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Home My WebLink About08. Apprv Amend to PSA w-So CA Permanente Medical Grp - Occupational Health & Safety Svcs.Item No, TO: HONORABLE MAYOR AND MEMBERS OF THE CITY COUNCIL FROM: OFFICE OF THE CITY MANAGER BY: JAMES MCQUEEN, DIRECTOR OF HUMAN RESOURCE DATE: SEPTEMBER 22, 2020 SUBJECT: AMMENDMENT TO PROFESSIONAL SERVICES AGREEMENT WITH SOUTHERN CALIFORNIA PERMANENTE MEDICAL GROUP (SCPMG) FOR OCCUPATIONAL HEALTH AND SAFETY SERVICES RECOMMENDATION It is recommended that the City Council authorize staff to execute the attached amendment to the professional services agreement with Southern California Permanente Medical Group (SCPMG) to provide occupational health and safety services for the City of Downey. DISCUSSION The City currently utilizes SCPMG to provide occupational health and safety services for both current and prospective employees. These type of services include, but not limited, to pre -employment physical exams, physicals for Police Officers, executive physicals for management personnel, workers compensation treatment of injuries, and other related health services. Staff has recently been in discussions with Kaiser on updating the City's occupational health protocols and a proposed rate increase. The last time the rates were increased was June 22, 2010. Attached is the proposal provided by Kaiser for occupational health services which comply with health and safety industry standards. Staff has reviewed these costs and finds Kaiser's rates to be competitively priced. Additionally Kaiser's medical facilities close proximity being located in the City of Downey is a valued benefit. Also, Kaiser Occupational Health and Safety Services is currently an authorized medical provider for the City's workers' compensation program. CITY COUNCIL PRIORITIES Fiscal Responsibility MEDICALPERMANENTE -• . PAGE 2 There is no fiscal impact• e.• been • •i -• into the budget. ATTACHMENTS Attachment1 Southern CaliforniaMedical• Agreement K Company Name: CITY OF DOWNEY Corporate Address: 11111 Brookshire Avenue Primary Contact: James McQueen Alternate Contact: Sandra Vera Date: October 1, 2020 City, State: Downey, CA Zip 90241 Email: imcgueen(a?downeyca.org Phone: (562) 904-7292 Fax: (562) 622-4648 Email: sveraL&downeyca.org Phone: (562) 904-7292 Fax: (562) 622-4648 Billing Address: 11111 Brookshire Avenue Billing Contact: Sandra Vera City, State: Downey, CA Zip 90241 Email• sveraL&downeyca.org Phone: (562) 904-7292 Fax: (562) 622-4648 Re: Letter of Agreement for Occupational Health and Safety Services between The Southern California Permanente Medical Group and CITY OF DOWNEY Dear James McQueen, Through a series of meetings, CITY OF DOWNEY and The Southern California Permanente Medical Group ("SCPMG") have reached an agreement regarding SCPMG's provision of occupational health and safety services to CITY OF DOWNEY. The purpose of this letter is to set forth this agreement. SCPMG, through its Occupational Health Centers collectively known as Kaiser Permanente On - the -Job, will provide occupational health and safety services, as requested by CITY OF DOWNEY. This letter does not obligate CITY OF DOWNEY to utilize SCPMG services, but it does set forth applicable prices and conditions of such services when elected by CITY OF DOWNEY. What SCPMG Will Do For CITY OF DOWNEY SCPMG physicians and other practitioners will provide services for CITY OF DOWNEY's current or prospective workers as requested by CITY OF DOWNEY. The prices for such services are listed in Schedule A, attached to this letter. SCPMG will complete appropriate documentation of those services. If further tests or other services are required, SCPMG will notify CITY OF DOWNEY. SCPMG shall submit a monthly invoice to CITY OF DOWNEY for services rendered during the previous month. CITY OF DOWNEY's Obligations If and when CITY OF DOWNEY determines to send prospective employees or employees to SCPMG for services, CITY OF DOWNEY will specify the services to be performed by SCPMG. CITY OF DOWNEY agrees to pay SCPMG for services rendered within thirty days after receipt of the invoice. Page 1 of 13 Kaiser Permanente - ® D General Provisions of This Letter of Agreement This letter of agreement is effective as of 10/01/20 and will be in force for the period of 10/01/20 through 10/01/23 and for consecutive 12-month periods thereafter, unless either party provides written notification of termination at least 30 days before the end of each 12-month period. This letter of agreement can also be terminated by either party; such termination shall be effective thirty days from the notice of the terminating party. This letter of agreement replaces any previous agreements between SCPMG and CITY OF DOWNEY and will control the relationship between SCPMG and CITY OF DOWNEY until it is terminated, amended or replaced. SCPMG reviews its prices for occupational health and safety services on a yearly basis. If SCPMG determines to change its prices, it shall notify CITY OF DOWNEY of any price changes at least 180 days prior to the effective date of the change. Miscellaneous This Agreement will be governed in accordance with the laws of the State of California without reference to conflict of laws principles. This Agreement may be executed in separate counterparts, none of which need contain the signatures of both Parties, and each of which, when so executed, shall be deemed an original and all together constitute and be one of the same instrument. The Parties agree that an electronic signature or a scanned or electronically reproduced copy or image of this Agreement bearing the signatures of the Parties will be deemed an original and will represent competent evidence of the execution, terms and existence of this Agreement notwithstanding the failure or inability to produce an original, executed counterpart of this Agreement, and without the requirement that the unavailability of such original executed counterpart of this Agreement first be proven. Any determination that any provision of this Agreement or any application thereof is invalid, illegal, or unenforceable shall not affect the validity, legality, and enforceability of such provision in any other instance, or the validity, legality or enforceability of any other provision of this Agreement. This Agreement contains the complete understanding among the Parties with respect to the subject matter of this Agreement and supersedes all prior or contemporaneous oral or written representations, communications, proposals or agreements not expressly included. All Exhibits to this Agreement are incorporated into this Agreement by this reference. No changes, amendments, cancellation, or modification to this Agreement will be effective unless signed by duly authorized representatives of both Parties. Please indicate your agreement with the terms of this Agreement by signing the enclosed copy of this Agreement and returning it to [Cindy Barker via Adobe Sign] The Southern California Permanente Medical Group Occupational Medicine Regional Coordinating Chief— SCAL: Signature: Date: Thomas W. Wang, MD Page 2 of 13 Kaiser Permaniente On-the-JobD, CITY OF DOWNEY Company James McQueen Representative: Signature: Date: Title: Director ofHuman Resources Company Representative: K4oho Alicia DuarteCIVIC Signature: Title: City Clerk Company Yvette M. Abioh GarciaRepresentative:� Signature: Date: Title: City Attorney Page 3 of 13 Schedule A OCCUPATIONAL HEALTH AND SAFETY SERVICES TOBEPROVIDED TOCITY {}FOOVVNEY Services will boprovided toCITY (]FD0VVNEYaofollows: Visit Category: A Executive Physical 300400 Executive Physical Exam (Detailed Medical History & Exam, vitals, vision, whisper test, UA dip and body fat $95.00 86580 PPD, one placement and one reading $20.00 Creatine, Fasting Glucose, AlkPhos, Potassium (K), Sodium (Na), Urea Nitrogen (BUN) 80061 Lipid Panel $28.00 85025 Complete Blood Count with automated differential $15.00 86735 Mumps antibody titer/screen $35.00 86762 Rubella antibody screen $35.00 300415 Review of Respirator Questionnaire by MD/NP/RN $35.00 As Clinically Indicated: 71046 Chest X-Ray for positive PPD + symptoms (2 views) $65.00 99211 Brief encounter with non -MD provider (PPD-review of symptoms form) $20.00 As Clinically Indicated - Optional: 90746 Hepatitis B vaccine, per does (series of 3) $94.00/injection 90707 Vaccine: MMR injection (series of 2 injections, if $76.00/injection 84152 PSA; prostate specific antigen (Males over 45) $53.00 Employee Optional: 82274 F cal Immunochernical Test (FIT) (officers over 45) $30.00 93015 Cardiac stress test w/ treadmill $230.00 Page 4 of 13 Visit Category: B Police Bi-Annual Exam 300399 POST Physical Exam $95.00 92552 Audiogram, screening $30.00 94010 Spirometry $35.00 300415 Review of Respirator Questionnaire by MD/NP/RN $35.00 93000 EKG, resting $50.00 93015 Cardiac Stress Test with Treadmill $230.00 86580 PPD, one placement and one reading $20.00 80100 Quick Test for Drug Screen (5 Panel) — Medtox $25.00 85025 CBC with automated differential $15.00 80053 Chem Comprehensive Panel $35.00 86708 Hepatitis A IgG antibody, HAAb (titer) $40.00 86706 Titer: Hepatitis B Surface antibody, HBsAb $31.00 86803 Titer: Hep C Antibody Screen $45.00 86735 Titer: Mumps antibody screen $35.00 86762 Titer: Rubella antibody screen $35.00 86765 Titer: Rubeola antibody screen $35.00 86765 Titer: Varicella antibody screen $35.00 36415 Venipuncture $15.00 81001 Urinalysis with microscopic (if abnormal UA dipstick) $15.00 90715 Vaccine: Tdap (tetanus, diphtheria, pertussis) $63.00 80061 Lipid Panel $28.00 As Clinically Indicated: 90632 Vaccine: Hepatitis A (series of 2 injections) $96.00/injection 90746 Vaccine: Hepatitis B (series of 3 injection) $94.00/injection 90707 Vaccine: MMR injection (series of 2 injections, if indicated $76.00/injection 90716 Vaccine: Varivax (chickenpox) (series of 2 injections if indicated 132.00/injection 300464 Medical Review Officer Fee — Medtox $40.00 71045 Chest X-Ray for positive PPD (1 view) $55.00 71046 Chest X-Ray for positive PPD + symptoms (2 views) $65.00 99211 Brief encounter with non -MD Provider (PPD-Review of Symptoms Form) $20.00 84152 PSA for males (over 40 if family history or African American or as clinically indicated, everyone over 4) $53.00 Visit Category: C Firefighter Bi-AnnualiExam Page 5 of 13 Kaiser Permanente On-the-JobD, 300398 Firefighter Physical Exam $95.00 86580 PPD, one placement and one reading $20.00 92552 Audiogram, screening $30.00 94010 Spirometry $35.00 300415 Review of Respirator Questionnaire by MD/NP/RN $35.00 93000 EKG, resting $50.00 93015 Cardiac Stress Test with Treadmill $230.00 80100 Quick Test for Drug Screen (5 Panel) - Medtox $25.00 85025 CBC with automated differential $15.00 80053 Chem Comprehensive Panel $35.00 80061 Lipid Panel $28.00 86706 Titer: Hepatitis B Surface Antibody, HBsAb $31.00 86803 Titer: Hepatitis C antibody screen $45.00 86735 Titer: Mumps antibody screen $35.00 86762 Titer: Rubella antibody screen $35.00 86765 Titer: Rubeola antibody screen $35.00 86787 Titer: Varicella antibody screen $35.00 36415 Venipuncture $15.00 81001 Urinalysis with microscopic (if abnormal UA dipstick) $15.00 90715 Vaccine: Tdap (tetanus, diphtheria, pertussis) $63.00 86708 Hepatitis A IgG antibody, HAAb (titer) $40.00 As Clinically Indicated: 71045 Chest X-Ray for positive PPD (1 view) $55.00 71046 Chest X-Ray for positive PPD + symptoms (2 views) $65.00 99211 Brief encounter with non -MD Provider (PPD-Review of Symptoms Form $20.00 90746 Vaccine: Hepatitis B (series of 3 injections) $94.00/injection 90707 Vaccine: MMR injection (series of 2 injections, if indicated) $76.00/injection 90716 Vaccine: Varivax (chickenpox) (series of 2 injections if indicated) $132.00/injection 300464 Medical Review Officer Fee - Medtox $40.00 90632 Vaccine: Hepatitis A (series of 2 injections) $96.00/injection 300413 Form completion (2 or more pages for DL51) $25.00 84152 PSA for males (over 40 if family history or African American or as clinically indicated, everyone over 45) $53.00 All Other OHS Services Visit Category: 1 Preplacement Clerical & Admin (lift up to 10 lbs. regularly) Page 6 of 13 Kaiser Permanents 300388 Preplacement Physical Exam $65.00 86580 PPD, one placement and one reading $20.00 As Clinically Indicated: 71045 Chest X-Ray for positive PPD (1 view) $55.00 71046 Chest X-Ray for positive PPD + symptoms (2 views) $65.00 99211 Brief encounter with non -MD Provider (PPD-Review of Symptoms Form) $20.00 Visit Category:; 2 Preplacement Support (lift up to 25 pounds frequently) 300388 Preplacement Physical Exam $65.00 86580 PPD, one placement and one reading $20.00 97750 Lift Test Evaluation for job placement, each 30 minutes $60.00 As Clinically Indicated: 71045 Chest X-Ray for positive PPD (1 view) $55.00 71046 Chest X-Ray for positive PPD + symptoms (2 views) $65.00 99211 Brief encounter with non -MD Provider (PPD-Review of Symptoms Form) $20.00 Visit Category: 3 Preplacement - Transit Driver, Maintenance Worker, Water Service Operator & Graffiti Abatement Positions. (Frequently lift 50;pounds) 300388 Preplacement Physical Exam $65.00 86580 PPD, one placement and one reading $20.00 97750 Lift Test Evaluation for job placement, each 30 minutes $60.00 As Clinically Indicated: 71045 Chest X-Ray for positive PPD (1 view) $55.00 71046 Chest X-Ray for positive PPD + symptoms (2 views) $65.00 99211 Brief encounter with non -MD Provider (PPD-Review of Symptoms Form $20.00 Visit Category, 4 Police Pre -Placement Exam 300399 POST Physical Exam $95.00 92552 Audiogram, screening $30.00 94010 Spirometry $35.00 300415 Review of Respirator Questionnaire by MD/NP/RN $35.00 93000 EKG, resting $50.00 Page 7 of 13 Kaiser Permanente On-the-JobD, 93015 Cardiac Stress Test with Treadmill $230.00 86580 PPD, one placement and one reading $20.00 80100 Quick Test for Drug Screen (5 Panel) - Medtox $25.00 85025 CBC with automated differential $15.00 80053 Chem Comprehensive Panel $35.00 86708 Hepatitis A IgG antibody, HAAb (titer) $40.00 86706 Titer: Hepatitis B Surface antibody, HBsAb $31.00 86803 Titer: Hep C Antibody Screen $45.00 86735 Titer: Mumps antibody screen $35.00 86762 Titer: Rubella antibody screen $35.00 86765 Titer: Rubeola antibody screen $35.00 86765 Titer: Varicella antibody screen $35.00 36415 Venipuncture $15.00 81001 Urinalysis with microscopic (if abnormal UA dipstick) $15.00 90715 Vaccine: Tdap (tetanus, diphtheria, pertussis) $63.00 80061 Lipid Panel $28.00 As Clinically Indicated: 90632 Vaccine: Hepatitis A (series of 2 injections) $96.00/injection 90746 Vaccine: Hepatitis B (series of 3 injection) $94.00/injection 90707 Vaccine: MMR injection (series of 2 injections, if indicated $76.00/injection 90716 Vaccine: Varivax (chickenpox) (series of 2 injections if indicated 132.00/injection 300464 Medical Review Officer Fee - Medtox $40.00 71045 Chest X-Ray for positive PPD (1 view) $55.00 71046 Chest X-Ray for positive PPD + symptoms (2 views) $65.00 99211 Brief encounter with non -MD Provider (PPD-Review of Symptoms Form) $20.00 84152 PSA for males (over 40 if family history or African American or as clinically indicated, everyone over 45) $53.00 Visit Category: 5 Firefighter Pre -Placement Exam 300398 Firefighter Physical Exam $95.00 86580 PPD, one placement and one reading $20.00 92552 Audiogram, screening $30.00 94010 Spirometry $35.00 300415 Review of Respirator Questionnaire by MD/NP/RN $35.00 93000 EKG, resting $50.00 93015 Cardiac Stress Test with Treadmill $230.00 Page 8 of 13 Kaiser Permanente On-the-JobD, 80100 Quick Test for Drug Screen (5 Panel) - Medtox $25.00 85025 CBC with automated differential $15.00 80053 Chem Comprehensive Panel $35.00 80061 Lipid Panel $28.00 86706 Titer: Hepatitis B Surface Antibody, HBsAb $31.00 86803 Titer: Hepatitis C antibody screen $45.00 86735 Titer: Mumps antibody screen $35.00 86762 Titer: Rubella antibody screen $35.00 86765 Titer: Rubeola antibody screen $35.00 86787 Titer: Varicella antibody screen $35.00 36415 Venipuncture $15.00 81001 Urinalysis with microscopic (if abnormal UA dipstick) $15.00 90715 Vaccine: Tdap (tetanus, diphtheria, pertussis) $63.00 86708 Hepatitis A IgG antibody, HAAb (titer) $40.00 As Clinically Indicated: 71045 Chest X-Ray for positive PPD (1 view) $55.00 71046 Chest X-Ray for positive PPD + symptoms (2 views) $65.00 99211 Brief encounter with non -MD Provider (PPD-Review of Symptoms Form) $20.00 90746 Vaccine: Hepatitis B (series of 3 injections) $94.00/injection 90707 Vaccine: MMR injection (series of 2 injections, if indicated) $76.00/injection 90716 Vaccine: Varivax (chickenpox) (series of 2 injections if indicated $132.00/injection 300464 Medical Review Officer Fee - Medtox $40.00 90632 Vaccine: Hepatitis A (series of 2 injections) $96.00/injection 300413 Form completion (2 or more pages for DL51) $25.00 84152 PSA for males (over 40 if family history or African American or as clinically indicated, everyone over 4) $53.00 Visit Category: 6 Preplacement Ambulance Operator 300388 Preplacement Physical Exam $65.00 86580 PPD, one placement and one reading $20.00 92552 Audiogram, screening $30.00 94010 Spirometry $35.00 300415 Review of Respirator Questionnaire by MD/NP/RN $35.00 93000 EKG, resting $50.00 81001 Urinalysis with microscopic (if abnormal UA dipstick) $15.00 80100 Quick Test for Drug Screen (5 Panel) - Medtox $25.00 85025 CBC with automated differential $15.00 Page 9 of 13 Kaiser rmanen - - �- 80053 Chem Comprehensive Panel $35.00 90715 Vaccine: Tdap (tetanus, diphtheria, pertussis) $63.00 86708 Hepatitis A IgG antibody, HAAb (titer) $40.00 86706 Titer: Hepatitis B Surface Antibody Screen $31.00 86803 Titer: Hepatitis C antibody screen $45.00 86735 Titer: Mumps antibody screen $35.00 86762 Titer: Rubella antibody screen $35.00 86765 Titer: Rubeola antibody screen $35.00 86787 Titer: Varicella antibody screen $35.00 36415 Venipuncture $15.00 80061 Lipid Panel $28.00 As Clinically Indicated: 71045 Chest X-Ray for positive PPD (1 view) $55.00 71046 Chest X-Ray for positive PPD + symptoms (2 views) $65.00 99211 Brief encounter with non -MD Provider (PPD-Review of Symptoms Form) $20.00 90632 Vaccine: Hepatitis A (series of 2 injections) $96.00/injection 90746 Vaccine: Hepatitis B (series of 3 injections) $94.00/injection 90707 Vaccine: MMR injection (series of 2 injections, if indicated) $76.00/injection 90716 Vaccine: Varivax (chickenpox) (series of 2 injections if indicated) $132.00/injection 300464 Medical Review Officer Fee — Medtox $40.00 300413 Form completion (2 or more pages for DL51) $25.00 Visit Category: 7 Preplacement dispatcher POST Exam (lift up to 25 pounds frequently) 300388 Preplacement Physical Exam $65.00 86580 PPD, one placement and one reading $20.00 92552 Audiogram, screening $30.00 97750 Lift Test Evaluation for job placement (25lbs), each 30 minutes $60.00 300413 Form completion (2 or more pages) $25.00 As Clinically Indicated: 71045 Chest X-Ray for positive PPD (1 view) $55.00 71046 Chest X-Ray for positive PPD + symptoms (2 views) $65.00 99211 Brief encounter with non -MD Provider (PPD-Review of Symptoms Form $20.00 Visit Category:; 8 DMV/DOT Page 10 of 13 Kaiser ri - - �- 300390 DMV/DOT Physical Exam $115.00 Visit Category: 9 NON -DOT DRUG 80100 Quick Test for Drug Screen (5 Panel) — Medtox $25.00 As Clinically Indicated: 300464 Medical Review Officer Fee — Medtox $40.00 Visit Category:,10 DOT DRUG 300465 DOT/DMV Drug Screen with MRO - MedTox $60.00 Visit Category: + 11 Breath Alcohol BAT 82075 Breathalyzer, alcohol screen (random, Follow up, Reasonable Suspicion) $30.00 300421 Breathalyzer, alcohol confirmation test $30.00 Visit Category: 12 Physical Exam/Return to Work 300396 Physical Exam, other limited (Return to Work) $95.00 300408 Physician Consultation; each 15 min $60.00 Visit Category: 13 Form Completion 300413 Form completion (2 or more pages for DL51 for Ambulance Operators, DMV, etc.) $25.00 Visit Category: 14 VAX (Vaccinations) 86580 PPD, one placement and one reading $20.00 90715 Vaccine: Tdap (tetanus, diphtheria, pertussis) $63.00 86708 Hepatitis A IgG antibody, HAAb (titer) $40.00 86706 Titer: Hepatitis B Surface antibody, HBsAb $31.00 36415 Venipuncture $15.00 As Clinically Indicated: 71046 Chest X-Ray for positive PPD (1 view) $55.00 Page 11 of 13 Kaiser Permanente On-the-JobD, 71046 Chest X-Ray for positive PPD + symptoms (2 views) $65.00 99211 Brief encounter with non -MD Provider (PPD-Review of Symptoms Form $20.00 90632 Vaccine: Hepatitis A (series of 2 injections) $96.00/injection 90746 Vaccine: Hepatitis B (series of 3 injections) $94.00/injection 90707 Vaccine: MMR injection (series of 2 injections, if indicated) $76.00/injection 90716 Vaccine: Varivax (chickenpox) (series of 2 injections if indicated) $132.00/injection 300406 History/Review of tests/Brief Screen — No Physical Exam $35.00 Visit Category., 15 PPD — Infection Control Fire Only 86580 PPD, one placement and one reading $20.00 As Clinically Indicated: 99211 Brief encounter with non -MD Provider (PPD-Review of Symptoms Form $20.00 71045 Chest X-Ray for positive PPD (1 view) $55.00 71046 Chest X-Ray for positive PPD + symptoms (2 views) $65.00 Visit Category: 16 RESPIRATOR MEDICAL EVALUATION- BASELINE/ ANNUAL (RESP) (with RESP Fit testing) 300415 Review of Respirator Questionnaire by MD/NP/RN $35.00 300410 Respirator Fit Test, qualitative (When employer requested) $35.00 As Clinically Indicated: 71046 Chest X-Ray (2 views) $65.00 300391 Respirator Physical Exam $60.00 93015 Cardiac Stress Test with Treadmill $230.00 94010 Spirometry $35.00 300408 Physician Consultation; each 15 minutes $60.00 Visit Category: 17 Worksite Consult 300417 Worksite Patient Consult by PT — every 15 minutes $30.00 300412 Administrative Activity $60.00 Visit Category:;18 ONSITE SERVICES NURSING 300418 Site: Nursing Onsite between/during business hours of $30.00 Page 12 of 13 Kaiser Permanente On-the-JobD, 8:30am — 5:OOpm — each 15 min. (minimum one hour) (Round trip travel time to and from clinic is calculated with onsite) 300412 Site: Nursing Onsite prior to or after business hours noted $45.00 above - each 15 min. (minimum one hour) (Round trip travel time to and from clinic is calculated with onsite) 300412 Administrative Activity (per day) $60.00 90632 Vaccine: Hepatitis A (series of 2 injections) $96.00/injection If CITY OF DOWNEY is requesting a health screening/physical examination of a job applicant/employee, CITY OF DOWNEY will provide to SCPMG detailed information concerning the physical requirements for performing the job at issue. This information should include a written job description, including physical and mental requirements and environmental conditions. The examination and any medical conclusions will be based on the information furnished by CITY OF DOWNEY and the physician's general understanding of the requirements of the jobs of similar nature. SCPMG conducts such examinations with CITY OF DOWNEY's assurances that the examination and CITY OF DOWNEY's medical inquiries are job -related and consistent with the business needs of CITY OF DOWNEY, and otherwise comply with all applicable legal obligations. Based on its health screening/physical examination of a job applicant/employee, SCPMG will advise CITY OF DOWNEY of the following: a) the applicant/employee's physical limitations, if any, and the specific job tasks that cannot be performed and/or environmental conditions, if any, that are related to any risk to health and safety, and b) changes that may be made to permit the job tasks to be performed and/or eliminate/reduce the risk. SCPMG will make no determination of whether job tasks are essential to the position in question. Any changes that are recommended are advisory only, based on the physician's general understanding of the job and environment in question, and are not intended to supplant the right of CITY OF DOWNEY to determine what modifications are available and reasonable. To the extent that other conditions are identified, SCPMG will also: a) notify the employee/applicant of any medical condition, identified during the limited medical evaluation that CITY OF DOWNEY requested, that SCPMG believes requires further attention, and recommend that the employee/applicant seek care from his or her personal provider, thereby encouraging health and wellness, leading to a more productive workforce, and b) upon authorization of the employee/applicant, SCPMG will inform his or her personal medical provider by transmitting copies of the medical records created during the visit. SCPMG will maintain a medical record, for each individual that will contain records of employer requested services, in addition to past, present and future services requested by the employee/applicant. Page 13 of 13 Kaiser Permanente On-the-JobD,