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CONTRACT 3912D Amendment CLOSEDLA,�n FOURTH AMENDMENT TO AGREEMENT NO. 3912 BETWEEN THE CITY OF EL SEGUNDO AND WESTCHESTER MEDICAL GROUP /CENTER FOR HEART AND HEALTH THIS 4TH AMENDMENT ( "Amendment ") is made and entered into this First day of October, 2012, by and between the CITY OF EL SEGUNDO, a general law city and municipal corporation existing under the laws of California ( "CITY "), and WESTCHESTER MEDICAL GROUP /CENTER FOR HEART AND HEALTH, a General Partnership ( "CONSULTANT "). 1. Pursuant to Agreement No. 3912 ( "Agreement"), executed by the parties on or about February 25, 2009 and subsequently amended, the term of the agreement is extended until September 30, 2013. 2. This Amendment may be executed in any number of counterparts, each of which will be an original, but all of which together constitute one instrument executed on the same date. 3. Except as modified by this Amendment, all other terms and conditions of Agreement No. 3912 remain the same. 4. Exhibit A is incorporated by reference. IN WITNESS WHEREOF the parties hereto have executed this contract the day and year first hereinabove written. CITY EL SEGUNDO WESTCHESTER MEDICAL GROUP/ 14 CE R HEART AND HEALTH ATTEST: M Robert A. Reiss, M. .A.C.P. Co- Medical Director, Partner �i Taxpayer ID No. ice` y APPROVED A TO MARK D. H LE C l orney Y: Ka, H. Berger, Assjit nt City Attorney MBIBIT A ° PERFORMANCE OF SERVICES • A physical examination by a physician will always include, but not limited to, the following: 1. HEENT (Head, Ears, Eyes, Nose and Throat). 2. Cardiopulmonary examination. 3. Abdominal examination. 4. Musculoskeletal examination. 5. Vascular examination. 6. Neurological status examination. 7. Vital Signs. 8. Upper /Lower extremity exam for mobility and strength. 9. Digital rectal examination and fecal occult blood for males 40 years of age and older,. 10. Testicular examination for males. 11. Breast examination and Pap smear will be offered to females. 12. Family and Personal Medical History. 13, Social /personal history to discuss exercise, diet, alcohol intake, tobacco usage, and perceived stress level. 14, Review of all laboratory data, x- ray(s), pulmonary function tests, audiometry results, and resting /exercise EKG interpretation. 15. Discuss preventative health measures that are specific to each examinee. 16. Final recommendations provided in a detailed report to examinee and only a "Fitness For leg " report form will be provided to the City of El Segundo, Each examinee will work one -on -one with an Exercise Physiologist throughout the testing protocol. The Exercise Physiologists on staff are well trained in every aspect of the testing protocol. This allows for a timely and comfortable transition through the physical. It also allows the Exercise Physiologist to get to know the examinee to help assist in developing an appropriate exercise prescription and advise lifestyle modifications per conversations with that examinee. 1 of 3 SERVICE COMPONENTS PROVIDED AS PART OF THE CITY OF EL SEGUNDO EXECUTIVE HEALTH AND FITNESS PROGRAM • A physical examination by a physician • Blood Analysis (chemistry panel, complete blood count, thyroid, blood type, prostate specific antigen) • Urinalysis • Hemoccult slide testing • Height /Weight measurement • Body Composition Analysis • Vision Testing (Titmus /Snellen) • Color vision (Ishihara/Farnsworth) • Hearing Test (Audiogram 500Hz — 8000Hz) • Pulmonary Function Testing • Chest x -ray (1- view /2 views) • Back x -rays when applicable • Resting EKG • Maximal Stress EKG (treadmill or bike) • Push -up evaluation • Curl -up evaluation • Flexibility evaluation (Acuflex I — "sit & reach ") • Vaccinations, immunizations, antibody testing, etc. upon request. • Follow -up or referral to health care practitioner • Counseling, after the examination, by both the physician and Exercise Physiologist to review the results that are available, discuss exercise and dietary guidelines, and ways to reduce risk factors for heart disease. • A report with all laboratory /x -ray results, exercise prescription and physician recommendations will be mailed to examinee. 2 of 3 CONTRACTOR RATES EVALUATION COMPONENT I Executive, Police, Fire Physician examination $200.00 . . .............. ........... Vision . . . .................................. ........ $15.00 Audiometry .... . . . ..... ......... . ...... . . ....... . . ........... $10.00 Chest x-ray (1 view) ........_._- ...W.... $35.00 Blood panel includes: $53.00 Chemistry panel .. . Negotiable Complete blood count $40.00 .......... ...... . . . ... .............. Prostate Specific Antigen As needed/recommended Urinalysis $12.00 ............. . .... . . . . ....... Pulmonary function FEV, FVQ ....... .... $25.00 Resting EKG $50.00 Stress EKG (Bruce protocol) $150.00 . .. ........................ ........... Strength & flexibility $20.00 Body comoosition . . . ................................ . . ...... $10.00 Report to El Segundo "Fit for Duty" Report Form Only Report to patient No charge Total Cost: $580.00 . ......................... .. .. . . . ...... . . ....... . . ...... Citv discount cost: $450.00 . ..... . .... Additional Components: �Resting EKG & Stress test (a la carte) $200.00 Chest x-ray (2 views—PA/Lateral) . $65.00 ... ....... ................ — TB Skin Test (PPD). Includes admin. fee and supplies. $65.00 ... ........ . ......... . . . .............. ........... Hepatitis A (2 doses) Negotiable Hepatitis B (3 doses) . . ................. .. . Negotiable Hepatitis C Antibody $40.00 .......... ...... . . . ... .............. Hepatitis B Surface Antibody $...... 37.00 ....... ........... . ....... ................ Immunizations ...... . . . .................. . ..... . . ....................... .. . . . ..... Negotiable Vaccinations ... .......... . . . . . ......................... Negotiable Pap smear_ . .... ... ...... . ........ ........... ...... . . . ................ . . ............ . . . Referral only Colonoscol)-v Referral only Mammogram .. ....... .......... Referral only Cardiology consultation Referral only Agreement active from October 1, 2012 through September 30, 2013. 461 3 of 3