1 Project Analysis

Practice/Operational Analysis, Economic Feasibility, Master Planning

One of the most important services we can offer our clients is to put their project on a firm foundation, one that is based on sound economics, efficient design, realistic construction costs, marketplace rents, and consistent with the current trends in healthcare.

This project analysis can be as brief as a one- or two-day consultation, to several weeks of in-depth study, and can include any or all of the following:

• Development of a facility master plan.

• Study of site advantages and disadvantages or studies of alternative sites.

• Detailed space programming and analysis.

• Determination of probable building size to meet the physician’s needs.

• Development of an economic pro forma detailing the total project cost, total project financing, annual costs of operation, monthly rent and or mortgage cost and monthly operating analysis.

• Study of alternative construction methods (bidding, negotiating, construction management, etc.).

• Study of alternative methods of finance (local bank, mortgage brokers, pension funds, etc.).

• Assistance in developing a multi-suite medical complex.

• Development of Tenant Information Brochure to attract physicians to the project.

• Review of ownership options.

• Development of preliminary Lenders’ Packages.

• Review of leases and deal terms.

• Preliminary evaluation of licensing requirements for outpatient surgical facilities.

• Evaluation of staff and administrative costs for yearly operation of various types of facilities.

• Marketing and Patient Geographic Analysis.

• Specific Problems Analysis (develop more storage, insufficient files, waiting room layout is poor, reception area is inefficient, etc.)

The result of this process is a very detailed report on all aspects under review.

2 Medical Planning

Some of our clients like to take advantage of our expertise in the design of medical facilities in a "Tenant Improvement" situation were we would provide all the required services or while working simultaneously with their local "general practice" architect or developer/contractor in the development of a new building.

For those, we offer our Space Planning service which includes the following:

• A visit to the physician’s office to observe the practice so that we can study the flow of both patients and paperwork, suggest changes where needed, and develop improved systems in the new facility.

• Project programming to determine space requirements for a new suite.

• Development of Functional Relationship Diagrams to express the operational requirements of the practice.

* • Preliminary design of the project; suite design as well as common space, and exterior building design if a total building space plan is desired.

• Detailed design of cabinets, electrical/telephone outlet placement, nurse call systems, ceilings, lighting, room finishes and door schedules.

• Outline and or performance specifications that include both specific materials and ancillary support systems (heating, air conditioning, ventilation, electrical and plumbing).

• Detailed recommendations regarding soundproofing, and interior finishes, such as carpet, wall covering, furniture, etc.

• Review of final working drawings when they are completed by the physician’s local general architect, if appropriate.

If this service MAY be performed in conjunction with a local architect, Raymond Fox & Associates will assist the client in selecting the local architect.

*Exterior design is best developed in conjunction with the interior space planning. We suggest this be considered in selecting which services best suit your project.

3 Architectural Services

Raymond Fox & Associates is licensed in several states and can easily add others as required. Additionally, Raymond Fox & Associates quite often "Joint Ventures" with local Architects to assist clients with their needs.

Most of our clients wish to utilize our Medical Expertise from initial programming through construction, for those we offer complete Architectural Services. Despite the availability of local architectural services, our clients usually require a much greater level of expertise in the Design, Contract Documentation and Construction management of their Medical Facility.

With a team of highly experienced Medical Architects, coupled with Engineers who have many years of Healthcare experience, we can provide a level of services unparalleled in the industry.

Our services in this area would include the following:

• Initial Feasibility Study

• Economic Analysis and assistance in the acquisition of financing

• Programming

• Initial Space Planning

• Complete Architectural Working Drawings

• Mechanical, Electrical, Plumbing, and other Engineering services which may be required.

• Permit Processing (planning, zoning, building department, etc.)

• Contractor interviewing and selection

• Bidding

•Construction Administration and Observation

4 Interior Design

For those Clients who are concerned with Patient Comfort, Aesthetics, Functional and durable surroundings, and a quality professional image, we offer complete Interior Design services which include the following:

• Consultation with client and staff to program specific needs and establish design criteria.

• Inventory of existing furnishings and equipment and suggestions on which of these components should be retained for continued use.

• Establish furnishings, accessories, and interior finishes budget.

• Provide complete interior finish selections for floorcoverings, wallcoverings, ceiling materials, paint colors and cabinetry finishes.

• Provide selections for window treatments, i.e. drapery, vertical or horizontal blinds, shades or shutters.

• Specify decorative lighting selections.

• Specify new furnishings and equipment, including artwork/graphics and accessories.

• Assist owner in color selections of medical equipment.

• Complete signage program, as required.

• Itemized costs of all of the above components.

• Designer will act as the owner’s agent in negotiating the designer’s cost for purchasing all furnishings.

• Designer will work closely with the selected contractor to insure competitive pricing of interior finishing materials such as floorcoverings, windowcoverings, and wallcoverings, if supplied by the contractor.

• Follow-up of orders and coordination of deliveries and installation of all components.

5 Lecture Services

"Education is the cornerstone of success in whichever field or endeavor one chooses"

Raymond Fox has been involved in educating the Healthcare Industry for the past twenty five years. Lecturing to various Medical Societies, Healthcare Symposiums, large and small Physician groups, Hospital staffs and Educational Institutions are but a few examples.

The following is a summary of some topics on which lecturing and teaching courses are provided:

1. Practice Review

2. Feasibility Studies

- Patient Flow

- Economic Proformas

- Nurse Management

- Preliminary Design Studies

- Special Needs

- Physician Productivity

3. Master Planning

4. Financing

- Site Studies

- Alternatives/Options

- Hospital Campus

- Construction Loans

- Office Expression

- Permanent Loans

- Small Business Administration (S.B.A.) Loans

5. Architectural Design

6. Lease Negotiating

- Space Planning o Base Rent

- Front Office o Terms

- Back Office o Utilities

- Ancillary/Support Areas o Options

- Exterior Building Design o Major Deal Points

- Site Planning

- Handicapped Access

- Medical Patient Accessibility

- Relationships to Other Facilities

- Architectural Design/Style

7. Outpatient Services

- Surgical Centers o Urgent Care Facilities

- MRI Units o Linear Accelerators

- C.T. Scanners o Radiology

Lectures can be custom tailored to meet virtually any of our clients' needs.

6 Additional Services

• Some of our larger physician and institutional client groups require very sophisticated Master Planning programs for both long- and short-term projection of space needs and budget requirements.

• Practice Management is an area in which we are able to assist many of our clients. Collection, patient marketing, and referral base, are just a few areas in which we can be helpful.

• We can assist developers with not only design services, but also in locating, identifying, and solidifying tenants, or “Tenant Marketing,” into a spec. office building. The ultimate success of a project is 100% occupancy.

• On occasion, a client may be required to use another firm for the design of his or her project. When this does occur, we can work as a consultant to the physician in order to perform a “Design Critique” to advise the client where changes in design or specifications may be required.

Other services may include:

o New Building Purchase Evaluation

- Verify existing as-built drawing if available

- Develop as-built drawings

- Evaluate existing building systems

o Mechanical, Electrical, Plumbing, etc.

- Code Compliance

o City, State, or Federal

o ADA and other handicapped code review

o Lease Negotiations

o Healthcare Real Estate Broker Services

o Medical Building Developer Services

o Relocation Services

1. Moving companies

2. Utility coordination

3. Telephone systems:

- Relocation of existing

- Analysis, selection and installation of new

4. Computer relocation:

- Cable installation

5. Graphics and printing services:

- Corporate identity

- Announcements

- Letterhead and business cards

6. Vendor coordination

7. Music systems

o Governmental Agency Review and Processing:

1. Local building permits:

- County health department approvals

- Hazardous materials and medical waste permits

- Variances

- Conditional use permits

2. State permits and review:

- OSHPD (Office of Statewide Health Planning and Development)

- OSA (Office of the State Architect)

- S.F.M. (State Fire Marshall)

- Dept. of Licensure and Certification

Many other services are available through Raymond Fox & Associates, including variations of the previously described services.