Combine Solicitation – TRANSCRIPTION SERVICES

Notice Type: Combine Solicitation

Posted Date: 01-SEP-15

Office Address: Department of the Navy; Bureau of Medicine and Surgery; Naval Medical Center San Diego; Bldg 134800 Bob Wilson Drive San Diego CA 92134-5000

Subject: TRANSCRIPTION SERVICES

Classification Code: R - Professional, administrative, and management support services

Solicitation Number: N00259-15-T-0317

Contact: Reynaldo R. DeVera, Contract Specialist, Phone 6195325564, Fax 6195325596, Email [email protected]

Setaside: Total Small BusinessTotal Small Business

Place of Performance (address): Naval Medical Center San DiegoAnatomical Pathology Laboratory 34800 Bob Wilson Drive San Diego, CA

Place of Performance (zipcode): 92134-5000

Place of Performance Country: US

Description: Department of the Navy

Bureau of Medicine and Surgery

Naval Medical Center San Diego

The proposed contract action is for commercial item, which the Naval Medical Center San Diego intends to solicit this requirement as 100% small business set-aside. This is a combined solicitation/synopsis for commercial items, prepared in accordance with the format in FAR subpart 12.6 as supplemented with additional information included in this notice. This announcement constitutes only solicitation, quotations are being requested and a written solicitation will not be issued. The solicitation number, N00259-15-T-0317 is issued as a request for quotation (RFQ). The North American Industry Classification System (NAICS) Code for this acquisition is 561410. All interested bidders shall submit quotations electronically by email to [email protected] or by facsimile at 619-532-5596, attention Rey de Vera. E-mail submissions are limited to 2MB. The submitter should confirm receipt of facsimile and email submissions. Quotations are due on or before 30 September 2015 at 6:00 AM Pacific Standard Time to be considered responsive.

CLIN 0001 Transcription Services (Unit of issue "each" used for unit of issue "per line" QTY 360,000 EA $__________ To be provided in accordance with the Statement of Work. Period of Performance: 01 October 2015 - 30 September 2016

CLIN 0002 On-Site Admin Support QTY: 12 MO $___________ To be provided in accordance with the Statement of Work. Period of Performance: 01 October 2015 - 30 September 2016

Contractor must be registered to the System for Award Management (SAM) prior to award. The website address for SAM registration is www.sam.gov

Contractor MUST complete FAR 52.212-3, Offeror Representations and Certifications - Commercial Items, when submitting a proposal. The website address is http://www.acquisition.gov. DELIVERY ADDRESS: Naval Medical Center San Diego, 34800 Bob Wilson Drive, San Diego, CA 92134-5000

52.204-7 System for Award Management (JUL 2013) 52.204-10 Reporting Executive Compensation and First-Tier Subcontract Awards (JUL2013) 52.204-13 System for Award Management Maintenance (JUL 2013) 52.212-1 Instruction to Offerors-Commercial Item (APR 2014) 52.212-2 Evaluation-Commercial Items (OCT 2014).The following factors shall be used to evaluate offers in descending order: 1) Technical Capability; 2) Price; 3) Past Performance; 4) Technical Capability and Past Performance when combined is more important than price. 52.212-3 Offeror Representations and Certification--Commercial Items (DEC 2014) 52.212-4 Contract Terms and Conditions--Commercial Items (DEC 2014) 52.212-5 Contract Terms and Conditions Required to Implement Statutes or Executive Orders--Commercial Items (DEC 2014) 52.219-6 Notice of Total Small Business Set-Aside (JUN 2003) 52.219-28 Post Award Small Business Program Representative (JUL 2013) 52.222-19 Child Labor -- Cooperation with Authorities and Remedies (JAN 2014) 52.222-26 Equal Opportunity (MAR 2007) 52.222-36 Equal Opportunity for Workers with Disabilities (JUL 2014) 52.222-50 Combating Trafficking in Persons (MAR 2015) 52.223-18 Encouraging Contractor Policies to Ban Text Messaging while Driving (AUG 2011) 52.225-13 Restrictions on Certain Foreign Purchases (JUN 2008) 52.232-18 Availability of Funds (APR 1984) 52.232-33 Payment by Electronic Funds Transfer - System for Award Management (JUL 2013) 52.252-2 Clauses Incorporated By Reference (FEB 1998) 252.203-7998 (DEV) Prohibition on Contracting with Entities that Require Certain Internal Confidentiality Agreements-Representation. (FEB 2015) 252.203-7999 Prohibition on Contracting with Entities that Require Certain Internal Confidentiality Agreements (Deviation 2015-O0010) (FEB 2015) 252.204-7012 Safeguarding of Unclassified Controlled Technical Information (NOV 2013) 252.225-7001 Buy American And Balance of Payments Program (NOV 2014) 252.225-7002 Qualifying Country Sources As Subcontractors (DEC 2012) 252.232-7003 Electronic Submission of Payment Requests (JUN 2012))

All responsible sources may submit a quotation which shall be considered by the agency.

AVAILABILITY OF FISCAL YEAR 2016 FUNDS.

THE GOVERNMENT OBLIGATION MADE HEREUNDER IS CONTINGENT UPON THE ENACTMENT OF THE FISCAL YEAR 2016 APPROPRIATION ACT.

THIS ORDER IS ISSUED SUBJECT TO THE 2016 DOD APPROPRIATION ACT OR AN EXTENDED FISCAL YEAR 2015 CONTINUING RESOLUTION ACT AND IS SUBJECT TO ALL PROVISIONS OF WHICHEVER ACT BECOMES APPLICABLE. THE CLAUSE 52.232-18 REFERENCED HEREIN APPLIES TO THIS CONTRACT.

STATEMENT OF WORK Naval Medical Center San Diego, California Anatomical Pathology Laboratory: Pathology Transcription Services 1.0 INTRODUCTION 1.1 Organization The Naval Medical Center (NMC) located in San Diego, California is responsible for providing the U.S. Navy, other military branches, and their military families with reliable quality health care. In addition to maintaining status as the nation's premier care provider, NMC is responsible for preparing for deployable support of operational forces, as well as shaping the future of military medicine through education, training and research. 1.2 Background and Objective Pathology transcription is a specialized branch in medical transcription that focuses on disease diagnosis. Transcription covers the entire process from microscopic to description to diagnosis. Dictation includes patient history and reports, pathology notes from gross description to final diagnosis, preparation of pathology consultation notes, medical documentation, patient progress reports, discharge summaries, procedure notes, ER reports, and operative reports. Accurate transcription and rapid turnaround time is essential for delivering optimal treatment to potentially critically ill patients. Due to the highly specialized skills and the lack of required resources, it is not cost effective for transcription to be performed in house. Professional resources, required space, and technology needed prevents NMCSD from maintaining this service on-site. The objective of this contract is to provide Pathology Transcription Services for NMCSD Anatomical Pathology Laboratory in accordance with the requirements as stated herein. 2.0 REQUIREMENT 2.1 Task Description and Deliverables The purpose of pathology transcription services is to transcribe dictation that will cover Pathology type workload. Voice recordings, to include contractor-owned/leased digital dictation systems, are to be sent from or recorded directly from NMCSD Anatomical Pathology. The Contractor must furnish all managerial, supervisory, direct and overhead personnel; equipment including maintenance; facilities; supplies; and other items or services; except specified herein as Government-furnished, to provide medical transcription services as defined in this contract for Laboratory Department, Naval Medical Center San Diego. Requirements Turn Around Time (TAT) Reporting Requirements Critical Nature The Contractor must provide medical transcription services to transcribe and type from specific dictated directions when provided or in prescribed formats from highly specialized medical dictation. The dictation must cover all types of Pathology workload for the Laboratory Department, including Surgical Pathology, Bone Marrow, Autopsy, and Cytology case reports, grossing, microscopic description, diagnoses, amendments, addendums, consults, submitted cases, special studies, and any other information for pathologic-radiographic, or pathologic-clinical correlation. The Contractor must transcribe from voice recordings (either Government-owned digital dictation system or a Contractor-owned system) into COPATH in correct Government required format. In addition, the Government may provide hard-copy reports for entry and transcription. Contractor will provide full-time (40 hours per week) on-site administrative support from 0700 to 1530 to process cases, perform quality assurance checks, distribute cases, and prepare logs and reports. Hours of Operation: transcription services are required Monday through Friday, except federal holidays: New Year's Day, Martin Luther King Jr. Day, President's Day, Memorial Day, Fourth of July, Labor Day, Columbus Day, Veteran's Day, Thanksgiving, and Christmas Day. Hours of operation should coincide to meet TAT requirements for transcribing dictations and hard-copy documents. Turnaround times (TAT): reports following the completion of all dictations or receipt of hard-copy documents must be within 4 hours when received by 2:00 p.m. Pacific Time,. Dictations or hard-copies received after 2:00 p.m. Pacific Time must be transcribed by 8:00 a.m. the following day. The Contractor must provide reports that conform to CAP standards. CAP required information in reports include the patient's full name, patient number, requesting physician, date and time of collection, date and time of receipt by the lab, date and time reported, and results. The Contractor must distribute transcribed documents to pathology staff daily corresponding with the workload documents (i.e. X-log) as required by the Laboratory Department. Accurate and timely patient diagnosis is required for proper treatment and management of disease. Optimal patient care cannot be provided without rapid TAT. Pathology cases are required by CAP to be completed no later than 48-hours after specimen receipt. (CAP Requirement: ANP.12150, CYP.07690)

The Contractor must provide medical transcription services to transcribe and type from specific dictated and/or printed directions when provided or in prescribed formats that may differ based upon report type, specimen type, and facility accepted practices. The required formats will be provided upon contract award.

The dictation must cover all types of Pathology workload for the Laboratory Department, including Surgical Pathology, Bone Marrow, Autopsy, and Cytology case reports, grossing, microscopic description, diagnoses, amendments, addendums, consults, submitted cases, special studies, and any other information for pathologic-radiographic, or pathologic-clinical correlation. The Contractor must transcribe from voice recordings (either Government-owned digital dictation system or a Contractor-owned system) into COPATH in correct Government required format. In addition, the Government may provide hard-copy reports for entry and transcription. The contractor must be capable of delivering any dictation electronically in the format described. The Contractor must customize the dictation system menu to collect SSN, work types, consult order numbers and location code (duty station and inpatient register number) and any other data required to deliver the transcription electronically as required. 2.2 Task Personnel Requirements 2.2.1 US Citizenship US citizenship is required. 2.2.2 Personnel The Contractor shall provide and train sufficient qualified personnel to perform services specified in this contract beginning on the established start date of the contract. The Contractor shall also be able to provide disaster support if needed.

2.2.3 Off-site Transcriptionist The Contractor must enter transcription data directly into COPATH and Composite Health Care System (CHCS). The Government must provide a web-based portal to access COPATH and CHCS, subject to security requirements outlined in Section 4.3 below. Addenda will be provided via electronic voice file and/or faxed to the transcriptionist and will be entered into the COPATH system. The Government will provide the Contractor with a line count of work based on the standard in 4.1.1. The contractor will check all SF 515s against what is already provided in the COPATH system to make any corrections needed, adding QA administrative codes into the COPATH system for missing information on SF 515s as needed via fax. The gross and final dictation will be transcribed and merged to form the final report. The same process will be accomplished for all Surgical Pathology reports submitted from NH Port Hueneme and NH Twenty Nine Palms (except duty station and register number lookup); said information will be entered into the NH Camp Pendleton COPATH system. 2.2.4 On-site Administrative Support The Contractor must distribute transcribed documents to pathology staff daily corresponding with the workload documents (i.e. X-log) as required by the Laboratory Department. The Contractor must maintain specific records that are transcribed for each case (i.e. grossing documents, SF515 paperwork on written submission, outside consult case paperwork, final reports, addendums, extra departmental consult paperwork, etc.), filing all paperwork at NMCSD with each transcribed case file and storing in chronological order for a 2 year storage period as required by the COR and Laboratory Department. The estimated number of files to be maintained is equivalent or greater than the annual caseload. The Contractor must accurately transcribe demographic, military, and clinical information for all cases from CHCS into COPATH. Any discrepancies with demographic, military, and clinical information will be researched and corrected through DEERS, Patient Records, medical providers, decedent affairs, on-site and off-site clinics, CHCS, CoPath, or other appropriate resource. Any additional information submitted after the specimen is accessioned will be input to CoPath. Patients not found in CHCS will be added using the mini-registration function. The Contractor must correct intermediate and final cases with transcription errors or with incomplete work to allow pathologists to re-access cases, input addendums for outside facilities that provide a definitive diagnosis for surgical and autopsy cases, accession submitted cases, accession slides, blocks and specimens submitted from external providers and/or facilities, and "accession in error" cases with unalterable data (i.e. patient demographics, order error, etc.). A rough estimate of corrections, addendums, submitted cases, external slide, block, and specimen submissions, and "accession in error" cases is 20% of the annual caseload. Upon the discovery of discrepancies in patient demographics, specimen submission, order error, or other information that would affect patient safety, the contractor must prepare Error Variance Reports and submit report to appropriate Government personnel. The Contractor must create and maintain monthly log reports for frozen section cases that are transcribed into CoPath from specimen submission requests (SF 509E) and will submit said report(s) to the appropriate Government personnel. The Contractor must serve as the primary transcription service point of contact for pathology staff, residents, and medical providers to resolve transcription issues. The Contractor must perform other duties specific to transcription services as required. 2.2.5 Technical and Personal Skills Laboratory professionals who perform highly technical pathology transcription must possess the appropriate knowledge and skills associated pathology and transcription. Extensive knowledge of medical terminology, anatomy, physiology, CPT and ICD coding is required. A minimum typing skill of 60 wpm is necessary to process a minimum of 100 cases per day. The Contractor must provide and train sufficient qualified personnel to perform services specified in this contract beginning on the established start date of the contract. The Contractor must also be able to provide disaster support if needed. Laboratory Reports must comply with the Health Insurance Portability and Accountability Act (HIPAA) regulations with necessary HIPAA clauses included. Reports will include medical liability clauses for non-personal medical services. Information provided in the reports must comply with the CAP standards. The Contractor must ensure strict adherence to all security requirements for all contents and systems of reports applicable to this contract; meeting all requirements as imposed by HIPAA and JCAHO. 3.0 CLASSIFICATION Unclassified 4.0 TECHNICAL REQUIREMENTS 4.1 Specifications All transcription for the Laboratory Department shall be performed using the COPATH system. Dictation from the Laboratory Department must be provided to the contractor using telephone based, PC based dictation devices, and various handwritten or typed forms. Dictation system must connect to the hospital's LAN and PBX systems but the server must be the responsibility of the contractor and must be a secure system to ensure HIPPA compliance. The Laboratory Department may require customization of the dictation call flow and software. Dictation system must need fault tolerance and backup capabilities. The Government must provide a copy of department accession number protocol to the Contractor prior to commencement of work. 4.1.1 Line Counting Methods For counting and billing purposes, reports entered into COPATH must be counted by the line counter module in COPATH. NOTE: COPATH uses 78 characters per line, and counts blank lines and partial lines as billable line. 4.1.2 Pathology Reports The Contractor must work with laboratory staff to troubleshoot and correct errors with the Pathology Reports. The contractor must be able to transcribe demographic, military, and clinical information from CHCS or a hard-copy (i.e., SF-515) into COPATH. Information missing on hard-copy documentation must be properly coded in COPATH. The Contractor must provide transcribed COPATH working draft reports daily with the COPATH case log to the Pathologist signing out the corresponding cases. The Contractor must cumulatively transcribe dictations and hard-copy reports upon receipt into a single report based on the COPATH report format until the report is finalized. The Contractor must perform the same process for all pathology dictations and hard-copy reports submitted from outlying medical facilities authorized by NMCSD, to include: Naval Hospital (NH) Camp Pendleton, NH Twenty-nine Palms, and Naval Branch Health Clinic, Port Hueneme. The Government must provide addenda via electronic voice file and/or fax to the transcriptionist for entry into the COPATH system. The Contractor must prioritize the transcription of dictation and hard-copy documents as defined by the Laboratory Department. 4.1.3 CHCS, COPATH, or Other Automated Information System Procedure When required by the Government, the Contractor must enter patient reports into the CHCS and/or COPATH computer network or other computer information systems. The Contractor must furnish all necessary transcription equipment, supplies, parts, tools, and labor to perform this contract. 4.2 Training of NMCSD Personnel The Contractor must provide instructions and materials necessary to instruct NMCSD personnel in the use of the contractor's dictation system at no additional cost to the Government. Areas of instruction and schedule of staff personnel must be provided by the government. List of personnel requiring initial training must be provided at contract award. The Contractor must furnish all necessary equipment, supplies, parts, tools, and labor to perform this contract. 4.3 Requirements A. The Contractor must act in accordance with commercial practices. B. The Contractor must include Medical liability clauses for non-personal medical services. C. All subcontracted referral facilities used by the contractor shall also meet the above requirements. D. The Contractor must call the originator regarding clarification of work submitted or questions about specific requirements. Unusual terminology and non-standard test requests must be verified with the originator when unclear. 4.3.1 Information Systems Security. All Navy Medicine IT systems must maintain an appropriate level of confidentiality, integrity, authentication, non-repudiation, and availability. The Business-To-Business (B2B) Gateway provides confidentiality, integrity, authentication, non-repudiation, and availability to Navy Medicine Enclaves. The B2B Gateway is the solution to be used by Navy MTFs to provide remote connectivity to MHS Business Partners. The B2B Gateway is designed to provide MHS Business Partners with a securely managed, single point of entry into Navy Medicine Enclaves. The B2B Gateway is sponsored by TIMPO and is managed by DISA. Contractor responsibilities must include all of the following: A. Provides network information B. Procures and installs B2B Gateway compatible VPN/encryption device C. Procures Tier I or Tier II Internet Service Provider for connectivity D. Provides qualified on-site touch labor technical support 1. Help resolve telecommunications and support routine maintenance activities E. Obtains DOD Information Assurance Certification and Accreditation Process /DOD Information Assurance Certification and Accreditation Process (DITSCAP/DIACAP) accreditation, if required 1. http://www.tricare.osd.mil/tmis_new/IA.htm#ditscap F. Completes Data Use Agreement, if required G. Ensures personnel have appropriate security qualifications H. Ensures personnel complete annual Information Assurance Training I. Reports all problems to the MHS Help Desk J. Provides 24 X 7 on call technical points of contact 1. Assist in problem resolution K. Provides configuration management of B2B Gateway Questionnaire 5.0 GOVERNMENT-FURNISHED PROPERTY/MATERIAL 5.1 Equipment Government-furnished equipment must be used only in the performance of services required in this contract. No alterations must be made without specific written permission of the COR. Each request must be submitted to the COR, in writing, for approval. The Contractor must return the equipment to the Government in the same condition and quantity as received, except for fair wear and tear. The Government must furnish repairs, alterations, and maintenance service to facilities which include electrical power into and including panel boards, circuit breakers, magnetic conductors, fixed equipment, and wall outlets, and all alterations and repairs to the NMCSD and its real property fixtures. The Contractor must furnish all necessary transcription equipment, supplies, parts, tools, and labor to perform this contract. The Government must provide dictation devices, such as hands free, handhelds, PDAs, etc., capable of connecting to the dictation system through a Local Area Network (LAN) or PBX systems. The Government must provide user information and security codes for use by the contractor. The contractor must immediately terminate the use of these codes upon notification by the Government. Title to all Government-furnished equipment must remain with the Government. The Contractor is required to use the ADT feed from the Composite Healthcare System (CHCS). The ADT feed is a stream of HL7 messages that provides patient demographic information, social security number, etc. to ensure appropriate data quality checks (i.e., spelling, etc.). 5.2 Care of Property The contractor must exercise care in the use of all Government-furnished fixtures, facilities, and furnishings to prevent undue wear, breakage, and/or consumption. 6.0 TRAVEL No travel required. 7.0 QUALITY ASSURANCE SURVEILLANCE PLAN (QASP) The Quality Assurance Surveillance Plan (QASP) is established to ensure quality and consistency of transcribed dictation, data entry, and accuracy of line counts used for invoicing. The quality of transcription services is a critical component in the delivery of timely and accurate diagnosis and patient safety. Random sampling of completed reports is conducted to assess grammatical and spelling error rates. Additionally line counts of transcribed reports are used to verify consistency with monthly invoices. The COR is responsible for the review of quality reports provided by the Contractor and results from random sampling of completed reports. Any discrepancies are communicated to the Contractor by the COR. The Quality Assurance Plan will conform to the following requirements: a) A random sample of 5% of completed pathology reports from the previous month must be forwarded in a zipped, password protected file to the COR by the third business day of the new month for review. b) The COR or designated representative in Anatomical Pathology reviews the reports for spelling and grammatical errors. The line count of the completed report is compared to the same report in CoPath to verify consistency of line counts. c) The Contractor must provide a monthly Quality Assurance report to the COR by the third day of the month that includes percentage of grammatical errors, spelling errors, and average line count for the previous month. d) The COR will respond to the Contractor within 5 business days with the results from the Quality Assessment review. e) Any discrepancies are addressed by the Contractor within 5 business days of notification and corrective action communicated to the COR. Corrections or any rework of errors or discrepancies must be performed at no additional charge to the Government. 8.0 PERIOD OF PERFORMANCE See Schedule. 9.0 PERSONAL SERVICES NON PERSONAL SERVICES STATEMENT Contractor employees performing services under this order will be controlled, directed, and supervised at all times by management personnel of the contractor. Contractor management will ensure that employees properly comply with the performance work standards outlined in the statement of work. Contractor employees will perform their duties independent of, and without the supervision of, any Government official or other Defense Contractor. The tasks, duties, and responsibilities set forth in the task order may not be interpreted or implemented in any manner that results in any contractor employee creating or modifying Federal policy, obligating the appropriated funds of the United States Government, overseeing the work of Federal employees, providing direct personal services to any Federal employee, or otherwise violating the prohibitions set forth in Parts 7.5 and 37.1 of the Federal Acquisition Regulation (FAR). The Government will control access to the facility and will perform the inspection and acceptance of the completed work. 10.0 INVOICE SCHEDULE Contractor may invoice monthly in arrears. Invoices shall be submitted once a month for services rendered during the previous month. Only one invoice may be submitted per month. Invoices must identify the invoicing period. If charges against more than one line item have occurred during the invoicing period, all charges must be combined into one invoice. Specific invoicing instruction will be provided in the contract award. The contractor's failure to include the necessary information or a more frequent invoice submission than authorized will result in invoices being rejected. Payment will be made by WAWF. Invoices for goods received or services rendered under this contract shall be submitted electronically through Wide Area Work Flow - Receipt and Acceptance (WAWF).

QASP Naval Medical Center San Diego, California Anatomical Pathology Laboratory: Pathology transcription services Quality Assurance Surveillance Plan (QASP) SOW Reference: The Contractor must provide medical transcription services to transcribe and type from specific dictated directions when provided or in prescribed formats from highly specialized medical dictation. The dictation must cover all types of Pathology workload for the Laboratory Department, including Surgical Pathology, Bone Marrow, Autopsy, and Cytology case reports, grossing, microscopic description, diagnoses, amendments, addendums, consults, submitted cases, special studies, and any other information for pathologic-radiographic, or pathological correction. The Contractor must transcribe from voice recordings (either Government owned digital dictation system or a Contractor owned system) into COPATH in correct Government format. In addition, the Government may provide hard-copy reports for entry and transcription.

Requirement/ Desired Outcome: Deliverables.

Performance Standards: All deliverables IAW the SOW should be accurate and timely.

Acceptable Quality Level (AQL): The Contractor must ensure that completed transcription is medically consistent and accurate in content. This requires an extensive knowledge of medical terminology, including but not limited to anatomy, pharmacology, surgical procedures, laboratory values, etc. The Contractor must analyze transcription for accuracy and meaning to ensure transcribed report is an accurate representation of the dictated report. The Contractor must, in all cases possible, ensure that the demographic information at the top of each report is complete using information provided by the Government. Contractor must ensure completed work contains no more than two (2) spelling, grammar, punctuation, or typographical errors and omissions per page prior to returning the final output to originator. Completed work containing more than two (2) errors or omissions on any single page must be considered unacceptable and subject to correction by the Contractor at no additional cost to the Government. Contractor must provide an Acceptable Quality Level Assessment Report quarterly for the individual services pertaining to outputs dealing with summary of line count, timeliness of delivery, use of correct format, provision of original reports, specified number of copies, and other performance requirements and acceptable levels of quality.

Monitoring Method: Government Review and Approval of Deliverables identified in the SOW.

Note: If performance fall below the AQL defined above, the COR shall document the instance(s), coordinate with the Contracting Officer and advise the Contractor. The Contractor will be requested to review the documentation and provide a written response on how performance will be corrected in the future. Re-performance on any work for failure to perform in accordance with the specified AQL or task requirement shall be borne at the Contractor's own expense and at no cost to the Government.

Link/URL: https://www.fbo.gov/spg/DON/BUMED/N00259/N00259-15-T-0317/listing.html