Specifications include, but are not limited to: A. Services shall include, but are not limited to: orthopedic, neurological, psychiatric consultations/evaluations and emergency evaluations not covered by the three (3) categories previously mentioned; x-rays, employee record review up to over 2”, testing, dictation and final certification/report. B. Physicians providing services under this Agreement shall be licensed by the California Department of Consumer Affairs, Medical Board of California (MBC), with board certification in Orthopedic surgery, Psychiatry and Neurology. i. Psychological evaluators must have their report signed off by a licensed physician (M.D. or D.O.). C. Contractor shall review documents submitted by DSH, which may include, but not limited to the following*: i. Letter describing the reason for the FFD examination and questions to be addressed by the Contractor. ii. Release of information form signed by the DSH employee. iii. Documents of circumstances leading to the request for the FFD examination. These documents are confidential and shall not be released to anyone without the prior authorization from the DSH Medical Director. iv. Duty Statement. v. Job Analysis. vi. DSH – Metropolitan Administrative Directive #2163 – Fitness for Duty. vii. Government Code Section 19253.5. viii. State Personnel Board Rule 172.3. *Pages listed above are approximate and may increase or decrease depending on the employee being evaluated.
