Inactive Total Small Business Set-Aside (FAR 19.5)

Page 1 of 17 I SCHEDULE OF SERVICES Services Provided: The Contractor shall provide onsite Chiller/Boiler Operators to provide services to operate the VA Northern California Health Care System (VANCHC... Page 1 of 17 I SCHEDULE OF SERVICES Services Provided: The Contractor shall provide onsite Chiller/Boiler Operators to provide services to operate the VA Northern California Health Care System (VANCHCS) Utility System Energy Center as further defined in this PWS in accordance with the specifications contained herein. Place of Performance: Contractor shall furnish services at the VANCHCS, Sacramento VA Medical Center, 10535 Hospital Way, Mather, California 95655. Period of Performance (BASE PERIOD): Six (6) Months after date of Award Option: Six (6) Months II PERFORMANCE WORK STATEMENT GENERAL SERVICES REQUIRED: The Contractor shall provide two Boiler/Chiller Operators who will have responsibility for operating the VANCHCS Utility System Energy Center onsite as further defined in this PWS. PLACE OF PERFORMANCE: VANCHCS, Sacramento VA Medical Center, 10535 Hospital Way, Mather, CA 95655. POLICY AND REGULATIONS: Contractor shall comply with all applicable policy and regulations, including, but not limited to, the following: Privacy Act of 1974 (5 U.S.C. 552a) as amended http://www.justice.gov/opcl/privacy-act-1974. DEFINITIONS/ACRONYMS: CDR: Contract Discrepancy Report Contracting Officer (CO): The person executing this contract on behalf of the Government with the authority to enter into and administer contracts and make related determinations and findings. Contracting Officer s Representative (COR): A person appointed by the CO to take necessary action to ensure the Contractor performs in accordance with and adheres to the specifications contained in the contract and to protect the interest of the Government. The COR shall report to the CO promptly any indication of non-compliance in order that appropriate action can be taken. CPARS: Contractor Performance Assessment Reporting System HIPAA: Health Insurance Portability and Accountability Act ISO: Information Security Officer NFPA: National Fire Protection Association OSHA: Occupational Safety and Health Administration PWS: Performance Work Statement QASP: Quality Assurance Surveillance Plan TJC: Joint Commission on the Accreditation of Hospital Organizations VA: The Department of Veterans Affairs. Veterans Health Administration (VHA): The central office for administration of the VA medical centers through throughout the United States. The VHA is located in Washington, D.C. Veterans Integrated Services Network (VISN): The regional oversight for the VA medical centers in California, Hawaii and Nevada. VISTA (Veterans Integrated Systems Technology Architecture): A PC-based system that will capture and store clinical imagery, scanned documents and other non-textual data files and integrates them into patient s medical record and with the hospital information system. Veterans Affairs Medical Center (VAMC): Unless identified with the name of a different VA medical center, for purposes of this contract, this term shall mean the Sacramento VA Medical Center. QUALIFICATIONS STAFF: Education, Training and Experience: The Chiller/Boiler Operators will possess formal or informal education, training and experience in utility systems operations. Contractor personnel performing services under this contract shall possess a minimum of one year documented experience as a plant operator. Technical Proficiency: The contract Chiller/Boiler Operators must have recent documented experience working as a Chiller/Boiler Operator. Experience in a health care setting is desirable. The Contract Chiller/Boiler Operators shall have the following knowledge, skills and abilities to successfully perform the work: Ability to perform the common tasks associated with journeyman duties in a line of work on one's own initiative, subject to occasional inspection. Ability to do the common tasks associated with journeyman duties in a line of work, under close supervision and subject to inspection at the end of each task. Read and record temperatures, pressures, and operating data as required within a boiler pant. Ability to perform boiler inspections to all boiler controls, combustion equipment, water leveler regulation, steam regulators, 0-2 recorder, automatic 0-2 trim systems, safety devices, instruments, flow meters, feed pumps, gas regulators, automatic controls and air regulators. Maintain constant observation of the meters, charts, gauges, water levels and temperatures to ensure that all systems are functioning properly. Read and record temperatures, pressures, and operating data as required within a boiler plant. Ability to interpret instruction, specifications operating procedures: Determine proper chemicals to be added to the water in the proper proportions in which they are to be added to prevent corrosion and scale formation. Add chemicals to the chiller system and record test results and chemicals added. Perform adjustments and corrections to boilers based on recorded inspection date. Knowledge of equipment assembly, installation repairs: make repairs on boilers, chillers and related equipment, such as replacing bearings, packing and mechanical seals in pumps both liquid transfer and vacuum. Install and maintain all auxiliary air conditioning equipment consisting of chill water pumps, glycol circulating pumps, cooling towers, control air compressors, refrigerated /desiccants type air-dryers, pneumatic/electric control valves, variable frequency drives, digital pneumatic variable air volume boxes, electronic air filters, electric/steam humidifiers, automatic/manual water treatment systems, exhaust fans, air-balancing accessories. Ability to perform minor steam fitting, plumbing, electrical work, painting, and housekeeping of the boiler plant. Possess the ability to work independently without direct supervision. The Contract Chiller/Boiler Operators shall be technically proficient in the skills necessary to fulfill the Government s requirements, including the ability to speak, understand, read and write English fluently. Possess working knowledge of computers, specifically the Windows Operating System including experience using Internet and Microsoft Outlook or other email program. Experience utilizing Microsoft Word, Microsoft Excel, Microsoft Outlook is desirable. Contractor shall provide documents upon request of the CO/COR to verify current and ongoing competency, skills, and any certifications related to the services being performed. Contractor shall provide verifiable evidence of all educational, training and work experience as requested by the CO/COR. NON-PERSONAL SERVICES Inherently Governmental Functions: Contractor and Contractor Personnel shall not perform inherently governmental functions. This includes, but is not limited to, determination of agency policy, determination of federal program priorities for budget requests, direction and control of government employees, selection or non-selection of individuals for federal government employment, including the interviewing of individuals for employment, approval of position descriptions and performance standards for federal employees, approving any contractual documents, approval of federal licensing actions and inspections, and/or determination of budget policy, guidance, and strategy. The Contractor shall be responsible for the management, supervision, leave approval, and discipline of their employees. At no time shall the Contractor supervise any federal employee. There shall be no work directed or supervision of Contractor s employees by any Government/VA employee. Any issues or concerns shall be addressed to the COR. The Contractor shall not represent the VA as a COR nor shall the Contractor have any authority to sign any document on behalf of the VA. No Employee Status: The Contractor shall be responsible for protecting the Contract Personnel furnishing services to the Government under this contract. The Contractor shall provide or certify that the following is provided for all their staff providing services under the resultant contract: Workers compensation Professional liability insurance (as applicable) Health examinations Income tax withholding, and Social security payments. Tort: The Federal Tort Claims Act does not cover Contractors or Contractor Personnel. When a Contractor or a member of their staff has been identified in a tort claim, the Contractor is responsible for notifying their legal counsel and/or insurance carrier. Any settlement or judgment arising from an action or non-action Contractor s Personnel is the responsibility of the Contractor and/or insurance carrier. KEY PERSONNEL AND EMERGENCY SUBSTITUTIONS: The VA Full Time Equivalency (FTE) for the services required is 2.0 FTE is defined by VA as two personnel, each providing a minimum of 80 hours of services every two weeks, excluding federal holidays as specified herein. Emergency Substitutions: During the first ninety (90) calendar days of performance, the Contractor shall make NO substitutions of key personnel unless the substitution is necessitated by illness, death or termination of employment. The Contractor shall notify the Contracting Officer (CO), in writing, within 15 calendar days after the occurrence of any of these events and provide the information required below. After 90 days, the Contractor shall submit the information required below to the CO at least 15 calendar days prior to making any permanent substitutions. The Contractor shall provide a detailed explanation of the circumstances necessitating the proposed substitutions, complete resumes for the proposed substitutes, and any additional information requested by the CO. Proposed substitutes shall have comparable qualifications to those of the persons being replaced. The CO will notify the Contractor within 15 calendar days after receipt of all required information of the decision on the proposed substitutes. The contract will be modified to reflect any approved changes of key personnel. For temporary substitutions where the key person will not report to work for three (3) consecutive work days or more, the Contractor shall provide a qualified replacement for the key person. The substitute shall have comparable qualifications to the key person. Any period exceeding two weeks will require the procedure as stated above. The Government reserves the right to refuse acceptance of any Contractor personnel at any time after performance begins, if personal or professional conduct jeopardizes patient care or interferes with the regular and ordinary operation of the facility. Breaches of conduct include intoxication or debilitation resulting from drug use, theft, patient abuse, dereliction or negligence in performing directed tasks, or other conduct resulting in formal complaints by patients or other staff members to designated Government representatives. Standards for conduct shall mirror those prescribed by current federal personnel regulations. Should the VA Contracting Officer s Representative (COR) or designee encounter documented problems or continual unprofessional behavior/actions with any Contractor Personnel, s/he may request, without cause, immediate replacement of said contract Personnel. CONFLICT OF INTEREST: The Contractor and all Contractor Personnel performing services under this contract are responsible for identifying and communicating to the CO and COR conflicts of interest at the time of proposal and during the entirety of contract performance. At the time of proposal, the Contractor shall provide a statement which describes, in a concise manner, all relevant facts concerning any past, present, or currently planned interest (financial, contractual, organizational, or otherwise) or actual or potential organizational conflicts of interest relating to the services to be provided. The Contractor shall also provide statements containing the same information for any identified consultants or subcontractors who shall provide services. The Contractor must also provide relevant facts that show how it s organizational and/or management system or other actions would avoid or mitigate any actual or potential organizational conflicts of interest. These statements shall be in response to the VAAR provision 852.209-70 Organizational Conflicts of Interest (Jan 2008) and fully outlined in response to the subject attachment in Section D of the solicitation document. CITIZENSHIP REQUIREMENTS The Contractor certifies that the Contractor shall comply with any and all legal provisions contained in the Immigration and Nationality Act of 1952, As Amended; its related laws and regulations that are enforced by Homeland Security, Immigration and Customs Enforcement and the U.S Department of Labor as these may relate to non-immigrant foreign nationals working under contract or subcontract for the Contractor while providing services to the VA. While performing services for the VA, the Contractor shall not knowingly employ, contract or subcontract with an illegal alien; foreign national non-immigrant who is in violation their status, as a result of their failure to maintain or comply with the terms and conditions of their admission into the United States. Additionally, the Contractor is required to comply with all E-Verify requirements consistent with Executive Order 12989 and any related pertinent Amendments, as well as applicable Federal Acquisition Regulations. If the Contractor fails to comply with any requirements outlined in the preceding paragraphs or its Agency regulations, the VA may, at its discretion, require that the foreign national who failed to maintain their legal status in the United States or otherwise failed to comply with the requirements of the laws administered by Homeland Security, Immigration and Customs Enforcement and the U.S Department of Labor, shall be prohibited from working at the Contractor s place of business that services the VA; or other place where the Contractor provides services; and shall form the basis for termination of this contract for breach. This certification concerns a matter within the jurisdiction of an agency of the United States and the making of a false, fictitious, or fraudulent certification may render the maker subject to prosecution under 18 U.S.C. 1001. The Contractor agrees to obtain a similar certification from its subcontractors. The certification shall be made as part of the offerors response to the RFP using the subject attachment in Section D of the solicitation document. HOURS OF OPERATION BUSINESS HOURS AND WORK SCHEDULE: The Sacramento VA Energy Center operates 24 hours a day, 365 days per year. Chiller/Boiler Operators shall genrally provide services during regular weekdays, however on occasion due to shift schedule rotations may be requested to work a holiday or weekend day. The Contractor shall be notified no less than 5 days prior to the shift schedule rotation. Each Boiler Operator is expected to work maximum of 8 hours per day which includes a 30-minute lunch break, and a maximum of 40 hours per week. If an emergency replacement shift is required in excess of the 40 hours per week, it will be requested through a bi-lateral modification issued from the VA Contracting Officer. Contractor shall appoint one Chiller/Boiler Operator to perform each of the following shifts: Day Shift: Monday through Friday, 7:00 a.m. to 3:30 p.m. Swing Shift: Monday through Friday, 3:30 p.m. to 11:00 p.m. FEDERAL HOLIDAYS: The following holidays are observed by the VA: New Year s Day Washington s Birthday* Martin Luther King Jr. s Birthday Memorial Day Independence Day Labor Day Columbus Day Veterans Day Thanksgiving Day Christmas Day Any day specifically declared by the President of the United States to be a national holiday. *This holiday is designated as "Washington s Birthday" in section 6103(a) of title 5 of the United States Code, which is the law that specifies holidays for federal employees. Though other institutions such as state and local governments and private businesses may use other names, it is VA s policy to always refer to holidays by the names designated in the law. Unless a state of emergency has been declared or VANCHCS facilities are closed by the VA, the Contractor shall be responsible for providing services. In the event Contractor Personnel are unable to complete an assigned shift, the Contractor shall notify the COR or designee on the day or evening prior to the shift, or on the morning of the scheduled shift, no less than one hour prior to the start of the shift. CONTRACTOR RESPONSIBILITIES SERVICES REQUIRED Working onsite in the Engineering & Facilities Management Service (E&FMS), the Chiller/Boiler Operator(s) will be responsible for independently operating and maintaining utility plant equipment and systems with minimal or no supervision. SPECIFIC CONTRACTOR TASKS Operate the boiler feed water treatment plant and test the water, adding proper chemicals to boiler feed water if necessary. Operate the air conditioning management system consisting of an automatic data system for gathering and recording plant and remote air conditioning data. Maintain one or multiple gas/propane fired water or fire tube boilers equipped with electronic controls, and associated auxiliary control equipment. Observe boiler controls, gauges and charts to make necessary adjustments for proper fuel and airflow to maintain system pressure. Perform boiler inspections to all boiler controls, combustion equipment, water leveler regulation, steam regulators, 0-2 recorder, automatic 0-2 trim systems, safety devices, instruments, flow meters, feed pumps, gas regulators, automatic controls and air regulators. Maintain constant observation of the meters, charts, gauges, water levels and temperatures to ensure that all systems are functioning properly. Read and record temperatures, pressures, and operating data as required within the boiler plant. Determine proper chemicals to be added to the water in the proper proportions in which they are to be added to prevent corrosion and scale formation. Add chemicals to the chiller system and record test results and chemicals added. Perform adjustments and corrections to boilers based on recorded inspection date. Make repairs on boilers, chillers and related equipment, such as replacing bearings, packing and mechanical seals in pumps both liquid transfer and vacuum. Install and maintain all auxiliary air conditioning equipment consisting of chill water pumps, glycol circulating pumps, cooling towers, control air compressors, refrigerated /desiccants type air-dryers, pneumatic/electric control valves, variable frequency drives, digital pneumatic variable air volume boxes, electronic air filters, electric/steam humidifiers, automatic/manual water treatment systems, exhaust fans, air-balancing accessories. Perform minor steam fitting, plumbing, electrical work, painting, and housekeeping of the boiler plant. PERFORMANCE STANDARDS, QUALITY ASSURANCE (QA) AND QUALITY IMPROVEMENT (QI): All services will be provided in accordance with regulatory guidelines, which include: local policies and standard operating procedures, NFPA codes, JCAHO standards, OSHA regulations, equipment manufacturer s operation s manuals. Contractor personnel will have a full understanding of these regulations and procedures as they pertain to the field of Chiller/Boiler Plant Operations. In accordance with VA regulations, a record-keeping system will be established and maintained by the Contracting Officer s Representative (COR) to ensure contract compliance. Upon verification of services, payment will be authorized by the COR. Contractor agrees to provide services which meet or exceed the standards as established by the JCAHO, VA policies, VANCHCS accepted standard services, and the organizations stated in 4.3.1 above. Contractor personnel shall report any catastrophic or emergency situations to the COR immediately so appropriate action can be taken to preserve the environment of care. The COR shall be responsible for monitoring the performance of the contract Chiller/Boiler Operators. The services specified herein may be changed by mutual written agreement of the parties, in accordance with the terms and conditions set forth herein. The Government reserves the right to refuse acceptance of Contractor s personnel at any time after performance begins, if personal or professional conduct jeopardizes patient care or interferes with the regular and ordinary operation of the facility. Breaches of conduct include intoxication or debilitation resulting from drug use, theft, patient abuse, dereliction or negligence in performing directed tasks, or other conduct resulting in formal complaints by patients or other staff members to designated Government representatives. Standards for conduct shall mirror those prescribed by current federal personnel regulations. The CO and COR shall deal with issues raised concerning the conduct of the contract Chiller/Boiler Operators. The final arbiter on questions of acceptability is the CO. The CO shall resolve complaints concerning Contractor and/or Contractor personnel relations with the Government employees or patients. The CO is final authority on validating complaints. In the event that the Chiller/Boiler Operators are involved and named in a validated patient complaint, the Government reserves the right to refuse acceptance of the services of such personnel. This does not preclude refusal in the event of incidents involving physical or verbal abuse. The Government may evaluate the quality of professional and administrative services provided. Methods of Surveillance/Performance Standards: Contractor shall comply with the required standards as outlined in the QASP. The QASP shall be attached to the resultant contract and shall define the methods and frequency of surveillance conducted. DRESS AND APPEARANCE: Contractor personnel shall present a professional, conservative, and neat appearance. Contractor shall report for duty in a professional manner, in appropriate attire befitting a healthcare setting, and having complied with acceptable standards of personal hygiene expected of health care workers. Facial hair (including beards, mustaches, and sideburns) shall be controlled (restrained) or trimmed. It shall not interfere with safe work practices or be unclean. Contractor employee(s) clothing shall fit to provide a professional, modest appearance, in keeping with normally accepted community standards of dress for the work being performed as further described in Section 5.1.2. RECORDKEEPING: The Chiller/Boiler Operators shall be required to sign-in and sign-out when in attendance. Timesheets will be used by the COR to confirm hours/day and services provided against the Contractor s invoices. STANDARD PERSONNEL TESTING (PPD, ETC.): Contractor shall provide proof of the following tests for Contractor Personnel within five (5) calendar days after contract award and prior to the first duty shift to the COR and CO. Tests shall be current within the past year. Tuberculosis Testing: Contractor shall provide proof of a negative reaction to PPD testing for all Contractor Personnel peforming services under this contract. A negative chest radiographic report for active tuberculosis shall be provided in cases of positive PPD results. The PPD test shall be repeated annually. Rubella Testing: Contractor shall provide proof of immunization for all Contractor Personnel performing services under this contract, for measles, mumps, rubella or a rubella titer of 1.8 or greater. If the titer is less than 1.8, a rubella immunization shall be administered with follow-up documentation to the COR. GOVERNMENT RESPONSIBILITIES VA SUPPORT PERSONNEL, SERVICES OR EQUIPMENT: Although the majority of the work environment of the Chiller/Boiler Operators is indoors in a utility plant some activities may be performed outside (for example on the roof or other external areas where equipment is located). VA will provide shared conventional office equipment and associated supplies provided such as desk, filing cabinets, telephone, facsimile, PC computer system, photocopier, paper, pens, pencils, staples etc. Note: depending on the availability and need, equipment and supplies may vary in type, kind and quantity. VA will provide uniforms which shall consist of a fire-retardant uniform shirt, fire-retardant jeans and steel-toed workboots. Contractor personnel shall be required to wear the uniform and other government-furnished personal protective equipment (PPE) as required by VA to ensure a safe work environment. The Government will purchase repair or spare parts as required by the Chiller/Boiler Operators in the performance of services under this contract. Such purchases will be processed through existing VA procurement channels. The Chiller/Boiler Operators will coordinate these purchases through the COR. The Government will provide the Chiller/Boiler Operators with a Personal Identification Verification (PIV) badge. Contractor personnel are expected to wear/display this badge at all times while on VA property. OVERSIGHT OF SERVICE/PERFORMANCE MONITORING: After award of contract, all inquiries and correspondence relative to the administration of the contract shall be addressed to: CO (CONTRACTING OFFICER) COR (CONTRACTING OFFICER S REPRESENTATIVE) CO RESPONSIBILITIES: The CO is the only person authorized to approve changes or modify any of the requirements of this contract. The Contractor shall communicate with the CO on all matters pertaining to contract administration. Only the CO is authorized to make commitments or issue any modification to include (but not limited to) terms affecting price, quantity or quality of performance of this contract. The CO shall resolve complaints concerning Contractor relations with the Government employees or patients. The CO is final authority on validating complaints. In the event the Contractor effects any such change at the direction of any person other than the CO without authority, no adjustment shall be made in the contract price to cover an increase in costs incurred as a result thereof. In the event that contracted services do not meet quality and/or safety expectations, the best remedy will be implemented, including but not limited to, a targeted and time limited performance improvement plan; increased monitoring of the contracted services; consultation or training for Contractor personnel to be provided by the VA; replacement of the contract personnel and/or renegotiation of the contract terms or termination of the contract. COR RESPONSIBILITIES: The COR shall be the VA official responsible for verifying contract compliance. After contract award, any incidents of Contractor noncompliance as evidenced by the monitoring procedures shall be forwarded immediately to the CO. The COR will be responsible for monitoring the Contractor s performance to ensure all specifications and requirements are fulfilled. The COR will maintain a record-keeping system of services by electronic and paper file. The COR will review this data monthly when invoices are received and certify all invoices for payment by comparing the hours documented on the VA record-keeping system and those on the invoices. Any evidence of the Contractor's non-compliance as evidenced by the monitoring procedures shall be forwarded immediately to the CO. The COR will review and certify monthly invoices for payment. If, in the event the Contractor fails to provide the services in this contract, payments will be adjusted to compensate the Government for the difference. All contract administration functions will be retained by the VA. ORIENTATION: Contractor Personnel shall be oriented to the VANCHCS, Sacramento VA Medical Center, prior to providing services. The Orientation will be properly documented and the VA COR will assess the competency of the Contractor Personnel. Onsite orientation will be provided on the first day of work. EMERGENCY HEALTH SERVICES: The VA will render emergency health services for an incapacitating injury or otherwise serious illness occurring while on duty at the VANCHCS. All services, to include wages earned during the period of initial medical evaluation provided by the VA, shall be reimbursed by the contractor. The contractor shall furnish the VA with the necessary injury/illness form(s) for reporting purposes. The VA for statistical and/or billing purposes will retain a copy of the completed form(s). SECURITY ISSUES AND ACCESS: General: The Sacramento VAMC is a federal government installation and therefore a personnel background check may need to be processed and sent to the CO prior to the contractor personnel reporting for work. All background checks will be performed by VA s Security Investigation Center (SIC). All personell assigned to this contract must have held a VA SAC security clearance within the past 36 months and will be required to obtain a new SAC (Non-PIV) security clearance within 10 days of date of contract award. Personal Identification Verification (PIV) Card: Upon completion of the background check, VANCHCS Human Resources will issue the contract employee with a PIV card, which will be required for local VA identification as well as access to the government computer systems. Each contract employee shall wear and display their assigned PIV card so that it is visible at all times, and in accordance with guidance provided by Human Resources. The badge will display the full name, title and if required by Human Resources, the words Contractor in front. Upon termination of their services under the contract Contractor/Contract employees shall turn in the PIV card to the COR or designated representative. The Contractor shall be responsible for the replacement cost of lost or non-returned PIV cards. The Contractor is responsible for absences of contract employees due to expired or lost PIV cards. Vehicle Decals: All contract employees must register their vehicles with the VA Police Office to gain access onto the VA Campus. A valid driver s license, government-furnished civilian ID, proof of insurance and current registration must be presented to the VA Police Office, at which time a VA decal will be issued. The decal shall be placed on the vehicle s front windshield in accordance with instructions provided by the VA Police. Upon termination of services under this contract, Contract employees shall follow VA procedures for removal and turn-in of the vehicle decal. Vehicles, with or without a VA decal, are subject to search while on VA property. PIV cards and VA parking decals will not be issued until the background checks are completed and approved by the SIC. Security: All contractors and contractor personnel shall be subject to the same federal security and privacy laws, regulations, standards and VA policies, including the Privacy Act, 5 U.S.C. 552a, and VA personnel, regarding information and information system security. Contractors shall follow policies and procedures outlined in VA Directive 6500, Information Security Program which is available at: http://www1.va.gov/vapubs and its handbooks to ensure appropriate security controls are in place. Confidentiality. Contractor personnel who obtain access to hardware, software or media, which may manipulate or store any sensitive information, that is protected under 38 USC 4132 or 3305, as defined by the VA, must not access information unless absolutely necessary to perform their contractual duties. Disclosure of any sensitive data obtained during performance of assigned duties under this contract is prohibited. Violation of these statutory provisions may involve imposition of criminal penalties. Contractor is considered to be a VA contractor for purposes of Privacy Act, Title 5 U.S.C. 552a. HIPAA. The Contractor shall abide by the Standards for Privacy of Individually Identifiable Health Information of the Health Insurance Portability and Accountability Act (HIPAA), Public Law 104-01. The Contractor shall not use or further disclose Protected Health...