CHAPTER 01 MASTER.A Coast Guard Medical Manual

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MEDICAL MANUAL
COMDTINST M6000.1B
Includes Change 17
U.S. Department
of Transportation
United States
Coast Guard
DISTRIBUTION – SDL No. 139
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 2 2 2 1 1 1 3
B 8 10* 12 5 2 11 2 20613 2260 1
C 1* 1* * 1 * *2 * 1 1 1 1 1
D 3 1 * *11
E
F 111
G *
H
NON-STANDARD DISTRIBUTION:
Commandant
U.S. Coast Guard
2100 2nd Street S.W.
Washington, DC 20593-0001
Staff Symbol: G-WKH-1
Phone: (202) 267-0767
COMDTINST M6000
March 27, 2002
CANCELLED:
March 27, 2003
COMMANDANT NOTICE 6000
Subj: CH-17 TO MEDICAL MANUAL, COMDTINST M6000.1B
1. PURPOSE. This Notice publishes revisions to Medical Manual, COMDTINST M6000.1B. Intended
user of this directive are all Coast Guard Units that maintain Medical Manuals.
2. ACTION. Area and district commanders, commanders of maintenance and logistics commands,
commanding officers of Headquarters units, Assistant Commandants for directorates, Chief Counsel and
special staff offices at Headquarters shall ensure compliance with the provisions of this Notice.
3. DIRECTIVES AFFECTED. Medical Manual, COMDTINST M6000.1B.
4. SUMMARY. Newly revised material and editorial changes are denoted by a line on the outside of the
page. Enclosure (1) summarizes the substantial changes throughout the Manual provided as enclosure
(2).
5. PROCEDURES. No paper distribution will be made of this Manual. Official distribution will be via the
Coast Guard Directives System CD-ROM and the Department of Transportation Website
http://isddc.dot.gov/. An electronic version will also be made available via the Commandant (G-WK)
Publications and Directives website (see # 6, below).
a. Remove and insert the following pages
Remove Insert
Chapter 1 CH-16 pg 39-40 Chapter 1 CH-17 pg 39-40
Chapter 2 CH-16 pg 9-10 Chapter 2 CH-17 pg 9-10
Chapter 3 CH-16 Chapter 3 CH-17
Chapter 4 CH-16 Chapter 4 CH-17
Chapter 7 CH-15 Chapter 7 CH-17
Chapter 8 CH-15 pg 13-14 Chapter 8 CH-17 pg 13-14
Chapter 10 CH-15 pg 17-18 Chapter 10 CH-17 pg 17-18
Chapter 11 CH-15 Chapter 11 CH-17
Chapter 12 CH-16 Chapter 12 CH-17
Chapter 13 CH-13 pg i-iii Chapter 13 CH-17 pg i-iii
Chapter 13 CH-13 pg 11-14 Chapter 13 CH-17 pg 11-14
Chapter 13 CH-13 pg 27-28 Chapter 13 CH-17 pg 27-28
Chapter 13 CH-13 pg 97-104 Chapter 13 CH-17 pg 97-104
Chapter 14 CH-17
6. FORMS AVAILABILITY. All forms listed in this Manual with the exception noted in this paragraph
are available from stock points listed in the Catalog of Forms, COMDTINST 5213.6. Local
reproduction authorized for the Modified Physical Examination. Availability of DD-2808 Report of
Medical Examination and DD-2807-1 Report of Medical History is only by .pdf format, a web link is
provided on the Pubs and Directives web page. Some forms referenced in this Manual are also available
on SWSIII Jet Form Filler. Web links to forms in .pdf format have been provided on the Pubs and
Directives page; http://www.uscg.mil/hq/g-w/g-wk/g-wkh/g-wkh-1/Pubs/Pubs.Direct.htm.
Encl (1) Summary of substantial changes
(2) CH-17 to Medical Manual, COMDTINST M6000.1B
Enclosure (1) to COMDTNOTE 6000.1B
1
CH-17 to Medical Manual, COMDTINST M6000.1B
Chapter 1
Chapter 1-B-21 Adds new sub-section 1-B-21, and provides guidance for (Volunteers).
Chapter 2
Chapter 2-A-6-(4) Provides clarification of Elective Health Care and fitness for duty.
Chapter 3
Chapter 3-A-7-d Provides new guidelines for Overseas Transfer, Sea Duty Deployment and
Port Security Units.
Figure 3-A-1 Revised Modified Physical Exam Form. Form authorized for local
reproduction.
Chapter 3-C Section revised to match sequence of the new DD-2808 (Report of
Medical Exam) and 2807-1 (Report of Medical History). No content was
changed.
Chapter 3-B-1&2 Revised paragraphs to reflect new physical exam forms.
Chapter 3-C-21-
b(9)(b)4 Revised paragraph to read HIV testing is every 5 years.
Chapter 3-C-21-
b(9)(b)8 Added new sub-paragraph to identify tuberculin reactors.
Chapter 3-C-21-b(i) Removed reference to Reportable Disease Data Base (RDDB) no longer
used.
Chapter 3-C-20-
b(9)(e) Revised paragraph to provide narrative summary to be obtained by the
referring medical officer.
Chapter 3-C-
22.j(1)(a)(5) Revised paragraph to reflect update to the process of color perception
testing.
Chapter 3-F-2 Provides new guidance for the List of Disqualifying Conditions and
Defects.
Chapter 3-F-22 Revised definition for Human Immunodeficiency Virus (HIV)
Chapter 3 –G-4-d. Added required self-balancing test for aviation physicals.
Replaced all references to the new DD-2808 (Report of Medical
Examination) and DD-2807-1 (Report of Medical History)
Chapter 3 Chapter layout re-formatted.
Chapter 4
Chapter 4-A-6-b Provides guidance for the transfer of Active Duty Health records.
Chapter 4-A-2(5)(g) Updated section to provide placement of the audiogram microprocessor
test strip in the Health Record.
Chapter 4-B-6 Revised section to delete form SF-88 (Report of Medical Examination)
and replaced form with new form DD-2808 (Report of Medical
Examination)
Chapter 4-B-7 Revised section to delete form SF-93 (Report of Medical History) and
replaced form with DD-2807-1 (Report of Medical History).
Chapter 4-D-8-b Provides guidance for the transfer of Dependant Health Records
Chapter 4-B-3-b(2) Revised section to include NKDA (no known allergies) in section 1-a of
the DD-2766 (Adult Preventive and Chronic Care Flowsheet)
Chapter 4-B-9&10 Revised section to make the DD-2215 (Reference audiogram and DD-
2216 (Hearing Conservation Data Sheet and optional form.
Chapter 4-B-11 Updated section to include placement of audiogram results into the health
record.
Cha
p
ter 4- Reformatted Cha
p
ter 4 addin
g
(
Enclosure
(
1
)
Medical/Dental Record
Enclosure (1) to COMDTNOTE 6000.1B
2
Enclosure (1) Forms(.jpegs)). Developed this new enclosure to prevent having to
download forms, when new text is added to Chapter 4.
Chapter 7
Chapter 7-B-2-b(3) Revised paragraph to send a Coast Guard intranet e-mail message Disease
Alert report.
Figure 7-B-1 Revised List of Reportable Conditions.
Chapter 7-B-3-b Revised subsection (1) to submit Initial Report to MLC(k), copy to
WKH-1.
Figure7-B-3 Revised line 5 to read: Laboratory test done, if any, and results.
Chapter 7-C-4-f Revised paragraph for the administration of vaccines.
Re-formatted Chapter 7 page numbers have changed.
Chapter 8
Chapter 8-E-3.b(2) Removed Optical Fabrication Laboratory form table.
Chapter 10
Chapter 10-B-2-
b(1)(a) Revised paragraph to reduce letters of designation for the Controlled
Substance Audit Board.
Chapter11
Chapter 11-C-3-a(1) Removed reference to CG-5534 (Non-Fed Med form) form removed with
CH-16
Chapter11-C-5-b(2) Removed reference to CG-5534 (Non Fed Med form) form removed with
CH-16
Chapter reviewed for accuracy and re-formatted.
Chapter12
All references to the SF-88 Medical Examination & SF-93 Medical
History have been removed. These forms are replaced with the DD-2808
Report of Medical Examination and DD-2807-1 Report of Medical
History
Chapter12-A-2-c(3) Revised text to include new (Note) section to cover new OMSEP
enrollees.
Chapter 12-C-3-
d(2)b.c.d. Revised text to provide new guidelines for acute exposure examination.
Figure12-C-2 Revised text to include: blood or breath benzene level (optional-if
available)
Chapter12-C-7-d-(5) Revised paragraph to clarify guidance for audiogram STS.
Chapter 12-C-9-d Paragraph revised to clarify Examination protocol.
Chapter12 re-issued, page numbers have changed.
Chapter13
Chapter –13-B-4-f Revised section to provide guidelines for: Proof of current competences.
Chapter 13-B-5-b(4) Revised section to submit documentation of CME credentials every other
year.
Chapter 3-G-1-c(2) Revised paragraph to increase “other element” from 60% to 80%.
Chapter 13-M-2-c(4) Deleted Practicum Guide for HS’s
Chapter 14
Introducing new Chapter 14 - Medical Information System (MIS) Plan
DISTRIBUTION – SDL No.
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 2 2 2 1 1 1 3
B 8 10* 12 5 2 11 2 20613 2260 1
C 1* 1* * 1 * *2 * 1 1 1 1 1
D 3 1 * *11
E
F 111
G *
H
NON-STANDARD DISTRIBUTION:
Commandant
U.S. Coast Guard
2100 2nd Street S.W.
Washington, DC 20593-0001
Staff Symbol: G-WKH-1
Phone: (202) 267-0767
COMDTINST M6000
27 June 2001
COMMANDANT NOTICE 6000
Subj: CH-16 TO MEDICAL MANUAL, COMDTINST M6000.1B
1. PURPOSE. This Notice publishes revisions to Medical Manual, COMDTINST M6000.1B. Intended
user of this directive are all Coast Guard Units that maintain medical Manuals.
2. ACTION. Area and district commanders, commanders of maintenance and logistics commands,
commanding officers of Headquarters units, Assistant Commandants for directorates, Chief Counsel and
special staff offices at Headquarters shall ensure compliance with the provisions of this Notice.
3. DIRECTIVES AFFECTED. Medical Manual, COMDTINST M6000.1B.
4. SUMMARY. Newly revised material and editorial changes are denoted by a line on the outside of the
page. Enclosure (1) summarizes the substantial changes throughout the Manual provided as enclosure
(2).
5. PROCEDURES. No paper distribution will be made of this Manual. Official distribution will be via the
Coast Guard Directives System CD-ROM and the Department of Transportation Website
http://isddc.dot.gov/. An electronic version will also be made available via the Commandant (G-WK)
Publications and Directives website (see # 6, below).
a. Remove and insert the following pages
Remove Insert
Chapter 1 CH-15 Chapter 1 CH-16
Chapter 2 CH-14 Chapter 2 CH-16
Chapter 3 CH-15 Chapter 3 CH-16
Chapter 4 CH-15 Chapter 4 CH-16
Chapter 5 CH-15 Chapter 5 CH-16
Chapter 6 CH-14 Chapter 6 CH-16
Chapter 9 CH-15 Chapter 9 CH-16
Chapter 12 CH-15 Chapter 12 CH-16
6. FORMS AVAILABILITY. All forms listed in this Manual with the exception noted in this paragraph
are available from stock points listed in the Catalog of Forms, COMDTINST 5213.6. The stock number
for DD Form 2766 (Rev 01-00), Adult Preventive and Chronic Care Flowsheet, Sponsor (Navy) is 2766-
0102-LF-984-8400 (pkg 100). The DD-877, Request for Medical/Dental Records no longer has a stock
number. Availability of this form is only by .pdf format, a web link is provided on the Pubs and
Directives web page. Some forms referenced in this manual are also available on SWSIII Jet Form
Filler. Web links to forms in .pdf format have been provided on the Pubs and Directives page;
http://www.uscg.mil/hq/g-w/g-wk/g-wkh/g-wkh-1/Pubs/Pubs.Direct.htm.
JOYCE M. JOHNSON
Director of Health and Safety
Encl (1) Summary of substantial changes
(2) CH-16 to Medical Manual, COMDTINST M6000.1B
1
Enclosure (1) to COMDTNOTE 6000
CH-16 TO MEDICAL MANUAL, COMDTINST M6000.1B
Chapter 1
Chapter 1-B-1.a.i: Specifies the patient will be notified of all abnormal test results.
Chapter 1 Chapter layout re-formatted for uniformity.
Chapter 2
Chapter 2-A-6 Provides guidelines for Elective Health Care.
Chapter 2-A-7 Provides guideline for Other Health Insurance (OHI).
Chapter 2-F-3.a Provides new guidelines for Members of Foreign Military Services.
Chapter 2-I-1-e: Provides definition for Super Sickbay
Chapter 2 Chapter layout re-formatted for uniformity.
Chapter 3
Figure 3-A-1 Revised Overseas Modified Screening to reflect DNA sample.
Figure 3-B-2 Revised to show current routing symbol. Re-added (5) to NOTES.
Chapter 3-B-c.(3) Revised text to read: Upon completion of flight training and assignment to a
Coast Guard unit, the NOMI approved physical will be considered valid until the
last day of the member’s next birth month.
Chapter 3-C-19 Item 18 (Dental) portion of the SF 88, Report of Medical Exam, updated to show
current accession standards in 3-D.
Chapter 3,
Figure 3-C-2 Dental Carious Teeth Standards removed from chapter. Reflects current
standards in section 3-D.
Chapter 3,
Figure 3-C-3 Reduced height standard for (Candidate for Flight Training) from 64 to 62 inches.
Chapter 3-D Revised Section D to reflect DOD Directive 6130.4 dtd Dec 14,2000, P.E.
Standards for Entrance into the Coast Guard.
Chapter 3-F-5- Provides guidelines for Corneal Refractive Surgery.
Chapter 3-F-7-b.(2) Provides new definition for Bronchial Asthma.
Chapter 3-F-8-a.(5) Provides new definition for Myocarditis and degeneration of the myocardium.
Chapter 3-F-8.b.(9) Revised text to read: Any condition requiring anti-thrombotic medication other
than aspirin.
Chapter 3-F-10-a.(8)
& (13) Provides new definition for Crohn’s Disease and Ulcerative Colitis.
3-F-10.e Provides new definition for Diabetes Mellitus.
3-F-15.e Provides new definition for Convulsive Disorders.
3-F-18.e Provides new definition for Purpura and other bleeding diseases.
3-F-22 Revised definition for HIV to read identical to HIV ALCOAST #425/00
3-G-4.d Provides new height standards for Class 1 Aviators (62) inches.
3-G-6.a.(1).(a) Provides new guidelines for anthropometric measurements for Candidates for
Flight Training.
Chapter 3 Chapter layout re-formatted for uniformity
2
Enclosure (1) to COMDTNOTE 6000
Chapter 4
Chapter 4-A-5.a.(8) Provides definition for Custody of Health Records.
Chapter 4-A-6 Provides new guidance for Transfer of Health Records.
Chapter 4-B-3 Provides guidance and adds new form DD-2766 (Adult Preventive and Chronic
Care Flowsheet) Note: Problem Summary List is now obsolete.
Chapter 4-B-32 Provides guidance and adds form DD-877 (Request for Medical/Dental Records
or Information).
Chapter 4-D-8 Provides guidelines for the Transfer of Clinic Records.
4-G Provides guidelines for Mental Health Records (a new section).
Chapter 4 Chapter layout re-formatted for uniformity. Most forms updated to show current
form available as a word document..
Chapter 5
Chapter 5-C Provides new section C. Command directed Mental Health Evaluation of CG
Members.
Chapter 5 Chapter layout re-formatted for uniformity.
Chapter 6
Chapter 6-A-6 Provides new guidance for Inpatient Hospitalization message to include ICD-9
code for diagnosis.
Chapter 6-B-8 Provides guidelines for the DD-2766 Adult Preventive and Chronic Care
Flowsheet.
Removed CG5534 Removed CG 5534 Non Fed Med as per ALCOAST #129/01,
cancellation of COMDTINST 6010.20.
Chapter 6 Chapter layout re-formatted for uniformity.
Chapter 9
Chapter 9-A-4.a.(10) Provides guidelines for unit instruction or SOP in the event of family violence.
Chapter 9-A-
9.b.(2).(a) Provides guidelines for signs on interior surfaces of cutters.
9.A.7.h. Removes the reference to Chapter 10 of the Coast Guard Rescue and Survival
Systems Manual for guidance on inspection and maintenance of the Rescue EMT
Set and requirements for documentation of those procedures in a Preventive
Maintenance Schedule (PMS) log.
9-A-8.b.(2)(f) Removes requirement to maintain a Preventive Maintenance Schedule (PMS) log.
The requirement for this has been removed from the Coast Guard Rescue and
Survival Systems Manual (COMDTINST M10470.10 (series).
Chapter 9 Chapter layout re-formatted for uniformity.
Chapter 12
Chapter 12-A-2.c Provides guidelines for Enrollment Criteria.
Chapter 12-A-3.a.(1) Provides guidance for using the most current OMSEP Physical Form (6-00).
Chapter 12-A-3.b Provides guidance for the OMSEP database.
Chapter 12-A-5 Provides new guidance for Roles and Responsibilities.
Chapter 12-A-5.a Provides new guidance for OMSEP Coordinators.
3
Enclosure (1) to COMDTNOTE 6000
Chapter 12-A-5.e Provides new guidance for Medical Officer’s responsibilities.
Chapter 12-A-5.f Provides guidance for Medical Administrators.
Chapter 12-A-g Provides guidelines for civilian OMSEP enrollees.
Chapter 12-B-2.d.(1)
& (2) Provides new section (1) and (2), End of Exposure guidelines.
Chapter 12-B-2.e Provides guidance for time intervals between OMSEP examinations.
Chapter 12 forms Table 12-C-1 to 12-C-12 were revised and updated to show current requirements.
Chapter 12 Chapter layout re-formatted for uniformity.
RECORD OF CHANGES
CHANGE
NUMBER
DATE OF
CHANGE
DATE
ENTERED
BY
WHOM ENTERED
1-1 CH 16
CHAPTER 1. ORGANIZATION AND PERSONNEL
Section A - Organization.
1. Mission of the Coast Guard Health Services Program.
a. The Health Services Program supports Coast Guard missions by providing quality
health care to maintain a fit and healthy active duty corps, by meeting the health care
needs of dependents and retirees to the maximum extent permitted by law and
resources, and by providing authorized occupational health services to civilian
employees.
2. Director of Health and Safety.
b. Mission. The mission of the Director of Health and Safety is to:
(1) serve as advisor to the Secretary of Transportation;
(2) serve as advisor to the Commandant; and
(3) develop and implement the Coast Guard’s overall health care program.
c. Duties and Responsibilities. Under the general direction and supervision of the
Commandant, Vice Commandant, and the Chief of Staff, the Director of Health and
Safety shall assume the following duties and responsibilities:
(1) serve as Program Director (PD) for the Health Services Program (G-WKH),
and the Safety and Environmental Health Program (G-WKS);
(2) act as advisor to the Commandant in providing counsel and advice on:
(a) health care issues affecting operational readiness and quality of life in the
Coast Guard;
(b) interdepartmental and interservice agreements for health care of Coast
Guard personnel;
(c) the significance of legislative matters affecting the Coast Guard Health
Services and Safety and Environmental Health Programs; and
(d) important developments in the Department of Defense and the
Department of Health and Human Services which affect the Coast Guard
Health Services and Safety and Environmental Health Programs;
(3) serve as advisor to the Secretary in developing and implementing departmental
national defense emergency medical, health, and sanitation policies and plans
(except those involving civil aviation) and such other advisory services that
may be required or requested;
CH 16 1-2
(4) plan, develop, and administer a comprehensive, high quality health care
program (quality is defined as the desired level of performance against
established standards and criteria) for all authorized beneficiaries;
(5) plan, develop and administer a comprehensive program for the prevention of
illness and injury of Coast Guard personnel and dependents, to reduce losses,
and protect the environment in Coast Guard working facilities and living
spaces/by establishing and maintaining adequate safety and environmental
health standards for aircraft, vessel, shore facilities, and motor vehicle;
providing information and encouragement to beneficiaries for personal
wellness programs and providing healthy and pleasing meals at Coast Guard
dining facilities;
(6) administer TRICARE Management Activity (TMA), including the
appropriation of funds, on behalf of the Coast Guard as provided in the
Dependents Medical Care Act and regulations pursuant thereto;
(7) monitor and protect the health of personnel attached to the Coast Guard
through the Occupational Medical Surveillance and Evaluation Program
(OMSEP);
(8) direct the administration of funds in those appropriations or allotment fund
codes under the control of the Office of Health and Safety, including furnishing
total budget estimates and apportionment or allotment recommendations to the
Chief of Staff;
(9) advise responsible offices concerning establishing physical standards for
military duty and special operational programs;
(10) procure and recommend assignments to the Commander, Coast Guard
Personnel Command (CGPC), and review the performance of Public Health
Service personnel detailed to the Coast Guard;
(11) provide professional health care guidance to all health services personnel;
(12) maintain liaison with the Public Health Service, the Department of Veterans
Affairs, the Department of Defense, and other Federal agencies and serve on
interservice boards and committees as appointed;
(13) set policy and guidelines for the subsistence program;
(14) provide technical advice to operating program managers;
(15) set policy and guidelines for health care quality assurance; and act as the
Governing Body for Coast Guard health care;
(16) set policy and guidelines for the Alcohol Abuse Prevention program; and
(17) serve as a member of the Human Resources Coordinating Council.
(18) administer the Coast Guard Emergency Medical system.
1-3 CH 16
(19) Public Health Service. The responsibility of the Public Health Service for
providing physicians, dentists, and other allied health personnel support to the
Coast Guard is set forth in 42 USC, 253. These personnel are provided on a
reimbursable basis and are subject to Coast Guard regulations and the Uniform
Code of Military Justice (UCMJ).
3. Health and Safety Division, Maintenance and Logistics Commands MLC (k).
a. Mission. The mission of MLC (k) is to:
(1) interpret and implement health care policies as set forth by the Commandant;
(2) develop and implement the Coast Guard’s overall Health Services, and Safety
and Environmental Health Programs for the Area; and
(3) serve as Health Care Advisor to Commander, Maintenance and Logistics
Command.
b. Functions and Responsibilities. Under the direction and supervision of the
Commander, Maintenance and Logistics Command (MLC), the Chief, Health and
Safety Division shall:
(1) act as Medical Advisor to the Area commander in providing counsel and
advice on:
(a) interagency and interservice agreements for health care of Coast Guard
personnel;
(b) the significance of legislative matters affecting the Coast Guard health
care program; and
(c) important developments in the Department of Defense which affect the
Coast Guard health care program.
(2) serve as advisor to the Area commander in developing and implementing
national defense emergency medical, health, and sanitation policies and plans;
(3) plan, develop, and administer a comprehensive health care program for all
beneficiaries;
(4) develop health services mobilization requirements and support documents;
(5) review and act on requests for contract health care services;
(6) act as contract technical representative in reviewing health care contract
proposals;
(7) administer the health care quality assurance program;
(8) administer the Safety and Environmental Health Programs;
(9) administer the Alcohol Abuse Prevention program;
(10) develop and implement pharmaceutical support services;
CH 16 1-4
(11) be responsible for providing funding for direct health care expenditures;
(12) be responsible for the general oversight of health care budgets;
(13) be responsible for the oversight of general clinic policy to include setting
standards for clinic operations and prioritizing of clinic functions;
(14) designate clinics as catchment area patient management sites;
(15) maintain liaison with U. S. Public Health Service, the Department of Veterans
Affairs and the health departments of the Department of Defense and other
Federal agencies within you area of responsibility; and
(16) be responsible for the general oversight of the subsistence program by
providing assistance to Coast Guard units (ashore and afloat) to ensure the
maintenance of high quality food service operations.
c. In addition, the MLC (k)s shall have the right, in coordination with unit commanding
officers, to detail health services personnel (officer and enlisted, Coast Guard and
Public Health Service) for special assignments including meeting short-term staffing
needs.
4. Responsibilities of Commands with Health Care Facilities. Unit commanding officers
shall be responsible for:
a. oversight of clinic procurements;
b. ensuring adherence to policies, military regulations and general administrative
procedures,
c. funding for administrative and non-health care expenditures for clinics;
d. maintenance, repair and general support of clinic facilities;
e. ensuring compliance with action items required by quality assurance site surveys;
and
f. working with the appropriate MLC in fostering quality, productivity, and operating
efficiencies.
1-5 CH 16
Section B.- Personnel.
1. General Duties of Medical Officers. The principal duty of medical officers is to
understand and support the operational missions of the Coast Guard. Medical Officers
include Physicians, Physician Assistants (PA/PYA), and Nurse Practitioners (NP) who
are members of the Coast Guard or Public Health Service detailed to the Coast Guard.
Medical officers are required to have appropriate certification or licensure while assigned
to the Coast Guard. Physicians must have an unrestricted state license to practice
medicine. See 1-B-11 for nurse practitioner and physician assistant credential
requirements. Civilian medical practitioners (under contract to the Coast Guard or GS
employees) assigned to a medical treatment facility are considered medical officers to the
limits defined by the language of their contract and/or job description. Civilian medical
practitioners who have a contract with the Coast Guard to see patients in their private
offices are not considered medical officers for the purpose of this instruction.
a. General Responsibilities.
(1) Medical officers must keep informed in all fields of general and military
medicine and shall:
(a) ensure the fitness for unrestricted worldwide duty of active duty
personnel;
(b) provide health care for all eligible beneficiaries as authorized by
applicable laws and regulations;
(c) make appropriate referrals of eligible beneficiaries following existing
policy and regulation;
(d) treat sick and injured personnel;
(e) prevent and control disease;
(f) promote health;
(g) give advice on such matters as hygiene, sanitation, and safety;
(h) recommend duty status of active duty personnel and Coast Guard civil
service employees;
(i) ensure that each patient is notified of results of all PAP smears,
mammograms, biopsies, pregnancy tests, and all tests that are abnormal
or whose results indicate a need to initiate or change treatment.
(j) thoroughly understand all operational missions of the unit, units within
the local area, and the human factors involved in performing them;
CH 16 1-6
(k) ensure that personnel are physically and psychologically fit for duty and
attempt to learn of any unusual circumstances which might adversely
affect their proficiency;
(l) maintain an active interest and participate in the local unit’s safety
program, assist the safety officers in planning, implementing, and
coordinating the unit safety program, and advise the command on safety
issues;
(m) be thoroughly familiar with the types of personal protective and survival
equipment carried at the unit. Assist the engineering officer in
maintaining and issuing the equipment, and be familiar with the Rescue
and Survival System Manual, COMDTINST M10470.10 (series);
(n) actively participate in the unit physiology training program to ensure that
personnel are capable of coping with the hazards of mission performance
by presenting lectures and demonstrations which include, but are not
limited to:
1 fatigue
2 emergency medicine,
3 survival,
4 disorientation,
5 night vision,
6 stress, and
7 drug and alcohol use and abuse.
(o) ensure that HSs who participate in EMT operations maintain their
certification, knowledge and Health Services skills in EMT operations,
physiology;
(p) provide Health Services refresher training on emergency procedures; and
(q) participate in a program of continuing education in operational medicine
including familiarity with information published for other branches of the
Armed Forces.
(2) Medical officers act as medical members in physical disability evaluation
cases.
(3) Medical officers are responsible for advising commanding officers on: health
status of personnel; nutritional adequacy, food handling and preparation;
1-7 CH 16
heating, ventilation, and air conditioning; housing; insect, pest, and rodent
control; water supply and waste disposal; safety; items sold in exchanges,
commissaries, and other CGES facilities; the physical fitness of personnel; and
immunization standards.
b. Physical Examinations. Medical officers shall conduct physical examinations in
accordance with Section 3-C of this Manual and in cases involving disability
evaluation be guided by the Physical Disability Evaluation System, COMDTINST
M1850.2 (series), and the Department of Veterans Affairs Publication, Physician’s
Guide for Disability Evaluation Examinations.
c. Reports to Command. Report injuries to, or deaths of, personnel; damage,
destruction, or loss of health services department property; and any other important
occurrence, to the officer of the day or other command official for entry into
appropriate log. Report any suspected child/spouse abuse to the commanding officer,
family advocacy representative, and local law enforcement/child protective agency in
accordance with Family Advocacy Program, COMDTINST 1750.7 (series), and
other local, state, or Federal law. Report patients in serious or critical condition to
the commanding officer or officer of the day, together with the information needed to
notify the next of kin. Death imminent procedures are contained in the Physical
Disability Evaluation System, COMDTINST M1850.2 (series).
d. Educational Measures. Conduct health education programs, including disseminating
information about preventing disease and other subjects pertaining to hygiene and
sanitation.
(1) Sexually Transmitted Diseases. Conduct or supervise the instruction of
personnel regarding sexually transmitted diseases and advise them of the
associated dangers.
(2) First Aid Instruction. Conduct or supervise a program which will ensure
knowledge and ability in first aid.
(3) Occupational Medical Surveillance and Evaluation Program (OMSEP).
Conduct or supervise a program to indoctrinate personnel in the various aspects
of occupational health and the OMMP.
(4) Human Immunodeficiency Virus (HIV). Conduct or supervise the instruction
of personnel regarding (HIV) and advise them of the associated dangers.
(5) Wellness. Conduct or supervise a program to emphasize the importance of
life-styles in maintaining health.
(6) Human Services. Conduct or supervise the instruction of Health Services
personnel to ensure they are aware of all the services available to maintain a
state of well being for personnel.
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e. Cooperation With Other Agencies. Cooperate with Federal, state,
and local agencies for preventing disease, reporting communicable diseases, and
collecting vital statistics.
f. Designated Supervising Medical Officer (DSMO). Medical officers assigned as
“designated supervising medical officer” (DSMO) will assume clinical responsibility
for the treatment provided by each health services technician in their clinic for whom
they are responsible. Assignments shall be made in writing and signed by the
DSMO’s commanding officer. Clinical supervision and accountability is defined as
follows:
(1) during normal clinic hours, HS consultation with the DSMO as determined by
that medical officer, review 20 percent of each day’s new patient encounters
seen only by the HS, and review 100 percent of all patient encounters seen only
by the HS who return with no improvements. (Ideally these reviews would
include the patient’s presentation to the medical officer.) The DSMO shall
countersign all records reviewed.
(2) outside normal clinic hours, direct or telephone consultations as determined by
the DSMO or duty MO; and, the following working day, a review of 100
percent of all visits seen only by the HS. The DSMO or duty MO shall
countersign all records reviewed.
g. Designated Medical Officer Advisor (DMOA). Health Services Technicians on
independent duty (IDTs) shall have a “designated medical officer advisor” (DMOA)
identified. The DMOA shall provide professional advice and consultation to the
IDT. The cognizant MLC (k) shall apportion units with IDTs to units with medical
officers attached. The cognizant MLC (k) shall make changes as necessary and
forward such information to the affected units and Commandant (G-WKH). At the
unit level, assignments shall be made in writing (addressed to the DMOA) and
signed by the DMOA’s commanding officer, with copies to the IDT unit and the
cognizant MLC (k). Assignment letters shall be addressed to the specific individuals
involved, and new letters shall be issued following a change of DMOA or IDT.
Professional advice and consultation, in this instance, is defined as follows:
(1) Telephone or radio consultation regarding specific cases as necessary between
the HS and the DMOA. This does not preclude consultation between the HS
and another Coast Guard medical officer, a medical officer of the Army, Navy,
Air Force, or USPHS, or a physician under contract to the Coast Guard whose
contract provides for such consultations; and
(2) Treatment record review: At the end of each quarter, the commanding officer
of the independent duty HS or his designee (cannot be the HS) shall select at
random 15 health records which have at least one entry made by the HS during
the previous quarter. For each of these records, copies shall be made of all SF
600 entries during the quarter. Copies of the SF-600's shall be sealed in an
envelope and marked for the DMOA's Eyes Only. The copies are then
forwarded to the DMOA for review. The DMOA shall review these record
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entries according to established criteria for record review at his/her facility.
Each record entry (copy) shall be annotated “reviewed,” dated, and stamped
with the DMOA’s name and pertinent comments concerning the record entry.
One copy of the reviewed record entries shall then be returned to the HS via
the unit’s commanding officer. A second copy of the reviewed entries shall be
retained by the DMOA. Both the HS and DMOA copies shall be retained at
the respective commands for a period of three years, for MLC review during
QA site surveys. The record review shall be discussed with the HS in the
quarterly phone contact between the DMOA and the HS. The DMOA is
encouraged to provide input to the unit CO or XO regarding the professional
performance of the independent duty HS.
(3) Review of MLC quality assurance site survey reports for the independent duty
site: The DMOA and HS shall review the MLC quality assurance site reports
for the site. They shall collaborate on the required written plan of corrective
actions which must be submitted to the MLC following the site survey. The
DMOA should also consult with the unit commanding officer regarding the
findings of the survey report.
2. Duties of Senior Medical Officers. The senior medical officer attached to a unit is
responsible to the commanding officer of the unit for the provision of health services. In
addition to the general duties of a medical officer, the senior medical officer is
responsible for:
a. performing those duties as prescribed in Coast Guard Regulations, COMDTINST
M5000.3 (series) if designated by Commander, Coast Guard Personnel Command
(CGPC) as division chief;
b. advising the commanding officer of any deleterious environmental health factors;
c. supervising any assigned PYA/PAs and NPs including, on a monthly basis, random
review of approximately five percent of the PYA/PA/NP’s charts for adequacy and
appropriateness of treatment rendered;
d. in the absence of a pharmacy officer, maintaining antidotes for narcotics and poisons
and ensuring only properly trained personnel are assigned to the pharmacy;
e. acting as the commanding officer’s representative on local emergency planning
boards, and, during emergencies or disasters, furnishing advice to the commanding
officer, formulating plans, and helping civilian authorities meet health care needs;
f. managing the quality of health care services provided;
g. maintaining liaison with the hospital commander or senior medical officer of nearby
(75 miles) USMTF’s;
h. acting as quality assurance technical supervisor for all contracted health services;
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i. ensuring efficient and effective use of all assigned medical officers and civilian
consultants;
j. preparing, through training and experience, health services technicians for
independent duty assignments;
k. recommending to the command a designated supervising medical officer (DSMO)
for each HS who provides medical treatment to patients; and
l. convening medical boards as appropriate in accordance with Chapter 3, Physical
Disability Evaluation System, COMDTINST M1850.2 (series)
m. ensuring that all ancillary service areas (e.g., laboratory, radiology, etc.) maintain
adequate policy and procedures manuals;
n. in conjunction with the MLC, providing professional oversight and establishing
qualifications standards and privileging for assigned personnel, including contract,
reserve and student providers;
o. assigning personnel and ensuring position and billet descriptions are accurate and
that credentials and privileging requirements are met;
p. within general Coast Guard and unit guidelines, determining the priority and range of
services for each beneficiary group;
q. maintaining liaison with counterparts in MTF, USTF, VA and private sector
facilities;
r. preparing performance appraisals for assigned staff;
s. reviewing and ensuring accuracy of Clinic Automated Management System
(CLAMS) and other statistical and informational reports;
t. ensuring that appropriate training is conducted on a regularly scheduled basis;
u. ensuring active participation and compliance with the Quality Assurance Program;
v. ensuring strict adherence to current infection control procedures and standards;
w. keeping the division chief informed;
x. other duties assigned by the Chief, Health Services Division.
3. Duties of Flight Surgeons. In addition to fulfilling the general duties of medical officers,
flight surgeons must:
a. thoroughly understand all operational missions of the aviation unit and participate as
a flight crew member as required on MEDEVACS and to meet the requirements as
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set forth in the Coast Guard Air Operations Manual, COMDTINST M3710.1
(series);
b. be familiar with the operational missions of other Coast Guard units in the local area;
c. obtain a general understanding of the flight characteristics of the aircraft assigned to
the unit and be thoroughly familiar with the human factors involved in pilot and crew
member interaction with the aircraft;
d. be familiar with the Air Operations Manual, COMDTINST M3710.1 (series), with
specific emphasis on Chapter 6, Rescue and Survival Equipment; Chapter 7, Flight
Safety; and the sections of Chapter 3 (Flight Rules) dealing with protective clothing
and flotation equipment;
e. ensure that aviation personnel are physically and psychologically fit for flight duty
and attempt to learn of any unusual circumstances which might adversely affect their
flight proficiency, this includes getting acquainted with each pilot and crew member;
f. make recommendations to the commanding officer concerning the health status of
aviation personnel, and in particular, only a flight surgeon or aviation medical officer
(AMO) shall issue “up” chits, except as noted in Section 3-G-2;
g. maintain an active interest and participate in the air station flight safety program and
assist the flight safety officer in planning, implementing, and coordinating the station
flight safety program, and advising the command on the aeromedical aspects of flight
safety;
h. participate as the medical member of Aircraft Mishap Analysis Boards and, when so
assigned, be responsible for completing the Medical Officer’s Report in accordance
with Chapter 2 of Safety and Environmental Health Manual, COMDTINST
M5100.47 (series);
i. be thoroughly familiar with the types and uses of personal pro-protective and
survival equipment carried on aircraft at the unit [The flight surgeon shall assist in
inspecting the equipment, shall advise the engineering officer and aviation survival
members in maintaining and issuing the equipment, and shall be familiar with
Rescue and Survival Systems Manual, COMDTINST M10470.10 (series)];
j. actively participate in the unit aviation physiology training program to ensure that
aviation personnel are capable of coping with the hazards of flight by presenting
lectures and demonstrations which include, but are not limited to:
(1) fatigue,
(2) emergency medicine,
(3) survival,
(4) disorientation,
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(5) night vision,
(6) reduced barometric pressure,
(7) crash injury avoidance,
(8) stress, and
(9) drug and alcohol use and abuse.
k. advise the command on MEDVAC operations:
l. ensure that HSs who participate in aviation operations maintain their knowledge and
skills in aeromedical physiology, and provide refresher training lectures and
demonstrations to emergency medical technicians (EMTs) and health services
technicians on emergency medical procedures; and
m. participate in a program of continuing education in aviation medicine including
familiarity with information published for flight surgeons by other branches of the
Armed Forces.
4. General Duties of Dental Officers. The principal duty of dental officers is to support the
Coast Guard operational mission by determining each member’s fitness for unrestricted
duty on a worldwide basis. Coast Guard dental officers are assigned to perform duties as
general dental officers. Exceptions will be authorized in writing by Commander, Coast
Guard Personnel Command (CGPC).
a. General Responsibilities.
(1) Coast Guard dental officers must stay informed in all fields of general and
military dentistry and be responsible for:
(a) ensuring the fitness for unrestricted duty of active duty personnel on a
worldwide basis;
(b) providing dental care for all eligible beneficiaries as authorized be
applicable laws and regulations (ensure non-enrollment in United
Concordia or Delta Dental before providing covered services);
(c) preventing and controlling dental disease (this includes performing
dental prophylaxis);
(d) promoting dental health;
(e) referring eligible beneficiaries for dental treatment per MLC (k) SOP;
(f) prioritizing the delivery of dental care to meet Coast Guard unit
operational readiness requirements;
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(g) ensuring that patients with gingivitis or periodontal disease have the
opportunity to receive follow up care;
(h) ensuring that results of all biopsies are received and reviewed by a dentist
to ensure that the appropriate action is taken;
(i) ensuring that when dental externs are assigned to the clinic, that a
protocol is developed detailing lodging and subsistence arrangements,
types of procedures allowed, available population to be treated and
supervising dental officer responsibilities. The protocol must be signed
by the Commanding Officer and provided to all participating dental
schools;
(j) ensuring that procedures for handling medical emergencies within the
dental clinic are clearly written and emergency drills are practiced
periodically; and
b. Dental examinations. Dental officers shall conduct the dental examination portion of
physical examinations in accordance with Chapter 3 of this Manual. Dental
examinations shall be conducted as soon as practical on personnel who report for
duty so as to determine the need for dental treatment and to verify their dental
records. Annual Type 2 dental examinations shall be conducted on all active duty
personnel collocated with dental examiners (i.e., Coast Guard DOs, DOD DOs, or
civilian contract dentists).
c. Care of Mass Casualties. Dental officers shall be qualified to perform first aid
procedures in order to treat or assist in treating mass casualties.
d. State Licensure. While assigned with the Coast Guard, dental officers are required to
have an unrestricted state license to practice dentistry.
e. Continuing Education. Participate in a program of continuing training in operational
medicine/dentistry including familiarity with information published for other
branches of the Armed Forces.
5. General Duties of Senior Dental Officers. The senior dental officer is responsible for:
a. performing duties outlined in Coast Guard Regulations, COMDTINST M5000.3
(series) if designated by Commander, Military Personnel Command as division chief;
b. conducting an organized preventive dentistry and dental health education program
for all eligible beneficiaries;
c. preparing, through training and experience, health services technicians for
independent duty assignments;
d. overseeing the preparation of reports, updating the dental clinic policy and
procedures manual, and maintaining records connected with assigned duties;
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e. overseeing the overall working condition, cleanliness and infection control of the
dental clinic, which includes sterilization procedures, dental supply, equipment,
publications maintenance, and the establishment of a preventive maintenance
program for dental equipment and supplies;
f. maintaining custody, security, and records of the dispensing of dental stores
including all controlled substances and poisons under the cognizance of the dental
branch, and maintaining antidotes for narcotics and poisons;
g. issuing prescriptions for, and supervising the dispensing of controlled substances
used in the dental branch;
h. maintaining custody, security, and records of precious metals dispensed and ensuring
that precious metals are reclaimed as required and necessary forms are filed with the
Department of Treasury;
i. managing the quality of dental care services provided;
j. in conjunction with the MLC (k), providing professional oversight and establishing
qualifications standards and privileging for assigned personnel, including contract,
reserve and student providers;
k. assigning personnel and ensuring position and billet descriptions are accurate and
that credentials and privileging requirements are met;
l. within general Coast Guard and unit guidelines, determining the priority and range of
services for each beneficiary group;
m. maintaining liaison with counterparts in MTF, USTF, VA and private sector
facilities;
n. preparing performance appraisals for assigned staff;
o. and reviewing and ensuring accuracy of CLAMS and other statistical informational
reports;
p. ensuring that appropriate training is conducted on a regularly scheduled basis;
q. ensuring active participation and compliance with the Quality Assurance Program.
r. ensuring strict adherence to current infection control procedures and standards;
s. keeping the division chief informed;
t. other duties assigned by the Chief, Health Services Division.
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6. General Duties of Chief, Health Services Division. The Chief, Health Services Division
will:
a. act as an advisor to the commanding officer regarding all health related matters;
b. under the unit executive officer, carry out the plan of the day as it pertains to the
Health Services Division;
c. ensure that clinic performs Supporting Clinic duties for units designated by the
cognizant MLC in their area of responsibility (AOR) IAW this instruction, cognizant
MLC Instructions and SOP, and other pertinent directives. These duties include but
are not limited to the following:
(1) Ensure the medical/dental readiness of all active duty personnel within their
area of responsibility. This includes the review of health records and
correction of deficiencies issues such as:
(a) Immunizations
(b) physical examinations
(c) annual dental exams
(d) HIV testing
(e) DNA specimen submission
(f) tuberculosis testing
(2) Provide pharmacy oversight to designated units via collateral duty Pharmacy
Officer.
(3) Provide prime vendor pharmaceutical services to designated units via collateral
duty Pharmacy Officers.
(4) Provide prime vendor medical/surgery services to designated units.
(5) Ensure that a Designated Medical Officer Advisor program is in place for
designated units. This should include CPR/Lifesaver training to designated
individuals.
(6) Provide physical examination review (approval/disapproval) to designated
units.
(7) Ensure that health care delivery is provided in a timely manner to units for
which a clinic is designated as their primary management site.
(8) Provide health benefits advice to designated units.
CH 16 1-16
(9) Assist with nonfederal medical and nonfederal dental preauthorization
processing for designated units.
(10) Assist with nonfederal invoice processing for designated units.
(11) Assist with the timely completion of Medical Boards.
d. ensure the medical/dental readiness of all active duty personnel within their area of
responsibility;
e. review the division AFC-30 and AFC-57 budget submittals;
f. be responsible for the allocation of resources (personnel, funds, space, and
equipment) within the division;
g. when directed by the command, represent the division at staff meetings and ensure
timely dissemination of the information to division personnel;
h. prepare performance appraisals as appropriate and ensure that performance
evaluations for all health services personnel are prepared and submitted in
accordance with current directives;
i. review all division reports;
j. be responsible for the division training program, including rotation of personnel
assignments for training and familiarization, in the health care delivery system;
k. oversee clinic policies, procedures and protocols for compliance with this Manual,
COMDTINST M6000.1B, MLC Instructions and S.O.P, and other pertinent
directives;
l. provide oversight with regard to applicable Federal, state, and local statutes and
regulations;
m. seek opportunities for cost reduction and enhancement of patient care through billet
conversions, resource sharing, contracting, etc.;
n. designate a clinic Quality Assurance Coordinator and ensure that the QA program is
carried out;
o. proctor student extern programs;
p. proactively support and promote the command wellness program;
q. participate in health care initiatives with local/regional DOD delivery systems, under
Headquarters and MLC guidance;
r. oversee and promote work-life issues pertaining to health care;
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s. ensure strict compliance to current infection control procedures and standards;
t. serve as chair of the Patient Advisory Committee;
u. oversee DSMO and DMOA programs;
v. in coordination with their respective MLC (k), establish their clinic as a Patient
Management Site for units within their area of responsibility;
w. And perform other duties as directed by the Commanding Officer.
7. General Duties of Pharmacy Officers. While assigned with the Coast Guard, pharmacy
officers are required to have an unrestricted state license to practice pharmacy.
Pharmacy officers shall ensure that medications are acquired, stored, compounded, and
dispensed according to applicable Federal laws in their primary and collateral duty
clinics. This includes the direct supervision and management of the following:
a. dispensing and labeling of all drugs, chemicals, and pharmaceutical products;
b. maintaining signature files for all health care providers;
c. providing patient-oriented pharmaceutical services including monitoring for
appropriate drug therapy, allergies, therapeutic duplication, and medication
interactions. Significant patient interactions should be documented on the SF-600;
d. providing verbal and written patient medication counseling when appropriate;
e. maintaining routinely stocked items at levels consistent with anticipated usage
between regularly scheduled procurements of pharmacy supplies and determining the
most effective expenditure of funds;
f. ensuring that security measures are instituted to prevent unauthorized entrance into
the pharmacy or misappropriation of pharmacy stock;
g. receiving, safeguarding, and issuing all controlled substances as the command-
designated custodian of controlled substances;
h. ensuring adequate quality control of all pharmaceuticals locally compounded;
i. maintaining current drug information files and a reference library of pertinent
textbooks and professional journals;
j. implementing the decisions of the Pharmacy and Therapeutics Committee and serve
as secretary of that committee;
k. inspecting monthly all clinic stocks of drugs and biologicals;
l. developing and maintaining a formulary for local use by medical and dental officers;
CH 16 1-18
m. informing the clinical staff of new drug information, policy changes, or other
pertinent data on drugs;
n. participate in a program of continuing education in pharmacy or related fields;
o. maintaining, updating, and documenting monthly inspections of poison antidote and
emergency drug supplies;
p. providing technical advice to the unit concerning drug testing, substance abuse, and
other pharmaceutical matters;
q. providing guidance and advice to the medical staff on current immunization
requirements,
r. serving as a resource for designated therapeutic categories of medications as they
relate to the Coast Guard Health Services Allowance Lists, Core formulary, HS Drug
Formulary and other drug lists, and.
s. participate in a program of continuing training in operational medicine/pharmacy
including familiarity with information published for other branches of the Armed
Forces.
8. Maintenance and Logistics Command Pharmacy Officers. Under the general direction
and supervision of the Chief, Quality Assurance Branch, MLC, the MLC pharmacy
officer shall:
a. plan, develop and implement, within the resources available, an MLC-wide
pharmacy quality assurance program to:
(1) eview and evaluate the delivery of pharmaceutical services in support of
mission operations, implement established policies pertaining to
pharmaceutical services, and recommend appropriate changes, and
(2) monitor pharmacy operations, via quality assurance site visits, financial
monitoring, and other workload indicators to ensure optimum utilization of
personnel and financial resources.
b. plan and administer the acquisition and distribution of pharmaceuticals:
(1) review, analyze, and recommend the most efficient and cost effective means
for providing pharmaceutical services throughout the Area, including the
financial resources to be allocated to each operating facility under MLC
oversight;
(2) monitor the procurement of controlled substances by Coast Guard units within
the Area;
(3) provide to MLC (kqa) a system for the random monitoring of drugs procured
from nonfederal sources.
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c. serve as pharmaceutical consultant on pharmacology, pharmacy, and drug utilization
and provide technical pharmacy expertise, assistance, and advice to the MLC
Commander and command elements within the Area;
d. provide guidance and advice regarding the evaluation, training, and justification for
pharmacy personnel to meet operational needs of units within the Area;
e. provide liaison or representation to regional Federal and professional pharmacy
groups and committees; and
f. administer and monitor the collateral duty assignments of pharmacy officers in their
respective Area.
9. Environmental Health Officers.
a. Duties: Environmental health officers are responsible for recognition, evaluation,
and control of biological, chemical, physical, and ergonomic factors or stresses
arising from the environment which may cause sickness, impaired health and well-
being, or significant discomfort and inefficiency, property damage, or which could
adversely affect the Coast Guard’s industrial hygiene, pest management, radiological
health, and sanitation. Specific responsibilities can include:
(1) planning, budgeting, implementing and directing an environmental health
program to support commands within their geographic area of jurisdiction.
(2) conducting environmental health audits of Coast Guard facilities and
operations in order to detect health hazards and noncompliance with applicable
safety and environmental health laws, regulations, standards, and procedures.
Facilities and operations include:
(a) work environments;
(b) storage, handling, treatment, and disposal of hazardous materials and
hazardous waste;
(c) storage, handling, treatment, and disposal of infectious medical waste;
(d) food preparation, service and storage operations;
(e) solid wastes storage, handling, treatment, and disposal;
(f) pest management operations;
(g) potable water treatment, storage and distribution systems;
(h) waste water collection, treatment, and disposal system;
(i) housing facilities;
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(j) ionizing radiation sources;
(k) non-ionizing radiation sources;
(l) recreational facilities;
(m) health care facilities;
(n) child care facilities;
(o) laundry and dry-cleaning operations; and
(p) barber shop operations
(3) providing technical assistance to units to abate deficiencies identified by the
environmental health officer during the audit.
(4) monitoring ongoing hazard abatement actions to ensure that identified hazards
are being eliminated promptly.
(5) providing environmental health training to commands within their jurisdiction.
(6) providing technical assistance to units on request to identify and abate health
risks.
(7) reviewing engineering plans and specifications for new facilities and
modifications to existing facilities to ensure conformance with environmental
health standards and practices.
(8) serving as technical advisor to commands within their jurisdiction.
(9) initiating and conducting special health risk assessment studies.
(10) maintaining liaison with Federal, state, and local government agencies
concerning environmental health for commands within their jurisdiction.
(11) advising commands when medical monitoring data indicates the possibility of
occupationally-induced or aggravated disease and investigating possible causes
so that corrective measures can be initiated.
(12) providing consultation, advice, and training on the occupational medical
monitoring program to Coast Guard commands within their area of
jurisdiction.
(13) enrolling personnel in the OMSEP when they meet the criteria of occupational
exposure as defined in paragraph 12-A-2.
(14) disenrolling personnel from the OMSEP when they do not meet the criteria of
occupational exposure as defined in paragraph 12-B-4.
b. Reports. Environmental health officers shall submit reports to the appropriate MLC
(k) about environmental health conditions observed during their surveys.
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c. Duty Limitations. Environmental health officers shall carry out all management
functions required to operate the safety and environmental health program within
their AOR. They may be required to perform only those technical duties for which
they are trained. They may represent health services at various staff meetings in
matters relating to the management and budgetary aspects of their assignment. They
will be primarily responsible for special studies as in the case of monitoring chemical
spill response and enforcement personnel. They will be responsible to the
Commander, MLC (k) for proper implementation of the safety and environmental
health program.
10. Clinic Administrators. Officers, Chief Warrant Officers (experience indicator 19), or
senior enlisted personnel assigned to manage and administer health care facilities.
a. Under the direction of the Chief, Health Services Division, manage the
administrative functions required to operate the health care facility. The Clinic
Administrator will not be required, nor attempt, to perform clinical duties for which
he/she is not trained.
b. General Responsibilities. The Clinic Administrator will:
(1) plan, supervise, and coordinate general administration of the health services
facility;
(2) prepare, submit, manage, and exercise fiduciary control and accountability over
the health services division AFC-30 and AFC-57 funds;
(3) provide fiscal oversight over the acquisition of equipment and supplies;
(4) maintain a planned program of equipment maintenance and replacement;
(5) provide physical security of health services division supplies and
pharmaceuticals;
(6) maintain liaison with other local agencies (military and civilian) in all health
care related matters;
(7) provide resources to assist medical and dental officers in emergency care of the
sick and injured when necessary;
(8) prepare the disaster preparedness plan as it relates to the health services
division;
(9) prepare the heavy weather bill as it relates to the health services division;
(10) seek opportunities for cost reduction and enhancement to patient care through
billet conversions, resource sharing, contracting, etc.;
(11) serve as an advisor to the chief, health services division on all administrative
matters;
(12) oversee the supervision of enlisted personnel assigned to the health services
division;
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(13) ensure that correspondence, reports, and records comply with appropriate
instructions (i.e. Paperwork Management Manual, Coast Guard
Correspondence Manual, etc.);
(14) maintain an adequate health services division reference library;
(15) train subordinates, conduct classes, instruct enlisted personnel in their duties,
and supervise their study of regulatory and professional publications and
courses for advancement in rating;
(16) participate in a program of continuing education in Health Care
Administration;
(17) assist beneficiaries with health benefits information;
(18) enforce standards of appearance and conduct of health services division
personnel;
(19) ensure that accurate, appropriate data is submitted to the CLAMS information
system, CHCS system, etc.;
(20) oversee clinic rotation assignments of Health Services Technicians;
(21) implement clinic policies, procedures, and protocols, for compliance with
Coast Guard regulations, the Medical Manual, MLC INST/SOP, and other
pertinent directives;
(22) ensure compliance with all applicable Federal, state, and local statutes, together
with the medical, dental and pharmacy officers;
(23) oversee and promote work-life issues pertaining to health care
(24) serve as assistant chair for the Patient Advisory Committee;
(25) ensure that enlisted personnel evaluations for members assigned to the health
services department are prepared and submitted in accordance with the Coast
Guard Personnel Manual;
(26) provide administrative oversight in the areas of NONFED health care,
contracts, and BPAs;
(27) ensure that health care invoices are processed in accordance with MLC
INST/SOP;
(28) ensure that physical examinations comply with current standards;
(29) promote and administer the unit’s environmental sanitation program (in the
absence of an environmental health officer); and
(30) oversee the unit’s Occupational Medical Surveillance and Evaluation Program
(OMSEP), in the absence of an environmental health officer.
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11. Physician Assistants (PA/PYA(s)) and Nurse Practitioners (NP).
a. General Responsibilities. PA/PYA(s) and NP(s) responsibilities are defined in
Section 1-B-1. Under the supervision of the senior medical officer they are subject to
the duty limitations listed below.
b. Duty Limitations.
(1) Senior Medical Officers (SMO) of units with mid-level providers (physician
assistants or nurse practitioners) assigned shall assign clinical duties and
responsibilities to each provider and shall be accountable for the actions of
those providers.
(a) To determine the extent of oversight required, SMOs shall be guided by
this section, the provider’s clinical training and previous experience, by
personal observation, and Chapter 13-C, Clinical Privileges.
(b) The SMO may delegate supervisory responsibility to another staff
physician or certified mid-level provider (mentor). A copy of this
delegation shall be filed in the non-certified provider’s Professional
Credentials File (PCF).
(c) Physicians responsible for supervising mid-level providers shall perform
and document reviews of at least five percent of the mid-level provider’s
charts each calendar month for accuracy of diagnosis and appropriateness
of treatment rendered.
(2) Physician assistants who are not certified by the National Commission on
Certification of Physician Assistants (NCCPA), recent graduates who have not
taken or passed the NCCPA examination, and nurse practitioners who have not
taken or passed a specialty board examination offered by the pertinent nurse
practitioner certifying organization, shall practice in Coast Guard facilities only
under the following conditions:
(a) all health record entries shall be co-signed by a licensed or certified
provider by the end of the next working day;
(b) all prescriptions, except for those on the Coast Guard HS formulary,
shall be co-signed by a licensed or certified provider by the end of the
next working day;
(c) when a supervisory provider is not present at the unit, noncertified mid-
level providers shall be restricted to providing medical care, except for
emergencies, to active duty members only;
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(d) noncertified mid-level providers may stand clinic watches providing a
standby licensed or certified provider is available via telephone to
discuss any questions or concerns; and,
(e) with the exception of operational emergencies, noncertified mid-level
providers are not eligible for independent TAD assignments at locations
where a supervisory provider is not present.
c. Nothing in this section limits PA/PYA's or NP’s access to any available source of
information or advice during an emergency.
12. TRICARE Management Acitivity-Aurora (TMA) Liaison Officer.
a. Responsibilities. The Coast Guard TMA liaison officer maintains liaison between
TRICARE and Commandant (G-W) on matters of policy, operations, and program
administration. This function will not involve the responsibility for formulating
department policies. Departmental policies will continue to be developed by
members of the liaison group for the Uniformed Services Health Benefits Program.
b. Duties.
(1) Specific Duties. Specific duties include, but are not limited to the following:
(a) coordinate and assist, as necessary, in preparing and submitting uniform
workload data for use in budgetary programming at departmental level;
(b) ensure timely notification to Commandant (G-W) concerning changes in
TRICARE operational or administrative procedures;
(c) identify gaps in the TRICARE information program and recommend
solutions;
(d) represent Coast Guard viewpoints on matters relating to TRICARE
operational and administrative procedures;
(e) assist in developing future TRICARE information programs;
(f) keep the Coast Guard informed of problem areas relating to service
beneficiaries and service health care facilities, where appropriate, and
recommend changes which will benefit the TRICARE operation; and
(g) monitor purchases of high-cost equipment for use by TRICARE
beneficiaries and make recommendations concerning future purchases as
opposed to rental.
(2) Duties within TMA Liaison Division.
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(a) Investigate and respond to Presidential, Congressional, and beneficiary
inquiries and complaints. Investigate and respond to inquiries
concerning eligibility.
(b) Make public presentations concerning program benefits to various
groups.
(c) Prepare special studies relating to program activities.
(d) Serve as liaison representative for USPHS, DVA, and NOAA.
(3) Other Duties. Participate in contract performance appraisal visits to the fiscal
administrators. This function involves a comprehensive review and evaluation
of the operations of the civilian agencies which, under contract, administer the
program within each region.
13. Health Services Technicians.
a. Rating Structure. The rating structure for health services technicians is contained in
Group VIII, Enlisted Qualifications Manual, COMDTINST M1414.8 (series).
b. General Duties of Health Services Technicians.
(1) The primary purpose of a health services technician is to provide supportive
services to medical and dental officers and primary health care in the absence
of such officers. In accordance with Paragraph 7-5-4, Coast Guard
Regulations, COMDTINST M5000.3 (series), health services technicians shall
not be detailed to perform combatant duties.
(2) In particular, health services technicians are responsible for all administrative
aspects of health care and health record maintenance for both their command
and subordinate commands without health services personnel attached.
Geographically separate subordinate commands will retain responsibility for
security (i.e. physical custody) of health records. In addition to the military
duties common to all enlisted personnel, health services technicians perform
health services department functions, such as:
(a) respond to calls for emergency medical assistance or evacuations
(MEDEVACS);
(b) maintain appointments and appointment records;
(c) perform occupational medical monitoring duties;
(d) render first aid;
(e) perform tentative diagnosis and emergency treatment (In doing so,
appropriate drugs, oral or injectable, may be administered as required in
emergency situations to prevent or treat shock or extreme pain. In all
CH 16 1-26
other incidents where injection of controlled substances is required,
permission must be obtained from a physician prior to administration. In
either case, the commanding officer shall be notified immediately and
entries shall be made in the patient’s health record.);
(f) provide nursing care where trained;
(g) provide definitive treatment;
(h) provide prophylactic treatments;
(i) instruct crew members in first aid and oral hygiene;
(j) prepare materials (including sterile instruments) and medications for use;
(k) maintain military readiness of the health services division by complying
with the appropriate Health Services Allowance List;
(l) perform administrative procedures in health care matters, maintain health
and dental records current in all aspects;
(m) adhere to regulations, instructions, and control of precious metals,
controlled substances, and poisons;
(n) exercise responsibility for all equipment and stores placed in their
charge, and exercise personal supervision over their condition,
safekeeping, and economic expenditure;
(o) maintain cleanliness of all health services spaces;
(p) provide services as a health benefits advisor; and
(q) assist in the processing of nonfederal health care requests and invoices.
(3) Each HS who provides medical treatment to patients at a Coast Guard clinic
staffed by one or more medical officers shall have a medical officer from that
facility assigned in writing as his/her designated supervising medical officer
(DSMO). The DSMO shall assume responsibility for all clinical treatment
provided by the HS. Each independent duty HS, and HSs assigned to clinics
without a medical officer, shall have a medical officer assigned in writing as
his/her “Designated Medical Officer Advisor” (DMOA), to provide
professional advice and consultation when needed. Refer to 1-B-1.f. and 1-B-
1.g. for further details concerning DSMO/DMOA. Health services technicians
assigned to units without a medical officer shall provide only “first response”
emergency care to non-active duty personnel.
(4) Care shall be taken during medical examinations which involve chest, genital,
and rectal areas to afford maximum privacy and minimum exposure of the
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patient. An attendant of the same gender as the patient may be requested by
the patient during examination or treatment. Health services technicians are
authorized to conduct examinations to include: auscultation, palpation,
percussion, and visual inspection as indicated by the medical complaint.
Exceptions to the above are:
(a) health services technicians shall not perform:
1 routine digital examinations of the prostate;
2 routine examinations through instrumentation of the urethra; or
3 routine gynecological examinations.
(b) such routine examinations shall be referred to a medical officer. In
situations where no medical officer is readily available and such
examination is necessary to provide emergency care, the health services
technician is authorized to do so. If the HS and patient are of different
gender, an attendant of same gender as the patient shall accompany the
patient during the examination or treatment.
(5) Participate in a course of continuing education, either clinical or
administrative, through correspondence courses, resident courses, etc.
14. Health Services Technicians - Dental (HSDs).
a. The primary responsibility of HSDs is to provide chairside assistance to dental
officers.
b. Additional duties include:
(1) Cleansing, sterilization, maintenance, and preparation of dental instruments;
(2) Cleansing, disinfecting, and maintenance of dental equipment and dental
operatories;
(3) Preparing of dental materials;
(4) Assessing, referral, and treatment (under direct supervision of a dental officer)
of common dental conditions;
(5) Charting dental conditions;
(6) Maintaining dental records;
(7) Exposure and development of dental radiographs;
(8) Providing oral hygiene instruction;
(9) Taking impressions and fabricating study models; and
(10) Performance of emergency intervention as necessary.
CH 16 1-28
c. HSDs may be assigned to supplement HS duty sections, HSDs may not stand watch
independently.
15. Independent Duty Health Services Technicians.
a. Duties.
(1) General Duties.
(a) Health services technicians on independent duty perform the
administrative duties and, to the extent for which qualified, the clinical
duties prescribed for medical officers of vessels and stations. (See Coast
Guard Regulations, COMDTINST M5000.3 (series) and Section 1-B of
this Manual.) They shall not attempt nor be required to provide health
care for which they are not professionally qualified. They shall provide
care only for active duty personnel, however they may provide care to
non-active duty patients on an emergency basis. The filling of
prescriptions for other than active duty personnel shall be strictly limited
to emergency situations and to authorized stock on hand under the
allowance list for the unit. They may, under the guidance set forth in
Paragraph 10-A-6-h. of this Manual, establish non-prescription
medication handout programs for eligible beneficiaries.
(b) Health services technicians shall not be detailed to perform combatant
duties in accordance with Paragraph
(c) 7-5-4, Coast Guard Regulations, COMDTINST M5000.3 (series).
(d) In accordance with the Personnel Manual, COMDTINST M1000.6
(series), commanding officers are authorized to use health services
technicians for general duties except noted below:
1 Health services technicians shall not be used for duties that require
bearing arms (except for the limited purposes allowed by the Geneva
Convention for their own defense or protection of the wounded and
sick in their charge) even though the bearing of arms may be purely
ceremonial.
2 Health services technicians shall not be used for combat duties that
are unrelated to health care or administration.
(2) Specific Duties.
(a) Sanitation of the Command. Make daily inspections to ensure that
appropriate sanitation practices are maintained.
(b) Health of Personnel. Establish and maintain a system for determining
those who need immunizations, tuberculin tests, X-rays, dental services,
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and routine physical examinations. The system shall include all return
appointments requested by physicians or dentists from outside referrals
requested by the command.
(c) Care of Sick and Injured. Hold daily sick call. Diagnose and treat
patients within capabilities. When indicated, refer cases to facilities
where medical or dental officers are available or, if this is not practical,
obtain help and advice by radio or other expeditious means.
(d) Procurement, Storage, and Custody of Property. All parts of the Health
Services Allowance List (HSAL) Afloat, COMDTINST
M6700.6(series), and Health Service Allowance List Ashore,
COMDTINST M6700.5 (series) contain information needed for ordering
and procuring supplies. The HSAL also contains procedures for storage
and custody of property.
(e) Reports. Prepare and submit reports required by Chapter 6 of this
Manual and other directives.
(f) Health Records. Maintain health records as required by Chapter 4 of this
Manual. Ensure that all treatment records and/or consults from outside
referrals are obtained and placed in the health record. In addition, ensure
that each patient is notified of all physical exams, consultations, and
diagnostic tests (i.e., pap smears, mammograms, biopsies, x-rays, etc.)
performed at any facility prior to filing in the health record.
(g) Training. Prepare and carry out a program for training non-medical
personnel in first and self-aid, personal hygiene, sexually transmitted
disease prevention, medical aspects of CBR warfare, cardiopulmonary
resuscitation, etc., as part of the unit’s regular training program.
(h) Other Duties. As assigned by the commanding officer.
b. Reporting Procedures.
(1) Policy. Upon reporting for independent duty, the health services technician
shall consult with the commanding officer and executive officer to determine
their policies regarding health care and the administration of the health services
department.
(2) Inventory. Obtain the unit Health Services Allowance List and inspect the
inventory of all health services department equipment, supplies, and
publications. Initiate action for repair, survey, or replenishment of equipment,
supplies, and publications. Verify inventory records and check logs of
controlled substances. Report any discrepancies to the commanding officer
without delay. Amplification of requirements and procedures is contained in
Chapters 8 and 10 of this Manual.
CH 16 1-30
(3) Health Records. Check health records against the personnel roster. Any
missing records should be accounted for or requested from previous duty
stations. If records cannot be accounted for within one month’s time, open a
new health record. Check health records for completeness, and if not current,
obtain and enter all missing information to the fullest extent possible. (See
Chapter 4 of this Manual for instructions pertaining to health records.)
(4) Operational Readiness. Ascertain the state of operational readiness of the
health services department and advise the commanding officer. Operational
readiness refers to the immediate ability to meet all health care demands within
the unit’s capabilities.
c. Responsibilities. The commanding officer is responsible for the health and readiness
of the command. The health services department is charged with advising the
commanding officer of conditions existing that may be detrimental to the health of
personnel and for making appropriate recommendations for correcting such
conditions. Meticulous attention to all details and aspects of preventing disease must
be a continuing program. It is imperative that shipboard and station sanitation and
preventive health practices be reviewed constantly in order that any disease
promoting situation may be discovered immediately and promptly eradicated.
d. Routines.
(1) Daily Routines.
(a) Sickcall. Hold sickcall daily at a time prescribed by the commanding
officer.
(b) Binnacle List. Prepare the unit Binnacle List and submit it to the
commanding officer. (See section 6-B of this Manual for instructions
pertaining to the Binnacle List.)
(c) Inspections. The following shall be inspected daily:
1 coffee messes;
2 living spaces;
3 heads and washrooms;
4 fresh provisions received (particularly milk and ice cream);
5 scullery in operation;
6 drinking fountains;
7 garbage disposals;
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8 sewage disposals;
9 water supplies;
10 and industrial activities. (See Chapter 7 of this Manual and the
Food Service Sanitation Manual, COMDTINST 6240.4(series)).
(d) Testing of Water. Perform water tests for chlorine/bromine content daily
outside of CONUS and at all units that make or chlorinate/brominate
their own water and record the results in the Health Services Log.
Consult the Water Supply and Wastewater Disposal Manual,
COMDTINST M6240.5 (series).
(e) Cleaning. Health services department spaces shall be cleaned daily and
all used instruments cleaned and stored until sterilization can be
accomplished.
(2) Weekly Routines.
(a) Health Services Logs. A health services log shall be kept by all activities
and shall be submitted to the commanding officer for review, approval,
and signature. Section 6-B of this Manual contains the information
needed for maintaining the log.
(b) Inspections. Conduct sanitation inspection of the ship or station with
emphasis on food service, living spaces, and sanitary spaces, specifically
including food handlers, refrigerators and chill boxes, and galley spaces
and pantries. Submit a written report to the commanding officer and
make an appropriate entry in the health services log.
(c) Training. Conduct training in some aspect of health care or treatment
unless required more frequently by the commanding officer or other
directive.
(d) Hold field day.
(e) Resuscitators. Inspect and test resuscitators to ensure proper functioning.
Record results in the health services log.
(3) Monthly Routines.
(a) Reports. Submit all required health services monthly reports, outlined by
Chapter 6 of this Manual and other appropriate directives.
(b) Inspection of Battle Dressing Station Supplies. Monthly, inspect battle
dressing station supplies to ensure adequate and full inventory. Check
sterile supplies and re-sterilize every six months (refer to Health Services
Allowance List Afloat, COMDTINST M6700.6 (series). Replace
CH 16 1-32
expired or deteriorated supplies and materials. Enter an appropriate entry
in the health services log indicating that the inspection was conducted
and the action taken.
(c) First Aid Kits. Inspect hinges and hasps to ensure that they are free from
rust, corrosion, or excessive paint.
(4) Quarterly Routines.
(a) Inventory of Controlled Substances. The Controlled Substances
Inventory Board shall conduct an inventory, as required by Chapter 10 of
this Manual, and submit a written report of the findings to the
commanding officer.
(b) Reports. Submit all required health services reports as outlined in
Chapter 6 of this Manual and other appropriate directives.
(c) Inventory. Conduct a sight inventory of all health services consumable
supplies/equipment as required by Chapter 8 of this Manual and the
Health Services Allowance List.
(d) First Aid Kits. Inspect the contents to ensure adequate and full
inventory. Replace expired and deteriorated supplies and materials.
Make an appropriate entry in the health services log.
16. Coast Guard Beneficiary Representatives at Uniformed Services Medical Treatment
Facilities (USMTF).
a. Duties. Health Services Technicians may be detailed to duty as representatives at
USMTF’s where the Coast Guard patient workload warrants. The purpose of these
assignments is to ensure, for active duty personnel:
(1) that Coast Guard authorities are provided prompt and current information
concerning the status of Coast Guard personnel being treated;
(2) that Coast Guard personnel being treated receive necessary command
administrative support;
(3) that the USMTF use the patient’s Coast Guard health record and that entries
are made in it or on forms that are filed in it; and
(4) that necessary health records and forms either accompany the patient or are
forwarded to the command having custody of the health record.
b. Responsibilities. The representative is responsible for the following:
(1) Notification of Patient Status. It is essential that the representative keep
cognizant command levels advised of the status of Coast Guard patients
admitted for inpatient treatment. The following procedures shall be used:
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(a) notify commands, by the most expedient means possible, within 24 hours
of admission or discharge of members of their command.
(2) Health Record Entries. The representative is responsible for ensuring that all
information concerning inpatient hospitalization, (e.g., admissions, operative
summaries, discharge summaries) which is required to be entered in the health
record, is furnished to the command which maintains the patient’s health
record. The representative shall also make the USMTF aware that all entries or
forms associated with outpatient medical and dental activity must be entered in
the patient’s Coast Guard health record.
(3) Copies of Forms. The USMTF is responsible for completing and furnishing at
least one copy of the following forms to the representative. The representative
is responsible for preparing any additional copies needed.
(a) Inpatient hospitalizations:
1 SF-502, Narrative Summary (or other discharge summary form), and
2 Operative summary if surgery was done.
(b) Physical examinations:
1 SF-88, Report of Medical Examination.
2 SF-93, Report of Medical History.
3 ANY specialty reports obtained pursuant to the physical
examination.
(c) Initial and Disposition Medical Boards:
1 NAVMED 6100/1, Medical Board Report Cover Sheet;
2 SF-88, Report of Medical Examination;
3 SF-93, Report of Medical History;
4 SF-502, Narrative Summary;
5 ANY specialty reports obtained pursuant to the physical
examination;
6 CG-4920, Patient’s Statement Regarding the Findings of the
Medical Board, signed by the patient;
7 The command endorsement, Line of Duty/Misconduct Statement (if
any), and members rebuttal (if any) should normally be done at/by
the command.
CH 16 1-34
(4) Liaison and Assistance. The representative shall:
(a) Maintain liaison between the Coast Guard units in the area and the
USMTF as follows:
1 Clinical services to obtain timely appointments for Coast Guard
personnel;
2 Pharmacy to facilitate drug exchange with Coast Guard units; and
3 Biomedical repair to help originate and maintain agreements for
repair and maintenance of local Coast Guard medical equipment.
(b) Whenever possible, personally meet with each hospitalized Coast Guard
active duty member and meet or phone the immediate family of the
member, offering them assistance.
(c) In appropriate cases, channel other Coast Guard and DOD resources such
as Mutual Assistance, Family Programs, Red Cross, etc. to assist
hospitalized members and their dependents.
(5) Assignment and Duties. Health Services technicians assigned to a USMTF as
Coast Guard Beneficiary Representatives are attached to MLC (k) which will
exercise military control over them. The representative is expected to comply
with the rules and orders of the USMTF to which assigned, and is subject to
the orders of the hospital commander. However, it is expected that any duties
assigned will be consistent with the purpose noted in subparagraph 13a. above.
17. Coast Guard Representative at the Department of Defense Medical Examination Review
Board (DODMERB).
a. General. DODMERB is located at the USAF Academy, CO and is a joint agency of
the military departments responsible for scheduling, reviewing, and certifying service
academy and ROTC scholarship applicant medical examinations, and other programs
assigned by the Office of the Assistant Secretary of Defense, Health Affairs.
b. Responsibilities.
(1) As a member of DODMERB, the Coast Guard:
(a) establishes entrance standards for the Coast Guard Academy; and
(b) makes its health care facilities available for completing entrance physical
examinations for all service academies.
(2) As a member of DODMERB, the Coast Guard liaison:
(a) is assigned as an examination evaluator/administrator; and
1-35 CH 16
(b) participates in implementing plans and organizational procedures for
board actions.
c. Duties.
(1) Maintain a current list of examining centers which includes dates and
examination quotas.
(2) Schedule examinations for the applicants.
(3) Notify applicants and program managers of scheduled examinations.
(4) Review and apply medical standards.
(5) Notify applicants and program managers of the status and qualifications of
applicants.
(6) Provide copies of medical examinations and medical information to the various
programs on applicants until they are no longer eligible.
(7) Provide copies of medical examinations and medical information to eligible
applicants as requested.
18. Health Benefits Advisors (HBA).
a. Responsibilities. Individuals designated as Health Benefits Advisors (HBAs) at
CGMTFs are responsible for advising and assisting beneficiaries concerning their
health benefits. This individual shall:
(1) keep current on the TRICARE Program, Uniformed Services Family Health
Benefits Program (USFHBP) and on all other health benefits programs
available for members, former members, and their eligible dependents;
(2) advise all beneficiaries on matters pertaining to healthcare benefits, including;
(a) obtaining Nonavailability Statements,
(b) using the local appeal system for Nonavailability Statements, and
(c) conducting a local information program on healthcare benefits;
(3) advise TRICARE beneficiaries on the relationship between TRICARE, DVA
programs, Social Security, Medicare, insurance provided through employment,
and the effect of employment and private insurance on benefits available under
TRICARE:
(a) stress availability of TRICARE and explain financial implications of
using non-participating providers,
(b) explain provider participation in TRICARE and explain financial
implications of using non-participating providers,
CH 16 1-36
(c) provide beneficiaries the names and addresses of participating providers
of the specific services the beneficiary requires, and
(d) caution beneficiaries to verify that the provider participates in TRICARE
at the time the services are provided;
(4) coordinates TRICARE problem cases with MLC HBAs, TRICARE contractors
and the Coast Guard liaison officer at TMA-Aurora when required;
(5) assist beneficiaries in properly completing TRICARE claim forms;
(6) serve as a single point of contact for all health benefits programs available to
active duty and retired members and their dependents;
(7) provide information and assistance based upon personal, written, or telephone
inquiries concerning healthcare benefits;
(8) keep beneficiaries informed of changes within the various programs, e.g.,
legislative changes affecting benefits available or other policy/procedures
impacting upon the usage of civilian medical care. Provides for an ongoing
program of lecture services, informational seminars, and group counseling to
various beneficiary groups, service clubs, retirement briefings, etc.;
(9) maintains liaison with local providers and encourages them to increase their
acceptance of the TRICARE program, and;
(10) maintains liaison with cognizant MLC HBA, and unit collateral duty HBAs in
local area.
b. Training.
(1) Individuals designated as HBAs must be trained in TRICARE benefits,
exclusions, claims preparation, processing, cost sharing formulas, eligibility
criteria, and alternatives to TRICARE.
(2) Training Schedule.
(a) Requests for attendance at the TRICARE course should be submitted via
the Chain of Command to the CG TRICARE Liaison Officer at TMA-
Aurora.
(b) TRICARE course registration form is available at
http://www.TRICARE.osd. mil. This form may be submitted
electronically or by mail.
(3) TMA-Aurora Liaison Staff Seminars. The Liaison Office at TMA-Aurora
provides seminars for large beneficiary groups, e.g., recruiter, career counselor,
etc. Arrangements for seminars should be made directly with CG Liaison.
(4) Funding. Training requests for the TRICARE course will be funded by the
cognizant unit, MLC, or Headquarters component.
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c. Sources of Reference Materials. HBAs shall acquire and become familiar with
specific reference materials on Federal and nonfederal health programs. Specifically,
as TRICARE policies change, the HBA shall maintain an updated reference library
through distribution channels as outlined below:
(1) TRICARE Information.
(2) Contact: Coast Guard Liaison Officer
Commercial: (303) 676-3538
Website: http://www.TRICARE.OSD.MIL
Coast Guard Headquarters Distribution.
Stock Point: Commandant (G-WKH-3)
Via: Rapidraft Letter
Tel: (COMM) (202) 267-0846
TRICARE Standard Handbook 6010.46-H
(3) TRICARE Claim Forms (DD-2642, OCT93)
Now available at Website: http://www.TRICARE.OSD.MIL or by contacting:
Stock Point: Navy Publications and Forms Center
5801 Tabor Avenue
Philadelphia, PA 19120
U/I: PD
(4) Referral for Civilian Medical Care (DD-2161).
May be printed locally by accessing CG Standard Workstation III, Jetform
Filler Database or by contacting:
Stock Point: Navy Publications and Forms Center
5801 Tabor Avenue
Philadelphia, PA 19120
U/I: PD
(5) Fiscal Intermediary Distribution by Region. Fiscal Intermediary Newsletter
(6) Local Community. Local Publication - Social Services Directory
19. Dental Hygienists. Dental hygienists are licensed graduates of American Dental
Association accredited schools of dental hygiene. Whether contract or active duty
providers, they are authorized to treat beneficiaries in Coast Guard dental clinics under
the oversight of a dental officer. Restrictions on the degree of required oversight and the
scope of services vary from state to state.
a. In the interests of standardization, quality assurance, and risk management, dental
hygienists in Coast Guard health care facilities shall, in most circumstances, treat
patients only when a dental officer is present for duty at the command. At the
CH 16 1-38
discretion of the SDO, and in the interest of expediency, this guideline may be
overridden if each of the following conditions is met on each patient:
(1) Only active duty members are treated;
(2) A medical officer is present in the building;
(3) Patients’ Periodontal Screening and Recording (PSR) scores are 10 or less; and
(4) The licenses of the SDO and dental hygienist are not jeopardized by this action.
b. In every case, patients must receive a Type 2 examination by a dental officer no more
than six months prior to treatment by a dental hygienist.
c. The Senior Dental Officer (SDO), or a staff dental officer designated by the SDO,
shall review no fewer than 5% of the dental hygienist’s patients for completeness of
plaque/deposit removal and damage to hard/soft tissues. The responsible dental
officer shall document these reviews in the patients’ dental records.
d. The scope of the dental hygienist’s services shall be governed by either the state in
which the license is held or the state in which the clinic is located, whichever is more
restrictive, and shall be itemized in the clinic’s Standard Operating Procedures
(SOP).
e. In some cases the state license may contain an addendum certificate which
“privileges” the dental hygienist to administer injections of local anesthesia under the
direct oversight of a licensed dentist. If the state in which the clinic is located also
allows this, then the dental hygienist may deliver local anesthesia under the direct
oversight of the dental officer. In all cases, the dental hygienist must possess specific
credentials from the state of licensure allowing him/her to administer local
anesthesia. “Direct oversight” shall mean that the dental officer personally has
authorized the dental hygienist to administer local anesthesia to the specific patient
being treated at the specific time (i.e., “blanket approvals” are not authorized). The
dental officer shall be physically present in the clinic while local anesthesia is
administered by the dental hygienist. While direct oversight does not require the
dental officer to be physically present in the dental hygienist’s operatory, the dental
officer must be in the clinic and be capable of responding to an emergency
immediately.
20. Red Cross Volunteers. Red Cross Volunteers are persons who have completed a formal
training program offered by a Red Cross Chapter and have a certificate of successful
completion. Red Cross training is a screening and educational tool that enables
individuals with an interest in helping others to function as supervised medical assistants
in the clinic.
a. Responsibilities. Red Cross Volunteers are responsible for scheduling their time in
the clinic with clinic staff, accepting supervision, and carrying out activities mutually
agreed upon by themselves and the clinic. These duties must fall within the scope of
duties for which Red Cross training has prepared the volunteer. Duties may include:
1-39 CH 16
patient transport via gurney or wheelchair within the clinic; assessing and properly
recording temperature, respiratory rate, heart rate, and blood pressure; acting as a
chaperone during exams or treatment; assisting in specialty areas, i.e., laboratory
(with appropriate additional training and supervision); answering telephones, filing
and other clerical duties; cleaning and wrapping instruments.
b. Supervision. Supervision of Red Cross volunteers is the responsibility of the Clinic
Administrator and may be delegated.
c. Orientation. Each volunteer must have an initial orientation to the clinic
documented. Orientation shall include at least the following topics:
(5) Fire Safety,
(6) Emergency procedures (bomb threats, mass casualty, power outages,
hurricanes/tornadoes),
(7) Universal precautions and infection control,
(8) Proper handling of telephone emergency calls,
(9) Phone etiquette, paging, proper message taking,
(10) Patient Bill of Rights and Responsibilities, to include confidentiality, and
chaperone duties in accordance with Chapter 2-J-3-b of this Manual.
21. Volunteers
a. Volunteer health care workers (HCW) who are not health care providers and who are
members of the U. S. Public Health Service (USPHS), Department of Defense
(DOD) or Coast Guard Auxiliary (AUX) shall work under the supervision of clinic
staff and will provide support services that include but are not limited to: patient
transport via gurney or wheelchair within the clinic, assessing and recording vital
signs, acting as a chaperone during examination or treatment, clerical duties such as
answering telephone or filing, cleaning and wrapping instruments, etc.
b. Health care providers who are members of the USPHS or DOD who volunteer to
work in Coast Guard clinics for up to fourteen days per year will not be required to
apply to G-WK for clinical privileges.
(1) Volunteer providers in this category will submit a copy of a current active state
license, copy of current clinical privileges and a current CPR card to the local
clinic when they report in. They will also complete a request for clinical
privileges appropriate to their category and submit to the local SMO/SDO.
Volunteer providers can also submit a Credentials Transfer Brief in lieu of
their license and CPR card.
(2) The SMO/SDO will evaluate the clinical privileges requested and by signing
the request will authorize the provider to perform those health care services.
CH-17
CH 16 1-40
c. Health care providers who are members of the USPHS or DOD who volunteer to
work in Coast Guard clinics for more than fourteen days per year will be required to
apply for clinical privileges from G-WK as described in Chapter 13-B, and C of this
Manual.
d. Health care providers who are members of the AUX will be required to apply for
clinical privileges from G-WK as described in Chapter 13-B, and C of this Manual.
e. Volunteer providers will work under the direct or indirect supervision of Coast
Guard clinic providers.
f. Each volunteer must have an initial orientation to clinic standard operating
procedures which must be documented and must include at the minimum:
(1) Fire safety
(2) Emergency procedures (e.g., bomb threats, mass casualty, power outages,
hurricanes/tornadoes)
(3) Universal precautions and infection control
(4) Proper management of telephone calls, emergency calls
(5) Telephone etiquette, paging, taking messages
(6) Patient sensitivity and confidentiality
CH-17
2-i
CHAPTER 2.
HEALTH CARE AND FACILITIES
Page
SECTION A - HEALTH CARE FOR ACTIVE DUTY PERSONNL……………………………………………..1
CARE AT UNIFORMED SERVICES MEDICAL TREATMENT FACILITIES. ........................................................................ 1
EMERGENCY CARE AT OTHER THAN CG OR DOD FACILITIES.................................................................................. 2
DENTAL CARE AND TREATMENT............................................................................................................................... 4
CONSENT TO AND REFUSAL OF TREATMENT. ............................................................................................................ 7
ELECTIVE SURGERY FOR PRE-EXISTING DEFECTS..................................................................................................... 9
ELECTIVE HEALTH CARE ........................................................................................................................................ 10
OTHER HEALTH INSURANCE .............................................................................................................................................10
PROCEDURES FOR OBTAINING NON-EMERGENT HEALTH CARE FROM NONFEDERAL SOURCES.............................. 11
OBTAINING VASECTOMIES AND TUBAL LIGATIONS. .................................................................................................. 13
CARE AT DEPARTMENT OF VETERANS AFFAIRS (DVA) MEDICAL FACILITIES. ....................................................... 13
SECTION B - HEALTH CARE FOR RESERVE PERSONNEL. ....................................................................... 17
CARE AT UNIFORMED SERVICES MEDICAL TREATMENT FACILITIES. ...................................................................... 17
EMERGENCY CARE AT OTHER THAN CG OR DOD FACILITIES................................................................................ 19
NON-EMERGENT CARE AT OTHER THAN CG OR DOD FACILITIES. ........................................................................ 19
SECTION C - HEALTH CARE FOR RETIRED PERSONNEL......................................................................... 20
CARE AT UNIFORMED SERVICES MEDICAL TREATMENT FACILITIES. ...................................................................... 20
CARE UNDER THE TRICARE EXTRA AND STANDARD OPTIONS (FORMERLY CHAMPUS). ................................... 20
CARE AT VETERANS ADMINISTRATION MEDICAL FACILITIES.................................................................................. 20
SECTION D - HEALTH CARE FOR DEPENDENTS. ........................................................................................ 21
CARE AT UNIFORMED SERVICES MEDICAL TREATMENT FACILITIES. ...................................................................... 21
CARE UNDER COAST GUARD CIVILIAN CONTRACTS............................................................................................... 21
RIGHTS OF MINORS TO HEALTH CARE SERVICES. ................................................................................................... 21
SECTION E - CARE FOR PREADOPTIVE CHILDREN AND WARDS OF THE COURT........................... 22
GENERAL. ............................................................................................................................................................... 22
SECRETARY'S DESIGNATION.................................................................................................................................... 22
SECTION F - HEALTH CARE FOR OTHER PERSONS................................................................................... 24
MEMBERS OF THE AUXILLARY. .......................................................................................................................... 24
TEMPORARY MEMBERS OF THE RESERVE............................................................................................................... 24
MEMBERS OF FOREIGN MILITARY SERVICES........................................................................................................... 25
CH-16 2-ii
FEDERAL EMPLOYEES............................................................................................................................................. 25
SEAMEN.................................................................................................................................................................. 25
NONFEDERALLY EMPLOYED CIVILIANS ABOARD COAST GUARD VESSELS............................................................. 26
SECTION G - MEDICAL REGULATING............................................................................................................ 27
TRANSFER OF PATIENTS AT COAST GUARD EXPENSE............................................................................................. 27
TRAVEL VIA AMBULANCE OF PATIENTS TO OBTAIN CARE...................................................................................... 27
AEROMEDICAL EVACUATION OF PATIENTS............................................................................................................. 27
SECTION H - USE OF THE DEFENSE ENROLLMENT ELIGIBILITY REPORTING SYSTEM (DEERS)
IN COAST GUARD HEALTH CARE FACILITIES............................................................................................ 28
DEFENSE ENROLLMENT ELIGIBILITY REPORTING SYSTEM (DEERS) ...................................................................... 28
RESPONSIBILITIES.................................................................................................................................................... 28
SECURITY................................................................................................................................................................ 28
PERFORMING DEERS CHECKS. .............................................................................................................................. 30
REPORTS.:............................................................................................................................................................... 33
ELIGIBILITY/ENROLLMENT QUESTIONS, FRAUD AND ABUSE. .................................................................................... 33
DENIAL OF NONEMERGENCY HEALTH CARE BENEFITS FOR INDIVIDUALS NOT ENROLLED IN DEFENSE ENROLLMENT
ELIGIBILITY REPORTING SYSTEM (DEERS).............................................................................................................. 34
DEERS ELIGIBILITY OVERRIDES.: .......................................................................................................................... 34
SECTION I - HEALTH CARE FACILITY DEFINITIONS. ............................................................................... 46
COAST GUARD FACILITIES. ..................................................................................................................................... 46
DEPARTMENT OF DEFENSE MEDICAL FACILITIES.................................................................................................... 46
UNIFORMED SERVICES TREATMENT FACILITIES. .................................................................................... 47
SECTION J - POLICIES AND PROCEDURES REQUIRED AT COAST GUARD HEALTH CARE
FACILITIES.............................................................................................................................................................. 49
ADMINISTRATIVE POLICIES AND PROCEDURES........................................................................................................ 49
OPERATIONAL POLICIES AND PROCEDURES............................................................................................................. 49
PATIENT RIGHTS...................................................................................................................................................... 50
HEALTH CARE PROVIDER IDENTIFICATION.............................................................................................................. 51
SECTION K - GENERAL STANDARDS OF CARE............................................................................................ 53
GENERAL STANDARDS OF CARE:.............................................................................................................................. 54
2-1 CH-16
CHAPTER 2. HEALTH CARE AND FACILITIES
Section A - Health Care for Active Duty Personnel.
1. Care at Uniformed Services Medical Treatment Facilities.
a. Authority for Health Care. Title 10 USC, 1074(a) provides that under joint
regulations to be prescribed by the Secretary of Defense and the Secretary of
Transportation, a member of a uniformed service who is on active duty is entitled to
health care in any facility of any uniformed service. Members of the reserve
components who are on active duty (including active duty for training) are entitled to
the same health care in any facility of the uniformed services as that provided for
active duty members of the regular services.
b. Use of Own Service Medical Treatment Facilities. Under ordinary circumstances,
members shall receive health care at the Uniformed Services Medical Treatment
Facility (USMTF) which serves the organization to which the member is assigned.
However, Commanding Officers may request assignment to another USMTF through
the cognizant MLC. Members away from their duty station or on duty where there is
no USMTF of their own service may receive care at the nearest USMTF.
c. Use of Other Services Medical Treatment Facilities and/or Civilian Facilities. The
closest USMTF having the appropriate capabilities shall be used for non-emergency
health care. Health care in civilian medical facilities for non-emergent conditions is
not authorized without prior approval of MLC (k). All health care received at other
than a CG Clinic shall be recorded in the Coast Guard health record.
d. Definitions.
(1) Uniformed Services are the Army, Navy, Air Force, Marine Corps, Coast
Guard, Commissioned Corps of the Public Health Service, and the
Commissioned Corps of the National Oceanic and Atmospheric
Administration.
(2) Active Duty means full-time duty in a Uniformed Service of the United States.
It includes: duty on the active list; full-time training duty; annual training duty;
and attendance, while in the service, at a school designated as a service school
by law or by the Secretary of the Uniformed Service concerned.
(3) Health Care means outpatient and inpatient professional care and treatment,
nursing care, diagnostic tests and procedures, physical examinations,
immunizations, prophylactic treatment, medicines, biologicals, other similar
medical services, and ambulance service. Prostheses, hearing aids, spectacles,
orthopedic footwear, and similar adjuncts to health care may be furnished only
where such adjuncts are medically indicated.
e. Application for Care. Members of the Coast Guard on active duty may be provided
health care at a USMTF when requested by appropriate Coast Guard authority, a
CH-16 2-2
Public Health Service medical officer detailed to the Coast Guard, or by application
of the member by presenting an Armed Forces Identification Card (DD-2-CG).
f. Subsistence Charges. All active duty members of the uniformed services are
required to pay subsistence in a USMTF at a rate prescribed by the Department of
Defense.
g. Loss of Entitlement. A member of the Coast Guard who is separated from active
duty, for any reason other than retirement, is not eligible for health care at a USMTF
by reason of that previous service unless otherwise noted on the Certificate of
Release or Discharge from Active Duty form DD-214.
2. Emergency Care at Other Than CG or DOD Facilities.
a. Definition of Emergency Condition.
(1) An emergency medical condition exists when the patient's condition is such
that, in a medical officer's opinion, failure to provide treatment or
hospitalization would result in undue suffering or endanger life or limb.
(2) In an emergency, the patient's safety and welfare, as well as that of the
personnel around the patient, must be protected. When a USMTF cannot
render immediate care, other local medical facilities, Federal or civilian, may
be used. The decision to admit the patient to any of these facilities shall be
made by the command with regard for only the health and welfare of the
patient and the other personnel of the command.
b. Eligibility for Emergency Treatment. The following members of the Coast Guard are
eligible for emergency medical treatment:
(1) active duty personnel of the regular Coast Guard;
(2) reserve personnel on extended active duty or temporary active duty (ASWAC);
and
(3) reserve personnel who become ill, injured, or contract a disease in line of duty
while on active duty for training or inactive duty for training, including
authorized travel to or from such duty. [see Reserve Policy Manual,
COMDTINST M1001.28 (series)]
c. Responsibilities.
(1) Patient.
(a) The patient is responsible for notifying the civilian physician or dentist
that he or she is in the:
1 Regular Coast Guard;
2 Coast Guard Reserve on active duty or active duty for training; or
2-3 CH-16
3 Coast Guard Reserve in an inactive duty training drill or appropriate
duty status.
(b) It is also the responsibility of the patient or someone acting in the
patient's behalf to request that the physician or dentist notify the
member's command or the closest Coast Guard organization that he or
she is undergoing emergency treatment at a civilian medical facility.
(c) The patient shall provide to appropriate authority all information needed
to verify the course of treatment received and authorize release of all
records associated with the episode of care.
(2) Commanding Officer. When notified that a member of the Coast Guard is
hospitalized, transferred to another facility, or discharged from inpatient status,
the commanding officer shall notify MLC (p) and (k) via message in
accordance with MLC directives.
(3) Commander, Maintenance and Logistics Command. When notified that a
member of the Coast Guard is hospitalized, MLC (k) shall:
(a) Be responsible for authorizing additional inpatient care at a civilian
medical facility prior to transferring the patient to a USMTF. It is
imperative, in the interest of good management, that the patient be
transferred as soon as medically feasible. However, nothing in the above
should be construed as precluding the necessary care for the patient
concerned. MLC (k) shall notify the member's unit of any authorization
action.
(b) Assist in ascertaining all necessary background information about the
case, when the patient can be moved, and the location of the nearest
CGMTF or USMTF which can accept the case. Patients shall be
transferred in accordance with the provisions of Medical Regulating to
and Within the Continental United States, COMDTINST M6320.8
(series).
(4) Commanding Officers of Reserve Units.
(a) A Reservist needing emergency treatment while performing inactive duty
training shall be taken to a USMTF. If the nature of the case is so
emergent as to preclude such transportation, a civilian medical facility
may be used. If outpatient follow-up treatment is required, (i.e., office
visits, tests, etc.) such treatment must be preauthorized by MLC (k) after
issuance of a Notice of Eligibility by Commander, Integrated Support
Command (FOT).
(b) The commanding officer of the reserve unit shall comply with Chapter
11 of the Reserve Policy Manual, COMDTINST M1001.28 (series) in
notifying the commander, MLC and ISC (FOT) when a Reservist
CH-16 2-4
engaged in inactive duty training is admitted to a civilian hospital or
USMTF, and subsequent follow-up.
(5) Government Responsibility. Non-adherence to these notification directives
cannot limit the Government's liability to pay bills for emergency medical and
dental treatment provided to authorized Coast Guard beneficiaries. However,
if prior approval is not obtained for NON-EMERGENT treatment in
nonfederal facilities, the member receiving the care will be liable for payment.
d. Elective Surgery or Medical Treatment. Elective surgery or medical treatment is
only authorized in USMTFs.
e. Emergency Care Outside the Continental United States. Coast Guard active duty
personnel outside the continental limits of the United States are entitled to health
care at USMTFs, where available. If such facilities are not available, emergency
health care may be obtained at Coast Guard expense, without prior authorization.
f. Absentees or Deserters. Charges incurred by Coast Guard personnel for civilian
health care when absent without authority or in desertion are the sole responsibility
of the individual. However, charges for civilian health care after actual or
constructive return of the individual to Coast Guard or military control may be paid
from Coast Guard funds. Refer questions on payment of health care in regards to
constructive return to MLC (k).
3. Dental Care and Treatment.
a. Extent of Dental Services.
(1) Active duty Coast Guard personnel are entitled to emergency, routine, and
accessory dental treatment at all USMTFs. Dental care from contract dentists
is authorized only as prescribed in Chapter 11 of this Manual.
(2) Reserve Coast Guard personnel ordered to active duty with their consent for
less than thirty days are eligible for emergency dental treatment only, and are
also subject to the following modifications;
(a) Reserve personnel are responsible for all dental diseases and conditions
in existence prior to the initiation of or call to active duty. They must be
in a class 1 or 2 dental status. (see section 4-C-3.c.)
(b) Reserve personnel shall not be eligible for routine or accessory dental
treatment which cannot be completed prior to termination of or release
from active duty status.
(c) Reserve personnel are responsible for maintaining their dental fitness for
duty while on inactive status or during periods of active duty less than 30
days.
2-5 CH-16
(3) Coast Guard Reserve personnel ordered to active duty for 30 days or more, are
eligible for emergency, routine, and accessory dental treatment at all USMTFs,
and are also subject to the modifications listed above. Reservists with active
duty orders for 30 days or more are encouraged to obtain a dental exam as part
of their check-in process at their newly assigned unit.
b. Definitions of Types of Dental Treatment.
(1) Emergency Dental Treatment. Emergency dental treatment includes those
procedures directed toward the immediate relief of pain, the removal of oral
infection which endangers the health of the patient, and repair of prosthetic
appliances where the lack of such repair would cause the patient physical
suffering.
(2) Routine Dental Treatment. Routine dental treatment includes the following:
examinations, radiographs, diagnosis and treatment planning, amalgam fillings,
synthetic fillings, prophylaxis, extraction, treatment of root canals, treatment
for allaying pain, treatment of oral pathological conditions, periodontal
conditions, other infections and related conditions detrimental to the patient's
health, and repairs and adjustment of dentures and prosthetic appliances.
(3) Accessory Dental Treatment. Accessory dental treatment includes prosthetic
replacement of missing teeth in cases where insufficient occlusal surfaces
prevent proper mastication and where missing anterior teeth prevent correct
phonation.
(4) Implants.
(a) Implant placement by Coast Guard dental officers (DOs) shall be
performed only by:
1 those DOs specifically privileged to do so by DOD facilities, or
2 those DOs who have received implant training as part of a formal
specialty program.
(b) Implant maintenance is the responsibility of all DOs. Each DO shall be
familiar with the techniques and armamentarium of implant maintenance,
as well as diagnosis of successful and unsuccessful implants.
(c) Requests for implants from nonfederal providers for active duty members
shall be approved or denied on a case-by-case basis by the cognizant
MLC. Factors to be considered include:
1 oral hygiene;
2 treatment alternatives;
3 feasibility and expectations for long-term success;
CH-16 2-6
4 length of service and anticipated rotation; and
5 qualifications of the provider(s).
c. Dental Care of Recruits. Only emergency dental treatment should be provided those
recruits who are to be separated from the Service prior to completing recruit training.
It is important that recruits in this category do not have teeth extracted in preparation
for prosthetic treatment and then be separated from the Service prior to the time
prosthetic appliances are provided.
d. Emergency Dental Treatment in Nonfederal and Non-contract Facilities.
(1) If a contract dentist is not available, emergency dental treatment required for
the immediate relief of pain or infection may be obtained by active duty Coast
Guard personnel from any available dentist. Once the emergency has been
alleviated, all follow-up treatment must be from a USMTF or contract dentist
unless preauthorized by MLC (k).
(2) Process all bills in accordance with Chapter 11 of this Manual.
e. Criteria To Be Followed When Requesting Orthodontic/Orthognathic Surgical Care.
(1) Orthodontic/orthognathic surgical treatment can affect release from active duty,
rotation dates, and fitness for duty. Therefore, written authorization to
commence all orthodontic/orthognathic surgical treatment (whether elective or
not, and whether provided by Federal or nonfederal practitioners) must be
requested from Commander (CGPC-epm) for enlisted and (CGPC-opm) for
officers via the cognizant MLC (k) prior to its initiation. Command
endorsement must include a copy of Administrative Remarks CG-3307
documentation described in article 2-A-3.e.(3)(b) below. Request nonfederal
care from appropriate MLC (k) following established guidelines. If authorized
by MLC (k), the request will be forwarded to Commander (CGPC-epm or
opm).
(2) Preexisting conditions are the member's responsibility.
(3) Treatment not required to maintain the member's fitness for duty is elective in
nature and is not authorized for payment by the Coast Guard. If the member's
condition does not impair job function, the treatment shall be considered
elective.
(4) Elective care may be obtained, if available, from USMTFs. If obtained from
nonfederal providers, payment is the member's responsibility. In addition, the
member is financially responsible for any care arising from complications that
require additional treatment, even if it is non-elective. Because complications
could lead to subsequent action by the Physical Disability Evaluation System
(PDES), and to protect the interests of both the service member and the Coast
Guard, the member's command is responsible for Service Record
Administrative Remarks CG-3307 documentation detailing:
2-7 CH-16
(5) The personnel action to be taken by the command regarding the granting of
absence.
(6) That the service member was instructed regarding the provisions contained
herein and other applicable directives; and
(7) That the service member must obtain copies of all treatment records from the
provider for inclusion into the Coast Guard dental record, including (for
example) initial evaluation, treatment plan, progress notes, and follow-up care.
(8) If elective treatment is approved, PDES processing shall be suspended pending
the outcome of the elective treatment. Aviation personnel and divers are
required to have a waiver request approved by CGPC - opm or epm. In
addition, members whose duties preclude regular visits to an orthodontist (e.g.,
icebreakers crews, isolated LORAN duty etc.) fall under this category.
(9) If the condition is service-related, the Coast Guard shall be responsible to
acquire care sufficient to return the member to fit for full duty status (e.g., that
which existed at the time of the member's entry to the service), but not
necessarily to ideal conditions not impacting on performance of duties. If
treatment is not available at a local MTF, use of a nonfederal provider may be
authorized.
(10) If pain is the only symptom causing the member to be not fit for full duty, then
it must be treated. Treatment may include, but is not limited to physical
therapy, bite plates to improve occlusion, stress management, and medications.
Since orthodontic treatment is of long duration, it is not an appropriate method
to relieve acute pain.
(11) All treatment must be completed, inactivated, or terminated prior to transfer or
release from active duty. Personnel who are being transferred or released from
active duty, and who request inactivation of orthodontic appliances, shall sign
an entry in the SF-603/603-A stating their intention to seek orthodontic therapy
at their own expense.
4. Consent to and Refusal of Treatment.
a. Regulatory Restrictions. Coast Guard Regulations, COMDTINST M5000.3 (series),
state in Section 8-2-1 that:
(1) "Persons in the Coast Guard shall not refuse to submit to necessary and proper
medical or dental treatment to render themselves fit for duty, or refuse to
submit to a necessary and proper operation not endangering life."
(2) "Persons in the Coast Guard shall permit such action to be taken to immunize
them against disease as is prescribed by competent authority."
b. Policy Concerning Refusal of Treatment.
(1) Policy.
CH-16 2-8
(a) It is the Commandant's policy that compulsion is not permissible at any
time to require Coast Guard personnel to submit to various types of
medical or dental treatment, diagnostic procedures, or examinations.
(b) Surgery will not be performed on persons over their protest if they are
mentally competent.
(c) Individuals who refuse to submit to measures considered by competent
medical or dental officers to be necessary to render them fit for duty, may
be processed for separation from the Coast Guard in accordance with
applicable regulations. Individuals may be subjected to disciplinary
action for refusal of necessary treatment or surgery if the refusal is
determined to be unreasonable. Refusal of medical care by vegetative or
comatose individuals in accordance with a Living Will shall not be
considered unreasonable.
(2) Non-Emergent Operations on Minors. A minor who enlists or otherwise enters
active duty with parental or guardian consent is considered emancipated during
the term of enlistment. There is, therefore, no legal requirement that the
consent of any person, other than the minor, be obtained prior to instituting
surgical procedures.
(3) Refusal of Emergency or Lifesaving Treatment or Emergency Diagnostic
Procedures. The refusal of recommended emergency or lifesaving treatment or
emergency diagnostic procedure required to prevent increased level of
impairment or threat to life is ordinarily determined to be unreasonable.
However, refusal of medical care by vegetative or comatose patients under the
authorization of a Living Will is not considered unreasonable. A medical
board shall be convened in accordance with the Physical Disability Evaluation
System, COMDTINST M1850.2 (series) for unreasonable refusal of
emergency or lifesaving treatment or emergency diagnostic procedures.
(4) Refusal of Non-Emergent Treatment. If a member of the Coast Guard refuses
non-emergent medical, surgical, dental, or diagnostic procedures that are
required to maintain a fit for full duty status, a determination of reasonable
basis for this refusal is required. A medical board shall be convened in
accordance with Physical Disability Evaluation System, COMDTINST
M1850.2 (series).
c. Advance Directives (Living Wills).
(1) Federal law enacted in 1993 requires hospitals to ask about advance directives
at the time of admission and provide patients with information to create
advance directives. Advance directives, commonly known as living wills,
express a person's wishes regarding certain aspects of treatment and care,
including but not restricted to CPR, mechanical life support measures, etc.,
which may arise in the course of hospitalization.
2-9 CH-16
(2) Coast Guard health care facilities are not required to provide such information
under the law. Clinics may elect to provide standardized information to
patients on request. Information given out shall conform to the implementing
laws of the state in which the clinic is located. Clinics providing such
information shall notify patients of its availability either by posted notice or via
patient handout materials.
(3) Clinic staff members usually do not have the required training and experience
to advise patients on the legal issues concerning creation of advance directives.
Patients shall be referred to the appropriate source of legal support, e.g.,
command or district legal officers.
(4) Clinic staff members, where allowed by state law, may serve as witnesses to
advance directive signatures.
(5) Advance directive documents shall be held by the member and/or the member's
next of kin. Advance directive documents shall not be filed in the member's
health record since health records are not universally available 24 hours a day,
seven days a week, for reference by a treating hospital.
5. Elective Surgery for Pre-Existing Defects.
a. General. In many medical/dental procedures undertaken to correct defects that
existed prior to entrance (EPTE) into the Service, the likelihood of return to full duty
is questionable. In addition, such cases have often resulted in long periods of
convalescence with subsequent periods of limited duty, outpatient care, and
observation which render the Government liable for benefits by reason of
aggravation of these defects.
b. Criteria. The following conditions must be met before attempting surgical correction
of an EPTE defect.
(1) It interferes with the member's ability to perform duty.
(2) The procedure being considered is an accepted one, carries a minimal risk to
life, and is not likely to result in complications.
(3) There should be a 90 percent chance that the procedure will correct the defect
and restore the member to full duty within a reasonable time (three months)
without residual disability. If the defect does not meet the above conditions
and the member is, in fact, unfit to perform the duties of grade or rate, action
shall be taken to separate the member from the Service.
c. Discussion. Whether elective medical/dental care should be undertaken in any
particular case is a command decision which should be decided using the above
guidelines. In questionable cases, the member may be referred to a medical board for
final decision prior to undertaking elective treatment for an EPTE defect.
CH-17 2-10
6. Elective Health Care.
a. Medical/Dental treatment not required to maintain the member’s fitness for duty is
elective in nature and is not authorized for payment by the Coast Guard. If the
member’s condition does not interfere with their ability to perform duty, the
treatment shall be considered elective.
(1) Elective care may be obtained, if available, from USMTF’s.
(2) If obtained from nonfederal providers, payment is the member’s responsibility.
In addition, the member is financially responsible for any care arising from
complications that require additional treatment, even if it is non-elective.
(3) Because complications could lead to subsequent action by the Physical
Disability Evaluation System (PDES), and to protect the interests of both the
service member and the Coast Guard, the member’s health record must contain
a SF-600 entry detailing:
(a) the personnel action to be taken by the command regarding the granting
of absence;
(b) that the service member was counseled regarding the provisions
contained herein and other applicable directives. Counseling will be
provided at the local Coast Guard primary care facility, or if there is no
near by Coast Guard primary care facility, then the cognizant MLC (k)
via phone. SF-600 will be faxed to the cognizant MLC (k) for
appropriate entries, then faxed or mailed back to the unit for
incorporation into the member’s health record.
(c) that the service member must obtain copies of all treatment records from
the provider for inclusion into the Coast Guard health record, including
initial evaluation, treatment plan, progress notes, and follow-up care.
(4) Members shall understand that once they have received an elective treatment or
procedure, they may be adversely effected for present or future assignments or
specialized duty. For example, Laser In-situ Keratomileusis (LASIK) is
disqualifying for divers, aviation personnel, and landing signal officers (LSO).
7. Other Health Insurance (OHI)
a. General. In some situations a member may desire to utilize their spouses’ health
insurance (OHI) to obtain health care outside of the Military Health Care System.
Whether elective health care or all other areas of health care, this decision has an
impact on the command and possibly on a member’s access to the Physical Disability
Evaluation System (PDES).
b. Criteria. The following conditions must be met before utilizing a spouse’s health
insurance or OHI,
2-11 CH-16
(1) ALL payment is the member’s responsibility. In addition, the member is
financially responsible for any care arising from complications that require
additional treatment, even if it is non-elective.
(2) Because complications could lead to a loss of access to the Physical Disability
Evaluation System (PDES), and to protect the interests of both the service
member and the Coast Guard, the member’s Coast Guard health record must
contain a SF-600 entry detailing:
(a) the personnel action to be taken by the command regarding the granting
of absence;
(b) that the service member was instructed regarding the provisions
contained herein and other applicable directives. Counseling will be
provided at the local Coast Guard primary care facility, or if there is no
near by Coast Guard primary care facility, then the cognizant MLC (k)
via phone. SF-600 will be faxed to the cognizant MLC (k) for
appropriate entries, then faxed or mailed back to the unit for
incorporation into the member’s health record.
(c) that the service member must obtain copies of all treatment records from
the provider for inclusion into the Coast Guard health record, including
initial evaluation, treatment plan, progress notes, and follow-up care.
8. Procedures for Obtaining Non-Emergent Health Care from Nonfederal Sources.
(Guidance reflecting current TRICARE procedures for obtaining Non-Emergent Health
Care will be promulgated in future changes to this Manual).
a. Nonfederal sources for active duty care are intended to supplement and not substitute
for care that is available through the federal system. USMTF's or DVA facilities, if
located within a 40 mile radius of the member's unit (except a 30 mile radius for
maternity care), shall be used first for non-emergent, non-elective health care before
nonfederal sources are used. Each case must be evaluated for:
(1) appropriateness of care;
(2) urgency of treatment;
(3) time and cost factors associated with obtaining such care from a USMTF;
(4) the member's anticipated length of stay at the given station; and,
(5) operational need of the unit for the member.
b. Before active duty personnel are treated in a nonfederal medical facility for non-
emergent conditions, prior approval must be obtained. Non-elective conditions are
those which, without repair or treatment, would render the member unfit for duty.
c. MLC (k) may approve requests for nonfederal health care (both medical and dental)
and may delegate, in writing, limited authority to qualified clinic administrators.
CH-16 2-12
d. Requests for nonfederal health care beyond a clinic administrator's authority will be
submitted by following the cognizant MLC(k) policy. Telephone authorization will
not be provided without a hard copy of the request. As a minimum, the following
information must be provided, as applicable:
(1) name, grade/rate, social security number;
(2) anticipated rotation date and expiration of enlistment;
(3) whether care will be completed before transfer or separation;
(4) diagnosis reported by International Classification of Diseases, 9th Revision,
Clinical Modification (ICD-9-CM) code number and a brief explanation;
(5) history of patient's condition;
(6) total amount of local/MLC approved nonfederal expenditures to date for this
condition;
(7) the necessity of treatment to maintain fitness to perform duty;
(8) treatment plan: length, type of therapy/treatment, and estimated cost (Cost
estimates must include total scope of care not just primary provider or hospital
costs.);
(9) name of facility where treatment will be done;
(10) attending physician's or dentist's prognosis with and without treatment,
including likelihood of medical board action;
(11) treatment plan and justification, radiographs and copy of dental records for all
dental requests (Study models will be submitted for all cases requiring crown
and bridge work and partial dentures;
(12) name of nearest USMTF capable of providing care:
(a) distance to facility (miles);
(b) earliest appointment available (not available is unacceptable);
(c) travel/per diem cost;
(d) estimated total lost time; and
(e) other factors for consideration, i.e., travel time, road conditions,
operational impact, etc; and
(13) indicate date of original submission and reason for resubmission, if previous
requests were submitted for this procedure.
e. If approval is granted, MLC (k) will provide the requester with an authorization
number. This authorization number must be noted on all bills submitted. Bills will
be submitted to MLC (k). If approval is denied, MLC(k) will outline the appropriate
appeals process to follow in their denial transmittal.
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f. When personnel are transferred prior to completing the approved care, the request is
canceled. Personnel are required to submit another request after reporting for their
new assignment.
g. Amounts authorized shall not be exceeded without further authorization from MLC
(k) which requires additional justification.
h. Inpatient hospitalization in nonfederal facilities shall be monitored closely by the
MLC (k) responsible for the geographical area in which the facility is located.
Normally, an inpatient stay will not exceed seven days duration without
consideration of movement to a USMTF. Cases suspected to extend past the seven-
day limit shall not be placed in a civilian facility, but shall be initially referred to a
USMTF.
i. If prior approval is not obtained for non-emergent treatment in nonfederal facilities,
the member receiving the care will be liable for payment.
j. EMERGENCY health care does not require prior approval.
9. Obtaining Vasectomies and Tubal Ligations from Nonfederal Providers.
a. Preauthorization is required. Submit all request for vasectomies and tubal ligations
by nonfederal providers to cognizant MLC(kma) following the guidelines for
requesting above. Request must show the provider of care decided on the procedure
based upon applicable local and state guidelines.
b. Request must contain evidence that the patient has been counseled by a physician and
has given informed consent to the procedure.
c. The request must contain evidence that the patient has completed a SF-600 entry
acknowledging that the Coast Guard will not pay for reversal of this procedure in a
non-federal facility.
d. The request must contain current information concerning the availability of the
requested procedure from federal sources.
e. Request for tubal ligation to be performed at the time of delivery should be submitted
with the request for nonfederal maternity care.
f. Sick leave may be granted for this procedure.
10. Care at Department of Veterans Affairs (DVA) Medical Facilities.
a. From time-to-time, acute medical, surgical, or psychiatric facilities are required for
Coast Guard personnel where transportation to the nearest USMTF will place the
individual's health or welfare in jeopardy. To preclude this and other similar
situations and to provide the best possible medical care for all active duty members, a
CH-16 2-14
support agreement between the Coast Guard and the Department of Veterans Affairs
was completed in 1979 and remains in effect. FIGURE 2-1 is a copy of the medical
service agreement.
b. DVA care must be requested by the member's commanding officer. The agreement
is limited to active duty Coast Guard personnel and does not include dependents.
c. MLC commanders and commanding officers should establish local contact with
DVA facilities to determine mission and facility capabilities and patient admission
procedures.
d. Forward all bills received from DVA facilities to the service member's unit for
certification prior to forwarding to MLC (k) for payment.
e. When a USMTF and a DVA facility are collocated, the USMTF shall be used unless
it cannot provide the required services.
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FIGURE 2-A-1
CH-16 2-16
FIGURE 2-A-1 con’t
2-17 CH-16
Section B - Health Care for Reserve Personnel.
1. Care at Uniformed Services Medical Treatment Facilities.
a. Authority for Reserve Personnel. Section 2-A of this Manual contains the authority
for medical care. Information concerning entitlement to various benefits is contained
in Chapter 11 of the Reserve Policy Manual, COMDTINST M1001.28(series).
Information concerning eligibility for benefits from the Department of Veterans
Affairs is included therein.
b. Application for Care. A member of the Coast Guard Reserve may be admitted to
USMTFs upon written authorization from an appropriate Coast Guard authority (e.g.,
Commanding Officer's letter, Notice of Eligibility, or appropriately endorsed orders).
c. Definitions. The following definitions apply throughout this section:
(1) Active duty means full-time duty in a Uniformed Service of the United States.
It includes duty on the active list, full-time training duty, annual training duty
and attendance, while in the service, at a school designated as a service school
by law or by the Secretary of the Uniformed Service concerned.
(2) Active Duty for Training is defined as full-time duty in a uniformed service of
the United States for training purposes.
(3) Inactive Duty Training.
(a) Duty prescribed for reservists by the Secretary concerned under 37 USC
206 or any other provision of law.
(b) Special additional duties authorized for reservists by an authority
designated by the Secretary concerned and performed by them on
voluntary basis in connection with the prescribed training or maintenance
activities of the units to which they are assigned.
(4) Disability. A temporary or permanent physical impairment resulting in an
inability to perform full military duties or normal civilian pursuits.
(5) Employed. Reservists are employed on duty during the actual performance of
duty, while engaged in authorized travel to or from active duty for training, and
while on authorized leave or liberty.
(6) Line of Duty. An injury, illness, or disease shall be deemed to have been
incurred in line of duty, if a reservist at the time of debilitating incident is
performing active duty or active duty for training, or is on authorized leave or
liberty, provided the disability is not the result of misconduct.
d. Injury Incurred in Line of Duty. A member of the Coast Guard Reserve who is
ordered to active duty or to active duty for training, or to perform inactive duty
training, for any period of time, and is disabled in line of duty from injury while so
CH-16 2-18
employed is entitled to the same hospital benefits as provided by law or required in
the case of a member of the regular Coast Guard. For the purpose of these benefits, a
member who is not in a pay status is treated as though receiving the pay and
allowances to which entitled if serving on active duty.
e. Disease Incurred in Line of Duty While on Active Duty. A member of the Coast
Guard Reserve who is ordered to active duty for training for a period of more than 30
days, and is disabled while so employed, is entitled to the hospital benefits as are
provided by law or regulation in the case of a member of the regular Coast Guard.
An exception is that a member of the Coast Guard Reserve ordered to perform
involuntary active duty for training under the provision of 10 USC 270 is only
eligible for the limited medical benefits described below, following termination of
the training duty period.
f. Illness or Disease Contracted in Line of Duty in Peacetime. A member of the Coast
Guard Reserve who, in time of peace, becomes ill or contracts a disease in line of
duty while on active duty for training or performing inactive duty training is entitled
to receive medical, hospital, and other treatment appropriate for that illness or
disease. The treatment shall be continued until the disability resulting from the
illness or disease cannot be materially improved by further treatment. Such a
member is also entitled to necessary transportation and subsistence incident to
treatment and return home upon discharge from treatment. The treatment may not
extend beyond ten weeks after the member is released from active duty, except:
(1) upon an approved recommendation of a medical board or
(2) upon authorization of the MLC (k), based on a physician's certification that the
problem is a continuation of that for which the member was initially treated,
and that benefit will result from further treatment. Refer to Section 11-B-3 of
the Reserve Administration Policy Manual, COMDTINST M1001.28(series),
for specific instructions regarding the extension of medical treatment beyond
10 weeks for those who are receiving treatment under a Notice of Eligibility
(NOE).
g. Injury or Disease En Route to or from Active Duty. A member of the Coast Guard
Reserve is authorized medical care for an injury or disease incurred while en route to
or from active duty, active duty for training, or inactive duty for training.
h. Injury or Disease Not in Line of Duty. A member of the Coast Guard Reserve is not
entitled to medical care for an injury or disease not incurred in the line of duty.
i. Pregnancy. Pregnancy in the Coast Guard, COMDTINST 1900.9, contains guidance
regarding pregnancy and reserve members. Use of reserve servicewomen who are
pregnant for ASWAC assignment is not encouraged. Reserve servicewomen may
accept Special Active Duty for Training (SADT) with the understanding that duty
must be completed by the 24th week of gestation.
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2. Emergency Care at Other Than CG or DOD Facilities. Section 2-A-2 contains the
requirements for treating reserves in emergency situations.
3. Non-Emergent Care at Other Than CG or DOD Facilities. Any non-emergent,
nonfederal care must be authorized in advance by MLC (k) through contract, blanket
purchase agreement or pre-authorization.
CH-16 2-20
Section C - Health Care for Retired Personnel.
1. Care at Uniformed Services Medical Treatment Facilities. As set forth in 10 USC,
1074(b), retired members of the uniformed services, as specified in that Act, are entitled
to required medical and dental care and adjuncts thereto to the same extent as provided
for active duty members in medical facilities of the uniformed services. However, access
to care is subject to mission requirements, the availability of space and facilities, and the
capabilities of the medical staff as determined by the cognizant medical authority in
charge. Patients enrolled in TRICARE Prime Options are not eligible for non-emergent
care in Coast Guard clinics. These patients shall be referred to their TRICARE primary
care manager (PCM). The PCM is responsible for appropriate care and referral of such
patients.
2. Care Under the TRICARE Extra and Standard Options (formerly CHAMPUS). Subject
to the cost sharing provisions set forth in 10 USC, 1086, retired members who are not
qualified for benefits under Title I of the Social Security Amendments of 1965
(Medicare) are entitled to receive inpatient and outpatient care from civilian sources.
3. Care at Veterans Administration Medical Facilities.
a. Eligibility for DVA Hospitalization. Coast Guard military personnel are eligible for
hospitalization in DVA facilities after separation from active duty or while in
retirement under one of the following circumstances:
(1) For injuries or diseases incurred or aggravated while on active duty during any
war, the Korean conflict period 27 June 1950 through 31 January 1955) or the
Vietnam conflict period (5 August 1964 through 7 March 1975).
(2) For service-connected or nonservice-connected disabilities, if receiving
disability compensation from the DVA, or if entitled to receive disability
compensation from the DVA, but has elected to receive retirement pay from
the Coast Guard instead of the compensation from the DVA.
b. Medical Care Benefits. Eligible veterans may receive hospitalization, outpatient
medical care, outpatient dental care, prosthetic appliances, etc., from the VA.
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Section D - Health Care for Dependents.
1. Care at Uniformed Services Medical Treatment Facilities.
a. Authority for Health Care. Title 10 USC, 1076 provides basic authority for medical
and dental care for:
(1) dependents of active duty members and dependents of members who died
serving on active duty; and
(2) dependents of retired members and the dependents of members who died while
in a retired status.
b. Availability of Care.
(1) Medical and dental care for dependents in uniformed services medical
treatment facilities is subject to the availability of space and facilities and the
capabilities of the medical and dental staff. With the approval of the
commanding officer, the senior medical officer and senior dental officer are
responsible for determining the availability of space and capability of the
medical and dental staffs. These determinations are conclusive. Patients found
enrolled in TRICARE Prime Options are not eligible for non-emergent care in
Coast Guard clinics. These patients shall be referred to their TRICARE
primary care manager (PCM). The PCM is responsible for appropriate care
and referral of such patients.
(2) Dependents entitled to medical and dental care under this section shall not be
denied equal opportunity for that care because the facility concerned is that of a
uniformed service other than that of the sponsor.
(3) Types of Care Authorized. Subject to the provisions set forth in 10 USC, 1079
and 1086, dependents who are not qualified for benefits under Title 1 of the
Social Security amendments of 1965 (Medicare) are entitled to receive
inpatient and outpatient care from civilian sources. Refer to your cognizant
MLC (k) for details and instructions.
2. Care Under Coast Guard Civilian Contracts. Under certain circumstances, dependents
are entitled to medical and dental care provided through Coast Guard civilian contracts.
See Chapter 11 for guidance.
3. Rights of Minors to Health Care Services. Where not in conflict with applicable Federal
law or regulation, unit commanding officers shall follow State law defining the rights of
minors to health care services and counseling in contraception, sexually transmitted
disease prevention and treatment, and pregnancy. Any protection with regard to
confidentiality of care or records afforded by applicable law or regulation will be
extended to minors seeking care or counseling for the above mentioned services or
conditions in Coast Guard facilities.
CH-16 2-22
Section E - Care for Preadoptive Children and Wards of the Court.
1. General.
a. A child placed in a sponsors home as part of a pre-adoption procedure, or by court-
ordered guardianship, is not eligible for care under the Uniformed Services Health
Benefits Program unless specific authority has been granted. Such authority may
come from the final adoption decree, a court-ordered legal custody determination (for
a period of at least 12 consecutive months), or through a Secretary's Designation
authorization for limited health care in a USMTF.
b. Eligibility for TRICARE benefits, the Uniformed Services Family Health Benefits
Plan (USFHBP), or the Uniformed Services Active Duty Dependents Dental Plan is
established upon the issuance of a uniformed services dependent ID card and DEERS
enrollment. Authorization for these health care programs, or for direct care (USMTF
use), will be reflected on the ID card and through DEERS.
c. Prospective dependents must meet the following eligibility rules: be unmarried; have
not attained the age of 21 (or 23 if a full-time student); be dependent on the sponsor
for over one-half of their support; or be incapable of self-support due to mental or
physical incapacity and were otherwise eligible when incapacity occurred.
d. If legal custody or placement is for 12 months or more, a uniformed services
dependent ID care, DEERS enrollment, and health care eligibility may be authorized.
Personnel are encouraged to contact their servicing personnel office for assistance.
2. Secretary's Designation. The following procedures apply in situations where a pre-
adoptive or court ordered guardianship or placement is for less than 12 consecutive
months.
a. Children under a prospective parent or guardians care may use a USMTF by
acquiring authority from the Secretary of the uniformed service to which the USMTF
belongs. This authority is normally called a Secretary's Designation. For example,
requests for care in a U. S. Navy facility must be authorized by the Secretary of the
Navy or their designee. The same holds true for U. S. Army and U. S. Air Force
facilities. When seeking care from a Department of Defense MTF, contact that
facilities Patient Affairs or Health Benefits Advisor staff for assistance.
b. In cases involving Coast Guard facilities, authority has been delegated to the
Commandant by the Secretary of Transportation to authorize treatment of pre-
adoptive children and wards of the court. Letter requests must be forwarded to
Commandant (G-WKH) and include the following information:
(1) member's name, grade/rate, SSN, and duty assignment or retired status if
applicable;
(2) address of residence;
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(3) name and age of the proposed adoptive child or court-ordered ward; and
(4) a copy of the court order, legal decree, or other applicable instrument issued by
a court or adoption agency which indicates the child has been placed in the
house for adoption or with the intent to adopt, or the court order granting
guardianship of the ward to the service member and any amounts of income to
which the ward is entitled.
c. Upon approval, the respective uniformed service will issue a letter of authority for
care in one or more of their USMTFs located in the United States. This letter is the
only authority for care (since designees are not DEERS-eligible) and must be
presented (or on file) when seeking authorized care. These letters have expiration
dates and may require the sponsor to request to reissue.
d. When there is a need for medical care outside the United States, the sponsor should
contact the nearest USMTF requesting humanitarian consideration. The Service
Secretaries have limited authority for designation of beneficiaries outside the United
States.
CH-16 2-24
Section F - Health Care for Other Persons.
1. Members of the Auxiliary.
a. Authority for Care of Auxiliary Members. Basic authority for health care for
members of the Auxiliary injured while performing Coast Guard duty is contained in
14 USC 832. Section 5.59 of Chapter 1, Title 33, CFR, states: "When any member
of the Auxiliary is physically injured or dies as a result of physical injury incurred
while performing patrol duty or any other specific duty to which he has been
assigned, such member or his beneficiary shall be entitled to the same benefits as are
now or as may hereafter be provided for temporary members of the Coast Guard
Reserve who suffer physical injury incurred in the line of duty. Members of the
Auxiliary who contract sickness or disease while performing patrol duty or any other
specific duty to which they have been assigned shall be entitled to the same hospital
treatment as is afforded members of the regular Coast Guard." Claims for Auxillary
healthcare shall be submitted to:
U. S. Department of Labor
OWCP Special Claims Branch (District 25)
800 North Capitol Street, NW, Room 800
Washington, DC 20211
b. Compensation Under Federal Employee's Compensation Act (FECA) Program. See
the Detail of Civilian Employees, COMDTINST M12300.7 (series).
2. Temporary Members of the Reserve.
a. Composition of the Reserve. The Coast Guard Reserve is a component part of the
United States Coast Guard and consists of two classes of reservists: Regular and
Temporary. Temporary members of the Reserve may be enrolled for duty under such
conditions as the Commandant prescribes, including but not limited to part-time and
intermittent active duty with or without pay, and without regard to age. Members of
the Auxiliary, officers and members of the crew of any motorboat or yacht placed at
the disposal of the Coast Guard, and persons (including government employees
without pay other than compensation of their civilian positions) who by reason of
their special training and experience are deemed by the Commandant qualified for
such duty. The Commandant is authorized to define the powers and duties of
temporary reserves, and to confer upon them, appropriate to their qualifications and
experience, the same grades and ratings as are provided for regular members of the
Reserve.
b. Authority for Care of Temporary Reservists. Section 760, Title 14, USC, contains
authority for health care and/or compensation of temporary reserves under conditions
set forth therein.
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c. Care at Coast Guard Expense. 14 USC 760(d) states: "Temporary members of the
reserve who incur physical disability or contract sickness or disease, while
performing any specific duty to which they have been assigned by competent Coast
Guard authority, shall be entitled to the same hospital treatment afforded officers and
enlisted men of the Coast Guard."
d. Compensation Under Federal Employee Compensation Act (FECA) Program. See
Detail of Civilian Employees, COMDTINST M12300.7
3. Members of Foreign Military Services.
a. General. Members and dependents of foreign services assigned or attached to a
Coast Guard unit for duty or training (such as Canadian Exchange Officers) or who
are on active duty with a foreign military unit within the United States (such as the
crew of a vessel being taken over at the Coast Guard Yard under the Military
Assistance Program) are eligible for inpatient health care at DoD MTF's provided by
US Code: Title 10, Section 2559. As there are several categories of foreign service
members for whom medical care benefits vary, both for themselves and their
dependents, if any doubt exists as to eligibility for health care and the authorized
sources from which it can be obtained, contact Commandant (G-WKH) for advice.
b. Care at Uniformed Services Medical Treatment Facilities. Members of foreign
military services and their dependents who are eligible, therefore, shall be provided
inpatient health care at DoD MTFs upon request of the member's commanding
officer or consular official, or by application of the member or dependent upon
presentation of proper identification.
4. Federal Employees.
a. Benefits Under Federal Employees Compensation Act (FECA) Program. All Federal
Employees assigned to Coast Guard vessels, e.g., National Marine Fishery Service
(NMFS), Drug Enforcement Agents, etc., are civilian employees of the United States
Government, and as such, are entitled to health care and compensation under FECA.
See Detail of Civilian Employees, COMDTINST M12300.7 (series).
b. Care Aboard Ship and Outside CONUS. Federal Employees may be given medical
care while serving with the Coast Guard in a locality where civilian health care is not
obtainable, such as on board a Coast Guard vessel or outside the United States.
Outpatient and inpatient care may be provided at Navy medical facilities outside
CONUS, if reasonably accessible and appropriate nonfederal medical facilities are
not available.
5. Seamen. Sick and disabled seamen may receive emergency health care aboard Coast
Guard vessels.
CH-16 2-26
6. Nonfederally Employed Civilians Aboard Coast Guard Vessels.
a. Authority for Care. There is no statute which either prohibits or authorizes the Coast
Guard to provide health care to civilians while aboard Coast Guard vessels. There is
no objection to furnishing emergency health care, but routine care should not be
furnished. When these civilians are aboard Coast Guard vessels for relatively
lengthy periods, the commanding officer must determine what treatment is to be
given.
b. Responsibility. Commanding officers of vessels deployed for extended periods shall
ensure that nonfederally employed civilians who are carried aboard Coast Guard
vessels under their cognizance are physically capable of withstanding the trip
contemplated and that they are free from medical conditions which could cause an
interruption of the vessel's mission. Nonfederally employed civilians must furnish
such evidence from a physician at no expense to the Coast Guard or Federal
Government.
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Section G - Medical Regulating.
1. Transfer of Patients at Coast Guard Expense.
a. Details for the transfer of Coast Guard personnel to, from, or between hospitals and
the responsibility for the expenses involved are contained in Chapter 4 of the
Personnel Manual, COMDTINST M1000.6 (series).
b. Information and requirements for the transfer of patients to, from, or between
medical facilities is contained in COMDTINST M6320.8 (series), Medical
Regulating to and Within the Continental United States.
2. Travel Via Ambulance of Patients to Obtain Care.
a. Active Duty Personnel. The Coast Guard is responsible for providing ambulance
service (Government or civilian), for active duty members when medically necessary.
Bills related to ambulance service provided to active duty personnel, shall be
processed as outlined in Chapter 11 of this Manual.
b. Retired and Dependent Personnel. Retired personnel and dependents are not
provided ambulance service for initial admission, except that a Government
ambulance may be used in an emergency situation as determined by the cognizant
medical authority. If an ambulance is ordered by a military hospital, TRICARE
Standard can not pay for it; the military hospital must pay. TRICARE Standard cost
–shares ambulances only when medically necessary; that is, the patient’s condition
does not allow use of regular, private transportation or taxis, “medicabs” or
“ambicabs.” Ambulance transportation must be needed for a medical condition that
is covered by TRICARE Standard. Should either the provider or patient have
additional questions regarding this issue check with the cognizant MLC(k), HBA or
TRICARE Service Center.
3. Aeromedical Evacuation of Patients. When the condition of the patient requires
aeromedical evacuation, the transfer shall be arranged in accordance with Medical
Regulating To and Within The Continental U.S. (Joint Pub), COMDTINST M6320.8
(series). If there is no USMTF in the area, a message prepared in accordance with the
above instruction shall be forwarded to MLC (k).
CH-16 2-28
Section H - Defense Enrollment Eligibility Reporting System (DEERS) in Coast Guard Health
Care Facilities.
1. Defense Eligibility Reporting System. This Section provides guidance for Coast Guard
health care facilities on the use of the Defense Enrollment Eligibility Reporting System
(DEERS) to verify patient eligibility to receive care.
a. DEERS was established in 1979 by the Department of Defense to comply with a
Congressional mandate. The two initial objectives of DEERS were to collect and
provide demographic and sociographic data on the beneficiary population entitled to
DOD health benefits, and to reduce the fraud and misuse of those benefits. The
original scope of DEERS has since been broadened to include the maintenance and
verification of eligibility status for all uniformed services beneficiaries. Worldwide
implementation of DEERS and its registration were completed in 1985.
2. Responsibilities.
a. Commandant (G-WKH) provides overall functional management of the Coast Guard
DEERS program for health services facilities. In this role, Commandant (G-WKH)
provides guidance to field activities, represents the Coast Guard to the DEERS
Central Systems Program Office (DCSPO), and on the DEERS Central Systems
Project Officers Committees.
b. Commanders, Maintenance and Logistics Commands (k) shall appoint an MLC
DEERS medical project officer and alternate, who shall ensure that facilities in their
respective areas participate in and comply with DEERS program requirements.
c. Commanding officers of units with health care facilities shall ensure that the Chief of
the Health Services Division appoints the following individuals in writing:
(1) DEERS Project Officer and alternate who are responsible for the overall
management of the DEERS system in the clinic;
(2) Site Security Manager (SSM) and alternate who are responsible for system
security as outlined in paragraph 3; and
(3) individuals authorized to deny care.
3. Security.
a. The Site Security Manager (SSM) should be the health services division or unit
computer systems administrator. The security manager is responsible for
maintaining passwords, authorized user list, etc., and advising the DEERS contractor
when changes occur.
b. The SSM also requests site identification (site-ID) codes for the clinic. These codes
are requested through the MLC DEERS Project Officer to Commandant (G-WKH).
2-29 CH-16
As a rule, there is only one site ID required per clinic. The SSM also ensures
information systems security awareness training/briefing is given to new DEERS
users prior to allowing them access to DEERS and to all DEERS users annually.
c. If the clinic DEERS project officer is not the SSM, the security manager must closely
coordinate activities with the DEERS project officer. Immediately after
appointment, the SSM must telephone the DEERS Security Maintenance Office at
(703) 820-4850 to notify that office of the appointment. When making this
notification, include the following information:
(1) Site ID number;
(2) Rank or grade of SSM;
(3) Name (last, first, middle initial);
(4) Social Security Number (SSN);
(5) Duty location;
(6) Duty title; and
(7) Telephone number.
(8) After telephone notification, submit a letter of appointment and a Request for
Data Base Additions, Deletions, or Changes (Figure 2-H-1) to:
(9) Security Maintenance Office
DEERS East Coast Center
1600 North Beauregard St.
Alexandria, VA 22311
d. User Password Maintenance.
(1) The DEERS security system requires a six-character user-ID and a six to eight
character password. The user-ID is assigned by DEERS, and is permanent. An
initial password is assigned by the DEERS government contractor. The
password expires at 30 day intervals. At the end of each 30 day period, the
user is required to change the initial password to one of his or her own
choosing, so long as it meets the six- to eight-character requirement. Access to
the data base is granted by using a unique user-ID, password, and the
transaction identifier (TRAN-ID). The TRAN-ID for medical/dental is GIQD.
(2) To add a new user, submit a Request for Data Base Additions, Deletions, or
Changes. Be sure to include the site-ID and SSN of any new personnel.
(3) To delete a current user, submit a Request for Data Base Additions, Deletions,
or Changes requesting the deletion to the DEERS Security Maintenance Office.
(4) User IDs not used for 60 days are automatically deleted and access is not
possible. To regain access, the SSM must reapply for a new user-ID by
submitting a new Security Manager Update.
CH-16 2-30
(5) Authorized users must be kept to the absolute minimum, consistent with job
requirements.
4. Performing DEERS Checks.
a. Whom to check: All beneficiaries of the military health care system are subject to
DEERS eligibility verification, with the following exceptions:
(1) Coast Guard cadets, officer candidates, and recruits while undergoing training;
(2) Active duty personnel receiving dental care at a military facility; and
(3) Secretarial Designees, including pre-adoptive children and wards of the Court,
ARE NOT ELIGIBLE for care under the TRICARE programs. They are also
not enrolled in DEERS. Verification of the eligibility of Secretarial Designees
for care in a military facility is accomplished through the individual's actual
letter of designation. Refer to Section 2-E for further information.
b. When to check: Coast Guard health services facilities should verify the eligibility of
all beneficiaries prior to providing health care. The following minimum eligibility
checks shall be made:
(1) 100% of all outpatient medical visits:
(2) 25% of all dental visits;
(3) 10% of pharmacy visits to fill "in-house" prescriptions;
(4) 100% of pharmacy visits with prescriptions written by civilian providers;
(5) 100% of all inpatient admissions; and
(6) 100% of dental visits when the patient may be eligible for the TRICARE
Family Member Dental Program;
(7) 100% of retired members at the initial visit to a dental facility, and annually
thereafter at the time of treatment.
(8) Upon initial presentation by dependents for evaluation or treatment. This
check will be valid for 30 days, if the period of eligibility (dates of treatment)
requested from DEERS is 30 days.
(9) When a non-active duty patient is referred to a civilian provider for
supplemental care.
(10) When active duty personnel are referred to a civilian provider under the Active
Duty Claims Program.
(11) When any patient (active duty, retired, dependent, or survivor) is referred to a
Military Treatment Facility (MTF) or a Uniformed Services Treatment Facility
(USTF).
(12) When in doubt verify enrollment and eligibility.
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(13) Coordinated/Managed Care: Verification of eligibility will be conducted
according to the policies and procedures of the sponsoring
hospital/organization. Coast Guard facilities participating in
coordinated/managed care programs are considered, by that participation, to be
in compliance with the eligibility verification requirements of the DEERS
program for medical patients. Dental patients will still be subject to the above
checking requirements until a dental coordinated care program is established.
(14) Each clinic is required to perform a published number of checks each month.
These requirements are based on the outpatient visits of each clinic from the
previous year. Updated annual requirements will be published each January by
Commandant Notice.
c. How to check. DEERS checks for patient registration and eligibility can be done in a
number of ways. The following examples are the most common ways to verify
eligibility:
(1) Telephone-Based System. Eligibility checks are done by contacting DEERS
direct by telephone. Procedures for performing DEERS checks by telephone
are found in Figure 2-H-2.
(2) Computer Link Using the Coast Guard Standard Terminal. Procedures for
using the Standard Terminal are attached as Figure 2-H-3.
(3) DEERS-owned Computer and Software (On-Line) System. Procedures for
using DEERS-owned equipment are contained in DOD DEERS Eligibility
Inquiry/Nonavailability Statement Users Guide [Pub # UG 0100EL (series)].
(4) Use of PERSRU/Admin RAPIDS Terminals. Personnel in health care
facilities are discouraged from performing DEERS checks using the RAPIDS
terminal that may be available in their unit's Administration Office or
PERSRU. Using this resource places an unnecessary burden on the
PERSRU/Admin personnel, and using these terminals does not indicate that
the required medical checks are being accomplished.
d. How to request site-ID, data base access, or equipment.
(1) Site ID.
(a) Site ID numbers are assigned to a facility by the DOD DEERS Office.
These numbers are used to identify the origin of activity in the DEERS
system, and to generate reports of system activity. Site IDs are a
mandatory part of the initial request to access DEERS. The request form
is attached as Figure 2-H-4. Site IDs are permanent; they need not be
renewed.
(b) Health Care facilities requesting an initial Site ID, or changing the status
of their existing ID shall complete Section I of Figure 2-H-4 and forward,
via MLC (k), for further endorsement to:
CH-16 2-32
(c) Commandant (G-WKH-3)
U. S. Coast Guard
2100 Second St., SW.
Washington, DC 20593-0001
ATTN: DEERS MEDICAL PROJECT OFFICER
Telephone: (202) 267-0835
(2) Data Base Access.
(a) Authorization for individual access to DEERS is done by written request
from the clinic/unit Site Security Manager to the DEERS Security
Maintenance Office using the "Request for Data Base Additions,
Deletions, or Changes" form.
(b) Clinic personnel who should be considered for access to the DEERS
Data Base include those working in medical/ dental records,
appointments, pharmacy, patient affairs, and the health benefits advisor.
(c) Information available from the DEERS data base is subject to the
provisions of the Privacy Act.
(3) Equipment Requests or Changes.
(a) Telephone Access. Requests for access to DEERS via telephone is the
simplest and most user friendly means. This method is recommended for
facilities making fewer than 20 checks per day. Requests for initial
facility and personnel access is done by completing Figures 2-H-1 and 2-
H-4 and forwarding them to DEERS security via the MLC and
Commandant (G-WKH).
(b) Computer link using the Coast Guard Standard Terminal. Use of the
Standard Terminal, with the proper software emulation package installed,
allows facilities with a greater number of required checks to perform
those checks without making repeated telephone calls. Equipment
required includes a Standard Terminal workstation, Bell 212A
compatible modem, appropriate emulation software (VT 100), and an
outside commercial/FTS touch-tone telephone line. Facility requests for
access using this equipment is done by completing Figure 2-H-4 with an
attached statement that the facility has the appropriate hardware and
software as listed above. The facility must also state that it will be
responsible for any telephone charges incurred using this means of
access. Figure 2-H-5 lists complete equipment requirements.
(c) DEERS-owned computer hardware and software system. This top of the
line system features a direct, on-line, computerized link with the DEERS
data base. The minimum justification for requesting this equipment is
performing more than 100 DEERS checks per day. A limited number of
2-33 CH-16
Coast Guard health care facilities have this equipment. For further
information on this system, contact the Medical Project Officer at
Commandant (G-WKH-1).
5. Reports. No reports from field units documenting DEERS activity are required. Two
commonly generated reports concerning DEERS activity are described below:
a. Monthly Statistical Reports. Upon receipt from DEERS, Commandant (G-WKH)
will forward the Monthly Statistical Reports to each MLC (k). These reports list
DEERS activity for each clinic during the preceding month. Clinics may also use the
on-line statistical report screen to monitor its activity.
b. Field Representative Visit Report. These report the findings of each training visit by
the DEERS Field Representative to a clinic. These reports reflect the compliance of
the facility to DEERS requirements, and whether or not further training for facility
personnel is needed. Copies are provided to each MLC (k) and
Commandant (G-WKH).
6. Eligibility/Enrollment Questions, Fraud and Abuse.
a. Eligibility/Enrollment Questions: Beneficiaries of the military health care system,
including active duty and retired personnel, their dependents, and survivors must
provide positive proof of eligibility before being provided health care. Eligibility is
determined by (a) presenting a valid ID Card and (b) verifying enrollment and
eligibility in DEERS.
(1) If an individual presents an ID card that is no longer valid (expired), the
individual should be refused care and the ID card confiscated.
(2) If the individual has a valid ID card, but is not enrolled in DEERS, they should
be refused routine care, and referred to their sponsor and/or service ID card
activity to be enrolled in DEERS. Following enrollment into DEERS, the
patient may prove temporary eligibility (pending their enrollment showing up
in the DEERS computer) by presenting a certified copy of Application for
Uniformed Services Identification Card DD Form 1172 from the ID card
activity. Upon presenting of this DEERS enrollment verification, the
individual should be considered as fully eligible, and treatment provided.
b. Fraud and Abuse: If, in the process of verifying eligibility through DEERS, clinic
personnel have reason to believe the person requesting care is doing so even though
that person is no longer eligible (e.g. a divorced spouse with a valid ID card, but
DEERS shows NOT ELIGIBLE), care should be refused, and the details of the
situation should be reported to the appropriate personnel activity and investigation
office. Clinic personnel reporting suspected fraud should document as much
information about the individual as possible (name, former sponsor's name, SSN,
service and status, as well as the individual's current address and telephone number if
known). Do not attempt to confiscate the ID card, or in any way restrict the
CH-16 2-34
individual. Recovery of invalid or no-longer-appropriate ID cards is the
responsibility of the parent service's investigation/law enforcement personnel.
Reports of possible fraud should be reported to the command of the clinic, and to the
DEERS Support Office (DSO) in Monterey, CA at (408) 646-1010.
7. Denial of Nonemergency Health Care Benefits for Individuals Not Enrolled in Defense
Enrollment Eligibility Reporting System (DEERS).
a. Policy.
(1) All CONUS USMTFs will deny nonemergency health care to dependent
beneficiaries not enrolled in DEERS. The DOD considers USMTFs located in
Alaska, Hawaii, and Puerto Rico as being in CONUS. Patients presenting for
care are required to have a valid ID card in their possession and meet DEERS
enrollment requirements.
(2) This policy effects only the delivery of nonemergency health care. Under no
circumstances are Coast Guard health service personnel to deny emergency
medical care or attention because a patient is not enrolled in DEERS.
(3) Health service personnel in CGMTF's are to conduct the minimum eligibility
checks for their facility as set annually by Commandant (G-WKH-1).
Whenever possible, prospective checking should be accomplished soon enough
to allow for notifying the patient and correcting enrollment problems before a
scheduled appointment.
(4) Patients with valid ID cards, but not enrolled in DEERS, presenting for
nonemergency medical care at CGMTFs will be denied care and instructed to
seek proper enrollment through their cognizant personnel office.
(5) Patients who present for nonemergency treatment without a valid ID card and
are in the DEERS data base, will not be provided health care without first
providing a statement, signed by a verifying personnel officer indicating that
they are eligible and providing a reason why a valid ID card is not in their
possession. A copy of this statement will be maintained in the clinical record
until the individual's eligibility is determined.
(6) If the beneficiary presenting with or without an ID card is suspected of fraud,
refer the case to the district (ole) branch for appropriate investigation.
(7) Denial of health care benefits represents a serious application of new and
complex regulations. Under no circumstances will a person be denied care by
the clerk performing the initial eligibility check. The decision to deny care will
be made only by clinic administrative officers or by a responsible person so
designated in writing by the command.
8. DEERS Eligibility Overrides. The below listed situations will override DEERS data
which indicates that a patient is not enrolled or eligible. Unless otherwise stated, all
situations assume that the beneficiary possesses a valid ID card:
2-35 CH-16
a. Dependents Recently Becoming Eligible for Benefits. Patients who have become
eligible for benefits within the previous 120 days may be treated upon presentation of
a valid ID card. In the case of children under age 10, the parent's ID card may be
used. Examples of patients expected to fall under this provision are: spouses
recently married to sponsors, newly eligible step children, family members of
sponsors recently entering active duty status for a period over 30 days,
parents/parents-in-law, or divorced spouses (not remarried) recently determined to be
eligible. After 120 days, these beneficiaries will no longer be considered recent.
b. DD-1172. Application for Uniformed Services Identification Card form. The patient
presents an original or a copy of the DD-1172 used for DEERS enrollment and
possesses a valid ID card over 120 days old, but is not enrolled in DEERS. This
copy of the DD-1172 should be Certified to be a True Copy by the ID Card issuing
authority which prepared it. It should also contain a telephone number where the
certifying individual can be contacted for verification. The person conducting the
DEERS check shall contact the issuing personnel office to verify enrollment.
c. Sponsors Entering Active Duty Status for a Period of Greater than 30 days. If the
sponsor is a reservist or guardsman recently ordered to active duty for a period of
greater than 30 days, a copy of the active duty orders may be accepted as proof of
eligibility for up to 120 days after the beginning of the active duty period.
d. Newborns. Newborns will not be denied care for a period of one year after birth
provided the sponsor is DEERS enrolled and the parent accompanying the infant
presents with a valid ID card.
e. Ineligible due to ID Card Expiration. When the data base shows a patient to be
ineligible due to ID card expiration, care may be rendered as long as the patient has a
new ID card issued within the previous 120 days.
f. Sponsor's Duty Station is Outside the 50 United States with an FPO or APO address.
Dependents whose sponsors are assigned outside the 50 United States or to a duty
station with an APO or FPO address will not be denied care as long the sponsor is
enrolled in DEERS.
g. Survivors. In a small percentage of cases, deceased sponsors may not be enrolled in
DEERS. This situation will be evidenced when the MTF does an eligibility check on
the surviving beneficiary and does not find the sponsor enrolled or the survivor
appears as the sponsor. In either of these situations, if the survivor has a valid ID
card, he/she should be treated and referred to the local personnel support activity to
correct the DEERS data base. In some situations, surviving beneficiaries who are
receiving SBP annuities will be listed in DEERS as sponsor and will be found under
their own social security number. These are eligible beneficiaries and should be
treated.
CH-16 2-36
h. Foreign Military Personnel. Foreign military personnel assigned via the personnel
exchange program are eligible through public law or other current directives, though
not enrolled in DEERS they will be treated upon presentation of a valid ID card.
2-37 CH-16
Figure 2-H-2
TO: Security Maintenance Office
DEERS East Coast Center SITE ID: __ __ __ __ __ __ (DEERS)Date: __________________
1600 N. Beauregard St.(Fill in six digits)
Alexandria, VA 22311
SUBJECT: Request for Data Base Additions, Deletions, or Changes
FROM: Site Security Manager: _____ ________________________________ ________________ _____________________
Rank Name (Last, First MI) SSAN Title
Phone #: AV: ______________ COM: (_____)____________________
Request the indicated actions be taken for the following individuals:
Action
SSAN Name (Last, First, MI)Duty Location
(MTF Records, HBA, Etc.)
Action SSN name duty location
Add Delete Change
__________________________________________________________________________________________________________________
________________________________
Unit OPFAC Code: _____________________(Signature) _____________________________________
Base/Installation/Facility
Site Security Manager
• All Site Security Manager's mailing address changes should be entered in this space.
• All items must be completed. Omission of any items may prevent or delay the processing of this form.
CH-16 2-38
Figure 2-H-2 (con’d)
INSTRUCTIONS FOR DEERS TELEPHONE USERS
A. Telephone Users.
1. Provide your LOGON-ID and Password to the Eligibility Telephone Center operator at:
(800) 336-0289 or (800) 368-4416. The hours of operation are 0400-1700 (Pacific Time),
Mon-Fri.
2. Approximately every 30 days the Telephone Center operator will ask you to establish a
new password. At that time, you will provide the operator a new Password of 5 to 8
characters. It is very important that you remember the new Password you have chosen.
3. If you forget your password, the operator in the Telephone Center will refer you to the
Security Maintenance office at (703) 578-5306, or AUTOVON 289-1953. At this time,
you will be provided a Temporary Password, which you will then provide to the Eligibility
Telephone Center operator on your next inquiry call.
4. The Eligibility Telephone Center operator will enter this Temporary Password into the
operator's terminal and then ask for your new password (as in [2] above).
B. Telephone-Based System.
1. Telephone type. The telephone line used for eligibility checks is a rotary In-WATS
telephone system. A rotary system means that when one of the lines at the eligibility
center is not being used, the incoming call will automatically be transferred to that line. If
a busy signal on the rotary line is received, all lines at the eligibility center are being used.
If this happens, hang up and try again later.
a. Eligibility Check Procedure. When an eligibility center operator answers the
telephone, the following procedures to perform a patient's eligibility check will be
used:
b. Note: When calling, greet the operator and identify the center from where you are
calling.
(1) You will supply the following information to the operator:
(a) Site name and site security code, UCA code (from medical, dental, or
pharmacy)
(b) DEERS ID (an optional family member prefix and sponsor's Social
Security Number)
(c) Date of birth of beneficiary if known. If not known, then 999999
(d) FROM date (YYMMDD) of medical treatment
2-39 CH-16
Figure 2-H-2 (con’d)
(e) TO date (YYMMDD) of medical treatment
(2) The operator will then perform an eligibility inquiry.
(3) If the patient is found to be on file, the operator will indicate that the patient is
enrolled in DEERS and is/is not eligible. When checking eligibility for more
than one member of a family, each of the family members must be identified
individually.
(4) If the patient is not found on file, the operator will indicate that the patient does
not appear as enrolled in DEERS.
(5) The procedure is repeated until all patients have been checked, and then the
call is ended.
SAMPLE ELIGIBILITY CHECK CALL
The following is an example of DEERS Eligibility Center Telephone Inquiry format:
Operator: Good Morning - DEERS Eligibility Center - May I help you?
Inquirer: Good morning, this is Support Center Alameda, Security Code AC, UCA Code BA,
Site Code 10123, inquiring the eligibility of 123 45 6789. The date of birth is 560324.
This is a single beneficiary request.
Operator: (enters SSN, DOB, SC, UC, and SITE CODE) What period of eligibility do you wish
to check?
Inquirer: 801201 through 801215 (December 1 - 15, 1980)
Operator: The beneficiary is Jane Smith, and she is enrolled and eligible for the period
requested. Any more inquiries?
Inquirer: Not at this time. Thank you, good-bye.
Operator: Thank you for calling the DEERS Eligibility Center.
CH-16 2-40
Figure 2-H-3
PERFORMING DEERS CHECKS USING THE COAST GUARD STANDARD TERMINAL
Ref: (a) DEERS Users Guide (UG0100ELR5) of Oct 1987
1. At the Standard Terminal "Command Bar", Type VT100, (Go). If you don't have a
"Command Bar", see your computer System Manager.
2. To dial-up the DEERS microcomputer access, enter ATDT8,7033795860, then press
(Return). This command tells the modem to dial the DEERS access number, and should
result in a message reading "connect 1200" on your screen. This means your computer and
the one at DEERS are talking to on another.
3. Upon "handshake" with the DEERS computer, enter M (for Menu), then VT100 (return).
4. At Security Protection Screen, enter DEERS (Return). See also page 2-2 of reference (a).
5. At Transaction Code Screen, enter LOGN (Return). Also see page 2-3 of reference (a).
6. At Security Screen, enter your User ID in the "LOGON-ID" space, then press TAB. See
page 2-4 of reference (a).
7. Enter your personal password in the designated area, then press TAB. See page 2-4, Step 5
of reference (a).
8. Enter GIQD in the "TRAN ID" space, then press Return. See pages 2-4 and 5, steps 6 & 7
of reference (a).
9. At the Main Menu, select the desired activity. For Eligibility checks, see pages 4-1 through
4-19 of reference (a), or as follows:
10. In Activity Code (AC) space, no entry is necessary if you wish to make an eligibility check.
See page 4-11 of reference (a). Press "Tab" to continue.
11. Enter your 6 character Site ID, then press "Tab".
12. In "UC" block, enter BA for Ambulatory Medical Care checks, CA for Dental checks, DA
for Pharmacy checks, or FN for TRICARE/HBA checks, then press "Tab". See page 4-12
of reference (a) for other codes.
13. Enter Sponsor's SSN, then press "Tab".
14. Enter PATIENT's Date of Birth (DOB) in the following format: YYYYMMDD, then press
"Tab".
15. In "DDS" block, enter DEERS Dependent Suffix as follows:
01-19 Eligible Dependent Children
20 Sponsor
30-39 Spouse of Sponsor
40-44 Mother of Sponsor
45-49 Father of Sponsor
50-54 Mother-in-Law of Sponsor
2-41 CH-16
55-59 Father-in-Law of Sponsor
60-69 Other Eligible Dependents
70-74 Unknown by DEERS
75 DDS is unknown by Inquirer
98 Service Secretary Designee
NOTE
If the DDS code for sponsor (20) is used, only sponsor data will be displayed on the Eligibility
Inquiry and Family Display Screens.
In the Treatment Date block, if the treatment dates are not the current date, enter the correct
dates in YYYYMMDD format, then press Tab.
16. After completing the SITE, UC, SPON SSN, PAT DOB, and DDS fields, press the
ENTER/RETURN key. If there is a record on the data base with the same SSN and patient
DOB or a multiple DOB match and a single DDS match, the DEERS Eligibility Screen will
be redisplayed, showing the pertinent data on the patient in the lower portion of the screen.
17. Once patient eligibility has been verified, that patient's data can be cleared from the screen
by pressing Return.
18. To exit from the DEERS Eligibility Inquiry System:
a. Select the appropriate two-character code and enter it into the AC field. The codes are:
MM - DEERS Inquiry System Main Menu Screen
SO - Sign Off
(1) If the MM code is used to return to the Main Menu, enter 10 in the activity field to
Sign Off, then press Return.
b. Press, Enter (Return) when prompted by the sign-off screen.
c. When at the Original screen, enter +++ (return), then AT H (return). (Steps b and c
"hang up" the modem link/telephone connection with the DEERS computer)
d. Press, Finish to return to the Command Bar.
CH-16 2-42
Figure 2-H-4
SITE-ID INITIAL REQUEST (DEERS)
SECTION I. (To be completed by the base/installation/facility Site Security Manager).
A new Site-ID is requested__________(base name).
SERVICE/ORGANIZATION (Check X One)
Air Force = F ___DOD = D ___ NOAA = O ___
Army = A ___Marine Corps = M ___TRICARE = C ___
Coast Guard = P__Navy = N ___ Public Health = W ___
Other = X ___
TYPE OF FACILITY (CHECK X One) FACILITY SECTION (Check X One)
Dental Clinic = D ___AAFES = S ___ FINCTR W/Title III = FT ___
Health Clinic = M ___AQCESS = G __ Med/Dent Rec = R ___
Hospital = H ___ Army Fin Off = F ___Tumor Registry = T ___
Personnel Office = P __Civ Pers Office = C ___ Other = Z ___
OPFAC code is ____________
Sample: Full Mailing Address:
Commander Point of Contact (Title not person’s name)
Integrated Support Command New Orleans
Attn: Medical Records
4640 Urquhart St.
New Orleans, LA 70017-1010
** This line of address must include a location identifier. For example, "USCG Clinic"
is not acceptable; USCG Clinic New Orleans is acceptable.
Requested by (Rank/Name Signature) DATE:_______
(Telephone) Comm ( ) , FTS .
SECTIONS II/III. (To be completed by Service Project Officer)
Recommended by: (Rank/Name/Signature) Date: .
APPLICATIONS: (Check X One)
ACTUR ___ ARED ___ DOLI ___ OLGR ___ RAPIDS ___
AQUESS ___ DMRIS ___ GIQD ___ OLPU ___ Other ___
EQUIPMENT (Check X One) *Note: Justification must be attached if equipment is required.
CRT ___ RAPIDS ___ Telephone Center ___
Facility Equipment ___ Timeshare ___
III. 12-Month Workload: (A) Avg Admissions: ____, (B) Avg Outpat Visits: ___; (C) Dental: ___
2-43 CH-16
Figure 2-H-4 (con’d)
SECTIONS IV/V. (To be completed by DCSPO representative V.
Director, Benefits Policy Division Inpatient_________
DEERS and Central Systems Program Office Outpatient _______
Six Skyline Place Dental _______
5109 Leesburg Pike, Suite 502
Falls Church, VA 22041-3201
The applications above are correct (or changed as indicated), and the equipment is confirmed.
Eligibility checking requirements are in Section V. Issue Site-ID.
Director, Benefits Policy Division_____________________________Date:______________
SECTION VI. (To be completed by Security Maintenance, DEERS East Coast Center)
Entered on DEERS Site-ID File by (initials) DATE .
Site-ID: __ __ __ __ __ __
Field Service Region State or Country (OCONUS).
CH-16 2-44
Figure 2-H-5
DEFENSE ENROLLMENT ELIGIBILITY REPORTING SYSTEM (DEERS)
DIAL-UP ACCESS POLICY
MICROCOMPUTER ACCESS
DEERS can be accessed by telephone by using an IBM PC or AT compatible microcomputer, or
the Coast Guard Standard Terminal with the proper software emulation package installed. There
are four criteria for microcomputer access to DEERS:
1. Site must have access to an outside commercial touch-tone telephone line.
2. The modem connected to the computer must be Bell 212A compatible.
3. Individuals must have DEERS assigned user-IDs and passwords,
4. An asynchronous communication software package must be installed in the computer. The
most common software for the Standard Terminal is the VT-100 emulator.
An asynchronous dial-up environment is used to allow existing asynchronous terminals at
military installations to interface with DMSSCNET through a modem. The required modem
must be compatible with a Bell 212A capable for 300 or 1200 baud. This equipment will be
communicating with a Renex Converter at the DEERS offices. The display terminal should be
set up as follows:
1. Line width of 80 characters
2. 24 line screen height.
The asynchronous communications program should be configured as follows:
1. Baud rate of 300 or 1200.
2. Parity of EVEN or MARK
3. Stop bits of one (1)
4. Terminal emulation selections are listed on the Renex menu
5. Word length of seven (7)
The following telephone number is used to dial into the Renex converter box at DEERS. This
number has 16 trunk lines, and should normally be available:
(703) 379-5860
2-45 CH-16
Figure 2-H-5 (con’d)
ENSURING HANDSHAKE
The following criteria must be met during the interface test to ensure the handshake
(communication between your computer/modem and the DEERS system) is successful:
1. Verify correct hardware and software configuration
2. Conduct a dial-up test using the above telephone number
3. Perform system access procedures to display the DEERS sign-on screen
4. If any problems or questions arise during the initial setup and testing of equipment, call the
DMSSC Technical Support Group at (703) 578-5021, -22, or -23.
CH-16 2-46
Section I - Health Care Facility Definitions.
1. Coast Guard Facilities.
a. Clinic. A health care facility primarily intended to provide outpatient medical
service for ambulatory patients. A clinic must perform certain non-therapeutic
activities related to the health of the personnel which are necessary to support the
operational mission of the unit, such as physical examinations, immunizations,
medical administration, and preventive medical and sanitary measures. A clinic staff
consists of at least one permanently assigned medical officer and health services
technician. The staff may include dentists, nurses, pharmacists, physician assistants
and other specialists as required. A clinic may be equipped with beds for observation
of patients awaiting transfer to a hospital, and for overnight care of patients who do
not require complete hospital services (e.g., isolation of patients with communicable
diseases) if accredited for that purpose by an external accreditation agency
(JCAHO/AAAHC).
b. Satellite Facility. A health care facility which is administered by a Coast Guard
clinic but is located off-site from the clinic.
c. Dental Clinic. A facility at a Coast Guard unit for the dental care and treatment of
active duty personnel. Dental clinics are staffed with one or more dental officers and
health services technicians.
d. Sick Bay. A small medical treatment facility (afloat or ashore) normally staffed only
by health services technicians for the care and treatment of active duty personnel.
Civilian health care providers contracted to provide in-house services at these
facilities, like any facility, may provide care only within the scope of their contracts.
The fact that these civilian health care providers are on board will not change the
status of the medical facility.
e. Super Sickbay. An intermediate size medical care facility (ashore) intended to
provide outpatient medical care for active duty personnel. A super sickbay will
perform activities related to the health of the personnel, which are necessary to
support the operational missions of all units within AOR, such as physical
examinations, immunizations, medical administration, and preventive medical and
sanitary measures. A super sickbay staff will normally be staffed with one medical
officer and three or more health service technicians.
2. Department of Defense Medical Facilities.
a. Nomenclature and Definitions. There are three types of DOD fixed medical
treatment facilities medical centers, hospitals, and clinics. The nomenclature and
definitions applicable to the classification of these facilities, as set forth below, are
used by the Army, Navy, Air Force, and Marine Corps.
2-47 CH-16
(1) Medical Center. A medical center is a large hospital which has been designed,
staffed and equipped to provide health care for authorized personnel, including
a wide range of specialized and consultative support for all medical facilities
within the geographic area of responsibility and post graduate education in the
health professions.
(2) Hospital. A medical treatment facility capable of providing definitive inpatient
care. It is staffed and equipped to provide diagnostic and therapeutic services
in the field of general medicine and surgery, preventive medicine services, and
has the supporting facilities to perform its assigned mission and functions. A
hospital may, in addition, discharge the functions of a clinic.
(3) Clinic. A medical treatment facility primarily intended and appropriately
staffed and equipped to provide emergency treatment and outpatient services.
A clinic is also intended to perform certain non-therapeutic activities related to
the health of the personnel served, such as physical examinations and
preventive medicine services necessary to support a primary military mission.
A clinic may be equipped with beds for observation of patients awaiting
transfer to a hospital, and for care of cases which cannot be cared for on an
outpatient status, but which do not require hospitalization.
b. Primary Mission. The primary mission of Department of Defense medical facilities
is to provide adequate medical care for members of the uniformed services on active
duty.
3. Uniformed Services Treatment Facilities (USTFs).
a. Public Law 97-99 (1981) authorized several former USPHS hospitals (sometimes
called Jackson Amendment facilities) to provide health care to active duty and retired
members and their dependents. The law was modified in 1991 and the USTF
program was mandated to implement a managed care delivery and reimbursement
model in order to continue as part of the Military Health Services System (MHSS).
This managed care plan went into effect on October 1, 1993 and is called the
Uniformed Services Family Health Plan (USFHBP).
b. USFHBP is a health maintenance organization-type of plan exclusively for the
dependents of active duty, retirees and their dependents. Where available, the
USFHBP serves a defined population, through voluntary enrollment, and offers a
comprehensive benefit package. The capacity at USFHBP sites varies and is limited.
Beneficiaries enroll in the USFHBP during a yearly open season, and may disenroll
after one year. Enrollment is confirmed by each USFHP site. Those not accepted
during the open season may be enrolled as openings occur on a first come-first
served basis. USFHBP enrollees are not authorized to use the TRICARE
Program or the direct care system (DOD and Coast Guard health care/dental
facilities included) while enrolled in the USFHP.
c. Dependents and retirees who do not enroll in the USFHBP or who are denied
enrollment because the USFHBP is at capacity can only be treated at USTFs on a
CH-16 2-48
space-available and fee-for-service basis. All USTFs are required to be TRICARE
preferred providers.
d. Active duty personnel are not eligible to enroll in the USFHBP, however, they can
still be treated at USTFs under the following conditions:
(1) for emergency care,
(2) when referred by a military treatment facility, or
(3) when authorized by the cognizant MLC for non-emergent care.
e. When active duty care is rendered, the USTFs are not authorized to bill or collect
payment from active duty members, they must bill the Coast Guard instead.
2-49 CH-16
Section J - Policies and Procedures Required at Coast Guard Health Care Facilities.
1. Administrative Policies and Procedures. All facilities shall develop and maintain the
following written administrative policies and procedures which shall be reviewed
annually and updated as needed.
a. Standard Operating Procedure (SOP) defining objectives and policies for the facility.
b. Organizational Chart if there is a Health Services Division or Branch. The Health
Services Division/Branch or Medical Department should also be shown on the
command's organizational chart.
c. Clinic protocols, posted in the respective department, for pharmacy, medical
laboratory, and medical and dental radiology.
d. Notices posted in pharmacy and radiology advising female patients to notify
department personnel if they are or might be pregnant or breast feeding (pharmacy
only).
e. Written guidelines advising patients how to obtain after-hours emergency medical
and dental advice or care. These must be readily available and widely publicized
within the command and the local eligible beneficiary community.
f. Quality Assurance (QA) program guidelines including assignment of a QA
coordinator and QA focus group members in writing. The QA focus group shall
meet at least quarterly and maintain written minutes.
g. Guidelines for a patient advisory committee (PAC) comprised of representatives of
the health care facility and each major, identifiable, patient interest group. The PAC
shall meet periodically and maintain written minutes.
h. Persons authorized to deny care shall be so designated in writing by the command.
2. Operational Policies and Procedures. Facilities shall also develop and maintain the
following written operational policies and procedures. These require annual review and
signature by all health services personnel.
a. Emergency Situation Bill including Health Services Division response to fire,
earthquake, bomb threat, heavy weather, etc.
b. Health Services Emergency Response Protocols for suicide attempt/threat,
rape/sexual assault, family violence and medical emergencies in the dental clinic.
c. Protocol for managing after-hours emergencies. Clinics at accession points and at
Coast Guard units with on-base family housing shall maintain a 24-hour live watch
schedule.
CH-16 2-50
3. Patient Rights. Health care shall be delivered in a manner that protects the rights,
privacy and dignity of the patient. Sensitivity to patient needs and concerns will always
be a priority.
a. Clinics shall post the Patient Bill of Rights and Responsibilities poster in clear view
in all patient waiting and urgent care areas (see Figure 2-J-1). Copies are available
from Commandant (G-WKH-1).
b. Chaperones shall provide comfort and support to patients during exams or treatment.
All patients shall be informed of the availability of chaperones.
(1) Chaperones are defined as persons who attend patients during medical exams
or treatment. Chaperones shall be of the same gender as the patient being
examined. Any nursing staff member, HS or volunteer may serve as a
chaperone as part of their duties. The Chief, Health Services Division shall
ensure that chaperones have appropriate training or experience (such as Red
Cross Orientation/Training) to enable them to carry out their duties properly.
Although a patient's request for a family member or friend to be present during
examination may be honored, that person is not a substitute for a chaperone.
(2) Patients who request the presence of a chaperone shall have their request
honored unless, in the opinion of the medical officer, the risk to the chaperone
outweighs the benefit to the patient (e.g., during x-ray exposures).
(3) Female patients undergoing breast examination or genital/rectal examination or
treatment must have a chaperone present during the examination. Male
patients may have a chaperone present at the patient's request.
(4) If a provider thinks a chaperone is necessary, and the patient refuses to permit
the services of a chaperone, the provider must consider whether to perform the
examination or treatment or to refer the patient to another source of care.
(5) Clinics shall have a written policy for reporting any episode of alleged
misconduct during medical/dental examinations to the unit commanding
officer. Unit commanding officers shall investigate such complaints in
accordance with regulations.
c. Chief, health services division shall enforce the patient chaperone policy and ensure
chaperones are qualified to perform their duties.
d. Chief, health services division shall ensure that allegations of misconduct are
forwarded to the command in a timely manner.
e. Clinics shall ensure that patient educational materials concerning gender-related
health issues (PAP smears, cervical cancer, mammography and breast disease,
testicular and prostate cancer, etc.) are readily available.
2-51 CH-16
4. Health Care Provider Identification.
a. In accordance with the Patient Bill of Rights and Responsibilities, all patients have
the right to know the identity and the professional qualifications of any person
providing medical or dental care. The recent addition of Nurse Practitioners and
commissioned Physician Assistants to our health care staffs has increased the
chances of misidentification. Accordingly, health care providers shall introduce
themselves and state their professional qualifications (level of provider) at each
patient encounter.
b. The standard Coast Guard name tag does not reflect any information concerning the
professional qualifications of the health care provider. Additionally, the standard
Coast Guard name tag is often not visible to patients with poor eyesight, or it may be
hidden by the provider's smock or lab coat. In lieu of the standard Coast Guard name
tag, all health care providers, civilian and military, shall wear a specific health care
provider identification tag on their outer smock or lab coat when engaged in direct
patient care in Coast Guard Clinics and Dental Clinics. The health care provider
identification tag shall be worn above the right breast pocket (or equivalent). The
following criteria shall be used by local commands and clinics in manufacturing the
health care provider identification tags:
(1) Size. The identification tag shall be 1" high by 3" wide.
(2) Materials. Standard plastic name tag blanks which may be purchased locally or
from Government sources.
(3) Color. Standard Coast Guard blue or black with white lettering.
(4) Contents. The identification tag shall contain the following information:
(a) The rank, first initial, and last name shall be centered on the
identification name tag and placed on the top line.
(b) One of the following professional titles, or any other commonly
recognized professional name, centered below the name line.
Abbreviations shall not be used.
1 Physician
2 Dentist
3 Physician Assistant
4 Nurse Practitioner
5 Pharmacist
6 Physical Therapist
CH-16 2-52
7 Optometrist
8 Registered Nurse
9 Health Services Technician
2-53 CH-16
CH-16 2-54
Section K - General Standards of Care. Patients at Coast Guard clinics and sickbays shall be
treated in accordance with the following general standards of care:
1. Diagnosis and therapy shall be performed by a provider with appropriate credentials.
2. Diagnoses shall be based upon clinical findings and appropriate tests and procedures.
3. Treatment shall be consistent with the working diagnosis, and shall be based upon a
current treatment plan.
4. Treatment shall be rendered in a timely manner. Providers should use their professional
judgement in accounting for the specific needs of patients and military readiness
obligations while attempting to meet the following goals for timeliness:
a. Sick call – If provided, the patient should be triaged immediately and be seen based
on urgency of the condition. The patient should be advised of the wait time to be
seen and offered a later appointment if the condition does not warrant immediate
attention.
b. Acute Illness (medical) - The wait time should not exceed 1 day. The condition
must be addressed, not necessarily resolved, within this time frame.
c. Routine Visit (medical) - The wait time should not exceed 1 week.
d. Specialty Care (medical) - To be determined by the primary care manager making
the referral based on the nature of the care required and the acuteness of the injury,
condition, or illness, but should not exceed a wait time of 4 weeks to obtain the
necessary care.
e. Well Visit - The wait time should not exceed 4 weeks.
f. Urgent Care (dental) - The wait time should not exceed 1 day. The condition must
be addressed, not necessarily resolved, within this time frame.
g. Routine Visit (dental) - The wait time should not exceed 4 weeks.
h. Scheduled Appointment (medical or dental) - The wait time should not exceed 30
minutes of appointed time. This may sometimes be delayed by the need to address
prior scheduled patients, emergency care, or unforeseen military obligations.
i. Pharmacy - Prescription available within 30 minutes.
5. Treatment shall be provided using currently accepted clinical techniques.
6. Patients shall participate in deciding among treatment alternatives available to them.
CH-17
3-i
CHAPTER 3
PHYSICAL STANDARDS AND EXAMINATION
PAGE
SECTION A - ADMINISTRATIVE PROCEDURES.................................................................................................................. 1
APPLICABILITY OF PHYSICAL STANDARDS. ................................................................................................................... 1
PRESCRIBING OF PHYSICAL STANDARDS........................................................................................................................ 1
PURPOSE OF PHYSICAL STANDARDS. ............................................................................................................................... 1
APPLICATION OF PHYSICAL STANDARDS........................................................................................................................ 1
INTERPRETATION OF PHYSICAL STANDARDS ................................................................................................................ 2
DEFINITIONS OF TERMS USED IN THIS CHAPTER........................................................................................................... 2
REQUIRED PHYSICAL EXAMINATIONS AND THEIR TIME LIMITATIONS.................................................................. 2
WAIVER OF PHYSICAL STANDARDS.................................................................................................................................. 9
SUBSTITUTION OF PHYSICAL EXAMINATIONS............................................................................................................. 11
SECTION B - REPORTING, REVIEWING, RECOMMENDATIONS, AND ACTIONS TO BE TAKEN ON REPORTS
OF MEDICAL EXAMINATION (DD-2808) AND MEDICAL HISTORY (DD-2807-1)....................................................... 15
DD-2808 (REPORT OF MEDICAL EXAMINATION)........................................................................................................... 15
DD-2807-1 (REPORT OF MEDICAL HISTORY)................................................................................................................... 15
REVIEW AND ACTION ON FINDINGS AND RECOMMENDATIONS OF REPORT OF MEDICAL EXAMINATION
(DD-2808)................................................................................................................................................................................. 15
CORRECTION OF DEFECTS PRIOR TO OVERSEAS TRANSFER OR SEA DUTY DEPLOYMENT. ............................ 19
OBJECTION TO ASSUMPTION OF FITNESS FOR DUTY AT SEPARATION.................................................................. 20
SEPARATION NOT APPROPRIATE BY REASON OF PHYSICAL DISABILITY............................................................. 20
PROCEDURES FOR PHYSICAL DEFECTS FOUND PRIOR TO SEPARATION............................................................... 20
SECTION C - MEDICAL EXAMINATION TECHNIQUES AND LAB TESTING STANDARDS……………………… 25
SCOPE. ..................................................................................................................................................................................... 25
SPEECH IMPEDIMENT. ......................................................................................................................................................... 25
HEAD, FACE, NECK, AND SCALP....................................................................................................................................... 25
NOSE, SINUSES, MOUTH, AND THROAT .......................................................................................................................... 26
EARS (GENERAL) AND DRUMS ......................................................................................................................................... 26
EYES (GENERAL), OPHTHALMOSCOPIC, AND PUPILS.................................................................................................. 27
OCULAR MOTILITY .............................................................................................................................................................. 29
LUNGS AND CHEST .............................................................................................................................................................. 32
HEART AND VASCULAR SYSTEM..................................................................................................................................... 29
ABDOMEN AND VISERA...................................................................................................................................................... 35
ANUS AND RECTUM ............................................................................................................................................................ 35
ENDOCRINE SYSTEM ........................................................................................................................................................... 42
LUNGS AND CHEST .............................................................................................................................................................. 32
ANUS AND RECTUM............................................................................................................................................................. 35
CH-17 3-ii
ABDOMEN AND VISCERA ................................................................................................................................................... 35
GENITOURINARY SYSTEM ................................................................................................................................................. 35
EXTREMITIES......................................................................................................................................................................... 35
SPINE AND OTHER MUSCULOSKELETAL ....................................................................................................................... 38
IDENTIFYING BODY MARKS, SCARS, AND TATTOOS .................................................................................................. 39
NEUROLOGIC......................................................................................................................................................................... 39
PSYCHIATRIC......................................................................................................................................................................... 41
ENDOCRINE SYSTEM ........................................................................................................................................................... 42
DENTAL................................................................................................................................................................................... 42
LABORATORY FINDINGS .................................................................................................................................................... 43
HEIGHT, WEIGHT, AND BODY BUILD............................................................................................................................... 51
DISTANT VISUAL ACUITY AND OTHER EYE TESTS). ................................................................................................... 51
AUDIOMETER......................................................................................................................................................................... 62
PSYCHOLOGICAL AND PSYCHOMOTOR ......................................................................................................................... 62
SECTION D - PHYSICAL STANDARDS FOR ENLISTMENT, APPOINTMENT, AND INDUCTION. ................ 67
SCOPE. ..................................................................................................................................................................................... 67
APPLICABILITY AND RESPONSIBILITIES........................................................................................................................ 67
ABDOMINAL ORGANS AND GASTROINTESTINAL SYSTEM. ...................................................................................... 68
BLOOD AND BLOOD-FORMING TISSUE DISEASES........................................................................................................ 69
DENTAL................................................................................................................................................................................... 70
EARS......................................................................................................................................................................................... 70
HEARING................................................................................................................................................................................. 70
ENDOCRINE AND METABOLIC DISORDERS. .................................................................................................................. 71
UPPER EXTREMITIES............................................................................................................................................................ 71
LOWER EXTREMITIES.......................................................................................................................................................... 73
MISCELLANEOUS CONDITIONS OF THE EXTREMITIES............................................................................................... 74
EYES......................................................................................................................................................................................... 75
VISION. .................................................................................................................................................................................... 78
FEMALE GENITALIA............................................................................................................................................................. 79
MALE GENITALIA……………………………………………………………………………………………………………80
URINARY SYSTEM. ............................................................................................................................................................... 80
HEAD........................................................................................................................................................................................ 81
NECK........................................................................................................................................................................................ 81
HEART...................................................................................................................................................................................... 81
VASCULAR SYSTEM............................................................................................................................................................. 82
HEIGHT. ................................................................................................................................................................................... 83
WEIGHT. .................................................................................................................................................................................. 83
BODY BUILD. ......................................................................................................................................................................... 85
LUNGS, CHEST WALLS, PLEURA, AND MEDIASTINUM................................................................................................ 83
CH-17
3-iii
MOUTH. ................................................................................................................................................................................... 84
NOSE AND SINUSES.............................................................................................................................................................. 84
NEUROLOGICAL DISORDERS............................................................................................................................................. 85
DISORDERS WITH PSYCHOTIC FEATURES...................................................................................................................... 87
ANXIETY, SOMATOFORM, DISSOCIATIVE, OR FACTITIOUS DISORDERS................................................................ 87
PERSONALITY, CONDUCT AND BEHAVIOR DISORDERS............................................................................................ 88
PSYCHOSEXUAL CONDITIONS. ......................................................................................................................................... 88
SUBSTANCE MISUSE. ........................................................................................................................................................... 88
SKIN AND CELLULAR TISSUES.......................................................................................................................................... 89
SPINE AND SACROILIAC JOINTS. ...................................................................................................................................... 91
SYSTEMIC DISEASES............................................................................................................................................................ 92
GENERAL AND MISCELLANEOUS CONDITIONS AND DEFECTS................................................................................ 93
TUMORS AND MALIGNANT DISEASES. ........................................................................................................................... 94
MISCELLANEOUS.................................................................................................................................................................. 94
SECTION E - PHYSICAL STANDARDS FOR PROGRAMS LEADING TO COMMISSION........................................... 97
APPOINTMENT AS CADET, UNITED STATES COAST GUARD ACADEMY................................................................. 97
COMMISSIONING OF CADETS............................................................................................................................................ 98
ENROLLMENT AS AN OFFICER CANDIDATE. ................................................................................................................. 98
COMMISSIONING OF OFFICER CANDIDATES................................................................................................................. 99
DIRECT COMMISSION IN THE COAST GUARD RESERVE............................................................................................. 99
DIRECT COMMISSION OF LICENSED OFFICERS OF U. S. MERCHANT MARINE.................................................... 100
APPOINTMENT TO WARRANT GRADE........................................................................................................................... 100
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......................................................................................................................................................................... 101
GENERAL INSTRUCTIONS................................................................................................................................................. 101
USE OF LIST OF DISQUALIFYING CONDITIONS AND DEFECTS. .............................................................................. 101
HEAD AND NECK. ............................................................................................................................................................... 101
ESOPHAGUS, NOSE, PHARYNX, LARYNX, AND TRACHEA........................................................................................ 101
EYES....................................................................................................................................................................................... 102
EARS AND HEARING. ......................................................................................................................................................... 105
LUNGS AND CHEST WALL. ............................................................................................................................................... 105
HEART AND VASCULAR SYSTEM................................................................................................................................... 107
ABDOMEN AND GASTROINTESTINAL SYSTEM........................................................................................................... 109
ENDOCRINE AND METABOLIC CONDITIONS (DISEASES) ........................................................................................ 111
GENITOURINARY SYSTEM. .............................................................................................................................................. 112
EXTREMITIES....................................................................................................................................................................... 113
SPINE, SCAPULAE, RIBS, AND SACROILIAC JOINTS. .................................................................................................. 117
SKIN AND CELLULAR TISSUES........................................................................................................................................ 117
CH-17 3-iv
NEUROLOGICAL DISORDERS........................................................................................................................................... 119
PSYCHIATRIC DISORDERS. (SEE SECTION 5-B CONCERNING DISPOSITION) ....................................................... 120
DENTAL................................................................................................................................................................................. 121
BLOOD AND BLOOD-FORMING TISSUE DISEASES...................................................................................................... 121
SYSTEMIC DISEASES, GENERAL DEFECTS, AND MISCELLANEOUS CONDITIONS.............................................. 121
TUMORS AND MALIGNANT DISEASES. ......................................................................................................................... 123
SEXUALLY TRANSMITTED DISEASE.............................................................................................................................. 123
HUMAN IMMUNODEFFICIENCY VIRUS (HIV) ................................................................................................................ 123
TRANSPLANT RECIPIENT.................................................................................................................................................. 123
SECTION G - PHYSICAL STANDARDS FOR AVIATION................................................................................................. 127
CLASSIFICATION OF AVIATION PERSONNEL............................................................................................................... 127
GENERAL INSTRUCTIONS FOR AVIATION EXAMINATIONS..................................................................................... 127
RESTRICTIONS UNTIL PHYSICALLY QUALIFIED. ....................................................................................................... 133
STANDARDS FOR CLASS 1................................................................................................................................................ 134
STANDARDS FOR CLASS 1R. ............................................................................................................................................ 136
CANDIDATES FOR FLIGHT TRAINING............................................................................................................................ 136
REQUIREMENTS FOR CLASS 2 FLIGHT OFFICERS....................................................................................................... 138
REQUIREMENTS FOR CLASS 2 AIRCREW. ..................................................................................................................... 138
REQUIREMENTS FOR CLASS 2 MEDICAL PERSONNEL............................................................................................... 139
REQUIREMENTS FOR CLASS 2 TECHNICAL OBSERVERS. ......................................................................................... 139
REQUIREMENTS FOR CLASS 2 AIR TRAFFIC CONTROLLERS................................................................................... 139
REQUIREMENTS FOR LANDING SIGNAL OFFICER (LSO)........................................................................................... 140
CONTACT LENSES. ............................................................................................................................................................. 140
SECTION H - PHYSICAL EXAMINATIONS AND STANDARDS FOR DIVING DUTY................................................ 147
EXAMINATIONS. ................................................................................................................................................................. 147
STANDARDS......................................................................................................................................................................... 147
3-1 CH-17
CHAPTER 3. PHYSICAL STANDARDS AND EXAMINATIONS
Section A - Administrative Procedures.
1. Applicability of Physical Standards.
a. The provisions of this chapter apply to all personnel of the Coast Guard and Coast
Guard Reserve on active or inactive duty and to commissioned officers of the Public
Health Service assigned to active duty with the Coast Guard.
b. Members of the other Armed Forces assigned to the Coast Guard for duty are
governed by the applicable instructions of their parent Service for examination
standards and for administrative purposes.
2. Prescribing of Physical Standards.
Individuals to be enlisted, appointed, or commissioned in the Coast Guard or Coast
Guard Reserve must conform to the physical standards prescribed by the Commandant.
Separate standards are prescribed for various programs within the Service.
3. Purpose of Physical Standards.
Physical standards are established for uniformity in procuring and retaining personnel
who are physically fit and emotionally adaptable to military life. These standards are
subject to change at the Commandant's direction when the needs of the Coast Guard
dictate.
4. Application of Physical Standards.
a. Conformance with Physical Standards Mandatory. To determine physical fitness,
the applicant or member shall be physically examined and required to meet the
physical standards prescribed in this chapter for the program or specialty and grade
or rate involved. An examinee who does not meet the standards shall be
disqualified.
b. Evaluation of Physical Fitness. The applicant's total physical fitness shall be
carefully considered in relation to the character of the duties to that the individual
may be called upon to perform. Physical profiling is not a Coast Guard policy.
Members shall be considered fit for unrestricted worldwide duty when declared
physically qualified. The examiner must be aware of the different physical standards
for various programs. Care shall be taken to ensure an examinee is not disqualified
for minor deviations that are clearly of no future significance with regard to general
health, ability to serve, or to cause premature retirement for physical disability.
However, conditions that are likely to cause future disability or preclude completing
a military career of at least twenty years, whether by natural progression or by
recurrences, are also disqualifying. This policy shall be followed when an authentic
history of such a condition is established, even though clinical signs may not be
evident during the physical examination.
CH-17 3-2
5. Interpretation of Physical Standards. Examiners are expected to use discretion in
evaluating the degree of severity of any defect or disability. They are not authorized to
disregard defects or disabilities that are disqualifying in accordance with the standards
found in this chapter.
6. Definitions of Terms Used in this Chapter.
a. Officers. The term "officers" includes commissioned officers, warrant officers, and
commissioned officers of the Public Health Service.
b. Personnel. The term "personnel" includes members of the Coast Guard and Coast
Guard Reserve, and the PHS on active duty with the Coast Guard.
c. Medical and Dental Examiners. Medical and dental examiners are medical and
dental officers of the uniformed services, contract physicians and dentists, or civilian
physicians or dentists who have been specifically authorized to provide professional
services to the Coast Guard. Some USMTFs have qualified enlisted examiners who
also conduct medical examinations and their findings require countersignature by a
medical officer.
d. Flight Surgeons and Aviation Medical Officers. Officers of a uniformed service who
have been so designated because of special training.
e. Command/Unit. For administrative action required on the Report of Medical
Examination (DD-2808), the command/unit level is the unit performing personnel
accounting services for the individual being physically examined.
f. Reviewing Authority. Commander Coast Guard Personnel (CGPC-adm) and
MLC (K) are responsible for approval of physical examinations as outlined herein.
Clinic Administrators may act as reviewing authority for physical examinations
performed in their AOR as designated by the cognizant MLC, except for those that
are aviation or dive related. Reviewing authority shall not be delegated below the
HSC level. Medical Administrative Officers (LDO and CWO-Meds) may review
physical examinations performed by contract physicians and USMTFs within their
AOR.
g. Convening Authority. Convening Authority is an individual authorized to convene a
medical board as outlined in Physical Disability Evaluation System, COMDTINST
M1850.2 (series).
h. Time Limitation. The time limitation is the period for which the physical
examination remains valid to accomplish its required purpose. The time limitation
period begins as of the day after the physical examination is conducted.
7. Required Physical Examinations and Their Time Limitations.
a. Enlistment. A physical examination is required for original enlistment in the Coast
Guard and the Coast Guard Reserve. This physical examination will usually be
performed by Military Entrance Processing Stations (MEPS) and is valid for twenty-
3-3 CH-17
four months. Approved MEPS physicals do not require further review.
Recommendations noted on separation physical examinations from other services
must have been resolved with an indication that the individual meets the standards.
A certified copy of that physical examination must be reviewed and endorsed by the
reviewing authority Commander (CGRC). The reviewing authority must indicate
that the applicant meets the physical standards for enlistment in the USCG.
(1) Recruiters who believe that applicants have been erroneously physically
disqualified by MEPS, may submit the DD-2808 and DD-2807-1 (original or
clean copies) along with supporting medical records to Commander (CGRC)
for review.
(2) Waiver of physical standards for original enlistment may also be submitted as
above, and in accordance with paragraph 3-A-8 of this instruction.
(3) Separation physical examinations from any Armed Service may be used for
enlistment in the Coast Guard, provided the examination has been performed
within the last twelve (12) months. The physical examination must be as
complete as a MEPS exam, include an HIV antibody test date (within the last
24 months) and result, and a Type II dental examination. An DD-2807-1 must
also be included with elaboration of positive medical history in the remarks
section (item #25). Forward all documents for review by Commander
(CGRC).
(4) Prior Service enlisted aviation personnel must obtain an aviation physical
examination from a currently qualified uniformed services flight surgeon or
AMO within the previous 12 months. This physical examination will be
submitted with the rate determination package to Commander (CGRC).
(5) Occasionally, applicants for initial entry into the Coast Guard will need to be
examined at Coast Guard MTFs. In these cases, the physical examination will
be performed per section 3-C. The examining medical officer may defer item
#46 of the DD-2808 to the Reviewing Authority. Otherwise, the physical
standards for entry (sections 3-D and 3-E, as appropriate) must be meticulously
applied when completing this item. The completed DD-2808 and DD-2807-1
will be forwarded to the reviewing authority, Commander (CGRC).
b. Pre-Commissioning/Appointments. A physical examination is required within 12
months prior to original appointment as an officer in the Coast Guard or Coast Guard
Reserve for personnel in the following categories:
(1) appointment to Warrant Grade, except that physical examinations for members
of the Coast Guard Ready Reserve must be within 24 months prior to the date
of execution of the Acceptance and Oath of Office, form CG-9556.
(2) appointment of a Licensed Officer of the U. S. Merchant Marine as a
commissioned officer (examination required within 6 months); and
(3) upon graduation from the Coast Guard Academy.
c. Separation from Active Duty.
CH-17 3-4
(1) A complete physical examination is required within 12 months for retirement,
involuntary separation, or release from active duty (RELAD) into the Ready
Reserves (selected drilling or IRR). The physical examination shall follow the
guidelines set forth for quinquennial physicals.
(2) Other members separating from the Coast Guard e.g., discharge or transfer to
standby reserve (non-drilling) may request a medical and/or dental
examination. The medical examination must include: notation of any current
problems, a blood pressure measurement, and address items on the preventive
medicine stamp. In addition to the above, the practitioner shall ascertain the
health needs of the member and undertake measures deemed necessary to meet
those needs. The dental examination, if requested, must at least be a Type III
exam. These examinations may be annotated on a SF-600, and upon
completion, do not require approval.
(3) For members enrolled in the Occupational Medical Surveillance and
Evaluation Program (OMSEP), see chapter 12 of this Manual for guidance.
(4) See chapter 12 of the Personnel Manual, COMDTINST M1000.6(series), for
amplification on administrative discharge procedures.
d. Overseas Transfer, Sea Duty Deployment and Port Security Unit (PSU) Health
Screening. A modified physical examination, utilizing Figure 3-A-1, is required for
all personnel departing for an overseas assignment for 60 consecutive days or
greater, PCS transfer to an icebreaker, vessel deployment for 60 consecutive days or
or more (out of 365), and annually for PSU personnel. This will help identify and
resolve health related issues prior to transfer or deployment, if no significant medical
status changes have occurred. Members who are transferring from one overseas
assignment to another overseas assignment do not require another overseas physical
examination. The completed modified physical examination and a copy of the last
completed/approved Report of Physical Examination (DD-2808) and Report of
Medical History (DD-2807-1), shall be submitted to the Reviewing Authority. The
modified physical examination will include the following:
(1) a health history completed by the evaluee. (The evaluee will certify by
signature that all responses are true);
(2) documentation of the previous approved physical examination to include the
status of recommendations and summary of significant health changes;
(3) review of the health record to ensure routine health maintenance items are up-
to-date to include: routine gynecologic examinations, two pairs of glasses and
gas mask inserts for PSU personnel if required to correct refractive error, DNA
sampling, G-6-PD screening, immunizations, and a Type 2 dental examination;
(4) review malaria chemoprophylaxis, PPD, and special health concern
requirements. Contact the Center for Disease Control and Prevention (CDC) at
http://www.cdc.gov or http://www.travel.state.gov for information;
3-5 CH-17
(5) if PCS transferring to a foreign country [refer to 3-C.20.b(9)(b)], HIV antibody
test must have been conducted within the past 6 months with results noted
prior to transfer;
(6) if an evaluee is enrolled (or will be enrolled based on new assignment) in the
Occupational Medical Surveillance and Evaluation Program (OMSEP), ensure
appropriate periodic/basic examination is performed.
e. Applicant.
(1) Commissioning Programs. A physical examination is required for applicants
for entry into the Coast Guard as follows:
(a) Coast Guard Academy: DODMERB physical examination within 24
months;
(b) Officer Candidate School: MEPS physical within 24 months of entry
date, except:
1 Coast Guard personnel on active duty may obtain the physical
examination at a USMTF within 24 months of entry date, and
2 Members of other Armed Services may submit a physical
examination from a USMTF provided the examination has been
performed within the past twelve (12) months and is as complete as
a MEPS physical examination.
(c) Direct commission: MEPS physical within 24 months of entry date or
oath of office for Ready Reserve Direct Commission, except aviation
programs, where examination by a uniformed service flight surgeon or
AMO is required within 12 months of entry date.
(2) Aviation. An aviation physical examination is required for applicants for
training in all categories of aviation specialties. This physical examination is
valid for 24 months for Class II applicants and 12 months for pilot applicants.
(3) Diving. A physical examination is required for all applicants for duty
involving diving, and is valid for twelve months.
f. Pre-Training Screening Examinations. A screening examination is required within 1
week of reporting to the Coast Guard Academy, Officer Candidate School, Direct
Commission Officer orientation, or the Recruit Training Center. This screening
examination shall be sufficiently thorough to ensure that the person is free from
communicable and infectious diseases, and is physically qualified. The results of
this examination shall be recorded on an SF-600 and filed in the health record.
g. Retired Members Recalled to Active Duty. A physical examination is required for
retired personnel who are recalled to active duty. This physical examination is valid
for twelve months. A physical examination performed for retirement may be used
CH-17 3-6
for recall providing the date of recall is within six months of the date of the physical
examination.
h. Annual. An annual physical examination is required on all active duty personnel
who are 50 years of age or older and all air traffic controllers.
i. Biennial.
(1) Biennial physical examination is required every 2 years after initial
designation, until age 48, for the following:
(a) all aviation personnel (except air traffic controllers); and
(b) all Landing Signal Officers (LSO).
(2) The biennial exam will be performed within 90 days before the end of the birth
month. The period of validity of the biennial physical will be aligned with the
last day of the service member’s birth month. (Example: someone born on 3
October would have August, September, and October in which to accomplish
his/her physical. No matter when accomplished in that time frame, the period
of validity of that exam is until 31 October two years later.)
(3) This process of aligning the biennial exam with the birth month is a new
process effective immediately. In order to phase in this process the valid
period of future biennial exams may be extended up to a total of thirty months
(6 months from the current valid date) to align the valid date with the birth
month. (See Table 3-A-1).
(a) Example 1: A member with an October birth month accomplishes
biennial exam in May 2000 (previously valid until May 2002). Biennial
exam is now valid until October 2002 (29 months total) to allow the
member to align biennial exam with birth month.
(b) Example 2: A member with a June birth month accomplishes a biennial
exam in October of 1999 (previously valid until October 2001). Biennial
exam is now valid until June 2001 (20 months total) to allow the member
to align biennial exam with birth month.
(4) The requirement to perform a biennial exam will not be suspended in the event
of training exercises or deployment. Aircrew with scheduled deployment
during their 90 day window to accomplish their biennial exam may accomplish
their biennial exam an additional 90 days prior and continue with the same
valid end date. This may result in a member having a valid biennial for 30
months. Members unable to accomplish a biennial exam prior to being
deployed will be granted an additional 60 days upon return in which to
accomplish their physical. Align subsequent biennial exam with the aircrew
member’s birth month using Table 3-A-1.
(5) Additionally, a comprehensive physical may be required during a post-mishap
investigation, FEB, or as part of a work-up for a medical disqualification.
3-7 CH-17
(6) Personnel designated as aircrew are expected to maintain a biennial exam
schedule regardless of current aviation duty status.
Table-3-A-1
Number of months for which a biennial exam is valid
Month in which last biennial exam was given
Birth
Month JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC
JAN 24 23 22 21 20 19 30 29 28 27 26 25
FEB 25 24 23 22 21 20 19 30 29 28 27 26
MAR 26 25 24 23 22 21 20 19 30 29 28 27
APR 27 26 25 24 23 22 21 20 19 30 29 28
MAY 28 27 26 25 24 23 22 21 20 19 30 29
JUN 29 28 27 26 25 24 23 22 21 20 19 30
JUL 30 29 28 27 26 25 24 23 22 21 20 19
AUG 19 30 29 28 27 26 25 24 23 22 21 20
SEP 20 19 30 29 28 27 26 25 24 23 22 21
OCT 21 20 19 30 29 28 27 26 25 24 23 22
NOV 22 21 20 19 30 29 28 27 26 25 24 23
DEC 23 22 21 20 19 30 29 28 27 26 25 24
Notes:
Read down the left column to the examinee’s birth month; read across to month of last biennial
exam; intersection number is the maximum validity period. When last biennial exam was within
the 3 month period preceding the end of the birth month, the validity period will normally not
exceed 27 months. When the last biennial exam was for entry into aviation training, for FEB,
post-accident, post-hospitalization, etc., the validity period will range from 19 to 30 months.
Validity periods may be extended by 1 month only for completion of an examination begun
before the end of the birth month.
j. Quinquennial/Quinquennial Diving. A physical examination is required every five
(5) years after entry on all active duty personnel, age 25 through age 50, and for all
personnel maintaining a current diving qualification (also note "Diving" in item #5 of
DD-2808). Quinquennial physical examinations are also required for:
(1) all Selected Reservists within 30 days of their birth date starting at age 25
continuing until retirement, and
(2) reserve officers assigned to the Individual Ready Reserve (IRR) who are on a
promotion list.
CH-17 3-8
(3) Officers in 3-A-7.e.(1)(a) and (b) above must have a current approved physical
examination documented by PMIS data base entry prior to being promoted
(i.e., a quinquennial physical examination within the last 5 years).
k. Occupational Medical Surveillance and Evaluation Program (OMSEP). Those
individuals who are occupationally exposed to hazardous substances, physical
energies, or employed in designated occupations must undergo physical
examinations as required by Chapter 12 of this Manual.
l. Miscellaneous Physical Examinations.
(1) Retention. This examination is done at the direction of the commanding
officer when there is substantial doubt as to a member's physical or mental
fitness for duty.
(2) Pre-confinement Physical Screening. In general, personnel who are presented
for this screening, who do not require acute medical treatment or
hospitalization, are fit for confinement. Cases where a member requires more
than routine follow-up medical care, or has certain psychiatric conditions, that
may make them unfit for confinement, should be discussed with the chief
medical officer (or his/her representative) at the confining facility. Personnel
requiring detoxification for alcohol or drug dependency are not fit for
confinement; however, members that have been detoxified or that may require
rehabilitation alone are fit for confinement. This screening shall be recorded on
an SF-600 (per FIGURE 3-A-1) and, together with a copy of the last complete
and approved Report of Physical Examination (DD-2808) and Report of
Medical History (DD-2807-1), shall be submitted to the Reviewing Authority.
(3) Post Confinement Physical Examination. Ensure a separation physical
examination has been completed prior to the member departing the confining
facility. The separation physical shall meet the standards of section 3-F and
must be approved by the appropriate MLC(k).
(4) Reservists. A district commander may require any reservist attached to a
command within that area to undergo a complete physical examination if
reasonable doubt exists as to the reservist's physical or mental fitness for duty.
(5) Non-Fitness for Duty Determination Physical Examinations. The Chief of
Health Services retains the authority and responsibility to determine capability
and capacity to conduct non-fitness for duty physical examinations for all
eligible beneficiaries.
m. Annual Command Afloat Medical Screening. Officers and enlisted personnel
scheduled to assume command afloat shall undergo a medical screening prior to
assignment. The initial screening may be conducted by a medical officer where
applicable, or an HS not in the prospective chain of command of the member being
screened. Thereafter, all commanding officers and officers-in-charge of afloat units
will have an annual command afloat medical screening. This screening will also be
performed by a medical officer where available, otherwise, the screening may be
performed by a Health Services Technician who IS NOT in the chain of command of
3-9 CH-17
the person being screened. The screening process will include a medical history
completed by the member, a visual acuity check, blood pressure measurement, and a
thorough review of interval history in the member's health record. Results are to be
recorded using the format in Figure 3-A-2. The medical screening form (Figure 3-A-
2) and a copy of the last approved DD-2808 and DD-2807-1 shall then be forwarded
to the appropriate MLC (kma) for review. The MLC (kma) will approve or
disapprove the screening using section 3-F (retention standards) as the guiding
directive. If a question arises as to the fitness of the individual, the MLC (kma) may
request additional information from the examining unit. If the MLC (kma) is unable
to render a decision as to the fitness for command, the entire command afloat
screening package will be forwarded to Commandant (G-WKH) for final action.
The reviewed form shall be returned to the member's command for filing in the
member's health record.
n. Dental Examinations. Annual Type II dental examinations are required for all active
duty personnel assigned to commands collocated with dental examiners (i.e., Coast
Guard DOs, DOD DOs, or civilian contract dentists).
8. Waiver of Physical Standards.
a. Definition of Waiver. A waiver is an authorization to change a physical standard
when an individual does not meet the physical standards prescribed for the purpose
of the examination.
(1) Normally, a waiver will be granted when it is reasonably expected that the
individual will remain fit for duty and the waiver is in the best interests of the
Coast Guard. A service member will not be granted a waiver for a physical
disability determined to be not fit for duty by a physical evaluation board
approved by the Commandant. In these cases, the provisions for retention on
active duty contained in the Physical Disability Evaluation System,
COMDTINST M1850.2 (series), and the Personnel Manual, COMDTINST
M1000.6 (series) apply.
(2) If a member is under consideration by the physical disability evaluation
system, no medical waiver request shall be submitted for physical defects or
conditions described in the medical board. All waiver requests received for
conditions described in the medical board will be returned to the member's unit
without action.
(3) A waiver of a physical standard is not required in a case where a Service
member's ability to perform on duty has been reviewed through the physical
disability evaluation system and the approved finding of the Commandant is fit
for duty.
b. Authority for Waivers. Commander CGPC-epm (enlisted), CGPC-opm (officers),
and CGPC-rpm (reserve) have the sole authority to grant waivers. The decision to
authorize a waiver is based on many factors, including the recommendations of the
Chief, Office of Health and Safety; the best interest of the Service; and the
CH-17 3-10
individual's training, experience, and duty performance. Waivers are not normally
authorized but shall be reviewed by Commander (CGPC) for the following:
(1) original enlistment in the regular Coast Guard of personnel without prior
military service;
(2) appointment as a Cadet at the Coast Guard Academy; and
(3) training in any aviation or diving category specialty.
c. Types of Waivers.
(1) Temporary. A temporary waiver may be authorized when a physical defect or
condition is not stabilized and may either progressively increase or decrease in
severity. These waivers are authorized for a specific period of time and require
medical reevaluation prior to being extended.
(2) Permanent. A permanent waiver may be authorized when a defect or condition
is not normally subject to change or progressive deterioration, and it has been
clearly demonstrated that the condition does not impair the individual's ability
to perform general duty, or the requirements of a particular specialty, grade, or
rate.
d. Procedures for Recommending Waivers.
(1) Medical Officer. A medical officer who considers a defect disqualifying by
the standards, but not a disability for the purpose for which the physical
examination is required, shall:
(a) enter a detailed description of the defect in Item 77 of the DD-2808; and
(b) indicate that either a temporary or permanent waiver is recommended.
(2) Command/Unit Level. When the command receives a Report of Medical
Examination (DD-2808) indicating that an individual is not physically
qualified, the command shall inform the individual that he/she is not physically
qualified. The individual shall inform the command via letter of his/her
intentions to pursue a waiver. The medical officer is required to give a
recommendation on whether the waiver is appropriate and if the individual
may perform his/her duties with this physical defect. This recommendation
shall be completed on an (SF-502) Narrative Summary. A cover letter stating
the command's opinion as to the appropriateness of a waiver, the individual's
previous performance of duty, special skills, and any other pertinent
information, shall accompany the medical officers report. The waiver request
package shall be forwarded directly from the member's unit to Commander
CGPC-epm or opm, or Commandant (CGPC-rpm) as appropriate.
e. Command Action on Receipt of a Waiver Authorization. A command receiving
authorization from the Commander CGPC-epm/opm/rpm for the waiver of a
physical standard shall carefully review the information provided to determine any
duty limitation imposed and specific instructions for future medical evaluations.
3-11 CH-17
Unless otherwise indicated in the authorization, a waiver applies only to the specific
category or purpose for which the physical examination is required. A copy of the
waiver authorization shall be retained in both the service and health records for the
period for which the waiver is authorized. Copies of future DD-2808's for the same
purpose shall be endorsed to indicate a waiver is or was in effect.
9. Substitution of Physical Examinations.
a. Rule for Substitution of Physical Examinations. In certain circumstances, a physical
examination performed for one purpose or category may be substituted to meet
another requirement provided the following criteria are met:
(1) the examinee was physically qualified for the purpose of the previous
examination and all the required tests and recommendations have been
completed;
(2) the DD-2808 used for substitution bears an endorsement from the Reviewing
Authority or Commandant (G-WKH), as appropriate, indicating that the
examinee was qualified for the purpose of the previous examination;
(3) there has been no significant change in the examinee's medical status since the
previous examination;
(4) a review of the report of the previous examination indicates that the examinee
meets the physical standards of the present requirement;
(5) the date of the previous examination is within the validity period of the present
requirement; and
(6) all additional tests and procedures to meet the requirements of the current
physical examination have been completed.
b. No substitutions are authorized for the following physical examinations:
(1) enlistment;
(2) pre-training; and
(3) applicants for or designated personnel in special programs (aviation, diving,
Academy).
c. Procedures for Reporting Substitution. Substitutions of a physical examination shall
be reported by submitting a copy of the DD-2808 and DD-2807-1 being used to meet
the present requirements with the endorsement illustrated in FIGURE 3-A-1, parts A,
B, and C. Retain a copy of the substitution endorsement in the health record.
FIGURE 3-A-1 (revised 02/02)
MODIFIED PHYSICAL EXAMINATION FOR:
SUBSTITUTION/OVERSEAS ASSIGNMENT/SEA DUTY/PSU HEALTH SCREENING
This form is subject to the Privacy Act Statement of 1974.
A. EVALUEE DATA
LAST NAME - FIRST NAME - MIDDLE INITIAL RATE/RANK SOCIAL SECURITY NUMBER
UNIT EXAMINING FACILITY
PURPOSE OF EXAMINATION TRANSFER/DEPLOYMENT LOCATION DATE
B. HEALTH HISTORY (completed by examinee)
1. Would you say your health in general is: [ ] Excellent [ ] Good [ ] Fair [ ] Poor
2. Do you have any medical or dental problems or concerns? [ ] No [ ] Yes
3. Do you have any health related duty limitations? [ ] No [ ] Yes
4. Could you be pregnant? (females request HCG if needed) [ ] N/A [ ] Unknown [ ] No [ ] Yes
5. Are you taking prescription medications? (request refills if needed) [ ] No [ ] Yes
6. During the past year, have you sought or required counseling or mental health care? [ ] No [ ] Yes
7. Explain any "fair, poor, yes, or unknown" responses:__________________________________________________________________
______________________________________________________________________________________________________________
8. Have you been hospitalized since your last physical? Yes / No. If (Yes) explain._________________________________________
I certify that responses above are true: (signature of examinee)_______________________________________________
C. PHYSICAL EXAMINATION REVIEW (current approved physical examination required)
9. Date and type of current approved physical examination:________________________________________________________________
10. Status of recommendations or further specialist examination:____________________________________________________________
_________________________________________________________________________________________
11. Summary of significant health history since last physical examination:______________________________________________
_________________________________________________________________________________________
D. HEALTH RECORD REVIEW
12. Have routine gynecologic (pap) examinations been completed in past year? (females) [ ] N/A [ ] No [ ] Yes
13. Does examinee have two pair of glasses? (if required to correct refractive error) [ ] N/A [ ] No [ ] Yes
14. Does PSU examinee have a gas mask insert? (if required to correct refractive error) [ ] N/A [ ] No [ ] Yes
15. Has DNA sampling been completed and documented? (once per career) [ ] No [ ] Yes
16. Has G-6-PD screening been completed and documented? (once per career) [ ] No [ ] Yes
17. Are immunizations up-to-date and meet requirements for destination? [ ] No [ ] Yes
18. Has an HIV AB test been drawn in the past 6 months? (foreign country PCS only) [ ] N/A [ ] No [ ] Yes
19. Are malaria chemoprophylaxis, PPD, and special health concern requirements met? [ ] No [ ] Yes
Contact the Center for Disease Control and Prevention at http://www.cdc.gov for information.
20. Has a Type 2 dental examination been completed in the past year and is examinee "Class 1 or 2"? [ ] No [ ] Yes
21. Explain any "no" answers:_______________________________________________________________________________________
_________________________________________________________________________________________
E. SIGNATURE AND APPROVAL/DISAPPROVAL
Medical Officer signature/stamp:__________________________________________________________ Date:____________
Dental Officer signature/stamp:___________________________________________________________ Date:___________
_
[ ] Approved
Reviewing/approving authority:___________________________________________________________ [ ] Disapproved
CH-17 3-12
3-13 CH-17
FIGURE 3-A-2 (revised 2/99)
ANNUAL COMMAND AFLOAT MEDICAL SCREENING
Name:________________________________________ Rank/Grade:_________________
SSAN:_______________Date of Birth:_____________ Work Telephone: ____________
Unit OPFAC:__________ Unit Name: ______________ Date of Screening: ___________
To be completed by the member: (use reverse side as needed)
List any significant medical history since your last physical examination or
medical screening (describe any illnesses, injuries, etc.):____________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
Have you experienced any significant changes in stress level, mood,
or family life? YES NO
If yes, describe:____________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
Do you have any alcohol-related problems (including DWI)? YES NO
If yes, describe: ____________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
Are you presently taking any medication (including over-the-counter)? YES NO
If yes, list: ________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
The information I have provided above is complete and accurate.
___________________________________________Date:___________
(Signature of member)
________________________________________________________________________
The following section is to be completed by health services personnel:
______________________________________________________________________
Review of Health Record performed. Significant findings are:_________________________
___________________________________________________________________________
___________________________________________________________________________
Best Distant Visual Acuity (with correction, if required): R:_____________ L:____________
Sitting blood pressure:_________________ ________________
NOTE: ATTACH A COPY OF LAST APPROVED DD-2808 AND DD-2807-1
___________________________________ UNIT: ________________Date: ______________
(Signature/Title of medical reviewer)
___________________________________ Date: ________________
(Signature/MLC reviewer
CH-17 3-14
This Page Intentionally Left Blank
3-15 CH-17
Section B - Reporting, Reviewing, Recommendations, and Actions to be Taken on Reports of
Medical Examination (DD-2808) and Medical History (DD-2807-1).
1. DD-2808 (Report of Medical Examination).
a. DD-2808 (July 2001) is the proper form for reporting a complete physical
examination. DD-2808 revised (July 2001) is the newest version of the physical
examination report and can be obtained from the WKH-1 Publications and Directives
web site at http://www.uscg.mil/hq/G-W/g-wk/g-wkh/g-wkh-1/Pubs/Pubs.Direct.htm
or by http://www.dior.whs.mil/forms/DD2808.PDF directly from the DOD forms
web site.
b. Detailed instructions for the preparation and distribution of this form are contained in
section 4-B of this Manual.
2. DD-2807-1 (Report of Medical History).
a. DD-2807-1 (July 2001) is the proper form for reporting a member's medical history.
DD-2807-1 revised (July 2001)) is the newest version of the medical history report
and can be obtained from the WKH-1 Publications and Directives web site at
http://www.uscg.mil/hq/G-W/g-wk/g-wkh/g-wkh-1/Pubs/Pubs.Direct.htm or by
http://www.dior.whs.mil/forms/DD2807-1.PDF directly from the DOD forms web
site.
b. Detailed instructions on the preparation and distribution of this form are contained in
section 4-B of this Manual.
3. Review and Action on Findings and Recommendations of Report of Medical
Examination (DD-2808).
a. Action by the Medical Examiner.
(1) Review of Findings and Evaluation of Defects. When the results of all tests
have been received and evaluated, and all findings recorded, the examiner shall
consult the appropriate standards of this chapter to determine if any of the
defects noted are disqualifying for the purpose of the physical examination.
When physical defects are found that are not listed in the standards as
disqualifying, but that, in the examiner's opinion, would preclude the
individual from performing military service or the duties of the program for
which the physical examination was required, the examiner shall state that
opinion on the report indicating reasons. If in the examiner's opinion, a defect
listed as disqualifying is not disabling for military service, or a particular
program, the examiner shall indicate the basis for this opinion and recommend
a waiver in accordance with the provisions of section A of this chapter.
(2) Remediable Defects. When the physical examination of active duty personnel
indicates defects that are remediable or that may become potentially disabling
unless a specific medical program is followed, the examiner shall clearly state
any recommendations. If the examining facility has the capability of
correcting the defect or providing extended outpatient follow-up or medical
CH-17 3-16
care, tentative arrangements for care shall be scheduled, subject to the approval
of the examinee's command. If the examining facility does not have the
capabilities of providing the necessary care, tentative arrangements for
admission or appointment at another facility shall be scheduled, again subject
to the approval of the individual's command.
(3) Advising the Examinee. After completing the physical examination, the
medical examiner will advise the examinee concerning the findings of the
physical examination. At the same time, the examinee shall be informed that
the examiner is not an approving authority for the purpose of the examination
and that the findings must be approved by proper authorities.
(4) Disposition of Reports. The original DD-2808 and the original DD-2807-1,
together with any reports of consultations or special testing reports not entered
on the DD-2808 or DD-2807-1, shall be forwarded to the activity that referred
the individual for the physical examination.
b. Review and Action on Reports of Physical Examination by Command.
(1) Command Responsibility.
(a) The command has a major responsibility in ensuring the proper
performance of physical examinations on personnel assigned and that
physical examinations are scheduled sufficiently far in advance to permit
the review of the findings and correction of medical defects prior to the
effective date of the action for which the examination is required. The
command is also responsible to ensure that the individual complies with
the examiner's recommendations and to initiate any administrative action
required on a Report of Medical Examination.
(b) All DD-2808's shall be reviewed by commanding officers, or their
designee, to determine that the prescribed forms were used and that all
necessary entries were made.
(c) When the medical examiner recommends further tests or evaluation, or a
program of medical treatment (such as hearing conservation, periodic
blood pressure readings, etc.), the command will ensure that these tests
or examinations are completed or that the individual is directed to and
does comply with the recommended program. When a necessary test,
evaluation, or program can be completed within a 60 day period, the unit
may hold the DD-2808 to permit the forwarding of results. In all cases
the command shall endorse the DD-2808 to indicate what action has
been taken and forward the report to the reviewing authority if the 60
day period cannot be met or has elapsed.
(d) Disposition of Reports.
1 If a physical examination is accomplished for a purpose for which
the command has administrative action, the original DD-2808 and
3-17 CH-17
DD-2807-1 and a return self-addressed envelope shall be forwarded
to the reviewing authority. No action will be taken to accomplish
the purpose for which the physical examination was taken until the
endorsed original of the report is returned by the reviewing authority
indicating the examinee meets the physical standards for the purpose
of the examination.
2 Approved MEPS physicals do not require further review. The
original physical (DD-2808 and DD-2807-1) will be carried to the
training center by the individual.
3 If the physical examination is for a purpose requiring the consent or
approval of the MLC commander, or Commandant, the procedures
previously described for command review and action will be
accomplished, except rather than forwarding the report of the
examination directly to the reviewing authority, it will be included
with other supporting documents (letters, recommendations, etc.)
and forwarded through the chain of command.
4 Units not using a CGMTF shall send physical examinations to the
appropriate CG Clinic (as designated by the cognizant MLC), MLC
(k), or CGPC (adm) as appropriate.
c. Action by the Reviewing Authority.
(1) The Commandant is the final reviewing authority for all physical
examinations, except for applicants to the Coast Guard Academy.
(2) Administratively, MLC (k) acts as the reviewing authority for physical
examinations performed on personnel assigned to their Areas except as in (4)
and (5) below.
(3) Another exception to this rule pertains to those flight physicals performed on
aviation school students during training that are reviewed and approved by the
Navy Operational Medicine Institute (NOMI). NOMI, not MLC (k) will be the
approving authority for these physicals. CGPC will remain the waiver
approval authority for these physicals, when a waiver is required prior to final
approval. Upon completion of flight training and assignment to a Coast Guard
unit, the NOMI approved physical will be considered valid until the last day of
the member’s next birth month. The unit flight surgeon will clear the aviator
for all flight related duties based on the NOMI approved flight physical.
(4) Commander Coast Guard Personnel Command (CGPC-adm) is the reviewing
authority for aviator candidate, flight officer candidate, aircrew candidate, and
diving candidate physical examinations. Commandant (G-WKS) is also the
reviewing authority for OMSEP physical examinations. Commander (CGPC-
adm) shall review disapproved MEPS physicals to ensure proper application of
physical standards.
CH-17 3-18
(5) The Department of Defense Medical Examination Review Board (DoDMERB)
is the reviewing authority for physical examinations performed on Academy
applicants. MEPS is the reviewing authority for physical examinations
performed in their facilities.
(6) Each DD-2808 shall be carefully reviewed to determine whether the findings
reported indicate the examinee does or does not meet the appropriate physical
standards. If further medical evaluation is required to determine that the
examinee does meet the standards, or to resolve doubtful findings, the
reviewing authority shall direct the commanding officer or recruiting station to
obtain the evaluation and shall provide such assistance as may be required.
(7) The reviewing authority shall endorse the original of the DD-2808 indicating
whether the examinee does or does not meet the physical standards required.
If the examinee does not meet the physical standards, the endorsement shall
indicate the particular disqualifying defect or defects. Endorsements can be in
the format contained in FIGURE 3-B-1 or use of blocks #74.a, #77 and
signature in block #81.a, of the DD-2808.
(8) The endorsed original of the physical examination shall be forwarded to the
individual's unit for filing in the member's health record.
(9) Input of physical examination status of personnel into the PMIS system is
required. Reviewing Authorities shall collect and submit data regarding all
physical examinations/screenings (per paragraph 3-A-7, except subparagraph
3-A-7.f) they review to the appropriate PERSRU on a monthly basis. Data to
be collected for transmittal to the PERSRUs is as follows:
(a) Member's name;
(b) Member's rank/rate;
(c) Member's SSAN;
(d) Member's unit OPFAC;
(e) Date of physical examination;
(f) Purpose of examination;
(g) Date acted upon by Reviewing Authority; and
(h) Status code for physical examination. Status codes are
as follows:
1 Code A- member qualified for periodic (biennial, quinquennial, etc.)
physical examination.
2 Code D- member qualified for RELAD/discharge/retirement.
3-19 CH-17
3 Code O- member qualified for overseas duty.
4 Code N- member not physically qualified.
d. Disposition of Reports.
(1) When the individual meets the appropriate physical standards, forward the
physical examination as indicated in FIGURE 3-B-2.
(2) When the individual does not meet the appropriate physical standards and a
waiver has been recommended, endorse the physical examination and forward
it in accordance with section 3-A-8.
(3) When the individual is not physically qualified for the purpose of the
examination and a waiver is not recommended, the reviewing authority will
arrange for the examinee to be evaluated by a medical board and provide
administrative action as outlined in Physical Disability Evaluation System,
COMDTINST M1850.2(series).
4. Correction of Defects Prior to Overseas Transfer or Sea Duty Deployment.
a. Medical Defects. Before an individual departs for an overseas assignment for 60
consecutive days or greater days, to permanent assignment aboard a Polar
Icebreaker, or to a vessel deploying from its home port for 60 consecutive days or
greater, all remediable medical defects, such as hernias, pilonidal cysts or sinuses
requiring surgery, etc., must be corrected. Those defects that are not easily corrected
will be referred to Commander CGPC for consideration. These procedures also
apply to personnel presently assigned to such vessels. In these cases all necessary
corrective measures or waivers will be accomplished prior to the sailing date.
b. Dental Defects. All essential dental treatment shall be completed prior to overseas
transfer or sea duty deployment except those described in 4-C-3.c.(3)(b). Essential
dental treatment constitutes those procedures necessary to prevent disease and
disabilities of the jaw, teeth, and related structures. This includes extractions, simple
and compound restorations, and treatment for acute oral pathological conditions such
as Vincent's stomatitis, acute gingivitis, and similar conditions that could endanger
the health of the individual during a tour of duty. Missing teeth are to be replaced
when occluding tooth surfaces are so depleted that the individual cannot properly
masticate food. Elective dental procedures (those that may be deferred for up to
twelve months without jeopardizing the patient's health, i.e., Class II patient) need
not be completed prior to overseas transfer providing both of the following
conditions exist:
(1) completion of such elective procedures prior to transfer would delay the
planned transfer; and
(2) adequate Service dental facilities are available at the overseas base.
c. Vision Defects. A refraction shall be performed on all personnel whose visual acuity
is less than 20/20 in either eye (near or distant) or whose present eyewear
prescription does not correct their vision to 20/20. All personnel requiring glasses
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for correction shall have a minimum of two pair prior to overseas transfer or sea duty
deployment. All personnel requiring corrective lenses shall wear them for the
performance of duty.
5. Objection to Assumption of Fitness for Duty at Separation.
a. Any member undergoing separation from the service who disagrees with the
assumption of fitness for duty and claims to have a physical disability as defined in
section 2-A-38 of the Physical Disability Evaluation System, COMDTINST
M1850.2(series), shall submit written objections, within 10 days of signing the
Chronological Record of Service (CG-4057), to Commander CGPC. Such
objections based solely on items of medical history or physical findings will be
resolved at the local level. The member is responsible for submitting copies of the
following information along with the written objections:
(1) Report of Medical Examination (DD-2808);
(2) Report of Medical History (DD-2807-1);
(3) signed copy of the Chronological Record of Service (CG-4057);
(4) Appropriate consultations and reports; and
(5) "other pertinent documentation."
(6) The rebuttal is a member's responsibility and command endorsement is not
required.
b. The file shall contain thorough documentation of the physical examination findings,
particularly in those areas relating to the individual's objections. Consultations shall
be obtained to thoroughly evaluate all problems or objections the examinee indicates.
Consultations obtained at the examinee's own expense from a civilian source shall
also be included with the report.
c. Commander (CGPC) will evaluate each case and, based upon the information
submitted, take one of the following actions:
(1) find separation appropriate, in which case the individual will be so notified and
the normal separation process completed;
(2) find separation inappropriate, in which case the entire record will be returned
and appropriate action recommended; or
(3) request additional documentation before making a determination.
6. Separation Not Appropriate by Reason of Physical Disability. When a member has an
impairment (in accordance with section 3-F of this Manual) an Initial Medical Board
shall be convened only if the conditions listed in paragraph 2-C-2.(b), Physical
Disability Evaluation System, COMDTINST M1850.2(series), are also met. Otherwise
the member is suitable for separation.
7. Procedures for Physical Defects Found Prior to Separation.
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a. Policy. No person shall be separated from the Service with any disease in a
communicable state until either rendered noninfectious, or until suitable provisions
have been made for necessary treatment after separation.
b. Remediable Non-Disqualifying Defects. Remediable physical defects that would not
normally prevent the individual from performing the duties of grade or rate shall be
corrected only if there is reasonable assurance of complete recovery and sufficient
time remaining prior to separation.
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FIGURE 3-B-1