HomeMy WebLinkAbout1996 NS Jail Medical services Contract Renewal with Orange Family Medical Group 1
ORANGE COUNTY
BOARD OF COMMISSIONERS
Action Agenda
Item No.X11/
ACTION AGENDA ITEM ABSTRACT
Meeting Date: June 26, 1996
SUBJECT: JAIL MEDICAL SERVICES CONTRACT RENEWAL
DEPARTMENT: PURCHASING AND Public Hearing: No
CENTRAL SERVICES Budget Amendment Reqd? No
ATTACHMENT(S): INFORMATION CONTACT:
Renewal PAM JONES, ext.2650
Contract
Fee schedule Telephone Number-
Hillsborough 732-8181
Chapel Hill 967-9251
Mebane 227-2031
Durham 688-7331
PURPOSE: To consider renewing a contract with the Orange Family Medical Group for Jail Medical
services through June 30,1997.
BACKGROUND: Since 1985 the County hm conbacted with this medical group to provide medical
services to the inmates of the Orange County Jail. We are aid by State law to provide medical
care for any inmate in the custody of the Orange County Jail.
Orange Family Medical Group will renew the contract through June 30, 1997 at the 1996 rate of
$16,500 per year. A copy of the terms and conditions as approved by the Board in July, 1989 is
attached for your information. This method of service delivery to inmates continues to be the most
economical and efficient means of providing the service required.
The County will continue to be invoked separately for testing and x-rays required as treatment for the
inmate. Historically,the cosh for these services have been$2,000,$3,000 per year. The fee schedule
will remain at the same rate which were in effect In 1995 and 1996.A rate schedule Is attached for your
information.
RECOMMENDATION: The Manager recommends that the Board approve the renewal of the Jail
Medical Services contract with Orange Family Medical Group through June 30, 1997 for a sum of
$16,500 per year; and authorize the Chair to sign on behalf of the Board.
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RENEWAL AGREEMENT BETWEEN
COUNTY OF ORANGE
AND
ORANGE FAMILY MEDICAL GROUP, P.A.
NORTH CAROLINA
COUNTY OF ORANGE
WHEREAS,- an agreement was made and entered into as of the 1 st day of July, 1989 by and
between Orange County, hereinafter referred to as the "County" and Orange Family Medical
Group, P.A., hereinafter referred to as "Medical Group", for the provision of primary medical
services for the Orange County Jail.
WHEREAS, the COUNTY and the MEDICAL GROUP mutually agree to the following:
1. The agreement will be continued for a period beginning July 1, 1996 and ending at 12:00
midnight on June 30, 1997.
2. All other terms and conditions shall remain the same.
FOR AND ON BEHALF OF
COUNTY OF ORANGE
Date:
MOSES CAREY, JR., CHAIR
FOR AND ON BEHALF OF
ORANGE FAMILY MEDICAL GROUP, P.A.
Date:
DR. ARTHUR AXELBANK, PRESIDENT
This instrument has been pre-audited in the manner required by the Local Government Budget and Fiscal
Control Act.
Kenneth T. Chavious, Finance Director
3
AGREEMENT BETWEEN
ORANGE COUNTY
AND
ORANGE FAMILY MEDICAL GROUP, P.A.
This agreement is made and entered into this the 1st day of July,
1, 1989, by and between Orange County, a body politic and corporate
organized and existing pursuant to the Constitution and laws of the
State of North Carolina, hereinafter referred to as "County" and
Orange Family Medical Group, P.A. , a professional association
organized and existing pursuant to Chapters 55 and 55B of the North
Carolina General Statutes, hereinafter referred to as "Medical
Group. "
W I T N E S S E T Hs
WHEREAS, County desires to contract with Medical, Group for the
provision of primary medical services for the Orange County jail,
and
WHEREAS, Medical Group desires to provide those services,
NOW, THEREFORE, in consideration of the premises and of the
following mutual promises, covenants and conditions, County and
Medical Group agree as follows:
A) Medical Services:
1) Medical Group shall provide medical personnel who are
qualified in their respective fields and who maintain
applicable licenses and registration to perform the
necessary medical practice required by this agreement.
2) Medical Group shall be responsible for the health program
of the jail. All medical procedures and decisions shall
be followed and made by the responsible physician, in
accordance with accepted methods and procedures, state
and federal law and consistent with any local health
ordinances.
3) Medical Group shall process inmate health complaints
daily. If it is necessary that Medical Group examine an
inmate, that examination will take place as soon as
practicable after determination is made that an
examination is necessary. All such examinations snail
take place at the jail, at the office of Medical Group,
or other health care facility at the discretion of the
attending physician after consultation with the sheriff
or his designee.
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4) Medical.Group shall conduct a sick call once per week at
the jail.
5) Medical Group shall conduct, at the jail, a health
appraisal of each inmate within 14 days after the
inmate's arrival at the jail.
6) Medical Group shall provide for administration of
injections to inmates in situations where the inmate
cannot administer his/her own injection.
7)• All admissions for hospital or emergency care shall be
to the North Carolina Memorial Hospital at Chapel Hill,
Durham County General Hospital or such other qualified
hospital as designated by Medical Group.
8) County will provide adequate space, security and non-
medical supplies and equipment in the jail for Medical
Group to use in meeting the terms of this agreement.
9) County will perform receiving and screening on all
inmates upon their arrival at the jail.
8) Policies and Procedures:
1) Medical Group and County agree to negotiate a contract
for the preparation by Medical Group in cooperation with
County of a manual of written policies and defined
procedures which will meet Orange County's and the
sheriff of Orange County's responsibilities under N.C.
Gen. Stat. Sections 153A-224 and 153A-225. The points
of negotiation shall be limited to the time provided for
the preparation of the manual and the compensation to
Medical Group for its preparation. If the parties agree
to the time for and cost to County of the manual
preparation, they will reduce their agreement to writing.
The manual shall contain provisions for:
A) implementation and maintenance of medical services
as described in section a of this agreement;
H) health record patient folders on any inmate who
requires intervention after initial screening which
shall contain at a minimums
- patient authorization for release of all
information contained in the patient health
record;
- completed receiving and screening forms, if
applicable;
2
S
health appraisal data forms;
all findings, diagnoses, treatments,
dispositions;
prescribed medications and their
administration;
laboratory, x-ray and diagnostic studies;
signature and title of each documenter;
consent and refusal forms;
place, date and time of health encounters;
discharge summary of hospitalizations;
health service reports (e.g. , dental,
psychiatric and other consultation) .
C) develop health record transfer practices and record
retention policy;
D) paper management of pharmaceuticals including the
following stipulations:
adherence to state pharmacy law;
- adherence to federal controlled substance act;
- re-evaluation of prescriptions before renewal;
- maximum security of pharmaceuticals, syringes
and needles;
- prohibition of misuse of psychotropic
medication.
Bj a training guide for jail employees which would
cover:
action required for potential emergencies;
signs and symptoms of an urgency;
obtaining urgency care;
patient transfer procedures;
chemical dependency and emotional disturbance;
3
0
health and hygiene;
receiving and screening.
F) the following miscellaneous items:
standing orders for inmates in: isolation,
chemically dependent, detoxification, and
special medical care, hospitals, need of
preventative care, chronic care, convalescent
care;
- health kit contents, number, location and
inspection procedures;
- access to diagnostic services;
- notification of next of kin for serious
illness, injury or death;
- coordination/notification of medical examiner
for post-mortem exam;
- coordination with other County departments on
health inspections and the facility's disaster
plan;
- peer review;
- information sharing;
- psychiatric patient handling;
- transfer of ill patients.
2) County reserves the right to require any modifications
to the manual that it deems reasonably necessary to
provide adequate policies and procedures which meet its
responsibilities under federal, state and local laws.
3) The manual after completion will be the exclusive
property of County.
C) Reporting t
1) Medical Group shall meet at least quarterly with the
sheriff to discuss the inmates' health care status and
the facility health care plan.
2) Medical Group shall submit a quarterly report to the
sheriff which will include:
4
A7
A) the effectiveness of the health care system;
B) description of any health environment factors of
importance;
C) program changes since last report.
3) Medical Group shall prepare an annual statistical report
which indicates the number of inmates receiving health
services by:
A) disease diagnosis category;
B) referral to specialists by specialist area;
C) hospital admission by reason;
D) injuries/accidents by type.
D) Insurance and Indemnification:
1) Medical Group will insure itself for general
comprehensive liability, professional liability and
errors and omissions coverage in the amount of $1,000,000
with county named as additional insured on the policy.
A certificate of insurance evidencing the above coverage
will be provided by Medical Group to County upon
execution of this agreement.
Each physician of Medical Group shall be covered by
professional liability insurance in the amount of
$11000,000 or be self-insured for the same risks to an
equal or greater degree of coverage. A certificate of
insurance or satisfactory proof of self-insurance
evidencing this coverage will be provided by Medical
Group to county upon the execution of this agreement.
2) Medical Group shall indemnify and save harmless County,
its agents and its employees from and against any and
all suits, claims, actions, losses, costs, penalties,
and damages of whatsoever kind or nature arising out of
or in connection with its practice of medicine as
described in this agreement.
E) Payment:
1) Medical Group shall be compensated as follows:
A) Six Thousand Six Hundred Dollars ($6,600) per annum
to be paid in equal monthly installments of $550.00
each. This compensation is for all services
5
described in this agreement performed by Medical
Group during its normal business hours including the
52 sick calls and all other visits to the jail, the
office of Medical Group or such other health care
facility selected by the attending physician
pursuant to Section A of this agreement.
B) In the event a jail inmate requires treatment or
otherwise must be seen by Medical Group other than
during the normal business hours of Medical Group,
Medical Group must be compensated for each such
treatment or visit at the emergency services fee
schedule of Medical Group in effect July 1, 1989.
Medical Group shall provide County with its normal
business hours and with a schedule of its emergency
service fees and its holidays for the period July
1, 1989 until June 30, 1990. Any changes in the
normal business hours or schedule of holidays during
the term of this agreement shall be provided to
County as soon as adopted by Medical Group.
C) Charges for laboratory fees, x-ray, suture
materials, sterilized instrument usage and
medication if purchased by Medical Group for use in
connection with this agreement will be invoiced
separately to County at cost.
F) Terms
1) This agreement shall run for one year from the 1st day
of July, 1989 to the 30th day of June, 1990, and shall
be renewable upon written notice executed by both
parties.
G) Terminations
This agreement or its renewals may be terminated at any time
without penalty by either party, provided that notice of such
termination is furnished to the other party in time to
properly arrange for professional coverage. in the event of
such termination, any payment due shall be prorated to the
date and time of termination.
This agreement contains the entire understanding of the
parties and cannot be altered, amended or modified, except by
an agreement in writing executed by the duly authorized
officials of both parties.
The laws of North Carolina shall govern the validity and
interpretation of this agreement.
6
IN WITNESS WHEREOF, the parties have hereunto signed this
agreement in their official capacities on the day and year
listed below.
ORANGE COUNTY ORANGE FAMILY MEDICAL GROUP, P.A.
MOSES CAREY, JR. ARTHUR AXELAANK
CHAIR, ORANGE CO PRESIDENT
BOARD OF COMISSJONtRS
THIS INSTRUMENT HAS BEEN PREAUDITED IN THE MANNER REQUIRED BY THE
LOCAL GOVERNMENT BUDGET AND FISCAL CONTROL ACT.
FINANCE DIRECTOR
J
t
7
i
/U
ORANGE FAMILY MEDICAL GROUP PA
06/15/93 PROCEDURE FEES PAGE 1
PROCEDURE DESCRIPTION ALT. DESC. DEPT T.O.S. STD, FEE
------------------------------------------------------------------------------------------------------------------------------------
82954(X4) GTT OL 1 25.00
829 O'S�JLL:VAN OL OL 1 .00
36406 VENIPUNCTURE, UNCER AGE 3, OTHER VEIN 36406 OL 0 35.00
Zia *ET MOUNT/KOH OL OL 1 12.00
111 URINALYSIS OL OL 5 14,00
172 URINE )IPSTICK OL OL 1 1,00
167 MONOSPOT OL OL 1 25.00
35651 SED ;ATE B_OOD WORK OL 0 15.00
164 GRAM STAIN OL OL 20.00
161 FINGERSTICK BS 82948 OL 5 11.00
99000 HAND. SPECIMEN TRANSFER(OFFICE TO LAS) OL 0 10.00
80073 RENAL PROFILE OL OL i 29.00
162 GTT 3 HR 6 HR OL OL i 45.00
83118 HDL CHOLESTEROL STUDY HDL OL 5 21.00
155 URINE CULTURE 87086 OL 1 35.00
82952(X2) GTT OL 1 20.00
140 LIPID PROFILE OL OL 1 27.00
82948 GLUCOSE, FINGERSTICK 52948 OL 5 11.00
94520 BUN (URIC NITROGEN) URIC OL 1 18.00
168 ENZYNE IMMONOASSAY FOR INFECT AG OL OL 0 16.00
86317 IMMUNOASSAY-INFEC. AGENT ANTIGEN RAPID STRE OL 5 19.00
36600 ARTERIAL PUNCTURE OL 0 55.00
82565 CREATINIE OL 5 18.00
34132 POTASSIUM OL OL 1 21.00
80019 MULTICHEM PANEL 80019 OL 5 29.00
131 3LOOD COL:ECTION-IN HOUSE BLOOD-IN OL 1 3.00
166 HEMOCCULT X1 X 3 OL OL 1 3.50
165 nEMA"OCRiT 93040 OL 5 11.00
x7220 KOH PREP OL 5 12.00
PEAK F±ON PEAK FLOP 4l 0 18.00
:o HEMOGLOBIN A-1C OL OL 5 18.00
?` GC CJLTLRE OL OL 1 20.00
:00 EKG WITH INTERPRETATION OL OL 1 45.00
;56:0 PROTnOMBIN TIME BLOOD WORK OL 1 30.00
44 POTASSIUM OL OL 5 14.00
'C THROAT CULTURE OL OL 5 12.00
59 SED RATE OL OL 1 15.00
<6410 VESIPUNCT,,RE,NEEDIN6 0 SKILL OL 0 35.00
:73 URINE PREGNANCY TEST OL OL 1 16.00
?: 36 HEMOGLOBIN, GLYCOSYLATED ALC OL 0 31.00
�41178 TRIGLYCERIDES OL OL 5 19.00
::415 VENIPUNCTURE, ROUTINE OL 5 3.00
32465 TOTAL CHOLESTEROL OL OL 5 19.00
151 DERMOPATH RL RL 99 45.00
38305 SURGICAL PATH SURD. PATH RL 0 85.00
)06049 BLOOD TYPE BLOOD WORK RL 1 .00
86006 HEP S S BLOOD WORK RL 1 .00
85044 RETIC COUNT RL 0 .00
92662 TEGRETOL BLOOD WORK RL 1 62.50
82952 GLUCOSE TOLERANCE TEST GTT RL 1 48.00
86592 VDRL, SERUM BLOODWORK RL 5 33.00'
133 CULTURE/SENSITIVITY RL RL 99. 35.00
88160 BREAST SECRETIONS BLOOD WORK RL 1 .00
ORANGE FAMILY MEDICAL GROUP PA
06/115/93 PROCEDURE FEES PAGE 2
PROCEDURE DESCRIPTION ALT. OESC. DEPT T.O.S. STD. FEE
------------------------------------------------------------------------------------------------------------------------------------
152 SURGICAL PATH (COMP.) RL RL 99 85.00
363;5 PROSIAIE SPECIFIC ANTIGEN RL 0 36.00
82951 D'S�LLIVAN i:NCLGDES GLUCOSE) RL 0 .00
39 HEPATITIS PANEL RL RL 99 .00
116':40 :9P BLOOD WORK RL 0 .00
83001 FS1 BLOOD RL 81.75
37063 ,PP:R RES?.CUL',J E 81000 WORK RL 1 .00
82135 :MNUNEGLOBINS BLOOD WORK RL 1 .00
:2486 NORTRIP':YLINE BLOOD WORK RL 1 .00
83002 LH BLOOD WORK RL O 81.00
83750 MAGNESIUM BLOOD WORK RL 1 39.00
31,825 MERCURY 6LOOD MURK RL 1 .00
84066 ACID PHOS. RL 1 .00
36255 MUMPS TITER RL 1 .00
35999 ANEMIA PROFILE 8 BLOOD WORK RL 1 30.80
85014 HEMATOCRIT BLOOD WORK RL 0 11.00
81205 GRAM STAIN 87205 RL 0 20.00
138A HEMOGLOBIN A-1C RL 99 45.04
86262 VAL?ORIC ACID RL 1 67.00
80118 DNA PROBE (x2) RL 0 .00
82705 FECAL cAT RL 1 .00
89051 CELL COUNT RL RL 1 35.00
701149 T4 81000 WORK RL
37086 URINE CULTURE 87086 RL 5 372
37106 FUNGAL CULTURE RL
34231-GP DRUG SCREEN RL 1 10.00
37206 CHLAMYDIA MICROTRAK BLOODWORK RL 5 38.00
36357 T&8 LYMPH PROFILE BLOOD WORK RL 0 .00
""A COLLECTION, LAB SPECIMEN RL RL 99 1$.00
34132A P^TASSIUM RL RL 99 22.25
3625: ANA ANA RL 5 .00
32:50 AMYLASE BLOODWORK RL 5 32.00
BLOOD WORK RL 1 .00
�e130ii3) T-LYMPHOSYTE SUPP./HELPER PROFILE BLOOD WORK RL 0 154.00
cuC04 EC'ROLYTES BLOOD WORK RL 0 23.20
39060 CRYSTAL ANALYSIS BLOOD WORK RL 1 .Do
312 VITAMIN LAB RL 1 70.50
32947 SERUM GLUCOSE ROOD WORK RL 1 .00
34015 ALKALINE PHO. RL 0 31.50
33125 LITHIUM LEVEL RL 99 41.00
RMSF TITER ROOD WORK RL 1 95.75
?.533 CARTISOL AN RL 99 89.25
? 28 iUBELtA RL 1 36.00
1040 BLOOD CULTURE BLOOOMORK RL 99 60.00
:2:50 TOTAL BILI. BLOOD WORK RL 1 .00
799007 URINE TOK SCREEN DRUG SCR. RL 1 55.00
146 PROTIME RL RL 99 28.00
86278 HEP 8 SAG BLOOD ,Nat RL 1 .00
86312 HIV TITER BLOOD WORK RL 1 36.00
86517 VARCELLA ZOSTER IQG RL 0 70.50
APA ANEMIA PROFILE A APA RL 5 27.80
82468 NARTRIPTHLINE BLOOD WORK RL 1 .00
88302 SURD. PATHOLOGY RL 99 .00
ORANGE FAMILY MEDICAL GROUP PA
06/15/93 PROCEDURE FEES PAGE 3
PROCEDURE DESCRIPTION ALT. DESC. DEPT T.O.S. STD. FEE
------------------------------------------------------------------------------------------------------------------------------------
82746 FOLATE BLOOD WORK RL 0 61.75
80099 UNLISTED PANEL BLOODWORK RL 5 .00
94:55 PROTEIN BLOODWORK RL 5
82370 STONE ANAYLIS BLOOD WORK RL 1 43.15
825,715 CREATININE CLEARANCE BLOOD WORK RL 0 41.75
84703 PREG. SERIUM RL RL 1 19.00
:07831 OUINIDINE QUANT, 81000 WORK RL 1 .00
33690 LIPASE BLOOD WORK RL 1 .00
196925 ID PANEL IV BLOOD WORK RL 0 154,00
APB ANEMIA PROFILE B PROFILE RL 5 84,50
84403 TESTERONE BLOOD WORK RL 1 .00
145 PRENATAL PANEL RL RL 99 37.00
82552 CPK ISOENZYME BLOOD WORK RL 1 .00
85025 CBC & DIFF BLOODWORK RL 0 .00
80009 LIVER PANEL RL 0 25.18
86291 ANTI-MBS BLOOD WORK RL 1 60.00
80073A RENAL PANEL RL RL 99 24,05
87252 VIRAL CULTURE RL 1 39.00
83655 LEAD BLOOD WORK RL 1
88304 SURGICAL PATH - SKIN,CYST,TAG/DEBRID. SURG, PATH RL 0 40.00
87178(X2) DNA PROBE GC/CHLAMYDIA RL 99 38.45
81000 URINALSIS, COMPLCTE LAB WORK RL 0 14.00
92768 FOLATE BLOOD WORK RL 0 .00
/HELPER P T-LYMPHOSYTE SUPP./HELPER PROFILE BLOOD WORK RL 0 '154.00
82570 24 HR. URINE CREAT. RL 0 .00
33053 HEMOGLOBIN S (SICKLE CELL) BLOODWORK RL 1 36.00
87230 C. DIFF. TOXIN BLOOD WORK RL 1 90.75
93'150 PAP SMEAR RL 0 28.00
84146 PROLACTIN BLOOD WORK RL 0 93.25
150 STOOL CULTURE RL RL 99 60.00
84999 UNLISTED CHEMISTRY OR TOXI PROC. BLOODWORK RL 5 .00
6593 VDRL, SPINAL FLUID BLOODWORK RL 5 39.50
98105 SPUTUM CYTOLOGY RL 0 .00
"4443 TSH SLOODWORK RL 5 .00
43 PAP SMEAR RL RL 99• 28.00
153 THEOPH LEVEL RL RL 99 59.00
9545. CEA RL 0 68.50
'�9 ANEMIA PROFILE A RL RL 99 35.00
,:1478A TRIGLYCERIDES RL RL 99 31.75
:2383 FRACTIONATED CATECHOLANINES BLOOD WORK RL 1 .00
37'163 STOOL, CULTURE 87163 RL 0 63.00
92784 !GM LEVELS RL 0 .00
84479 THYROID PANEL W/TSH BLOOD WORK RL 0 40,68
:0003 ELECTROLYTES RL 1 .00
,,2435 CHLORIDE RL 99 .00
137 GLUCOSE RL RL 99 23.00
82060 ETHANOL BLOOD WORK RL 1 .00
84030 PKU RL O 18.00
86080 BLOOD TYPE BLOOD WORK RL 1 .00
80085 ANEMIA PROFILE BLOOD WORK RL 0 30.80
041780 URINE BLOOD BLOOD WORK RL 1 58.75
84231 DRUG SCREEN RL 1 34.00
134 DIGOXIN LEVEL RL RL 99 51.00
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ORANGE FAMILY MEDICAL GROUP PA
06/15/93 PROCEDURE FEES PAGE 4
PROCEDURE DESCRIPTION ALT. DESC. DEPT T.O.S. STD. FEE
------------------------------------------------------------------------------------------------------------------------------------
82565A CREATININE RL RL 99 28.50
88155 PAP M/ MATURATION INDEX MATURATION RL 0 36.00
88172 BREAST CYTOLOGY RL 1 .00
85615 ESR RL 1 26.00
86050 F'4 BLOOD WORK RL 0 ,00
RPR RPR RL 1 23.00
84165 IMMUNOGLOBULIN ELECTROPHORESIS BLOOD YORK RL 1 .00
82365 STONE ANALYSIS RL 1 57.00
33545 IRON BINDING CAPACITY BLOOD YORK RL 1 .00
87208 STOOL 0 AND P RL 0 62.00
81211 YET PREP RL 5 12.00
82660 DRUG SCREEN BLOOD YORK RL 1 50.00
86403 BETA STREP CULTURE RL 0 65.50
81002-GP URINE DIPSTICK RL 1 8.00
82009 SERUM KETONES BLOOD YORK RL 1 .00
81081 THROAT CULTURE BLOOD YORK RL 1 14.00
140A LIPID PROFILE RL RL 99 31.61
87117 AFB CULTURE & SMEAR RL 5 65.00
83718A HOLESTEROL, HDL RL RL 99 38.00
87101 SPUTUM FUNGAL CULTURE RL 0 .00
147 RHEUM PANEL B RL RL 99 39.00
80072 RHEUM PANEL B BLOOD WORK RL 0 37.71
84520A 8UN (URIC NITROGEN) URIC RL 99 27.75
92955 156PD BLOODWORK RL 99 50,75
82310 CALCIUM 82310 RL 0 33.00
82524 INSULIN TESTING BLOODWORK RL 99 .00
87178 DNA PROSE BLOOD WORK RL 0 38.45
82643 DIGOXIN LEVEL BLOOD WORK RL 0 58.00
86225 MUMPS TITER BLOOD WORK RL 0 58.50
80031 VALPORIC ACID RL 0 68.50
141 LIVER PANEL RL RL 99 26.00
34295 SODIUM RL 99 .00
82540 RL 1 .00
35,348 WBC BLOOD WORK RL 5 .00
36994 C. DEFICILE TOXIN RL 1 .00
88108 CYTOLOGY SPUTUM RL 0 .00
30061 LIPID PROFILE BLOOD WORK RL 0 40.00
96244 ALPHAFETOPROTEIN BLOOOWORK RL 1 .00
82465A C4LESTEROL, TOTAL RL RL 99 28.00
80059 HEPATITIS PANEL BLOOD WORK RL 0 .00
84.80 24 HR. URINE PROTEIN RL 0 .00
81207 MALARIA BLOOD WORK RL 1 .00
3102 BRINE DIPSTICK RL 0 8.00
32999 SERUM FRUCTOSANINE BLOOD WORK RL 1 36.25
142 MULTICHEM PANEL 80019 RL 99 29.00
87250 VARICELLA IOSTER CULTURE BLOOD WORK RL 1 .00
80009Y LIVER PROFILE BLOOD WORK RL 0 25.18
85730 PTT BLOOD WORK RL 1 37.00
82251 BILI T&D BLOODWORK RL 99 .00
86032 ANTIBODY SCREEN BLOOD WORK RL 0 36.00
83020 HEMOGLOBIN ELECT. BLOOD WORK RL 1 .00
80082 BLOOD TYPING BLOOD WORK RL 1 .00
84045 DILANTIN LEVEL BLOOD WORK RL 0 60.00
ORANGE FAMILY MEDICAL GROUP PA
06%15/93 PROCEDURE FEES PAGE 5
PROCEDURE DESCRIPTION Alf. DESC. DEPT T.O.S. STD. FEE
------------------------------------------------------------------------------------------------------------------------------------
83715 LIPOPROTEIN BLOOOWORK RL 5 .00
84144 PROGESTERONE LEVEL RL 1 78.00
86319 CARBAMAZOPINE LEVEL BLOOD WORK RL 1 .00
?d175 PRO'EIY CSF RL 1 .00
07220 TOXICOLOGY SCREEN BLOOD WORK RL 1 JO
31211Y WET PREP RL 0 12.00
87010 CULTURE, ANY OTHER SOURCE RL 1 .00
84550 URIC ACID BLOOD WORK RL 1 100
83525 INSULIN BLOOD WORK RL 1 100
96289 HEP B CORE BLOOD WORK RL 1 .00
38180 T-CELL HEL./SUPP. PROF. BLOOD WORK RL 0 188.00
4006 PROSTATIC ACID PHOS. BLOOD WORK RL 1 55.00
86430 RHEUMATOID A BLOOD WORK RL 1 .00
136 ELECTROLYTE PANEL RL RL 99 24.05
148 RUBELLA TITER RL RL 99 42.00
84702 BETA HCG QUANT RL RL 99 31.00
87256 CHLAMYDIA 106 RL 0 82.75
144A POTASSIUM RL RL 99 22.25
86293 HEP BE AG BLOOD WORK RL 0 .00
82550 CPK BLOOD WORK RL 1 100
35240 FACTOR VIII BLOOD WORK RL 0 .00
85544 L E CELL PREP BLOOD WORK RL 1 .00
135 DILANTIN RL RL 99 56.25
3900i 1ANDLING SPEC.-PT TO LAB RL 0 10.00
81117 STOOL D & P D & P RL 0 62.00
34701 PRENATAL PANEL OB RL 0 36.00
34436 THYROID PROFILE BLOOD RL 1 .00
80050 EXECUTIVE III BLOOD WORK RL 0 53.00
82728 FERRITIN BLOOD WORK RL 1 58.50
86300 MONOSPOT 86300 RL 5 34.25
81016 AMA RL 0 .00
E2270 HEMOCCUL' BLOOD WORK RL 0 3.50
32470 CHOLESTEROL & ESTERS. BLOOD WORK RL 1 .00
94420 THEOPHYLLINE LEVEL BLOOD WORK RL 0 63.00
34681 C-PEPTIDE BLOOD WORK RL 1 .00
cou92 BLOOD TYPE & RH BLOOD WORK RL 5 .00
154 THYROID PANEL W/TSH RL RL 99 41.00.
x;,53 EXECUTIVE 0 WITH TSH RL 1 60.00
?!3295 HEP BE A8 BLOOD WORK RL 0 .00
3' 05Y PHENOBARBITAL RL 0 .00
36280 ANTITHYROID ANTIBODIES BLOOD WORK RL 1 .00
i2i14 CARBON DIOXIDE BLOOD WORK RL 1 .00
37075 ANARAIC CULTURE RL 1 .00
34:85 BENCE JONES PROTEIN BLOOD WORK RL 1 .00
33317 VIRAL CULTURE RL 1 173.75
38107 CYTOLOGY JOINT FLUID BLOOD WORK RL 1 .00
208 XRAY THORACIC SPINE, 2 VIEWS W/INTERPRET XR XR 31 .00
230 XRAY OPP.VIEW FOR COMPARISON W/INTERPRET XR XR 31 .00
13100 WRIST XRAY 1 VIEW XRAY XR 0 .00
252 XRAY MANDIBLE 4 V W/INTERPRET XR XR 31 .00
218 XRAY, CLAVICLE,1 V W/INTERPRET XR XR 31 .00
71020 XRAY,CHEST,2 VIEWS, W/INTERPRET. XR XR 31 71.00
225 XRAY ELBOW, 3 VIEWS W/INTERPRETATION XR XR 31 .00
/5
ORANGE FAMILY MEDICAL GROUP PA
06/15/93 PROCEDURE FEES PAGE 6
PROCEDURE DESCRIPTION ALT, DESC. DEPT T.O.S. STD. FEE
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:030 XRAY,CHEST, 3 VIEWS,W/INTREPRET. XR XR 0 96.00
251 XRAY SELLA TURCICA, 2 V W/INTERPRET XR XR 31 .00
;9) XRAY,CHEST,2 VIEWS, W/INTERPRET. XR XR 31 .00
2.6 XRAY FOREARM, 2
VIEWS WiINTERPRET XR XR 31 .00
243 XRAY ACROMI13CLAV.o3INTS w/INTERPRET XR XR 31 .00
258 XRAY FEMUR W/!NTERPRET XR XR 31 .00
239 XRAY TIBIA&FIBULA W/INTERPRETATION XR XR 31 .00
220 XRAY SCAPULA, 3 V W/INTERPRETATION XR XR 31 .00
205 XRAY 571ERNO-CLAV.JOINTS,3VIEWS W/INTERPR XR XR 31 .00
206 XRAY CERVICAL SPINE, 2 VIEWS W/INTERPRET XR XR 31 .00
727110 XRAY,L/S SPINE,5 VIEWS W/INTERPRET. XR XR 0 128.00
198 XRAY,CHEST,3VIEWS,W/INTERPRET. XR XR 31 .00
203 XRAY RIBS,SILAT.W/CHEST PA & INTERPRET XR XR 31 .00
229 XRAY FINGER, 3 V W/INTERPRET XR XR 31 .00
245 XRAY SKULL 6 VIEWS W/INTERPRET XR XR 31 .00
200 XRAY RIBS,UNILATERAL,3VIEWS W/INTERPRETY XR XR 31 .00
72100 XRAY, L/S SPINE, 2 VIEWS W/INTERPRET. XR XR 0 96.00
255 TEM.MANOIBULAR JOINT,BILAT.6 V WINTER. XR XR 31 .00
246 XRAY SKULL, 4 VIEWS W/INTERPRET XR XR 31 .00
243 XRAY FOOT 2 VIEWS W/INTERPRET XR XR 31 .00
256 XRAY NECK SOFT TISSUE 2 V W/INTERPRET XR XR 31 .00
71120 XRAY,STERUM, 3 VIEWS W/INTERPRET. XR XR 31 .00
71021 CHEST APICAL LORDOTIC X-RAY XR 1 47.00
=53 XRAY ZYGONATIC ARCHES,6V W/FACIAL&INTERP XR XR 31 .00
71010 XRAY,CHEST, 1 VIEW W/INTREPRET, XR XR 0 61,00
215 PELVIS, 3 VIEWS, W/INTERPRETATION XR XR 31 .00
224 XRAY HUMERUS, 2 VIEWS W/INTERPRET XR XR 31 A
240 XRAY ANKLE 2 VIEWS W/INTERPRET. XR XR 31 .00
250 XRAY SELLA TURCICA, 1 VIEW W/INTERPRET XR XR 31 .00
209 XRAY, L/S SPINE 2 VIEWS W/INTERPRET XR XR 0 .00
:96 XRAY,CHEST,APiCAL LORDOTIC W/INTERPRET. XR XR 31 .00
':070 XRAY, THORASIC SPINE,2 VIEWS W/INTERPRET XR XR 0 77.00
.o XRAY SACROILIAC JOINTS,4 V,W/INTERPRET XR XR 31 .00
221 XRAY WRIST, 3 V W/INTERPRET XR XR 31 .00
XRAY ABDOMEN, 2 V W/INTERPRET XR XR 31 .00
13 XRAY PELVIS, STERE0,1 V WiINTERPRET XR XR 31 .00
5 XRAY,C4EST,IVIEW W/ INTERPRETATION XR XR 31 .00
31 XRAY KNEE, 2 VIEWS W/INTERPRETATION XR XR 31 .00
2�9 XRAY NASAL BONES 4 V U/INTERPRET XR XR 31 .00
22 XRAY, SHOULDER, 3 V, VANTERPRET XR XR 31 .00
:10 L/S SPINE ,5 VIEWS VINTERPRETATION XR XR 31 .00
2�9 XRAY TOES, W/INTERPRETATION XR XR 31 .00
-11 XRAY SHOULDER, 2 V, W/INTERPRETATION XR XR 31 .00
234 XRAY NAVICULAR W/INTEPRET XR XR 31 .00
:130 XRAY STERNO-CLAV.JOINTS,3VIEWS W/INTER. XR XR 0 71.00
231 XRAY POST REDUCTION,1 V W/INTERPRET XR XR 31 .00
199 CHEST, 4 VIEWS W/INTERPRETATION XR XR 31 .00
219 XRAY CLAVICLE, 2 V W/INTERPRETATION XR XR 31 .00
2418 XRAY HAND, 3 VIEWS W/INTERPET XR XR 31 .00
244 XRAY OS CALCIS, 2 VIEWS W/INTERPRET XR XR 31 .00
238 XRAY KNEE 3 VIEWS W/INTERPRETATION XR XR 31 .00
247 XRAY SINUSES, 4 VIEWS W/INTERPRET XR XR 31 .00
72050 XRAY, CERVICAL SPINE,4-5 V W/INTERPRET. XR XR 0 116.00.
�6
ORANGE FAMILY MEDICAL GROUP PA
36/15/93 PROCEDURE FEES PAGE 7
PROCEDURE DESCRIPTION ALT. DESC. DEPT T.O.S. STD. FEE
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'4000 XRAY ABDOMEN 1 VIEW (XUB) XUB XR 0 16.00
'.1 0 XR4Y,RTBS,8ILAT. 6 VIEWS W/INTREPRET. XR XR 31 80.00
XRAY STERNUM, 3 VIEWS W/INTERPRET XR XR 31 .00
214 SPAY PELVIS 3 SAT H*P, 2 V. WiINT_RPPET. %R XR 31 .00
_42 XRAY 1007, 2 VIEWS W/INTERPRET XR XR 31 .00
XPAY CERVICAL SPINE,4-5 V W/INTERPRET XR XR 31 .00
'0220 SINUS SERIES XR 0 .00
^a0 XRAY,,.^ERV,CAL SPINE, 2 VIEWS W INTERPRET XR XR 0 19.00
2-7 XRAY SACRUM & COCCYX W/INTERPRETATION XR XR 31 .00
241 XRAY ANKLE 3 VIEWS/W/INTERPRET. XR XR 31 .00
202 XRAY RIBS,BILAT. 6 VIEWS W/INTERPRET XR XR 31 .00
254 TENP.NANDISULAR JOINT,UNILAT 4 V W%INTER XR XR 31 .00
XRAY A8DOMEN,2 V W/PA CHEST & INTERPRET XR XR 31 .00
X.RAY,PELVIS AP W/,NTERPRETATION XR XR 31 .00
248 XRAY FACIAL BONES, 4 V W/INTERPRETATION XR XR 31 .00
201 XRAY RISS,UNILAT.W/PA CHEST & INTERPRET XR XR 31 .00
257 XRAY SCOLIOSIS, 1 VIEW XR XR 31 .00
236 XRAY ABDOMEN, 3 V W%INTERPRET. XR XR 31 100
21i XRAY SPINE, ENTIRE,AP & LAT W/INTERPRET XR XR 31 .00 -
233 XRAY ABDOMEN, SINGLE AP W/INTERPRET XR XR 31 100