3c_CIM 6000.1F Medical Manual.pdf

Note: 13 September 2022.

Re: The Coast Guard Medical Manual, COMDTINST M6000.1 (series)

Due to indexing changes, this Commandant Instruction will be cancelled and removed from the Directives library and replaced with a new version in the very near future IAW Publication of Directives:

Commandant Instruction (CI), ALCOAST and ALCOAST Commandant Notices (ACN), COMDTINST 5215.6I (April 2022).

New Commandant Instructions containing medical content will include (final publication titles may vary slightly):

Dental Policy and Operations, COMDTINST 6000.2 Physical Standards and Examinations for Accession and Retention, COMDTINST 6000.3 Health Record Management, COMDTINST 6000.4 Behavioral Health, COMDTINST 6000.5 Medical Readiness and Deployment Health, COMDTINST 6000.6 Preventative Medicine and Population Health, COMDTINST 6000.7 HIPAA Privacy Rule Compliance in Coast Guard Medical Programs, COMDTINST 6000.8 Health Information Systems, COMDTINST 6000.9 Pharmacy Policy and Operations, COMDTINST 6000.10

The remaining core content of the Medical Manual, COMDTINST 6000.1 (series) will include:

Chapter 1. Organization and Personnel Chapter 2. Health Care and Facilities Chapter 3. Fiscal and Supply Management Chapter 4. Heath Services Technician Assigned to Independent Duty Chapter 5. Health Care Procurement Chapter 6. Quality Improvement

Department of Homeland Security United States Coast Guard

COAST GUARD MEDICAL MANUAL

COMDTINST M6000.1F

JUNE 2018

DISTRIBUTION – SDL No. 168

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COMDTCHANGENOTE 6000

05 JUNE 2018

COMMANDANT CHANGE NOTICE 6000

Subj: CH-2 TO THE COAST GUARD MEDICAL MANUAL M6000.1F

1. PURPOSE. This Commandant Change Notice publishes revisions to the Coast Guard

Medical Manual, COMDTINST M6000.1F. This Notice is applicable to all active duty and reserve Coast Guard members and the other Services Members assigned to duty with the Coast Guard.

2. ACTION. All Coast Guard unit commanders, commanding officers, officers-in-charge, deputy/assistant commanders, and chief of headquarters staff elements shall comply with the provisions of this Notice and Manual. Internet release is authorized.

3. DIRECTIVES AFFECTED. With the addition of this Commandant Change Notice, the

Coast Guard Medical Manual, COMDTINST M6000.1F is updated.

4. DISCLAIMER. This guidance is not a substitute for applicable legal requirements, nor is it itself a rule. It is intended to provide operational guidance of Coast Guard personnel and is not intended to nor does it impose legally-binding requirements on any party outside the Coast Guard.

5. MAJOR CHANGES. Major changes of this Notice are summarized below:

a. Chapter 2 Section E. Requires medical clearance per the Coast Guard

Occupational Medicine Manual, COMDTINST M6260.32 (series) for federally employed civilians, non-federally employed civilians, and United States Public

Health Service officers not assigned to the Coast Guard for boat crew job assignments if they will be berthing (whether at sea or in port) on a Coast Guard cutter.

Commandant US Coast Guard Stop 7907 United States Coast Guard 2703 Martin Luther King Jr. Ave

SE Washington, DC 20593-7907 Staff Symbol: CG-11 Phone: (202) 475-5173

b. Chapter 4 Section B. Changes include:

(1) Deleted the following forms from the Health Record Forms List: History and

Report of OMSEP Examination, Form CG-5447; Periodic History and Report of OMSEP Examination, Form CG-5447A; Bloodborne Pathogens Exposure

Guidelines, Form CG-6201; Examination Protocol for Exposure to:

Chromium Compounds, Form CG-6202; Examination Protocol for Exposure to: Asbestos, Form CG-6203; Examination Protocol for Exposure to:

Benzene, Form CG-6204; Examination Protocol for Exposure to: Noise, Form CG-6205; Examination Protocol for Exposure to: Hazardous Waste, Form CG-6206; Examination Protocol for Exposure to: Lead, Form CG-

6207; Examination Protocol for Exposure to: Respirator Wear, Form CG-

6208; Examination Protocol for Exposure to: Pesticides, Form CG-6209;

Examination Protocol for Exposure to: Respiratory Sensitizers, Form CG-

6210; Examination Protocol for Exposure to: Bloodborne Pathogens, Form

CG-6211; Examination Protocol for Exposure to: Tuberculosis, Form CG-

6212; Examination Protocol for Exposure to: Solvents, Form CG-6213;

Examination Protocol for Exposure to: Radiation, Form CG-6214; How to

Calculate a Significant Threshold Shift, Form CG- 6215; and Record of

Occupational Exposure to Ionizing Radiation, Form DD-1141.

(2) Added the following forms to the Health Record Forms List: Acute Exposure

Information Form, Form CG-6000-1; Written Opinion, Form CG-6010B;

Summary Report, Form CG-6010C; Occupational Medical History and

Examination, Form CG-6010E; Respiratory Sensitizer Questionnaire, Form

CG-6010H; Asbestos Exposure, Part I – Initial Medical Questionnaire, Form

DD-2493-1; and Asbestos Exposure, Part II – Periodic Medical

Questionnaire, Form DD-2493-2.

c. Chapter 4 Section E. Changes include:

(1) Deleted the following forms from the Contents of the Employee Medical

Folder, SF-66D: History and Report of OMSEP Examination, Form CG-

5447; Record of Occupational Exposure to Ionizing Radiation, Form DD-

1141; Report of Medical History, Form DD-2807-1 and Report of Medical

Examination, Form DD-2808.

(2) Added the following forms to the Contents of the Employee Medical

Folder, SF-66D: Acute Exposure Information, Form CG-6000-1; Written

Opinion, Form CG-6010B; Summary Report, Form CG-6010C; Civilian

Medical Clearance, Form CG-6010D; Occupational Medical History and

Examination, Form CG-6010E; Respirator Questionnaire, Form CG-

6010F; Respirator Clearance Request, Form CG-6010G; Respiratory

Sensitizer Questionnaire, Form CG-6010H; Guest Crew Member Health

Questionnaire, Form CG-6010J; Reference Audiogram, Form DD-2215;

Hearing Conservation Data, Form DD-2216; Asbestos Exposure Part I –

Initial Medical Questionnaire, Form DD-2493-1; and Asbestos Exposure

Part II – Periodic Medical Questionnaire, Form DD-2493-2.

d. Chapter 12. Removed contents of this chapter and referred reader to the Coast

Guard Occupational Medicine Manual, COMDTINST M6260.32 (series).

e. Chapter 14 Section C. Occupational Medical Surveillance and Evaluation

Program (OMSEP) examination dates will be entered into the Medical Readiness

Reporting System (MRRS) database.

6. ENVIRONMENTAL ASPECT AND IMPACT CONSIDERATIONS.

a. The development of this Manual and the general policies contained within it have been thoroughly reviewed by the originating office in conjunction with the Office of Environmental Management, Commandant (CG-47). This

Manual is categorically excluded under current Department of Homeland

Security (DHS) categorical exclusion (CATEX) A3 from further environmental analysis in accordance with "Implementation of the National

Environmental Policy Act (NEPA), DHS Instruction Manual 023-01-001-01

(series).

b. This Manual will not have any of the following: significant cumulative impacts on the human environment; substantial controversy or substantial change to existing environmental conditions; or inconsistencies with any Federal, State, or local laws or administrative determinations relating to the environment. All future specific actions resulting from the general policy in this Manual must be individually evaluated for compliance with the National Environmental Policy

Act (NEPA), Department of Homeland Security (DHS) and Coast Guard NEPA policy, and compliance with all other applicable environmental mandates.

7. DISTRIBUTION. No paper distribution will be made of this Commandant Change

Notice. An electronic version will be located on the following Commandant (CG-612) websites. Internet: http://www.dcms.uscg.mil/directives, and CGPortal:

https://cgportal2.uscg.mil/library/directives/SitePages/Home.aspx

8. PROCEDURE. If maintaining a paper copy, please remove and insert the following pages:

Remove Replace

Contents 3-4 Contents 3-4 CH-2

Contents 7-10 Contents 7-10 CH-2

Contents 15-22 Contents 15-21 CH-2

Chapter 2 Contents Chapter 2 Contents CH-2

Chapter 2 Section E Pg 3-4 Chapter 2 Section E Pg 3-4 CH-2

Chapter 4 Contents Chapter 4 Contents CH-2

Chapter 4 Section A Pg 1-14 Chapter 4 Section A Pg 1-14 CH-2

Chapter 4 Section B Pg 15-36 Chapter 4 Section B Pg 15-28 CH-2

Chapter 4 Section E Pg 1-5 Chapter 4 Section E Pg 1-5 CH-2 http://www.dcms.uscg.mil/directives

Chapter 12 Chapter 12 Pg 1 CH-2

Chapter 14 Section C Pg 1 Chapter 14 Section C Pg 1 CH-2

9. RECORDS MANAGEMENT CONSIDERATIONS. This Commandant Change

Notice has been thoroughly reviewed during the directives clearance process, and it has been determined there are no further records scheduling requirements, in accordance with Federal Records Act, 44 U.S.C. 3101 et seq., National Archives and Records Administration (NARA) requirements, and Information and Life

Cycle Management Manual, COMDTINST M5212.12 (series). This policy does not have any significant or substantial change to existing records management requirements.

10. FORMS /REPORTS. The forms referenced in this Manual are available in the

USCG Electronic Forms on Standard Workstation or on the Internet:

https://dcms.uscg.afpims.mil/Our-Organization/Assistant-commandant-for-

C4IT-CG-6/The-Office-of-Information-Management-CG-61/Forms-

Management/; CG Portal https://cgportal2.uscg.mil/library/forms/SitePages/Home.aspx.

11. REQUESTS FOR CHANGES. Recommendations for changes or improvements to the Coast Guard Medical Manual, COMDTINST M6000.1 (series), are welcome and should be submitted via the chain of command to Commandant

(CG-1121) Publications and Directives.

ERICA G. SCHWARTZ /s/

Rear Admiral, U.S. Public Health Service

Director, Health, Safety, and Work-Life https://dcms.uscg.afpims.mil/Our-Organization/Assistant-commandant-for-C4IT-CG-6/The-Office-of-Information-Management-CG-61/Forms-Management/ https://dcms.uscg.afpims.mil/Our-Organization/Assistant-commandant-for-C4IT-CG-6/The-Office-of-Information-Management-CG-61/Forms-Management/ https://dcms.uscg.afpims.mil/Our-Organization/Assistant-commandant-for-C4IT-CG-6/The-Office-of-Information-Management-CG-61/Forms-Management/ https://cgportal2.uscg.mil/library/forms/SitePages/Home.aspx

DISTRIBUTION – SDL No. 168

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a b c d e f g h i j k l m n o p q r s t u v w x y z

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27 FEB 2017

COMMANDANT CHANGE NOTICE 6000

Subj: CH-1 TO THE COAST GUARD MEDICAL MANUAL, COMDTINST M6000.1F

1. PURPOSE. This Commandant Change Notice publishes revisions to the Coast Guard Medical Manual, COMDTINST M6000.1F. This Notice is applicable to all active duty and reserve Coast Guard members and the other Services Members assigned to duty with the Coast Guard.

2. ACTION. All Coast Guard unit commanders, commanding officers, officers-in-charge, deputy/assistant commanders, and chief of headquarters staff elements shall comply with the provisions of this Notice and Manual. Internet release is authorized.

3. DIRECTIVES AFFECTED. With the addition of this Commandant Change Notice, the Coast Guard Medical Manual, COMDTINST M6000.1F is updated.

4. DISCLAIMER. This guidance is not a substitute for applicable legal requirements, nor it itself a rule. It is intended to provide operational guidance of Coast Guard personnel and is not intended to nor does it impose legally-binding requirements on any party outside the Coast Guard.

5. MAJOR CHANGES. Major changes of this Notice are summarized below:

a. Chapter 1. Primary changes include:

(1) Section B – Added paragraph addressing shadowing policy.

(2) Section C – Updated medical, dental and pharmacy officer training requirements.

Commandant US Coast Guard Stop 7907 United States Coast Guard 2703 Martin Luther King Jr. Ave SE

Washington, DC 20593-7907 Staff Symbol: CG-11 Phone: (202) 475-5173

b. Chapter 2 Section I. Clarifies chaperone policy.

c. Chapter 4 Section B. Added new paragraph mandating the use of the Disability Benefits Questionnaire.

d. Chapter 7 Section C. Clarifies administration requirements for multiple vaccines. Updates the training requirements for providers that provide Allergy Immunotherapy (AIT).

e. Chapter 9 Sections A-C. Clarifies that there must be a prearranged mechanism in Unit Instructions or Standard Operating Procedures (SOPs) for a timely physical exam by a Sexual Assault Medical Forensic Examiner (SAMFE) or Sexual Assault Nurse Examiner (SANE) in case of rape and sexual assault. Adds requirement that unit SOPs for cases of alleged rape and sexual assault must refer to Sexual Assault Prevention and Response (SAPR) Program, COMDTINST M1754.10 (series) for further guidance.

f. Chapter 12 Section B. Added content that the completion of the OSHA Respirator Medical Evaluation Questionnaire is required only for civilian workers using respirators.

g. Chapter 13. Primary changes include:

(1) Section C – Changed interval of full staff privileges from two to three years.

(2) Section G – Updates to HIPAA policies to include defining and identifying duties of the HIPAA Security Officer. States that clinics will be evaluated periodically to ensure adequate privacy data protection, administrative, and physical security. Updates the acceptable training venue for HIPAA training. Clarifies Commanding Officer’s authority to mandate others, as deemed necessary, to take HIPAA training.

6. ENVIRONMENTAL ASPECT AND IMPACT CONSIDERATIONS.

a. The development of this Commandant Change Notice and the general policies contained within it have been thoroughly reviewed by the originating office in conjunction with the Office of Environmental Management, and are categorically excluded (CE) under current USCG CE # 33 from further environmental analysis, in accordance with Section 2.B.2. and Figure 2-1 of the National Environmental Policy Act Implementing Procedures and Policy for Considering Environmental Impacts, COMDTINST M16475.1 (series).

b. This Commandant Change Notice will not have any of the following: significant cumulative impacts on the human environment; substantial controversy or substantial change to existing environmental conditions; or inconsistencies with any Federal, State, or local laws or administrative determinations relating to the environment. All future specific actions resulting from the general policies in this Commandant Change Notice must be individually evaluated for compliance with the National Environmental Policy Act (NEPA), Council on Environmental Policy NEPA regulations at 40 Code of Federal Regulations Parts 1500-1508, Department of Homeland Security and Coast Guard NEPA policy, and compliance with all other environmental mandates.

7. DISTRIBUTION. No paper distribution will be made of this Commandant Change Notice. An electronic version will be located on the following Commandant (CG-612) web sites. Internet: http://www.uscg.mil/directives/, and CGPortal:

https://cgportal2.uscg.mil/library/directives/SitePages/Home.aspx

8. PROCEDURE. If maintaining a paper copy, please remove and insert the following pages:

Remove Replace Contents 1-2 Contents 1-2 CH-1 Contents 9-10 Contents 9-10 CH-1 Contents 19-20 Contents 19-20 CH-1 Chapter 1 Contents Chapter 1 Contents CH-1 Chapter 1 Section B Pg 39 Chapter 1 Section B Pg 39 CH-1 Chapter 1 Section C Pg 1-7 Chapter 1 Section C Pg 1-3 CH-1 Chapter 2 Section I Pg 1-4 Chapter 2 Section I Pg 1-4 CH-1 Chapter 4 Contents Chapter 4 Contents CH-1 Chapter 4 Section B Pg 33-36 Chapter 4 Section B Pg 33-36 CH-1 Chapter 7 Section C Pg 5-8 Chapter 7 Section C Pg 5-7 CH-1 Chapter 9 Section A Pg 3-4 Chapter 9 Section A Pg 3-4 CH-1 Chapter 9 Section A Pg 13-14 Chapter 9 Section A Pg 13-14 CH-1 Chapter 9 Section B Pg 3-4 Chapter 9 Section B Pg 3-4 Chapter 9 Section B Pg 9-10 Chapter 9 Section B Pg 9-10 CH-1 Chapter 9 Section C Pg 3-4 Chapter 9 Section C Pg 3-4 CH-1 Chapter 9 Section C Pg 9-10 Chapter 9 Section C Pg 9-10 CH-1 Chapter 12 Section B Pg 5-6 Chapter 12 Section B Pg 5-6 CH-1 Chapter 13 Contents Chapter 13 Contents CH-1 Chapter 13 Section C Pg 5-6 Chapter 13 Section C Pg 5-6 CH-1 Chapter 13 Section G Pg 1-15 Chapter 13 Section G Pg 1-13 CH-1

9. RECORDS MANAGEMENT CONSIDERATIONS. This Commandant Change

Notice has been thoroughly reviewed during the directives clearance process, and it has been determined there are no further records scheduling requirements, in accordance with Federal Records Act, 44 U.S.C. 3101 et seq., National Archives and Records Administration (NARA) requirements, and Information and Life Cycle Management Manual, COMDTINST M5212.12 (series). This policy does not have any significant or substantial change to existing records management requirements.

http://www.uscg.mil/directives/

10. FORMS /REPORTS. The forms referenced in this Manual are available in the USCG Electronic Forms on Standard Workstation or on the Internet:

http://www.uscg.mil/forms/; CG Portal https://cgportal2.uscg.mil/library/forms/SitePages/Home.aspx.

11. REQUESTS FOR CHANGES. Recommendations for changes or improvements to the Coast Guard Medical Manual, COMDTINST M6000.1 (series), are welcome and should be submitted via the chain of command to Commandant (CG-1121) Publications and Directives.

ERICA G. SCHWARTZ /s/ Rear Admiral, U.S. Coast Guard Director of Health, Safety, and Work-Life http://www.uscg.mil/forms/

COMMANDANT INSTRUCTION M6000.1F

Subj: COAST GUARD MEDICAL MANUAL

1. PURPOSE. This Manual establishes policies, procedures, and health care standards for all active duty and reserve Coast Guard members and other Service Members assigned to duty with the Coast Guard.

2. ACTION. All Coast Guard unit commanders, commanding officers, officers-in-charge, deputy/assistant commanders, and chief of headquarters staff elements shall comply with the provisions of this Manual. Internet release is authorized.

3. DIRECTIVES AFFECTED. The Coast Guard Medical Manual, COMDTINST M6000.1E, is cancelled.

4. MAJOR CHANGES. Major changes to this Manual include: updated guidance on the Quality Improvement Program and Medical Event Reporting, and incorporated Command Notification Requirements to Dispel Stigma in Providing Mental Health Care to Service Members.

5. REQUEST FOR CHANGES. Units and individuals may recommend changes by writing via the chain of command to: Commandant (CG-1121); U. S. Coast Guard; 2703 Martin L. King Jr. Ave SE; STOP 7907; WASHINGTON, DC 20593-7907.

6. DISCLAIMER. This guidance is not a substitute for applicable legal requirements, nor is it itself a rule. It is intended to provide operational guidance for Coast Guard personnel and is not intended to nor does it impose legally-binding requirements on any party outside the Coast Guard.

7. PRIVACY COMPLIANCE. When completed, the numerous forms identified in this Manual contain Sensitive Personally Identifiable Information (SPII). The Privacy Act of 1974, 5 U.S.C. 552a mandates that agencies establish administrative, technical, and physical safeguards to ensure the integrity of records maintained on individuals. The Privacy Act also requires the protection against any anticipated threats which could result in substantial harm, embarrassment or compromise to an individual. In order to maintain the public’s trust and prevent privacy breaches, the Coast Guard has a duty to safeguard all types of Personally Identifiable Information (PII) in its possession. Unintended disclosure or compromise of an

Commandant United States Coast Guard

2703 MARTIN L. KING JR. AVE SE

STOP 7907

Washington DC 20593-7907 Staff Symbol: CG-11 Phone: (202) 475-5173 Fax: (202) 475-5909

COMDTINST M6000.1F

22 AUGUST 2014

DISTRIBUTION – SDL No. 162 a b c d e f g h i j k l m n o p q r s t u v w x y z

A X X X X X X X X X X X X X X X X X X B X X X X X X X X X X X X X X X X X X X X X X X X X C X X X X X X X X X X X X X X X X X X X X X X X X X D X X X X X X X X X X X X X X E X X X X X X X F X X X G X X X H

NON-STANDARD DISTRIBUTION:

individual’s PII constitutes a Privacy Incident and must be reported in accordance with COMDTINST 5260.5 (series), Privacy Incident Response, Notification and Reporting Procedures for Personally Identifiable Information.

8. DISTRIBUTION. No paper distribution will be made of this Manual. Official distribution will be via the Coast Guard Directive (CGGS) DVD. An electronic version will be located on the following Commandant (CG-612) websites. Intranet:

http://cgweb.comdt.uscg.mil/CGDirectives/Welcome.htm, Internet:

http:///www.uscg.mil/directives/ and CG Portal:

https://cgportal2.uscg.mil/library/SitePages/Home.aspx

9. RECORDS MANAGEMENT. This Manual has been thoroughly reviewed during the directives clearance process, and it has been determined there are further records scheduling requirements, in accordance with Federal Records Act, 44 U.S.C. 3101 et seq., NARA requirements, and Information and Life Cycle Management Manual, COMDTINST M5212.12 (series). This policy creates significant or substantial change to existing records management requirements.

10. ENVIRONMENTAL ASPECTS AND IMPACT CONSIDERATIONS.

a. The development of this Manual and the general policies contained within it have been thoroughly reviewed by the originating office in conjunction with the Office of Environmental Management, and are categorically excluded (CE) under current USCG CE # 33 from further environmental analysis, in accordance with Section 2.B.2. and Figure 2-1 of the National Environmental Policy Act Implementing Procedures and Policy for Considering Environmental Impacts, COMDTINST M16475.1 (series). Because this Manual implements without substantive change guidance on, and provisions for, compliance with applicable environmental mandates, Coast Guard categorical exclusion #33 is appropriate.

b. This Directive will not have any of the following: significant cumulative impacts on the human environment; substantial controversy or substantial change existing environmental conditions; or in consistencies with any Federal, State, or local laws or administrative determinations relating to the environment. All future specific actions resulting from the general policies in this Manual must be individually evaluated for compliance with the National Environmental Policy Act (NEPA), DHS and Coast Guard NEPA policy, and compliance with all other environmental guidance provided within it for compliance with all applicable environmental laws prior to promulgating any directive, all applicable environmental considerations are addressed appropriately in this Manual.

http://cgweb.comdt.uscg.mil/CGDirectives/Welcome.htm http://www.uscg.mil/directives/

11. FORMS/REPORTS. The forms referenced in this Manual are available in USCG Electronic Forms on the Standard Workstation or on the Internet: http://www.uscg.mil/forms/, CGPortal at https://cgportal2.uscg.mil/library/SitePages/Home.aspx; and Intranet at http://cgweb.comdt.uscg.mil/CGForms.

Maura K. Dollymore /s/ Rear Admiral, U. S. Coast Guard Director of Health, Safety, and Work-Life http://www.uscg.mil/forms/ http://cgweb.comdt.uscg.mil/CGForms

RECORD OF CHANGES

CHANGE

NUMBER

DATE OF

CHANGE

DATE

ENTERED

BY WHOM

ENTERED

CH-1 27Feb2017 28Feb2017 CWO2 Matthew

Geraets, CG-1121

CH-2 05June2018 02July2018 LT Matthew Geraets, CG-1121

Medical Manual Table of Contents

CHAPTER 1

ORGANIZATION AND PERSONNEL

Section A. Organization.

1. Mission of the CG Health Services Program

2. Director of Health, Safety, and Work-Life (CG-11)

3. Office of Health Services (CG-112)

4. Health, Safety, and Work-Life Service Center (HSWL SC)

5. Responsibilities of Commands with Health Care Facilities

6. Governance

Section B. Personnel.

1. Chief of the Clinical Staff

2. Collateral Duty Command Surgeons

3. Regional Manager (RM)

4. Regional Practice Director (RPD)

5. Regional Practice Senior Medical Executives (SME)

6. Regional Practice Senior Dental Executive (SDE)

7. Regional Practice Senior Independent Duty Health Services Technician (SIDHS)

8. Regional Pharmacy Executive (RPE)

9. Senior Health Services Officer (SHSO)

10. Duties of Medical Officers (MO)

11. Duties of Flight Surgeons (FS)

12. General Duties of Dental Officers

13. General Duties of Pharmacy Officers

14. Health, Safety, Work-Life Service Center (HSWL SC) Pharmacy Officer(s)

15. Environmental Health Officers

16. Health Services Administrators (HSA)

17. Physician Assistants (PA) and Nurse Practitioners (NP)

18. Contract Health Care Providers

19. TRICARE Management Activity-Aurora (TMA) Liaison Officer

20. Health Services Technicians (HS)

21. HS - with a Dental Qualification Code (13)

22. Independent Duty Health Services Technicians (IDHS)

23. CG Beneficiary Representatives at Uniformed Services Medical Treatment

Facilities (USMTF)

24. CG Representative at the Department of Defense Medical Examination Review

Board (DODMERB)

25. Health Benefits Advisors (HBA)

26. Dental Hygienists

CONTENTS 1 CH-1

27. Red Cross Volunteers

28. Volunteers

29. Shadowing

Section C. CG Health Services Officer Training Matrix.

1. Introduction

2. Table 1-C-1 CG Medical Officer/Dental Officer/Pharmacy Officer Training Matrix. 1

3. Table 1-C-2 CG Chemical, Biological, Radiological, Nuclear, and Explosive (CBRNE)

Courses Matrix

CHAPTER 2

HEALTH CARE AND FACILITIES

Section A. Health Care for Active Duty & Reserve Personnel.

1. Care at Uniformed Services Medical Treatment Facilities (USMTF)

2. Emergency Care

3. Dental Care and Treatment

4. Consent to and Refusal of Treatment

5. Elective Surgery for Pre-Existing Defects

6. Women’s Health

7. Elective Health Care

8. Other Health Insurance (OHI)

9. Procedures for Obtaining Non-Emergent Health Care from Nonfederal Sources

10. Obtaining Vasectomies and Tubal Ligations from Nonfederal Providers

11. Care at Department of Veterans Affairs (DVA) Medical Facilities

12. Uses and Disclosures of Health Information of Active Duty & Reserve Personnel

13. Non-Covered TRICARE Purchased Health Care Services

Section B. Health Care for Retired Personnel.

1. Care at Uniformed Services Medical Treatment Facilities

2. Care Under TRICARE Standard and Extra

3. Care at Veterans Administration Medical Facilities

Section C. Health Care for Dependents.

1. Care at Uniformed Services Medical Treatment Facilities

2. Referral for Civilian Medical Care, Form DD-2161

3. Rights of Minors to Health Care Services

CH-1 CONTENTS 2

CONTENTS 3

Section D. Care for Preadoptive Children and Wards of the Court.

1. General

2. Secretary’s Designation

Section E. Health Care for Other Persons

1. Members of the CG Auxiliary

2. Temporary Members of the CG Reserve

3. Members of Foreign Military Services

4. Federal Employees

5. Merchant Marine Seaman

6. Federally Employed Civilians, Non-Federally Employed Civilians, and United States

Public Health Service Officers Not Assigned to the CG Aboard CG Vessels

7. Civilians Physical Exams prior to Entry to the CG

Section F. Medical Regulating.

1. Transfer of Patients at CG Expense

2. Travel Via Ambulance of Patients to Obtain Care

3. Aeromedical Evacuation of Patients

Section G. Defense Enrollment Eligibility Reporting System (DEERS) in CG Health Care Facilities.

1. Defense Enrollment Eligibility Reporting System

2. Responsibilities

3. Performing DEERS Checks

4. Eligibility/Enrollment Questions, Fraud and Abuse

5. Denial of Non-emergency Health Care Benefits for Individuals Not Enrolled in

Defense Enrollment Eligibility Reporting System (DEERS)

6. DEERS Eligibility Overrides

Section H. Health Care Facility Definitions.

1. CG Facilities

2. Department of Defense Medical Facilities

3. Uniformed Services Military Treatment Facilities (USMTFs)

Section I. Policies and Procedures Required at CG Health Care Facilities.

1. Administrative Policies and Procedures

2. Operational Policies and Procedures

3. Patient Rights

4. Health Care Provider Identification

CH-2

CONTENTS 4

Section J. General Standards of Care.

1. Standard of Care

2. Diagnosis and Therapy

3. Bases for Diagnoses

4. Treatment

5. Time Line for Treatment

6. Correct-Site Surgery Policy

7. Patients Role

8. Documentation

9. Deaths

Section K. Patient Centered Wellness Home

1. Policy

2. Beneficiaries

CHAPTER 3

PHYSICAL STANDARDS AND EXAMINATION

Section A. Administrative Procedures

1. Applicability of Physical Standards

2. Prescribing of Physical Standards

3. Purpose of Physical Standards

4. Application of Physical Standards

5. Interpretation of Physical Standards

6. Definitions of Terms Used in this Chapter

7. Required Physical Examinations & Assessments and Their Time Limitations

8. Waiver of Physical Standards

9. Substitution of Physical Examinations

Section B. Report of Medical History, Form DD-2807-1 / Medical Examination, Form

DD-2808

1. Report of Medical History, Form DD-2807-1

2. Report of Medical Examination, Form DD-2808

3. Findings and Recommendations of Report of Medical Examination, Form DD-2808

4. Correction of Defects Prior to Overseas Transfer or Sea Duty Deployment

5. Objection to Assumption of Fitness for Duty at Separation

6. Separation Not Appropriate by Reason of Physical Disability

7. Procedures for Physical Defects Found Prior to Separation

Figure 3-B-1 Figure 3-B-2

Section C. Medical Examination Techniques and Lab Testing Standards

1. Scope

2. Speech Impediment

3. Head, Face, Neck, and Scalp (Item 17 of the Report Of Medical Examination, Form

DD-2808)

4. Nose, Sinuses, Mouth, and Throat (Item 19, 20 of the Report Of Medical

Examination, Form DD-2808)

5. Ears (General) and Drums (Item 21, 22 of the Report Of Medical Examination, Form DD-2808)

6. Eyes (General), Ophthalmoscopic, and Pupils (Item 23, 24, 25 of the Report Of

Medical Examination, Form DD-2808)

7. Ocular Mobility (Item 26 of the Report Of Medical Examination, Form DD-2808)

8. Heart and Vascular System (Item 27 of the Report Of Medical Examination, Form

DD-2808)

9. Lungs and Chest (Item 28 of the Report Of Medical Examination, Form DD-2808)

10. Anus and Rectum (Item 30 of the Report Of Medical Examination, Form DD-2808)

11. Abdomen and Viscera (Item 31 of the Report Of Medical Examination, Form

DD-2808)

12. Genitourinary System (Item 32 of the Report Of Medical Examination, Form

DD-2808)

13. Extremities (Item 33, 34, 35 of the Report Of Medical Examination, Form DD-2808) ...12

14. Spine and Other Musculoskeletal (Item 36 of the Report Of Medical Examination, Form DD-2808)

15. Identifying Body Marks, Scars, and Tattoos (Item 37 of the Report Of Medical

Examination, Form DD-2808)

16. Neurologic (Item 39 of the Report Of Medical Examination, Form DD-2808)

17. Psychiatric (Item 40 of the Report Of Medical Examination, Form DD-2808)

18. Endocrine System

19. Dental (Item 43 of the Report Of Medical Examination, Form DD-2808)

20. Laboratory Findings

Figure 3-C-1

21. Height, Weight and Body Build

22. Distant Visual Acuity and Other Eye Tests Table 3-C-1

23. Audiometer

24. Psychological and Psychomotor

Figure 3-C-2 Figure 3-C-3 Figure 3-C-4

Section D. Medical Standards for Appointment, Enlistment and Induction in the Armed Forces

1. Scope

2. Medical Standards

CONTENTS 5

3. Policy

4. Responsibilities of Commandant (CG-11)

5. Height

6. Weight

7. Head

8. Eyes

9. Vision

10. Ears

11. Hearing

12. Nose, Sinuses, Mouth and Larynx

13. Dental

14. Neck

15. Lungs, Chest Wall, Pleura, and Mediastinum

16. Heart

17. Abdominal Organs and Gastrointestinal System

18. Female Genitalia

19. Male Genitalia

20. Urinary System

21. Spine and Sacroiliac Joints

22. Upper Extremities

23. Lower Extremities

24. Miscellaneous Conditions of the Extremities

25. Vascular System

26. Skin and Cellular Tissues

27. Blood and Blood-Forming Tissues

28. Systemic

29. Endocrine and Metabolic

30. Rheumatologic

31. Neurologic

32. Sleep Disorders

33. Learning, Psychiatric, and Behavioral

34. Tumors and Malignancies

35. Miscellaneous

Figure 3-D-1 Evaluation for Risk of Head Injury Sequelae Figure 3-D-2 Classification and Comparative nomenclature of Cervical Smears

Section E. Physical Standards for Programs Leading to Commission

1. Appointment as Cadet, USCG Academy

2. Commissioning of Cadets

3. Enrollment as an Officer Candidate

4. Commissioning of Officer Candidates

5. CG Direct Commission Program

6. Direct Commission in the CG Reserve

7. Direct Commission of Licensed Officers of U. S. Merchant Marine

CONTENTS 6

CONTENTS 7

8. Appointment to Warrant Grade

Section F. Physical Standards Applicable to All Personnel (Regular and Reserve) For:

Reenlistment; Enlistment of Prior Service USCG Personnel; Retention; Overseas Duty;

and Sea Duty

1. General Instructions

2. Use of List of Disqualifying Conditions and Defects

3. Head and Neck

4. Esophagus, Nose, Pharynx, Larynx, and Trachea

5. Eyes

Figure 3-F-1

6. Ears and Hearing

7. Lungs and Chest Wall

8. Heart and Vascular System

9. Abdomen and Gastrointestinal System

10. Endocrine and Metabolic Conditions (Diseases)

11. Genitourinary System

12. Extremities

13. Spine, Scapulae, Ribs, and Sacroiliac Joints

14. Skin and Cellular Tissues

15. Neurological Disorders

16. Psychiatric Disorders

17. Dental

18. Blood and Blood-Forming Tissue Diseases

19. Systemic Diseases, General Defects, and Miscellaneous Conditions

20. Tumors and Malignant Diseases

21. Sexually Transmitted Infection

22. Human Immunodeficiency Virus (HIV)

23. Transplant recipient

3-F Exhibit 1 3-F Exhibit 2

Section G. Physical Standards for Aviation

1. Physical Standards for Aviation

Section H. Physical Examinations and Standards for Diving Duty

1. Examinations

2. Standards

CONTENTS 8

CHAPTER 4

HEALTH RECORDS AND FORMS

Section A. Health Records.

1. Purpose and Background

2. Contents of the Health Record

3. Custody of Health Records

4. Opening Health Records

Figure 4-A-1

5. Checking out the Health Record

6. Terminating Health Records

7. Creating an Additional Volume

8. Lost, Damaged, or Destroyed Health Records

9. Accuracy and Completeness Check

Section B. Health Record Forms.

1. Health Record Cover, CG-3443

2. Drug Sensitivity Sticker, CG-5266

3. Adult Preventive and Chronic Care Flowsheet, Form DD-2766

4. Consultation Sheet, Form SF-513

5. Medical Record, Form SF-507

6. Pre-Deployment Health Assessment, Form DD-2795

7. Post-Deployment Health Assessment, Form DD-2796

8. Post-Deployment Health Re-Assessment, Form DD-2900

9. Medical Recommendation for Flying, Form CG-6020

10. Report of Medical Examination, Form DD-2808

11. Report of Medical History, Form DD-2807-1

12. Medical Board Report Cover Sheet, Form CG-5684

13. Chronological Record of Medical Care, Form SF-600

14. Emergency Care and Treatment, Form SF-558

15. Emergency Medical Treatment Report, Form CG-5214

16. Radiographic Reports, Form SF-519

17. Laboratory Reports

18. Eyewear Prescription, Form DD-771

19. Serology Record, SF-602

20. Request for Administration of Anesthesia and Performance of Operations and other Procedures, Form OF-522

21. Audiogram Results

22. Reference Audiogram, Form DD-2215

CONTENTS 9

23. Hearing Conservation Data, Form DD-2216

24. Chronological Record of Service, Form CG-4057

25. Authorization for Disclosure of Medical or Dental Information, Form DD-2870

26. Request to Restrict Medical or Dental Information, Form DD-2871

27. Disability Benefits Questionnaires

28. International Certificate of Vaccination, CDC-731

29. Tissue Examination, Form SF-515

30. Request for Medical/Dental Records or Information, Form DD-877

31. Modified Screening For: Overseas Assignment and/or Sea Duty Health Screening, Form CG-6100

32. Occupational Medical History and Examination, Form CG-6010E

33. Asbestos Exposure, Part I – Initial Medical Questionnaire, Form DD-2493-1

34. Asbestos Exposure, Part II – Periodic Medical Questionnaire, Form DD-2493-2

35. Respiratory Sensitizer Questionnaire, Form CG-6010H

36. Acute Exposure Information, Form CG-6000-1

37. Written Opinion, Form CG-6010B

38. Summary Report, Form CG-6010C

Section C. Dental Records Forms, Classification, and Treatment Priority.

1. Dental Record Cover, Form CG-3443-2

2. Dental Health Questionnaire, Form NAVMED 6600/3

3. Dental Record, Form SF-603

4. Dental Continuation, Form SF-603-A

5. Consultation Sheet, Form SF-513

6. Lost Dental Records

7. Special Dental Records Entries

8. Dental Examination Requirements

9. Recording of Dental Treatments on Chronological Record of Care, Form SF-600

Section D. Clinical Records (Dependents/Retiree).

1. Purpose and Background

2. Contents of Clinical Records

3. Extraneous Attachments

CONTENTS 10

4. Opening Clinical Records

5. Terminating Clinical Records

6. Custody of Clinical Records

7. Safekeeping of Clinical Records

8. Transfer of Clinical Records

9. Lost Damaged or Destroyed Clinical Records

Section E. Civilian Employee Health Record.

1. Purpose and Background

2. Custody of Employee Medical Folders, SF-66D

3. Contents of the Employee Medical Folders, SF-66D

4. Accountability of Disclosures

5. Opening Employee Medical Folder, SF-66D

6. Terminating Employee Medical Folders, SF-66D

7. Transferring to Other Government Agencies

8. Lost, Damaged, or Destroyed Employee Medical Folders, SF-66D

9. Employee Medical Folder, SF-66 D

Section F. Inpatient Medical Records.

1. Purpose and Background

2. Maintenance and Storage

3. Disposition of Inpatient Medical Record (IMR)

4. Inpatient Medical Record Forms and Required Entries

Section G. Mental Health Records.

1. Active Duty

2. Non-active Duty

3. Psychiatric Evaluation Format

4. Custody of Mental Health Records

CHAPTER 5

PSYCHIATRIC CONDITIONS

Section A. Psychiatric Conditions (including personality disorders).

1. General

2. Personality Disorders

3. Adjustment Disorders

4. Organic Mental Disorders

5. Psychoactive Substance Use Disorders

6. Schizophrenia

7. Psychotic Disorders Not Elsewhere Classified

8. Delusional (Paranoid) Disorder

9. Neurotic Disorders

10. Mood Disorders

11. Anxiety Disorders (or Anxiety and Phobic Neuroses)

12. Somatoform Disorders

13. Dissociative Disorders (or Hysterical Neuroses, Dissociative Type)

14. Sexual Disorders

15. Sexual Dysfunctions

16. Factitious Disorders

17. Disorders of Impulse Control Not Elsewhere Classified

18. Disorders Usually First Evident in Infancy, Childhood, or Adolescence

19. Psychological Factors Affecting Physical Condition

20. V Codes for Conditions Not Attributable to a Mental Disorder that are a Focus of

Attention or Treatment

21. Additional Codes

Section B. Command Directed Mental Health Evaluation of Coast Guard Service members.

1. Active Duty Mental Health Evaluation Protection

2. Emergency Evaluations

3. Non-emergent Mental Health Evaluation

4. Service Member’s Rights

5. Things Not To Do

6. Evaluations NOT covered

7. Memorandum Requesting a Mental Health Evaluation

5-B Figure 1 5-B Figure 2

8. Commander’s Need to Know

CHAPTER 6

MEDICAL READINESS/DEPLOYMENT HEALTH

Section A. Overview.

1. Purpose

2. Deployment Definitions

3. Responsibilities

4. Individual Medical Readiness

Table 6-A-1

5. Readiness Definitions and Scoring

CONTENTS 11

6. Medically Ready

Section B. Expeditionary Deployment.

1. Electronic Deployment Health Assessment (EDHA)

2. Responsibility and timeline for the EDHA

3. EDHA Overview

4. EDHA Healthcare Provider Review Process

5. Mental Health Assessment

6. Neurocognitive Testing

7. Pre-Deployment Requirements

8. Deployment Requirements

9. Post-Deployment Requirements

10. Compliance Program

Table 6-B-1 Table 6-B-2

Section C. Routine Deployment.

1. Pre Deployment Requirements

2. Deployment

3. Post-Deployment

4. Additional References

Table 6-C-1

CHAPTER 7

PREVENTIVE MEDICINE

Section A. General.

1. Scope

2. Responsibilities

Section B. Communicable Disease Control.

1. General

2. Disease Outbreak

3. Medical Event Reporting

Figure 7-B-1 Figure 7-B-2

4. Sexually Transmitted Infection (STI) Program

5. STI Treatment

6. STI Drug Prophylaxis

CONTENTS 12

7. STI Immunizations

8. STI Reporting

Section C. Immunization and Allergy Immunotherapy (AIT) No table of contents entries found.

CHAPTER 8

FISCAL AND SUPPLY MANAGEMENT

Section A. Resource Management.

1. CG Headquarters

2. Health, Safety, and Work-Life Service Center (HSWL SC)

3. Regional Manager’s (RM) Responsibility

Section B. General Property Management and Accountability.

1. Basic Policies

2. Physical Property Classifications

3. Property Responsibility and Accountability

4. Expending Property Unnecessarily

5. Stock Levels, Reorder Points, and Stock Limits

6. Transferring and Loaning Property

Section C. Custody, Issues, and Disposition.

1. Transferring Custody

2. Storerooms

3. Issuing Material

4. Inspecting Storerooms

5. Disposing of Property

Section D. Health Services Supply System.

1. Health Services Control Point

2. Responsibility for General Stores Items

3. Supply Support Assistance

4. Authorized Allowances

5. Supply Sources

6. Health Care Equipment

7. Emergency Procurement

8. Factors for Replacing Equipment

Section E. Eyeglasses and Ophthalmic Services.

1. General

CONTENTS 13

2. Personnel Authorized Refractions

3. Procuring and Issuing Standard Prescription Eyewear

Table 8-E-1 Table 8-E-2

4. Aviation Prescription Lenses

5. Contact Lenses

6. Sunglasses for Polar Operations

7. Safety Glasses

CHAPTER 9

HEALTH SERVICES TECHNICIANS ASSIGNED TO INDEPENDENT DUTY

Section A. Independent Duty Afloat.

1. Introduction

2. Mission, General Duties and Responsibilities

3. Providing Health Care Afloat

4. Training

5. Supply and Logistics

Table 9-A-1

6. Health Services Department Administration

Table 9-A-2 Table 9-A-2 Table 9-A-3

7. Combat Operations

8. Environmental Health

Section B. Independent Duty Ashore at Sectors, Sector Field Offices, Air Stations, and Small Boat Stations.

1. Introduction

2. Mission, General Duties and Responsibilities

3. Chain Of Command

4. Operation of the Health Services Division

5. Providing Health Care

6. Training

7. Supply and Logistics

Table 9-B-1

8. Health Services Department Administration

Table 9-B-2 Table 9-B-3 Table 9-B-4

CONTENTS 14

CONTENTS 15

9. Search and Rescue (SAR) Operations

10. Environmental Health

Section C. Independent Duty in Support of Deployable Specialized Forces

1. Introduction

2. Mission, General Duties and Responsibilities

3. Chain Of Command

4. Operation of the Health Services Division

5. Providing Health Care

6. Training

7. Supply and Logistics

Table 9-C-1

8. Health Services Department Administration

Table 9-C-2 Table 9-C-3 Table 9-C-4

9. Tactical Operations

10. Environmental Health

Section D. Quality Improvement Compliance Program (QICP)

1. Background

2. Purpose

3. Overview

4. Program Elements

5. Collaborative Program

6. Monitoring the QICP

7. Assistance Program

8. Responsibility

9. QI Compliance Checklist

10. Compliance Certification Standards

11. Post Survey

Section E. Independent Duty Management of TRICARE

1. Introduction

2. Discussion

3. Access to Care

4. Access to Care Standards

5. Enrollment

6. Resources

CONTENTS 16

CHAPTER 10

PHARMACY OPERATIONS AND DRUG CONTROL

Section A. Pharmacy Administration.

1. Responsibilities

2. Prescribers

3. Prescriptions

4. Prescribing in the Medical Record

5. Signatures

6. Dispensing

7. Labeling

8. Drug Stock

9. Credit Return Program (Reverse Distribution Program)

10. Pharmacy and Therapeutics Committee

Figure 10-A-1 Regional Practice Site Non-Prescription Medication Program

Section B. Controlled Substances.

1. General

2. Custody and Controlled Substance Audits

3. Drug Enforcement Administration (DEA) Registration

4. Reporting Theft or Loss

5. Procuring, Storing, Transferring, and Disposing of Controlled Substances

6. Prescribing Practices

Section C. Forms and Records.

1. General

2. Prescription Forms

3. Quality Control Forms

4. Controlled Drug Forms

5. Forms Availability

Section D. Drug Dispensing Without a Medical Officer.

1. General

2. Child-Resistant Containers

3. Controlled Substances

4. Formulary

5. Non-prescription Medication Program

CONTENTS 17

CHAPTER 11

HEALTH CARE PROCUREMENT

Section A. Contracting For Health Care Services.

1. General

2. Type of Services

3. Eligibility For Contract Health Care Services

4. Approval to Contract for Services

5. Funding

6. Pre-contract Award Actions

7. Award Evaluation Factors

8. Post-Contract Award Actions

Figure 11-A-1 Table 1-A-1

Section B. Health Care Services Invoice Review and Auditing.

1. General

2. Invoices Subject to Review and Audit

3. Review and Audit Procedures

4. Report of Potential Third Party Liability (RCN 6000-2)

Section C. Claims Processing.

1. General

2. Certification

3. Administrative Screen

4. Technical Screen

5. Appropriateness Review

6. Peer Review

7. Guidelines for Initial Appropriateness and Peer Reviews

CHAPTER 12

OCCUPATIONAL MEDICAL SURVEILLANCE AND EVALUATION

PROGRAM (OMSEP)

Section A. Information on OMSEP.

CONTENTS 18

CHAPTER 13

QUALITY IMPROVEMENT

Section A. Quality Improvement Program.

1. Mission

2. Internal Quality Assurance Reviews

3. Healthcare Process Assessment Program (HPAP)

4. External Accreditation

5. Goals

6. Objectives

7. Definitions

8. Responsibilities

9. Confidentiality Statement

10. QIP Review and Evaluation

Section B. Credentials Maintenance and Review.

1. Purpose

2. Responsibilities

3. Definitions

4. Pre-selection Credentials Review

5. Provider Credentials File (PCF)

6. Documentation

7. Electronic Credentialing System

8. Verification

9. Contract Provider Credentials Review

10. Reverification

11. National Practitioner Data Bank (NPDB)

12. National Provider Identifiers Type 1 (NPI)

Section C. Clinical Privileges.

1. Purpose

2. Applicability and Scope

3. Definitions

4. Clinical Privileges

Section D. Healthcare Process Assessment Program (HPAP).

1. Purpose

2. Overview

3. HPAP Compliance Process

CONTENTS 19

Section E. Quality Improvement Implementation Guide (QIIG).

1. Purpose

2. Responsibilities

Section F. National Provider Identifiers.

1. National Provider Identifiers (NPI) Type 1 ...