DEPARTMENT OF THE ARMY SRRC FORT BLISS, TEXAS 79916 NLC

DEPARTMENT OF THE ARMY SRRC FORT BLISS, TEXAS 79916 NLC Deployers General Medical Recommendations and Preparations As of: JULY 2018

References for Medical Processing Department of the Army Personnel Policy Guidance (PPG) for Overseas Contingency Operations, Chapter 7, update 22 MAY 2012: https://www.cpms.osd.mil/expeditionary/pdf/PPG.pdf Department of Defense Instruction (DoDI) 3020.41, Enclosure 3: Guidance for Contractor Medical and Dental Fitness DD 2795 Pre Deployment Health Assessment should be completed by the deploying individual within 120 days of arrival at CRC, Fort Bliss (This will be validated and signed by a Provider at SRRC) If going to CENTCOM: Mod 13: Individual Protection and Individual/Unit Deployment Policy: https://www.express-scripts.com/TRICARE/tools/USCENTCOM M OD THIRTEEN.PDF PPG- Tab A: Amplification of the Minimal Standards of Fitness for Deployment: https://www.express-scripts.com/TRICARE/tools/USCENTCO

Getting Ready to Deploy You are responsible for arriving medically ready to deploy Purpose of this Medical Review: Validate your current medical and health status to ensure you meet deployment requirements. Check all references. Ensure you are within medical fitness standards. Review the cited references with your Health Care Provider. Ensure you can: Understand and accomplish the mission Arrive at SRRC medically ready Arrive at SRRC with all of the medical documentation and approved waiver (if required). SRRC will not initiate waivers.

Getting Ready to Deploy Accomplish medical requirements as soon as possible and complete vaccination requirements at least 30 days before arrival to maximize level of disease protection DoD beneficiaries: When obtaining your prescription medications at home station, register for mail order refills at: https://www.express-scripts.com/TRICARE/index.shtml DoD beneficiaries: See the Deployment Prescription Program slides: https:// tricare.mil/dpp

Documents to Bring to Medical SRRC Copy of medical records related to: Significant current or past medical issues that may affect deployability Mental health history and treatments Documents related to a VA Disability Rating Copy of all waivers and response from applicable COCOM Obstructive Sleep Apnea: Bring a copy of initial (untreated) sleep study results and card reading/download from CPAP machine showing adherence. *May require waiver* Adherence is defined as PAP machine data download (i.e. compliance report) that reveals the machine is being used for at least four hours per night for greater than 70% of nights over the previous 30-day period. CPAP must have a rechargeable battery backup and sufficient supplies for the deployment duration. Suggest hand carry to CRC to avoid damage, but do not bring CPAP machine to Medical SRRC

Documents to Bring to Medical SRRC Asthma or COPD prescribed/requiring medication: (inhalers, etc.) Bring copy of a pulmonary function test. *May require waiver* Copy of records demonstrating High Blood Pressure is controlled (can be on physical examination records) with no change in medication regimen in past 90 days (start, stop or change in dosage of medication). Copy of results of Neurological and/or Psychological evaluation if history of Concussion/Traumatic Brain Injury (even if mild) - may be accomplished by your Primary Care Provider.

Documents to Bring to Medical SRRC Copy of medical records or letter from Medical/Behavioral Health Provider treating any psychiatric disorders (anxiety, depression, PTSD, etc.) stating: Stability for at least three months using the same treatment and are not expected to decompensate in a deployed environment Same treatment is defined as having used the same dosage of current medication for at least 90 days without the discontinuation of any other behavioral health medication during that 90 days No inpatient/residential psychiatric or substance abuse treatment in the past 12 months (requires waiver if within past 12 months)

Documents to Bring to Medical SRRC (Tuberculosis Screening/PPD) Current TB screen and TB skin test results within 90 days of deployment. If you have ever had a positive TB skin test, bring records documenting: Proof of previous BCG Vaccination History of exposure to TB, proof of past treatment No TB symptoms currently exist, results of chest X‐ray 90 days prior to deployment Documentation of completed public health nursing evaluation for TB disease and counseling for latent tuberculosis infection

Documents to Bring to Immunization Section All civilian records of valid vaccinations (or lab results demonstrating immunity) Serum titers are acceptable proof of immunity for Hepatitis A, Hepatitis B, MMR (measles/mumps/rubella), and VZV (varicella or chickenpox) CDC (formerly PHS) 731 (yellow shot card) if your deployment requires yellow fever or polio vaccination If you do not have a CDC (formerly PHS) 731, one will be provided at SRRC Immunizations

Immunizations Screening Requirements Review references with your Health Care Provider to understand all requirements At minimum, the first vaccination in a series is required to deploy, unless medically or administratively contraindicated Recommend receiving required vaccinations at least 30 days before arrival to SRRC Polio booster vaccination is currently required prior to entry into Afghanistan or Pakistan for greater than four weeks, due to a current polio outbreak in these countries Your Combatant Command Immunization Requirements can be found at: https:// health.mil/Military-Health-Topics/Health-Readiness/Immunization-Healthcare/VaccineRecommendations/Vaccine-Recommendations-by-AOR

Vision Screening Requirements Every NLC will be processed through vision section, even if they do not wear glasses. Vision Prescription (valid for 24 months) Two (2) pairs prescription eyeglasses One (1) pair prescription protective mask inserts One pair (1) of inserts for ballistic eye protection Inserts from prior deployment are ok if prescription still valid; these will be provided, if needed NO contacts lenses are to be worn while deployed to an austere environment or during CRC process (to include SRRC processing) Eye surgery – must NOT be using steroid eye drops Letter from eye doctor clearing you after PRK/LASIK, if deploying within 90 days of the surgery, must not need follow up Letter from eye doctor clearing you after LASIK surgery, if deploying within 30 days of surgery, must not need follow up

Documents to Bring to Medical SRRC (Audiology) Hearing Assessment/Audiology: DD Form 2215 - hearing exam completed and certified by an Audiologist within 90 days of SRRC processing and the following MUST be documented Name, SSN, Credentials of the authorizing Audiologist (M.D/D.O), Audiologist’s NPI Number, and Audiologist’s signature If performed by an audiology technician: needs CAOHC certification number Audiometer make, model, serial number, and calibration date (within one year) Audiologist must perform diagnostic audiogram to include air, Bone, SRT, speech recognition, tympanometry, Sprint or hint screening if audiogram exceeds the following thresholds: Audiometer average level for each ear 500, 1000, 2000 Hz, not more that 30dB or Not more than 30dB with no individual level greater than 35 dB at these frequencies, and not more than 55dB at 4000Hz; or audiometer level 30dB at 500Hz, 25 dB at 1000 and 200Hz, and 35 dB at 4000Hz in better ear. All requirements listed are Mandatory to be considered a Valid Audiogram. Hearing aids and six months supply of batteries

Documents to Bring to Medical SRRC (Dental) DD Form 2813 (DoD Active Duty/Reserve Forces Dental Examination): Valid for one year. Must document: Dental Classification (Class 1 or 2) Class 3: are non-deployable, corrective dental action must be completed prior to arrival and a new DD Form 2813 indicating new dental class of 1 or 2. Bitewing and Panoramic X‐rays required to be reviewed by dentist and block 6, item 5 marked “yes” and date that is either prior to or same day as the exam. Dentist’s information: Name, State Dental license number, Office address, Office phone number

Documents to Bring to Medical SRRC (Dental) Individuals with Orthodontic appliances are non-deployable without a waiver Bring these documents: Approved Waiver response if Orthodontic appliances worn. Waiver request should include: Letter of evaluation from Orthodontic Provider stating that wires with neutral force are in place

Documents to Bring to Medical SRRC (Physical Exam) Copy of physical examination report – Completed within 90 days of deployment due to being valid for 15 months (allows for 12 month deployments because performing a physical in theater may not be possible) NLCs must use DD Forms 2808 and 2807-1 A Periodic Health Assessment performed as a service member or FAA certificates ARE NOT acceptable substitutes Physical examination results must reflect: The Deployer is psychologically and physically fit for working in an austere environment and capable of wearing respiratory, chemical, and biological protective equipment ECG/EKG (everyone 40 years of age and older): within the past five years Results of Framingham Calculation if: 40 years old and older and/or if treated for Diabetes Mellitus Type

Documents to Bring to Medical SRP (Physical Exam) If Framingham Calculation is 15% for a Deployer who is older than 40 years old and/or is treated for Diabetes Mellitus type 2, bring: Results of cardiology evaluation with a completed Stress Echocardiogram or Nuclear Stress Test. PCM or Cardiologist recommendations to deploy Requires a Waiver

Documents to Bring to Medical SRRC (Physical Exam: Lab Requirements) Lab test requirements (must have results from the lab, not written on physical exam) Blood type and RH factor lab results: One time draw G6PD lab results: One time draw Lipid panel results required if 35 years or older: Within five years (ensure results meet CENTCOM standard) Hemoglobin A1C (within 90 days) if you have Diabetes Mellitus or if you take a medicine typically used for Diabetes Mellitus Sickle Cell screen (one time draw): PACOM, AFRICOM, and EUCOM

Documents to Bring to Medical SRRC (Physical Exam: Lab Requirements) Provide negative pregnancy test results within 30 days of departure to theater* If during Medical SRRC a vaccination is required, females must have a blood pregnancy test drawn prior to receiving the vaccination (done at SRRC lab)* * Exemptions to pregnancy testing are the following (with documentation): Bilateral tubal ligation, Hysterectomy, or are Post-menopausal

What to Bring to Medical SRRC (Medications) Chronic/daily use medications – Bring 180 days supply or an amount sufficient to cover the entire deployment if 180 days Certain medications require a Waiver; refer to the CENTCOM formulary for restricted medications and those that do require a waiver. https://www.express-scripts.com/TRICARE/tools/deployedrx.shtml (The CNS Psychotropic List Sheet states which medications require waivers and which are non-deployable) All COCOMS follow CENTCOM Formulary Come prepared. Please do not expect to get your deployment supply of daily medications at Fort Bliss Military Treatment Facility. Malaria prevention medications will be provided to you at the SRRC site with instructions, if required per theater of operations. Inform the SRRC provider if you have any medication allergies Allergy warning tags (Red ID/Dog Tags with allergen listed). These can be purchased locally if needed.

Waivers If you need a waiver to deploy, you must come with the APPROVED waiver completed. Waiver must be presented to the SRRC Providers (See PPG, MOD 13 Tab A, and the CENTCOM formulary for details). If a condition is found during Medical SRRC process that requires a waiver, the NLC will be sent home to complete the waiver process with contracting agency. Bottom line: Have all your information and documents ready to ensure an easy process.

Waivers When assigned to CENTCOM, the CENTCOM Surgeon is the Approving Authority for all medical and behavioral health conditions: Send requests to: [email protected] If assigned to ARCENT, send requests to: arcent‐[email protected] The SOCCENT Surgeon is the approving authority for all Special Operations Personnel. The other Component Surgeons are the delegated Approving Authority for all medical conditions in their respective AORs (AFRICOM, EUCOM, NORTHCOM, PACOM/USFK, and SOUTHCOM).

Common Documents Required for Waivers BMI over 35 DA Form 5500 Diabetes Mellitus HgbA1C within past 90 days, list of ALL medications Sleep Apnea ORIGINAL sleep study documenting untreated severity, 30-day compliance download within past 30 days, list of ALL medications Framingham 15% Cardiac evaluation (nuclear stress test preferred), list of ALL medications, lipid panel results Hypertension medication change within 90 days Five-day blood pressure check on current dosage of medication, list of ALL medications Behavioral health medication change within 90 days Documentation of stability at current regimen and dosage ADHD medications, Benzodiazepine, Antipsychotic, Sleep medications (i.e. Ambien, Lunesta), Anticonvulsants Documentation from treating provider including diagnosis, medication regimen, stability, length of time on medication, any adverse reaction/side-effect from medication Seizure disorder/Narcolepsy Documentation from Neurologist including diagnosis, last seizure/cataleptic event, medication regimen, stability, length of time on medication, any adverse reaction/side-effect from medication

Medical SRRC Determination “Cleared to deploy”: Meets all the theater medical requirements Is “medically ready” to deploy “Not cleared to deploy”: Does not meet all theater medical requirements Is “not medically ready” to deploy “Hold Over”: Does not meet all theater medical requirements Not yet “medically ready” to fly out, but is expected to meet theater medical requirements within one week.

Questions Call if your questions are not addressed in these slides, the PPG or the Mod 13: Fort Bliss SRRC Medical Operations at (915) 742-6855 We look forward to seeing you!

Glossary of Terms/Acronyms SRRC: Soldier Readiness and Resiliency Center CRC: CONUS Replacement Center NLC: Non-Log Cap MOD 13: Modification #13 to the U.S. CENTCOM Individual Protection and Individual-Unit Deployment Policy PPG: Personnel Policy Guidance