Department of Homeland Security United States

Coast Guard

▬▬▬▬▬▬▬▬▬▬▬▬▬▬▬▬▬▬▬ COAST GUARD MEDICAL MANUAL COMDTINST M6000.1E April 2011

This page intentionally left blank

COMMANDANT INSTRUCTION M6000.1E

CommandantUnited States Coast Guard

2100 2ND ST SW STOP 7902Washington DC 20593-7902 Staff Symbol: CG-11 Phone: (202) 475-5173 Fax: (202) 475-5909 COMDTINST M6000.1E APR 29 2011

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 Notice, Instruction, or Manual. Internet release is authorized.

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

4. MAJOR CHANGES. Major changes to this Manual include: updated guidance on the Periodic Health Assessment and incorporation of modernization initiatives, more specifically the Health, Safety, and Work-Life Service Center.

5. PROCEDURES. No paper distribution will be made of this Manual. Official distribution will

be via the Coast Guard Directives System (CGDS) DVD. An electronic version will be located on the following Information and Technology CG-612 web sites Intranet: http://cgweb.comdt.uscg.mil/CGDirectives/Welcome.htm, Internet: http://www.uscg.mil/directives/, and CGPortal: http://cgportal.uscg.mil/delivery/Satellite/CG612.

6. ENVIRONMENTAL ASPECT AND IMPACT CONSIDERATIONS. Environmental

considerations were examined in the development of this Manual and have been determined not to be applicable.

DISTRIBUTION – SDL No. 158

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 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 B 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 C 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 D 1 1 1 1 1 1 1 1 1 1 1 1 1 1 E 1 1 1 1 1 1 1 F 1 1 1 G 1 1 1 H

http://cgweb.comdt.uscg.mil/CGDirectives/Welcome.htmhttp://www.uscg.mil/directives/http://cgportal.uscg.mil/delivery/Satellite/CG612

COMDTINST M6000.1E

2

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 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. RECORDS MANAGEMENT. All data/documents created for Coast Guard use and delivered to, or falling under the legal control of the Coast Guard are Federal records. Ensure that all records created as a result of processes prescribed in this directive are maintained and disposed of in accordance with the Coast Guard Information and Life Cycle Management Manual, COMDTINST M5212.12 (series).

9. 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/, CG Central at http://cgcentral.uscg.mil/, and Intranet at http://cgweb2.comdt.uscg.mil/CGFORMS/Welcome.htm.

Mark J. Tedesco /s/ Director of Health, Safety, and Work-Life

http://www.uscg.mil/forms/http://cgcentral.uscg.mil/http://cgweb2.comdt.uscg.mil/CGFORMS/Welcome.htm

RECORD OF CHANGES

CHANGE NUMBER

DATE OF CHANGE

DATE ENTERED

BY WHOM ENTERED

This page intentionally left blank.

CONTENTS 1

Medical Manual Table of Contents

CHAPTER 1

ORGANIZATION AND PERSONNEL

Section A. Organization.

1. Mission of the CG Health Services Program .......................................................................1 2. Director of Health, Safety, and Work-Life ..........................................................................1 3. Health, Safety, and Work-Life Service Center (HSWL SC) ...............................................3 4. Responsibilities of Commands with Health Care Facilities ................................................5

5. Governance ..........................................................................................................................5

Section B. Personnel.

1. Chief of the Clinical Staff ....................................................................................................1 2. Collateral Duty Command Surgeons ...................................................................................1 3. Regional Manager (RM) ......................................................................................................1 4. Regional Practice Director (RPD) .......................................................................................3 5. Regional Practice Senior Medical Executives (SME) .........................................................3 6. Regional Practice Senior Dental Executive (SDE) ..............................................................5 7. Regional Practice Senior Independent Duty Health Services Technician (SIDHS) ............6 8. Regional Pharmacy Executive (RPE) ..................................................................................6 9. Senior Health Services Officer (SHSO) ..............................................................................6 10. General Duties of Medical Officers .....................................................................................7 11. Duties of Flight Surgeons ..................................................................................................13 12. General Duties of Dental Officers .....................................................................................15 13. General Duties of Pharmacy Officers ................................................................................17 14. HSWL SC Pharmacy Officers ...........................................................................................18 15. Environmental Health Officers ..........................................................................................19 16. Clinic Administrators .........................................................................................................21 17. Physician Assistants (PA) and Nurse Practitioners (NP) ...................................................23 18. Contract Health Care Providers .........................................................................................25 19. TRICARE Management Activity-Aurora (TMA) Liaison Officer ....................................25 20. Health Services Technicians ..............................................................................................26 21. Health Services Technicians - with a Dental Qualification Code (13) ..............................28 22. Independent Duty Health Services Technicians (IDHS) ...................................................29 23. CG Beneficiary Representatives at Uniformed Services Medical Treatment

Facilities (USMTF) ............................................................................................................33 24. CG Representative at the Department of Defense Medical Examination Review

Board (DODMERB) ..........................................................................................................35 25. Health Benefits Advisors (HBA) .......................................................................................36 26. Dental Hygienists ...............................................................................................................38 27. Red Cross Volunteers ........................................................................................................39

CONTENTS 2

28. Volunteers ..........................................................................................................................39 Section C. CG Health Services Officer Training Matrix.

1. Introduction ..........................................................................................................................1 Tables. Table 1-C-1 CG Medical Officer Matrix……………………………………. ...........................1 Table 1-C-2 CG Dental Officer Matrix………………………………………………... ...........2 Table 1-C-3 CG Leadership Courses Matrix………………………………………….. ............3 Table 1-C-4 CG Chemical, Biological, Radiological, Nuclear, and Explosive (CBRNE) Courses Matirx ............................................................................................................4 Table 1-C-5 CG Disaster Training Matrix .............................................................................….5

CHAPTER 2

HEALTH CARE AND FACILITIES Section A. Health Care for Active Duty Personnel.

1. Care at Uniformed Services Medical Treatment Facilities ..................................................1 2. Emergency Care ...................................................................................................................3 3. Dental Care and Treatment ..................................................................................................6 4. Consent to and Refusal of Treatment .................................................................................11 5. Elective Surgery for Pre-Existing Defects .........................................................................13 6. Elective Health Care ..........................................................................................................13 7. Other Health Insurance (OHI) ...........................................................................................14 8. Procedures for Obtaining Non-Emergent Health Care from Nonfederal Sources .............15 9. Obtaining Vasectomies and Tubal Ligations from Nonfederal Providers .........................17 10. Care at Department of Veterans Affairs (DVA) Medical Facilities ..................................17 11. HIPAA and the Uses and Disclosures of Health Information of Active Duty

Personnel ............................................................................................................................18

Section B. Health Care for Reserve Personnel.

1. Eligibility for Emergency Treatment at any DOD, CG or Civilian Medical Facility ..........1 2. Care at Uniformed Services Medical Treatment Facilities ..................................................1 3. Non-Emergent Care at Other Than CG or DOD Facilities ..................................................3

Section C. Health Care for Retired Personnel.

1. Care at Uniformed Services Medical Treatment Facilities ..................................................1 2. Care under TRICARE Standard and Extra (formerly CHAMPUS) ....................................1 3. Care at Veterans Administration Medical Facilities ............................................................1

CONTENTS 3

Section D. Health Care for Dependents.

1. Care at Uniformed Services Medical Treatment Facilities ..................................................1 2. Referral for Civilian Medical Care (DD-2161) ...................................................................1 3. Rights of Minors to Health Care Services ...........................................................................2

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

1. General .................................................................................................................................1 2. Secretary's Designation ........................................................................................................1

Section F. Health Care for Other Persons.

1. Members of the Auxiliary ....................................................................................................1 2. Temporary Members of the Reserve ....................................................................................1 3. Members of Foreign Military Services ................................................................................2 4. Federal Employees ...............................................................................................................3 5. Seamen .................................................................................................................................3 6. Non-Federally Employed Civilians Aboard CG Vessels.....................................................3 7. Civilians Physical Exams prior to Entry to the CG .............................................................4

Section G. Medical Regulating.

1. Transfer of Patients at CG Expense .....................................................................................1 2. Travel Via Ambulance of Patients to Obtain Care ..............................................................1 3. Aeromedical Evacuation of Patients ....................................................................................1

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

1. Defense Enrollment Eligibility Reporting System ..............................................................1 2. Responsibilities ....................................................................................................................1 3. Performing DEERS Checks .................................................................................................1 4. Eligibility/Enrollment Questions, Fraud and Abuse ............................................................2 5. Denial of Non-emergency Health Care Benefits for Individuals Not Enrolled in

Defense Enrollment Eligibility Reporting System (DEERS) ..............................................3 6. DEERS Eligibility Overrides ...............................................................................................3

Section I. Health Care Facility Definitions.

1. CG Facilities ........................................................................................................................1 2. Department of Defense Medical Facilities ..........................................................................2 3. Uniformed Services Military Treatment Facilities (USMTFs) ............................................2

CONTENTS 4

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

1. Administrative Policies and Procedures ..............................................................................1 2. Operational Policies and Procedures ...................................................................................1 3. Patient Rights .......................................................................................................................2 4. Health Care Provider Identification .....................................................................................3

Section K. General Standards of Care.

1. Standard of care ...................................................................................................................1 2. Diagnosis and therapy ..........................................................................................................1 3. Bases for Diagnoses .............................................................................................................1 4. Treatment .............................................................................................................................1 5. Time Line for Treatment ......................................................................................................1 6. Correct-site Surgery Policy ..................................................................................................2 7. Patients role ..........................................................................................................................2 8. Documentation .....................................................................................................................2

CHAPTER 3

PHYSICAL STANDARDS AND EXAMINATION

Section A. Administrative Procedures

1. Applicability of Physical Standards .....................................................................................1 2. Prescribing of Physical Standards ........................................................................................1 3. Purpose of Physical Standards………………………………………………........... ..........1 4. Application of Physical Standards…………………………………………………. ..........1 5. Interpretation of Physical Standards……………………………………………….. ..........2 6. Definitions of Terms Used in this Chapter ..........................................................................2 7. Required Physical Examinations and Their Time Limitations ............................................3 8. Waiver of Physical Standards ............................................................................................10 9. Substitution of Physical Examinations ..............................................................................12

Section B. Medical Examination (DD-2808) and Medical History (DD-2807-1)

1. Report of Medical Examination DD-2808 ...........................................................................1 2. Report of Medical History DD-2807-1 ................................................................................1 3. Findings and Recommendations of Report of Medical Examination (DD-2808) ...............1 4. Correction of Defects Prior to Overseas Transfer or Sea Duty Deployment .......................5 5. Objection to Assumption of Fitness for Duty at Separation ................................................5 6. Separation Not Appropriate by Reason of Physical Disability ............................................6 7. Procedures for Physical Defects Found Prior to Separation ................................................6

CONTENTS 5

Figure 3-B-1 .................................................................................................................................7 Figure 3-B-2 .................................................................................................................................8

Section C. Medical Examination Techniques and Lab Testing Standards

1. Scope ....................................................................................................................................1 2. Speech Impediment ..............................................................................................................1 3. Head, Face, Neck, and Scalp (Item 17 of DD-2808) ...........................................................1 4. Nose, Sinuses, Mouth, and Throat (Item 19, 20 of DD-2808).............................................2 5. Ears (General) and Drums (Item 21, 22 of DD-2808) .........................................................2 6. Eyes (General), Ophthalmoscopic, and Pupils (Item 23, 24, 25 of DD-2808) ....................3 7. Ocular Mobility (Item 26 of DD-2808) ...............................................................................5 8. Heart and Vascular System (Item 27 of DD-2808) .............................................................5 9. Lungs and Chest (Item 28 of DD-2808) ..............................................................................9 10. Anus and Rectum (Item 30 of DD-2808) ..........................................................................11 11. Abdomen and Viscera (Item 31 of DD-2808) ...................................................................11 12. Genitourinary System (Item 32 of DD-2808) ....................................................................11 13. Extremities (Item 33, 34, 35 of DD-2808) .........................................................................12 14. Spine and Other Musculoskeletal (Item 36 of DD-2808) ..................................................14 15. Identifying Body Marks, Scars, and Tattoos (Item 37 of DD-2808) .................................15 16. Neurologic (Item 39 of DD-2808) .....................................................................................16 17. Psychiatric (Item 40 of DD-2808) .....................................................................................17 18. Endocrine System ..............................................................................................................18 19. Dental (Item 43 of DD-2808) ............................................................................................18 20. Laboratory Findings ...........................................................................................................19 Figure 3-C-1 ...............................................................................................................................25 21. Height, Weight and Body Build.........................................................................................26 22. Distant Visual Acuity and Other Eye Tests .......................................................................26 23. Audiometer ........................................................................................................................33 24. Psychological and Psychomotor ........................................................................................33 Figure 3-C-2 ...............................................................................................................................34 Figure 3-C-3 ...............................................................................................................................37 Figure 3-C-4 ...............................................................................................................................38

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

1. Scope……………………………………………………………………………........ ........1 2. Medical Standards………………………………………………………………….... ........1 3. Policy………………………………………………………………………………... ........2 4. Responsibilities of Commandant (CG-11)………………………………………...............2 5. Height………………………………………………………………………………... ........3 6. Weight……………………………………………………………………………….. ........3 7. Head…………………………………………………………………………………. ........3 8. Eyes………………………………………………………………………………….. ........3 9. Vision………………………………………………………………………………... ........7 10. Ears………………………………………………………………………………….. ........8

CONTENTS 6

11. Hearing .................................................................................................................................8 12. Nose, Sinuses, Mouth and Larynx .......................................................................................9 13. Dental .................................................................................................................................10 14. Neck ...................................................................................................................................11 15. Lungs, Chest Wall, Pleura, and Mediastinum ....................................................................11 16. Heart ...................................................................................................................................13 17. Abdominal Organs and Gastrointestinal System ...............................................................16 18. Female Genitalia ................................................................................................................19 19. Male Genitalia ....................................................................................................................20 20. Urinary System ..................................................................................................................21 21. Spine and Sacroiliac Joints ................................................................................................22 22. Upper Extremities ..............................................................................................................23 23. Lower Extremities ..............................................................................................................25 24. Miscellaneous Conditions of the Extremities ....................................................................27 25. Vascular System.................................................................................................................28 26. Skin and Cellular Tissues...................................................................................................29 27. Blood and Blood-Forming Tissues ....................................................................................31 28. Systemic .............................................................................................................................31 29. Endocrine and Metabolic ...................................................................................................34 30. Neurologic..........................................................................................................................35 31. Learning, Psychiatric, and Behavioral ...............................................................................37 32. Tumors and Malignancies ..................................................................................................40 33. Miscellaneous ....................................................................................................................40 Figure 3-D-1 Evaluation for Risk OF Head Injury Sequelae ...................................................42 Figure 3-D-2 Classification and Comparative nomenclature of Cervical Smears ....................43

Section E. Physical Standards for Programs Leading to Commission

1. Appointment as Cadet, USCG Academy .............................................................................1 2. Commissioning of Cadets ....................................................................................................2 3. Enrollment as an Officer Candidate .....................................................................................2 4. Commissioning of Officer Candidates .................................................................................3 5. Coast Guard Direct Commission Program ..........................................................................4 6. Direct Commission in the CG Reserve ................................................................................4 7. Direct Commission of Licensed Officers of U. S. Merchant Marine ..................................4 8. Appointment to Warrant Grade ...........................................................................................4

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………………………………………………………………… .........1 2. Use of List of Disqualifying Conditions and Defects………………………………. .........1 3. Head and Neck……………………………………………………………………… .........2 4. Esophagus, Nose, Pharynx, Larynx, and Trachea………………………………….. .........2

CONTENTS 7

5. Eyes ......................................................................................................................................2 6. Ears and Hearing ..................................................................................................................5 7. Lungs and Chest Wall ..........................................................................................................5 8. Heart and Vascular System ..................................................................................................7 9. Abdomen and Gastrointestinal System ................................................................................9 10. Endocrine and Metabolic Conditions (Diseases) ...............................................................11 11. Genitourinary System ........................................................................................................12 12. Extremities .........................................................................................................................14 13. Spine, Scapulae, Ribs, and Sacroiliac Joints......................................................................17 14. Skin and Cellular Tissues...................................................................................................18 15. Neurological Disorders ......................................................................................................19 16. Psychiatric Disorders. (See section 5-B concerning disposition) ......................................20 17. Dental .................................................................................................................................21 18. Blood and Blood-Forming Tissue Diseases .......................................................................21 19. Systemic Diseases, General Defects, and Miscellaneous Conditions................................22 20. Tumors and Malignant Diseases ........................................................................................23 21. Sexually Transmitted Diseases ..........................................................................................23 22. Human Immunodeficiency Virus (HIV) ............................................................................23 23. Transplant recipient ...........................................................................................................24

Section G. Physical Standards for Aviation

1. Classification of Aviation Personnel ...................................................................................1 2. General Instructions for Aviation Examinations .................................................................1 3. Restrictions Until Physically Qualified ...............................................................................4 4. Standards for Class l ............................................................................................................4 5. Candidates for Flight Training .............................................................................................7 6. Requirements for Class 2 Aircrew .....................................................................................10 7. Requirements for Class 2 Medical Personnel ....................................................................10 8. Requirements for Class 2 Technical Observers .................................................................11 9. Requirements for Class 2 Air Traffic Controllers ..............................................................11 10. Requirements for Landing Signal Officer (LSO) ..............................................................11 11. Refractive Surgery .............................................................................................................12 12. Contact Lenses ...................................................................................................................13

Section H. Physical Examinations and Standards for Diving Duty

1. Examinations........................................................................................................................1 2. Standards ..............................................................................................................................2

CONTENTS 8

CHAPTER 4

HEALTH RECORDS AND FORMS

Section A. Health Records.

1. Purpose and Background .....................................................................................................1 2. Contents of the Health Record .............................................................................................1 3. Custody of Health Records ..................................................................................................4 4. Opening Health Records ......................................................................................................6 5. Checking out the Health Record ..........................................................................................7 6. Terminating Health Records ..............................................................................................10 7. Creating an Additional Volume .........................................................................................13 8. Lost, Damaged, or Destroyed Health Records ...................................................................13 9. Accuracy and Completeness Check ...................................................................................14

Section B. Health Record Forms. FORM TITLE

1. CG-3443 Health Record Cover .......................................................................................1 2. CG-5266 Drug Sensitivity Sticker ..................................................................................2 3. DD-2766 Adult Preventive and Chronic Care Flowsheet Form .....................................2 4. SF-513 Consultation Sheet ..........................................................................................3 5. SF-507 Medical Record ...............................................................................................4 6. DD-2795 Pre-Deployment Health Assessment ...............................................................4 7. DD-2796 Post-Deployment Health Assessment .............................................................4 8. DD-2900 Post-Deployment Health Re-Assessment .......................................................4 9. CG-6020 Medical Recommendation for Flying .............................................................5 10. DD-2808 Report of Medical Examination ......................................................................5 11. DD-2807-1 Report of Medical History ............................................................................11 12. CG-5447 History and Report of OMSEP Examination ................................................15 13. CG-5447A Periodic History and Report of OMSEP Examination .................................18 14. CG-5684 Medical Board Report Cover Sheet ..............................................................19 15. SF-600 Chronological Record of Medical Care ........................................................19 16. SF-558 Emergency Care and Treatment ....................................................................22 17. CG-5214 Emergency Medical Treatment Report .........................................................23 18. SF-519 Radiographic Reports....................................................................................25 19. Laboratory Reports ............................................................................................................26 20. DD-771 Eyewear Prescription ....................................................................................26 21. SF-602 Syphilis Record .............................................................................................28 22. OF-522 Authorization for Anesthesia, Operations, etc. .............................................28 23. DD-1141 Record of Occupational Exposure to Ionizing Radiation .............................28 24. Audiogram Results.............................................................................................................30 25. DD-2215 Reference Audiogram ...................................................................................30

CONTENTS 9

26. DD-2216 Hearing Conservation Data ...........................................................................30 27. CG-4057 Chronological Record of Service ..................................................................30 28. DD-2870 Authorization for Disclosure of Medical or Dental Information ..................31 29. DD-2871 Request to Restrict Medical or Dental Information ......................................31 30. PHS-731 International Certificate of Vaccination ........................................................31 31. SF-515 Tissue Examination .......................................................................................32 32. DD-877 Request for Medical/Dental Records or Information ....................................32 33. CG-6100 Modified Screening For: Overseas Assignment and/or Sea Duty

Health Screening ...........................................................................................33 34. CG-6201 Bloodborne Pathogens Exposure Guidelines ................................................33 35. CG-6202 Examination Protocol for Exposure to: CHROMIUM

COMPOUNDS ............................................................................................ 33 36. CG-6203 Examination Protocol for Exposure to: ASBESTOS...................................33 37. CG-6204 Examination Protocol for Exposure to: BENZENE ............………………33 38. CG-6205 Examination Protocol for Exposure to: NOISE. ..........................................33 39. CG-6206 Examination Protocol for Exposure to: HAZARDOUS WASTE ...............33 40. CG-6207 Examination Protocol for Exposure to: LEAD. ...........................................33 41. CG-6208 Examination Protocol for Exposure to: RESPIRATOR WEAR .................33 42. CG-6209 Examination Protocol for Exposure to: PESTICIDES ................................34 43. CG-6210 Examination Protocol for Exposure to: RESPIRATORY

SENSITIZERS ..............................................................................................34 44. CG-6211 Examination Protocol for Exposure to: BLOODBORNE

PATHOGENS. ..............................................................................................34 45. CG-6212 Examination Protocol for Exposure to: TUBERCULOSIS .........................34 46. CG-6213 Examination Protocol for Exposure to: SOLVENTS. .................................34 47. CG-6214 Examination Protocol for Exposure to: RADIATION. ...............................34 48. CG-6215 How to Calculate a Significant Threshold Shift ...........................................34

Section C. Dental Records Forms. FORM TITLE

1. CG-3443-2 Dental Record Cover .......................................................................................1 2. NAVMED 6600/3 Dental Health Questionnaire ...............................................................2 3. SF-603 Dental Record .................................................................................................2 4. SF-603-A Dental Continuation ......................................................................................14 5. SF-513 Consultation Sheet ........................................................................................14 6. Lost Dental Records ...........................................................................................................14 7. Special Dental Records Entries ..........................................................................................14 8. Dental Examination Requirements ....................................................................................14 9. Recording of Dental Treatments on Chronological Record of Care, SF-600 ....................15

Section D. Dental Records Forms. 1. Purpose and Background .....................................................................................................1 2. Contents of Clinical Records ...............................................................................................2 3. Extraneous Attachments ......................................................................................................3

CONTENTS 10

4. Opening Clinical Records ....................................................................................................3 5. Terminating Clinical Records ..............................................................................................4 6. Custody of Clinical Records ................................................................................................4 7. Safekeeping of Clinical Records ..........................................................................................4 8. Transfer of Clinical Records ................................................................................................4 9. Lost Damaged or Destroyed Clinical Records .....................................................................5

Section E. Employee Medical Folders.

1. Purpose and Background .....................................................................................................1 2. Custody of Employee Medical Folders (EMF’s) .................................................................1 3. Contents of the Employee Medical Folders .........................................................................2 4. Accountability of Disclosures ..............................................................................................3 5. Opening Employee Medical Folder .....................................................................................3 6. Terminating Employee Medical Folders .............................................................................3 7. Transferring to Other Government Agencies ......................................................................4 8. Lost, Damaged, or Destroyed Employee Medical Folders ..................................................4 9. Employee Medical Folder, SF-66 D ....................................................................................4

Section F. Inpatient Medical Records.

1. Purpose and Background .....................................................................................................1 2. Maintenance and Storage .....................................................................................................2 3. Disposition of IMRs .............................................................................................................3 4. Inpatient Medical Record Forms and Required Entries .......................................................4

Section G. Mental Health Records.

1. Active duty ...........................................................................................................................1 2. Non-active duty ....................................................................................................................1 3. Psychiatric Evaluation Format .............................................................................................1 4. Custody of Mental Health Records ......................................................................................1

CHAPTER 5

DEATHS AND PSYCHIATRIC CONDITIONS

Section A. Deaths.

1. General .................................................................................................................................1 2. Duties of health services department ...................................................................................1 3. Determining Cause of Death ................................................................................................1

CONTENTS 11

4. Death Certificates for Deaths Occurring Away From Command or in Foreign Ports .....................................................................................................................................1

5. Relations with Civilian Authorities .....................................................................................2 6. Reporting Deaths to Civilian Authorities ............................................................................2 7. Death Forms for Civilian Agencies and Individuals ............................................................2 8. Identification of Remains .....................................................................................................2

Section B. Psychiatric Conditions.

1. General .................................................................................................................................1 2. Personality Disorders ...........................................................................................................1 3. Adjustment Disorders ..........................................................................................................2 4. Organic Mental Disorders ....................................................................................................2 5. Psychoactive Substance Use Disorders ...............................................................................3 6. Schizophrenia .......................................................................................................................3 7. Psychotic Disorders Not Elsewhere Classified ....................................................................4 8. Delusional (Paranoid) Disorder ...........................................................................................4 9. Neurotic Disorders ...............................................................................................................4 10. Mood Disorders ...................................................................................................................4 11. Anxiety Disorders (or Anxiety and Phobic Neuroses) ........................................................5 12. Somatoform Disorders .........................................................................................................5 13. Dissociative Disorders (or Hysterical Neuroses, Dissociative Type) ..................................5 14. Sexual Disorders ..................................................................................................................6 15. Sexual Dysfunctions ............................................................................................................6 16. Factitious Disorders .............................................................................................................7 17. Disorders of Impulse Control Not Elsewhere Classified .....................................................7 18. Disorders Usually First Evident in Infancy, Childhood, or Adolescence ............................7 19. Psychological Factors Affecting Physical Condition ..........................................................9 20. V Codes for Conditions Not Attributable to a Mental Disorder that are a Focus of

Attention or Treatment .........................................................................................................9 21. Additional Codes ...............................................................................................................10

Section C. Command directed Mental Health Evaluation of Coast Guard Service members.

1. Active Duty Mental Health Evaluation Protection ..............................................................1 2. Emergency Evaluations .......................................................................................................1 3. Non-emergent Mental Health Evaluation ............................................................................1 4. Service Member’s Rights .....................................................................................................2 5. Things Not To Do ................................................................................................................2 6. Evaluations NOT covered ....................................................................................................3 7. Memorandum Requesting a Mental Health Evaluation .......................................................3

CONTENTS 12

CHAPTER 6

MEDICAL READINESS/DEPLOYMENT HEALTH

Section A. Overview.

1. Purpose .................................................................................................................................1 2. Responsibilities ....................................................................................................................1 3. Individual Medical Readiness ..............................................................................................1 4. Standard Definitions and Scoring ........................................................................................1 5. Medically Ready ..................................................................................................................3 6. Deployment Definitions .......................................................................................................3

Section B. Expeditionary Deployment.

1. Electronic Deployment Health Assessment (EDHA) ..........................................................1 2. Responsibility and timeline for the EDHA ..........................................................................1 3. EDHA Overview ..................................................................................................................1 4. EDHA Healthcare Provider Review Process .......................................................................1 5. Pre-Deployment Requirements ............................................................................................2 6. Deployment ..........................................................................................................................3 7. Post-Deployment..................................................................................................................3 8. DD-2900, Post-Deployment Health Reassessment via the EDHA (see above) ..................4 9. Compliance Program ...........................................................................................................4

Section C. Routine Deployment.

1. Pre Deployment Requirements ............................................................................................1 2. Deployment ..........................................................................................................................1 3. Post-Deployment..................................................................................................................1 4. Additional References ..........................................................................................................2

CHAPTER 7

PREVENTIVE MEDICINE

Section A. General.

1. Scope ....................................................................................................................................1 2. Responsibilities ....................................................................................................................1

CONTENTS 13

Section B. Communicable Disease Control.

1. General .................................................................................................................................1 2. Disease Outbreak .................................................................................................................1 3. Medical Event Reporting .....................................................................................................1 4. Figure 7-B-1 Medical Event Reporting Chart Within 24 Hours ..........................................3 5. Figure 7-B-2 Medical Event Reporting Chart Within 7 Days .............................................4 6. Sexually Transmitted Infection (STI) Program ...................................................................5 7. STI Treatment ......................................................................................................................7 8. STI Drug Prophylaxis ..........................................................................................................7 9. STI Immunizations ...............................................................................................................7 10. STI Reporting.......................................................................................................................7

SECTION C. IMMUNIZATIONS AND ALLERGY IMMUNOTHERAPY (AIT)

1. General .................................................................................................................................1 2. Unit Responsibilities ............................................................................................................1 3. Equipment and Certification Requirement ..........................................................................1 4. Immunization Site Responsibilities .....................................................................................1 5. Immunization on Reporting for Active Duty for Training ..................................................4 6. Specific Vaccination Information ........................................................................................4

CHAPTER 8

FISCAL AND SUPPLY MANAGEMENT Section A. Resource Management.

1. Unit’s Commanding Officers Responsibility.......................................................................1 2. Health, Safety, and Work-Life Service Center (HSWL SC) ...............................................2 3. CG Headquarters ..................................................................................................................2

Section B. General Property Management and Accountability.

1. Basic Policies .......................................................................................................................1 2. Physical Property Classifications .........................................................................................1 3. Property Responsibility and Accountability ........................................................................1 4. Expending Property Unnecessarily ......................................................................................1 5. Stock Levels, Reorder Points, and Stock Limits ..................................................................1 6. Transferring and Loaning Property ......................................................................................3

Section C. Custody, Issues, and Disposition.

1. Transferring Custody ...........................................................................................................1 2. Storerooms ...........................................................................................................................1

CONTENTS 14

3. Issuing Material ...................................................................................................................1 4. Inspecting Storerooms .........................................................................................................1 5. Disposing of Property ..........................................................................................................2

Section D. Health Services Supply System.

1. Health Services Control Point ..............................................................................................1 2. Responsibility for General Stores Items ..............................................................................1 3. Supply Support Assistance ..................................................................................................1 4. Authorized Allowances ........................................................................................................2 5. Supply Sources.....................................................................................................................2 6. Health Care Equipment ........................................................................................................3 7. Emergency Procurement ......................................................................................................4 8. Factors for Replacing Equipment ........................................................................................4

Section E. Eyeglasses and Ophthalmic Services.

1. General .................................................................................................................................1 2. Personnel Authorized Refractions .......................................................................................1 3. Procuring and Issuing Standard Prescription Eyewear ........................................................1 4. Aviation Prescription Lenses ...............................................................................................3 5. Contact Lenses .....................................................................................................................3 6. Sunglasses for Polar Operations ..........................................................................................4 7. Safety Glasses ......................................................................................................................4

CHAPTER 9

HEALTH SERVICES TECHNICIANS ASSIGNED TO INDEPENDENT DUTY

Section A. Independent Duty Afloat.

1. Introduction ..........................................................................................................................1 2. Mission and Responsibilities ...............................................................................................1 3. Providing Health Care Afloat ..............................................................................................5 4. Training ..............................................................................................................................13 5. Supply and Logistics ..........................................................................................................17 6. Health Services Department Administration .....................................................................23 7. Combat Operations ............................................................................................................26 8. Environmental Health ........................................................................................................27

CONTENTS 15

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

1. Introduction ..........................................................................................................................1 2. Mission and Responsibilities ...............................................................................................1 3. Chain Of Command .............................................................................................................2 4. Operation of the Health Services Division ..........................................................................2 5. Providing Health Care ..........................................................................................................5 6. Training ................................................................................................................................9 7. Supply and Logistics ..........................................................................................................11 8. Health Services Department Administration .....................................................................17 9. Search and Rescue (SAR) Operations ...............................................................................20 10. Environmental Health ........................................................................................................20

Section C. Independent Duty in Support of Deployable Specialized Forces (DSF)

1. Introduction ..........................................................................................................................1 2. Mission and Responsibilities ...............................................................................................1 3. Chain Of Command .............................................................................................................2 4. Operation of the Health Services Division ..........................................................................2 5. Providing Health Care ..........................................................................................................5 6. Training ..............................................................................................................................10 7. Supply and Logistics ..........................................................................................................12 8. Health Services Department Administration .....................................................................18 9. Tactical Operations ............................................................................................................21 10. Environmental Health ........................................................................................................21

Section D. Quality Improvement Compliance Program (QICP)

1. Background ..........................................................................................................................1 2. Purpose .................................................................................................................................1 3. Overview ..............................................................................................................................1 4. Program Elements ................................................................................................................1 5. Collaborative Program .........................................................................................................2 6. Monitoring the QICP ...........................................................................................................2 7. Assistance Program ..............................................................................................................2 8. Responsibility ......................................................................................................................2 9. QI Compliance Checklist .....................................................................................................3 10. Compliance Certification Standards ....................................................................................3 11. Post Survey ..........................................................................................................................4

Section E. Independent Duty Management of TRICARE

1. Introduction ..........................................................................................................................1 2. Discussion ............................................................................................................................1 3. Access to Care ......................................................................................................................1

CONTENTS 16

4. Access to Care Standards .....................................................................................................1 5. Enrollment............................................................................................................................2 6. Resources .............................................................................................................................2

CHAPTER 10

PHARMACY OPERATIONS AND DRUG CONTROL

Section A. Pharmacy Administration.

1. Responsibilities ....................................................................................................................1 2. Prescribers ............................................................................................................................4 3. Prescriptions .........................................................................................................................6 4. Prescribing in the Medical Record .......................................................................................8 5. Signatures ...........................................................................................................................11 6. Dispensing..........................................................................................................................11 7. Labeling .............................................................................................................................16 8. Drug Stock .........................................................................................................................17 9. Credit Return Program (Reverse Distribution Program) ...................................................19

10. Pharmacy and Therapeutics Committee ............................................................................20 11. Figure 10-A-1 Clinic Non-Prescription Medication Program ...........................................22

Section B. Controlled Substances.

1. General .................................................................................................................................1 2. Custody and Controlled Substance Audits ..........................................................................1 3. Drug Enforcement Administration (DEA) Registration ......................................................4 4. Reporting Theft or Loss .......................................................................................................4 5. Procuring, Storing, Transferring, and Disposing of Controlled Substances ........................5 6. Prescribing Practices ............................................................................................................7

Section C. Forms and Records.

1. General .................................................................................................................................1 2. Prescription Forms ...............................................................................................................1 3. Quality Control Forms .........................................................................................................2 4. Controlled Drug Forms ........................................................................................................2 5. Forms Availability ...............................................................................................................5

Section D. Drug Dispensing Without a Medical Officer. 1. General .................................................................................................................................1 2. Child-Resistant Containers ..................................................................................................1 3. Controlled Substances ..........................................................................................................1 4. Formulary .............................................................................................................................1

CONTENTS 17

5. Non-prescription Medication Program ................................................................................2

CHAPTER 11

HEALTH CARE PROCUREMENT

Section A. Contracting For Health Care Services.

1. General .................................................................................................................................1 2. Type of Services ..................................................................................................................1 3. Eligibility For Contract Health Care Services .....................................................................2 4. Approval to Contract for Services .......................................................................................2 5. Funding ................................................................................................................................3 6. Pre-contract Award Actions .................................................................................................4 7. Award Evaluation Factors ....................................................................................................6 8. Post-Contract Award Actions ..............................................................................................6

Section B. Health Care Services Invoice Review and Auditing.

1. General .................................................................................................................................1 2. Invoices Subject to Review and Audit .................................................................................1 3. Review and Audit Procedures ..............................................................................................1 4. Report of Potential Third Party Liability (RCN 6000-2) .....................................................2

Section C. Claims Processing.

1. General .................................................................................................................................1 2. Certification .........................................................................................................................1 3. Administrative Screen ..........................................................................................................1 4. Technical Screen ..................................................................................................................2 5. Appropriateness Review ......................................................................................................3 6. Peer Review .........................................................................................................................4 7. Guidelines for Initial Appropriateness and Peer Reviews ...................................................5

CHAPTER 12

OCCUPATIONAL MEDICAL SURVEILLANCE AND EVALUATION PROGRAM (OMSEP)

Section A. General Requirements.

1. Description ...........................................................................................................................1 2. Enrollment............................................................................................................................1 3. Reporting Requirements ......................................................................................................3

CONTENTS 18

4. Medical Removal Protection ................................................................................................4 5. Roles and Responsibilities ...................................................................................................4

Section B. Administrative Procedures.

1. General .................................................................................................................................1 2. Examination Types ..............................................................................................................1 3. Use of OMSEP Forms .........................................................................................................5 4. Medical Removal Standards ................................................................................................6 5. Reporting of Examination Results .......................................................................................6

Section C. Medical Examination Protocols.

1. General .................................................................................................................................1 2. Asbestos, CG-6203 ..............................................................................................................1 3. Benzene, CG-6204 ...............................................................................................................4 4. Chromium Compounds, CG-6202 .......................................................................................6 5. Hazardous Waste, CG-6206........................................................................... ......................8 6. Lead, CG-6207 ...................................................................................................................10 7. Noise, CG-6205 and CG-6215...................................................................... .....................12 8. Pesticides, CG-6209 ...........................................................................................................17 9. Respirator Wear, CG-6208............................................................................ ....................19 10. Respiratory Sensitizers, CG-6210 ......................................................................................21 11. Solvents, CG-6213 .............................................................................................................23 12. Tuberculosis, CG-6212 ......................................................................................................26 13. Bloodborne Pathogens, CG-6211................................................................. .....................27 14. Radiation (Ionizing/Non-ionizing), CG-6214 ....................................................................32

CHAPTER 13

QUALITY IMPROVEMENT

Section A. Quality Improvement Program.

1. Mission .................................................................................................................................1 2. Background ..........................................................................................................................1 3. Internal Quality Assurance Reviews ....................................................................................1 4. External Quality Improvement Reviews ..............................................................................1 5. Goals ....................................................................................................................................2 6. Operational Health Readiness Program (OHRP) .................................................................2 7. Objectives ............................................................................................................................2 8. Definitions............................................................................................................................3 9. Responsibilities ....................................................................................................................4 10. Confidentiality Statement ....................................................................................................7

CONTENTS 19

11. QIP Review and Evaluation .................................................................................................7 Section B. Credentials Maintenance and Review.

1. Background ..........................................................................................................................1 2. Definitions............................................................................................................................1 3. Pre-selection Credentials Review ........................................................................................2 4. Provider Credentials File (PCF)...........................................................................................3 5. Documentation .....................................................................................................................4 6. Verification ..........................................................................................................................5 7. Contract Provider Credentials Review .................................................................................6 8. Reverification .......................................................................................................................6 9. National Practitioner Data Bank (NPDB) ............................................................................7 10. National Provider Identifiers Type 1 (NPI) .........................................................................7

Section C. Clinical Privileges.

1. Purpose .................................................................................................................................1 2. Background ..........................................................................................................................1 3. Definitions............................................................................................................................1 4. Applicability and Scope .......................................................................................................3 5. Clinical Privileges ................................................................................................................4

Section D. Operational Health Readiness Program.

1. Background ..........................................................................................................................1 2. Purpose .................................................................................................................................1 3. Overview ..............................................................................................................................1 4. OHRP Compliance Process .................................................................................................2

Section E. Quality Improvement Implementation Guide (QIIG).

1. Background ..........................................................................................................................1 2. Responsibilities ....................................................................................................................1

Section F. National Provider Identifiers.

1. National Provider Identifiers (NPI) Type 1 ........................................................................1 2. Clinic National Provider Identifiers (NPI) Type 2 ..............................................................1

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

1. Background ..........................................................................................................................1 2. HIPAA Privacy/Security Officials (P/SO)...........................................................................1 3. HIPAA Training Requirements ...........................................................................................4

CONTENTS 20

4. Handling HIPAA Complaints and Mitigation .....................................................................7 5. Unintentional Disclosures of Protected Health Information ................................................9 6. Protected Health Information and the Coast Guard Messaging System ............................10 7. Other CG Members Who Utilize Protected Health Information .......................................10 8. Electronic Transmission of Protected Health Information ................................................11

Section H. Quality Improvement Studies.

1. Background ..........................................................................................................................1 2. Responsibilities ....................................................................................................................1 3. Definitions............................................................................................................................1 4. General information .............................................................................................................2 5. QIS Focus.............................................................................................................................2 6. QIS Process ..........................................................................................................................2 7. QIS Report Form..................................................................................................................2 8. Frequency of Quality Improvement Studies ........................................................................2 9. Completing the QIS Report Form ........................................................................................2 10. Follow-up Reporting ............................................................................................................5 11. Integration ............................................................................................................................5 12. Filing ....................................................................................................................................5

Section I. Peer Review Program.

1. Background ..........................................................................................................................1 2. Characteristics of a Peer Review Program ...........................................................................1 3. Responsibilities ....................................................................................................................1 4. Process .................................................................................................................................2 5. Definitions............................................................................................................................2

Section J. Infection and Exposure Control Program.

1. Introduction ..........................................................................................................................1 2. Policy ...................................................................................................................................2 3. Standard Precautions ............................................................................................................2 4. Precautions for Invasive Procedures ....................................................................................5 5. Precautions for Medical Laboratories ..................................................................................6 6. Handling Biopsy Specimens ................................................................................................6 7. Using and Caring for Sharp Instruments and Needles .........................................................7 8. Infection Control Procedures for Minor Surgery Areas and Dental Operatories ................8 9. Sterilizing and Disinfecting ...............................................................................................14 10. Clinic Attire .......................................................................................................................19 11. Storage and Laundering of Clinic Attire, PPE and Linen ..................................................19 12. Cleaning and Decontaminating Blood or Other Body Fluid Spills ...................................20 13. Infectious Waste.................................................................................................................20 14. Managing Exposures (Bloodborne Pathogen Exposure Control) ......................................21

CONTENTS 21

15. Training Personnel for Occupational Exposure .................................................................26 Section K. Patient Safety and Risk Management Program.

1. Purpose .................................................................................................................................1 2. Informed Consent.................................................................................................................1 3. Adverse Event Monitoring and Reporting ...........................................................................4 4. Patient Safety Training ........................................................................................................8

Section L. Training and Professional Development.

1. Definitions............................................................................................................................1 2. Unit Health Services Training Plan (In-Service Training) ..................................................1 3. Emergency Medical Training Requirements .......................................................................3 4. Health Services Technician "A" School ..............................................................................4 5. Health Services Technician "C" Schools .............................................................................4 6. Continuing Education Programs ..........................................................................................5 7. Long-Term Training Programs ............................................................................................6

Section M. Patient Affairs Program.

1. Patient Sensitivity ................................................................................................................1 2. Patient Advisory Committee (PAC) ....................................................................................1 3. Patient Satisfaction Assessment ...........................................................................................2 4. Patient Grievance Protocol ..................................................................................................2 5. Congressional Inquiries .......................................................................................................3 6. Patient Bill of Rights and Responsibilities ..........................................................................3

CHAPTER 14

MEDICAL INFORMATION SYSTEM (MIS) PROGRAM

Section A. Medical Information Systems (MIS) Plan.

1. Purpose .................................................................................................................................1 2. Background ..........................................................................................................................1 3. Privacy rights .......................................................................................................................2 4. Applicability and Scope .......................................................................................................4 5. Objectives .........................................