Appendix D_COMDINST M6000.1F_CG Medical Manual.pdf

Department of Homeland Security United States

Coast Guard

COAST GUARD MEDICAL MANUAL

COMDTINST M6000.1F

AUGUST 2014

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

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

27. Red Cross Volunteers

28. Volunteers

Section C. CG Health Services Officer Training Matrix.

1. Introduction

2. Table 1-C-1 CG Medical Officer Training Matrix

3. Table 1-C-2 CG Dental Officer Training Matrix

4. Table 1-C-3 CG Leadership Courses Matrix

5. Table 1-C-4 CG Chemical, Biological, Radiological, Nuclear, and Explosive (CBRNE)

Courses Matrix

6. Table 1-C-5 CG Disaster Training 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

CONTENTS 2

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. Non-Federally Employed Civilians 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

CONTENTS 3

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

CONTENTS 4

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

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 7

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. History and Report of OMSEP Examination, Form CG-5447

13. Periodic History and Report of OMSEP Examination, Form CG-5447A

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

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

16. Emergency Care and Treatment, Form SF-558

17. Emergency Medical Treatment Report, Form CG-5214

18. Radiographic Reports, Form SF-519

19. Laboratory Reports

20. Eyewear Prescription, Form DD-771

21. Serology Record, SF-602

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

23. Record of Occupational Exposure to Ionizing Radiation, Form DD-1141

24. Audiogram Results

25. Reference Audiogram, Form DD-2215

CONTENTS 8

26. Hearing Conservation Data, Form DD-2216

27. Chronological Record of Service, Form CG-4057

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

29. Request to Restrict Medical or Dental Information, Form DD2871

30. International Certificate of Vaccination, CDC-731

31. Tissue Examination, Form SF-515

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

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

34. Bloodborne Pathogens Exposure Guidelines, Form CG-6201

35. Examination Protocol for Exposure to: CHROMIUM COMPOUNDS, Form CG-6202

36. Examination Protocol for Exposure to: ASBESTOS, Form CG-6203

37. Examination Protocol for Exposure to: BENZENE, Form CG-6204 .......………………35

38. Examination Protocol for Exposure to: NOISE, Form CG-6205

39. Examination Protocol for Exposure to: HAZARDOUS WASTE, Form CG-6206

40. Examination Protocol for Exposure to: LEAD, Form CG-6207

41. Examination Protocol for Exposure to: RESPIRATOR WEAR, Form CG-6208

42. Examination Protocol for Exposure to: PESTICIDES, Form CG-6209

43. Examination Protocol for Exposure to: RESPIRATORY SENSITIZERS, Form CG-6210

44. Examination Protocol for Exposure to: BLOODBORNE PATHOGENS, Form CG-6211

45. Examination Protocol for Exposure to: TUBERCULOSIS, Form CG-6212

46. Examination Protocol for Exposure to: SOLVENTS, Form CG-6213

47. Examination Protocol for Exposure to: RADIATION, Form CG-6214

48. How to Calculate a Significant Threshold Shift, Form CG-6215

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 9

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. Employee Medical Folders.

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

CONTENTS 10

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

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

CHAPTER 10

CONTENTS 15

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

CHAPTER 11

CONTENTS 16

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. General Requirements.

1. Description

2. Enrollment

3. Reporting Requirements

4. Medical Removal Protection

CONTENTS 17

5. Roles and Responsibilities Table 12-A-1

Section B. Administrative Procedures.

1. General

2. Examination Types

3. Use of OMSEP Forms

4. Medical Removal Standards

5. Reporting of Examination Results

Section C. Medical Examination Protocols.

1. General

2. Asbestos, Form CG-6203

3. Benzene, Form CG-6204

4. Chromium Compounds, Form CG-6202

5. Hazardous Waste, Form CG-6206

6. Lead, Form CG-6207

7. Noise, Form CG-6205

8. Pesticides, Form CG-6209

9. Respirator Wear, Form CG-6208

10. Respiratory Sensitizers, Form CG-6210

11. Solvents, Form CG-6213

12. Tuberculosis, Form CG-6212

13. Bloodborne Pathogens, Form CG-6211

14. Radiation (Ionizing/Non-ionizing), Form CG-6214

Table 12-C-1 Table 12-C-2

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

CONTENTS 18

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

Section E. Quality Improvement Implementation Guide (QIIG).

1. Purpose

2. Responsibilities

Section F. National Provider Identifiers.

1. National Provider Identifiers (NPI) Type 1

2. Clinic National Provider Identifiers (NPI) Type 2

Section G. Health Insurance Portability and Accountability Act (HIPAA).

CONTENTS 19

1. Background

2. HIPAA Privacy/Security Officials (P/SO)

3. Permitted Users and Disclosures for Treatment, Payment, and Operations

4. Uses and Disclosures for which Authorization is Required

5. Minimum Necessary Rule

6. Individual Privacy Rights Related to Protected Health Information

7. PHI Disclosure and the Military Mission

8. Accounting for Disclosures

9. Breaches and Unauthorized Uses and Disclosures of Protected Health Information

10. Responding to HIPAA Complaints

11. Electronic Transmission of Protected Health Information

12. HIPAA Training Requirements

Table 13-G-1

13. Other CG Members Who Utilize Protect Health Information

Section H. Quality Improvement Studies.

1. Background

2. Responsibilities

3. Definitions

4. General information

5. QIS Focus

6. QIS Process

7. QIS Report Form

8. Frequency of Quality Improvement Studies

9. Completing the QIS Report Form

10. Follow-up Reporting

11. Integration

12. Filing

Figure 13-H-1

Section I. Peer Review Program.

1. Purpose

2. Characteristics of a Peer Review Program

3. Definitions

4. Responsibilities

5. Process

Section J. Infection Control Program (Exposure Control Plan).

1. Introduction

2. Policy

CONTENTS 20

3. Standard Precautions

4. Precautions for Invasive Procedures

5. Precautions for Medical Laboratories

6. Handling Biopsy Specimens

7. Using and Caring for Sharp Instruments and Needles

8. Infection Control Procedures for Minor Surgery Areas and Dental Operatories

9. Sterilizing and Disinfecting

10. Clinic Attire

11. Storage and Laundering of Clinic Attire, PPE and Linen

12. Cleaning and Decontaminating Blood or Other Body Fluid Spills

13. Infectious Waste

14. Managing Exposures (Bloodborne Pathogen Exposure Control)

15. Training Personnel for Occupational Exposure

Section K. Patient Safety and Risk Management Program.

1. Purpose

2. Informed Consent

3. Adverse Event Monitoring and Reporting

Table 13-K-1

4. Patient Safety Training

Section L. Training and Professional Development.

1. Definitions

2. Unit Health Services Training Plan (In-Service Training)

3. Emergency Medical Training Requirements

4. Health Services Technician "A" School

5. Health Services Technician "C" Schools

6. Continuing Education Programs

7. Long-Term Training Programs

Section M. Patient Affairs Program.

1. Patient Sensitivity

2. Patient Advisory Committee (PAC)

3. Patient Satisfaction Assessment

4. Patient Grievance Protocol

5. Congressional Inquiries

6. Patient Bill of Rights and Responsibilities

CHAPTER 14

MEDICAL INFORMATION SYSTEM (MIS) PROGRAM

CONTENTS 21

Section A. Medical Information Systems (MIS) Plan.

1. Purpose

2. Background

3. Privacy rights

4. Applicability and Scope

5. Objectives

6. Definitions

7. Organizational Responsibilities

Section B. Medical Information System.

1. Background

2. Systems

Section C. Medical Readiness Reporting System (MRRS).

1. Description

2. Recorded tests

3. Questions Related to MRRS

4. Access Instructions

Section D. Medical Information Implementation Guide (MIIG)

1. Background

2. Responsibilities

CONTENTS 22

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 (DO)

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)