U.S. Geological Survey Manual

Appendix 24-1

USGS Sample Scope of Work for Medical Services Provider for Lyme Disease

1. The medical services provider in conjunction with the responsible Regional Safety Manager will develop and review the Regional Lyme Disease (LD) Program. The extent of the program will be determined based upon a review of the disease/tick prevalence and risk factors associated with anticipated service employee activities.



2. The medical services provider shall provide information/training in the prevention of LD. Such information/training may be in the form of presentations, live and/or recorded, and/or informative newsletters or bulletins.



3. The medical services provider or its contractors will provide medical monitoring as determined to be appropriate. Medical monitoring will reflect the most current protocols. An internal quality assurance program will be used to warrant the accuracy and reliability of all laboratory services.



4. The medical services provider shall provide to each office an annual summary of their activities. The summary should contain the following information. Office should forward copies to the Bureau Industrial Hygienist.



1. Total number of employees tested.



2. Total number of employees testing positive for LD but without symptoms.



3. Total number of employees testing positive for LD with symptoms.



4. Total number of employees testing negative for LD.



5. Total number of employees referred to private physicians.



6. Cost of initial visits (consultation and blood drawn).



7. Cost of blood work (laboratory analysis).



8. Cost of follow-up visits (consultation and further diagnostic procedures).



5. The medical services provider shall immediately refer all employees diagnosed as having LD to their personal physicians.



6. The medical services provider shall notify the local office of all individuals diagnosed as having LD within one week of diagnosis. Collateral Duty Safety Program Coordinators should notify the respective Regional Safety Officer or Manager as applicable.



7. The medical services provider shall provide copies of the testing results and referrals if applicable to the following locations:



1. The employee/volunteer.



2. The employee's servicing personnel office for inclusion into the employee's medical file.



The medical services provider at the option of the organization may be requested to maintain a copy of the tests in their files.