -Annual physicals- Pre-Employment -CT Calcium Score Annual Physical Pre-employment physicals -Cardiac Ultrasound Examinations physicals -Drug and alcohol testing Screenings -OSHA -Return to work -DOT testing -Cancer Ultrasound -Exposures -Vaccinations -Fitness for Duty Screenings -Drug and Alcohol -Hazmat testing -OSHA screening including DOT. -Drug testing DOT& -Exposures -Fitness for Duty Non-DOT drug -Immunizations -Immunizations testing -Employee Health Including Police& Fire Department. Name of individuals Dr. Doris Danko M.D, Dr. Doris Danko M.D, Dr. Doris Danko M.D, Dr. Doris Danko M.D, that worked on the M.A, M.P.H. M.A,M.P.H. M.A,M.P.H. M.A,M.P.H. referred projects Elyana Mitchell Elyana Mitchell Elyana Mitchell Elyana Mitchell MSN,APRN MSN,APRN MSN,APRN MSN,APRN Sylvana Saintiche Sylvana Saintiche Sylvana Saintiche Sylvana Saintiche MSN,APRN MSN,APRN MSN,APRN MSN,APRN Client Project Manager Sonia Bridges Elise Spina Taylor Michael Edwards City of Miami Fire and contact 305-673-7524 305-673-7776 305-375-2643 Chief Christian Information Ext 5543 Guzman Ph:305-416-5450 City of Miami Police Major Esther Farmer Ph:305-300-6101 Annual contract value $ 101, 000 Plus $181,000 Plus $1,500,000 $410,00 Plus Contract duration Over 18 years- 2019 - Present 29 years 2010—Present (dates covered) Present 6 DocuSign Envelope ID: 192DD89C-A3C5-4226-BF99-1A23E2A1 F635 Mount Sinai MEDICAL CENTER Proposer's Client List (cont'd) Project Name Project Name Project Name Project Name The Client Bal Harbour City of Aventura Miami Dade School Sunrise Fire Village Hall Police Police Department Rescue Hazmat Scope of Service Provide professional Provide professional Provide professional Provide professional medical and health medical and health care medical and health care medical and health care care services services program services program services program for all program for Police Classification -Police Annual and -Annual physicals -Annual physicals- Pre Employment -Pre-employment -Annual physicals Pre-Employment physicals physicals -Hazmat Testing physicals -Drug and Alcohol -Return to work -Drug testing Testing -Drug testing Name of individuals Dr. Doris Danko M.D, Dr. Doris Danko M.D, Dr. Doris Danko M.D, Dr.Doris Danko M.D, that worked on the M.A,M.P.H. M.A, M.P.H. M.A, M.P.H. MA,M.P.H. referred projects Elyana Mitchell Elyana Mitchell Elyana Mitchell Elyana Mitchell MSN,APRN MSN,APRN MSN,APRN MSN,APRN Sylvana Saintiche Sylvana Saintiche Sylvana Saintiche Sylvana Saintiche MSN,APRN MSN,APRN MSN,APRN MSN,APRN Client Project Bryan Corcoran Chief Bryan Pegues Major Manuel Arrebola Deputy Chief Manager and 305-993-7317 305-466-8995 305-757-7708 Chris Shannon contact information Ext 2608 954-746-3412 Annual contract $10,000 Plus $10,000 Plus $127,000 Plus $40,000 Plus value Contract duration Over 13 Years- Over 13 years - Over 23 years— Over 18 years- (dates covered) Present Present Present Present 7 DocuSign Envelope ID: 192DD89C-A3C5-4226-BF99-1A23E2A1F635 Mount Sinai MEDICAL CENTER Proposer's Client List (cont'd) Project Name Project Name Project Name The Client Town of Surfside Town of Bay Harbor Village of Key Biscayne Islands Police Dept. Scope of Service -Provide professional medical Provide professional medical Provide professional medical and health care services program and health care services and health care services for all Classification program program -Annual physicals -Annual physicals -Pre employment -Pre-employment physicals -Pre-Employment Physicals -Drug testing physicals --Vaccinations -Drug Testing -FMLA/Fitness for Duty -Drug testing -Hazmat testing -Drug testing DOT&Non- DOT drug testing Name of individuals Dr.Doris Danko M.D,M.A, Dr. Doris Danko M.D,M.A, Dr. Doris Danko M.D,M.A, that worked on the M.P.H. M.P.H. M.P.H. referred projects Elyana Mitchell Elyana Mitchell Elyana Mitchell MSN,APRN MSN,APRN MSN,APRN Sylvana Saintiche Sylvana Saintiche Sylvana Saintiche MSN,APRN MSN,APRN MSN,APRN Client Project Yamileth Slate-McCloud Janice Rosado Chief Marcos Osorio Manager and contact 305-861-4863 305-866-6241 305-365-8989 information Annual contract value $10,000 Plus $10,000 Plus $15,000 plus Contract duration 2012 - Present Over 18 years- Present 2009 - Present (dates covered) S DocuSign Envelope ID: 192DD89C-A3C5-4226-BF99-1A23E2A1F635 Mount Sinai Medical Center IN THIS SECTION: 71-• :,.--1 W r," co cr a 4 APPROACH W©o w � 0 0 AND Nw • zz CD w w w METHODOLOGY zo ,.., .., , ›. • 3.1 Approach and Methodology :54' E---1 • 3.2 Similar Services 6T4 pi*o a ,�/ • 3.3 Capacity of the Organization to Accommodate , 0 ../ the City's Business Volume • 3.4 Hours of Operation w • 3.5 Value Added Services o • 3.6 References CA CI) • 3.7 Addendum P4 DocuSign Envelope ID: 192DD89C-A3C5-4226-BF99-1A23E2A1F635 Mount Sinai MEDICAL CENTER TAB 3 3 . 1 APPROACH AND METHODOLOGY DocuSign Envelope ID: 192DD89C-A3C5-4226-BF99-1A23E2A1F635 Mount Sinai MEDICAL CENTER APPROACH AND METHODOLOGY A. FACILITY SERVICES AND HOURS OF OPERATION The Occupational Health Center will conduct and review laboratory results,x-rays, and other medical reports; evaluate reports and makes appropriate recommendations as needed; review special medical problems such as but not limited to contagious disease cases,return from sick leave, on-duty injuries, disability, and other medical issues as required; provide reports and medical opinions when applicable; counsel personnel and job applicants about medical conditions and findings, and refer to appropriate follow-up care,when indicated. Mount Sinai Medical Center is located at 4304 Alton Road,Miami Beach, Florida 33140. The Occupational Health Center at Mount Sinai is located on the first floor of the Samuel Jacobson Building with adjacent free parking for the City of Miami Beach employees. Hours of operations are Monday thru Friday, 7:00 a.m.to 5:00 p.m. (Hours are flexible). Drug and alcohol test services will be available(7)days a week, twenty-four(24)hours a day. The City will have the ability to schedule same day or next day appointments with the Occupational Health Center for all services if necessary. The Occupational Health Center will provide convenient parking adjacent to the Samuel Jacobson Building at no cost to applicants,employees,and the City for individuals referred. B. DESIGNATED LIAISON The Occupational Health Center will supply the City of Miami Beach with a Project Manager/primary contact,which will be Dr. Doris Danko, Director, Occupational Health, which will be assigned to address all questions and concerns of the City. Dr. Doris Danko will be available for any issues during business hours, and after hours if needed. Luz Perez, Program Billing Coordinator, Occupational Health will be the alternate contact person in the event the Project Manager is unavailable. Ms. Perez, is fully informed in all areas. All other staff providing services under this contract will be properly informed and trained on procedures, forms, changes, and requirements. Any special instructions will be communicated to all staff. 9 DocuSign Envelope ID: I92DD89C-A3C5-4226-BF99-1 A23E2A1 F635 C. LICENSED PHYSICIAN/MEDICAL REVIEW OFFICER CERTIFICATION Please look under Tab 1; Section 2-1 Organization Chart, for all personnel resumes and certifications. D. EXAMINATION RESULTS All medical evaluation results will be reported to the Human Resources Department within forty- eight(48)hours from the time the applicant and/or employee is first seen. With the assistance of the City's Information Technology Department, the Occupational Health Center will set up and utilize an electronic mail system compatible with the City. If requested by the City, all reports and other necessary communication will be utilized through this system. Occupational Health Center also offers to work with the city to provide any other electronic services. The Occupational Health Center will assure that instructions, changes, and transfer of information and documents will be only with those individuals or firms designated by the Human Resources Director. Immediate notification will be made to designated City staff of"no-shows"or any problems with an individual's cooperation or compliance. The Occupational Health Center will provide applicant deadlines for follow-up as needed,as determined by the City's policy. The Occupational Health Center is and will maintain compliance with HIPAA throughout the duration of contact. E. SUPPLY AND EQUIPMENT The designated area is comprised of: • 4 Diagnostic exam rooms: Vision, Pulmonary, Hearing and EKG testing • 4 Physical examination rooms • 2 Laboratory • 1 Drug and Alcohol testing area prepared to conduct three testing at the time. The following equipment is used to perform services: • Audiology testing booths that meets OSHA standards with testing capabilities from 500 to 8000 Hz. 10 DocuSign Envelope ID: 192DD89C-A3C5-4226-BF99-1 A23E2A1 F635 SUPPLY AND EQUIPMENT (cont') • Visual Screening instruments for visual acuity,muscle balance(horizontal and vertical phoria), depth perception, color perception, and binocular vision. • 14 and 24 plate Ishihara and 15 D-Farnsworth test for color deficiency. • Diagnostic Spirometry Testing using a Fleish-Type Pneumotachometer with computer graphics and interpretation. • Handheld non-contract tonometer for glaucoma measurements • 12 Lead EKG machines electronically connected to Board Certified Cardiologists for interpretation. • Completed phlebotomy and comprehensive services. • US DOT approved ALCOMonitor for breath alcohol testing. The Occupational Health Center has back up equipment on premises. F. MEDICAL RECORDS The Occupational Health Center will maintain health files for all City employees and/or applicants. These files will include medical records regarding injuries and accidents related to employees in accordance with all state and federal laws. Upon request of the Human Resources Director or their designee,the Occupational Health Center will provide medical records within twenty-four(24) hours of request. Medical records may only be released to the Human Resources Director, Risk Management Director, or their designee. All requests and designee's assignments must be made and accepted in writing only(e-mail is acceptable). G. PHYSICAL EXAMINATIONS FOR PRE-EMPLOYMENT AND PROMOTIONAL Based on the physical requirements of the job description provided by the City,the Occupational Health Center will conduct physical examinations and drug/alcohol testing, as required for pre- employment and promotional applicants. The results of the pre-employment and promotional physical examinations will be reported to the Human Resources Director's designee within forty-eight (48)hours from the time the applicant is first seen. The Occupational Health Center will provide capacity for up to twenty(20) appointments per day from the City. Occupational Health Center is flexible of all scheduling that is required by the City of Miami Beach. The City will have the ability to schedule same day or next day appointments for pre- employment and promotional examinations. I1 DocuSign Envelope ID: 192DD89C-A3C5-4226-BF99-1 A23E2A1 F635 PHYSICAL EXAMINATIONS FOR PRE-EMPLOYMENT AND PROMOTIONAL (cont') Tuberculosis testing will be performed using the Quantiferon—Gold Blood Test. Positive results will be handled by the Occupational Health Center Medical Director and will not be referred to the Department of Health or other facility unless agreed to in writing by the City. In any case, there will be no additional charge to the applicant for this service. Police Officer and Firefighter applicant physical examinations will include tests for heart disease,AIDS or HIV,Hepatitis, Pulmonary Tuberculosis, or Meningococcal Meningitis. Mount Sinai Medical Center, Occupational Health provides private and isolation rooms for all applications and employees providing urine specimens and provide cloth gowns for all patients. Mount Sinai Medical Center—Emergency Department 24-hours, 7 days a week(urine and alcohol collection including after hours,weekends and holidays). H. PSYCHIATRIC SERVICES The Occupational Health Center will be able upon request to conduct psychological or psychiatric consultations with general City employees as requested by the City and prepare appropriate summary and recommendation reports. The Occupational Health Center will be able upon request to review and research psychological factors relating to personnel especially public safety. The Occupational Health Center will be able upon request to conduct stress-reduction meeting with spouses of Police personnel and other employees referred by the City. I. EXPOSURE/IMMUNIZATION PROGRAM The Occupational Health Center recommends Quantiferon Blood test for Tuberculosis screening, this blood test enables one visit instead of 2 to 4 visits. If the Quantiferon—Gold Blood test is positive,a screening chest x-ray will be provided. The Occupational Health Center will administer a Tetanus Toxoid Booster Immunization for Police Officers, Firefighters, Waste Collectors and Parks personnel. This may include other occupations depending on the job specification and/or individual requirements. The Occupational Health Center will administer Hepatitis B vaccine for those City employees with a potential risk exposure to infected blood or body fluids, as determined by the City. 12 DocuSign Envelope ID: 192DD89C-A3C5-4226-BF99-1 A23E2A1 F635 EXPOSURE/IMMUNIZATION PROGRAM (cont') The Occupational Health Center will administer other vaccines that may be required such as measles,mumps and rubella vaccine, or any additional immunizations, tests, vaccines, as required by local, state, or federal requirements, or by industry recommendations or guidelines. The Occupational Health Center will administer and make available, anti-viral medications against the AIDS virus for emergency responders according to current federal guidelines. These medications will be given within two hours of a significant exposure to the AIDS virus. The City's employees will have access to the administration of anti-viral medications for the AIDS virus on a twenty-four(24) hour basis. The Occupational Health Center will administer HIV/AIDS baseline tests to sworn Fire Department employees and perform other tests requested by the City to comply with future union contracts. J. DRUG & ALCOHOL TEST PROGRAM The Occupational Health Center will conduct a Drug and Alcohol Test Program as required by local, state and federal law and regulations. This will include a certified Substance Abuse Professional (SAP), Breath Alcohol Technician(BAT) and Medical Review Officer(MRO) as defined by the U.S. Department of Transportation(DOT), Title 49 Code of Federal Regulations (CFR), Part 40. The Occupational Health Center will conduct pre-employment drug and alcohol testing on all applicants, as well as conduct promotional drug and alcohol testing to all safety sensitive applicants before they actually perform safety sensitive functions for the first time. The Occupational Health Center will conduct random testing on all City employees and the safety sensitive employees who drive vehicles that require Commercial Driver Licenses in accordance with Title 49 CFR, Part 40. The Occupational Health Center conducts all alcohol and drug tests in compliance with procedures spelled out in 49 CFR,Part 40. The Occupational Health Center will conduct post-accident drug and alcohol drug testing as determined by the City. Testing will be available twenty-four(24)hours a day,seven (7) days a week at either the Occupational Health Center or the ER. The Occupational Health Center will conduct testing on employees when the City observes behavior or appearance that is characteristic of drug use or abuse or alcohol use or misuse. 13 DocuSign Envelope ID: 192DD89C-A3C5-4226-BF99-1 A23E2A1 F635 DRUG & ALCOHOL TEST PROGRAM (cont') The Occupational Health Center will conduct return-to-duty and follow-up drug and alcohol testing for employees who violate the City's drug free workplace standards at intervals and frequently determined solely by the City. The Occupational Health Center will provide drug and alcohol testing services with licensed and certified personnel and laboratories as required by local, state, and federal law. The Occupational Health Center drug and alcohol testing services will be overseen by the Medical Review Officer (MRO). The Occupational Health Center will insure proper and documented chain of custody during and after sample collection and testing. The Occupational Health Center has appropriately private facilities to conduct these tests, including a locked, secured box for private articles and police weapons. Individuals referred to Occupational Health Center for reasonable suspicion or post-accident alcohol and/or drug testing should not have a waiting time that exceeds 30 minutes. K. FITNESS FOR DUTY AND RETURN TO WORK EVALUATIONS The Occupational Health Center will evaluate employees'ability to continue employment in their current capacity and to assess and recommend reasonable accommodation for other job opportunities for which they may be qualified. This may include a physical examination, return to work evaluation,psychological and/or psychiatric evaluation,and/or any reports to be completed as requested by the City for fitness for duty. The Occupational Health Center will complete evaluations within two (2)working days of the request and on the same day in case of an emergency. A status report and recommendations will be forwarded to the City within twenty-four(24)hours of the appointment or receipt of test results, if any. The Occupational Health Center shall assist the City in the evaluation and verification of questionable Family Medical Leave requests as needed. 14 DocuSign Envelope ID: 192DD89C-A3C5-4226-BF99-1A23E2A1 F635 L. COMMUNICATION With the assistance of the City's Information Technology Department,the Occupational Health Center(OHC) will set up and utilize an electronic mail system compatible with the City. All reports and other necessary communication will be utilized through this system. Any and all associated costs with the set up will be absorbed by the Occupational Health Center. The Occupational Health Center also offers to work with the City of Miami Beach to provide any other electronic services. The Occupational Health Center will have qualified personnel available during all business hours to supply all services including final physician sign-off for pre-employment examinations. All test results under the Scope of Services and the agreement will be communicated only to the Human Resources Director, or his/her designees. M. BILLING The Occupational Health Center will submit monthly invoices to the City designated representative reflecting fees for all exams and tests for the previous month. The Occupational Health Center will submit invoices no more than thirty(30) days after the month ends. The Occupational Health Center will include itemize pricing on all invoices,test date,type of exam conducted name of the applicant tested. N. STAFFING The Occupational Health Center will staff sufficiently to provide all services stated in the Scope of Services and the Agreement and will increase staffing when necessary to fully comply with what has been outlined in the Scope of Services. Doris J. Danko,M.D., M.A. M.P.H. Medical Director of Occupational Health Center,Medical Review Officer,Board Certified in Occupational and Preventive Medicine, SAP, and Workers Compensation. Luz Perez, Secondary Contact Person Program/Billing Coordinator Larissa Hemandez,M.D. Board Certified in Internal Medicine,Medical Doctor of Occupational Health, Medical Review Officer(MRO), and Worker's Comp. 15 DocuSign Envelope ID: 192DD89C-A3C5-4226-BF99-1 A23E2A1 F635 STAFFING (cant') Elizabeth Kury Perez,M.D. Board Certified in Internal Medicine, Medical Doctor of Occupational Health, and Worker's Comp. Christos Mihos, M.D. Board Certified Cardiologist Alfonso Tolentino, M.D. Board Certified Cardiologist Marc Umlas, M.D. Board Certified Orthopedist Chetan Rajadhyaksha, M.D. Board Certified Radiologist Steven Resnick, M.D. Board Certified Neurologist Yanko Enamorado,M.D. Board Certified Psychiatrist Sylvana Saintiche, MSN,APRN Board Certified Advance Practice Registered Nurse Certified in Medical Monitoring and Exposure Testing of Hazardous materials and Safety Issues, Mask Fitting, ADA, FMLA, and ACLS. Elyana Mitchell,MSN, APRN Board Certified Advance Practice Registered Nurse Certified in Medical Monitoring and Exposure Testing of Hazardous materials and Safety Issues, Mask Fitting,ADA, FMLA, and ACLS Patricia Wilson,LPN Clinical Supervisor, Certified DOT Drug Screening Technician, Certified Breath Alcohol Technician(BAT)/(DOT) Lourdes Campos Medical Assistant Certified DOT Drug Screening Technician, Certified Breath Alcohol Technician(BAT)/(DOT), Pulmonary Testing, Hearing/Vision Testing,EKG and Phlebotomist 16 DocuSign Envelope ID: 192DD89C-A3C5-4226-BF99-1A23E2A1 F635 STAFFING (cont') Linda Dieujuste Medical Assistant Certified DOT Drug Screening Technician, Certified Breath Alcohol Technician(BAT)/(DOT), Pulmonary Testing,Hearing/Vision Testing, EKG and Phlebotomist Gorvens Sene Medical Assistant Certified DOT Drug Screening Technician, Certified Breath Alcohol Technician (BAT)/(DOT), Pulmonary Testing,Hearing/Vision Testing,EKG and Phlebotomist Lisbeth Moharam Medical Assistant, Certified DOT Drug Screening Technician, Certified Breath Alcohol Technician(BAT)/(DOT), Pulmonary Testing, Hearing/Vision Testing, EKG and Phlebotomist Meredith R. Portee Supervisor of Scheduling, Registration, Billing and Medical Records. Linda Ivory Patient Representative Registration, Scheduling, and Medical Records Specialist. Erika Wright Patient Representative, Registration, and Scheduling. 17 DocuSign Envelope ID: 192DD89C-A3C5-4226-BF99-1A23E2A1 F635 Mount Sinai MEDICAL CENTER TAB 3 3 .2 SIMILAR SERVICES DocuSign Envelope ID: 192DD89C-A3C5-4226-BF99-1 A23E2A1 F635 Mount Sinai MEDICAL CENTER SIMILAR SERVICES Occupational Health Center at Mount Sinai Medical Center provides pre-employment and post- employment testing for the City of Miami and City of Miami Beach. The Client City of Miami Beach City of Miami Scope of Service Provide professional medical and Provide professional medical and health care services program for all health care services Classification Program for all Classification -Pre and Post-employment -Annual physicals- Pre-employment physicals physicals - Drug and alcohol testing -Return to work -DOT testing -Vaccinations - Fitness for Duty -Hazmat testing -OSHA -Drug testing DOT&Non-DOT drug - Exposures testing - Immunizations Including Police & Fire Department. -Employee Health Contract duration Over 18 years - Present 2010—Present (dates covered) 18 DocuSign Envelope ID: 192DD89C-A3C5-4226-BF99-1 A23E2A1 F635 Mount Sinai MEDICAL CENTER TAB 3 3 .3 CAPACITY OF THE ORGANIZATION TO ACCOMMODATE THE CITY' S BUSINESS VOLUME DocuSign Envelope ID: 192DD89C-A3C5-4226-BF99-1A23E2A1 F635 Mount Sinai MEDICAL CENTER CAPACITY OF THE ORGANIZATION TO ACCOMMODATE THE CITY'S BUSINESS VOLUME The Occupational Health Center has approximately 8,000 sq. ft. dedicated to the waiting area that is designed to hold a maximum capacity of 60 persons at one given time. The Occupational Health Center employs the following dedicated and qualified personnel to perform the service outlined in the contract: Project Manager and primary account representative, three board certified Medical Doctors, board certified Cardiologists, Radiologists, LPN (DOT/BAT certified),two APRNs, five Medical Assistants (DOT/BAT certified), three Patient Representatives/Reception (Registration/Scheduling/Medical Records personnel),and two Billing Specialists. The Occupational Health Center hours of operation are Monday through Friday, 7:00 a.m. to 5:00 p.m. (hours are flexible)with an Emergency Center opened 24-hours, 7 days a week for urine and alcohol collection including after hours,weekends and holidays. 19 DocuSign Envelope ID: 192DD89C-A3C5-4226-BF99-1 A23E2A1 F635 Mount Sinai MEDICAL CENTER TAB 3 3 .4 HOURS OF OPERATION DocuSign Envelope ID: 192DD89C-A3C5-4226-BF99-1 A23E2A1 F635 Mount Sinai MEDICAL CENTER HOURS OF OPERATION The Occupational Health Center operates Monday through Friday, 7:00 a.m. to 5 p.m. (Hours are flexible); Mount Sinai Medical Center MRO will conduct consultations in person, Monday- Friday between the hours of 7:00 a.m. —5 p.m.,unless otherwise requested or approved by the City. Drug and alcohol tests performed after hours in the Emergency Department 24/7,365 days a year. 20 DocuSign Envelope ID: 192DD89C-A3C5-4226-BF99-1 A23E2A1 F635 Mount Sinai MEDICAL CENTER TAB 3 3 .5 VALUE-ADDED SERVICES DocuSign Envelope ID: 192DD89C-A3C5-4226-BF99-1A23E2A1F635 Mount Sinai MEDICAL CENTER VALUE-ADDED SERVICES QuantiFERON Gold Blood Test; an alternative to traditional TB skin test. One patient visit requirement instead of 2 to 4 visits. Hep A Titer Measles,Mumps and Rubella (MMR) Titer Tetanus and Diphtheria and Pertussis (T-DAP) Vaccine Pregnancy Test Blood Alcohol CDL Physical: Review of medical history/Physician examination and consultation Urine Dipstick: specific, gravity, blood, protein and glucose Visual Exam Whisper Test Comprehensive Health Assessment Program Blood Work: Lipid Profile (Cholesterol - HDL/LDL& Triglycerides) CBC (Complete Blood Count- White/Red Blood Cells) Complete Metabolic Panel (Metabolism/Glucose/Calcium/Liver/Kidneys/Electrolytes Function) Quantiferon(TB) PSA(Prostate)(Men 40 yrs and over) TSH (Thyroid Stimulating Hormone Level) CT Calcium Score Cardiac Screening Echocardiogram Ultra Sound- Carotid/Aorta EKG Cancer Screening—Ultra Sound Liver/Kidneys/Pancreas Preferred pricing is available to you for any additional services you may request. Under this agreement: • A Board certified Cardiologist will read all Echocardiograms and EKGs. • A Board certified Radiologists will read all Ultrasounds. • Dependents may get the same benefit to be paid out of pocket at the time of service. • The agreed price includes all the services, studies and labs listed above. 21 DocuSign Envelope ID: 192DD89C-A3C5-4226-BF99-1A23E2A1 F635 Mount Sinai MEDICAL CENTER TAB 3 3 .6 REFERENCES DocuSign Envelope ID: 192DD89C-A3C5-4226-BF99-1A23E2A1 F635 LTitg uf 41lianzi • . ,,,,,,..„;•.. .,.4...." Ts'. • 11118 . ARTHUR NORIEGA,V iii e City Manager c March 9, 2020 To Whom It May Concern: RE: Vender Reference—Mount Sinai Medical Center This is in response to your request for a letter of recommendation for Mount Sinai which has been the City of Miami's vender since 2010 for Physical Examinations (i.e., pre-employment/annual physical. return to duty and fitness for duty), Drug and Alcohol Screening Services (i.e., pre- employment/annual DOT/CDL, follow up,and random and suspicion. My name is Esther Farmer, Police Major. My experience with the staff has been of excellent standard and professionalism.As far as a vender to do business with,the Miami Police Department is pleased with their service.Mount Sinai's staff arc friendly and professional, and we are pleased with their work product. Mount Sinai staff are easy to work with and has always made themselves available to us as needed;any customer should be very pleased to be the one that selects them do business with. If you would like further elaboration, feel free to call me at(305)300-6101. Sincerely, :/t.Z.....„._ Major Esther Farmer F1 rr. Acto), :RIGHTS r. _i MIAMI P011(7 1)1 I'.\RTM1-NTil'.C) BM 016777/.Miami,rlurid, t I lnl :I V THING:, aot ntrltt fi . .„ we..r.,,ys..a I .m...I Arlrires:r hi,9oinolicro n,idmi!milke.org DocuSign Envelope ID: 192DD89C-A3C5-4226-BF99-1 A23E2A1 F635 `t,opoADE CpLy, Miami-Dade Count Public Schools giving our students the world Superintendent of Schools Miami-Dade County School Board Alberto M. Carvalho Perla Tabares Hantman, Chair Dr Steve Gallon Ill, Vice Chair Dr.Dorothy Bendross-Mindingall Susie V Castillo Dr Lawrence S.Feldman Dr. Martin Karp Dr.Lubby Navarro Dr Marta Perez Mari Tere Rojas March 6, 2020 To Whom It May Concern: Mount Sinai Medical Center has been a vendor for Miami-Dade Schools Police Department for over 23 years. We provide annual and pre-employment physicals, return to work and drug testing. Our department has been quite pleased with both the administration and quality of service performed by the staff of Mount Sinai Occupational Health. I would recommend Mount Sinai Medical Center's Occupational Health Facility to any employer considering a relationship with a medical service provider that ensures convenient, quality customer service and clear concise communication. If you have any further questions regarding the services provided to Miami-Dade Schools Police Department by Mount Sinai Medical Center Occupational Health, please free to contact me, Major Manuel J. Arrebola at 305-757-7708 extension 2608. Sincerely, Manuel J. Arrebola, Major Miami-Dade Schools Police Department 3300 N.W. 27th Avenue Miami, FL 33142 Miami-Dade Schools Police Department• 3300 N.E. 27th Avenue• Miami, FL 33142 305-636-5640• www.mdspolice.corn DocuSign Envelope ID: 192DD89C-A3C5-4226-BF99-1A23E2A1 F635 BA l_ I-IARB () UR VILLAGE - February 25,2020 To Whom It May Concern: RE: Vendor Reference—Mount Sinai Medical Center This is in response to your request for a letter of recommendation for Mount Sinai which has been with the Village of Bal Harbour over the past several past years.We have utilized the services of Mount Sinai Medical Center for the City's medical and health needs.The scope of services includes: pre-employment drug screening/physical exams,OSHA's respiratory evaluation,and immunization needs. Bal Harbour Village Hall is located in Miami Dade County, Florida and our address is 655 96th Street, Bal Harbour, FL 33154. My name is Bryan Corcoran and I am the Management Analyst for the Village. If I can be of further assistance, I can be reached at my office, 305-993-7317. Thank you. Sincerely, Bryan Corcoran DocuSign Envelope ID: 192DD89C-A3C5-4226-BF99-1A23E2A1 F635 BAMR • March 4, 2020 Town Council To Whom It May Concern: Stephanie Bruder Mayor Joshua D. Fuller Please accept this letter from the Town of Bay Harbor Islands based on the professional Vice Mayor association over the past several years with Mount Sinai Medical Center Occupational Health Jordon W. Leonard Department. Council Member The Town of Bay Harbor Islands is located in Miami Dade County, Florida and our address is Kelly Reid 9665 Bay Harbor Terrace, Bay Harbor Islands,FL 33154. My name is Janice Rosado; I am the Council Member Human Resources Manager. Isaac Salver Council Member We have utilized the services of Mount Sinai Medical Center for a minimum of the past eighteen years for the Town's medical and health needs.The scope of services includes: pre- Elizabeth Tncoche employment drug screening/physical exams,worker's compensation injury evaluation,and Council Member immunization needs. My experience with the staff has been of excellent standard and Robert Yaffe professionalism. Council Member If I can be of further assistance, I can be reached at my office, 305-866-6241. Town Officials J.C.Jimenez Thank you— Town Manager Valk Marlene M. Siegel Je'ice 'osado Town Clerk HR Manager Frank C. Simone Town Attorney MAYOR JOSEPH J. GARDNER GOVERNMENT CENTER DocuSign Envelope ID: 192DD89C-A3C5-4226-BF99-1 A23E2A1 F635 Mount Sinai MEDICAL CENTER TAB 3 3 .7 ADDENDUM DocuSign Envelope ID: 192DD89C-A3C5-4226-BF99-1A23E2A1 F635 MIAMI BEACH PROCUREMENT DEPARTMENT 1755 Meridian Avenue,3'd Floor Miami Beach,Florida 33139 www.miamibeachfl.gov ADDENDUM NO. 1 REQUEST FOR INFORMATION (RFI) 2020-144-JC FOR MEDICAL SERVICES FOR PRE AND POST-EMPLOYMENT SERVICES March 13, 2020 This Addendum to the above-referenced RFI is issued in response to questions from prospective proposers, or other clarifications and revisions issued by the City.The RFI is amended in the following particulars only(deletions are shown by strikethrough and additions are underlined). I. RFI DUE DATE AND TIME. The deadline for the receipt of proposals is extended until 3:00 p.m., on Friday,April 3,2020. City of Miami Beach Procurement Department 1755 Meridian Ave, 3rd Floor Miami Beach, FL 33139. Late proposals will not be accepted. Proposers are cautioned to plan sufficient time to allow for traffic or other delays,for which the Proposer is solely responsible. Any questions regarding this Addendum should be submitted in writing to the Procurement Department to the attention of the individual named below, with a copy to the City Clerk's Office at RafaelGranado@miamibeachfl.gov Procurement Contact: Telephone: i Email: Jason Crouch 305-673-7000, ext.26694 j JasonCrouch@miamibeachfl.gov Propo s are reminded to acknowledge receipt of this addendum as part of your RFI submission. Si er ly ik..._\ Ale enis �/c Pr cure - Director I ADDENDUM NO. 1 RFI 2020-144-JC DocuSign Envelope ID: 192DD89C-A3C5-4226-BF99-1A23E2A1F635 PROCUREMENT DEPARTMENT M I AMI BE1755ACH Avenue, 3r0 Floor Miami Beach,Florida 33139 www.miamibeachfl.gov ADDENDUM NO. 2 REQUEST FOR INFORMATION (RFI) 2020-144-JC FOR MEDICAL SERVICES FOR PRE AND POST-EMPLOYMENT SERVICES March 27, 2020 This Addendum to the above-referenced RFI is issued in response to questions from prospective proposers, or other clarifications and revisions issued by the City.The RFI is amended in the following particulars only(deletions are shown by strikethrough and additions are underlined). I. RFI DUE DATE AND TIME. The deadline for the receipt of proposals is extended until 3:00 p.m., on Friday,April 17, 2020. City of Miami Beach Procurement Department 1755 Meridian Ave, 3rd Floor Miami Beach, FL 33139. Late proposals will not be accepted. Proposers are cautioned to plan sufficient time to allow for traffic or other delays, for which the Proposer is solely responsible. Any questions regarding this Addendum should be submitted in writing to the Procurement Department to the attention of the individual named below,with a copy to the City Clerk's Office at RafaelGranado@miamibeachfl.gov Procurement Contact: Telephone: Email: Jason Crouch 305-673-7000, ext 26694 JasonCrouch@miamibeachfl.gov Proposers are reminded to acknowledge receipt of this addendum as part of your RFI submission. c Aly, lex Deni rocure Director DocuSign Envelope ID: 192DD89C-A3C5-4226-BF99-1A23E2A1F635 PROCUREMENT DEPARTMENT M I AM I B EACH 1755 Meridian Avenue,T tl Floor Miami Beach, Florida 33139 www.miamibeachfl.gov ADDENDUM NO. 3 REQUEST FOR INFORMATION (RFI) 2020-144-JC FOR MEDICAL SERVICES FOR PRE AND POST-EMPLOYMENT SERVICES March 31, 2020 This Addendum to the above-referenced RFI is issued in response to questions from prospective proposers. or other clarifications and revisions issued by the City. The RFI is amended in the following particulars only(deletions are shown by strikethrough and additions are underlined). I. RFI DUE DATE AND TIME. The deadline for the receipt of proposals is extended until 3:00 p.m., on Friday, May 8, 2020. City of Miami Beach Procurement Department 1755 Meridian Ave, 3rd Floor Miami Beach, FL 33139. Late proposals will not be accepted. Proposers are cautioned to plan sufficient time to allow for traffic or other delays, for which the Proposer is solely responsible. Any questions regarding this Addendum should be submitted in writing to the Procurement Department to the attention of the individual named below, with a copy to the City Clerk's Office at RafaelGranado@miamibeachfl.gov Procurement Contact: Telephone: Email: Jason Crouch 305-673-7000, ext.26694 JasonCrouch@miamibeachfl.gov Proposers are reminded to acknowledge receipt of this addendum as part of your RFI submission. 8±i erely, Alex Denis Procurem n Director DocuSign Envelope ID: 192DD89C-A3C5-4226-BF99-1A23E2A1F635 PROCUREMENT DEPARTMENT MIAMI B EAC H 1755 Meridian Avenue,3rd Floor Miami Beach,Florida 33139 www.miamibeachfl.gov ADDENDUM NO. 4 REQUEST FOR INFORMATION (RFI) 2020-144-JC FOR MEDICAL SERVICES FOR PRE AND POST-EMPLOYMENT SERVICES April 22, 2020 This Addendum to the above-referenced RFI is issued in response to questions from prospective proposers, or other clarifications and revisions issued by the City. The RFI is amended in the following particulars only(deletions are shown by strikethrough and additions are underlined). I. RFI DUE DATE AND TIME. The deadline for the receipt of proposals is extended until 3:00 p.m., on Friday, May 29, 2020. City of Miami Beach Procurement Department 1755 Meridian Ave, 3rd Floor Miami Beach, FL 33139. Late proposals will not be accepted. Proposers are cautioned to plan sufficient time to allow for traffic or other delays, for which the Proposer is solely responsible. Any questions regarding this Addendum should be submitted in writing to the Procurement Department to the attention of the individual named below, with a copy to the City Clerk's Office at RafaelGranado@miamibeachfl.gov Procurement Contact: Telephone: Email: Jason Crouch 305-673-7000, ext.26694 _ JasonCrouch@miamibeachfl.gov Proposers are reminded to acknowledge receipt of this addendum as part of your RFI submission. i erely, Alex Denis Procurem n Director DocuSign Envelope ID: 192DD89C-A3C5-4226-BF99-1A23E2A1F635 DEPARTMENT I\/\ I A M I B E/\C I-IPROCUREMENT 1755 Meridian Avenue, 3'0 Floor Miami Beach,Florida 33139 www.miamibeachfl.gov ADDENDUM NO. 5 REQUEST FOR INFORMATION (RFI) 2020-144-JC FOR MEDICAL SERVICES FOR PRE AND POST-EMPLOYMENT SERVICES May 21, 2020 This Addendum to the above-referenced RFI is issued in response to questions from prospective proposers, or other clarifications and revisions issued by the City. The RFI is amended in the following particulars only(deletions are shown by strikethrough and additions are underlined). IMPORTANT NOTICE The City of Miami Beach in order to comply with the Centers for Disease Control (CDC) requirements, pursuant to COVID-19. will until further notice, only accept electronic RFI submittals. Therefore, all RFI responses must be submitted via email,with a corresponding PDF attachment containing the proposal item(s), to Jason Crouch,jasoncrouch o(�miamibeachfl.gov , prior to 3:0.0 PM, Friday, June 5,2020. RFI responses will not be accepted in-person or via BidSync. I. RFI DUE DATE AND TIME. The deadline for the receipt of proposals is extended until 3:00 p.m., on Friday, June 5, 2020. City-of-Miami Beast Procurement Department Miami Beach, FL 33139. Late proposals will not be accepted. Proposers are cautioned to plan sufficient time to allow for email delivery of the proposal documents traffic or other delays, for which the Proposer is solely responsible. A forthcomin• addendum will be issued to BidS nc with res•onses to all •uestions received. Any questions regarding this Addendum should be submitted in writing to the Procurement Department to the attention of the individual named below, with a copy to the City Clerk's Office at RafaelGranado@miamibeachfl.gov Procurement Contact: Telephone: Email: Jason Crouch 305-673-7000, ext.26694 JasonCrouch@miamibeachfl.gov Proposers are reminded to acknowledge receipt of this addendum as part of your RFI submission. :)2± i erely, Alex Denis Procurem n Director DocuSign Envelope ID: 192DD89C-A3C5-4226-BF99-1 A23E2A1 F635 PROCUREMENT DEPARTMENT MIAMI B E AC H 1755 Meridian Avenue. 3'd Floor Miami Beach,Florida 33139 www.miamibeachfl.gov ADDENDUM NO. 6 REQUEST FOR INFORMATION (RFI) 2020-144-JC FOR MEDICAL SERVICES FOR PRE AND POST-EMPLOYMENT SERVICES May 29, 2020 This Addendum to the above-referenced RFI is issued in response to questions from prospective proposers, or other clarifications and revisions issued by the City. The RFI is amended in the following particulars only(deletions are shown by strikethrough and additions are underlined). IMPORTANT NOTICE The City of Miami Beach in order to comply with the Centers for Disease Control (CDC) requirements, pursuant to COVID-19, will until further notice, only accept electronic RFI submittals. Therefore, all RFI responses must be submitted via email, with a corresponding PDF attachment containing the proposal item(s), to Jason Crouch, jasoncrouch anmiamibeachfl.gov , prior to 3:00 PM, Friday, June 19, 2020. RFI responses will not be accepted in-person or via BidSync. I. RFI DUE DATE AND TIME. The deadline for the receipt of proposals is extended until 3:00 p.m., on Friday, June 19, 2020. Late proposals will not be accepted. Proposers are cautioned to plan sufficient time to allow for email delivery of the proposal documents traffic or other delays, for which the Proposer is solely responsible. A forthcomin• addendum will be issued to BidS nc with responses to all •uestions received. Any questions regarding this Addendum should be submitted in writing to the Procurement Department to the attention of the individual named below, with a copy to the City Clerk's Office at RafaelGranado@miamibeachfl.gov Procurement Contact: Telephone: Email: Jason Crouch 305-673-7000, ext.26694 JasonCrouch@miamibeachfl.gov Proposers are reminded to acknowledge receipt of this addendum as part of your RFI submission. Sincerely, Alex Denis Procurement Director DocuSign Envelope ID: 192DD89C-A3C5-4226-BF99-1A23E2A1F635 PROCUREMENT DEPARTMENT f\/\ I A M I B E AC H 1755 Meridian Avenue,3�d Floor Miami Beach,Florida 33139 www.miamibeachfl.gov ADDENDUM NO. 7 REQUEST FOR INFORMATION (RFI) 2020-144-JC FOR MEDICAL SERVICES FOR PRE AND POST-EMPLOYMENT SERVICES June 5, 2020 This Addendum to the above-referenced RFI is issued in response to questions from prospective proposers, or other clarifications and revisions issued by the City. The RFI is amended in the following particulars only (deletions are shown by strikethrough and additions are underlined). I. ATTACHMENT(S) Exhibit A: FY19 Testing Volume II. RESPONSES TO QUESTIONS RECEIVED. Q1: We did not see the pages where we can enter the fees for the services? Al: Please provide your fees on a separate document attached to your RFI response. Format should be in PDF or Excel. 02: Pertaining hallucinogen of any kind will this be included for every employee that needs lab work?Please specify who will be tested? A2: All employees, except Police and Fire. Q3: For hallucinogens, beside Phencyclidine (aka angel dust); do you want to include the more rarely abused? Ketamine (aka special K), LSD, Mescaline (peyote,mushrooms), Dimthyltryptamine, Belladonna alkaloids, Dextromethorphan (aka red devils); Salvia Divinorum(aka: ska)? A3: Yes. Q4: Do you want an EKG for pre-employment police and firefighter? A4: All sworn police and fire staff. Q5: What departments are currently being tested? A5: Testing is done for multiple departments depending on the issue and language in collective bargaining agreements. For instance, post-accident drug and alcohol testing is required of all employees after a vehicle accident, except police&fire. I 1 ADDENDUM NO.7 REQUEST FOR INFORMATION(RFI)2020-144-JC FOR MEDICAL SERVICES FOR PRE AND POST-EMPLOYMENT SERVICES DocuSign Envelope ID: 192DD89C-A3C5-4226-BF99-1 A23E2A1 F635 Q6 What services and what expectations do you have regarding"mobile services"? A6: Mobile services for post-accident drug testing and random drug testing as an option. Q7: How many employees does the City of Miami Beach have? A7: 2,279. Q8:Comprehensive HIV/AIDS(currently not part of NFPA guidelines,but is it preferred because of pension protocol)? A8: HIV/AIDS testing is preferred. Testing is required if a first responder or field worker has been exposed to a positive individual. Q9: Comprehensive Hepatitis B and C titer(Hep B antibody quantitative) (Hepatitis C testing-preferred because of pension protocol)? A9: Standard medically accepted tests that fail to indicate the presence of Hep B and C is required. Q10:Nasal Swab Culture(Why a nasal swab culture? Need more information to when this would completed. This is not a common test for our standards.) A10: Nasal Swab Culture is not required. Q11: Hema Cult(Confirming if this is 40 years and over or part of a sperate fitness test) rectal for colon cancer? Al1: Confirmed this test is for 40 years and older as part of a fitness exam, not pre-employment physical. Q12:Visual Exam, (Confirming complexity of vision testing-acuity+depth+color+visual fields)? Al2: Yes, use NFP Guidelines and California Standard. Q13:Glaucoma Screen(Is this being completed with a tonometer and can you confirm over 40 years old)? A13:Glaucoma screening for Police and Fire over the age of 40. Q14:Tuberculin Skin Test(1 step of 2 step,do we need to do blood testing)? A14: Would prefer Interferon Gamma Release Assay Testing(IGRA)instead of TB Skin test. Either of the two FDA approved IGRA tests are acceptable(QuantiFeron®-TB Gold In-Tube and T-Spot®). Q15:OSHA compliant PA and LAT(assuming this is done if medically indicated)? A15: Not aware of any OSHA testing that is required. Q16:Chest X-ray with Cardiologic Interpretation(There is no difference here from the chest Xray 2 view,need clarity)? A16: Chest X-ray to show if lungs are clear, evidence of fluid or consolidation, placement of trachea and mediastinum,the condition of bony thorax and diaphragm. a ADDENDUM NO.7 REQUEST FOR INFORMATION(RFI)2020-144-JC FOR MEDICAL SERVICES FOR PRE AND POST-EMPLOYMENT SERVICES DocuSign Envelope ID: 192DD89C-A3C5-4226-BF99-1 A23E2A1 F635 Q17:Tetanus Toxoid Booster(We normally recommend TDAP instead of Tetanus only,would this be ok)? A17: Prefer the TDAP instead of Tetanus only. Q18:Anti-viral medication for HIV/AIDS exposure (Do we need to carry a 3-day supply) (this is reserved for post exposure prophylaxis,when would this be administered assuming if medically appropriate?) A18:A 3-day supply should be available to administer for post exposure cases of first responders or field workers. Q19:Would you please provide an approximate number of physicals expected to be requested by the city on a monthly basis? A19:We had an average of 438 physicals in 2019(including police and fire). Q20:Item G -We have the ability to facilitate on-site physicals. Would our bid be disqualified if we do not have a "mobile unit"? A20: No. Any questions regarding this Addendum should be submitted in writing to the Procurement Department to the attention of the individual named below: Procurement Contact: Telephone: Email: Jason Crouch 305-673-7000,ext.26694 JasonCrouch@miamibeachfl.gov Proposers are reminded to acknowledge receipt of this addendum as part of your RFI submission. Sincerely Ale enis Procurement Director 3 ADDENDUM NO.7 REQUEST FOR INFORMATION(RFI)2020-144-JC FOR MEDICAL SERVICES FOR PRE AND POST-EMPLOYMENT SERVICES DocuSign Envelope ID: 192DD89C-A3C5-4226-BF99-1A23E2A1 F635 Exhibit A: FY19 Testing Volume 4 I AEN7 REQDDUEST DUM FORNO INFORMATION(RFI)2020-144-JC FOR MEDICAL SERVICES FOR PRE AND POST-EMPLOYMENT SERVICES DocuSign Envelope ID: 192DD89C-A3C5-4226-BF99-1A23E2A1 F635 The City's responses are bolded and underlined below. a. Standard Pre-Employment Physical including: 363 conducted 1. Review of medical history/physical examination and consultation 2. Breath Alcohol Test 3. Urine Drug Screen—12 Panel 4. Hearing Screen/Whisper 5. Vision Screen 6. Tuberculin Skin Test b. Police, Firefighter Pre-Employment Physical including:75 conducted 1. Review of medical history/physical examination and consultation 2. Breath Alcohol Test 3. Urine Drug Screen 12-Panel(test panels include Amphetamines, Barbiturates, Benzodiazepines,Cocaine Metabolites, Methaqualone, Hallucinogens of any kind, Marijuana Metabolites, Methadone, Methaqualone, Methylenedioxyamphetamine (MDA) Analogues,Opiates, Phencyclidine, Methadone, and Propoxyphene.) 4. Comprehensive Blood Cell counts 5. Comprehensive Blood Chemistries 6. Comprehensive Lipid Panel 7. Comprehensive HIV/AIDS 8. Comprehensive Hepatitis B and C titer 9. Comprehensive Urinalysis 10. Nasal Swab Culture 11. Hem Cult(40 years and over) 12. Visual Exam, (acuity+depth+color+visual fields) 13. Glaucoma Screen (40 years and older) 14. Comprehensive Pulmonary Function Test 5 ADDENDUM NO.7 REQUEST FOR INFORMATION(RFI)2020-144-JC FOR MEDICAL SERVICES FOR PRE AND POST-EMPLOYMENT SERVICES DocuSign Envelope ID: 192DD89C-A3C5-4226-BF99-1 A23E2A1 F635 15. Tuberculin Skin Test 16. OSHA compliant PA and LAT(if medically indicated) 17. Chest X-ray with Cardiologic Interpretation c. Immunization Services to include:350 conducted 1. Tetanus Toxoid Booster 2. Hepatitis B Vaccination(complete series of 3) 3. Hepatitis A&B Vaccination(complete series of 3) 4. Measles, Mumps and Rubella 5. Anti-viral medication for HIV/AIDS exposure(3-day supply) d. EKG (5)EKG to be conducted on all sworn police and fire personnel e. Random, Reasonable Suspicion, Return to Work and Post-Accident Drug and Alcohol Testing Including Consultation with the Medical Review Officer and Evaluation by the Substance Abuse Professional Pursuant to DOT Requirements 750 conducted f. Respirator Review and Clearance 5 conducted g. Mobile Unit 4 conducted 6 ADDENDUM NO.7 REQUEST FOR INFORMATION(RFI)2020-144-JC FOR MEDICAL SERVICES FOR PRE AND POST-EMPLOYMENT SERVICES DocuSign Envelope ID: 192DD89C-A3C5-4226-BF99-1A23E2A1F635 PROCUREMENT DEPARTMENT MIAMI BEACH 1755 Meridian Avenue,3rd Floor Miami Beach,Florida 33139 www.miamibeachfl.gov ADDENDUM NO. 8 REQUEST FOR INFORMATION (RFI) 2020-144-JC FOR MEDICAL SERVICES FOR PRE AND POST-EMPLOYMENT SERVICES June 17, 2020 This Addendum to the above-referenced RFI is issued in response to questions from prospective proposers, or other clarifications and revisions issued by the City. The RFI is amended in the following particulars only(deletions are shown by strikethrough and additions are underlined). IMPORTANT NOTICE The City of Miami Beach in order to comply with the Centers for Disease Control (CDC) requirements, pursuant to COVID-19, will until further notice, only accept electronic RFI submittals. Therefore, all RFI responses must be submitted via email,with a corresponding PDF attachment containing the proposal item(s), to Jason Crouch, jasoncrouch(a,miamibeachfl.gov , prior to 3:00 PM, Friday, June 26, 2020. RFI responses will not be accepted in-person or via BidSync. I. RFI DUE DATE AND TIME. The deadline for the receipt of proposals is extended until 3:00 p.m., on Friday, June 26, 2020. Late proposals will not be accepted. Proposers are cautioned to plan sufficient time to allow for email delivery of the proposal documents traffic or other delays, for which the Proposer is solely responsible. A forthcomin• addendum will be issued to BidS nc with res•onses to all •uestions received. Any questions regarding this Addendum should be submitted in writing to the Procurement Department to the attention of the individual named below, with a copy to the City Clerk's Office at RafaelGranado@miamibeachfl.gov Procurement Contact: Telephone: Email: Jason Crouch 305-673-7000, ext.26694 JasonCrouch(a miamibeachfl.gov Proposers are reminded to acknowledge receipt of this addendum as part of your RFI submission. Si cera ly, le Denis l 1 'rocureme- I rector DocuSign Envelope ID: 192DD89C-A3C5-4226-BF99-1A23E2A1 F635 PROCUREMENT DEPARTMENT M I AM I B EACH 1755 Meridian Avenue,3 d Floor Miami Beach, Florida 33139 www.miamibeachfl.gov ADDENDUM NO. 9 REQUEST FOR INFORMATION (RFI) 2020-144-JC FOR MEDICAL SERVICES FOR PRE AND POST-EMPLOYMENT SERVICES June 25, 2020 This Addendum to the above-referenced RFI is issued in response to questions from prospective proposers, or other clarifications and revisions issued by the City. The RFI is amended in the following particulars only (deletions are shown by strikethrough and additions are underlined). I. MODIFICATIONS. RFI DUE DATE AND TIME. The deadline for the receipt of proposals is extended until 3:00 p.m., on Thursday,July 2,2020. II. RESPONSES TO QUESTIONS RECEIVED. Q1: I have a question regarding the Addendum 7. On question#2,the question was who was going to be tested for the hallucinogen. The answer was"All employees. except Police and Fire", now on page 5 of the addendum. point "b" Police Firefighter Pre-Employment,#3, all the hallucinogen tests are listed. Is this an error?Please clarify. Al Drugs that Police and Fire are tested for: 1. Amphetamine, 2. Barbiturates, 3. Benzodiazepines, 4. Cocaine Metabolites, 5. Marijuana Metabolites, 6. Methadone, 7. Methaqualone, 8. Methylenedioxyamphetamine(MDA)Analogues, 9.Opiates, 10. Phencyclidine, and 11. Propoxyphene. Q2: The Pre-Employment Physical for Police and Firefighter includes the drug test. Do you want that to change? A2: No. THE DEADLINE FOR QUESTIONS HAS PASSED AND NO FURTHER QUESTIONS WILL BE CONSIDERED. Any questions regarding this Addendum should be submitted in writing to the Procurement Department to the attention of the individual named below: Procurement Contact: Telephone: Email: Jason Crouch 305-673-7000, ext.26694 JasonCrouch@miamibeachfl.gov Proposers are reminded to acknowledge receipt of this addendum as part of your RFI submission. -rely, r 11 s /lex roc ent Director i ADDENDUM NO.9 REQUEST FOR INFORMATION(RFI)2020-144-JC FOR MEDICAL SERVICES FOR PRE AND POST-EMPLOYMENT SERVICES DocuSign Envelope ID: 192DD89C-A3C5-4226-BF99-1A23E2A1 F635 Mount Sinai Medical Center IN THIS SECTION: FEES FOR N 0 MEDICAL w N z • z SERVICES & H 0 w VALUEADDED4, ap SERVICES z o -4w ATTACHMENT w A c � w O � 4) DocuSign Envelope ID: 192DD89C-A3C5-4226-BF99-1A23E2A1F635 Mount Sinai MEDICAL CENTER TAB 4 ATTACHMENT A FEES FOR MEDICAL SERVICES & VALUE ADDED SERVICES 0 0 MEDICAL SERVICES FOR PRE AND POST-EMPLOYMENT SERVICES FEES cn RFI 2020-144-JC Description Unit Price Standard Pre-Employment Physical Including: $ 115.00 Review of medical history/Physician examination and consultation Breath Alcohol Test Urine Drug Screen - 12 Panel (Amphetamines, Barbiturates, Benzodaizepines, Cocaine Metabolites, Methaqualone, D Hallucinogens of any kind, Marijuana Metabolites, Methadone, Methylenedioxyamphetamine Analogues (MDA), Opiates, N Phencyclidine, and Propoxyphene.) Hearing Screen/Whisper OJ Vision Screen QuantiFeron -TB Gold Test (Tuberculosis test) N Description Unit Price W Police, Firefighter Pre-Employment Physical Including: $ 285.00 Review of medical history/Physician examination and consultation Breath Alcohol Test Urine Drug Screen - 12 Panel (Amphetamines, Barbiturates, Benzodaizepines, Cocaine Metabolites, Methaqualone, Hallucinogens of any kind, Marijuana Metabolites, Methadone, Methylenedioxyamphetamine Analogues (MDA), Opiates, Phencyclidine, and Propoxyphene.) Comprehensive Blood Cell Counts Comprehensive Blood Chemistry Comprehensive Lipid Panel Comprehensive Urinalysis HIV/AIDS - Elisa TestNVestern Bolt Hepatitis B Titer Hepatitis C Titer Hem Cult (40 years & older) Visual Exam (NFP Guidelines & California Standards) Glaucoma (40 years and older) Comprehensive Pulmonary Function Test Quantiferon _ TB Gold Test (Tuberculosis test) OSHA Compliant PA and LAT (If medically indicated) Chest PA & LAT with Radiologist Interpretation Electrocardiogram (EKG) 0 0 0 c 0 m C) Description Unit Price Immunization Services o Tdap (Tetanus, Diptheria, Pertussis) $ 40.00 0 Hepatitis B Vaccine (series of 3) $ 140.00 Hepatitis A&B Vaccine (series of 3) $ 335.00 Measles, Mumps and Rubella (MMR) $ 90.00 A Anti Viral Medication for HIV/AIDS (1 day supply) $ 75.00 co Description I Unit Price Additional Services Stress Test $ 265.00 Electrocardiogram (EKG) $ 40.00 Chest PA & LAT with Radiologist Interpretation $ 40.00 Fitness for Duty Evaluations $ 135.00 Psychiatric Services $ 185.00 Drug/Alcohol Testing for Random, Reasonable Suspicion, Return to work and Post-Accident and Alcohol Testing Including Consultation with Medical Review Officer and Evaluation by the Substance Abuse Professional Pursuant to DOT requirements. $ 40.00 Respirator Review and Clearance $ 65.00 On-Site Tech (Nurse or Physician Assistant) $ 65.00 After Hours Medical Personnel $ 160.00 After Hours Drug/Alcohol Testing Tech $ 30.00 Drug Testing for Phencyclidedine, Ketamine, LSD, Mescaline, Dinthyltryptamine, Belladonna Price as Incurred alkaloids, Dextromethorphan, and Salvia Divinorum. Mobile Unit (VAN) $ 900.00 0 0 C, m 0 m 0 0 m Value Added Services by Proposer Description Unit Price CDL Physical $ 143.85 9 Review of medical history/Physician examination and consultation o Urine Dipstick: specific, gravity, blood, protein and glucose Visual Exam Whisper Test Blood Alcohol $ 26.25 Pregnancy Test $ 20.00 Tetanus and Diphtheria and Pertussis (T-dap) Vaccine $ 40.00 Hep A Titter $ 33.60 QuantiFeron Blood Test (Tuberculosis test) $ 45.00 An alternative to traditional TB skin test. One patient visit requirement; instead of 2 to 4 visits. Measles, Mumps and Rubella (MMR) $ 50.00 Workers' Compensantion Services Available DocuSign Envelope ID: 192DD89C-A3C5-4226-BF99-1A23E2A1F635 Mount Sinai Medical Center IN THIS SECTION: ATTACHMENT B CURRICULUM w VITAE/RESUME, CERTIFICATES, LICENSES OF d- MOUNT SINAI MEDICAL w CENTER PERSONNEL o x � N O Cl w w ATTACHMENT C SUBCONTRACTOR'S w CURRICULUM OVITAE/RESUME, CERTIFICATES , LICENSES a) v (QUEST DIAGNOSTIC) ATTACHMENT D LOCAL BUSINESS TAX RECEIPT DocuSign Envelope ID: 192DD89C-A3C5-4226-BF99-1A23E2A1 F635 Mount Sinai MEDICAL CENTER TAB 5 ATTACHMENT B Curriculum Vitae/Resume, Certificates, Licenses of Mount Sinai Medical Center Personnel DocuSign Envelope ID: I92DD89C-A3C5-4226-BF99-1 A23E2A1 F635 DORIS J. DANKO MD, MA, MPH Page one 6799 Collins Ave S—310, Miami Beach, Florida 33141 cell: (201) 835-8689 e-mail: dorisdanko@yahoo.com ,doris.danko@msmc.com, CAS_HML@yahoo.com SUMMARY: Physician, Board Certified in Occupational and Preventive Medicine, and Ophthalmology(Germany), licensed to practice Medicine in Florida, New Jersey, Michigan, and Pennsylvania. Employment: Mount Sinai Medical Center : Medical Director, Employee Health/ 1/2016-Present OccHealth Dept,4304 Alton Rd, Samuel Jacobson BLDG, Miami Beach 33141 Care Spot: Full Time Physician 9/2014- 12/2016 7751 Kingspoint Pkwy, Orlando, Florida 32819 Barnabas Health : Medical Director 3/2012- 9/2014 Corporate Care/Employee Health Dept Clara Maass Medical Center One Clara Maass Drive, Belleveille NJ 07109 Concentra ; Center Medical Director 11/2011-3/2012 283 Piaget Ave., Clifton NJ Merck Corporation Director of Employee Health Services 11/09-11/2011 Summit,New Jersey (Schering merged with Merck 11/2009) Schering-Plough Corporation Director of Employee Health Services 6/2000 - 11/2009 Summit, Kenilworth and Lafayette in New Jersey. *First Med Urgent Care/Surgery Center,Northvale,New Jersey 2/99-4/05 Practiced Clinical and Occupational Medicine. *BASF Practice of Occupational Medicine in 2/99-6/03 the Employee Health Department at Mt. Olive,New Jersey *Bergan Medical Center, Practice of Occupational Medicine 8/97-8/99 and Clinical Medicine in Paramus,New Jersey New Jersey State Fire Fighters and Department of Transportation 3/99-4/00 *Omni-Med Urgent Care Center Florham Park, New Jersey 8/97-3/99 Provided patient care in a community setting. DocuSign Envelope ID: 192DD89C-A3C5-4226-BF99-1A23E2A1 F635 Doris Danko Residency: Resident-Occupational Medicine 7/01-6/02 Hospital of the University of Penn,Philadelphia,Pennsylvania Resident-Emergency Medicine 7/94- 6/96 Morristown Memorial Hospital,Morristown,New Jersey Resident- Internal Medicine 3/93 - 6/94 St. Barnabas Medical Center, Livingston,New Jersey Resident/Board Certification/Ophthalmology 10/86- 10/90 Eye Clinic of the City Hospital of Pforzheim,Pforzheim, Germany (*)contract physician States Licensed to Practice Medicine: • Pennsylvania State Medical license: #MD 442358 3/2011 - 12/31/2020 • Michigan State Medical license# 076902 7/2000 - 1/31/2022 • NJ State Medical License#66092 7/1997 - 6/30/2021 • Florida State Medical License# 121313 8/23/14— 1/31/2021 Board certifications • Board Certification and Re-Cert in Occupational Medicine 1/04, 1/2014 (exp: 2024) • Board Certification in Ophthalmology(Germany) 2/1992 • ECFMC - Certification 3/1993 Graduate Degrees • M.D., Ruprecht-Karls University of Heidelberg Medical School 10/80-5/86 • Masters degree in Public Health(MPH)University of Michigan 6/1999 • BA/MA in Biology with Distinction, Boston University, Boston, MA grad 1/1980 Certifications • ACLS (Advance Cardiac life support) certified/Active re-certified 9/2012- 9/2020 • Medical review officer, MRO #01-04613 7/2000— 12/2021 • DOT- Certified Medical Examiner(Active 411-572-4423) through 2024 • DEA BD7674612 active : 6/30/2023 • CDS D07272600 active: 10/31/2020 Awards • America's top physician : 2010, 2011, 2012,2013, 2014,2015,2016,2017.2018 by Consumers Research Council of America Additional INTERNSHIPS/COURSES/HOSPITAL ROTATIONS: • Johns-Hopkins University,Baltimore, MD, Aug. 6th—Sept. 28th 1984 Medical Rotation in Psychiatry, Meyer 5 June 2020 0 0 0 C CO 0 ,m y wt m , ' <co i II;t ntho ul � _�,� s' itr .. :2- i,C: ro ! , r. r t ilV tr.. 'ri tit. _k.xa r \, ". lir ( V D N W ,,,,,,,,,d4,,ei., .4-z..,+, 0,,,.,/,,, ma,,,,„ .• M NT 041, '•0W cn C4,4-. Wet/1)&4, gal 'Bath; Ju1Uar Danko/ B MA, OW li OecOr !rtmtftttuat ' ,ys- GFj ' f a ,, J tCLt�tY 1 1, ;•'•' ,POH ..Y. t' 2.114 'k r-� rn� MPS r "' , r girt S E.i\ L '- J u ru. .31, 2.-24 CHAIR _. 43,-.:-4 ,•,ti;..-; _{��l�y�/� 25.144 'f , •f•f7 4h„.•_6-\.-,- Y- CLCKff'l/(p• VICE CHAIR Ce die SECRETARY 0i• o 0 , 0) l» 0 t` 7 m i 0 1 MROCC . E N op 00 , D w Medical Review Officer Certification Council certifies that N W m Doris J. Danko, M.D., M.A., M.P.H. W I has successfully met all eligibility and examination criteria and is hereby designated a Certified Medical Review Officer I 1 Certification Number: 16-12023 i Effective from December 03, 2016 I to December 03, 2021 1 oRoc ,,r i a. �i 1 ! 0 0 0 c r •77/7F,,,,/ , ,/::.7.. ..'r 4,7:".."../7"s4r777.77/47:7rFoirwr'//:....." ,/,';''77:7// r//%7/„/"..':-... ..- ':, '' ': ..r./7F77(;'W/7":777;;'''T.X.;":":'."7/1 '7" ..e.'///r,,'•77- r., 7,F,.')'".111 0 4-r .:... ..:_\:....._..:._ ..._\.__.. ._\.:....\L_\...I.\....._\.......\..:_\„..:,_::_s\.:::_c_ ...._....t... ...... ..1... _\.,\...:..:„...... ..:._.„...±........:....\-.::__ ...... .......\...,....t.\.:_. ......... ....... ..i..._—.\.......t ..\...,....t-.2m -A il � 0 (h) 5 S si\ pA A . . 1 Certificate ofQualification 1 ( 1 1 , ,� worldwide ( W (, y Ti ( N kr)jTrAn», c.,(1 D , 04 N Im �, i 0Em , 1 (( This document certifies that '1� 1� � Doris Danko(ti ,r1 „ 1� has successfully completed SAPAA's Substance Abuse Professional Qualification TrainingCourse '� �1 and Examination, and if all otherqualification requirements are met �1 q (see note below), may l)) `' , perform all SAP duties as stipulated byDOT regulations. `' 1 p g 11 11 Note. This certificate is valid only if the person is a licensed physician (Doctor of Medicine or Osteopathy); a licensed or certified Social Worker, a licensed or certified Psychologist; a licensed or certified Employee Assistance Professional; an �/�_-- �� \ F)j) Alcohol and Drug Abuse Counselor certified by the National Association of Alcoholism and Drug Abuse Counselors �J , - -(� CertificationCommission, theInternationalCertificationReciprocity Consortium/AlcoholandotherDrug Abuse(ICRC),orthe ,I cKa+r �1(/1� National Board for Certified CounselorsIncand Affiliates(NBCC)—specifically NBCC's Master Addictions Counselor(MACS; i /) /� ((/j) or state-licensed or certified Marriage and Family Therapists. SAPAA makes no warranty as to educational qualification orbest practices of the Substance Abuse Professional. • �� Approval of Professional Development Hours: 16 �;� ® \� (( EACC Approval Number: SSSAPA0219-502, Domain II l(� ,, C` (.14.,.,4 \1� Qualification Instruction & Exam \ (` • r5sr�cr�++”' • ,�� ►�\'t - I--�' � (t Taye CaC�iveCC March 4. 2020 �-^' � SAPAA President Date r'3 0 g Co z m-- ci .8 a, National Registry of Certified Medical Examiners P 0 The Federal Motor Carrier Safety Administration certifies that .- ow> f ' ,': r, 1.yi‘.• ,F z It . ?:, itil,,, g ;_ z, ,2. .„. ,i,,„ ,.„ ff. '-'-•,. , ,, ' . N AL 1.:, DORIS J DANKO MD ).- . "'4' ,,,t,L•-1; U; „..-. .t._. z1,;':_,42 " --x-,•. ,.,., A, .,g:::- ?A..._ :' ..,,,,_ ._,L. ,:,' .A is a registered medical examiner on the Federal Motor Carrier Safety Administration's National Registry of Certified Medical Examiners. DORIS J DANKO has completed the required training and testing concerning the Federal physical qualOcations and standards for truck and bus drivers and possessesihe neeessarp lo:i64ledke'andiprofes'Sional credentials to perform physical , , ,, qualification examinatiom fof commercial motor vehicle drivers in'accordance with the Federal Motor , 1, -, Carrier SafetyRegu-lationS (49 CFR39.11.,41 --391.49).' Issued at: Washington, DC 20590 -, ; i ,, , • t ; • ' Date: 11/07/2014 Charles A. Horan III, Director National Registry No.: 4115724423 Office of Carrier, Driver and Vehicle Safety Standards Expires: 11/07/2024 eaNATIONAL REGISTRY U.S.Department of Transportation or CI:MIRD MEDICAL MAIIIIMIS Federal Motor Carrier Safety Administration ,..........,........... x DocuSign Envelope ID: 192DD89C-A3C5-4226-BF99-1A23E2A1F635 AC .72130 b §T.ATEOP FORItiA ".•• DEPilitEN ART . ' tori4EALTH DIVISION QF MEDICAL QUALITY ASSURANCE DATE • ' : tICENSE NO.::. : CONTROL NO. • 01163/2010 ME 121313 647643 . The MEDICAL.DOCTOR QUALIFICATION(3): DISPENSING PRACTITIONER named below hits Met all requirements of the laws,and rules of the state of Florida. ExpirationDate,, `,; JANUARY 31, 2021 DORIS JUL)A,DANKO 4304 ALTON ROAD MOUNT SINAI MEDICAL CENTER SAMUEL JACOBSON HEALTHCARE;ENTER MIAMfBEACH,FL 33140 01 . Arow • • Rick Scot Celeste02.11"...hilip, M.D., M.P.H. : • QOVERNOR Surgeon General and Secretary DISPLAY IF REQUIRED BY LAW . „ , - • DocuSign Envelope ID: 192DD89C-A3C5-4226-BF99-1 A23E2A1 F635 Elyana Mitchell, MSN, APRN CONTACT INFORMATION Address: 574 Ne 94 St Miami Shores, FL 33138 Cell Phone:305-987-4027 Email:elyicaza@gmail.com PERSONAL INFORMATION Date of Birth:07/26/1988 Place of Birth:USA Citizenship: USA Citizen Gender:Female Marital Status:Married Spouse's Name:George Mitchell SUMMARY OF QUALIFICATIONS: CLINICAL ROTATIONS s• Pediatric Health Rotation August 2014-December 2014 125 hours South Florida Pediatric Partnership,Dr.Mayra Capote Proficient:Vaccinations,Well Child visits,Sick Child Visits •:• Family Practice Rotation January 2015-December 2015 375 hours Dr. Dayna Clarke/Benjamin Wellness Center Proficient:Prenatal Visits, Management of Diabetes and Hypertension,Cervical Cytology ❖ Dermatology Rotation January 2016-May 2016 125 Hours Greater Miami Skin and Laser Center,Dr.Martin Zaiac Proficient:Punch Biopsy,Cyst removal,Cryotherapy,Supervised Botox administration. Observation :Candela V beam laser,Candela GentleYag laser, Laser hair removal with Alexandrite laser, Tattoo removal with Med Lite 6 laser, Photodynamic therapy,Mohs Surgery,Botox and Filler administration. Licensure August 2016-Present Florida Advanced Registered Nurse Practitioner#ARNP9319994 February 2011-Present Florida Registered Nurse#RN9319994 Education August 2013-May 2016 Masters of Science in Nursing,Barry University August 2008-December 2010 Bachelor of Science in Nursing,Nova Southeastern University Certifications and Competencies July 2016-Present ANCC Family Nurse Practitioner—Board Certified October 2016-Present American Heart Association Advanced Cardiovascular Life Support July 2016-Present American Heart Association Pediatric Advanced Life Support October 2016-Present American Heart Association Basic Life Support October 2012-October 2014 Oncology Nursing Society Chemotherapy and Biotherapy Provider DocuSign Envelope ID: 192DD89C-A3C5-4226-BF99-1 A23E2A1 F635 Work Experience August 2018-Present Nurse Practitioner,Mount Sinai Employee/Occupational Health -Obtain histories and perform physical assessment for pre-employment/annual exams and worker's compensation. -Order/Follow up on Labs,diagnostics as per protocol -Order medication per protocol for worker's compensation and post exposure -Review and revise current department policies and procedures as well as implement new policies to conform to current practices. August 2016-August 2018 Nurse Practitioner, VilMed,Inc.Infectious disease specialist -Treatment and management of HIV and infectious disease. -Inpatient and Outpatient setting -Perform consolation in the inpatient and outpatient setting -Managing septic patients in ICU setting -Coordinating discharges/outpatient antibiotics with the healthcare team July 2014-August 2016 Centralized Staffing Nurse,Baptist Health South Florida -Provide exceptional health care delivery in any of the six Baptist health entities in South Florida. -Orient nurses to the different Baptist health entities -Ability to be able to provide care for patients in different medical surgical specialized floors such as telemetry,respiratory,orthopedics,observation, rehabilitation,oncology,bariatrics,neuro surgical,and women's services.. March 2011-July 2014 Staff/Resource Nurse,Oncology/Hematology Unit,South Miami Hospital -Render exceptional health care services to patients and families. -Maintain and develop individualized plan of care based on patient's specific needs -Administer oncology medication,examinations and assist with biopsies. -Selected to precept staff,serve on key committees and assume liaison role. Professional Activities and Meetings 2012-2014 Culture and Diversity Committee Unit Representative 2012-2014 Oncology Nursing Society 2010-Present Sigma Theta Tau International, Honor Society of Nursing 2010 Delta Epsilon Iota,Academic Honor Society Awards 2011 Angel Pin:Recognition for excellent health care service 2008 Baptist Health Nursing Scholarship Community Activities 2008-Present Tijeras Unidas:Breast Cancer Foundation Volunteer/Organizer June 2013-Present Emmaus Medical Missions;Guatemala Skills Fluent in Spanish DocuSign Envelope ID: 192DD89C-A3C5-4226-BF99-1 A23E2A1 F635 PEDIATRIC ADVANCED LIFE SUPPORT PALS " American Heart American Academy l -� Provider Association. of Pediatrics Elyana Mitchell has successfully completed the cognitive and skills evaluations in accordance with the curriculum of the American Heart Association Pediatric Advanced Life Support(PALS)Program. Issue Date Recommended Renewal Date 6/14/2020 06/2022 Training Center Name Instructor Name Nationwide Health L I C Aurelia Amaya Instructor ID Training Center ID F120236 10102087317 eCard Code Training Center Address 207003457115 1000 W McNab Rd Suite 242 Pompano Beach FL 33069 USA QR Code -Raining Center Phone o- ::7 o Number • �� (954)943-8002 To wee.or verify authenticity.students and employers should scan this OR code with Meir mehib device or yo to www heart onyctrimycards.4 O 2016 American heart Association All rights reserved 15-9006 10/16 DocuSign Envelope ID: 192DD89C-A3C5-4226-BF99-1A23E2A1F635 ADVANCED CARDIOVASCULAR LIFE SUPPORT • ACLS American Provider Heart Association t, Elyana Mitchell has successfully completed the cognitive and skills evaluations in accordance with the curriculum of the American Heart Association Advanced Cardiovascular Life Support (ACLS) Program. Issue Date Recommended Renewal Date 6/13/2020 062022 Training Center Name Instructor Name Nationwide Health LLC Instructor ID Training Center ID 10102087'317 FL20236 eCard Code Training Center Address 05603-t 'Og? 1000 W McNab Rd Suite 242 Pompano Beach FL 33069 USA OR Code Training Center Phone off'. o Number if93'ZV (954)943-8002 r. To view or verNy suthent{dry.students end empbysrs should scan this OA code with their mobile device or go to www.Mmt.orycpr/mycard 0 2016 American Heart Association.AN rights reserved. 15-3000 3/16 DocuSign Envelope ID: 192DD89C-A3C5-4226-BF99-1A23E2A1 F635 BASIC LIFE SUPPORT BLS American Provider Heart Association,. Elyana Mitchell has successfully completed the cognitive and skills evaluations in accordance with the curriculum of the American Heart Association Basic Life Support (CPR and AED) Program. Issue Date Recommended Renewal Date 6,13,2020 06/2022 Training Center Name Instructor Name Nationwide Health LLC A irc:ia Anav; Instructor ID Training Center ID 10102087317 FL20236 Training Center Address eCard Code 20F.S03n-,' `„t 1000 W McNah Rd Suite 24? Pompano Beach FL 33069 USA OR Code Training Center Phone o;[ • o Number (954)943-8002 © .r: .:. To view or verity authenticity,students and employers picgars ahnrJd scan this QR code with their moss dews a go to www.neart.orsycprimycar•fk 02016 American Heart Asaode5on.AM rights reserved. 15-3001 3,16 DocuSign Envelope ID: 192DD89C-A3C5-4226-BF99-1A23E2A1F635 JA DEPARTMENT OF HEALTH g DIVISION OF MEDICAL QUALITY ASSURANCE g 1 N DATE LICENSE NO. CONTROL NO • u — eo 06/09/2020 RN 9319994 3005292 t g u0w THE REGISTERED NURSE QUALIFICATION(S): ?NN W I W o 0 st CC Single-stats License < il 5 s =O NAMED BELOW HAS MET ALL REQUIREMENTS OF ` f THE LAWS AND RULES OF THE STATE OF FLORIDA 3 J u g v ? C O W v r W O_ Z 3 Expiration Date:JULY 31,2022 c LL 1 3 c ELYANA LUCIA MITCHELL �J w a g . u LL W R Q W ol `� NOT PRACTICING y ccg o 1sa�o S a ZZ NOR t Z X W ,� C „ A. (••vim Ron DeSantis Scott A. Rivkees, MD S i GOVERNOR . State Surgeon General 1 i DISPLAY IF REQUIRED BY LAW R S AC-X. STATE OF FLORIDA DEPARTMENT OF HEALTH g DIVISION OF MEDICAL QUALITY ASSURANCE 1 II s o Pi DATE LICENSE NO. CONTROL NO. ei 06109/2020 APRN 9319994 67226 B' THE ADVANCED PRACTICE REGISTERED NURSE QUALIFICATION(S): Iu w S. i g ° s i. Nurse Practitioner O1i5 , NAMED BELOW HAS MET ALL REQUIREMENTS OF W1 e U ¢ W THE LAWS AND RULES OF THE STATE OF FLORIDA. 8 = a uo 6 j `: g 0 w u • Expiration Date:JULY 31,2022 52.-a L" ELYANA LUCIA MITCHELL nIn 4304 ALTON ROAD t] ty` w3 S t�a MIAMI BEACH,FL-33140 NgB� 'X 3'X 2:),--, ig ( ---- 56-.7 A. 6-..,1,...A.b ,. Ron DeSantis Scott A. Rivkees, MD t t GOVERNOR State Surgeon GenetLL al S DISPLAY IF REQUIRED BY LAW 0 _ EXPIRATION DATE: JULY 31,2022 Your license number is APRN 9319994.Please use it in all correspondence with your board/council.Each licensee is solely responsible for notifying the Department In writing of the licensee's current mailing address and practice location address.If you have not received your renewal notice 90 days prior to the expiration date shown on this license,please visit www.FLHealthSource.gov and click'Renew A License"to renew online. The Medical Quality Assurance Online Services Portal gives you the ability to manage your license to perform address updates,name changes, request duplicate licenses and much more. It's simple. Log onto your MQA Online Services account today at httpi/flhealthsource.gov/. Select the'Account Login'button to access your - ---'-a.__e............,i.....4....�.r,...,,...4a.•uana..0 LAv DocuSign Envelope ID: 192DD89C-A3C5-4226-BF99-1 A23E2A1 F635 Sylvana Saintiche 1046 NE 208th street Miami, FL 33179 305-546-6009 Saintichel@yahoo.com Education: Florida Atlantic University,Boca Raton, Florida • Masters in Science Degree,Nursing, May 2014 • Concentration in Adult/Geronotology Nurse Practitioner Florida Agricultural & Mechanical University,Tallahassee,Florida • Bachelors in Science Degree,Nursing, December 2008 Skills: • Ability to meet and interact with people appropriately. • Ability to plan, organize, prioritize and coordinate work assignments. • Ability to follow verbal and written instructions. • Ability to work quickly and accurately. • Ability to work both independently and as a team member. • Culturally sensitive • Advanced Cardiac Life Support(ACLS) certification • Enthusiastic caregiver • IV drug therapy management • Critical Thinking • Compassionate (Drawn to care for the sick and injured. Empathetic to pain and suffering) • Good at multi-tasking • Excellent listening skills • Great observational skills/Strict attention to details • Adaptability(Situations, people, schedules) • Teaching/Instructing others how to do something • Ability to complete a thorough physical assessment • Ability to electronically chart thoroughly Employment Experience: Mount Sinai Medical Center,Nurse Practitioner,Miami Beach, Florida 33140. June 2015 —current • Obtains histories and performs physical assessments for pre- employmentlannual exams and worker's compensation DocuSign Envelope ID: 192DD89C-A3C5-4226-BF99-1A23E2A1 F635 • Orders laboratory,radiology tests per protocol • Provides general health counseling as required • Orders and dispenses medications as per protocol • Transmits information to the appropriate Personnel/Human Resources Department as needed • Participates in pre-employment and reasonable cause drug screening • Ensures compliance of Employee Health/Occupational Health procedures and regulatory standards (HIPPA and JCAHO) • Serves as a resource for Employee Health/Occupational Health issues • Helps in the review and revision of current department policies and procedures as documented and reported as well as implement new policies to confirm with current practices when required • Employee Health: Responsible for completing pre-employment physicals including interpreting drug and nicotine screening results, ordering and reviewing titer results, completing history and physical on all potential employees. Provide clearance to appropriate personnel for physical ability to complete job description. Evaluate,treat, and follow-up with employees who sustain a work-related injury under Florida Workers Compensation. Counsel and treat employees who experience a blood-bodily fluid exposure. • Occupational Health: Responsible for reviewing and interpreting all pre- employment and annual requirements set forth by contract holders including but not limited to: audiometric testing, EKGs, stress tests, pulmonary function tests,vision screening, tonometry readings, chest x- ray results, HIV screening, basic labs, and drug screening results. Complete history and physical. Consult appropriate medical providers for additional clearance and/or testing. Mobile Medical Examinations Services Inc(MedXM), Nurse Practitioner, Santa Ana, Ca 92705. November 2014—May 2015 Accurately completes in home Comprehensive Health Risk Assessments on adults/geriatric clients and electronically charts data Memorial Hospital West,Registered Nurse, Pembroke Pines, Florida 33028. May 2009—March 2017 • Interviews patients to obtain medical information and measure their vital signs,weight and height. • Delivers high-quality and compassionate treatment to indigent and low- income patients. • Monitors post-op vitals, set up PCA pumps, set up and monitor IV fluids, reviewed post-op orders and orient patients to unit. • Sound, ethical and independent decision-making ability consistent with medical protocols. DocuSign Envelope ID: 192DD89C-A3C5-4226-BF99-1A23E2A1F635 :z,::r.y,nl V�� eruncaucln A11[011CAN NYIISGS CCS0GNTIALINO C[NrC* 2014014581 Certification Valid 7/9/2019 to 7/8/2024 • Name of Certification: ADULT-GERONTOLOGY PRIMARY CARE NURSE PRACTITIONER Awarded to: Sylvana Saintiche, AGPCNP-BC • • I BASIC LIFE SUPPOR BASIC LIFE SUPPORT Nationwide Health LLC BLSAmerican I Training BLS VI Heart 1 Conter Name Provider Association. l Training FL20236 Sylvana Saintiche Center ID 1 The above individual has successfully completed the cognitive and skills 000 W McNab Rd Suite 242 TC Address evaluations in accordance with the curriculum of the American Heart Pompano Beach Ft.33069 USA Association Basic Lite Support(CPR and AEI))Program. 4 ' IC Phone (954)943.8002 • o^••;' instructor Aurelia Amaya ' " Name : Issue Date Recommended Renewal Date 112!2019 01/2021 , • tc , 21 Instructor 10 10102087317 Io.r.or..,,4,.fi.nrcay.slne.!ta and.mµo • Dl.i. n.}d sC,IP.t CR eol,wilt thea moth,der.Or 0 2010 Amnma^Noel/Aatc V al:,n 16•:031 }16 yo le w..,.n.an vy'eP..myeatdr ADVANCED CARDIOVASCULAR LIFE SUPPORT ADVANCED CARDIOVASCULAR LIFE SUPPOR ACLS American Training Nationwide Health LLC V LJ I Heart Center Name Provider flp Association- Training FL20236 Sylvana Saintiche Centerl0 The above individual has successfully completed the cognitive and skills IC Address 1000 W McNab Rd Suite 242 evaluations in accordance with the cunicutum of the American Heart Pompano Beach FL 33069 USA Association Advanced Cardiovascular Life Support(ACLS)Program. TC Phone (954)943.8002 Issue Date Recommended Renewal Date n 1.' .1 S4 InstntCtOr Aurelia Amaya t;. ` Name 1/2/2019 0112021 }�+rrr _1 .A.) :i, Instructor ID 10102087317 ....o.0....o.0To Is rr..y.Ui000IG1Y[1!.7001,a-d.mpioY ai•43 .^ovld sc.n,,.CR‘ode will thea t^etto deco.Or re . qo to www te.lta;i0Pttmy00t0. i 02016 Amo^un Hac Ac00000on 15.3000 3110. 0 0 0 C Z m 0 CD 0 CD• 0 CD N 0 0 CO 0 D C...) 0 N 4- N N 01 W AC# CD 4' STATE OF FLORIDA N DEPARTMENT OF HEALTH I m -11 DIVISION OF MEDICAL QUALITY ASSURANCE ° 1 • D • DATE � LICENSE NO. :-04 N w i cn CONTRQLNOCD U N 1 06/03/2020 APRN 9289216 ,, ss�a1 • THE ADVANCED PRACTICE REGISTERED NURSE ~ OUALIFICATICaN(S) iW :; •.: ! :. NAt lLtj ULLU`.V HAS MCT ALL RI OUIREh1ENTS OF flume Praeutpncr X I. . ti j V. I: ~ li Z W V ' W THE LAW';AND Fit ILLS OF THE STATE OF FLORIDA , i ,M, ti ;+ s '-Li I G ,' y Expiration Date JULY 31,2022 ' "' SYLVANA SAINTICIIE r� .W o i + :i J��I y:W:O U 4304 ALTON ROAD W z ',jam ci p a SAMUEL JACOBSON BLDG.. 1ST FLOOR e ' yT . I: C A I OCCUPATIONAL HEALTH ._ I W = ' MIAMI BEACH.FL-33140 " ` '" Ron DeSantis Scott A.Rivkees, MD J s GOVERNOR State Surgeon General ;. a DISPLAY IF REQUIRED BY LAW DocuSign Envelope ID: 192DD89C-A3C5-4226-BF99-1 A23E2A1 F635 Patricia Wilson LICENSED PRACTICAL NURSE Compassionate and patient-focused LPN with 10+years of professional experience WORK EXPERIENCE patricia.wilson@msmc.corn 1-1 LPN 305-674-2312 Miami Heart Institute/Mount Sinai Medical Center 1971-Present SKILLS Achievements/Tasks ° Provided post-op care for patients,such as post-surgical wound treatment,pain Proficient in management,and infection treatment. administering IV ° Provided patients with basic care or treatments,including taking temperature or blood medications and pressure,giving enemas or douches,or performing catheterizations. collecting blood samples for labs ° Distributed medications to patients in proper doses, recorded times of administration to ensure ongoing accuracy. Trained in instrument o Observed patients and reported concerns to a physician on duty. sterilization and ° Tested blood glucose and administered insulin. equipment handling ° Administered breathing treatments and provided tracheostomy care and suctioning,SVN treatment and 02 administration. Skilled in observing ° Maintained accurate,detailed reports and records and visually assessing ° Coordinated and scheduled work hours,resolved conflicts patients ° Trained and managed 10+new hires and co-workers and achieved significant improvements in their productivity for Employee Health/Occupational Health Demonstrated Department understanding of vascular care LICENSES & CERTIFICATES Excellent oral and Licensed Practical Nurse written communication skills Basic Life Support and ability to work collaboratively with a team of medical EDUCATION professionals High School Diploma Miami Northwestern High School LANGUAGES 1965 7968 English Full Professional Proficiency Nursing Diploma Lindsey Hopkins Technical College INTERESTS 1970- 1971 Basketball Courses ° Practical Nursing Crossword Puzzles Cooking Travel Family Time o C -NN V S//��_�440"0040,P� . 313101 11 1// *•ON 11P5,45100/PAOtta 1,1 /� %TA /j a \ �� /"_ \��.��..�/�iA=w �� i.,I/�j�;w I:�w 1 / �e:�w� �I� 111 / I NO,Tri` m L \ NI, / j .!,.,... 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DocuSign Envelope ID: 192DD89C-A3C5-4226-BF99-1A23E2A1 F635 BASIC LIFE SUPPORT BLS eo American Provider Heart Association Patricia Wilson has successfully completed the cognitive and skills evaluations in accordance with the curriculum of the American Heart Association Basic Life Support (CPR and AED) Program.• Issue Date __;;Recommended Renewal Date 12/30/2018 ?i ;;r 12/2020 ;a• �g�tal' • Training Center Name Instructor Name Nationwide Health LLC Claudio Amaya ' { t' Instructor ID Training Center ID ' • FL20236 `� 03112374643 s t `I ,'eCard CoderiJ4•3 ( -de4 Training Center Address `� A•,t� 185509003512 1000 W McNab Rd Suite 242 •Pompano Beach FL 33069 USA QR Code =, Training Center Phone ❑, o.��.❑ �'`. xkFK Number �, : �,; k ,F • (954)943-8002 ' To view or veYify authenticity,students and employers should"scan this OR code with their mobile device or go to www.heartorg/cpr/mycards. 0 2016 Ame,icart,heart Association.All rights reserved. 15.3001 3/16 DocuSign Envelope ID: 192DD89C-A3C5-4226-BF99-1 A23E2A1 F635 LARISSA H CABARGA, MD. SUMMARY Dedicated and accomplished physician with extensive clinic and hospital experience. Qualified to facilitate quality improvement initiatives and committed to providing quality patient care.Skilled in training and supervising medical students and residents with devotion to fostering medical education.Well versed in practicing evidence based medicine. Highly familiar with diagnosis and treatment of multiple disease states and health concerns. Licensed in the state of Florida and board certified in Internal Medicine. LICENSES AND CERTIFICATIONS; • Florida state practitioner's license • Certified,American Board of Internal Medicine • Educational Commission for Foreign Medical Graduates(ECFMG) EDUCATION Residency: Internal medicine,Mercy Hospital and Medical Center,Major affiliate of the University of Illinois(July 2011-July 2014) Medical School: Doctor of Medicine,Saint Matthew's University School of Medicine,Grand Cayman,CI,(January 2007-April 2011) Undergraduate: Bachelors in Health Sciences,Florida International University (FIU),(August 2001-May 2006) PROFESSIONAL BACKGROUND: Mount Sinai Medical Center,Miami Beach,FL Associate Program Director (APD), Internal Medicine Residency Program (January 2018- present) • Assist the program director with facilitating the requirements of an Internal Medicine residency program as deemed by the Accreditation Committee of Graduate Medical Education(ACGME) • Manage the residency ambulatory educational curriculum • Supervise residents in both the inpatient medical teaching service and outpatient continuity clinic • Conduct high value care and quality improvement training and initiatives in the ambulatory setting • Oversee faculty development in the ambulatory setting • Active faculty member of the clinical competency committee • Active faculty member of the residency management team • Active member of the residency expansion committee Mount Sinai Medical Center,Miami Beach,FL Medical Director,Primary Care Center(November 2017-Present) DocuSign Envelope ID: 192DD89C-A3C5-4226-BF99-1A23E2A1 F635 • On-call schedule manager for the internal medicine primary care group • Active member of the research subcommittee Mount Sinai Medical Center,Miami Beach, FL Medical Review Officer(MRO) (November 2017-Present) • Licensed and certified to evaluate laboratory drug test results within federally mandated/non-mandated workplace drug testing programs. • Carry out varied administrative duties associated with the drug testing evaluation process. Mount Sinai Medical Center,Miami Beach,FL Academic Primary Care Physician,Department of Medicine (August 2014-Present) • Core faculty member of the Internal Medicine Residency Program • Manage patients and supervise residents in the inpatient medical teaching service and outpatient continuity clinic • Conduct didactic lectures regarding ambulatory internal medicine topics • Peer selected mentor for internal medicine resident physicians Herbert Wertheim College of Medicine,FIU,Miami,FL Associate clinical professor,Department of Medicine (September 2015-Present) • Supervise, educate, and evaluate 1st-4th year medical students in the inpatient and outpatient setting. Mercy Hospital and Medical Center,Chicago,IL Internal medicine resident physician (July 2011-June 2014) • Completed internal medicine residency rotations • Conducted a quality improvement project to determine the impact of screening for depression in the general population. • Peer selected as class representative for the social committee,which aimed to foster and cultivate the resident's activities outside the academic realm Miami-Dade Area Health Education Center,Miami FL Recruitment intern (May 2006-January 2007) • Assistant coordinator and foreign medical school liaison for the annual south Florida pre-medical conference. • Assisted in recruiting physicians and students to participate in the organization's health education programs. • Assisted in creating and implementing health care career modules for Dade county public schools. SCHOLARLY ACTIVITIES: Publications: • Robert C Goldszer,MD,MBA,Alexandra Franco,MD,Bryan Tolentino,MD, Denise Diaz,MD,Pooja Pundhir,MD,Cynthia Rivera MD,Claudio Tuda MD,Kenneth Ratzan MD,Larissa Cabarga, MD,Luigi Cubbedu, MD.Serum Procalcitonin,Use of DocuSign Envelope ID: 192DD89C-A3C5-4226-BF99-1A23E2A1 F635 Antibiotics,and Patient Outcome. International Journal of Innovative Research in Medical Sciences (IJIRMS).2016,2455-8737,Vol.01,Issue 07. Status:Published • Larissa H Cabarga,MD.,Luigi X.Cubeddu, MD.,Ph.D.,Samira Habibnejad, MD., Elizabeth Kury-Perez,MD.,jiny Olickal, MD.Pooja Pundhir,MD.; Daniela Pirela,MD., Robert C Goldszer,MD.,MBA.Breaking the Barriers in Resident Education:A Quality Improvement Initiative. Status:Abstract winner at the National American College of Physicians(ACP) meeting 2017;accepted for publication on October 2017 to Journal of Healthcare Quality. • Hamid-Reza Moein,MD.,Garrett Van Ostren,DO.,Larissa Hernandez,Cabarga,MD; Hidrosmin:A Potential Cause of Drug-induced Acute Pancreatitis. Status:Case presentation;submitted for publication to American Journal of Gastroenterology Quality improvement projects: • Jeffrin Joseph,MD; Larissa Cabarga,MD; Luigi X C Cubeddu,MD; Elizabeth Kury- Perez,MD;Clifford Medina,MD;Juan Carlos Murillo,MD;Yamil Michelen,MD;Jiny Olickal,MD;Jorge Martinez,MD;Ying Long,MD.Screening the At Risk Population for Hepatitis C:A Quality Improvement Initiative.Mount Sinai Medical Center, Miami Beach,FL. (September 2016- February 2018) Status:Completed Publication: Not submitted • Jeffrin Joseph,MD;Asaad Trabolsi,MD; Marilia Bernardes,MD;Maria Fernandez Jimenez, MD;Alma Pulido,MD;Garrett Van Ostren,MD; Rehan Malik,MD;Angelica Torres,MD,Daniela Fonseca,MD; Diego Lugo, MD; Molly Bilderback,DO.Increase screening for Abdominal Aortic Aneurysms in male smokers.(September 2017- Present) Status:Study and Act phase Publication: Not submitted • Hernando Torres,MD;Karel Diaz,MD;Isis Romero,MD;Janki Patel,D0; Gisell Mansur,MD;Oxana Harlamova,MD;Zenith Hag,MD; Michael Syme,MD;Aldo Ribeiros,MD;Rebecca Armenteros,DO; Erika Quintana,DO. Decrease the use of unnecessary urinalysis during routine annual exams in asymptomatic adult patients.. (September 2017-Present) Status:Study and Act phase Publication:Not submitted • Daniela Urina,MD; Ehimen Aneni,MD;Jyotsna Kochiyil,MD; Carlos Rodriguez,MD; Claudia Santiesteban,MD;Adnan Younus, MD;Francisco Armas,MD;Sana Shamji, DocuSign Envelope ID: 192DD89C-A3C5-4226-BF99-1A23E2A1 F635 DO;Tarec Elajmi,DO;Susanna Leonard,DO;Simon Astor,DO;Benjamin Hurwitz, MD.Increase compliance with Hba1c measurements in the diabetic population. (September 2017-Present) Status:Study and Act Phase Publication:Not submitted • Jorge Martinez,MD;Ying Long, MD;Vivian Ussui, MD;Uday Malhotra,MD; Megan Winter,MD; Neha Garg,MD; Ben Johns Vadasseril,MD;Ajaypal Gill, DO;Ashneal Sharma, DO; Nikita Carvalho,MD.Improve Tdap vaccination rate in adult patients. (September 2017-Present) Status:Study and Act phase Publication:Not submitted • Niharika Yedla,MD;Jorge Perez,MD; George Skopis,MD;Ailyn Rivero,MD; Barbara Pociurko,MD;Maria Skopis,MD;Allison Hales,DO;Israel Ugalde,DO;Ahmed Elgahwy,DO;Yana Caminer,MD; Mahmoud Mahfouz,MD.Increase the PPSV23 (Pneumovax 23)vaccination rate in immunocompetent patients between the ages of 18-65 years with applicable comorbidities.(September 2017-Present) Status:Study and Act phase Publication:Not submitted Poster presentations: • Awareness of Human Papilloma Virus(HPV)and the HPV Vaccine Among At Risk African American Women; Poster presentation at Florida American College of Physicians(ACP) conference (November 2010) • More Than Just a Sore Throat in a Case with no Correlating Risk Factors; Poster presentation at Illinois ACP conference(November 2011) • A Case of Sclerosing Encapsulating Peritonitis in a Peritoneal Dialysis Patient; Poster presentation at the Illinois ACP conference (October 2012) • A Rare Diagnosis of Intractable Back Pain; poster presentation for ACP Lectures and Workshops: • Fundamentals Friday:Tailoring an Ambulatory Educational Curriculum. Academic Alliance of Internal Medicine,San Antonio,TX (March 18, 2018) • Introduction to Quality Improvement,Workshop, Part I. Mount Sinai Medical Center,Miami Beach, FL(March 2015,2016, 2017) • Introduction to Quality Improvement, Workshop, Part II. Mount Sinai DocuSign Envelope ID: 192DD89C-A3C5-4226-BF99-1 A23E2A1 F635 Medical Center, Miami Beach, FL(May 2015, 2016, 2017) • Clinical Preventive Services Part I. Mount Sinai Medical Center,Miami Beach,FL (November 2014, 2015, 2016) • Clinical Preventive Services, Part II. Mount Sinai Medical Center, Miami Beach,FL (January 2014, 2015, 2016) • Morbidity and Mortality:An Internist's Perspective. Mount Sinai Medical Center,Miami Beach,FL (December 19, 2014) AWARDS • House Staff Choice for Teaching Attending of the Year: Mount Sinai Medical Center, Miami Beach,FL(2014-2015) • Pan-Hellenic council president of the year,FIU(2004) MEMBERSHIPS AND HONORARY SOCIETIES • American Medical Association(October 2014-present) • American College of Physicians:Active member(July 2011 - Present) LANGUAGES • Fluent in English and Spanish 0 0 (-) cn OD = m n (11 .Y5 co o_ .-4,--.---r.^--- - - .. - ...;-> r 1 . •-•—•"----7-'----- ---- ..;•e-zd-,-,•••- .. .a.'..:.0 . ; • CAD • .:••:_ . ` - . -:":"-• . :' • ''. ; --.. •AS-- ","...'• - ..• •• .. 4-',."4.".qt• '' , ry _ . 0 0 .'.'• - ...Ya:.(4•••0 gr.- . ,;,,, . co 03 .,, - •....› g,....0 c, fn . ‘•;.1,... ' • • (-) :- .•..=,,,...i. c 1, z :ci i-i; -a . . (.51 c.) 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' '' • • . :•4 4 .r '. 4. . 4 ,.:.. • '''fil'...'4'.ti.'4,7 4': , ... :r.-• _.... ,_,..;;-:,._, ! _ : -• :.•,,, , :-n 1 .• : -- '....-pz.. .voltil,,i_‘.._:;._;_ .... t-k!-‘!--,....,,q- .-4...-t4.,...spip-•:-.,„.-•,,,,,.:„...,,-....,". .._ DocuSign Envelope ID: 192DD89C-A3C5-4226-BF99-1A23E2A1F635 ELIZABETH MARIE•KURY PEREZ, M.D. MOUT SINAI MEDICAL CENTER,Miami Beach,FL Coordinator of Geriatric Medicine,Internal Medicine Department,January 2011-Present • Actively work as an attending in the Internal Medicine department evaluating private patients and following patients with the residents in both ambulatory setting and inpatient with the medical teaching service. Schedule and coordinate the Geriatrics Rotation for the Internal Medicine residents and FIU and Nova Southeastern University students at Mount Sinai Medical Center. Clinical Assistant professor, Herbert Wertheim College of Medicine, FIU Core faculty member of the internal medicine residency program, member of the internal medicine residency management team, active member of the internal medicine residency program clinical competency committee and member of the ambulatory quality improvement projects committee. Medical Director of the Adult Autism Clinic,Internal Medicine Department,January 2017-Present Provide primary care of Adults in the Autism Spectrum;coordinate the interdisciplinary care of these patients. UNIVERSITY OF MIAMI-JACKSON MEMORIAL HOSPITAL,Miami,FL Fellow,Division of Geriatric Medicine,July 2009-June 2010 UNIVERSITY OF MIAMI-MILLER SCHOOL OF MEDICINE,Miami,FL Clinical Translational Science Workshop,September 2009 MOUT SINAI MEDICAL CENTER,Miami Beach, FL Chief Resident,Internal Medicine Residency Program,July 2008-June 2009 MOUNT SINAI MEDICAL CENTER,Miami Beach,FL Resident,Internal Medicine Residency Program, June 2005-June 2008 EDUCATION UNIVERSIDAD IBEROAMERICANA,Santo Domingo,Dominican Republic Doctor of Medicine, 1999-2003 UNIVERSIDAD NACIONAL PEDRO HENRIQUEZ URENA,Santo Domingo,Dominican Republic Bachelor of Medical Science, 1997-1999 RELEVANT EXPERIENCE DocuSign Envelope ID: 192DD89C-A3C5-4226-BF99-1 A23E2A1 F635 MOUNT SiNAI MEDICAL CENTER, Miami Beach,FL Mini-Residency Program, Department of Internal Medicine. June 2004. Actively participated during the admission process and diagnosis of patients assigned to the Internal Medicine team. Monitored patients progress during their hospital stay. CEDIMAT, Santo Domingo, Dominican Republic General Physician, Cardiovascular Department, March 2004 - May 2004. Screened patients upon admission for cardiac procedures, conducted routine care of hospitalized patients, and performed clinical research. MOUNT SINAI MEDICAL CENTER, Miami Beach,FL Mini-Residency Program, Division of Cardiology, January 2004. Followed patients under the direct guidance of Cardiology Fellows. Actively participated in teaching rounds and conferences. RESEARCH EXPERIENCE DIABETES RESEARCH INSTITUTE,University of Miami/JMH,Miami, FL Research Resident, Clinical Islet Transplant Program, Raquel N. Faradji, MD and Tatiana Froud, MD Conducted a retrospective observational study involving the patients that underwent Islet cell transplant between August 2000 and June 2006. Recorded data through chart review and created a database that analyzed the different factors that contributed to hypoglycemia in the peritransplant period. November 2006. ROBERT READ CABRAL CHILDREN'S HOSPITAL, Dominican Republic. Research Assistant, Department of Infectious Disease, Chabela Pena, MD, supervisor. Conducted epidemiological research on Dengue Fever.Reviewed medical records, gathered and analyzed data,organized information in tables and charts,examined results.January 2003-July 2004. PUBLICATIONS and PRESENTATIONS • "Breaking the Barriers in Resident Education:A Quality Improvement initiative"Cabarga L., Cubeddu, L,Habibnejad S. , Kury-Perez,E., Olickal,J., Pundhir, P., Pirela,D.,Goldszcr, R. Status: Abstract winner at the National American College of Physicians(ACP)meeting 2017; accepted for publication. • "Outcomes of Patients Who Have Do Not Resuscitate Status prior to Being Admitted to an intensive • Care Unit". Saha, D., Moreno,C.,Csete,M., Kury Perez, E.,Cubeddu, L., Farcy, D.,Henry,S., Glazer, Z.,Moreno-Walton, L., and Goldszer,R. Scientifica. Volume 2016(2016),Article ID 1513946,3 pages • "FRAX as a tool for osteoporosis screening in the outpatient primary care setting"Rosen I-1., Kury Perez, E.M., Lagari V., Farbman M. Poster Presented at the Florida Chapter ACP Session, St. Petersburg, FL October 2013. • "Adult Minimal Change disease presenting as massive bilateral Pulmonary Embolism"Zamora C., Kury Perez, E.M., Camp, A. Poster Presented at the Florida Chapter ACP Scientific Session, Palm Beach Gardens,FL. September 2008. DocuSign Envelope ID: 192DD89C-A3C5-4226-BF99-1 A23E2A1 F635 • "Hypoglycemia in the Peri-Transplant Period In Islet Cell Transplantation" Kury Perez, E.M., Froud T., Gon1 L., Faradji R.N., Sareh P., Monroy K., Baidal D., Cure P., Polite G., Ricordi C., Alejandro R. Abstract presented at the American Diabetes Association 67th Scientific Session,Chicago,IL.June 2007. • "Prevalence and Levels of GAD and IA-2 Autoantibodies in Patients with Long Duration of Type 1 diabetes at the Time of Screening for Islet Transplantation"Monroy K.,Faradji R.N.,Allende G.,Gom L, Denham M., Kury Perez E.M., Messinger S., Baidal D.A., Froud T., Ricordi C., Pugliese A.,Alejandro R. Abstract presented at the American Diabetes Association 67th Scientific Session, Chicago, IL. June 2007. • "Metastatic Neuroendocrine ACTI-I producing tumor of the pancreas treated with multivisceral transplant," Kury Perez E.M., Henao A., Prieto L.M. Winner of the Poster Competition at the Florida Chapter ACP Scientific Session, Palm Beach Gardens, FL. September 2006. • "Epidemiological characteristics of Dengue Fever in the Robert Read Cabral Children's Hospital in the period December 2002-December 2003" Pena C., Kury Perez E.M., Jerez P., Hernandez M.A., Garcia P., Medical Journal of the AMP, December 2004.Volume 13 No.2 Pages 22-27. • "The use of Cutting Balloon in Acute Myocardial Infarction"Valdez I., Urena P., Kury Perez E.M., Perez M., Baez A.C., Poster Presentation at the 24th Centro American Congress of Cardiology. Bavaro-Higuey, Dominican Republic.October 2004. • "Mortality due to Dengue Fever at the Robert Read Cabral Children's Hospital in the period December 2002 - June 2004," Kury Perez E.M., Pena C., Reyes L., Bulletin of the National Center of Maternal-Infantile Diseases,Volume: 14 No.2, Pages: 9-I I.October 2004. • "Cerebral Abscess due to Group B Beta-hemolytic streptococci,Case Report" Pena C.,Jerez P., Kury Perez E.M., Santos C., Flores N. Poster Presentation at the Primary Attention and Family Practice Meeting,Santo Domingo, Dominican Republic.April 2004. VOLUNTEER EXPERIENCE • Volunteer Physician and Clinic Translator, Heart Care International,2003-2004. • Nationwide Vaccination Campaign,Santo Domingo suburbs, 1998. • Volunteer,Corazones Unidos Foundation, 1996. LANGUAGES • Fluent in Spanish. • Intermediate-level French,written and spoken. French Language Institute,Dominican Republic, 1994-1997. • Advanced French Course. Paris, France, 1996. ACADEMIC AWARDS • Recipient of the "Paul J. Furlong, M.D. Award", as Resident in Internal Medicine 2008-2009, Mount Sinai Medical Center,July 2009. • "ACP Chief Resident Award", 40th Scientific Meeting, Palm Beach Gardens, Florida, September 2008. • Recipient of"The Mainlonides Award", Mount Sinai Medical Center,June 2008 . DocuSign Envelope ID: 192DD89C-A3C5-4226-BF99-1A23E2A1 F635 • Chief Resident in the Department of Internal Medicine, Mount Sinai Medical Center,July 2008- June 2009. • Winner of the Poster Competition at the Florida Chapter ACP Scientific Session, September 2006 • Graduated Summa Cum Laude, Universidad Iberoamericana,2003. • Member, Honor Roll,Universidad Nacional Pedro Henriquez Ure;iia, 1997— 1999. • Recipient,National Young Talent Award. INTEC, 1997. LECTURES • Giving a Voice to Adults with Autism. April 27,2017. • Morbidity and Mortality: Geriatric Medicine Perspective. Mount Sinai Medical Center, Miami Beach, FL(May 6,2016) • Schwartz Rounds Presentations. Mount Sinai Medical Center, Miami Beach, FL (February 24, 2016 and June 8,2011.) • Noon Conference Presentations in various Geriatric Didactic Topics. 0 0 2. Cl). 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I ;.r.ugr_,......,..t,..4.,,,,,,,,c,..."-r, ,,t..., - ,--,, - - , ,...--,,- ,..: ...,, .,-, - ., .... . ....„--„.„-........,--„,-...„.„!..- rq 2.21r.-, In •..,<-1...,.,•:. , ,,,,..., • 0"...1,:4 w.,.•,.,-•... .A.,,,,Z.V.,,k.• ct,.E. el., • ' ',:...L:,,,....Irv?",.-t",.,...',40 g,Isv-.4;,--,,...z,.4 .,., cp,an.$4:..i.' , /„.'' :A:4 ,W5,-/1„,„-, ''',.,,t'llr4z.,'"?'%.,,.... .n,,,vit-14%,,t;;":,97, iir,rti, , -,I.V ..z.:"/ 4q,.1 .,....<-,--,-;1,.,../IS• z.sg._ 4,1....:•,.. a..... ,-x...?,2 c?".4,-.-.41,-,.c•Atifia2,,ees.,??4; 4:10-- -4 , ••' ''"%-, '','-1--• : ‘'';1.4:.• g'i : gl•.,;M7-'1"V,.-:.e,';,5S:.71iletv- •,...ge4"'";i4jk-',^IL 4P41,Y4t$,....j,V.:.$,N,Agati,A"<,,, ,;Uira,?-24,-.-0-,.. :. ertlf,./.4...,, ,,Itity.„..":,-76,,,....E1,14.1. ....,...„..._4- 4 ,..;''..i.,-;:::3/4-.14.,,2,772.,•..:.'..4' .114..'44.X.J.,`:: , ' ..7....%-::WI'--. .i.A.,:"..r.F.,-Zw-t-,... -. -7-,.. • • • • . • • • • . • • . • • DocuSign Envelope ID: 192DD89C-A3C5-4226-BF99-1A23E2A1 F635 Chetan D. Rajadhyaksha M.D. ('Dr. Raj') Email:chetanr@chetanr.com 305-982-7252 Current Position: Attending Radiologist at Mt.Sinai Medical Center,Miami Beach,Fl.Since 2008 -Chairman—Department of Radiology since 2013 -Section Chief Nuclear Medicine since 2008 Residency/Post Graduation Training: MRI—University of Miami,Miami,FL.7/07—6/08 -Combined position of junior faculty/instructor and fellowship in MRI(MSK,Body,Neuro) Radiology Residency-St.Vincent Hospital at Worcester Medical Center,Worcester,Ma.7/1/04-6/30/07 Chief Resident Nuclear Medicine Residency-7/02-6/04-Joint Program in Nuclear Medicine-Brigham and Womens Hospital, Harvard Medical School Chief Resident Internship-7/01-6/02-Internal Medicine,Lenox Hill Hospital,New York,NY. Certification and Licensure: Board Certification— 1.American Board of Nuclear Medicine—Active-Recertified till 2024 2.American Board of Radiology—Active in good standing Florida State Medical Licence—Active,unrestricted,in good standing Education: 2000 M.D. DY Patil Medical College,Bombay University,India 1994 BA Biology Brandeis University,Waltham,MA Active Medical Societies/Memberships: Radiological Society of North America American Roentgen Ray Society American College of Radiology Society of Nuclear Medicine American College of Nuclear Medicine Society of Chairman of Academic Radiology Departments Professional Interests: 1. Functional Imaging—P.E.T./CT,MRI 2. Image Fusion 3. 3D Image reconstruction 4. Radiotherapy 5. Applications of Computers and Internet in Medical 6. Mobile Radiology DocuSign Envelope ID: 192DD89C-A3C5-4226-BF99-1A23E2A1 F635 Academic Activities/Presentations/Research/Publications: 2019 Transthyretin Cardiac Amyloidosis as Diagnosed by 99mTc-PYP Scanning in Patients with Acute Heart Failure and Preserved Ejection Fraction Saberio Lo Presti,MD,*Sofia A.Horvath,MD,*Christos G.Mihos,DO,*Chctan Rajadhyaksha,MD,t Veronica McCloskey,MD,*and Orlando Santana,MD*-Critical Pathways in Cardiology—accepted publication 2019 Jan Oral Presentation—2019 Annual Meeting—American College of Nuclear Medicine-Importance of Nuclear Imaging in Transthyretin Amyloidosis of the Heart:Discordant Relationship Between Degree ofTeclmetium-99m-PYP Uptake and Diastolic Dysfunction Measured by Echocardiography-Wymer,Patel,Burke III,Rajadhyaksha C. 2018 Nov RSNA 2018—Exhibit—Wymer,D.,Patel,K.P.,Burke Ill,William,Rajadhyaksha,C.Mullimodality Imaging of Dementia Patients:Clinical Importance and Role of Integrated Anatomic and Molecular Imaging 2016 Nov RSNA 2016—Exhibit-Niazi S,Nguyen C,Burke iIi W,Rajadhyaksha C.Back to the future:Revival and novel uses of 99mTc-pyrophosphate scintigraphy in the diagnoses and management of cardiac amyloidosis. 2014 July Delasotta L,Malik A,Wang M,Assad R,Hayden D,Reddy N,Burke W,Eber D,Rajadhyaksha C.Osteopoikilosis:A Benign Incidental Finding That Appears-Malignant.2014 Florida Radiologic Society meeting. 2014 May ARRS 2014—Invited Speaker—Nuclear Medicine Book Chapter: 'Approach to Diagnosis:A Case Based Imaging Review 2014 Malik A,Olivieri B,Nguyen C,Bhakoo A,Burke W,Rajadhyaksha C.Do Resident RVUs corelate with Standardized Exam Performance?A Retrospective Analysis.Presented at 2014 ACR Annual Meeting and Chapter Leadership Conference(AMCLC). 2013 November RSNA 2013—Scientific exhibit,`Spectrum of SPECT CT findings in head and neck lymphoscintigraphy' Awarded Certificate of Merit 2013 May ARRS 2013—Invited Speaker—Nuclear Medicine Book Chapter: 'Approach to Diagnosis:A Case Based Imaging Review.Nuclear Medicine Neurology'ISBN 978-1-890705-20-6 2011 May ARRS 2011—Invited Speaker—Nuclear Medicine Book Chapter: 'Approach to Diagnosis:A Case Based Imaging Review.Imaging of infection and Inflammation', ISBN 978-1-890705-17-6 2011 April ASNR 2011-Exhibit- "Use of MIM Cloud on the iPad for On Call Stroke Protocols.-Bhatia,A;Bhatia,V;Rajadhyaksha,Chetan;Plitnikas, M;Burke,W;Pizarro,J(2011,April). 2010 Sept Intramedullary Abscess of the Cervical Spinal Cord in an Otherwise Healthy Man,World Neurosurgery,Volume 76,Issue 3,361.e15-361.e19, 13 Hood,SQ Wolfe,RA.Trivedi,Chetan Rajadhyaksha,13 Green 2010 May ARRS 2010—Invited Speaker—Nuclear Medicine Book Chapter: 'Approach to Diagnosis:A Case Based Imaging Review,Nuclear Medicine-Skeletal Scintigraphy', ISBN 978-I-890705-15-2 2009 May ARRS 2009—Invited Speaker—Nuclear Medicine/PET-CT *Awarded best new speaker award Book Chapter: 'Approach to Diagnosis:A Case Based Imaging Review,Nuclear Medicine-PET-CT', ISBN 978-1-890705-13-8 2008 April ARRS 2008-Exhibits I.Budd-Chiari Syndrome:Spectrum of Imaging Findings.ARRS 2008 2.Renovascular Hypertension:an organized approach to diagnosis;ARRS 2008 3.imaging of Abdominal AIDS Related Lymphoma;ARRS 2008 4.Imaging with pathologic correlation of unusual adrenal masses;ARRS 2008 2006 September Society of Nuclear Medicine Massachusetts Chapter—'Basics of PETCT Including Normal and Benign Variants and Artifacts'—Invited Speaker 2006 April Society of Nuclear Medicine New England Chapter—'Basics of PET/CT Including Normal and Benign Variants and Artifacts'—Invited Speaker 2006 January All India Congress of Obstetrics and Gynecology 2006 Annual Meeting'Utility of PET/CT in Ovarian Cancer'—Invited Speaker 2005 May ARRS 2005-Exhibit-18 FDG PET/CT in Non-Small Cell Lung Cancer 2004 May ARRS 2004-Exhibit—Normal and Benign Pathologic Findings in 18-FDG-PET and PET/CT—*Rewarded Certificate of Merit 2003 December RSNA 2003-Oral Presentation—Prospective Comparison of FDG-PET and Ga-67-Citrate in patients with Hodgkin's disease treated with ABVD. 2003 Anewysnml bone cyst of the sacrum:value ofthree-phase imaging.Rajadhyaksha C,Connolly LP,Connolly SA,Treves ST.,Clinical Nuclear Medicine.2003 Nov;28(11):933-5 DocuSign Envelope ID: 192DD89C-A3C5-4226-BF99-1A23E2A1 F635 AC# 779578 STATE OF FLORIDA CO DEPARTMENT OF HEALTH t`` Z 1 DIVISION OF MEDICAL QUALITY ASSURANCE d N ' 0, z '<2 M DATE LICENSE NO. CONTROL NO. r. o 01!09!2019 ME 97785 0 651280 Z The MEDICAL DOCTOR '►~ " z° o named below has met all requirements of U co �' CI a c c the laws and rules of the state of Florida. is ' w W e s Expiration Date: Q 3 a < JANUARY 31, 2021 -I= s:t- '; _ a �O d � CRETAN D RAJADHYAKSHA w t4. ¢ i U a ° $ o 4300 ALTON RD } v Q .• '.... . CILLO pE o DEPT. RADIOLOGY ..� ' . o 0 Lu a o @ ; �¢ MIAMI BEACH, FL 33140 i' � �,• 'f w o '' ;a Fw'> a) k, W • Ron DeSantis GOVERNOR DISPLAY IF REQUIRED BY LAW EXPIRATION DATE:JANUARY 31,2021 Your license number is ME 97785.Please use it in all correspondence with your board/council.Each licensee is solely responsible for notifying the Department in writing of the licensee's current mailing address and practice location address.If you have not received your renewal notice 90 days prior to the expiration date shown on this license,please visit www.FLHealthSource govand click"Renew A License" to renew online. Medical Quality Assurance has a new and improved Online Services Portal.In the new system,you have the abilityto renew your license, update your mailing and practice location addresses,request a name change,request a duplicate license and update your profile information all from the convenience of your online account. 1. Go to www.FLHealthSource.gov. 2. Click on"Provider Services"and select"Manage Your License." 3. Select your profession and license type and click"Submit." 4. The question"Have you Renewed or Applied Online Since 2015?"will display. a. Click on"No"if you have not registered for an account in the new system and follow the instructions provided for new user registration. b. Click on"Yes"if you are a returning user.Enter the user ID and password you selected during the registration process,then select"Sign In"to access your MQA Online Services Portal account. IMPORTANT ANNOUNCEMENTS Are You Renewal Ready? Grounds for Discipline The Department of Health will now review your continuing education records at the You should be familiar with the Grounds for time of license renewal. Discipline found in Section 456.072(1), Florida Statutes,and in the practice act for To learn more,please visit the profession in which you are licensed. www.FLHealthSource.gov/AYRR Florida Statutes can be accessed at www.leg.state.fl.us/Statutes DocuSign Envelope ID: 192DD89C-A3C5-4226-BF99-1 A23E2A1 F635 Alfonso 0.Tolentino,MD 4300 Alton Rd.,Suite 2070 Miami Beach,FL 33140 305-674-2690 Alfonso.tolentino@msmc,com Place of Birth: Lucban,Quezon, Philippines Citizenship: USA ACADEMIC APPOINTMENTS, HOSPITAL APPOINTMENTS,AND OTHER WORK EXPERIENCE Academic Appointments 01/2013-present Columbia University Division of Cardiology at Mt Sinai Medical Center Miami Beach, FL Assistant Professor of Medicine Hospital Appointments 09/2013—present Mount Sinai Medical Center Miami Beach, FL Vice-Chair,Department of Medicine 01/2013—present Mount Sinai Medical Center Miami Beach,FL Director,Electrocardiography Laboratory 01/2012-present Mount Sinai Medical Center Miami Beach,FL Chairman, Pharmacy&Therapeutic Committee 01/2012-present Mount Sinai Medical Center Miami Beach, FL Member,Medical Services Committee 01/2000-present Mount Sinai Medical Center Miami Beach, FL Member,Cardiovascular Services Committee 01/2012-12/2012 Mount Sinai Medical Center Miami Beach,FL Co-Director,Electrocardiography Laboratory EDUCATION 07/1962—06/1967 University of the East-Ramon Magsayday Memorial Medical Center Quezon City, (UERMMMC) Philippines MD, 1967 07/1959—06/1962 University of the East Manila,Philippines Associate in Arts 1 DocuSign Envelope ID: 192DD89C-A3C5-4226-BF99-1 A23E2A1 F635 TRAINING 07/1974—06/1976 Mount Sinai Medical Center Miami Beach, FL Cardiovascular Disease Fellowship 07/1971—06/1974 Mercy Catholic Medical Center Philadelphia, PA Internal Medicine Residency 07/1967—06/1971 University of the East-Ramon Magsayday Memorial Medical Center Quezon City, (UERMMMC) Philippines Internal Medicine Residency LICENSURE AND BOARD CERTIFICATION BOARD QUALIFICATION American Board of Internal Medicine Cardiovascular Diseases 2007 American Board of Internal Medicine 2005 LICENSURE Florida Board of Medicine HONORS AND AWARDS 2016-2017 Cardiology Fellows Attending of the Year Award Miami Beach, FL Mount Sinai Medical Center 2009-2010 Cardiology Fellows Attending of the Year Award Miami Beach,FL Mount Sinai Medical Center 2007-2008 Cardiology Fellows Attending of the Year Award Miami Beach, FL Mount Sinai Medical Center 2004-2005 Cardiology Fellows Attending of the Year Award Miami Beach, FL Mount Sinai Medical Center 1998-1999 Residents Teacher of the Year Award Miami Beach, FL Mount Sinai Medical Center 2 DocuSign Envelope ID: 192DD89C-A3C5-4226-BF99-1 A23E2A1 F635 PROFESSIONAL ORGANIZATIONS AND SOCIETIES MEMBERSHIPS AND POSITIONS • Fellow,American College of Cardiology • Fellow,American College of Physician • Fellow,American Heart Association,Council for Thrombosis • Member, Heart Rhythm Society • Member,Cardiac Electrophysiology Society • Member,American Medical Association EDUCATIONAL CONTRIBUTIONS 07/2015-Present Clinical Competency Committee(Cardiovascular Disease Fellowship) Miami Beach, FL Description:ACGME evaluation of fellows twice per academic year Mount Sinai Medical Center 07/2000-Present MATCH Selection Committee(Cardiovascular Disease Fellowship) Miami Beach,FL Description: Interview and selection of candidates Mount Sinai Medical Center 07/1976-Present Cardiovascular Disease Fellowship Core Faculty Member Miami Beach, FL Description:Direct teaching and supervise during consultation service (twice a month)and ambulatory clinic(3 fellows weekly). Mount Sinai Medical Center 07/2010-06/2016 Annual ECG seminar for Emergency Department Residents Miami Beach,FL Mount Sinai Medical Center PUBLICATIONS ORIGINAL,PEER-REVIEWED RESEARCH PUBLICATIONS • Ugalde I,Anjum I, Lo Presti S,Tolentino A. Myocardial Infarction Presenting as Ear Fullness and Pain.J Investig Med High Impact Case Rep.2018 Mar 9;6:2324709618761753. doi:10.1177/2324709618761753.eCollection 2018 Jan-Dec. • Brenes JC, Brenes-Pereira C, Lupu C,Tolentino A.An Asymptomatic Man with an Abnormal ECG.Circulation.2017 Nov 7;136(19):1857-1859.doi: 10.1161/CI RCULATIONAHA.117.028373. • Peguero JG, Lo Presti S, Perez J, Issa 0,Brenes JC,Tolentino A. Reply: New Criteria for LVH Should Be Evaluated Against Age.J Am Coll Cardiol.2017 Oct 24;70(17):2207-2208.doi:10.1016/j.jacc.2017.08.045. • Peguero JG,Lo Presti 5,Perez J,Issa 0, Brenes JC,Tolentino A. Reply:Electrocardiographic Criteria for Diagnosing Left Ventricular Hypertrophy and Predicting Mortality in Patients With Aortic Stenosis.J Am Coll Cardiol.2017 Oct 3;70(14):1832.doi: 10.1016/j.jacc.2017.07.785. 3 DocuSign Envelope ID: 192DD89C-A3C5-4226-BF99-1 A23E2A1 F635 • Peguero JG, Lo Presti S, Perez J, Issa 0, Brenes JC,Tolentino A. Reply:Adjustments of Electrocardiographic Criteria for the Diagnosis of Left Ventricular Hypertrophy.J Am Coll Cardiol.2017 Aug 1;70(5):687.doi: 10.1016/j.j a c c.2017.05.05 9. • Peguero JG,Lo Presti S, Perez J,Issa 0, Brenes JC,Tolentino A.Electrocardiographic Criteria for the Diagnosis of Left Ventricular Hypertrophy.J Am Coll Cardiol.2017 Apr 4;69(13):1694-1703. doi: 10.1016/j.jacc.2017.01.037. • Mihos CG, Krishna RK,Kherada N, Larrauri-Reyes M,Tolentino A,Santana 0.The use of ranolazine in non-anginal cardiovascular disorders:A review of current data and ongoing randomized clinical trials. Pharmacol Res.2016 Jan;103:49-55.doi: 10.1016/j.phrs.2015.10.018. Epub 2015 Nov 4. • Pineda AM, Issa 0,Cortes-Bergoderi M, Mihos CG,Brenes JC,Tolentino A.An example of the deleterious effects of right ventricular apical pacing. Rev Cardiovasc Med.2015;16(1):84-9. • Eidelman RS1,Dieguez FJ Jr,Tolentino A,Zebede J. Malfunction of a biventricular pacing device?Pacing Clin Electrophysiol. 2004 Oct;27(10):1453-4. • Hildner FJ, Furst A, Krieger R,Chengot M,Javier RP,Tolentino AO,Samet P. New principles for optimum left ventriculography. Cathet Cardiovasc Diagn. 1986;12(4):266-73. • Tolentino AO,Javier RP,Samet P. Electrocardiographic patterns of normally functioning dual chamber pacemakers. Mt Sinai J Med. 1985 Feb;52(2):116-22. • Tolentino AO,Javier RP, Byrd C,Samet P. Pacer-induced tachycardia associated with an atrial synchronous ventricular inhibited (ASVIP) pulse generator.Pacing Clin Electrophysiol. 1982 Mar;5(2):251-9. • Hildner FJ,Javier RP,Tolentino A,Samet P. Pseudo complications of cardiac catheterization:update.Cathet Cardiovasc Diagn. 1982;8(1):43-7. • Gann D,Tolentino A,Samet P. Electrophysiologic evaluation of elderly patients with sinus bradycardia:a long-term follow-up study.Ann Intern Med.1979 Jan;90(1):24-9. • Narula OS,Tolentino AO.Ten Year Perspective Observations on HV Intervals in Patients with RBBB and LAD. Circulation; 1978 Nov. • Chandraratna PA,Tolentino AO,Mutucumarana W,Gomez AL. Echocardiographic observations on the association between mitral valve prolapse and asymmetric septal hypertrophy. Circulation. 1977 Apr;55(4):622-6. • Chandraratna PA,Rashid A,Tolentino A, Hildner FJ,Fester A,Samet P, Littman BB,Sabharwal S. Echocardiographic assessment of left ventricular function in coronary arterial disease. Br Heart J. 1977 Feb;39(2):139-44. ABSTRACTS • Omar Issa, Ben Hurwitz,Jody Ritter,Saberio Lo Presti;Alfonso Tolentino ECG Criteria for the Identification of Bi- Ventricular Pacing.ACC Poster-March 2017 • Rama Krishna,Alfonso Tolentino.Cardiology Education and Training Beyond Borders Using 3-D Holograph Projections and Robotics; ACC Poster-March 2015 4 DocuSign Envelope ID: 192DD89C-A3C5-4226-BF99-1A23E2A1 F635 • Valdez GD,Tolentino A,Santana 0, Lamas GA,Brenes JC. Left Ventricular Electrocardiographic Strain Pattern is Associated with an Abnormal Global Longitudinal Strain in Patients with Severe Aortic Stenosis and Normal Ejection Fraction;JASE vol 2,(6),June 2013. Book Chapter • Indications for Pacing in Bradyarrhythmias Tolentino AO,Javier RP,Samet P.Cardiac Pacing and Electrophysiology, Chapter 37, 1991;El-Sherif N, Samet P, authors. 5 . • . • . - - -—- __..., DocuSign Envelope ID:192DD89C-A3C5-4226-BF99-1A23E2A1F 635 -- di.u.x.e • • • . . • . . .. .. . .. _ i . . ,, '‘‘..1 - 1. a•,... ....., .•••tr. , • 41,64-..,•°fir.-4141-1- -PA)•.:- . .':?‘"1-414,:.-Thicittlit*-11.44-rii ,- fi•ki,,,,,,iff,;•.1.tZt il (4,:••••;',‘' l v• r t'letkrttl 1'•? i* '.1' . ' .. . " tfr,'? 1..e.o 0 Li-4,' :'c' l''' - ''.. sii14 'U.'ll;.4 4).)'1 V?,k•k i(Y) '' 'ir 5..,5'.1 Al •"kr..r.5^' 41r, t1.14ike,..-.., -p ff.Akmw ••4:ft.,04tcrii. ....., Iii , •!:,,,"44,—, !,....1 '%;°:,e. e,it 0.901194.PO'NTP4#11''.. '41-.70§ 0414ttiFR ..,7:sith •.'0.:f.diktw.4;1A1,:si... 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' . . .;;EXPIRATION DAlt:JANUARYS!.2022 i • •' Your license numlier Is ME 27147.Please use It In all cerrespondonoe v.121 your boord/council.Each licensee is coley moon sibie for notifying ..the Department In writing of the licensee's currant me:Erg address and practice location address.If you have not received your renewer notce 90 days prior to the explretIon date shown on this license,please vial!vAhiv.PLUttalthSouroo.gon end slick"Renew A Ucense to renew online. • ,The Medical Quality Assurance Online Services Poial gives you the ability to manage your license'.o perforgr address Updates,name changes, request duplicate licenses and much more. It's sirritie. Log onto your MQA Online Services account today at htividthealthsource.gov/.Selact the'Account Loginbutton to access your account For changes to your name,address or to request duplicate licenses,choose your selection from the dropdown Hat under'Manage My ,. -IJcenso%Your prelim:Ise.will open for renewal 90 days pdor 10 your expiration date.When the renewal cycle opens for your proresslon,the • , 'Renew My Uceitse7 header Wil automatically display on your license Dashboard. . • ' •-. . . . • • • ..• . . . • .' • , ' •6, • . . . . , .• • „ • jtepassaumgatisamiu , . • • ARE YOU RENEWAL READY/ ' GROUNDS FOR DISCIPLINE . i , The Department of Hselli at now review YcushOold be fainfiler with the Groonds for . . . . conenuing education records et The Disdefine found ki Section 40.07211), the of license renewal. FIolida Statutes,and in the pre sic,eel for 5 . . - • ino profession in ufith you An licensed. • • . . To loam more pleas.v;s11 Florida Statutes can bo accessed at .' viww.FaieslinSaurce.acrdAYRR moo iag.strite.d.ustStaiLles • • i! '-C.. - -- ---- -- . • . --- • • • . • . • • •. . ,..... • ' DocuSign Envelope ID: 192DD89C-A3C5-4226-BF99-1 A23E2A1 F635 Yanko Enamorado,M.D.,M.B.A. 1621 Collins Ave,Apt 916 Miami Beach FL 33139 Cell: (305)764-2148 yanko.enamorado.md@gmail.com EDUCATION AND TRAINING Healthcare Master of Business Administration (August 2017-December2018) Florida International University 1101 Brickell Avenue, Suite 300-S. Miami, FL 33131 Office: 305 779-9229IFax: 305 779-7890 https://hcmba.fiu.edu Electroconvulsive Therapy Mini-fellowship course(May 2017) Emory University School of medicine 100 Woodruff Circle NE, Atlanta, GA 30322 Phone: 404-727-5695 Fax: 404-727-5667 Fellowship/Child &Adolescents Psychiatry(July 2014-June 2016) Hofstra North Well-LU School of Medicine Child and Adolescent Psychiatry Fellowship 75-59 263rd Street @ 74th Avenue Glen Oaks,NY 11004 Phone: 718-470-4834 Fax: 718-470-4678 Residency/General Psychiatry(July 2011-June 2014) Cooper hospital of Rowan University, General Psychiatry Resident 401 Haddon Avenue Camden,NJ 08103 Ph: 856-757-7853 Fax: 856-757-9651 Graduate School(May 2004-February 2010) Iberoamerican University Medical School Ave. Francia,No 129 Gazcue, Santo Domingo, Dominican Republic (809) 689 4111 Fax:(809)687 9384 www.unibe.edu.do Undergraduate School (August 2002-April 2004) Miami Dade College 11011 SW 104 ST Miami,FL 33176 (305)237200 www.mdc.edu/kendal/ DocuSign Envelope ID: 192DD89C-A3C5-4226-BF99-1A23E2A1 F635 WORK EXPERIENCE 2016-Present Mount Sinai Medical Center,Miami Beach,FL Outpatient, Inpatient, ER, C&L, Psychiatrist of MSMC Adult Autism Clinic, ECT service 2016-2018 Unity Skilled Nursing and rehabilitation,Miami,FL Geriatric and Rehabilitation (MSMC contracted) 2015-2016 Lexington Center for the Deaf,Queens,NY Medical director(Part time) 2015-2016 NYU Lutheran Hospital,Brooklyn NY ER and C&L(Moonlighting) 2015-2016 Lincoln Hospital,Bronx,NY ER(Moonlighting) 2014-2015 Long Island Jewish Medical center, Queens,NY ER, C&L(Moonlighting) 2014-2015 Syosset Community Hospital,Long Island, NY ER,Adult Inpatient(Moonlighting) 2014-2015 North Shore Community Hospital,Long Island,NY ER, C&L(Moonlighting) 2011-2014 Atlanticare Regional Hospital,Atlantic City,NJ ER,Crisis center,Acute Partial program,ACT team 2010-2011 Fortis College,Miami FL Microbiology,Anatomy and Physiology Professor. 2010-2011 Kaiser University,Miami FL Anatomy and Physiology Professor SCHOLARY ACTIVITIES Grand Rounds Anxiety Disorders(Mount Sinai Medical Center,2017) ADHD and Bipolar Disorder in Children(Cooper Hospital, 2016) Intellectual Disabilities (LIJ, 2016) Anxiety Disorders (Atlanticare Hospital,2014) Overview and History of Psychotherapy(Cooper Hospital,2014) Committees Education Curriculum (Cooper Hospital of Rowan University,2013) Psychotherapy Curriculum (Cooper Hospital of Rowan University,2013) Monitoring program for APA meeting(San Francisco,2013) AWARDS/CERTIFICATIONS /LICENSES/ASSOCIATIONS Magna-Cum Laude Graduated,2010 Education Commission for Foreign Medical Graduates (ECFMG),2010 APA Resident Recognition Award for Clinical Excellence,2015 American Board of Psychiatry and Neurology Certification,2016 NJ Medical license,2013-2015 NY Medical License, 2014-2016 FL Medical License,2015-2019 American Psychiatry Association DocuSign Envelope ID: 192DD89C-A3C5-4226-BF99-1A23E2A1 F635 American Academy of Child and Adolescent Psychiatry Association ADDITIONAL TRAININGS AND COURSES Landmark Forum Curriculum, 2016 Landmark Leadership Personal Effectiveness and leadership Course, 2016 Lean-Six Sigma Green Belt Certification,2018 IMB-Watson Certification,2018 Global Education program 2018 (Germany/France/UK) 7,,54 . 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' A'41:::•74::••rz4.C..v, '1 ..,;:•(-,ilitiOft•'..e... --- ', N,,,•••.` .4 .44;• • ' . 44;:'r: '.7'r' ; S.60.P''..**1.":' ''."''''':.:11;i.'.:al?'3'Ck'...S.'431"4:14:44.fi"??.'‘.;!:47.:.1•40^.-. eir''''''.."‘i;t;Zf'''''':'•,• i'S ' ,-3,41195e113•02-151r,y1-'''2 r,'''''''5V445,...... .. li.1 :.',-;•'::•%sk'', ''''.:' '''..Yit b u. .9A 71/4R-r.'• 6 „ . - --.-,: ;**,..0?-t;::,::;.''‘iii;vv..t.?-0.,;:0-3,;..„-'01.i':.',,::::':,:....1:: -64thi..g„4.H. 1.'. . ., . „,,,,fl'ir ,,,tf-elc: • ;‘,,,, -,........,„,..., 1:;:i...,„ ...,..,,,_§.....ifow:..:......;.......* • , . . ,,,: •,. ,04-4 • 4„.,,,T; ,,•., ,4,..'1 .:, 4,., Ag,?4•••1...-.:;:,.....,,,q,., spfrA,y,,...=:m . 1. '3%144•,f; 14, '444e.R ,•,.:,.....i,;,:z•yil,..A•kt.....,..31,-, ...—.- -..•• ..- .. • • • • • • • • DocuSign Envelope ID: 192DD89C-A3C5-4226-BF99-1A23E2A1 F635 CHRISTOS G. MIHOS DO 2353 Massachusetts Avenue#74 Cambridge,MA 02140 (617) 922-4743 cmihos@mgh.harvard.edu dremihos@gmail.com DATE OF May 31, 2016 PREPARATION PERSONAL DOB: May 3, 1981 Place of birth: Cambridge, MA EDUCATION 08/2005-05/2009 Doctor of Osteopathic Medicine Nova Southeastern University 07/1999-05/2003 Bachelor of Art,Biology Brandeis University POST-GRADUATE TRAINING 07/2015-06/2017 Advanced Echocardiography Massachusetts General Hospital, Boston MA 07/2014-06/2015 Chief Fellow, Cardiovascular Disease Fellowship Mount Sinai Medical Center, Miami Beach FL 07/2012-06/2014 Fellowship, Cardiovascular Disease Mount Sinai Medical Center,Miami Beach FL 07/2011-06/2012 Chief Resident, Internal Medicine Mount Sinai Medical Center, Miami Beach FL 07/2009-06/2011 Internship/Residency, Internal Medicine Mount Sinai Medical Center, Miami Beach FL MEDICAL LICENSURE&CERTIFICATIONS 04/2015-present Massachusetts, License No. 262193 1 DocuSign Envelope ID: 192DD89C-A3C5-4226-BF99-1 A23E2A1 F635 04/2011-present Florida,License No. OS 11325 07/2009-present Advanced Cardiac Life Support(ACLS) BOARD QUALIFICATIONS 08/2015-present Cardiovascular Disease, Subspecialty Board Certification American Osteopathic Board of Internal Medicine 10/2014-present National Board of Echocardiography Adult Comprehensive Echocardiography,Level III (#28347) 09/2012-present Internal Medicine, Board Certification American Osteopathic Board of Internal Medicine(#4327) EMPLOYMENT 06/2011-present VITAS Innovative Hospice Care,Palliative Care Physician ACADEMIC APPOINTMENTS 01/2012-present Clinical Assistant Professor, Department of Internal Medicine Nova Southeastern University College of Osteopathic Medicine PROFESSIONAL ORGANIZATIONS AND SOCIETIES 07/2015-present Massachusetts Medical Society 12/2013-present American Society of Echocardiography 05/2013-present Heart Valve Society of America 07/2012-present American College of Cardiology 06/2011-present Florida Osteopathic Medical Association1 07/2009-present American College of Osteopathic Internists 01/2006-present American Osteopathic Association HONORS AND AWARDS 2 DocuSign Envelope ID: 192DD89C-A3C5-4226-BF99-1 A23E2A1 F635 06/2015 Howard Kane Fellow of the Year Award Mount Sinai Medical Center,Miami Beach FL 06/2015 Outstanding Performance in Clinical Research Mount Sinai Medical Center,Miami Beach FL 03/2015 Woldenberg Foundation Cardiology Fellow's Award Mount Sinai Medical Center,Miami Beach FL 06/2012 Howard Kane Resident of the Year Award Mount Sinai Medical Center,Miami Beach FL 1 1/201 1 Experimental Research Award Nova Southeastern University, Davie FL 06/2011 Klausner Award for Outstanding Clinical Research Paper Mount Sinai Medical Center,Miami Beach FL 06/2005 Volunteer Service Award Dana-Farber Cancer Institute, Boston MA FELLOWSHIP AND GRANT SUPPORT 04/2015-04/2016 "Papillary muscle sling combined with mitral valve repair for functional mitral regurgitation: the SLING multicenter study" Principal Investigator,Total funds: $2,500 Sponsor:American Medical Association Foundation RESEARCH 07/2015-06/2017 Clinical Research Fellow, Harvard Medical School,Boston,MA 06/2000-01/2001 Hormone-refractory prostate cancer, Dana-Farber Cancer Institute, Boston MA DEPARTMENTAL AND UNIVERSITY COMMITTEES 07/2014-06/2015 Quality Improvement Committee,Division of Cardiology Mount Sinai Medical Center, Miami Beach FL 07/2011-06/2012 Graduate Medical Education Committee Mount Sinai Medical Center,Miami Beach FL 3 DocuSign Envelope ID: 192DD89C-A3C5-4226-BF99-1 A23E2A1 F635 EDITORIAL ACTIVITIES Manuscript Peer Reviewer: Catheterization and Cardiovascular Interventions Heart European Journal of Cardio-Thoracic Surgery Expert Review of Cardiovascular Therapy Journal of Heart Valve Disease PUBLICATIONS A) Original Articles 1. Pineda AM,Mihos CG, Rodriguez-Escudero JP, Lamelas J, Beohar N, Santana O. A staged approach of proximal left anterior descending coronary artery percutaneous intervention followed by minimally invasive valve surgery. J Heart Valve Dis 2016: In press. 2. Mihos CG, Pineda AM, Santana O. A meta-analysis of early versus delayed surgery for valvular infective endocarditis complicated by embolic ischemic stroke. Innovations(Phila)2016: In press. 3. Mihos CG, Pineda AM, Capoulade R, Santana O. A systematic review of mitral valve repair with autologous pericardial leaflet augmentation for rheumatic mitral regurgitation. Ann Thorac Surg 2016: In press. 4. Pineda AM, Chandra R, Gowani SA, Santana, 0, Mihos CG, Kirtane AJ, Stone GW, Kurlansky P, Smith CR, Beohar N. Completeness of revascularization and its impact on the outcomes of a staged approach of percutaneous coronary intervention followed by minimally invasive valve surgery for patients with concomitant coronary artery and valvular heart disease. Catheter Cardiovasc Intery 2016: In press. 5. Mihos CG, Pineda AM, Horvath SA, Santana O. Anterior mitral leaflet augmentation for ischemic mitral regurgitation performed via a right thoracotomy approach. Innovations(Phila.)2015: In press. 6. Gosain P, Larrauri-Reyes M, Mihos CG, Escolar E, Santana O. Aortic and/or mitral valve surgery in patients with pulmonary hypertension performed via a minimally invasive approach. Interact Cardiovasc Thorac Surg 2016;22:668-70. 7. Mihos CG, Larrauri-Reyes M, Santana O. A meta-analysis of ring annuloplasty versus combined ring annuloplasty and subvalvular repair for moderate-to-severe functional mitral regurgitation.J Card Surg 2016;31(1):31-37. 4 DocuSign Envelope ID: 192DD89C-A3C5-4226-BF99-1A23E2A1 F635 8. Horvath SA, Mihos CG, Rodriguez-Escudero JP, Elmandy HM, Pineda AM, Rosen JP, Brenes JC, Santana 0. Bicuspid aortic valve and aortic root morphology in hispanic patients. J Heart Valve Dis 2015;24:673-78. 9. Mihos CG, Santana 0, Pineda AM, Stone GW, Hasty F, Beohar N. Percutaneous coronary intervention followed by minimally invasive mitral valve surgery in ischemic mitral regurgitation. Innovations (Phila)2015;10(6):394-397. 10. Mihos CG, Pineda AM, Larrauri-Reyes MC, Davila H, Santana 0. Combined mitral and tricuspid valve surgery performed via a right thoracotomy approach. Innovations(Phila)2015;10(5):304-308. 11. Pelliccia F, Parodi G, Greco C, Anton iucci D, Brenner R, Bossone E, Cacciotti L, Capucci A, Citro R, Delmas C, Guerra F, Ionescu CN, Lairez 0, Larrauri-Reyes M, Lee PH, Mansencal N, Marazzi G, Mihos CG, Morel 0, Nef HM, Nunez Gil IJ, Passaseo I, Pineda AM, Rosano G, Santana 0, Schneck F, Song BG, Song JK, Teh AW, Ungprasert P, Valbusa A, Wahl A, Yoshida T, Gaudio C, Kaski JC. Comorbidities frequency in Takotsubo Syndrome: An international collaborative systematic review including 1109 patients. Am J Med 2015;128:654.e11-654.e19. 12.Krishna RK, Santana 0, Mihos CG, Pineda AM, Weiss UK, Lamelas J. Minimally invasive aortic valve replacement in octagenarians performed via a right anterior minithoracotomy approach. J Heart Valve Dis 2014;23:671-74. 13. Urbandt P, Santana 0, Mihos CG, Pineda AM, Lamelas J. Minimally invasive approach for isolated tricuspid valve surgery. J Heart Valve Dis 2014;23:783-87. 14. LaPietra A, Pineda AM, Santana 0, Mihos CG, Lamelas J. Outcomes of aortic valve and concomitant ascending aorta replacement performed via a minimally invasive right thoracotomy approach. Innovations (Phila). 2014;9(5):339-342. 15.Mihos CG. Santana 0, Pineda AM, Lamas GA, Lamelas J. Right anterior mini- thoracotomy versus median sternotomy surgery for native mitral valve infective endocarditis. J Heart Valve Dis. 2014;23:343-349. 16.Mihos CG, Santana 0, Pineda AM, Lapietra A, Lamelas J. Aortic valve replacement and concomitant right coronary artery bypass via a right mini- thoracotomy approach. Innovations(Phila). 2014;9(4):302-305. 17. LaPietra A, Santana 0, DeBeer S, Mihos CG, Lamelas J. Incidence of cerebrovascular accidents in patients undergoing minimally invasive valve surgery. J Thorac Cardiovasc Surg.2014:148(1):156-60. 18. Santana 0, Pineda AM, Cortes-Bergoderi M, Mihos CG, Beohar N, Lamas GA, Lamelas J. Outcomes of a hybrid approach of percutaneous coronary intervention 5 DocuSign Envelope ID: 192DD89C-A3C5-4226-BF99-1 A23E2A1 F635 followed by minimally invasive valve surgery in patients with concomitant coronary and valvular disease. Ann Thorac Surg. 2014;97:2049-2055. 19. Mihos CG, Santana 0, Lamelas J. Intermediate results of transaortic edge-to- edge repair of the mitral valve in patients undergoing aortic valve replacement. J Heart Valve Dis. 2014;23(1):91-96. 20. Santana 0, Solenkova NV, Pineda AM, Mihos CG, Lamelas J. Minimally invasive papillary muscle sling placement during mitral valve repair in patients with functional mitral regurgitation. J Thorac Cardiovasc Surg. 2014;147(1):496- 99. 21. Valdez GD, Mihos CG, Santana 0, Heimowitz TB, Goldszer R, Lamas GA, Lamelas J. Incidence of post-operative acute kidney injury in patients with chronic kidney disease undergoing minimally invasive valve surgery. J Thorac Cardiovasc Surg.2013;146(6):1488-93. 22. Santana 0, Reyna J, Pineda AM,Mihos CG, Elkayam LU, Lamas GA,Lamelas J. Outcomes of minimally invasive valve surgery in patients with an ejection fraction of 35%or less. Innovations (Phila).2013:8(1):1-5. 23.Mihos CG, Santana 0, Brenes JC, Lamelas J. Outcomes of transaortic edge-to- edge repair of the mitral valve in patients undergoing minimally invasive aortic valve replacement. J Thorac Cardiovasc Surg. 2013;145(5):1412-13. 24. Mihos CG, Santana 0, Lamas GA, Lamelas J. Incidence of post-operative atrial fibrillation in patients undergoing minimally invasive versus median sternotomy valve surgery. J Thorac Cardiovasc Surg.2012;146(6):1436-41. 25.Mihos CG, Santana 0, Peguero J, Lamelas J. Intra-atrial placement of a mitral prosthesis in patients with severe mitral annular calcification. J Heart Valve Dis. 2012;21(6):702-06. 26.Mihos CG, Santana 0, Lamas GA, Lamelas J. Outcomes of right minithoracotomy mitral valve surgery in patients with previous sternotomy. Ann Thorac Surg. 2011; 91(6):1824-27. 27.Taplin ME, George DJ, Halabi S, Sanford B, Febbo PG, Hennessey KT, Mihos CG, Vogelzang NJ, Small EJ, Kantoff PW. Prognostic significance of plasma chromogranin A levels in patients with hormone-refractory prostate cancer treated in Cancer and Leukemia group B 9480 study. Urology.2005;66(2):386-91. B) Reviews, Chapters, and Editorials 1. Carvalho N, Pineda AM, Mihos CG, Gowani SA, Santana 0, Desouza KA, Stone GW, Beohar N. Managing multi-vessel coronary artery disease in patients with 6 DocuSign Envelope ID: 192DD89C-A3C5-4226-BF99-1 A23E2A1 F635 ST-elevation myocardial infarction: a comprehensive review. Cardiol Rev 2016: In press. 2. Groves DB, Mihos CG, Larrauri-Reyes M, Santana O. The use of statins in the treatment and prevention of atrial fibrillation. Cardiol Rev 2016: In press. 3. Mihos CG, Satana O. Mitral valve repair for ischemic mitral regurgitation: lessons from the Cardiothoracic Surgical Trials Network randomized study. J Thorac Dis 2016;8(1):E94-99. 4. Mihos CG, Santana O. Is an adjunctive subvalvular repair during mitral annuloplasty for secondary mitral regurgitation effective in preventing recurrent regurgitation?Interact Cardiovasc Thorac Surg 2016;22(2):216-221. 5. Santana 0, Larrauri-Reyes M, Zamora C, Mihos CG. Is a minimally invasive approach to mitral valve surgery more cost-effective than median sternotomy? Interact Cardiovasc Thorac Surg 2016;22(1):97-100. 6. Mihos CG, Picard MH. Mitral regurgitation in a patient with dilated cardiomyopathy. http://www.acc.org. December 7, 2015. http://education.acc.org/Lifelong-Learning-and-MOC/Certified- Learning/CaseVignettes/20I 5Nalvular/Valvular MR_Di lated_Cardiomyopathy.a spx. 7. Mihos CG, Santana O. Annluoplasty ring selection in ischemic mitral regurgitation for valve repair during coronary artery bypass grafting. J Card Surg 2015;30:906. 8. Pineda AM, Mihos CG, Singla S, Santana 0, Rhodes III J, Sommer RJ, Rihal C, Beohar N. Percutaneous closure of intracardiac defects in adults: state-of-the-art. J Invasive Cardiol 20I5;27:561-572. 9. Mihos CG, Krishna RK, Kherada N, Larrauri-Reyes M, Tolentino 0, Santana O. The use of ranolazine in non-anginal cardiovascular disorders: a review of current data and ongoing randomized clinical trials.Pharmacol Res 2016;103:49-55. 10. Mihos CG, Pineda AM, Santana O. Targeting the papillary muscles in mitral valve repair for ischemic mitral regurgitation. Rev Cardiovasc Med 2015;16(3):182-188. 11. Casanova P, Artola RT, Mihos CG, Pineda AM, Santana O. The cardiovascular effects of colchicine:a comprehensive review. Cardiol Rev 2015;23(6):317-322. 12. Mihos CG, Santana O. Can papillary muscle interventions improve mitral valve repair durability for ischemic mitral regurgitation? J Thorac Cardiovasc Surg 2015;150:427-28. 7 DocuSign Envelope ID: 192DD89C-A3C5-4226-BF99-1 A23E2A1 F635 13.Mihos CG, Pineda AM, Santana 0. Mitral valve repair for ischemic mitral regurgitation: should we be targeting the papillary muscles? Ann Thorac Surg 2015;99:1489-90. 14. Gosain P, Yamani N, Santana 0, Mihos CG, Lamelas J. Hybrid coronary revascularization: a systematic review. Cardiol Rev 2015;23:87-93. 15.Mihos CG, Pineda AM, Santana 0. Cardiovascular effects of statins, beyond lipid-lowering properties. Pharmacol Res. 2014;88:12-19. 16. Gomez SI, Mihos CG, Pineda AM, Santana 0. The pleiotropic effects of the hydroxyl-methyl-glutaryl-CoA reductase inhibitors in renal disease. Int J Nephrol Renovasc Dis. 2014;7:123-30. 17. Lamelas J, Mihos CG, Santana 0. Surgical technique: papillary muscle sling for functional mitral regurgitation during minimally invasive valve surgery. Heart Surg Forum. 2013;16(5):E295-97. 18. Santana 0, Solenkova NV, Pineda AM, Mihos CG, Lamelas J. Letter to the editor (Response: "Minimally invasive papillary muscle sling placement during mitral valve repair in patients with functional mitral regurgitation.") J Thorac Cardiovasc Surg.2013;146(5):1309-10. 19.Lamelas J, Mihos CG, Santana 0. Minimally invasive transaortic edge-to-edge repair of the mitral valve. J Heart Valve Dis. 2013;22:11-13. 20. Yanuck D, Mihos CG, Santana 0. Mechanisms and clinical evidence of the pleiotropic effects of the hydroxyl-methyl-glutaryl-CoA reductase inhibitors in central nervous system disorders: a comprehensive review. Int J Neurosci. 2012;122(11):619-29. 21. Mihos CG, Santana 0, Lamelas J. Letter to the Editor (Response: "Trans- ventricular edge-to-edge repair of the mitral valve during surgical ventricular restoration.") J Card Surg. 2012;27(5):601. 22. Zeichner S, Mihos CO, Santana 0. The pleiotropic effects and therapeutic potential of the hydroxy-methyl-glutaryl-CoA reductase inhibitors in malignancies: a comprehensive review. J Cancer Res Ther. 2012;8(2):176-83. 23. Mihos CG, Artola RT, Santana 0. The pleiotropic effects of the hydroxy-methyl- glutaryl-CoA reductase inhibitors in rheumatologic disorders: a comprehensive review. Rheumatol Int. 2012;32(2):287-94. 24.Mihos CG, Santana 0. Pleiotropic effects of the HMG-CoA reductase inhibitors. Int J Gen Med.2011;4: 261-71. 8 DocuSign Envelope ID: 192DD89C-A3C5-4226-BF99-1A23E2A1 F635 25. Artola RT, Mihos CG, Santana O. Immunology of mitral valve stenosis. Int J Interferon Cytokine Mediator Res.2011;3:1-8. 26. Mihos CG, Salas MJ, Santana O. The pleiotropic effects of the hydroxy-methyl- glutaryl-CoA reductase inhibitors in cardiovascular disease: a comprehensive review. Cardiol Rev. 2010; 18(6): 298-304. C) Case Reports 1. Pineda AM, Mihos CG, Nascimento FO, Santana 0, Lamelas J, Beohar N. Coronary embolization from a left atrial myxoma containing malignant lymphoma cells. Tex Heart Inst J 2015;42:565-68. 2. Mihos CG, Pineda AM, Santana 0, Krishna RK, Lamelas J. Tricuspid valve repair with pericardial tube placement via a right minithoracotomy. J Heart Valve Dis 2015;24(3):338-341. 3. Pineda AM, Issa 0, Cortes-Bergoderi M, Mihos CG, Brenes JC, Tolentino A. An example of the deleterious effects of right ventricular apical pacing. Rev Cardiovasc Med 2015;16(1):84-89. 4. Pineda AM, Valdez GD, Mihos CG, Santana 0, Beohar N. Coil embolization for spontaneous rupture of the left internal mammary artery secondary to lupus vasculitis. J Am Coll Cardiol. 2014;63(3):290. 5. Mihos CG, Santana 0, Lamelas J. Trans-ventricular edge-to-edge repair of the mitral valve during surgical ventricular restoration: Review of the Literature. J Card Surg.2012;27(1):52-55. 6. Mihos CG, Artola RT, Torres AM. Nonbacterial thrombotic endocarditis as a surgical complication in a patient status post mitral valve repair with patent foramen ovale closure. Internet Journal of Cardiology 2010; 9(1). D) Abstracts 1. Capoulade R, Handschumacher M, Mihos CG, Zeng X, Teoh JT, Park YH, Bartko P, D'Alessandro DA, Melnitchouk S, Levine RA, Hung J. Mitral valve mapping of tethering patterns in ischemic mitral regurgitation by 3D echocardiography analysis.J Am Soo Echocardiogr 2016: In press. 2. Krishna RK, Kherada N, Mihos C, Santana O. Outcomes of minimally invasive valve surgery after multiple redo cardiac surgeries.JACC Intery 2016;9:S45. 9 DocuSign Envelope ID: 192DD89C-A3C5-4226-BF99-1 A23E2A1 F635 3. Mihos CG, Larrauri-Reyes M, Hung J, Santana 0. Transaortic edge-to-edge mitral valve repair for functional mitral regurgitation in patients undergoing aortic valve replacement: a 13-year experience. Circulation 2015;132:A17113. 4. Pineda AM, Chandra R, Gowani SA, Mihos CG, Santana 0, Kirtane AJ, Stone GW, Kurlansky P, Smith CR, Beohar N. Completeness of revascularization and its impact on outcomes of a staged approach of percutaneous coronary intervention followed by minimally invasive valve surgery for patients with concomitant coronary artery and valvular heart disease. Circulation 2015;132:A 10460. 5. Pineda AM, Rodriguez-Escudero JP, Mihos C, Santana 0, Beohar N. Percutaneous coronary intervention followed by minimally invasive valve surgery versus conventional median sternotomy coronary artery bypass graft and valve surgery in patients with prior cardiac surgery. Catheter Cardiovasc Intery 2015;85(S2):S87-88. 6. Pineda AM, Chandra R, Mihos CG, Santana 0, Beohar N. Impact of complexity of coronary artery disease on outcomes in patients undergoing a hybrid approach of percutaneous coronary intervention followed by minimally invasive valve surgery. Catheter Cardiovasc Intery 2015;85(S2):S88-89. 7. Pineda AM, Rodriguez-Escudero JP, Mihos CG, Krishna R, Santana 0, Beohar N. Percutaneous coronary intervention followed by minimally invasive valve surgery versus conventional combined coronary artery bypass graft and valve surgery in patients with severely reduced left ventricular systolic function. Catheter Cardiovasc Intery 2015;85(S2):S85-87. 8. Mihos CG, Santana 0, Pineda AM, Lamelas J. Improved left ventricular remodeling after mitral valve repair combined with a papillary muscle sling for functional mitral regurgitation: an echocardiographic analysis. J Am Coll Cardiol 2015;10(Suppl A):A492-93. 9. Pineda AM, Escodero-Rodriguez JP, Mihos CG, Lamelas J, Beohar N, Santana 0. Predictors of long-term mortality in patients undergoing minimally invasive valve surgery. J Am Coll Cardiol 2015;10(Suppl A):A484. 10. Pineda AM, Escodero-Rodriguez JP, Mihos CG, Krishna R, Santana 0, Beohar N. Hybrid approach of percutaneous coronary intervention followed by minimally invasive valve surgery for patients with concomitant coronary artery and valvular heart disease and severely reduced left ventricular systolic function. JACC Intery 2015;8(2 Suppl S):S26-27. 1. Pineda AM, Mihos CG, Yang SC, Santana 0, Lamelas J, Beohar N. Hybrid approach of percutaneous coronary intervention followed by minimally invasive valve surgery versus conventional median sternotomy coronary artery bypass I0 DocuSign Envelope ID: 192DD89C-A3C5-4226-BF99-1A23E2A1 F635 graft plus valve surgery: a propensity matched comparison. Circulation 2014;130:A 16087. 12. Pineda AM, Escodero-Rodriguez JP, Santana 0,Mihos CG, Lamelas J, Beohar N. Hybrid approach of PCI followed by minimally invasive single valve sugery: outcomes by STS risk stratification. J Am Coll Cardiol 2014;64(11 Suppl B):B35. 13. Elmandy HM, Pineda AM, Horvath SA, Santana 0, Mihos CG, Beohar N, Lamelas J. Outcomes of a hybrid approach of percutaneous coronary intervention followed by minimally invasive aortic valve replacement. Cardiology 2014;128(Suppl l):131. 14. Pineda AM, Mihos CG, Horvath S, Nascimento FO, Kodali SK, Kirtane AJ, Beohar N. Mid-term outcomes of high risk left main coronary artery percutaneous coronary intervention in an elderly population. Cardiology 2014;128(Suppl 1):108-109. 15. Horvath SA, Mihos CG, Pineda AM, Elmandy HM, Santana 0, Rodriguez- Escodero JP, Beohar N, Lamelas J. Hybrid approach of percutaneous coronary intervention and minimally invasive mitral valve surgery in patients with coronary artery and mitral valve disease. Cardiology 2014;129(Suppl 1):145. 16. Horvath SA, Mihos CG, Elmandy HM, Pineda AM, Rodriguez-Escodero JP, Santana O. Bicuspid aortic valve and aortic root morphology in Hispanic patients. Cardiology 2014;128(Suppl 1):494. 17. Elmandy HM, Gomez SI, Mihos CG, Horvath SA, Pineda AM, Santana 0, Lamelas J. Predicted and observed outcomes of minimally invasive surgery for native aortic or mitral valve infective endocarditis via a right mini-thoracotomy approach. Cardiology 2014;128(Suppl 1):506. 18. Pineda AM, Santana 0, Mihos CG, Cortes-Bergoderi MJ, Beohar N, Lamas GA, Lamelas J. Outcomes of hybrid approach of proximal left anterior descending coronary PCI followed by minimally invasive surgery. Cardiology 2014;128: 108-109. 19. LaPietra A, Santana 0, Pineda AM, Mihos CG, Lamelas J. Outcomes of minimally invasive right anterior thoracotomy approach to reoperative aortic valve surgery. Cardiology 2014;128:174. 20. Mihos CG, Pineda AM, Santana 0, Lamelas J. Mitral valve repair and concomitant papillary muscle sling placement via a right anterior minithoracotomy in patients with functional mitral regurgitation. J Am Coll Cardiol. 2014;63(12 Suppl 1):A1992. 11 DocuSign Envelope ID: 192DD89C-A3C5-4226-BF99-1A23E2A1 F635 21. Pineda AM, Santana 0, Cortes-Bergoderi M, Mihos CG, Beohar N, Lamas GA, Lamelas J. Outcomes of a hybrid approach of percutaneous coronary intervention followed by minimally invasive valve surgery in patients with concomitant coronary and valvular disease. J Am Coll Cardiol. 2014;63(12 Suppl 1):A1938. 22. Pineda AM, Mihos CG, Nascimento FO, Santana 0, Lamelas J, Beohar N. Coronary embolization from a large left atrial myxoma with concomitant B-cell lymphoma. J Am Coll Cardiol. 2014;63(12 Suppl 1):A619. 23. Mihos CG, Santana 0, Brenes JC, Lamelas J. Outcomes of transaortic edge-to- edge repair of the mitral valve in patients undergoing minimally invasive aortic valve replacement. Innovations (Phila). 2012;7(2):116. 24. Minos CG, Santana 0, Lamas GA, Lamelas J. Incidence of post-operative atrial fibrillation in patients undergoing minimally invasive valve surgery. Cardiology. 2012;121:120-21. 25. Santana 0, Venkatesan VD, Mihos CG, Lamelas J. Outcomes of a right mini- thoracotomy approach for aortic valve replacement. Methodist Debakey Cardiovasc J. 2012;8(Suppl 1):S22. 26. Taplin ME, George DJ, Halabi S, Sellers WR, Sanford B, Hennessy KT, Mihos CG, Small EJ, Kantoff PW. Prognostic significance of plasma chromogranin A levels in hormone-refractory prostate cancer patients treated on Cancer and Leukemia Group B (CALGB) 9480. J Clin Oncol. 2004;22(14S):4557. PRESENTATIONS&LECTURES I. "Mitral valve repair for ischemic MR: echocardiographic insights into the CTSN randomized trial." Echocardiography CME Lecture Series, Massachusetts General Hospital. Boston MA, May 5 2016. 2. "Echocardiography in pulmonary hypertension."Echocardiography CME Lecture Series, Massachusetts General Hospital. Boston MA, April 7 2016. 3. "Early echocardiographic outcomes of mitral valve annuloplasty versus annuloplasty combined with a papillary muscle sling for moderate to severe functional mitral regurgitation." Heart Valve Society 2016 Annual Scientific Meeting.New York,NY.March 18 2016. 4. "Staged percutaneous coronary intervention followed by minimally invasive mitral valve surgery versus combined coronary artery bypass graft and mitral valve surgery for mulit-vessel coronary artery disease and severe ischemic mitral regurgitation." Heart Valve Society 2016 Annual Scientific Meeting. New York, NY. March 18 2016. 12 DocuSign Envelope ID: 192DD89C-A3C5-4226-BF99-1A23E2A1 F635 5. "Early versus delayed surgery for patients with valvular infective endocarditis complicated by embolic ischemic cerebrovascular events: a meta-analysis of 14 studies." Heart Valve Society 2016 Annual Scientific Meeting. New York, NY. March 18 2016. 6. "Mitral annular calcification: a complex disease." Echocardiography CME Lecture Series, Massachusetts General Hospital. Boston MA,January 14 2016. 7. "Relationship between ascending aorta morphology and progression of aortic stenosis." American Heart Association 2015 Scientific Sessions. Orlando FL, November 10 2015. 8. "Transaortic edge-to-edge mitral valve repair for functional mitral regurgitation in patients undergoing aortic valve replacement: a 13-year experience." American Heart Association 2015 Scientific Sessions. Orlando FL,November 9 2015. 9. "Echocardiography in Hypertrophic Cardiomyopathy: 2015 Update." Echocardiography CME Lecture Series, Massachusetts General Hospital. Boston MA, September 2 2015. 10. "Hypertrophic cardiomyopathy: diagnosis and management in 2015." Internal Medicine Core Curriculum Lecture Series. Mount Sinai Medical Center. Miami Beach FL, May 21 2015. 11. "Geometric and reverse remodeling effects of complex mitral valve repair utilizing a papillary muscle sling in patients with severe ischemic mitral regurgitation." 2015 Mitral Conclave,American Association for Thoracic Surgery. New York NY, April 23-24 2015. 12. "Staged approach of percutaneous coronary intervention followed by minimally invasive mitral valve surgery versus combined coronary artery bypass graft and mitral valve surgery for severe ischemic mitral regurgitation." 2015 Mitral Conclave, American Association for Thoracic Surgery. New York NY, April 23- 24 2015. 13. "Combined mitral and tricuspid valve surgery performed via a right minithoracotomy approach." 2015 Mitral Conclave, American Association for Thoracic Surgery. New York NY, April 23-24 2015. 14. "Improved left ventricular remodeling after mitral valve repair combined with a papillary muscle sling for functional mitral regurgitation: an echocardiographic analysis." American College of Cardiology 64" Annual Scientific Session, San Diego CA, March 16 2015. 13 DocuSign Envelope ID: 192DD89C-A3C5-4226-BF99-1A23E2A1 F635 15. "Ischemic mitral regurgitation: Current perspectives and future directions." Cardiology Grand Rounds, Columbia University Division of Cardiology, Mount Sinai Heart Institute. Miami Beach FL,October 30 2014. 16. "Ischemic mitral regurgitation." Mount Sinai Medical Center, Internal Medicine Core Curriculum Lecture Series. Miami Beach FL, August 25 2014. 17. "Mitral valve repair and concomitant papillary muscle sling placement via a right anterior minithoracotomy in patients with functional mitral regurgitation." American College of Cardiology 63"r Annual Scientific Session, Washington D.C., March 30 2014. 18. "Early effects of mitral valve repair with concomitant papillary muscle sling placement on left ventricular remodeling in patients with functional mitral regurgitation." Florida Osteopathic Medical Association 111th Annual Meeting, Weston FL, February 21 2014. 19. "Severe aortic stenosis: What should be the preferred management in 2014?" Cardiology Grand Rounds, Columbia University Division of Cardiology, Mount Sinai Heart Institute. Miami Beach FL, February 13 2014. 20. "Minimally invasive surgery for native aortic and/or mitral valve infective endocarditis." Florida Chapter of the American College of Cardiology Annual Meeting. Orlando FL,August 17 2013. 21. "Clinical and echocardiographic features of tricuspid and pulmonic valve stenosis." Cardiology Grand Rounds, Columbia University Division of Cardiology, Mount Sinai Heart Institute. Miami Beach FL,May 9 2013. 22. "Outcomes of transaortic edge-to-edge repair of the mitral valve in patients undergoing minimally invasive aortic valve replacement." The International Society for Minimally Invasive Cardiothoracic Surgery Annual Meeting. Los Angeles CA, June 2 2012. 23. "Outcomes of minimally invasive valve surgery versus median sternotomy in patients with chronic kidney disease." The International Society for Minimally Invasive Cardiothoracic Surgery Annual Meeting. Los Angeles CA, June 2 2012. 24. "Minimally invasive intra-atrial placement of a mitral valve prosthesis in a patient with severe mitral annular calcification." The International Society for Minimally Invasive Cardiothoracic Surgery Annual Meeting. Los Angeles CA, June 2 2012. 25. "Incidence of post-operative atrial fibrillation in patients undergoing minimally invasive valve surgery." Valves in the Heart of the Big Apple VII: Evaluation & Management of Valvular Heart Diseases 2012. New York NY,April 13 2012. 14 DocuSign Envelope ID: 192DD89C-A3C5-4226-BF99-1A23E2A1 F635 26. "Intra-atrial placement of a mitral valve prosthesis in patients with severe mitral annulus calcification." Consortium for Excellence in Medical Education 3'd Annual Resident Research Competition, Nova Southeastern University, Davie FL, November 10 2011. 27. "Outcomes of right minithoracotomy mitral valve surgery in patients with previous sternotomy." 2011 Mitral Conclave, American Association for Thoracic Surgery. New Yorlc NY, May 5 2011. 28. "Left circumflex coronary artery-left ventricular fistula presenting as coronary artery `steal' syndrome: a rare etiology of non-atherosclerotic myocardial ischemia." American College of Osteopathic Internists— 70'x'Annual Convention and Scientific Sessions Abstract Poster/Case Presentation Competition. San Francisco CA, October 24 2010. 29. `Nonbacterial thrombotic endocarditis as a surgical complication in a patient status post mitral valve repair with patent foramen ovale closure." Consortium for Excellence in Medical Education Resident Research Poster Competition. Nova Southeastern University, Davie FL,November 20 2009. SKILLS&INTERESTS Fluent in Greek, proficient in Spanish;Music and art, Olympic weightlifting, intramural sports. 15 DocuSign Envelope ID: 192DD89C-A3C5-4226-BF99-1A23E2A1F635 il 1 , . . i. . .. . .•. . . •.. . .. .... . • . • . - . . . . i . . . •• .. .. _ .• . . . - • . . 111011111 . ,. • . . . • . . . . .. . . . . . . .. •• • - . • • , . . . . • ' • . . , . . . . . .. . . c• ri. • • • • .• . .._ . • .: . . .. . m I HOS,CHRISTOS G DO • - • -.... co .i. OS 1 N VENETIAN DR 0 . cn APT*301 . •.' . • cn MIAMI BEACH,FL 33139-0000 • OS -464 14- . . ._ AS ill11.1.111.1111111111.141111111llilikatiblillillquidii :, . • ._........... — § . . • . • . .. CO . . . to . - - • . : . - . . O." - . • . . . . • • . . . . . . — DEA REGISTRATION • THIWREGISTRATION FEE CONTROLLED SUBSTANCE REGISTRATION CERTIFICATE NUMBER EXPIRES PAID UNITED STATES(DEPARTMENT OF JUSTICE FM2589838 •..01414023, $731 • . DRUG ENFORCEMENT ADMINISTRATION WASHINGTON D.C.20337 • --— . • . • • ' SCHEDULES. •''' • .:BUSINESSKIBIV.•'.. ISSUE DATE .• '• .. . . • 2,2N, . .P RAPTIONER•-•''' 01-04-2020 3,3N14,5 • . • - • ' S MIHOS,CHRISTOS G DO . '•.• Sections 304 and 1001(21 USC 824 and 060)of the Controlled Substances Act ofWO,.ai amended,provide that the Attorney MOUNT SIMI MEDICAI_CENTER ;,•!:' General,may revoke or suspend a regiatratIon to manufacture, 4300 ALTON ROO.. ., . .:, • distribute,&sponse,Import or export a controlled substance. DE HIRSH MEYER,TOWER,.SUITER.OO • " , MIAMI BEACH,Ft:33,004800„..s.• • THIS CERTIFICATE ISNOT TRANSFERABLE'ON CHANGE OF -1,1.1,-.p. • OWNERSHIP,CONTROL,LOCAT(ON,OR BUSINESS ACTIVITY, I . . . . MD IT IS NOT VALID AFTER THE EXPIRATION DATE, • . . . . . . •• • • '. ' . CONTROLLED SUBSTANCE REGISTRATION CERTIFICATE UNITED STATES DEPARTMENT OF JUSTICE . . . DRUG ENFORCEMENT ADMINISTRATION . _____ . •..•.:...'••••.:•.•,•.,. , •- WASHINGTON D.C.20537 • . . .•.• . . ....• DEA REGISTRATION • '..*OS REGISTRATION , -. • . FEE. . . • NUMBER _. EXPBIES.••:' •- '•; ' *PAID . . ....,_ ,. • ,... ... . .., . FM2569638 , - : 01-$1::2P23...i • •,'-',$T31 • ..,. . .. : - • SCHEDULES . ...: • . :BLANESS ACTB/IT*: ..:ISSUE DATE • • ili2,2N, • ..' FiRACTIT4NEIR ' 31•:04-2020 3,3N,4,51 • - • .:• -• • -, . — ' . . . . .. • . 6 . M1HOS,CHRISTOS G DO • . •• • '• • ,..,1 Seclions 304 and 1008(21 USC 824 and 958)of the (-; MOUNT SINAIVEDICAL CENTER:.':.. .. .. ... ... - ..-'' . . , Controlled Substances Act of 1970, as amended, . -- 4300 ALTON RoiND .. :••• '' . ''-•'!. ; .'... ...'.. ,.:: provide that the AttOn*..conal may revoke or • . 1 DE HIRSH MEYER TOWER,SUITE 2070. : • •‘ '..' suspend a registration to monufacture, distribute, . • dispense,Import or export a controlled substance. MIAMI BEACH,FL .33'14012800., _ •.' -,. . .. • . :. g . ... . . 1 THIS CERTIFICATE IS NOT•!TRANSFERABLE 6N CHANGE OF OWNERSHIP,CONTROL LOCATION,OR BUSINESS ACTIVITY, • AND IT IS NOT VALID AFTER THE EXPIRATION DATE. DocuSign Envelope ID: 192DD89C-A3C5-4226-BF99-1A23E2A1F635 Luz Marina Perez Lucymarina2@yahoo.com•6243 NW 170 Terrace Miami, FL 33015•(786)246-2284 Objectives I am a responsible,self-motivated, and detailed oriented Referral Coordinator proven leadership and organizational skills seeking to apply my interpersonal and customer service skills at Mount Sinai. Education 2014-2015 Bachelor in Science Degree:Health Services Administration Florida International University. Miami,FL 2010-2013 Associate in Science Degree:Health Services Administration Miami Dade College. Miami,FL 2005-2007 Associate in Science Degree:Medical Laboratory Technology Experience Mount Sinai Medical Center Coordinator April 2018-Present •Keeps required information as well as the control of records,statistics and reports regarding operations,personnel changes,etc. 'Maintains updated Human Resources files for employees within the Patient Access Department as well as maintains and updates employees contact information. 'Maintains and updates the policy and procedures t ensure that administrative signatures are obtains. *Assist with the arrangements of departmental meetings. *Completes presentations and reports to Director and/or Managers as requested, using collected data and other pertinent information to meet predetermined deadlines and guidelines. •Constant vendors for balances that have been identified as debtor's responsibilities and collects balances in full. Miami Beach Community Health Center Referral Coordinator March 2015-April 2018 Responsible for completing referrals for one physician and four residents following MBCH procedures: • Access patient's insurance information,personal information and type of referral patient has been ordered.Schedule patient with a specialist or a facility as needed. • Call patient to let him/her know of appointment and what needs to bring to appointment. DocuSign Envelope ID: 192DD89C-A3C5-4226-BF99-1 A23E2A1 F635 Luz Marina Perez •Prepare referral and authorization according to patient insurance using the necessary CPT Codes for visit and studies done at the specialist office,and send it to patient address as well to the specialist office. • Process authorization for Radiology Studies such as CT,MRI and Mammogram, also Sleep Study following insurance guidelines. • Process referrals forDurable Medical Equipment and Home Health by sending physician requisition,medical notes, images and lab results,to agency or insurance. Following up with insurance and agency until patient receives what he/she needs.Or if service was not approved by insurance I inform patient of insurance decision. •The final goal is to obtain medical notes from specialist's offices and/or facilities as soon as possible so PCP can manage patient care in the most efficient way. Miami Beach Community Health Center Patient Support Clerk February 2014—March 2015 • Welcomed patient to the department in a helpful and friendly manner;determined purpose of visit and direct patients to appropriate provider or department. •Keep patient's information always updated by asking patient of address,phone number email address and insurance information. •Used Intergy System to drop off lab orders,that have been ordered for the patient. • Exercised problem-solving and conflict resolution skills when handling patient complaints. Precision Ventilation and Associates Administrative&Sale Assistant July 2007-December 2013 •Answered and directed phone calls. • Assisted in the preparation of estimates of the air distribution products the company represented. • Kept in continue communication with the HVAC factories that we ordered products from, among those companies were:Carrie,Tuttle&Bailey,Champion and Coorlair. sin charge of comparing the original order our company had placed to the order confirmation received from the factory.This included number of pieces,model, and color. •Coordinated with freight carries the delivery of the orders. This involved constant communication with all parties involved: Factory, freight carrier,our company and finally the customer. Skills •Highly skilled in typing,scheduling and maintenance of confidential records. •Substantial knowledge of medical office rule and regulations. Proven record of following policy and procedures, and performing clerical duties. •Proficiency with Microsoft Office;Microsoft Word,Power Point, Excel,Outlook. DocuSign Envelope ID 192DD89C-A3C5-4226-BF99-1 A23E2A1 F635 Luz Marina Perez ... •Proficiency in creating presentations and writing report. •Bilingual,English and Spanish. Reference upon Request DocuSign Envelope ID: 192DD89C-A3C5-4226-BF99-1 A23E2A1 F635 111 G O rVe n S Se O' gorvens.sene@gmail.com 0 954-822-9231 o Certified Clinical Medical.Assistant +!* 1021 W.Las Olas Blvd,Apt.3,Fort Lauderdale,FL, 9 I am an outgoing,dependable MA with over eight United States years'experience,specializing in problem solving + _ and communication WORK EXPERIENCE SKILLS ICertified Medical Assistant Patient Care • • • • • Mount Sinai Medical Center 02/2018-Present Miami Beach,FL Phlebotomy • • • • • Occupational/Employee Health Achievements/Tasks • • • • • • Vital Signs,Injections,Phlebotomy,EKG,Drug Screens, Injections After hours on call Contact:Pat Wilson -305-674-2312 EKG • • • • 0 Medical AssistantI Computers and Electronics • • • • 0 OrthoNOW Biscayne Communication • • • 08/2017-02/2018 Miami,FL • Orthopedic Urgent Care Achievements/Tasks Teamwork • • • • 0 • Record patients'vitals,medical history and reason for visit • Enter patient history into EMR Complex Problem Solving • • • • • • Perform X-Ray's,Casting and splinting,fit patients for DME Contact:Tamika Kong-786-272-5565 CERTIFICATES Certified Clinical Medical Assistant(10/2014) IClinical Coordinator/Clinical Procedures Lab Assistant Basic Life Support(10/2017—Present) Nova Southeastern University- Physician Assistant Program 11/2015-11/2017 Fort Lauderdale,FL EDUCATION Achievements/Tasks • Schedule and coordinate clinical year rotations Certified Medical Assistant Program-Concorde Career • Responding to inquiries and resolving non-routine Institute(07/2000—04/2001) problems in a timely manner to ensure questions are answered and resolved • Instructing and supervising advanced didactic year LANGUAGES students with clinical procedures such as suturing, venipuncture,intravenous catheterization,injections(IM, English • • • • • SC,ID),urinary catheterization,naso-gastric intubation, scrubbing,gowning/gloving,casting/splinting Creole • 0 • 0 0 Contact:Alicia R.Bolden,MPAS,MPH,PA-C-abolden@nova.edu Spanish • 0 0 0 0 IMedical/Administrative Assistant Urgent Care of Fort Lauderdale INTERESTS 10/2014-10/2015 Fort Lauderdale,FL --- ------ Achievements/Tasks Volunteering I Reading TED Talks I Motivational Speeches I • Open office at the beginning of business day Innovation Exercise i Travel i Movies • Verify patient insurance and collect co payment,answering phone calls • Perform injections,draw blood,EKG,ear lavage,dress wounds and any treatment physician may order Contact:Jerry Gavlak,PA-C-954-822-7688 ' 7 .. . , . • - .- ' ;•._-, . . .- ,. . • ' ' ' ,. ., _ .• • . - --^-,"--,-.'", -,';‘,".••'--'47' i;.••••P.,a*,- '-••-t-'4',-;-,,,1..,-;;;.47, r.:.‘•:,...,, I. - --'2-'•'.,-'- - -'".--.-.Wi _.F„.......,,...,:if,,;,--•^..f.:".2.4t. -:-•,.,.,,--4-,..47.s.,-,..tt.x.....kr_k.,...•••• .....'',...-•:,. ir- .•---••••`,.1....,:: ,.....• ,. •-..,,,,...--:•• ' -.?••-•:;"1-,-7,-;:46'-?7 „ ... 1 -'.•.••,-;s7.-- ,C;.-1,,,::',Al.*".. -N-..: '"*""irr-.‘‘ :-;.'4r _...--,..V.. ...6.--e...,- '''-..7. -\---,-,f„..!'"7:. -F-,•\-r.,• '---*Agi,o, ,:•:,'-'`-.2P.7,------.-,-. -7._--, -,, -••••-•-*'-`-'-'--,---•''--1.,'-`- ' -',-•''--.-44-..-' ' -;-'7- ---.----.:' '• • - ,,,,.. ...,.,,,,,_ v.}- - -.04;•.-.:.,..- 0'6,4,-4,,›-R,a.-,,,,,,,,,.....,.. -;..7.-4.t .lei..- , Ir".;.•,•, - •z. •-•-''.3 ,-,4,..4".; 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Cll 5, al,•�3i'` n�liYtia)( �St x1 t,x l Yt¢ 'aA f22t E�'A 4!d`k ; V ,� b�.aX lti `1�. a t t ''h,�fi 4� 1� ,�jccf aayys +y�`'Vt S>�S' \�1�j,d ll�£^, w• ' - _ -'''1' h 4 f',,, t# ,, l ,r3 h ,,,, ) ',.•,,,,,,j,"2 ,,,,, , y '` d zg,,,: ,... .•.;:4.,,,,s,„:„12,,,,,tti,.% ; Lai �, 0 0 0 c N (450 m 0 CD 0 a CD 0 8 N 0 0 I i CO A a 0 .r 1 W 0 0 1,, N N 91 co "f1 ».,.,«.. ...........y..*Y.« .,,,.-..,..:.... ........h.,:.. «.:...,.:«, .. .- ..,rF ....-...,,...a. .......«r.... «....-...«..,..«..�«..w,�.mow.. ,..„w EXAMINATION SCORE REPORT m N D cn NHA Certified Clinical Medical Assistant (CCMA) 2011 Form A Paper- N Pencil Date: 10/30/2014 Scaled Score: 410 Name: GORVENS SENE Status: PASS DocuSign Envelope ID: 192DD89C-A3C5-4226-BF99-1A23E2A1 F635 Linda DieUjUsto breeishm@aol.com 786-246-6670 Q Certified Clinical Medical Assistant Dependable and highly motivated professional with over 8 years of experience WORK EXPERIENCE SKILLS ICertified Medical Assistant/MA Trainer patient Care • • Mount Sinai Medical Center- Occupational Health Customer Service • • • • 0 03/2008-Present Miami Beach,FL Achievements/Tasks Supervisor • • • • Q • Complete physicals on City of Miami and City of Miami Beach employees,Police,Fire Rescue,etc. Electronic Health Software • • • • Q • Employee Health for hospital employees • Training and supervising of new employees Time Management • • • • 0 • Breath Alcohol Testing and DOT/Drug Screens • • • 0 0 HIPAA Compliance ITeam Leader Phlebotomy • • • Precision Response Corporation 02/2002-05/2007 Miami,FL Teamwork • • • • Q Achievements/Tasks • Customer Service Conflict Resolution • • • • Q • Trouble shoot customer issues with Direct TV service • Supervising a team of 10 employees VOLUNTEER EXPERIENCE Fundraiser Coordinator CERTIF=ICATES MRM-Compassionate Ministry Group 02/2007-Present Breath Alcohol Technician(04/2008—Present) US Department of Transportation Technician (04/2008—Present) LANGUAGES Basic Life Support(04/2008—Present) English • • • • • Creole • • • • • EDUCATION French • 0 0 0 0 Certified Medical Assistant Concorde Career College INTERESTS 10/2002-10/2003 Courses ( i L_ ng Travel Fashion Fitness _Volunteering • Certified Medical Assistant Program .......-- ' Foreign Films ( Music l IPhlebotomy Tech Mount Sinai Medical Center 03/2008-Present ICertified in First Aid & CPR American Heart Association 03/2008-Present C espirator it est ha it�' cz raining® } SSi { "4r !� 1 CD t i 7 -�: This certificate is awarded to: �' ., , • T :./„., W '4 1,' k "j / P 1l I. t i o ff,,. ,r. v� ! y S t :. ' ; Who has been trained on the proper use of the + ` '1 r M Qualitative " 3 Q e Fit Test Kits (FTIO, FT20, and/or FT30) -� ti ia Y: H 44. li ;.,Z"::' 1 Trainer. Wc4 �� i ''‘e7dail z ti Date Trained: �iY ,101 ; .., ',-,.- 70-0715-7163-5 },\, liS, i ki , K wy 1 i 4. W 1 IWO ir m-1.! a a• t"� i qhs ;,! '"*.lis�.^ate t �''�aw`.`.+-T_ .,. ,4:::.,...-:,4-,-._.----7,..--:-, .0 4tiw. .,,,,.,-+°''I ,��r ....xi+-- eu:- ,..aed ,,i, ...,,:,....� ...„..--:,../%.,.. � ,a.'l eu^�u"�'a'`km.: ""m';,,s'/ .r .ir a o o /./r/ �% 4, m m r . m o • CERTII O co . — 2,„'.:*' 364 WATE : n .._. _ .._. .. . • ._.. ,.... . .. .. . _ . . _ .... ... ...... ._ ... a O F . CO- MP ETI ONNJ A Ndo co 2. — w THIS IS TO CERTIFY THAT - N 0... — ' ' . D T m . w cn • -. L A) d-4-. ., - . .-. . <= _r�'k kis I- . T - Has successfully completed-the .� = Breath Alcohol Tchr� _ _ •:. 0/ Mian __ - Prof2c ent - - _ - :4 :CFR Part 4�• Procedures _ - _ . _ :� -• ti- _ INSTRUCTOR. .- D TE _ \ - i .... --^ - 0 0 0_ — ---- C t v t n 5 i 4 F F ve ��ri+ 5 'v '�`',,:if 3 t 7 n „,,,i'',,,,,,. ss i„ , f,41#1�»r r Ge y ,d:} A� rf.,, t ;•S P v.4 I. I j )'''' .a r tr L.ijs.y iifi tpru s111,4$1,: Ski3. A L '. s^..'3'z� +�Tr�vrs�,2�sr:nra.�c., a. c¢xau�s.z•= :xvam �r•• >a��uuava+r�•.:?yew:r.v :v,e+s,_,�aav"o.�m,...xt..-�n.+�,. - g—, JAY�OSSYN Ab .„'ft.H<Cmt:KM .401f:fr i2�XxC..?uRY1U*Nry Rtlt+*.v^ CO17 E5 il, (, , i , fc','''':1;,:: T CERTIFICATI®N OF COMPLETION W :, /-/ti V#(— 4„,.V/.6—).,1 /45-/--&—:: co Name71 CD . r Qgz�� fi. ' W @a^*t�[ �1 N Has successfully completed the 3 T +r GO Professional Collector t R? = fcn F1 n ' 1 l� i Proficient in CFR Part 4o Procedure42> s for F t Specimen Collectionspi to q” i �� i ,� I u Awarded this,i/A71/2_0 ay of month, 2oyear �f' ' yy QV J).,,1,-,,,,.„,,;,,-.',,,,7 .1 2 4 .,......., (4...4... 19 ... Monitor or Instructor Signature4.1t1 1 ifl, t!v ' `081 . i"�� 7 '+^e;s7-7,,” :-- ------11_--- _ -—- __-_-_— --. _._- _ .. �� 1 DocuSign Envelope ID: 192DD89C-A3C5-4226-BF99-1A23E2A1 F635 Lisbeth Moharam 3349 NW 51st Terrace Miami, Florida 33142-3357 Phone: 786-359-2613 E-mail: karima1215Ayahoo.com Objective: Seeking a permanent full time position which will utilize and build upon my existing skills in the healthcare and patient care setting. Summary of Skills • Proficient with Medical Manager and Windows computer systems. • Bi-lingual English/Spanish, read, write and speak. • Outstanding interpersonal and customer service skills. • Exceptional ability to work independently and as part of team. • Experience with insurances, ICD 9 codes, referrals. • Responsible answering incoming calls • Scheduling appointments, Filling, Data Entry, Faxing Medical Records and Medication request • Clinical skills include EKG's, Injections, Vision Exam, Suture removal, Vitals, Labs procedures, and Venipuncture. • Multi-Task in a fast pace atmosphere • Knowledge of Electronic Medical Records System. (EMR) DocuSign Envelope ID: 192DD89C-A3C5-4226-BF99-1A23E2A1 F635 Work experience Mount Sinai Medical Center Occupational Health Register medical assistant (November 18,2019 to present) Perform Clinical duties as: .Vitals .Hearing test .Laboratories .Pulmonary function test .Vision .Drug & Alcohol test .Electrocardiogram .Mask fitting,etc Cardiology and Heart Institute Register Medical Assistant (July 17, 2017 to March 31,2019) Perform Clinical duties as: • EKG'S • Heart Monitors placement • INR (Anticoagulation Blood Monitor) test • Triage patients • Refill medications • Lab Control • Medication Inventory • Control Clinical Supplies • Maintaining rooms Clean and fully stocked with supplies • Monthly Cleaning log • Responsible in all areas of nursing station! Medical Assistant duties. DocuSign Envelope ID 192DD89C-A3C5-4226-BF99-1A23E2A1 F635 Surgical Oncology Department Register Medical Assistant (July 11, 2016 to July 14, 2017) Perform Clinical duties as: • Assist each patient professionally, while answering all questions • Responsible taking patient's vital signs and Triage • Assisting physician with procedure • Maintaining rooms Clean and fully stocked with supplies • Biopsy's (breast, thyroid, skin) • Responsible of preparing charts/ Records for the following day • Scheduling Surgeries/ Procedures • Data Entry and Scanning documents • Medication Refill request • Sterilizing all procedure instruments Medical Assistant/ Floater Register Medical Assistant (March 23, 2016 to July 8, 2016) • Responsible taking patient's vital signs and Triage • Assist each patient professionally, while answering all questions • Phlebotomy and EKG • Medication Refill request • Responsible of preparing charts/ Records for the following day • Data Entry and Scanning documents DocuSign Envelope ID: 192DD89C-A3C5-4226-BF99-1A23E2A1 F635 Paladina Health Registered and Certified Medical Assistant/Host (December 2014 to March- 2016) Front Desk Duties • Welcoming and greeting patients • Data Entry • Taking details messages for the physician. • Provide patient all the instructions and information when appropriate and as directed by the physician. • Schedule, Reschedule and Confirming appointments • Check in and check out patients. • Insurance and Referral knowledge. • Scanning Labs and Imaging report, referrals, medical records or any medical documents in the system. • Obtaining Preauthorization for the following test: MRI's, U/S,CT Scan, Bone Density, Mammogram Medical Assistant Duties • Responsible taking patient's vital signs and Triage • Assist provider during visit, providing supplies and chaperoning appropriately • Data Entry • Administer vaccines and parenteral medication • Perform Laboratory test • Assist patient • Perform EKG's, Glucose test, Phlebotomy, Ear Lavage, dressing changes and other office procedures. • Maintaining rooms Clean and fully stocked with supplies • Assist provider during visit, providing supplies and chaperoning appropriately • Sterilizing all procedure instruments including use of autoclave. DocuSign Envelope ID. 192DD89C-A3C5-4226-BF99-1A23E2A1 F635 Office duties • Responsible for Inventory of Medical supplies, Office and Break room supplies • Responsible for vaccines and order Sample medication • Refill Request • Responsible of any damages or Repairs in the clinic • Coordinate meeting and Conference calls. • Assist with other Medical Assistant duties as necessary. Jackson Health System. Miami, FL. Department of Occupational Health Registered and Certified Medical Assistant (January-2012 to November 2014) • Assist each patient professionally, while answering all questions • Perform EKG's vision test, hearing test, radiology, spirometry, phlebotomy, drug and alcohol test • Assist at the front desk • Scheduling Surgeries/ Procedures • Data Entry and Scanning documents • Responsible of preparing charts/ Records for the following day • Responsible taking patient's vital signs and Triage DocuSign Envelope ID: 192DD89C-A3C5-4226-BF99-1A23E2A1 F635 Woodbridge Pediatrics Woodbridge, VA. Registered and Certified Medical Assistant (July 2007 to September 2011) • Welcoming and greeting patients • Assisting patients ranging in age from Newborn old to 21 years of age. • Responsible of preparing charts, Records for the following day • Answering incoming calls • Responsible for Inventory of Medical supplies, Office and Break room supplies • Responsible taking patient's vital signs and Triage • Assist provider during visit, providing supplies and chaperoning appropriately • Perform EKG's, Injection, Spirometry, and perform other procedures as directed. • Assist with other Medical Assistant duties as necessary. Practice. Alexandria Northern Virginia Family, VA Medical Receptionist, MDVIP. (May 2009 to December 2009). . Checking patients in and out. . Scheduling appointments. . Calling in prescriptions. . Filling, preparing charts . Answering phones. . Data entry. . Verifying insurances. . Prepare referrals. . . Taking messages, etc. DocuSign Envelope ID: 192DD89C-A3C5-4226-BF99-1A23E2A1 F635 Parkers Pediatric Associates. Silver Spring, MD Registered and Certified Medical Assistant (January 2006 to July 2007). . Duties included greeting and escorting patients to exam room. . Obtained vitals signs and took histories. . Gave injections. . EKG's, and other duties as assigned. . Answered phones, Filled data entry. . Scheduled appointments. Williamsburg Square Family Practice Lorton, VA Registered and Certified Medical Assistant. (April 2005 to December2005). . Duties included like vitals. . Injections. . EKG's, .Greet and escort patients to the exam room. .Assist physician with procedures. .Assist with phones. .Filling data entry. DocuSign Envelope ID: 192DD89C-A3C5-4226-BF99-1 A23E2A1 F635 Lake Ridge Pediatrics Woodbridge, VA Registered and Certified Medical Assistant. (December 2002 to March 2005). . Worked for a large Pediatric practice. • Gave injections. . EKG's, . Lab specimens. . Vitals, histories. . Prepared patient charts for appointments. . Ordered supplies. . Worked closely with Dr.'s and nurses. Education Sanz School, Falls Church, VA (Now Medtech Institute) 2934 Patrick Henry Dr Falls Church, VA. 22044 Ph: (703)-533-.3750 Certified Medical Assistant American Registry of Medical Assistant 61 Union Street, suite 5 Westfield, MA. 01085 Ph: (413)-562-7336 Registered Medical Assistant DocuSign Envelope ID: 192DD89C-A3C5-4226-BF99-1A23E2A1 F635 Alcohol and Drug Test Certified Jackson Health System Miami,FL CPR Certified First Aide Trained CPT, ICD-9 `�y13��h-`t,. 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Issue Date Recommended Renewal Date 11/7/201g 11/2021 Training Center Name Mount Sinai Medical Center instructor Name Maureen Lewars Training Center instructor ID FL057t 12102204049 Training Center Address eCard Code 4300 Alton Road 195508163657 Miami Beach FL 33140 USA CQR Code Training Center Phone Number 4. .93 (305)674-2121 To view or verify authenticity,students and employers should scan this OR cone witn tne,mobile device or go to www.heart.org/cpr/mycards- Co 2016-enerlcan Heart Association.All rights reserved. 15-3001 3/16 DocuSign Envelope ID: 192DD89C-A3C5-4226-BF99-1A23E2A1 F635 BASiiC LE SUPPORT BASIC LI : ErJiPPORT BLSAmerican Training Mount Sinai Medical Center Provider U Heart Center Name Association LISBETH MOHARAM Training FL05574 The above individual has successfully completed the cognitive and skills Center ID evaluations in accordance with the curriculum of the American Heart IC Address 4300 Alton Road Miami Beach FL 33140 USA Association Basic Life Support(CPR and AED)Program. 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Campos 5400 S.W. 77 Ct,Apt. 1L Miami, FL 33155 Telephone: (786)444-5796 Email: Danilu68@aol.com OBJECTIVE: Seeking a key position in Medical Field where my achievements, experience and communication skills will enhance the opportunities of growth and advancement. HIGHLIGHTS: Certified Medical Assistant. Trained and Licensed in CPR, EKG and Phlebotomy. Certified in DOT Drug/Alcohol collection and OSHA certified. QUALIFICATIONS: Administrative Scheduling appointments and obtaining patient data. Medical Records and efficiently routing calls and taking messages. Clinical: Receiving patients, preparing chard, obtaining vital signs and medical history, assisting doctors with examinations and treatment of special procedures, performs routine lab tests, EKG, Pulmonary Testing, Vision, Hearing, Administration of PPD. EXPERIENCE: Mount Sinai Medical Center February 2005—Present Occupational Health Miami Beach, FL 33140 University of Miami January 2003 to May 2004 Patient Clinical Asst. Miami, FL 33136 Dr. Lawrence Wheatman August 2002 to January 2003 Patient Clinical Asst. Miami, FL 33129 INTERSHIP: CAC Medical Center August 1995 to August 1996 Miami, FL 33155 LANGUAGE: English/Spanish Read, write, and translate. o 0 s (n / • M V, ,,, CD 0 II/ m . . - .... . m .---- O . .. .. . . _. .. ...... ... . _. _ .. . _ ........ . _. - . ‘.. . . ..... . __. 0 $J ,... . ,,,, 0 . Co 1. n _ pk D A N OF• ,. CO-MPLETI Nno • no •. THIS IS TO CERTIFY THAT ND T m co cn01 , ... .._, , pte,) • . (/''rAi-z7._ . , • s - Has successfully completed the ._......... ... •......• •.,•..........•.. . .-_......_.......... ... ,T. _. ....E. ..-B.- read Alcohol=Technician --.---.-.---,•.-. -" _ .• aficzent zn-49--CF ._Part 40 . . . . .---......... .-. - .., .•,..•...._.._...._,......• .._....•._._. ._... ..•.....-._.„_.,. ,....._. .D. .... •. • • • - • •.• - •..-.:I_.-.. .,6•__.__... .. _...-... ‘• • _ _. _.. -'~ INSTRUCTOR ' - oA. -...h ----- ----- . . . .. .... _ . •_. .•...... --- . ..- , de;4_,__ -- ir Ager Ar P. in i m .. coV _ - __ - I 5 i • • IN co I 0 1; o 11 CERTIFICATION OF COMPLETICDON coft---Oldt""de\.5 L4O17 --0 65 ,1 CO Name W if N ' T , Has successfully completed the �, Professional Collector Proficient in CFRPart 4o Procedures for , `' `t' Specimen Collections ,`` 4,//C,Z0 ' 'eC'A° ',' 1,. Awarded this d y of month, 2oyear ' : i ��` Iii {{1itg� t tira i 1 s .vi t' Monitor or Instructor Signature f, . 'f tom. t. ritr ,=fir A dc , ;#,,,,24 , , 11,,.... . ,,51,,,, „, , , i k, -...,,,„ia , Rti,,,, Ill i ;.,,...,..,.... ,,,,,,i (� h t tit'x6F W .ii+ 4 YS ME..G,A 0.FN' a(^.wh-tr .'at.hl.\ � � � [4,' `- ._ } l'41� Ye t.�f'< G`,� :,:,,,P,. Alit i �..?v)..k."4.:,' ��1,---, 4' • 2 ' e 4 k°$4,\ im sh l .ni t „, � .A.f4�i. '@ - �`'i1 A, ;4/s `S fit ; 't zi1> l °tir Lc� tit of DocuSign Envelope ID: 192DD89C-A3C5-4226-BF99-1A23E2A1 F635 Meredith R. Portee 3420 N.W. 197th Street, Miami, Florida 33056 Cell(786) 285-2611 Email:mportee@msmc.com or naynay0607@aol.com Professional Summary Patient Access Team Leader with 32 years' experience in a hospital setting. Core Qualifications • Strong communication skills • Ability to work in fast past environment • Collect/Train DOT Drug and Alcohol testing for over 10 years • Knowledgeable of hospital policies procedures and HIPPA regulations • Develops and monitors front desk registration processes • The ability to communicate information and ideas with all levels of management Experience Mount Sinai Medical Center,Miami Beach, FL 8/2015 to Present Occupational Health,Patient Access Representative Team Leader Mount Sinai Medical Center, Miami Beach, FL 1987 to 8/2015 Occupational Health,Patient Access Representative • Oversee all of the Front Desk operations including those of the Occupational Health, Employee Health and Medical Records Departments. • Instrumental in the implementation of the EPIC Program ensuring the specifications were consistent with the requirements needed by the Occupational and Employee Health Departments. • Collect/ Train DOT drug and alcohol testing based on the standards as set forth by the DOT regulations 49 CFR Part 40. • Responsible for radiology registration, scheduling, and registration of outpatient procedures and answering phones. • Inform to director, co-workers, and subordinates by telephone, in written form, e-mail, or in person of day to day operational activities of the department. • Analyze billing information and evaluate results to choose the best solution and solve problems. • Explain policies, procedures, or services to patients using medical or administrative knowledge. • Investigate and direct patient inquiries or complaints to appropriate medical staff members and follow up to ensure satisfactory resolution. • Collect and report data on topics such as patient encounters and inter-institutional problems,making recommendations for change when appropriate for billing/charges. Mount Sinai Medical Center,Miami Beach,FL 1987- 1989 Radiology,Patient Access Registration DocuSign Envelope ID: 192DD89C-A3C5-4226-BF99-1 A23E2A1 F635 2 Education Ashford University 2008-2010 Bachelor of Arts Degree in Social/Criminal Justice Masters of Education Specializing in Family And Community Services 2012-2013 Kaplan University 2007-2008 General Education Miami Dade Community College 1984 Associates of Arts Degree in Criminal Justice Administration Recommendations Furnished Upon Request DocuSign Envelope ID. 192DD89C-A3C5-4226-BF99-1 A23E2A1 F635 Linda Ivory 7619 Embassy Blvd Miramar, FL 33023 (Cell)7862004264(home)954674-1225 OBJECTIVE To secure a position where my experience can be utilized in a position offering new and challenging responsibilities. Summary of Qualifications • Handle all Occupational/Employee Health electronically medical records • Capable of handling multiple tasks in a fast paced environment • Recognized for exceptional customer service and interpersonal skills • Knowledge of front desk patient care services • Capable of handling high phone call volume • Knowledge of Star,Windows, One Content,Secure Emails,Epic program,etc... • Maintain and update patient information regularly • Maintain and balance the cash drawer EDUCATION High School Diploma 1975 WORK EXPERIENCE _ Patient Representative 1 August 2000-Present Mount Sinai Medical Center, Miami Beach FL Medical Records Clerk 3 February 2004-Present Mount Sinai Medical Center, Miami Beach FL Medical Records Clerk 1 May 1992-August 2004 Mount Sinai Medical Center, Miami Beach FL Appointment Clerk March 1980-January 1992 Family Health Center,Miami FL Teacher's Aide August 1977-June 1979 Miami Park Elementary,Miami FL SKILLS: Proficient in EPIC System,Strong organization skills,excellent customer service skills DocuSign Envelope ID: 192DD89C-A3C5-4226-BF99-1 A23E2A1 F635 Erika Wright 11014 SW 152nd Terrace Miami, Fl 33157 (305)497-1917 Skills • Organizational Skills • Interpersonal Skills • Communication • Team Oriented Education 1997-2001 Miami Killian Senior High - Miami, Fl High School Diploma 2005-2006 National School of Technology - Miami, Fl Medical Assistant Diploma Career Chronology May 2019 - Current Mount Sinai Medical Center/ Employee Health Miami, Fl Patient Receptionist Duties Receives patients, guests, staff promptly and courteously. Demonstrate knowledge of EPIC Program. Responsible for performing daily clerical tasks such as filing, recording, record maintenance, copying and other similar duties. Demonstrates flexibility as well as ability to perform multiple functions within the department to increase department efficiency. After completion of the registration process ensures that an identification bracelet has been placed on all patients. Before placing I.D. bracelet confirm patient's Name and Date of Birth. After completion of the registration process ensures all registration documents, as well as orders, and accompany the patient to the appropriate area (i.e.. Nursing units, ancillary departments, etc.). Communicates all pertinent information regarding the patient to the appropriate departments patient care units. Schedules tests and procedures per physician's order and give proper instructions to the patient. DocuSign Envelope ID: 192DD89C-A3C5-4226-BF99-1 A23E2A1 F635 September 2011 - May 2019 Kasper Group/ Macy's Miami, Fl Vendor Merchandiser/ Business Lead Duties Communicate and partner with stores visual team. Weekly recap: analyze sales and sell through info. Track upcoming deliveries. Lead informal product knowledge class with associates. Assist sales associates with customers. June 2006 - January 2009 JJ's American Diner Miami, Fl Waitress Duties Preparing food for customers. Multitasking various duties in my assigned area. Handling money transactions. June 2005 -June 2006 CVS Pharmacy Miami, Fl Cashier Duties Responsible for all transactions within the register. Processing customer returns and exchanges. Stocking shelves and keeping track of ordered inventory. References Nancy Butler Jerome Gilbert (954) 609-6059 (305) 725-8715 Vendor Coordinator Retired Train Conductor LaWanda Hill Sherrie Santiago (305) 798-8059 (786) 303-9397 School Teacher Manager DocuSign Envelope ID: 192DD89C-A3C5-4226-BF99-1A23E2A1 F635 Mount Sinai MEDICAL CENTER TAB 5 ATTACHMENT C Subcontractor' s Curriculum Vitae/Resume, Certificates, Licenses (Quest Diagnostic) DocuSign Envelope ID. 192DD89C-A3C5-4226-BF99-1 A23E2A1 F635 Licensure-ATL Quest Diagnostics 1777 Montreal Circle,Tucker,GA 30084 Agency/State License Number Expiration Date California COS000800367 3/30/2020 CAP 7213172 12/15/2.020 CAP 1442304 10/27/2021 CLIA 11D1096780 10/7/2021 DEA RS0155867 4/30/2020 ANCA/State of FL T17 9/30/2021 Georgia State Board of Pharmacy Researchers PHRS001043 6/30/2020 Georgia 044-152 non-expiring Maine SA104 3/12/2020 Maryland 579 non-expiring New York 3498 6/30/2020 Nevada 384L1C-0 4/18/2020 NLCP 67 Ongoing Oklahoma 8380 9/30/2020 Pennsylvania 31399 8/15/2020 Rhode Island LC000608 12/30/2021 Texas non-expiring Vermont 1/20/2021 DocuSign Envelope ID: 192DD89C-A3C5-4226-BF99-1A23E2A1 F635 KS Lenexa : KS Lenexa Page 1 of 2 Quest Lenexa, KS Licensure Quest Diagnostics 10101 Renner Blvd., Lenexa, KS 66219 CAP expires 08-13-20 Lic.#2864601 CLIA expires 02-27-21 Lic.#17D0648226 California expires 08-28-20 Lic.#COS 800019 FUDT expires 06-16-20 Lic.#2864604 Hawaii expires 06-30-20 Maryland expires 06-30-20 Lic.#664 Maine(Tox) expires 07-27-20 LIC.#SA119 North Carolina expires 12-31-20 Lic.LH00192 Nevada(Tox) expires 05-02-20 Lic.#2709LIC-6 New York expires 06-30-20 Lic.#4907 Ohio expires 11-10-19 Lic.#C10043 Oklahoma expires 04-30-20 Lic.#8034 Pennsylvania expires 08-15-20 Lic.#022715A Rhode Island expires 12-30-20 Lic.#LC000900 Vermont(HIV) Effective June 10,2019 HIV License is no longer required Vermont(Tox) expires 01-01-20 West Virginia expires 12-31-19 Lic #HIV-RL-24 ................ State laboratory license is not required in the state of Kansas. http://www.questdiagnostics.com/home/about/locations/licenses-accreditations/ks-lenexa/ 2/3/2020 0 0 C) c N m' 0 m 0 CD 0 v CD PHL FORENSIC TOXICOLOGY LICENSURE 8 N 0 AGENCY LICENSE CATEGORY LICENSE# EXP DATE DESIGNATED LAB NAME ON DIRECTOR LICENSE D CAP FUDT 13278-04 05/28/2020 Susan Mills Quest Diagnostics N Incorporated N CLIA Certificate of Compliance 39D1023963 04/26/2020 R.H. Barry Sample Quest Diagnostics Incorporated CO DEA Controlled Substances P00067238 05/31/2020 Susan Mills Quest Diagnostics Registration Clinical Labs 6 m Maine Substance Abuse Testing #SA 122 06/24/2020 Susan Mills Quest Diagnostics T O) Maryland Forensic Tox- 1005 Non- R.H. Barry Sample Quest Diagnostics CO Employment Related expiring Incorporated NYS DOH Forensic Toxicology PFI:2510 06/30/2020 Richard Simpson Quest Diagnostics Incorporated Pa DOH Drugs of Abuse 027461 08/15/2020 R.H. Barry Sample Quest Diagnostics Alcohol Incorporated Rhode Island Drug Testing 00293 12/30/2021 Susan Mills Quest Diagnostics Incorporated SAMHSA NLCP Lab 0073 Current Susan Mills Quest Diagnostics Incorporated Vermont Drug Testing - 12/31/2021 Susan Mills Quest Diagnostics Incorporated m:\sop\lic DocuSign Envelope ID: 192DD89C-A3C5-4226-BF99-1A23E2A1 F635 CURRICULUM VITAE Irina Maramica, M.D., Ph.D., MBA., FCAP Current Position CLIA Laboratory Director Quest Diagnostics Nichols Institute, San Juan Capistrano Associate Professor of Clinical Pathology(Voluntary) University of California, Irvine, CA Contact Information 33608 Ortega Highway San Juan Capistrano, CA 92675 Irina.X.Maramica@,questdiagnostics.com Tel: 949-728-4690 Fax: 949-728-4930 Education Doctor of Medicine(includes B.S.), University of Belgrade Faculty of Medicine, Belgrade, Yugoslavia, graduated with distinction, 1982-1988 Doctor of Philosophy, (Pharmacology) University of Illinois at Chicago, Chicago, Illinois Klaus Una Scholar, 1988-1993 Health Care Executive MBA, Paul Merage School of Business, University of California, Irvine, 2012-2014 Postgraduate Training Residency: Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA Pathology,AP/CP, Chief resident in Clinical Pathology, 1997-2003 DocuSign Envelope ID: 192DD89C-A3C5-4226-BF99-1A23E2A1F635 Irina Maramica,M.D., Ph.D.,MBA,FCAP Curriculum Vitae Page 2 Fellowships: Junior Fellow of the American Heart Association of Metropolitan, Chicago, University of Illinois at Chicago, Chicago, IL, 1993-1997 Harvard Medical School Fellowship Program in Transfusion Medicine and Beth Israel Deaconess Medical Center, Boston,MA, 2000-2002 Additional training: "Lean Six Sigma Prescription for Healthcare"Johns Hopkins Green Belt Course, 2012 APC's Pathology Leadership Academy,2016 Quest Management Systems Silver Continuous Improvement Training,2017 Honors and Awards Recognition for Outstanding Academic Achievements University of Belgrade Faculty of Medicine, Belgrade, Yugoslavia, 1987 Travel Award,American Society of Hematology, St. Louis, MO, 1993 Klaus Una Scholar, Department of Pharmacology, University of Illinois at Chicago, Chicago, IL, 1993 "Golden Test Tube Award"Excellence in Teaching Award, Department of Pathology, Beth Israel Deaconess Medical Center, Boston, MA, 2005 Faculty Teaching Incentive Award, Department of Pathology and Laboratory Medicine Keck USC/LAC+USC Medical Center, 2011 Medical Licensure 214885, Massachusetts State Medical License, 2006 (inactive) A93510, California State Medical License, 2019 (active) Board Certification American Board of Pathology(Anatomic and Clinical), 2004 American Board of Pathology(Sub: Blood Banking/Transfusion Medicine),2005 DocuSign Envelope ID: 192DD89C-A3C5-4226-BF99-1A23E2A1 F635 Irina Maramica,M.D.,Ph.D.,MBA,FCAP Curriculum Vitae Page 3 Professional Background Board Certified Pathologist(AP/CP,sub. Blood Banking/Transfusion Medicine)with more than 10 years of experience as a Medical Director of Transfusion and Laboratory Medicine practiced in an academic hospital-based setting and currently major reference laboratory.Experience uniquely combines clinical, research,teaching and administrative roles as well as focus on Medical Quality. Employment/Clinical Administrative Appointments: Associate in Pathology(Transfusion Medicine and Clinical Chemistry), Beth Israel Deaconess Medical Center, Boston MA, 2003-2005 Medical Director, Transfusion Medicine(cross-covering Clinical Chemistry), University of California, Irvine Medical Center, Orange, CA, 2006-2009 Medical Director,Transfusion Medicine, USC University Hospital and Norris Comprehensive Cancer Center and Hospital,Los Angeles, CA, 2010-2011 Medical Co-Director,Transfusion Medicine Services, Department of Pathology, University of Southern California Keck School of Medicine, Los Angeles, CA, 2010-2011 Medical Director, HWH Laboratory, USC University Hospital and Norris Comprehensive Cancer Center and Hospital, Los Angeles, CA,2011 Medical Director,Transfusion Medicine (backup clinical pathologist for Clinical Chemistry 2015- 2016), University of California, Irvine Medical Center, Orange, CA, 2011-2016 Laboratory Director(POCT), Healthbridge Children's Hospital, Orange, CA,2015-2016 Medical Director, Laboratory Quality and Safety, University of California, Irvine Medical Center, Orange, CA,2016 Associate Medical Director, Quest Diagnostics Nichols Institute, San Juan Capistrano, CA, 2016-2018 Medical Director/NYCQ Oncology Soluble Tumor Markers, Quest Diagnostics Nichols Institute, San Juan Capistrano, CA, 2016-present CLIA and NY State Laboratory Director, Quest Diagnostics Nichols Institute, San Juan Capistrano, CA, 2018-present Academic Appointments: Clinical Fellow, Department of Pathology, Harvard Medical School, Boston, MA, 1997-2003 Clinical Instructor, Harvard Medical School,Boston, MA, 2003-2005 Assistant Professor of Clinical Pathology, University of California, Irvine, CA, 2006-2009 Associate Professor of Clinical Pathology,University of California,Irvine, CA,2009-2009 Volunteer Associate Professor of Clinical Pathology, University of California, Irvine, CA,2010- 2011 Assistant Professor of Clinical Pathology, Keck School of Medicine of USC,2010-2011 Associate Professor of Clinical Pathology, University of California, Irvine, CA, 2011-2016 Volunteer Associate Professor of Clinical Pathology, University of California, Irvine, CA,2016- present DocuSign Envelope ID: 192DD89C-A3C5-4226-BF99-1 A23E2A1 F635 Irina Maramica,M.D.,Ph.D.,MBA,FCAP Curriculum Vitae Page 4 Teaching Responsibilities: Teaching Assistant and Laboratory Instructor, Pharmacology, University of Illinois at Chicago, Chicago, IL, 1989— 1993 Laboratory Instructor, Medical Student Pathology Course, Harvard Medical School, 1997— 2000 Transfusion Medicine Attending, Medical Student Clinical Pathology Elective, Harvard Medical School, 2003—2005 Transfusion Medicine Attending, Clinical Pathology Residency, Beth Israel Deaconess Medical Center and Harvard Medical School Fellowship in Transfusion Medicine,2003- 2005 Lecturer, Clinical Pathology Residency, Beth Israel Deaconess Medical Center and Harvard Medical School Fellowship in Transfusion Medicine 2003-2005 Lecturer, Pathology Course, General and Systemic Pathology and Clinical Pathology (Lectures and Small Group Discussions), University of California, Irvine Medical Center, 2006-2009 Transfusion Medicine Attending,Medical Student Clinical Pathology Elective, University of California, Irvine Medical Center,2006-2009 Transfusion Medicine Attending, Pathology Residency, University of California, Irvine Medical Center, 2006-2009 Lecturer, Pathology Residency, University of California, Irvine Medical Center, 2006-2009 Lecturer, Medical Technologist Program, University of California, Irvine Medical Center, 2006-2009 Lecturer, Hematology-Oncology Fellowship, University of California, Irvine Medical Center, 2006-2009 Instructor, Pathology Course, Medical Student Year I Core Principles II 2010 (Small Group Discussions), Keck School of Medicine of USC, 2010-2011 Transfusion Medicine Attending, Medical Student Pathology Selective, Clinical Pathology, Keck School of Medicine of USC, 2010-2011 Transfusion Medicine Attending, Pathology Residency, LAC+USC Medical Center, Keck School of Medicine of USC, 2010-2011 Lecturer, Pathology Residency,LAC+USC,2010-2011 Lecturer, Pathology Course, General and Systemic Pathology and Clinical Pathology (Lectures and Small Group Discussions), University of California, Irvine Medical Center,2012-2016 Transfusion Medicine Attending, Medical Student Clinical Pathology Elective, University of California, Irvine Medical Center,2011-2016 Transfusion Medicine Attending, Pathology Residency, University of California, Irvine Medical Center, 2011-2016 Lecturer, Pathology Residency, University of California, Irvine Medical Center, 2011-2016 Lecturer, Medical Technologist Program,University of California, Irvine Medical Center, 2011-2016 Lecturer, Hematology-Oncology Fellowship, University of California, Irvine Medical Center, 2011-2016 DocuSign Envelope ID: 192DD89C-A3C5-4226-BF99-1 A23E2A1 F635 Irina Maramica,M.D.,Ph.D.,MBA,FCAP Curriculum Vitae Page 5 Educational Administrative Responsibilities: Director, Residency Program in Pathology, University of California Irvine Medical Center, 2008-2009 Associate Director, Residency Program in Pathology,LAC + USC Medical Center, University of Southern California Keck School of Medicine,2010-2011 Societies and Committees Professional American Association of Blood Banks, Member,2000-present American Society of Clinical Pathologists, Member, 2000-present College of American Pathologists, Fellow,2016-present American Society of Apheresis, Member, 2004-2010 American Society of Hematology, Member,2005-2007 CME Committee, California Blood Bank Society,2006-2007 California Blood Bank Society,Member, 2006-2010 Medical Advisory Committee,American Red Cross, Southern California Region, Member, 2006-2009, 2011-2012 Service National Professional Organizations: American Society of Apheresis, Donor Apheresis Subcommittee, Chair,2008-2009 American Society of Apheresis,Applications Committee,Member,2008-2012 American Association of Blood Banks, Coding and reimbursement Committee, Member, 2017-present College of American Pathologists, Accuracy Based Testing Committee, Member, 2018 University/Other Committees: Residency Review Committee, Department of Pathology, Beth Israel Deaconess Medical Center, Member, 1998-1999 Institutional Review Board Committee, University of Irvine Medical Center, Member, 2006- 2009 Performance Improvement Committee, University of California Irvine Medical Center, Member, 2006-2009 DocuSign Envelope ID: 192DD89C-A3C5-4226-BF99-1 A23E2A1 F635 Irina Maramica,M.D.,Ph.D.,MBA,FCAP Curriculum Vitae Page 6 Residency Review Committee, Department of Pathology, University of California Irvine Medical Center, Member,2006-2009 Gastrointestinal Fellowship Committee, Department of Pathology, University of California Irvine Medical Center, Member, 2008-2009 Faculty Search Committee, Hematopathology and Transfusion Medicine, Department of Pathology, University of California Irvine Medical Center, Member, 2006-2009 Renal Transplant Selection Committee, University of California Irvine Medical Center, Member, 2006-2009 Trauma Committee, University of California Irvine Medical Center,Member, 2008-2009 Graduate Medical Education Committee, Department of Pathology, LAC+USC Medical Center, University of Southern California Keck School of Medicine, Member, 2010- 2011 Transfusion Committee, USC University Hospital and Norris Comprehensive Cancer Center and Hospital, Member,2010-2011 Blood Utilization Committee, LAC+USC Hospital, Member, 2010-2011 Faculty Search Committee, Microbiology and Clinical Chemistry, Department of Pathology, USC University Hospital and Norris Comprehensive Cancer Center and Hospital, Member, 2010-2011 Blood Utilization Committee, University of California, Irvine Medical Center, Member, 2011-2016 Residency Review Committee, Department of Pathology, University of California Irvine Medical Center, Member, 2011-2016 Critical Care Committee, University of California Irvine Medical Center,Member, 2013- 2016 Trauma Systems Committee, University of California Irvine Medical Center, Member,2013- 2016 Compensation Plan Committee, Department of Pathology, University of California Irvine Medical Center, Member, 2013-2016 Clinical Competency Committee;Department of Pathology, University of California Irvine Medical Center, Chair, 2014-2016 Pathology Faculty Search Committee, Department of Pathology, University of California Irvine Medical Center, Member,2014-2016 Pathology Billing Committee, Department of Pathology, University of California Irvine Medical Center, Member, 2014-2016 Ebola Planning Committee, Department of Pathology, University of California Irvine Medical Center, Member, 2014-2016 Faculty Search Committee, CIinical Chemistry, Department of Pathology, University of California Irvine Medical Center, Chair, 2015-2016 Ancillary Services Director(Pathology and Radiology) Search Committee, University of California Irvine Medical Center, Chair, 2015 Pathology Administrative Director Search Committee, University of California Irvine Medical Center, Chair,2016 Laboratory Safety and Quality Committee, Department of Pathology, University of California Irvine Medical Center, Chair,2015-2016 DocuSign Envelope ID: 192DD89C-A3C5-4226-BF99-1 A23E2A1 F635 Irina Maramica,M.D.,Ph.D.,MBA,FCAP Curriculum Vitae Page 7 Journal Reviews: Journal of Clinical Apheresis,Transfusion, Archives of Pathology Research Activities Major Areas of Research: Platelet Biochemistry and Signal Transduction, Stern Cell Trafficking, Transfusion Practices, Bacterial Contamination of Blood Products Research Grants: "Direct Binding of the Platelet Integrin allbp3 (GPI1b-llla)to Talin: Evidence that Interaction is Mediated through the Cytoplasmic Domains of Both allb and p3". American Heart Association of Metropolitan Chicago Junior Fellowship Award Chicago, IL, Direct Cost of Award: $40,000, 1994— 1996 Invited Lectures "Massive Transfusion" Department of Pathology Scientific and Clinical Advances Seminar Series, University of California,Irvine medical Center, Irvine, CA, June 2006. "Transfusion Practices", Lecture, UCIMC Hospitalists Group, University of California, Irvine Medical Center, Irvine, CA, March 2006. "Massive Transfusion", Lecture, Graduate Program in Pathology, LAC+USC Medical Center, University of Southern California and Keck School of Medicine, Los Angeles, CA, September 2006. "Transfusion Support of Critically Ill Patient"Lecture, Graduate Program in Pathology, University of California at Los Angeles,Los Angeles, CA,November 2006. "Transfusion Support of Critically Ill Patient" Grand Rounds, Department of Surgery, Trauma Division, University of California at Los Angeles, Los Angeles,CA, December 2006. "Transfusion-Related Acute Lung Injury", Grand Rounds, Department of Surgery, University of California, Irvine Medical Center, December Irvine, CA,2007. "The impact of Transfusion-related Acute Lung Injury(TRALI) on Blood Banking" California Blood Bank Society, Southern California Regional Meeting, February, 2006. "Understanding TRALI and its impact on Donor Management"American Association of Blood Banks Annual Meeting, October 2007. "Blood Products: Uses, Risks and Precautions", Grand Rounds, Chapman Medical Center, Orange, CA,January 2008. "Blood Component Therapy"Lecture, OBGYN Fellowship Lecture Series, University of California Irvine Medical Center, Irvine, CA, March 2008. DocuSign Envelope ID: 192DD89C-A3C5-4226-BF99-1A23E2A1 F635 d. .-.11C. '1116::: .41::: .14 :41114(1°)PM:" )' 1°' 4M>P. % :::1 >''' 4r>. :". .. 1r11'... ' 4' 'IF Fil :1 A .. CENTERS FOR MEDICARE&MEDICAID SERVICF'S CLINICAL LABORATORY IMPROVEMENT AMENDMENTS A CERTIFICATE OF ACCREDITATION LABORATORY NAME AND ADDRESS CLIA ID NUMBER QUEST DIAGNOSTICS NICHOLS INSTITUTE 05D0643352 rA33608 ORTEGA HIGHWAY • SAN JUAN CAPISTRANO, CA 92675 EFFECTIVE DATE _. . . A ,.. 02/28/2019 . LABORATORY DIRECTOR EXPIRATION DATE 0 :-, IRINA MARAMICA M.D. 02/27!2021 Pursuant to Section 353 of the Public Health Services Act(42 U.S.C.263a)as revised by the Clinical Laboratory Improvement Amendments(CLIA), the above named laboratory located at the address shown hereon(and other appravcd locations)may accept human specimens for the purposes of performingluboratory ernminadons or procedures. 1 This certificate shall be valid until the expiration date above,but is subject to rcvucatiun,suspetulon,limitation,or other sanctions for violation of the Act or the regulations promulgated thereunder. j Vv V41111" � CwWa�uJ. + Ka W.Dyer,Admit Director�rvrs g . Division of Laboratory Services Survey and Certification Group • cumrsforMLDIC MswoWoutncts Center for Clinical Standards and Quality &:...,. + + s.: ' b W M 4G' gip '' _ ' '' 1240 cola2 012919 - If you currently hold a Certificate of Compliance or Certificate of Accreditation,below is a list of the laboratory specialties/subspecialties you are certified to perform and their effective date: LAB CERTIFICATION(CODE) EFFECTIVE DATE LAB CERTIFICATION(CODE) 'jFECTTVE DATE HISTOCOMPATIBILTY(010) 03/22/2000 GENERAL IMMUNOLOGY(220) 07/25/1995 ROUTINE CHEMISTRY(3,10) 07/25/1995 URINALYSIS(320) 11/05/2018 ENDOCRINOLOGY(330) 03/29/2003 TOXICOLOGY(340) 03/29/2003 HEMATOLOGY(400) 07/25/1995 • HISTOPATHOLOGY(610) 02/05/2004 .! CYTOLOGY(630) 12/29/2011 . CYTOGENETICS(900) 07/25/1995 P ' ' it II . :I a 3 FOR MORE INFORMATION ABOUT CLIA,VISIT OUR WEBSITE AT WWWCMS.GOV/CLIA OR CONTACT YOUR LOCAL STATE AGENCY.PLEASE SEE THE REVERSE FOR YOUR STATE AGENCY'S ADDRESS AND PHONE NUMBER PLEASE CONTACT YOUR STATE AGENCY FOR ANY CHANGES TO YOUR CURRENT CERTIFICATE. DocuSign Envelope ID: 192DD89C-A3C5-4226-BF99-1A23E2A1 F635 CURRICULUM VITAE Glen L. Hortin,M.D.,Ph.D. }Q„ 4,/ .20/cj Jan 4, 2019 ADDRESSES Quest Diagnostics Phone: 813-979-7831 4225 East Fowler Ave Tampa, FL 33617 Email: Glen.L.Hortin@questdiagnostics.com EDUCATION 1972-1976 Illinois State University,Normal, IL, Bachelor of Sciences with high honors, 1976-1983 Washington University School of Medicine, St. Louis, MO M.D., Ph.D. (Medical Scientist Program, Ph.D. in Molecular Biology) RESIDENCY 1983-1987 Barnes I Iospital/Washington Univ., St. Louis, MO, Laboratory Medicine PROFESSIONAL APPOINTMENTS 1987-1988 Instructor in Pediatrics, Washington University 1989-1992 Assistant Professor in Pediatrics and in Pathology, Washington University 1993-1997 Associate Professor of Pathology with tenure and Head,Clinical Chemistry Section, University of Alabama at Birmingham 1997-2000 Assistant Chief of Clinical Chemistry,Clinical Pathology Department,NIH 2000-2008 Chief of Clinical Chemistry. Department of Laboratory Medicine,NIH 2008-2010 Clinical Professor,Department of Pathology,Laboratory Medicine,and Immunology, University of Florida. 2010-2013 Medical Director,Quest Diagnostics,Cincinnati OH 2012-2018 Medical Director,Quest Diagnostics, South Florida Dec 2012- Clinical Pathologist,Quest Diagnostics,Florida Business Unit 2013-2016 Clinical Pathology Medical Director, Southeast Region,Quest Diagnostics Mar 2015- Medical Director,Quest Diagnostics, Tampa, FL BOARD CERTIFICATION 1984 National Board of Medical Examiners 1991 American Board of Pathology, Clinical Pathology MEDICAL LICENSURE 1987-1992 Missouri 1992-2010 Alabama 2008- Florida(licensed through Jan 2021) 2010-2016 Ohio 2011-2016 West Virginia DocuSign Envelope ID: 192DD89C-A3C5-4226-BF99-1 A23E2A1 F635 CV: Hortin Page 2 MEDICAL STAFF APPOINTMENTS 1987-1992 St. Louis Children's Hospital 1993-1997 University of Alabama Hospital 1993-1997 Birmingham Veterans Affairs Hospital 1997-2008 Clinical Center,National Institutes of Health 2008-2010 Shands Healthcare CLINICAL SERVICE APPOINTMENTS 1987-1992 Assistant Director of Clinical Chemistry, St.Louis Children's Hospital 1991-1992 Director of Clinical Immunology Laboratory,St. Louis Children's Hospital 1992 Director of Core Immunology Laboratory for AIDS Clinical Trial Unit 1993-1997 Head, Section of Clinical Chemistry, UAB 1993-1994 Laboratory Director, MSICU, UAB 1994-1997 Laboratory Director, Office of Bedside Testing,UAB 1994-1997 Medical Consultant for Specimen Receiving and Client Services,UAB 1994-1996 Laboratory Director,UAB Roebuck Clinic 1994-1996 Laboratory Director,UAB Bessemer Clinic 1995-1997 Laboratory Director,UAB Critical Care Transport 1996-1997 Laboratory Director, SICU,CICU,and RNICU,UAB Hospital 1997-2000 Assistant Chief of Clinical Chemistry, Clinical Center,NIH 1998-2000 Acting Chief of Clinical Chemistry, Clinical Center,NIH 2000-2008 Chief of Clinical Chemistry,Clinical Center,NIH 2008-2010 Medical Staff, Shands Healthcare 2009-2010 Laboratory Director, Shands at Live Oak Hospital 2010-2014 Medical Director,Quest Diagnostics,Cincinnati Business Unit 2012-2018 Medical Director, Quest Diagnostics,Miramar 2012- Clinical Pathologist,Quest Diagnostics,Florida Business Unit 2013-2016 Clinical Pathology Medical Director, Southeast Region, Quest Diagnostics 2013-2017 Medical Director,Estero Rapid Response Laboratory, Quest Diagnostics 2013- Medical Director,Vero Beach Rapid Response Laboratory,Quest Diagnostics 2014-2014 Medical Director,Tallahassee Rapid Response Laboratory, Quest Diagnostics 2014-2018 Medical Director,Leesburg Rapid Response Laboratory, Quest Diagnostics. AWARDS 1970 NSF Summer research fellowship,Luther College 1972 Co-Valedictorian,Zion-Benton Township High School 1972 National Merit Scholarship 1972-1976 Alumni Distinguished Scholarship,Illinois State University 1976 Bachelor of Science with High Honors,Illinois State University 1976-1983 Medical Scientist Training Award,Public Health Service 1985-1986 Individual National Research Service Award,Public Health Service 1987 Young Investigator Award,Academy of Clin. Lab.Physicians and Scientists 1990-1993 Charles E. Culpeper Foundation Medical Scholarship 1991 Young Alumni Achievement Award,Illinois State University 2001 FDA Group Research Award, To the team studying glucose meters DocuSign Envelope ID: 192DD89C-A3C5-4226-BF99-1A23E2A1F635 CV: Hortin Page 3 2002 Distinguished Chemistry Alumnus Award,Department of Chemistry, Illinois State University 2004 Scholarship,Bayer Executive Management Program,Notre Dame University 2005 10th Annual Roger Boeckx Lecture for the Capital Section of AACC 2008 NIH Clinical Center Director's Award to the Clinical Chemistry Science Team MANAGEMENT TRAINING 1995 American Board of Quality Assurance and Utilization Review 1996 Physicians in Management 1, American College of Physician Executives 1997 Physicians in Management H,American College of Physician Executives 2004 Bayer Executive Management Program at Mendoza College of Business at Notre Dame University 2006 Clinical Center Leadership Training,NIH Clinical Center 2007,2015 Team Leader Training, College of American Pathologists REVIEW PANELS 1990 Consultant,grant review panel,NHLBI 1992 Ad hoc reviewer,NSF 1993 Chair of reviews for Central Insulin and Glucose Laboratory for CARDIA study 1995 IRB panel for review of protocol M95-300,PI:BI Hirschowitz, M.D. 1997 Inspector, CAP Laboratory inspection,Smith-Kline Laboratories,Tucker GA 1997 Reviewer, SBIR Phase II grant proposal,NIDDK 1998 Review panel for CAP Foundation Scholar awards 1998 Team Leader,CAP inspection of Providence Laboratory,Rockville MD 2001 Chair of Review, SBIR Phase I proposal,NIDDK 2001 • Scientific reviewer of intramural clinical protocol,NIH Dept Lab Medicine 2002 Inspector,CAP Laboratory inspection,University of Maryland Pathology Associates,Baltimore,MD 2003 Scientific reviewer of intramural clinical protocol,NIH Dept Lab Medicine 2003 Reviewer, SBIR Phase II proposal,NIDDK 2004 Scientific reviewer, 510k submission to Office of In Vitro Devices,FDA 2004 Team leader,CAP laboratory inspection,Johns Hopkins Bayview Hospital. 2006 Reviewer,RFA-CA-07-012 Clinical Proteomic Technology Assessment,NCI. 2006 Inspector, CAP Laboratory inspection, St.Joseph's Hospital,Towson,MD 2006 Reviewer,Individual project grant,Medical Research Council 2006 Member, Site Review Panel, Office of Cellular, Tissue,and Gene Therapies, Center for Biologics Evaluation and Research,Food and Drug Administration 2007 External reviewer for faculty promotion, Chinese University of Hong Kong 2007,2008 Advisor, Saliva-Based Diagnostics U01 program NIDCR 2009 Member, CAP inspection team,University of Maryland,Baltimore MD. 2009 Member, Source Evaluation Group,RFP for R&D on biospecimen integrity by NCI Office of Biorepository Research and Resources 2009 Reviewer, Experimental Pathology Innovative Grant,Univ.Florida DocuSign Envelope ID: 192DD89C-A3C5-4226-BF99-1 A23E2A1 F635 • CV: Hortin Page 4 BOARDS OF PUBLICATIONS 1994- Board of Editors,Journal of Clinical Laboratory Analysis 1997-2001 Board of Directors, American Association for Clinical Chemistry Press 2001 Chair of Board of Directors,AACC Press 1998-2010 Board of Editors, Clinical Chemistry Associate Editor for Reviews in 2005 Associate Editor from 2006 Co-editor for special issue on proteomics in 2010 2000- Board of Editors,Archives of Pathology and Laboratory Medicine 2005-2010 Board of Editors, Clinical Proteomics 2008 Board of Editors,Bionanotechnology REVIEWER Biochemistry Journal of Proteome Research Nature Reviews Cancer Expert Review of Molecular Diagnostics Laboratory Medicine Rapid Comunications in Mass Spectrometry Expert Review of Proteomics Proteomics Journal of Chromatography B Clinical Chemistry and Laboratory Medicine American Journal of Clinical Pathology Journal of Clinical Microbiology Journal of Biological Chemistry Nature Medicine Comparative Biochem. and Physiology Nature Biotechnology Journal of Proteomics Clinica Chimica Acta Clinical Cancer Research Amino Acids Abstract reviewer,2008 and 2009 Annual Meeting of AACC Abstract reviewer,2009 Annual Meeting of College of American Pathologists PROFESSIONAL SOCIETIES 1986- American Association for Clinical Chemistry 1988-1995 American Society for Biochemistry and Molecular Biology 1989-1993 Society for Pediatric Research 1994- Fellow of the College of American Pathologists 1995-1999 Clinical Laboratory Management Association 1996-2002 American Society of Hematology 1997-2003 Academy of Clinical Laboratory Physicians and Scientists 1999- Fellow of the National Academy of Clinical Biochemistry 2007-2010 American Society for Mass Spectrometry 2008-2010 US Human Proteome Organization DocuSign Envelope ID: 192DD89C-A3C5-4226-BF99-1A23E2A1 F635 CV: Hortin Page 5 COMMITTEE AND OTHER APPOINTMENTS 1989-1992 Member of Graduate Faculty, Washington University 1990-1992 Animal Use Committee,Department of Pediatrics 1993-1997 Laboratory Medicine Curriculum Committee,UAB 1993-1994 Pathology Residency Selection Committee, UAB 1993-1994 Task Force on Bedside Testing,UAB Hospital 1993-1994 Faculty Search Committee, School of Health Related Professions, UAB 1994-1995 Laboratory Operational Benchmarking Committee,Univ. Hospital Consortium 1994-1997 Scientist,UAB Comprehensive Cancer Center 1995 Search Committee,Administrative Director,UAB Hospital Laboratories 1996-1997 Member,Alternative Site Testing Committee,College of American Pathologists 1996-1997 Member,Bedside Testing Committee of Birmingham VA Hospital 1996-1997 Consultant,Immunology Devices Panel of the Medical Devices Advisory Committee,Food and Drug Administration(FDA) 1997 Strategic Planning Group,Department of Pathology 1997-2000 Observer,NCCLS Subcommittee on Unit Use Testing 1997-2001 Member,Immunology Devices Panel,FDA(Chair in 2001) 1998-1999 Member,Technology Education Committee, CAP 2000-2001 Chair,Point-of-Care Testing Committee,CAP 2000- Member,NCCLS Subcommittee on Proficiency Testing 2001 Member,CLIA Advisory Committee Unregulated Tests Workgroup 2001-2002 Member,NCCLS workgroup on bedside glucose testing 2003-2004 Member,NACB Subcommittee on Laboratory Testing for Parathyroid Tumors 2003-2004 Chair,Ziering award nomination committee for Clinical Chemistry 2003-2005 Member,Institutional Review Board,NICHD 2003-2008 Member,AACC Continuing Medical Education Advisory Committee 2004 Observer,NCCLS Subcommittee on Mass Spectrometry in Clinical Chemistry 2004-2008 Member, Steering Committee of NIH Proteomics Interest Group 2005- Member,Laboratory Steering Group of Natl.Kidney Dis.Education Program 2005 Chair,Proteomics Division of American Association for Clinical Chemistry 2006 Member,Interview Committee for Laboratory Manager,NIH Dept Lab Medicine 2006 Past-Chair,Proteomics Division of AACC. 2007 Chair-Elect,Capital Section of AACC 2008- Member,Joint Working Group for Standardization of Albumin in Urine 2009 Consultant,Lab Values Working Group,Takeda Pharmaceutical 2011- Member,Medical and Technical Advisory Committee,Hoxworth Blood Center 2011- Medical Advisor, Clinical Chemistry Best Practice Team, Quest Diagnostics 2010- Member,Instrumentation Committee, CAP 2014- Member,Accuracy-Based Survey Committee, CAP DocuSign Envelope ID: 192DD89C-A3C5-4226-BF99-1 A23E2A1 F635 AC# STATE OF FLORIDA ,r-I �C\ o DEPARTMENT OF HEALTHr--, z DIVISION OF MEDICAL QUALITY ASSURANCE Oy & N :Lf) z - CL o DATE LICENSE NO. CONTROL NO. 'U."` ° a •C. ti) Z ill 11/24/2018 ME 103153 636621 I- CC a v=i ° `2 6 o z The MEDICAL DOCTOR ` as} to . 2 F W W E o '' W named below has met all requirements of z o 2 v o .n N the laws and rules of the state of Florida. J J 5 cp W CI W Expiration Date: JANUARY 31, 2021 a =ao J GLEN LEE HORTIN,MD o o o E ° re 4225 EAST FOWLER AVE o o 2 W b ° 3 I TAMPA,FL 33617 LL W o . 4 u o 2 w p rz O p$ m J Q W W a to Y ," w aa'5 4) g— oo 1- c cnn5 0 1 Rick Scott Celeste . hilip, M.D., M.P.N. GOVERNOR Surgeon General and Secretary DISPLAY IF REQUIRED BY LAW EXPIRATION DATE:JANUARY 31,2021 Your license number is ME 103153.Please use it in all correspondence with your board/council.Each licensee is solely responsible for notifying the Department in writing of the licensee's current mailing address and practice location address.If you have not received your renewal notice 90 days prior to the expiration date shown on this license,please visit www.FLllealthSource.govand click"Renew A License" to renew online. Medical Quality Assurance has a new and improved Online Services Portal.In the new system,you have the ability to renew your license, update your mailing and practice location addresses,request a name change,request a duplicate license and update your profile information all from the convenience of your online account. 1. Go to www.FLHealthSource.gov. 2. Click on"Provider Services"and select"Manage Your License." 3. Select your profession and license type and click"Submit." 4. The question"Have you Registered in Our New Online Service System?"will display. a. Click on"No"if you have not registered for an account in the new system and follow the instructions provided for new user registration. b. Click on"Yes"if you are a returning user.Enter the user ID and password you selected during the registration process,then select"Sign In"to access your MQAOnline Services Portal account. IMPORTANT ANNOUNCEMENTS Are You Renewal Ready? Grounds for Discipline The Department of Health will now review You should be familiar with the Grounds for your continuing education records at the Discipline found in Section 456.072(1), time of license renewal. Florida Statutes,and in the practice act for the profession in which you are licensed. To learn more,please visit Florida Statutes can be accessed at www.FLHealthSource.gov/AYRR www.leg.state.11.usiStatutes DocuSign Envelope ID: 192DD89C-A3C5-4226-BF99-1A23E2A1 F635 1111, didAj3. 5. Jci March 5,2019 JULIE LEVINE FRIEDMAN,M.D. Personal Data: Office Phone: 954-378-5101 Office Address: 10200 Commerce Parkway,Miramar,FL 33025 Higher Education: College: Massachusetts Institute of Technology,Cambridge, MA, B.S. Degree in Biology, 1984-1988 Medical School: University of Miami School of Medicine, Miami,FL, M.D.Degree, 1988-I992 Residency:Department of Pathology and Laboratory Medicine, Mount Sinai Medical Center,M.J. Robinson,M.D.,Chairman,Training in Anatomic and Clinical Pathology, Miami Beach,FL,July 1992 to June 1997 Chief Resident, Department of Pathology and Laboratory Medicine,Mount Sinai Medical Center,Miami Beach, FL,July 1995 to June 1996 A.M.Rywlin Fellow, Department of Pathology and Laboratory Medicine, Mount Sinai Medical Center,Miami Beach,FL,July 1996 to June 1997 Hospital Privileges: Hialeah Hospital,Hialeah,FL 1998-2000 Employment: Pathologist,Quest Diagnostics, Inc. (formerly known as SmithKline Beecham Clinical Laboratories before 2000), South Florida,August, 25, 1997—present -Medical Director,Quest Diagnostics,Miramar,FL,October 21,2018—present -Medical Director, Quest Diagnostics Rapid Response Lab,Estero,FL,November 1, 2018 -present -National Medical Advisor, Hematology Best Practice Team,January 22,2018 -present -Associate Medical Director,Quest Diagnostics, Miramar, FL,December 1, 2012. — October 20,2018 DocuSign Envelope ID: 192DD89C-A3C5-4226-BF99-1 A23E2A1 F635 2 -Interim Medical Director,Quest Diagnostics,Fort Myers,FL,December 4, 2015- February 29,2016 -Medical Director, Quest Diagnostics,Pompano Beach,FL,December 31,2012— present -Medical Director, Quest Diagnostics Rapid Response Lab,Vero Beach,FL,June 1, 2015—October 31,2018 -Medical Director, Solstas Lab Partners,Davie, FL,July 1,2014—Sept. 2014 - Interim Medical Director, Quest Diagnostics,Miramar,FL,July 21,2012—Nov. 30, 2012 -Pathologist, Senior Staff,Quest Diagnostics,Miramar,FL,Nov. 6,2001 —July 20,2012 -Interim Medical Director, Quest Diagnostics,Miramar,FL,August 20,2001 - November 5,2001 -Associate Medical Director of Surgical Pathology,Quest Diagnostics,Miramar,FL, March 1999-Aug 2000 -Associate Director of Clinical Pathology,Quest Diagnostics,Miramar,FL,Jan. 1998- March 1999 Pathologist,Hialeah Hospital, 1998—2000 Boards: Combined Anatomic and Clinical Pathology,passed June 11, 1997 Additional Training: Quest Diagnostics Management System, Bronze Certification,June,2017 College of American Pathologists Laboratory Accreditation Program Inspection Team Leader Training,March 10,2014 College of American Pathologists Laboratory Accreditation Program Initial Team Member Training, July 25,2011 College of American Pathologists Laboratory Accreditation Program Inspector Training, Miami Beach,FL, July 7-8, 1996 Cytc Thin-Prep Cytopathology Certification,2002. SUREPATH Morphology Training Certification, February 23.2004 License: Licensed to practice medicine in the State of Florida#ME 65344 DocuSign Envelope ID: 192DD89C-A3C5-4226-BF99-1 A23E2A1 F635 3 Organizations: United States and Canadian Academy of Pathology Fellow,American Society of Clinical Pathologists Fellow, College of American Pathologists Teaching Experience: Resident Instructor,School of Medical Technology, Mount Sinai Medical Center,Miami Beach, FL 1994-1995 Podiatric Pathology Lab Consultant, Barry University, Miami Shores,FL,autumn, 1995 Committees: Hematology Best Practice Team,2016—present Medical Advisor, 2018-present Immunohematology Best Practice Team,2018-present Safety Committee, Quest Diagnostics,2012—present Safety Committee, SmithKline Beecham Clinical Laboratories, 1997-2001 Transfusion Committee,Mount Sinai Medical Center, 1994-1995 Infection Control, Mount Sinai Medical Center, 1995-1996 Medical Services Review,Mount Sinai Medical Center, 1995-1996 Surgical Services Review,Mount Sinai Medical Center, 1995-1996 Awards: New England Life Award for Research,Massachusetts Institute of Technology, Cambridge,MA, 1985 and 1986 Class of 1970 Award for Research, Massachusetts Institute of Technology,Cambridge, MA, 1987 Sigma Xi Scientific Research E-Ionor Society,Massachusetts Institute of Technology, Cambridge,MA, 1988 Second Prize Poster,Eastern Student Research Forum,Miami,FL, 1990 Award for Research Distinction,University of Miami School of Medicine, Miami, FL, 1992 Certificate of Merit Citation,Radiologic Society of North America, Chicago, IL, November 1995 DocuSign Envelope ID: 192DD89C-A3C5-4226-BF99-1 A23E2A1 F635 4 Sydney Israel Resident in Pathology and Laboratory Medicine,Mount Sinai Medical Center,Miami Beach, FL,July 1995—June 1996 Howard Kane Mount Sinai Medical Center Best Hospital-wide Resident of the Year, Mount Sinai Medical Center,Miami Beach, FL, July 1995—June 1996 Presentations; Pleomorphic Liposarcoma of the Maxilla,South Florida Society of Pathologists,Mount Sinai Medical Center,November 1993 Malakoplakia, South Florida Society of Pathologists, Mount Sinai Medical Center, November 1994 Neuroendocrine(Merkel Celt)Carcinoma of the Vulva, George Papanicolaou Memorial Seminar in Gynecologic Pathology, Southern Medical Association, Orlando,FL, November 1994 Gastric Sarcoidosis, South Florida Society of Pathologists, Mount Sinai Medical Center, November 1995 In vitro Air-contrast-enhanced Spiral 3D CT(Virtual Colonoscopy) Appearance of Colonic Lesions,Radiologic Society of North America,Chicago, IL, November 1995 Autopsy: What does it really tell us?Perinatal Bereavement Training Program,Mount Sinai Medical Center, November 1995 Clear Cell Malignant Melanoma with and Unknown Primary, South Florida Society of Pathologists,Mount Sinai Medical Center,November 1996 Abstracts: Levine,J.E.,Pflugfelder, S., Crouse,C.A.,Atherton, S.S.: The presence of Epstein-Barr virus receptor in an additional mucosal tissue.Eastern Student Research Forum and National Student Research Forum,Miami,FL and Galveston, TX, 1990 Crouse,C.A.,Pflugfelder, S.C.,Perreirrea,I.E.,Rabinowitz, S.S., Levine,J.E.,Atherton, S.S.: Diagnosis of Herpetic Ocular Disease using PCR.Association for Research in Vision and Ophthalmology, Sarasota,FL, May 1990 Blodi,B.A., Pflugfelder, S.C.,Crouse,C.A.,Levine,J.E.,Atherton, S.S.: Immunocytochemical Evaluation of Class II MHC Antigen Expression of the DocuSign Envelope ID: 192DD89C-A3C5-4226-BF99-1A23E2A1 F635 5 Conjunctival Epithelium,Association for Research in Vision and Ophthalmology, Sarasota,FL,May 1990 Publications: Levine,J.E., Pflugfelder,S.C., Yen, M., Crouse, C.A.,Atherton, S.S.: Detection of Complement(CD21)/Epstein-Barr virus Receptor in Human Lacrimal Gland and Ocular Surface Epithelium. Regional Inununology, Vol.3 1990/1991. Barkin,J.S., Stollman,N. Friedman, J.,Willis,I.,Robbins,E: Idiopathic Fibrosing Pancreatitis Causing Obstructive Jaundice in Young Adults: Two case reports and literature review.The American Journal of Gastroenterology,Vo1.g9,No.11, 1994. Friedman,J.L., Bistritz,J.I.,Robinson,M.J.:Pleomorphic Liposarcoma of the Pterygomandibular Space Involving the Maxilla. Oral Surgery, Oral Medicine, Oral Pathology,Vol. 79,No.4, 1995. Mesko, T.W., Friedman,J.L.,Nixon,D.D.,Sendzichew, I-I.: Rectal Carcinoma Metastatic to the Thyroid Gland.The Journal of Laryngology and Otology, Vol. 110, 1996. DocuSign Envelope ID: 192DD89C-A3C5-4226-BF99-1 A23E2A1 F635 Ac#8 721335 STATE OF FLORIDA z N DEPARTMENT OF HEALTH r DIVISION OF MEDICAL QUALITY ASSURANCE ,r•r." � 3 J Z > rs DATE LICENSE NO. CONTROL NO. r,- o Cr) chi a W 01/03/2019 ME 65344 647540 > j O • ro < The MEDICAL DOCTORZ < < 0 „ g 5 '�� named below has met all requirements of ` '' rJ z 0 2 m -6 a a tu the laws and rules of the state of Florida. • 'e J 4" ib W Expiration Date: JANUARY 31, 2021 W o o W �' JULIE LEVINE FRIEDMAN o LL o LIE 8 LL 10200 COMMERCE PARKWAY 'T hi `. -- o o °' ° z MIRAMAR, FL 33025 :. ' ? u- wo a oI g $$ 0 c ❑ m ~O W� N J< aE> J/. woo , '2 fa° Vii t�� ______ _________4&% — Rick Scott Celeste . hilip, M.D., M.P.H. GOVERNOR Surgeon General and Secretary DISPLAY IF REQUIRED BY LAW EXPIRATION DATE:JANUARY 31,2021 Your license number is ME 65344.Please use it in all correspondence with your board/council.Each licensee is solely responsible for notifying the Department in writing of the licensee's current mailing address and practice location address.If you have not received your renewal notice 90 days prior to the expiration date shown on this license,please visit www.FLHealthSource.gov and click"Renew A License" to renew online. Medical Quality Assurance has a new and improved Online Services Portal.In the new system,you have the ability to renew your license, update your mailing and practice location addresses,request a name change,request a duplicate license and update your profile information all from the convenience of your online account. 1. Go to www.FLHealthSource.gov. 2. Click on Provider Services"and select"Manage Your License." 3. Select your profession and license type and click"Submit." 4. The question"Have you Renewed or Applied Online Since 2015?"will display. a. Click on"No"if you have not registered for an account in the new system and follow the instructions provided for new user registration. b. Click on"Yes"if you are a returning user.Enter the user ID and password you selected during the registration process,then select"Sign In"to access your MQA Online Services Portal account. IMPORTANT ANNOUNCEMENTS Are You Renewal Ready'? Grounds for Discipline The Department of Health will now review You should be familiar with the Grounds for your continuing education records at the • Discipline found in Section 456.072(1), time of license renewal. Florida Statutes,and in the practice act for the profession in which you are licensed. To learn more,please visit Florida Statutes can be accessed at www.FLHealthSource.gov/AYRR www.leg.state.fl.us/Statutes DocuSign Envelope ID: 192DD89C-A3C5-4226-BF99-1A23E2A1 F635 Curriculum Vitae DAWN M. HAHN Quest Diagnostics,Inc. 10101 Renner Boulevard Lenexa,KS 66219 (913)577-1632;Fax:(913)895-2622 E-mail:dawn.m.hahn@questdiagnostics.com questdiagnostics.com EDUCA 1984 Bachelor of Arts; Medical Technology Northwestern College; Orange City, Iowa 2014 Masters of Business; Administration John Hancock University, Chicago, Illinois EXl'EIZIh NCE September 2013 - Director, Laboratory Operations and Responsible Person Present Quest Diagnostics,Inc.; Lenexa,KS Responsibilities include:preparing and maintaining standard operating procedures for drug testing;, establish training protocol for personnel; ensure training is complete,ensure analytical methods are validated; establish acceptable performance limits on QC;ensure the laboratory follows!INS Guidelines for regulated testing;ensure all appropriate corrective action is implemented for any PT or inspection issue assisting; assisting in maintaining toxicology budget;and interfacing with inspection teams September 2010- Laboratory Operations Manager and Responsible Person September 2013 Quest Diagnostics,Inc.; Lenexa,KS Responsibilities include:preparing and maintaining standard operating procedures for drug testing:, establish training protocol for personnel; ensure training is complete, ensure analytical methods are validated; establish acceptable performance limits on QC;ensure the laboratory follows HHS Guidelines for regulated testing;ensure all appropriate corrective action is implemented for any PT or inspection issue assisting; assisting in maintaining toxicology budget;and interfacing with inspection teams November 2005— Manager of Toxicology September 2010 Quest Diagnostics, Inc.; Lenexa, KS August 2006- Responsible Person,Laboratory Manager Present Quest Diagnostics, Inc.; Lenexa, KS November 2005 - Alternate Responsible Person August 2006 Quest Diagnostics, inc.; Lenexa, KS (formerly LabOne, Inc.) DocuSign Envelope ID: 192DD89C-A3C5-4226-BF99-1 A23E2A1 F635 Dawn M.Hahn Curriculum Vitae Page 2 of 4 November 2000- Alternate Responsible Person November 2005 LabOne, Inc.; Lenexa, KS July 1999—November Director of Toxicology 2005 LabOne, Inc.; Lenexa, KS November 1997- Manager of Toxicology June 1999 LabOne, Inc.; Overland Park, KS January 1995 - SAT Lab Coordinator November 1997 LabOne, Inc.; Overland Park,KS February 1990- GC/MS Operator/Certifying Scientist Forensic Drug December 1994 Testing Laboratory LabOne, Inc.; Overland Park, KS October 1987- Generalist, Blood Laboratory February 1990 Home Office Reference Laboratory;Overland Park,KS November 1984- Medical Technologist September 1987 Terrell Community Hospital;Terrell,TX June 1984- Medical Technologist November 1984 Newburn Memorial Hospital;Jacksonville,TX PROFESSIONAL CERTIFICATIONS AND MEAIBFRSIlII'S Diplomate American Board of Forensic Toxicology (ABFT) Forensic Drug toxicology Inspector National Laboratory Certification Program(Team Leader) Inspector College of American Pathologists Forensic Urine Drug Testing Program Member Society of Forensic Toxicologists(SOFT) Member Midwest Association for Toxicology and Therapeutic Drug Monitoring Vice President 2005 -2006 President 2006—2007 Lab Supervisor New York State Department of Health DocuSign Envelope ID: 192DD89C-A3C5-4226-BF99-1 A23E2A1 F635 Dawn M.Hahn Curriculum Vitae Page 3 of 4 Lab Supervisor Nevada State Department of Health Lab Technical Supervisor College of American Pathologists (CAP) Medical Technologist American Society of Clinical Pathologists(ASCP) PROFESSIONAL. NII?N:TIN(.S October 2019 Society of Forensic Toxicologists,Annual Meeting, San Antonio,TX October 2018 Society of Forensic Toxicologists,Annual Meeting, Minneapolis,MN January 2018 Society of Forensic Toxicologists,Annual Meeting, Boca Raton,FL October 2016 Society of Forensic Toxicologists,Annual Meeting, Dallas,TX October 2015 Society of Forensic Toxicologists,Annual Meeting,Atlanta, GA October 2014 Society of Forensic Toxicologists,Annual Meeting, Grand Rapids,MI July 2012 Society of Forensic Toxicologists,Annual Meeting, Boston, MA September 2011 Society of Forensic Toxicologists,Annual Meeting San Francisco,CA October 2010 Society of Forensic Toxicologists,Annual Meeting, Richmond, VA October 2009 Society of Forensic Toxicologists,Annual Meeting, Oklahoma City,OK October 2008 Society of Forensic Toxicologists,Annual Meeting, Phoenix,AZ October 2007 Society of Forensic Toxicologists,Annual Meeting, RTP,NC April 2007 Midwest Association for Toxicologists and Therapeutic Drug Monitoring Annual Meeting, Indianapolis, IN May 2006 Society of Forensic Toxicologists, Annual Meeting,Nashville,TN May 2005 Society of Forensic Toxicologists,Annual Meeting, Washington, D.C. August 2004 Society of Forensic Toxicologists,Annual Meeting, Portland,OR October 2003 Society of Forensic Toxicologists,Annual Meeting, Dearborn, MI October 2002 Midwest Association for Toxicology&Therapeutic Drug Monitoring Annual Meeting; Kansas City, MO DocuSign Envelope ID: 192DD89C-A3C5-4226-BF99-1 A23E2A1 F635 Dawn M.Hahn Curriculum Vitae Page 4 of 4 May 2000 National Laboratory Certification Program,NLCP Workshop Research Triangle Park,NC April 1999 Society of Forensic Toxicologists,Annual Meeting, Salt Lake City, UT PUBLICA'T'IONS AND PRESENTATIONS 2003 William Seiter,Russell Robinson,Tiffany Porter,Barbara Rowland,Dawn Hahn,Michael Lehrer,Lance Presley. Opiate Prevalence in Oral Fluid. Poster Presentation, SOFT,Oct. 2003 Annual Meeting; Portland, OR. 2003 Lance Presley,Michael Lehrer, William Seiter, Dawn Hahn, Barbara Rowland,Melissa Smith, Keith Kardos,Dean Fritch, Sal Salamone,R.Sam Niedbala,Edward Cone. High Prevalence of 6-acetylmorphine in Morphine-Positive Oral Fluid Specimens,Forensic Science International, 133: 22—25 (2003). October 1997 Dawn M. Hahn,Alan E.Davis;Semi-Automated Urine Extraction by a Hamilton 2200 Microlab Extraction Unit; Society of Forensic Toxicologists,Oral Presentation,Annual Meeting; Salt Lake City, UT References available upon request. DocuSign Envelope ID: 192DD89C-A3C5-4226-BF99-1 A23E2A1 F635 SUSAN P. MILLS 400 EGYPT ROAD NORRISTOWN, PA 19403 (610)631-4502 EDUCATION: M.S. (Clinical Chemistry) 1979 Northeastern University, Boston, MA B.H.S. (Medical Technology) 1975 Duke University, Durham, NC EMPLOYMENT Quest Diagnostics HISTORY: Formerly SmithKline Beecham Clinical Laboratories 400 Egypt Road, Norristown, PA 19403 Toxicology Department 2000-Present Director, Lab Operations, Responsible Person, Forensic Toxicology Responsible for all operational aspects of the Forensic Toxicology laboratory including standard operating procedures, personnel, training programs, quality assurance, result certification, methods validation, regulatory compliance and strategic direction. 1995-2000 Director, Responsible Person, Forensic Toxicology Assumed permanent Director duties. 1993- 1995 Acting Director, Responsible Person, Forensic Toxicology Responsible for daily management of the Forensic Toxicology laboratory and staff including generation and maintenance of standard operating procedures,oversight of staff, overall quality assurance, project management and interaction with various regulatory agencies to ensure compliance. 1992- 1993 Technical Manager, Co-Responsible Person, Forensic Toxicology Responsible for monitoring technical, processing and client service functions of the department. Duties included maintaining compliance with SOPs and overseeing daily operations of accessioning,technical, certifying scientist and client service areas. 1989-1992 Forensic Supervisor Responsible for coordinating technical and client service operations of forensic testing area to assure compliance with regulatory agencies and corporate protocols. Duties included certification of test results, protocol documentation, client interaction and routine supervisory duties. 1987-1989 Shift Supervisor Responsible for shift operations involving drug confirmation testing and therapeutic drug monitoring. Duties included staffing, scheduling, resolution of technical and production problems, quality assurance, documentation, and evaluation and development of new procedures. 3/87-9/87 Mass Spectrometer Specialist Responsible for daily operation of mass spectrometers and related drug confirmation testing. 1985-1987 Medical Technologist II Worked as group leader to aid senior technologist. Duties included troubleshooting, maintenance, quality control review and methods development and validation. Methodologies included: HPLC, GC, GC/MS, HPTLC, Immunoassays and M. DocuSign Envelope ID: 192DD89C-A3C5-4226-BF99-1 A23E2A1 F635 SUSAN P, MILLS PAGE 2 SmithKline Bio-Science Laboratories 1777 Montreal Circle Tucker, GA 30084 1981 -1985 Assistant Supervisor Supervisor of area involving drug screening of biological fluids, mass spectrometry and UV/VIS assays. Analytical techniques included TLC, GC/MS, HPLC, RIA, EMIT AND UV scanning. 1979-1981 Medical Technologist Worked as bench level chemist. Duties included therapeutic drug monitoring and drug and heavy metal screening using a variety of techniques. Massachusetts General Hospital One Fruit Street Boston, MA 02114 Pediatric Microchemistry Laboratory 1977-1979 Supervisor Supervised a staff of 18 technologists at the MGH and a satellite lab at the Shriners' Burns Institute. 1975- 1977 Medical Technologist Worked as a bench level technologist. Duties included chemistry analyses of body fluids, blood gas analyses and capillary blood drawing from neonates and children. PROFESSIONAL American Academy of Forensic Sciences AFFILIATIONS: American Society of Clinical Pathologists Society of Forensic Toxicologists Inspector, National Laboratory Certification Program, 1992—Present Inspector, College of American Pathologists, 2000- Present Board Member,American Board of Forensic Toxicology, 2009-2018 Member, Drug Testing Advisory Board, 2012-2016 Nominating Committee,American Board of Forensic Toxicology 2019-Present CERTIFICATIONS: 2014 Diplomate—Forensic Toxicology(D-ABFT-FT)#1221 1993 Forensic Toxicology Specialist(ABFT)#5004(revised 08/2014) 1990 Toxicological Chemist(NRCC)#2214 1981 Clinical Chemist(NRCC)#1905 1975 Medical Technologist(ASCP)#103520 TESTIMONY American Arbitration Association Administrative,Adverse Action and Trial Board Hearings Montgomery County Court of Common Pleas New Jersey Municipal Court New York City Administrative Hearings New York State Court qualified as expert witness New York State Unemployment Compensation Review board Pennsylvania Unemployment Compensation Board of Review DocuSign Envelope ID: 192DD89C-A3C5-4226-BF99-1A23E2A1F635 STEVEN EDRIC SYKES Business Address: Quest Diagnostics 1777 Montreal Circle Tucker, GA 30084 Day/Evening Phone: 404-234-7085 Email: steven.e.sykes@questdiagnostics.com EDUCATION/CERTIFICATION • CLIA Certified Laboratory Director. May 2018. • D-ABFT-FD Diplomate in Forensic Drug Toxicology, American Board of Forensic Toxicology. February 2018. • Ph.D. in Cellular Biology. December 2012. University of Georgia, Athens, GA, USA • B.S. in Biology. May 2001. Morehouse College, Atlanta, GA, USA PROFESSIONAL EXPERIENCE July 2018—current Scientific Director Quest Diagnostics, Workplace Drug Testing, Prescription Drug Monitoring, Tucker, GA, USA. Oversight of the scientific and technical direction for Quest Diagnostics Employer Solutions in Tucker, GA. Direct, plan, and manage the activities of forensic scientist and lab staff in order to optimally align with laboratory testing goals. Ensure scientific integrity and consistency with laboratory strategy. Follow and maintain regulatory requirements and licensure to ensure compliance. Develop and review standard operating procedures (SOPs) and validations for technical lab processes. Provide guidance on adapting and maintaining a QA/QC program. Consult with clients on matters pertaining to workplace drug testing and prescription drug monitoring. Mar. 2017—Jun. 2018 Scientific Director—Associate Quest Diagnostics, Workplace Drug Testing, Prescription Drug Monitoring, Tucker, GA, USA. Oversight of the scientific and technical direction for Quest Diagnostics Employer Solutions in Tucker, GA. Assist in developing and reviewing standard operating procedures (SOPs) and validations for technical lab processes. Provide guidance on adapting and maintaining a QA/QC program. Consult with clients on matters pertaining to workplace drug testing and prescription drug monitoring. Qualify and apply for applicable boards, certifications and state licensure to maintain testing compliance. 1 DocuSign Envelope ID: 192DD89C-A3C5-4226-BF99-1A23E2A1F635 Steven Sykes Email: steven.e.sykes@questdiagnostics.com Mar. 2015—Mar. 2017 Postdoctoral Fellowship Forensic Toxicology. Workplace Drug Testing and Prescription Drug Monitoring. Dr. Barry Sample, Employer Solutions, Quest Diagnostics, Lenexa, KS and Tucker, GA, USA. Utilized a two-tier testing process to evaluate patient matrices for the presence of illicit drugs and prescribed medication. Assisted in developing and maintaining QA/QC and safety measures for the forensic toxicology laboratory. Reviewed and critiqued SOPs and method validations for technical procedures used in-house. Lead a team of lab-based investigators through completion of the College of American Pathologists self inspection. Provided continuing education in the form of journal clubs to laboratory staff. Created and reviewed literature for the Drug &Alcohol Testing Industry Association on drug education. Jan. 2014 — Feb 2015 Postdoctoral Research Fellow Infectious Disease. Amoebiasis. Dr. L.A. Temesvari, Eukaryotic Pathogens Innovation Center, Clemson University, Clemson, SC, USA. Responsible for developing and validating an in vitro encystation assay for the enteric pathogen Entamoeba histolytica. Utilized recombinant expression systems to manipulate eukaryotic initiation factor-2a, a key target in eukaryotic latency control. Involved in an antibody design project for elF2a. Assisted in the generation of data and ideas for a National Institutes of Health grant entitled "Translational Control of Encystation in the Entamoebae" (resubmitted). Advised and trained graduate and undergraduate students on proper laboratory practices, assay development, and time management. Jan. 2013— Dec. 2013 Postdoctoral Research Associate Molecular Parasitology. Dr. S. L. Hajduk, Biochemistry and Molecular Biology, University of Georgia, Athens, GA, USA. Utilized a combination of mass spectrometry, bioinformatics, biochemistry, and microscopy to understand an unconventional role for mitochondrial a-ketoglutarate dehydrogenase El in Trypanosoma brucei. Consulted labs on protein isolation and fractionation using native and denaturing gel-based conditions. initiated studies on parasite-parasite and parasite-host interactions mediated by extracellular nanovesicles. Created a cell line that produces scale-up quantities of nanovesicles needed in assay development. Apr. 2003—July 2004 Medical Technologist II Quest Diagnostics, Forensic Toxicology, Atlanta, GA, USA. Determined the concentrations of drug metabolites and other toxic substances in human biological samples. Mastered operation and maintenance of Olympus chemistry analyzers. 2 DocuSign Envelope ID: 192DD89C-A3C5-4226-BF99-1A23E2A1 F635 Steven Sykes Email: steven.e.sykes@questdiagnostics.com Pioneered the oral fluids drug-screening project. Personally advised and trained team members on operation of aliquotting machinery and equipment troubleshooting. Awarded for advancements made in the oral fluids screening project (April 2004). May 2002—Mar. 2003 Specimen Preparatory Technician Quest Diagnostics, Forensic Toxicology, Atlanta, GA, USA. Prepared urine samples for analytical testing. Received, sorted, and performed data entry for patient samples while maintaining chain of custody. Proficient in CV-1000 automatic aliquotter operation and maintenance. ACADEMIC EXPERIENCE May 2007—Dec. 2012 Research Assistant Ph.D., Protein Diversity in African Trypanosomes: The Role of Novel and Multifunctioning Mitochondrial Proteins in T. brucei. Dr. S.L. Hajduk, Biochemistry and Molecular Biology, University of Georgia, Athens, GA, USA. Validated the function of mitochondrial enzyme complexes in T. brucei using subcellular fractionation, biochemical assays, microscopy and immuno-detection. Provided research support for undergraduate investigators by aiding in experiment preparation and data analysis. Awarded for exemplifying high standards in the presentation of biochemical research at a scientific meeting (2010). Jan. 2005—Apr. 2006 Teaching Assistant Principles of Biology II Lab. University of Georgia, Athens, GA, USA. Guided students through an in-depth exploration of the scientific process while developing basic skills in experimentation and writing strategies. Provided consultation to students for lab techniques, applied research methodologies, and academics. Fine-tuned students' knowledge of organismal biology and presentation practices. Cited for superior instruction to undergraduates and aiding in developing lab curriculum (2007). SCIENTIFIC CONFERENCES • Caduceus Conference: (2018). Hair vs. Oral Fluid vs. Urine Panel Discussion • Society of Forensic Toxicologist Conference: (2015 - 2019) • Midwest Association for Toxicology and Therapeutic Drug Monitoring Meeting: (2016) • Drug and Alcohol Testing Industry Association Conference: (2016) 3 DocuSign Envelope ID. 192DD89C-A3C5-4226-BF99-1 A23E2A1 F635 Vinnette D. Batiste 31 Saint Aurics Drive Suwanee, GA 30024 E-mail: vinnette. t.batiste(u questdiagnostics.com Objective: To use the technical skills and managerial experience in any related field Certification: Toxicological Chemist,NRCC (National Registry Certified Chemist) Education: McNeese State University, Lake Charles,LA 70601 B.S in Chemistry, 1985 University of New Orleans,New Orleans,LA 70053 Post Graduate courses in Chemistry(1987-1989) American Intercontinental University,Dunwoody,GA 30328 MBA concentration Healthcare Management,2005 Capella University, Minneapolis, MN 55402 PhD: Human Services concentration Substance Abuse,2010 Forensic Science Research&Education, Willow Grove, PA 19090 Forensic Toxicology Certification: May 2015 Forensic Science Research and Education, Willow Grove,PA 19090 Forensic Pharmacology Certification: Nov 2019 Experience: April 2019-Present: Responsible Person(RP)Quest Diagnostics May 2018-Present: Visiting Professor at University of West Indies, Jamaica • Seminars in Forensic Toxicology courses May 2013-April 2019: AIternate Responsible Person(RP)at Quest Diagnostics Jan 2014-Present: NLCP Inspector for RTI (Research Triangle,NC) Jan 2011-Jan 2015: Adjunct Professor at University of Phoenix • Taught Healthcare Management courses DocuSign Envelope ID: 192DD89C-A3C5-4226-BF99-1 A23E2A1 F635 June 2007-Present: Operation Manager/Supervisor for Screening/Certification/ Confirmation and Client Service Departments • Manage personnel within different departments to meet overall production goals • Manage the operation to ensure quality testing,compliance,and company policies • Coordinate problem solving, troubleshooting, and allocate resources from departments • Review and approves payroll and benefit hours for accuracy • Manage supplies to maintain adequate costs and minimize waste • Conduct staff meeting to identify/resolve issues • Responsible for Safety and Compliance Training. • Coordinate all non-Technical and Technical Training. Nov 2000-June 2007: Group Leader/Certifying Scientist, Quest Diagnostics Inc. • Have all the responsibilities of a certifying scientist. • Responsible for scheduling, reviewing litigation packages,and monthly meetings • Involve in PDR yearly review with Responsible Person(Director) • Responsible for the entire Proficiency Testing for the laboratory • Participate in recruitment, interviews and selections of new employees • Regular Monthly meetings to communicate issues and resolve problems • Involve in overall training program for technical department Jan. 1992-Nov.2000: Certifying Scientist, Quest Diagnostics Inc.Atlanta,Georgia • Athletic Drug Testing and Steroid Testing • Responsible for the releasing and certification of all forensic data • Responsible for deposition and court hearing for the lab • Review all external and internal chain of custodies,open and blind QC Jan. 1990-Feb. 1992: ConfirmationTechnologist, Smithkline Beecham Clinical Lab, Atlanta, Georgia • Responsible for extraction, analysis and interpretation of specific drugs in urine • Verification of correct identification and proper chain of custody • Possess knowledge of Solid Phase and Liquid/Liquid extraction procedures and in HPLC,TLC,and GC/MS instrumentation Feb 1987-Dec. 1989: Chemist, Laboratory Specialist Inc.New Orleans, Louisiana • Specific duties were screening for drugs in urine using TDX and GCMS instrumentation Specialized Training • GC/MS,HPLC, &LCMS/MS,EMIT&ELISA (Immunoassay) • Forensic Toxicology Seminar- S.O.F.T • AACC Member • ACS Member • CAP Inspector Training • Fred Pryor Management Training DocuSign Envelope ID 192DD89C-A3C5-4226-BF99-1A23E2A1F635 • NLCP Inspector Training • AMA Management Training • Medical Review Officer(MRO) • Research Methods/Validation Member of Organization • S.O.F.T (2009-Present) • AACC • ACS • CAP Personal Skills • Management and supervisory experiences over 15 yrs • Practical expertise and experience in process flow and management • Excellence communication skills,both written and verbal • Knowledge with Microsoft Office word, excel,power point,and access References: Available upon request DocuSign Envelope ID: 192DD89C-A3C5-4226-BF99-1A23E2A1 F635 Email: amit.q.thakkar(a�questdiagnostics.com Phone: (678)-406-1108 Amit Thakkar Accomplishments • Over eighteen years'experience in forensic drug testing in SAMSHA certified laboratory. • Approved as Responsible Person in leading company for urine drug testing —Quest Diagnostics Inc.—Atlanta, GA by the U.S. Department of Health and Human Services/Substance Abuse and Mental Health Services Administration's National Laboratory Certification Program—2012. • Appointed as QA/QC supervisor in leading company for urine drug testing —Quest Diagnostics Inc.—Atlanta, GA—March—2010. • Approved as Alternate Responsible Person in leading company for urine drug testing—Quest Diagnostics Inc. —Atlanta, GA by the U.S. Department of Health and Human Services/Substance Abuse and Mental Health Services Administration's National Laboratory Certification Program— March—2011. • Appointed as Technical Manager for Prescription Drug Monitoring Operation in leading company for urine drug testing—Quest Diagnostics Inc. —Atlanta, GA—August—2011 • Completed Six Sigma Green Belt Certification in March 2011 • Developed automated aliquotting process for drug testing samples using Hamilton for initial and confirmation testing. • Developed Best Practice Procedures for Extraction to minimize cross-contamination. • Recognized for exceptional leadership in facilitating the relocation of forensic laboratory. • Developed electronic forms for quality control logs and instrument maintenance logs for entire forensic laboratory for monitoring and auditing electronically and remotely. • Assisted in developing standard operating procedure for verification and certification of analytical data generated by GC/MS, LC/MS/MS remotely using ftp application nationwide for leading pain management drug testing laboratory—Ameritox, Ltd. —Midland, TX • Developed competency program and continuing education program for employees to ensure compliance with standard operating procedures and program requirement. • Served as Assistant Manager for leading company for manufacturing resin based laminates and managed the production over one hundred twenty employees—Esquire Pvt. Ltd. —India. Professional Experience Responsible Person/Laboratory Manager—QA/QC Manager, Quest Diagnostics Inc., Atlanta, GA•September, 2006—Present • Responsible for establishing and maintaining Standard Operating Procedure Manual for day to day operation of laboratory in accordance with all FRA, HHS, NRC, HRS, CAP, CLIA, State and Federal regulations. • Responsible in development and enforcement of SOP manuals, regulations, and practices in all technical and non-technical departments involved in Work Place Drug Testing FRA, HHS, NRC, HRS, CAP, CLIA, Prescription Drug Monitoring, State, Federal and other referral testing. • Responsible for establishing and maintaining Quality Control Program to maintain acceptable analytical performance for all controls and standards and to assure proper performance and reporting of all test results which are in compliance with CAP, NRC, SAMSHA, HHS, State and Federal regulations and certification requirements. • Responsible for establishing tolerance limits and acceptance criteria for all the quality control samples as appropriate to the requirements of State and Federal requirements. • Responsible for Quality Assurance by reviewing and monitoring reliability, accuracy, precision, and performance characteristics of each test and equipments used for drug testing. DocuSign Envelope ID: 192DD89C-A3C5-4226-BF99-1A23E2A1 F635 Email: amit.q.thakkaraquestdiagnostics.com Phone: (678)-406-1108 • Responsible to take any remedial action in response any test system being out of control limits and implementing best practices in quality program to correct and improve the entire quality control program. • Responsible for ensuring the continued competence of laboratory personnel by establishing and reviewing training programs and certification of all the employees. • Performed staff training as needed to ensure adequate understanding and compliance to the quality control program. • Responsible to take any remedial action in response to any unsatisfactory performance of any laboratory personnel. • Responsible for management of the PDM/referral testing specimen processing department and recommend staff additions to achieve department goals. Monitor the overall training program of these specimen processing employees. • Responsible for ensuring efficient operations of Specimen Processing and collaborating with other managers in Screening, Confirmation and Certification departments by matching staffing, scheduling and workflow with to achieve TAT goals. • Responsible for reviewing new IT projects and giving requirement to enhance QTN LIMS to increase efficiency, improve quality and customer experience, reduce costing of the testing. Positive Certifying Scientist, Quest Diagnostics Inc., Schaumburg, IL • November, 1999— September, 2006 • Responsible for following company's policies and regulations which includes Federal, State and Local requirements • Responsible for verifying the daily calibration data and performed quality controls are in acceptable ranges to perform further testing • Performing drug screening on urine specimen with EMIT method using OLYMPUS 5200 and confirming positive results by Solid phase or Liquid phase extractions and by GC/MS • Responsible for work activities are completed thoroughly, accurately, efficiently and in timely manners ensuring quality standards are met • Responsible for double checking test results and confirmation procedure are performed before transferring results to computer mainframe and releasing and reporting results to clients and MRO Toxicology Specialist/ Certifying Scientist—www.ameritox.com , Midland, TX• July, 2007— March, 2010 • Review and Interpretation of patients results produced by AU5400, ELISA, GC/MS and LC/MS/MS tested for Pain Management Program • Posting patients results data into the laboratory information management system (LIMS) • Responsible for final verification and certification of patients results based on prescribed medication and reporting it to medical review officer • Responsible for communicating with the Laboratory Director and other designated laboratory staff to identify trends and issue with laboratory data. Medical Technician/Phlebotomist—Resurrection Medical Center, Chicago, IL• May, 2002—Jan, 2004 • Responsible for processing specimens for referral laboratories with monitoring supply inventories • Responsible for performing STAT, routine and timed venipunctures and capillary procedures on neonatal, nursery, pediatric, adult, geriatric patients using established procedures and policies • Responsible for handling the reception desk and aware of flow of phone-calls, doctor's requests and orders and incoming specimen Medical Laboratory Assistant—Laboratory Corporation of America, Elmhurst, IL• Feb, 1999—Nov 1999 • Assisted in laboratory setup, managing aliquoting specimen by its test ordering and further confirmation DocuSign Envelope ID: 192DD89C-A3C5-4226-BF99-1A23E2A1F635 Email: amit.q.thakkaraquestdiagnostics.com Phone: (678)-406-1108 • Providing accurate charting and pulling the worksheets for different tests for send-outs and further testing • Providing needed assistance to medical technologist for better turn-around time for resulting to patients and clients Assistant Manager—Esquire Decor Pvt. Ltd., India•April, 1997—Nov, 1998 • Responsible for over-looking the entire production and the quality of manufacturing of decorative laminates. • Responsible for inventory control and maintaining cost effectiveness of the company • Responsible for authorizing the shipment of finish products to client world-wide • Performed payroll, and gave out bonuses based upon annual performance of employees and entire company. Additional Skills: • Experience with laboratory environment, strong research and analytical skills, personal supervision problem solving with discrepancies, well organized time management, good communication skills, hands on daily operations management, dedication to achieving goals. Education: B.S. in Science(Chemistry), Gujarat University, INDIA B.S. Technical Management(Operations Management), Devry University, Atlanta Course work includes: General Chemistry, Organic chemistry, Inorganic Chemistry, Analytical Chemistry, Physical Chemistry, Physics, Computers, Mathematical and Technical Management courses. DocuSign Envelope ID: 192DD89C-A3C5-4226-BF99-1 A23E2A1 F635 CURRICULUM VITAE Mervat S. Ayad BS,MBA, CCS, CLSp(CG),CLSup Senior Director of Laboratory Operations Quest Diagnostics,Inc.-Nichols Institute Quest Diagnostics Inc.—Infectious Disease Home Address: 4 Mackenzie Lane Coto de Caza,CA 92679 Phone: (949)589-7895 Office Address: Quest Diagnostics,Nichols Institute Quest Diagnostics 33608 Ortega Highway San Juan Capistrano, CA 92690 Phone: (949)728-4302 Celluar: (949)573-3176 Mervat.s.ayad@questdiagnsotics.com PROFESSIONAL PROFILE Quest Diagnostics-Nichols Institute San Juan Capistrano,CA Director of Laboratory Operations- Esoteric 2007-2018 Senior Director of Laboratory Operations- Esoteric 2018-Present Quest Diagnostics-Nichols Institute San Juan Capistrano,CA Senior Laboratory Manager 2004-2007 Quest Diagnostics-Nichols Institute San Juan Capistrano,CA Laboratory Manager 1997-2004 DocuSign Envelope ID: 192DD89C-A3C5-4226-BF99-1A23E2A1 F635 Corning—Nichols Institute San Juan Capistrano,CA Unit Supervisor 1992-1997 Nichols Institute San Juan Capistrano,CA Lead Cytogenetics Technologist 1987-1992 Cytogenetics Center Torrance,CA Senior Cytogenetics Technologist 1983-1987 CAREER SKILLS/KNOWLEDGE Supervision and staff training Time Management Business Management Cost/Pricing Analysis Financial Analysis Organizational Leadership Marketing Management Operations and Managerial accounting Computer and IT applications Strategic planning and decision making Human Resources Statistics and Forecasting EDUCATION/CERTIFICATION; Chapman University Orange,CA Executive Master of Business Administration May, 1997 MBA National Certification Agency Lenexa,KS Clinical Laboratory Specialist in Cytogenetics 1983-Present CLSp(CG) Clinical Laboratory Supervisor CLSup 2000- Present California Clinical Scientist MTO 249 Ein Shams University Cairo,Egypt BS in Biochemistry 1978 SPECIAL TRAINING/CONTINUING EDUCATION • Association of Cytogenetics technologist(AGT)annual meeting, Monterey, CA. 1984 DocuSign Envelope ID: 192DD89C-A3C5-4226-BF99-1 A23E2A1 F635 • ACT annual meeting,Rochester, MN 1992 • Training Course on FISH methodology in University of California-San Francisco, UCSF,CA 1994 • ACT annual meeting, Virginia 1996 • FISH workshop, Maryland, Washington DC 1997 • Pacific Southwest Regional Genetics Network (PSRGN) meeting, Costa Mesa, CA. 1998 • American Society of Human Genetics (ASHG)annual meeting,Denver, CO. 1998 • PSRGN annual meeting, Quest Diagnostics-Nichols Institute, CA. May,1999. • AGT annual meeting, Orlando Florida,June 1999 • AGT annual meeting, Scottsdale,Arizona, June 2000 • AGT annual meeting, Minneapolis,June 2001 • AGT annual meeting,Cincinnati, Ohio,June 2002 • PSRGN annual meeting, UC Davis,Davis, California, March 2003 • AGT annual meeting, Atlanta, Georgia 2003 • AGT annual meeting, Anaheim, CA.2004 • PSRGN annual meeting, UCLA 2005 • AGT annual meeting, Missouri 2005 Publications Alonso,C., Ayad, M., Biggs, V., Chan, K., Huang, K., Pryor, D., Shi, L., Spear, C., Sulcova, V., Wang, S., and White,B. A familial t(5;13)(p15.3;q21.2) rearrangement resulting in a child with an unbalanced karyotype with del (5) (pter-p15.3) and dup (13) (g21.2- gter). FISH analysis of the translocation and comparison with 3 similar cases. The 22nd Annual AGT meeting, 1997 Ayad, M., Fraser, A., Sbeiti, A., Fenwick, R., and White, B. A six year experience in screening for cytogenetic abnormarlities and Fragile X mutations in patients with mental retardation. The 23rd Annual AGT meeting, 1998 Anguiano A, Ayad M, Edwards L, Winkler M, Entwistle T, White B: The Philadelphia translocation: Trends of utilization and results of genetic testing in a national reference laboratory, six years of experience. The 48th Annual American Society of Human Genteics Meeting, 1998 White, B., Ayad, M., Fraser, A., Entwistle, T., Sbeiti, A., and Fenwick, R.: A six year experience demonstrates the utility of screening for both cytogenetic and FMR-1 abnormalities in patients with mental retardation. The 48th Annual American Society of Human Genetics Meeting, 1998 Ayad M, Duckworth K, Wang S, Sulcova V, Bennett J, Santiago-Irizzarry L, Santiago- Cornier A, White B, Anguiano A.: Trisomy 9p, derived from a familial insertion (9;10) DocuSign Envelope ID: 192DD89C-A3C5-4226-BF99-1 A23E2A1 F635 Mount Sinai MEDICAL CENTER ATTACHMENT D LOCAL BUSINESS TAX RECEIPT 0 0 0 C to v7 m 0 m 5- 0 0 coco 0 D 0 01 N N rT Local Business Tax- Receipt LBT Miami-Dade County, State of Florida -n w -THIS IS NOT A BILL-DO NOT PAY N 1823476 01BUSINESS NAME/LOCATION RECEIPT NO EXPIRES MOUNT SINAI MEDICAL CENTER OF FLORIDA IN RENEWAL SEPTEMBER 30,2020 C 1823476 Must be displayed at place of business 4300 ALTON RD Pursuant to County Code MIAMI BEACH FL 33140 [3" ' Chapter BA-Art.9&10 o � ,ten, OWNER SEC.TYPE OF BUSINESS MOUNT SINAI MEDICAL CTR OF FL INC 173 NON-PROFIT CHAR REL/EDUC PAYMENT RECEIVED C/O STEVEN SONENREICH,PRES BY TAX COLtECTOS TOa S0.00 08/26/2019 FPPU07-19-009335 This Local Business Tax Receipt only confirms payment of the Local Business Tax. 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SINAI HOSPITAL -ADMINISTRATION (MAIN) 4300 Alton Rd, Administration MIAMI BEACH, FL 33140-2948 DocuSign Envelope ID:B49C1766-7BF6-41 BB-90CB-8955ED1BD5B6 MIAMIBEACH City of Miami Beach, 1700 Convention Center Drive,Miami Beach,Florida 33139,www.miamibeachfl.gov Funding and Background Screening Summary Cover for Independent Contractor or Professional Services Agreements Department: Parks and Recreation Monica Toledo Summary Scope of Work/Service: Literacy Instruction, Planning and Trainings as per Children's Trust Grant Agreement Duration of Work: June 7, 2021 —September 30, 2021 Amount: Not to Exceed the Amount of$10,000.00 Budget Code: 143-0950-000312-00-405-542-00-00-00-52520 Additional Funding Information: (brief notes explaining whether item is budgeted and if not where the funding will come from) The grant reimburses expenses. Background Screening Request: Contractor needs to be screened again if necessary for FY 21. Please advise at your earliest. 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