MCH Occupational Health ServicesOCCUPATIONAL HEALTH SERVICES
This Agreement made and entered into this day, September 1, 2020 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. c
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 $163.00
a. Medical Evaluation
b. Hearing/Vision Exam
c. EKG
d. UA
- e. Tb Test
2. Chest X -Ray
a. 1 view $60.00
b. 2 view $82.00
3. Urine Drug Screen- $60.00
4. 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.
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OCCUPATIONAL HEALTH SERVICES
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.
Either party with 30 days prior written notice may terminate this agreement. Any new charges will take
effect on September 1, 2020.
We appreciate your business and look forward to serving you in the future.
Kathy Brester 0 upational Health RN
September 1, 2020
September 1, 2020
City of Blair
218 S 16TH STREET
BLAIR, NEBRASKA 68008
RE: Occupational Health Accounts
Dear Sir / Madam,
We have recently implemented a new system for our occupational health accounts. During this
transition you may get two bills for the same account. The bills will not have duplicate charges so both
bills need to be paid. All payments will be applied to the oldest bill first until that account is paid off.
Any visits after September 1, 2020 will be billed through the new billing system. We appreciate your
understanding and if you should have any additional questions you may contact me at 402-426-1134 or
402-426-1291.
Thank you for your continued trust in Memorial Community Hospital and Health Systems for your
occupational health needs. We appreciate your business and look forward to serving you in the future.
Sincerely,
Kathy Brest
Occupational Health RN
Memorial Community Hospital & Health System I MCH Physicians Clinic
810 N. 22nd Street I Blair, Nebraska 68008 I Phone: 402.426.1134 1 www.mchhs.org