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									                          LABORATORY SERVICES AGREEMENT

This Laboratory Services Agreement (Agreement) made this 1st, day of July 2005, by and between
ADMINISTRATORS (hereinafter called "AIA") and UNILAB CORPORATION, d/b/a Quest
Diagnostics, a for-profit corporation, (hereinafter called "LABORATORY") with reference to the
following facts:

WHEREAS, the LABORATORY is engaged in the business of providing reference clinical
laboratory services and pursuant to the terms set forth herein, desires to provide clinical laboratory
services to eligible members of the County of Orange Health Care Agency’s Medical Services for
Indigents Program; and

WHEREAS, AIA is a fiscal intermediary for certain administrative services pertaining to hospitals,
physicians and clinics, and is contracted with the County of Orange Health Care Agency
(COUNTY) for the purpose of acting as fiscal intermediary as it relates to the County’s Medical
Services for the Indigents (MSI) Program; and,

WHEREAS, COUNTY desires to provide outpatient reference clinical laboratory services to the
MSI Program; and,

WHEREAS, AIA and LABORATORY desire to enter into an arrangement whereby
LABORATORY will provide outpatient reference clinical laboratory services as specified herein
for MSI Eligibles related to the Agreement between the COUNTY and AIA for the provision of
Fiscal Intermediary Services for the Medical Services for Indigents Program (MSI Agreement);

WHEREAS, AIA and LABORATORY agree to the definitions as stated in Paragraph I of
Exhibit B of the MSI Agreement as they pertain to the following terms: “MSI,” “MSI
Eligible(s),” “Eligible Persons,” “Case Management Unit (CMU)” and “MSI Program.”

NOW THERFORE, AIA and LABORATORY agree as follows:

   1.   TERM

        The initial term of the Agreement shall commence July 1, 2005 and terminate June 30,
        2006. The Agreement shall be automatically renewed each July 1 for a twelve (12) month
        period upon renewal of the MSI Agreement with AIA and concurrence of the County of
        Orange Health Care Agency. In the event that the MSI Agreement is not renewed with
        AIA, AIA shall provide thirty (30) days written notice to LABORATORY of said non-
        renewal and the subsequent non-renewal of this Agreement.


        2.1    Either party may terminate this Agreement without cause and without payment of
        termination fee or penalty, upon sixty (60) days written notice provide to the other party.

  2.2    Any obligation of AIA under this Agreement is contingent upon the continued
  availability of County funds included in the applicable budget approved by the Orange
  County Board of Supervisors for reimbursement of AIA’s expenditures. In the event that
  such funding is subsequently reduced or terminated, AIA may terminate or renegotiate
  this Agreement upon thirty (30) days prior written notice to LABORATORY.

  2.3      AIA has the right to terminate this Agreement immediately, without payment of
  termination fee or penalty, in the event of LABORATORY’S (i) gross negligence, (ii)
  willful misconduct, (iii) conviction of crimes involving moral turpitude or illegal acts,
  (iv) filing by or against LABORATORY of a petition in bankruptcy or in equity for
  receivership or for reorganization under the United States Bankruptcy Code, as now or
  hereafter amended, and/or (v) a material breach of any of its obligations under this
  Agreement which breach is not cured within thirty (30) days after receipt of written
  notice of such alleged breach.

  2.4     LABORATORY has the right to terminate this Agreement, without payment of
  termination fee or penalty, in the event of AIA’s (i) gross negligence, (ii) willful
  misconduct, (iii) conviction of crimes involving moral turpitude or illegal acts, (iv) filing
  by or against AIA of a petition in bankruptcy or in equity for receivership or for
  reorganization under the United States Bankruptcy Code, as now or hereafter amended,
  and/or (v) a material breach of any of AIA obligations under this Agreement which
  breach is not cured within thirty (30) days after receipt of written notice of such alleged


  In the event the Agreement terminates for reasons beyond the control of LABORATORY
  or AIA as a result of acts by third parties such as courts of competent jurisdiction and/or
  the County of Orange, then neither party shall have any further obligation hereunder.


  In the event the Agreement is terminated, for any reason, LABORATORY will (a)
  discontinue processing claims and existing accounts receivable as of the termination date;
  (b) deliver to AIA a final list of accounts receivable and original records within ten (10)
  business days after receiving full payment of all Fees owed up to the termination date; (c)
  have no further obligation to AIA with respect to the services or other obligations created
  by this Agreement as of the termination date; provided, however LABORATORY shall
  be obligated to perform such duties as would normally extend beyond the termination
  date, including but not limited to, obligations with respect to confidentiality,
  indemnification, audits, reporting, and accounting. LABORATORY agrees to provide
  AIA with transitional services after the date of termination on a time and materials basis
  as determined and agreed to by the parties in writing. Termination shall not relieve,
  release or discharge either party hereto from any obligation, debt or liability which may
  have accrued prior to the termination of this Agreement, and which remains to be
  performed upon the date of the termination, including but not limited to the obligation of
  LABORATORY to provide the specified services to AIA and the obligation of AIA to
  provide compensation to LABORATORY for Services relating to accounts receivable of

     AIA. In particular, in the event the Agreement is terminated for any reason, AIA will pay
     LABORATORY at the termination date or as soon thereafter as reasonably possible all
     outstanding Fees for services performed by LABORATORY of the outstanding accounts
     receivable through and including the termination date that have not already been retained
     by LABORATORY in accordance with this Agreement.


     5.1      LABORATORY agrees to perform only outpatient reference clinical laboratory
     testing services for MSI Program as are ordered by MSI or a non-hospital based MSI
     Provider or MSI Provider not specified in Section 5.2 below, during the Term of this
     Agreement for members eligible to receive benefits through this Agreement. Such services
     shall only include those tests listed in LABORATORY’S then current Directory of Services
     as the same may be modified from time to time and performed directly or indirectly by
     LABORATORY, and such additional services as the parties may agree.

     5.2      Testing services requested by a Dialysis Facility, Long Term Care Facility, Skilled
     Nursing Facility, Board and Care Facility, Tertiary Care Unit (TCU), Hospital Emergency
     Room, Hospital In-Patient Care Center, Mental Health Care Facility, Health Fairs or Out-
     Patient Surgery Center for MSI Eligibles will not be covered under this agreement.

     5.3      LABORATORY shall not be reimbursed by AIA for tests that are referred to
     another laboratory at the request of the ordering physician. For all other tests that are
     performed or arranged to be performed pursuant to this Agreement, LABORATORY will
     accept the compensation terms of this Agreement


     6.1.     Specimen Pick Up and Report Delivery - LABORATORY will provide a
     reference specimen pick up and report delivery service (hard copy, fax) to MSI Provider on
     an as needed basis Monday through Friday of each week. Results of a routine nature
     (general routine chemistries) will, in most cases, be delivered or transmitted back to the MSI
     Provider within forty-eight (48) hours of the time the specimen is submitted to the
     LABORATORY. Results of these tests performed on specimens of a special nature (special
     chemistries, tissues, etc.) will, in most cases, be delivered or transmitted back to the MSI
     Provider within a time frame based upon the testing procedure performed. Any electronic
     delivery of test reports will require the parties to execute a separate agreement or

     6.2.    Supplies - LABORATORY will provide, at no additional charge, routine supplies
     necessary for the collection, preparation and preservation of specimens to be submitted to
     LABORATORY for testing pursuant to this Agreement and to the extent the provision of
     such supplies does not conflict with fraud and abuse regulations or statutes.

     6.3.    Consultation - LABORATORY staff shall be available to consult with MSI
     Provider by telephone during normal LABORATORY working hours to discuss
     LABORATORY’S procedures and to explain test results.

      6.4.      Venipuncture - Blood drawing services, provided at LABORATORY’s Patient
      Service Centers, will be limited to "venous" venipunctures, i.e., excludes Heparin locks,
      arterial blood draws or any other blood collection method that cannot be collected by a
      certified phlebotomist. House calls to members are not included in this Agreement.

      6.5.      STAT Testing - STAT testing services are limited to the STAT Testing Menu that
      is in effect at the time of service (Exhibit A). Turn around time for STAT Testing is four (4)
      hours from time of specimen pick up from provider office (or patient service center).

 7.   FEES

      7.1.   Payment to LABORATORY for laboratory testing services shall be calculated at
      100% of the prevailing Medi-Cal Reimbursement Rates.

      7.2.     AIA shall pay claims submitted by LABORATORY based on such rate within
      thirty (30) days from the submission of a claim.

      7.3.     LABORATORY is not subject to Final Settlement procedures as stipulated in
      the current MSI Fiscal Intermediary agreement.

 8.   No Recourse Against Members

      LABORATORY agrees for eligible covered members of MSI Program properly identified
      to LABORATORY as MSI Eligibles, that it shall not bill, charge, collect a deposit from,
      seek compensation, remuneration or reimbursement from, or have any recourse against
      members of the MSI Program for services provided to such members pursuant to this
      Agreement, except for applicable co-payments, co-insurance, non-covered benefits, out of
      network utilization, coordination of benefits, TPL, workers compensation or retroactively
      disenrolled patients.


      9.1.     AIA shall provide LABORATORY an accurate list of MSI Program Physicians on
      a quarterly basis. Additions and/or deletions of MSI Program Physicians will be provided to
      LABORATORY within 24 hours of receipt from the COUNTY.

      9.2.     AIA will provide, on a daily basis, a list of MSI Eligibles (including their address
      and/or insurance billing information) who have been retroactively disenrolled from the MSI


      10.1. All Testing Services must be ordered through LABORATORY by registered MSI
      Providers on members eligible to receive services pursuant to this Agreement. These
      services shall be reimbursed to LABORATORY as defined in Section 7.1.

      10.2. Charges for laboratory work referred directly from an MSI Provider to a non-
      Unilab laboratory will not be covered under this Agreement. LABORATORY is not
      responsible for those charges.

      10.3. MSI Eligibles who utilize a non-registered provider and whose specimens are
      referred to LABORATORY will not be covered under this Agreement and will be billed
      “Fee-for-Service” as an “Out-of-Network” encounter.

      10.4. All laboratory testing that is not covered under the MSI Program, or laboratory
      testing for diagnoses that are not covered in the MSI Program as referenced in Exhibit B to
      this agreement, will be excluded from this Agreement and reimbursement for those services
      will be the patient's responsibility; provided, however, that if patient appeal for payment of
      said tests results in the MSI Medical Review Committee’s approval of said tests, then
      reimbursement will be at 70% of RBRVS, or 75% of the LABORATORY’S patient fee
      schedule rate, whichever is less.

      10.5. If Agreement between AIA and LABORATORY terminates, and LABORATORY
      receives any post termination laboratory requests, LABORATORY will bill AIA directly,
      unless a post termination fee-for-service rate schedule is negotiated.

      10.6. Invoices for the reimbursement of services described in Sections 5 and 6 above
      shall be sent, at least monthly, to AIA at the following address:

               American Insurance Administrators
               P.O. Box 6285
               Orange, CA 92863-6285

      10.7.     LABORATORY agrees to follow the established billing guidelines as set forth
      in the current MSI Fiscal Intermediary Agreement.


      Testing performed hereunder shall be performed at the LABORATORY’S testing facility
      located in Tarzana, California. The facility is and shall remain a duly licensed clinical
      laboratory under applicable federal, state and municipal law.

      The terms of this Agreement are intended to be in compliance with all federal, state and
      local statutes, regulations and ordinances applicable on the date the Agreement takes effect.
      Should legal counsel for either party reasonably conclude that any portion of this Agreement
      is or may be in violation of such requirements, or subsequent enactments by federal, state or
      local authorities, or if any such change materially alters the amount or method of
      compensating LABORATORY for testing performed for MSI Program or for any other
      party, or materially increases the cost of LABORATORY’s performance hereunder, this
      Agreement shall terminate upon THIRTY (30) day notice thereof to the other party, unless
      within said THIRTY (30) day period the parties agree to such modifications of the
      Agreement as may be necessary to establish compliance with such authorities or to reflect
      such change in compensation or cost.


      This Agreement shall not be assigned, delegated, or transferred by either party without the
      written consent of the other party. Notwithstanding the foregoing, LABORATORY may
      refer work to an affiliated testing facility without prior written consent and may also
      subcontract other work to the extent it is unable to perform work at it’s own facilities.


      Any notice required to be given pursuant to the terms and provisions hereof shall be in
      writing and shall be sent by certified or registered mail to LABORATORY at:
              UNILAB CORPORATION, d/b/a Quest Diagnostics
              18408 Oxnard Street
              Tarzana, California 91356
              Attn: Contracts Department
      To AIA at:
             3415 South Sepulveda Blvd.
             Suite 200
             Los Angeles, CA 90034
             Attn: Joanne Hoskins
      And to the County of Orange :
             COUNTY OF ORANGE
             Health Care Agency/MSI Program
             405 W. 5th Street
             Suite 681
             Santa Ana, CA 92701
             Attn: Dan Davis, MSI Program Manager
             COUNTY OF ORANGE
             HCA/Strategic Projects Administration
             405 W. 5th Street, 7th Floor
             Santa Ana, CA 92701
             Attn: Melissa Tober, Manager


      LABORATORY is, and shall at all times be deemed to be, an independent contractor and
      shall be wholly responsible for the manner in which it performs the services required of it
      by the terms of this Agreement.          LABORATORY is entirely responsible for
      compensating staff, subcontractors, and consultants employed by LABORATORY. This
      Agreement shall not be construed as creating the relationship of employer and employee,
      or principal and agent, between AIA and LABORATORY or any of LABORATORY’S
      employees, agents, consultants, or subcontractors. LABORATORY and AIA assume
      exclusively the responsibility for the acts of their respective employees, agents,
      consultants, or subcontractors as they relate to the services to be provided during the

      course and scope of their employment. LABORATORY, its agents, employees,
      consultants, or subcontractors, shall not be entitled to any rights or privileges of AIA
      employees and shall not be considered in any manner to be AIA employees and AIA, its
      agents, employees, consultants or subcontracts, shall not be considered in any manner to
      be LABORATORY employees.


      LABORATORY shall not be liable for any claims or damages if such claims or damages
      result or arise out of a failure or delay that is due to any act beyond the control of the


      LABORATORY warrants to AIA and COUNTY that all services provided hereunder shall
      be performed in accordance with established and recognized clinical laboratory testing
      procedures and with reasonable care in accordance with applicable federal, state, and local
      laws. No other warranties are made by laboratory. In no event shall laboratory be
      responsible for any consequential or special damages of AIA, COUNTY or of any third


      This Agreement is intended to inure only to the benefit of the LABORATORY and AIA.
      This Agreement is not intended to create, nor shall be deemed or construed to create, any
      rights in any third parties, including covered members.


      All services provided by LABORATORY hereunder shall be in compliance with all
      applicable federal and state laws prohibiting discrimination on the basis of race, color,
      religion, sex, national origin, handicap or veteran status.


      20.1     LABORATORY shall indemnify, defend, protect and hold harmless AIA and its
      respective officers, directors, agents, employees and representatives from and against any
      and all actual or threatened loss, liability, claim, damages, judgment, cost or expense,
      including actual attorney’s fees that may be incurred by AIA, or its respective officers,
      directors, agents, employees and representatives which arises out of or in any manner
      relates to the injury or damage to person or property that is caused by the gross
      negligence, willful misconduct, or intentional acts or omissions of LABORATORY or its
      employees, agents or legal representatives, or the failure by LABORATORY or its
      employees, agents or legal representatives to perform or satisfy the obligations and
      covenants of this Agreement.

       20.2 AIA shall indemnify, defend, protect and hold harmless LABORATORY and its
       officers, directors, agents, employees and representatives from and against any and all
       actual or threatened loss, liability, claim, damages, judgment, cost or expense, including
       actual attorney’s fees that may be incurred by LABORATORY or its officers, directors,
       agents, employees and representatives which arises out of or in any manner relates to the
       injury or damage to person or property that is caused by the gross negligence, willful
       misconduct, or intentional acts or omissions of AIA and their respective officers,
       directors, agents, employees, and representatives (other than LABORATORY), or the
       failure by AIA and their respective officers, directors, agents, employees, or legal
       representatives (other than LABORATORY) to perform or satisfy the obligations and
       covenants of this Agreement, including any liability resulting from claims submitted by


       The headings appearing in this Agreement are for convenience and reference only, and are
       not intended to, and shall not, define or limit the scope of the provisions to which they


       The invalidity or unenforceability of any terms or provisions hereto in any jurisdiction shall
       in no way affect the validity or enforceability of any of the other terms or provisions in that
       jurisdiction, or of the entire Agreement in any other jurisdiction.


       This instrument is intended by the parties as a final expression of their agreement and as a
       complete statement of the terms thereof, and shall supersede all previous understandings and
       agreements. The parties shall not be bound by any representation, promise or inducement
       made by either party or agent of either party that is not set forth in this Agreement.


       24.1 COUNTY has established an Office of Compliance and associated Compliance
       Program for the purposes of ensuring adherence to all rules and regulations related to the
       provision of services and expenditure of funds in Federal and State health care programs.
       The parties agree that LABORATORY has its own Compliance Program and that
       compliance with such a program satisfies the obligation to comply with the Compliance
       Program adopted by the Office of Compliance.

       24.2 LABORATORY shall comply with the United States Department of Health and
       Human Services, Office of Inspector General (OIG) requirements related to eligibility
       for participation in Federal and State health care programs.

24.3 LABORATORY and AIA shall review all organization, employees,
subcontractor agents and physicians for eligibility against General Services
Administration and OIG Parties Excluded from Federal Programs Lists and Cumulative
Sanction Lists respectively to ensure that Ineligible Persons are not employed or retained
to provide services related to this Agreement. Ineligible Persons may include both
entities and individuals and are defined as any individual or entity who:
       a.      Is currently excluded, suspended, debarred or otherwise ineligible to
       participate in the Federal or State health care programs; or

       b.      Has been convicted of a criminal offense related to the provision of
       health care items or services and has not been reinstated in the Federal or State
       health care programs after a period of exclusion, suspension, debarment, or
24.4 LABORATORY and AIA both acknowledge that Ineligible Persons, as defined
in Section 24.3.a and 24.3.b., shall be excluded from providing Federally and State
funded health care services covered by this Agreement.

precaution to ensure that the coding of health care claims and billing for same are
prepared and submitted in an accurate and timely manner and are consistent with Federal
and State, laws and regulations. This shall include compliance with Federal and State
health care program regulations and procedures or instructions otherwise communicated
by regulatory agencies including, but not limited to, the Centers for Medicare and
Medicaid Services or their agents.
       a.     LABORATORY shall not intentionally submit false, fraudulent,
       inaccurate or fictitious claims for payment or reimbursement of any kind.
       b.      LABORATORY shall bill only for those eligible services actually
       rendered. When such services are coded, LABORATORY shall use its best
       efforts to use correct billing codes that accurately describe the services provided.
       AIA acknowledges that LABORATORY is entitled to rely on the billing codes
       submitted by MSI participating physicians.

       c.      LABORATORY shall act promptly to investigate and correct any
       problems or errors in coding of claims or billing, if and when, any such problems
       or errors are identified.

24.6 COMPLIANCE TRAINING - ADMINISTRATOR shall provide annually, and
LABORATORY’S designated representative shall complete, Compliance Training when

24.7 In accordance with the Termination Paragraph of this Agreement, AIA may
terminate this Agreement upon fifteen (15) days written notice if LABORATORY fails
to perform any of the terms of this Compliance Paragraph. At the MSI Program’s sole
discretion, LABORATORY may be allowed up to thirty (30) days for corrective action.


      This Agreement may not be modified except, in writing, signed by authorized
      representatives of both parties.


      26.1 All information or data relating to the business or operations of any party to this
      Agreement acquired by any other party hereto in connection with this Agreement shall be
      treated as confidential by the acquiring party, and shall not, unless otherwise required by
      law or the requirements of any accrediting agency, be disclosed by the acquiring party
      without the prior written permission of the party hereto to whom the information in
      question relates. This provision shall survive termination of this Agreement.

      26.2 MSI and AIA acknowledge(s) that “QUEST”, “QUEST DIAGNOSTICS”, the
      associated logo, and all other marks displayed on websites owned by Quest Diagnostics
      Incorporated (“Quest Diagnostics”) are the trademarks and/or tradenames (“marks”) of
      Quest Diagnostics except as otherwise expressly indicated.             Quest Diagnostics
      acknowledges that the following marks belong to AIA:”AIA.”Any use of these marks in
      any manner, including as domain names, metatags, or identifiers of the source of any
      goods or services, is strictly prohibited unless the party using such marks has received
      prior express written consent of an authorized officer of the mark - owning party, which
      consent such owning party may withhold in its sole discretion. MSI is authorized to
      identify Quest Diagnostics by its company name “Quest Diagnostics Incorporated” and
      its facility addresses, in Participating Provider listings in MSI Program marketing
      materials. MSI shall hold Quest Diagnostics harmless from claims by Members arising
      from information in MSI’s listings. Quest Diagnostics shall have the right to designate
      and make oral or published reference to its status as a contracting laboratory. The entire
      content displayed on a party’s websites is the copyrighted property of such party except
      as otherwise expressly indicated. With the exception of limited downloading and
      copying rights which may be expressly posted by such owning party on its websites, and
      which may be amended in such party’s sole discretion, no rights are granted to the other
      party to reproduce, download, store, transmit or modify the content of such websites in
      any manner, to link to the home page, to “deeplink” to any content, or frame any portion
      of the websites.

      26.3 MSI shall list LABORATORY as a participating provider in its directory of MSI
      Program participating providers. LABORATORY consents to the accurate listing of its
      name, addresses, and telephone numbers in directories produced by MSI Program. In the
      event the listing information is or becomes inaccurate or incomplete, MSI shall correct
      such listing information. MSI shall hold harmless LABORATORY from claims by
      Members arising from information in MSI Program directory. LABORATORY shall
      have the right to designate and make oral or published reference to its status as a
      contracting laboratory. This provision shall survive the termination of this Agreement.

      26.4 Each of the parties represents and warrants to the other party that it will comply with
      all applicable laws, rules and regulations ("Applicable Laws"), including, but not limited to,
      the Health Insurance Portability and Accountability Act (“HIPAA”) privacy regulations, the
      HIPAA standard transactions and security regulations (as of the effective dates of those
      regulations). Failure by either party to comply with any applicable law shall be considered a
      material breach of this Agreement. Each party agrees that, upon request of the other party, it
      shall provide written verification of compliance with all applicable laws and confirm its full
      licensure and certification to the extent appropriate to its then current operations.


      Either party may amend this Agreement at any time by written notice to the other party of
      the proposed amendments hereto. The other party shall have thirty (30) days from the date
      of receipt of such notice, sixty (60) days for all financial amendments, to reject the proposed
      amendments in writing. If the party proposing the amendment does not receive such notice
      of rejection within that thirty (30) to sixty (60) day period, such proposed amendments shall
      be deemed accepted by and shall be binding upon the other party from and after the end of
      that thirty (30) or sixty (60) day period. If the other party so rejects any proposed
      amendment, the party proposing the amendment may terminate the Agreement effective
      within sixty (60) days of the written notification of rejection of the amendment.


      This Agreement shall be effective July 1, 2005 and only after it is signed by an authorized
      officer of LABORATORY.

IN WITNESS WHEREOF, the parties have caused this Agreement to be executed in their names as
their official acts by their respective officers, each of who is duly authorized to execute the same.

d/b/a Quest Diagnostics (“LABORATORY”)                a.k.a.  AMERICAN       INSURANCE
                                                      ADMINISTRATORS (“AIA”)

By: __________________________________                By: ______________________

   ___________________________________                      _______________________________
   (Title)                                                  (Title)

   ___________________________________                      _______________________________
  (Date Accepted by LABORATORY)                             (Date Accepted by Client)


HCA/Medical Services for Indigents Program            HCA/Strategic Projects Administration

By: ____________________________                      By:      ________________________

    ____________________________                               ________________________
    (Title)                                                    (Title)

                                      EXHIBIT A

                               STAT TESTING MENU

               Orange Rapid Response                  Newport Beach Rapid Response
                    Laboratory                                 Laboratory

           1201 W. La Veta Ave., Suite 601              1401 Avocado Ave., Suite 103
                   Orange, CA 92868                       Newport Beach, CA 92660
                Phone: (714) 288-4141                      Phone: (949) 729-1755;
                  Fax: (714) 288-4135                       Fax: (949) 640-1351
Hours: Monday - Friday 8:00 AM - 9:00 PM          Hours: Monday - Friday 8:00 AM - 7:00 PM
             Saturday: 9:00 AM - 5:00 PM

          Albumin                                 LDH, Total
          Alkaline Phosphatase                    Liver Panel
          Amylase                                 Magnesium
          Basic Metabolic Panel                   Mono Screen
          Beta HCG, Qualitative (Serum)           Phosphorus
          Beta HCG, Qualitative (Urine)           Potassium
          Beta HCG, Quantitative                  Protein, Total
          Bilirubin, Direct                       PT (Prothrombin Time)
          Bilirubin, Total                        PTT (Partial Thromboplastin Time)
          Bilirubin (Total) - Pediatric           Rapid Strep Screen
          BUN                                     Sedimentation Rate (ESR)
          Calcium                                 Semen Analysis, Complete
          Carbamazepine (Tegretol)                SGOT (AST)
          CBC                                     SGPT (ALT)
          Chloride                                PTT (Partial Thromboplastin Time)
          CO2                                     Rapid Strep Screen
          Comprehensive Metabolic Panel           Sedimentation Rate (ESR)
          CPK, Total                              Semen Analysis, Complete
          Creatinine                              SGOT (AST)
          Digoxin (Lanoxin)                       SGPT (ALT)
          Dilantin (Phenytoin)                    Sodium
          Electrolytes (Na, K, Chloride, CO2)              Uric Acid
          Estradiol                                        Urinalysis
          GGTP                                    Valproic Acid (Depakene)
          Glucose                                 Vancomycin
          Hemoglobin / Hematocrit

                                      EXHIBIT B

                 Medial Services for Indigents (MSI ) program
                      Non-Covered Laboratory Services

MSI is a medical safety-net program for adult indigents. Services are considered for
reimbursement if the medical service is required for immediate treatment of life
threatening and emergent conditions, treatment of acute exacerbation of chronic
conditions that are potentially life threatening, monitoring of chronic conditions that are
potentially life threatening or conditions that if not monitored, may result in significant
and permanent impairment in health status and or function.

The following laboratory services do not meet the purpose of the MSI program:

   •   Tests related to investigational treatments.

   •   Tests for routine physicals.

   •   Fertility, paternity and pregnancy tests.

   •   FSH, LH, and Estrogen levels to determine status of menopause.

   •   Screening PAP smear - PAP smear may be covered if diagnostic, i.e., suspicion
       of malignancy.

   •   Screening PSA Level - PSA test may be covered if diagnostic, i.e., suspicion of
       prostate malignancy.

   •   Routine lipid panel - Lipid panel may be covered (annually) if diagnosis of
       cardiovascular disease, hypertension, renal disease or diabetes is documented.

   •   Routine HIV Test - HIV test may be covered if symptomatology is documented.

   •   Genetic typing to determine risk factors for disease – Genetic typing may be
       covered if disease is present and typing necessary to confirm disease and/or
       determine treatment.

   •   Mental health related tests including blood levels for psychotropic medications.

   •   Preoperative tests for surgical procedures not covered under the MSI program.
       Refer to the MSI Provider Manual for more information about covered and
       non-covered surgical procedures.

   •   Tests not related to documented diagnoses.

   •   Laboratory service claims sent to the MSI program with “V” Codes.


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