Chinle IHS Mobile Breast Ultrasound Services

Form / Attachment / Pricing Sheet

This document is the "Indian Health Service Buy Indian Act Indian Economic Enterprise Representation Form." It serves as a self-certification for offerors to confirm they meet the definition of an "Indian Economic Enterprise" (IEE) as required by the Buy Indian Act. This form is to be submitted in response to a Sources Sought Notice, Request for Information (RFI), or Solicitation.

• Self-Certification: Offerors must certify whether they meet the definition of an IEE with "Indian Ownership."
• Eligibility Period: The enterprise must meet the IEE definition at the time of offer, contract award, and throughout the contract performance period.
• Notification Requirement: Contractors must immediately notify the Contracting Officer if they no longer meet eligibility requirements.
• Documentation: Contracting Officers may require documentation of eligibility, and awards may be subject to protest.
• Registration: Successful Offerors must be registered with the System of Award Management (SAM).
• Penalties: False or misleading information is subject to legal penalties.
• Required Fields: The form requires the Offeror to provide:
  • Name of Federally Recognized Tribal Entity (if applicable)
  • Name of the 51% owner of IEE Firm
  • Business Name
  • DUNS Number
  • Certifying Signature
  • Print Name

This form is crucial for any bidder seeking to participate in opportunities designated under the Buy Indian Act. Bidders must accurately complete and submit this representation to self-certify their eligibility as an Indian Economic Enterprise. Failure to meet the definition or properly complete the form could impact their ability to be considered for award.

Statement of Work (SOW) / Performance Work Statement (PWS)

This Performance Work Statement (PWS) outlines the requirements for non-personal services for Mobile Breast Ultrasound Services to support the Indian Health Service (IHS) mission of improving the health of American Indians and Alaska Natives.

• Provide mobile breast ultrasound imaging services as needed by physicians.

• Perform outpatient and inpatient sonographer technician and radiology physician duties.

• Manage patient needs as described by the Chinle Comprehensive Health Care Facility (CCHCF) and directed by the Assistant Clinical Director.

• Provide professional radiologic medical services and direct patient care in accordance with established standards and CCHCF policies.

• Conduct sonographic imaging with on-site interpretation and, as needed, on-site biopsy abnormalities.

• Evaluate and interpret diagnostic imaging examinations (US, XR, CT, MRI, Mammogram) and prepare comprehensive interpretive reports.

• Perform a wide variety of common and special radiologic diagnostic roentgenologic procedures.

• Provide sonography imaging for Breast, Abdomen and Small Parts, Obstetrics/Gynecology, and Vascular Ultrasound.

• Assist physicians with ultrasound-guided fine needle biopsies and procedures.

• Provide consultant services to interpret radiological findings and assist in determining appropriate treatment methods.

• Provide preliminary findings and refer specific diagnostic, treatment, or prognosis questions to the appropriate physician.

• Provide medical care and public health services to eligible individuals within the service unit.

• Assist with education and training of other radiology staff and physicians.

• Utilize CCHCF's Electronic Health Record (EHR) system for documentation.

• Period of Performance: Flexible, allowing for short-term (13 weeks) or long-term (1-3 years) contracts, with intermittent support for unplanned needs.

• Place of Performance: Chinle Comprehensive Health Care Facility (CCHCF).

• Personnel must meet minimum criteria, including ARDMS certification with Breast Certification, no adverse medical board actions, board certification in radiology (for MD/DO), and no history of drug abuse.

• Contractor must provide uniforms and personal medical instruments.

• Contractor must adhere to HIPAA, Privacy Act, and IHS policies.

• Contractor must undergo background checks and security investigations.

• Contractor must be subject to peer review and meet safety management reporting requirements.

• Cultural awareness and respect for American Indian and Alaska Native practices are mandatory, including completion of online training.

• Contractor must be familiar with the Navajo culture.

• Contractor must adapt to and utilize IHS information technology systems.

• Contractor must provide a rate that allows for no interruption of services for the Fiscal Year.