2019-07-01 MCH Occupational Health AgreementOCCUPATIONAL HEALTH SERVICES
This Agreement made and entered into this day, July 1, 2019 by and between Blair Police Department
and the Memorial Community Hospital Occupational Health.
The MCH Occupational Health Department agrees to provide services for Blair Police Department.
Occupational Health will provide adequate and qualified personnel in providing the Occupational Health
Services specified in this agreement.
Both parties agree that all patient records shall be treated as confidential so as to comply with all State,
Federal, and ethical requirements regarding confidentiality of medical records.
MCH Occupational Health agrees to provide the following services:
1. Pre -Employment Physical $245.00
a. Medical Evaluation
b. Hearing/Vision Exam
c. EKG .
d. UA
e. Tb Test
f. Chest X -Ray
2. If not up to date on immunizations titers may be drawn. These may include,
a. Hepatitis B Titer $98.00
b. Varicella Titer $135.00
c. MMR Titer $267.00
Blair Police Department will be contacted within 5 business days of appointment with either an update
on the status of all paperwork and/or completed paperwork.
Blair Police Department will be invoiced on a monthly basis. Blair Police Department will pay invoice
within thirty (30) days for receipt of invoice.
This agreement may be amended from time to time by an agreement in writing. This agreement will be
automatically renewed each year on its anniversary date.
OCCUPATIONAL HEALTH SERVICES
Either party with 30 days prior written notice may terminate this agreement. Any new charges will take
effect on September 1, 2019.
We appreciate your business and look forward to serving you in the future.
Kathy Brester Occupational Health RN
July 1, 2019