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Peace Corps

Technical Guideline 100

OFFICE OF HEALTH SERVICES

1. Purpose

To describe the mission and functions of the Office of Health Services (OHS).

2. Mission

The mission of the Office of Health Services (OHS) is to provide and maintain a healthy
Volunteer corps through the services of dedicated overseas and headquarters staff. To
achieve this mission, OHS supports a comprehensive, accountable and quality Volunteer
Health Program. Core components of the program are:
• medical and mental health assessment of applicants for Volunteer service
• comprehensive care of new medical and mental health conditions that arise during
PC service as well as monitoring and treating chronic stable pre-existing conditions
• assure that adequate, timely and appropriate healthcare education and training is
provided to Volunteers and Trainees
• monitor and endeavor to improve the quality of healthcare provided to Volunteers and
Trainees
• coordination of health benefits for Returned Peace Corps Volunteers (RPCVs)

3. Leadership
The OHS leadership team consists of the following positions:

The Associate Director (AD/OHS) and/or designee reports to the Director of Peace Corps
through the Deputy Director. The AD/OHS works with the agency’s Senior Staff to
implement and manage policies, practices, and procedures to ensure that the agency meets its
goals and fulfills its mission.

The Medical Director reports to the AD/OHS. This position is responsible for the oversight
of and ensuring that all clinical policies, practices and procedures pertaining to the overall
healthcare of Volunteers are implemented.

OHS is organized into functional units as follows:


• Pre-Service
• Field Support
• Post Service
• Education and Training
• Clinical Programs

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• Quality Improvement
• Epidemiology and Surveillance
• Medical Records

• Financial and Resource Management Unit

• Counseling and Outreach Unit

4. FUNCTIONS OF THE OFFICE OF HEALTH SERVICES

4.1 Pre-Service Unit


Medical clearance is required for all Peace Corps applicants. The core functions of the
Pre-Service Unit are to:

• Reach a determination on medical clearance, clearance with restrictions, deferral, or


disqualification for each applicant.
• Identify appropriate accommodations for applicants cleared with medical restrictions.
• Document the pre-service baseline medical status of all incoming Trainees.

4.2 In-Service Unit


The Field Support unit is organized into three regional teams consistent with the regional
structure of the Peace Corps. The three regions are: Europe, Mediterranean, and Asia
(EMA); Africa (AF); and Inter-America and the Pacific (IAP). The core functions of the
Field Support Unit are to:

• Support medical care provided to Volunteers overseas through field consultation with
Peace Corps Medical Officers (PCMOs)
• Authorize medical evacuation and provide case management for all Volunteers
medically evacuated to the U.S. and all Volunteers on medical hold status.
• Assist all Volunteers who require medical care while on home leave, vacation, or
emergency leave.
• Provide 24-hour medical duty officer coverage.
• Support PCMO activities and health unit operations.
• Participate in PCMO performance evaluation.

4.3 Post Service Unit


The Post Service Unit manages all health benefits for returned Volunteers. The core
functions of the Post Service Unit are to:

• Facilitate RPCV access to evaluation of unresolved medical conditions within six


months of Close of Service (COS).
• Contact RPCVs to ensure necessary follow-up of findings on COS exams and assist
returned Volunteers in submitting Federal Employees’ Compensation Act (FECA)
claims to the Department of Labor.
• Act as liaison between the Peace Corps and the Department of Labor on the eligibility
of former Volunteers for FECA benefits.

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• Provide claims coordination between CorpsCare and FECA for RPCVs.


• Provide feedback to PCMOs on the COS process.

4.4 Education and Training Unit


The Education and Training Unit is responsible for PCMO and headquarters staff training
and development. The core functions of the Education and Training Unit are to:

• Develop curriculum for, coordinate, and execute annual Medical Overseas Staff
Training (MOST) and Continuing Medical Education (CME) conferences.
• Develop and maintain health training materials.
• Serve as a resource for PCMOs, Regional Medical Officers (RMOs) and OHS
professional staff development.

4.5 Clinical Programs Unit


The Clinical Programs unit manages the organization's Health Care Program specifically
by providing clinical oversight and management of the Volunteer Health System. The
core functions of the Clinical Programs unit are:

• Provides professional guidance, direction, and support to the PCMOs and all agency
contracted health personnel.
• Provides the Country Directors and PCMOs with any assistance and support
necessary to improve the effectiveness and delivery of medical and health services
• Works with other OHS staff to establish and maintain protocols for new country entry
health assessments.
• Interprets medical aspects of regulations and policies concerning the operations of
OHS and contributes to the development of management information systems that
monitor and track quality of care standards, indicators, and disease trends.
• Provides medical consultations and guidance to the Pre-Service, Field Support and
Post Service teams regarding medical case management. Serves as a member of the
Pre-Service Review, Medical Review and Post-Service Review Boards.

4.6 Quality Improvement Unit


The Quality Improvement Unit develops health system policies, monitors the
effectiveness of health care, and provides information and analysis on health conditions
and programs. The core functions of the Quality Improvement Unit are to:

• Develop, disseminate, and monitor medical policies and procedures, primarily


through OHS Technical Guidelines.
• Assess the qualifications and credentials of PCMO applicants, back-up providers and
responsible for the oversight of the annual PCMO performance evaluation process.
• Support quality improvement initiatives in the field.
• Monitor the health care provided to Volunteers in order to assure quality and
accountability of clinical processes.

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4.7 Epidemiology and Surveillance Unit


The Epidemiology and Surveillance Unit develops, maintains, and analyzes all reportable
events and surveillance systems. The core functions of Epidemiology and Surveillance
Unit are to:

• Provide oversight to surveillance of health conditions among Volunteers through the


Epidemiological Surveillance System and other Volunteer Health System surveillance
systems.
• Conduct studies to analyze health conditions and identify risk factors for certain
conditions among Volunteers, and assist in the design of prevention strategies.

4.8 Medical Records


The Medical Records Unit manages the Volunteer health record system and releases
medical information to authorized facilities and persons. The core functions of the
Medical Records Unit are to:

• Create, distribute, track, and retire Volunteer health records.


• Maintain and monitor health records policies and procedures.
• Duplicate and distribute information from health records in response to requests from
Applicants, Volunteers and RPCVs.

4.9 Counseling and Outreach Unit (COU)


The Counseling and Outreach Unit core functions are to:
• Assist posts in the management of Volunteer behavioral and adjustment challenges
through telephone and secure email consultations.
• Provide input into the mental health medical clearance of applicants.
• Conduct direct mental health medevac support.
• Consult as necessary on mental health support.
• Provide support for families of deceased Volunteers.

4.10 Financial and Resource Management Unit (FARM)


The FARM core functions are to:
• Provide financial, human resources and contracts oversight.
• Provide fiscal oversight and monitor efficiency of healthcare delivery at post.

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Peace Corps
Technical Guideline 101
Medical Decision-Making in the context of Peace Corps

1. PURPOSE
To provide a framework for medical decision-making within the context of Peace Corps.

2. BACKGROUND
Medical decisions are not made in a vacuum. The Peace Corps medical environment is unique and
is not identical to the typical medical environment within the United States, nor is it identical to the
typical medical environment in the countries in which our Volunteers serve. Therefore, Peace
Corps Medical Officers (PCMOs) must make clinical decisions within the context of the Peace
Corps health system, the available resources in the country of service, the rules and regulations of
the Peace Corps program in the country of service, as well as Peace Corps policies and the Peace
Corps Act. Peace Corps is required to make reasonable accommodations for its Volunteers, but in
some cases the Peace Corps health system is unable to make such accommodations. These
considerations must be taken into account in order to make the most appropriate clinical decisions
for Volunteers.

3. PEACE CORPS HEALTH SYSTEM


The Peace Corps health system is unique and may provide resources that might otherwise not be
available in a typical health system, whether in the U.S. or overseas. For example, a PCMO (or
credentialed backup provider) is always available, 24 hours a day, 7 days a week, at every post, to
provide medical assistance to a Peace Corps Volunteer (PCV). Peace Corps provides all necessary
and appropriate medical care, which includes full coverage of all urgent and emergent medical
needs, all longitudinal care for stable, chronic conditions, as well as preventive care as available; all
prescription medications, as well as all available over-the-counter products are provided as needed;
all medical laboratory testing and imaging is provided, as available in country, as needed;
hospitalization, either locally or regionally, is provided as needed; all transportation for medical
needs is provided; regional medical evacuation (medevac) as well as medevac to the U.S. is
provided as needed; specialty referral and consultation is also available with local, regional, and
U.S.-based specialists. Health education is provided throughout a PCVs service. The availability
and coverage of these services makes the Peace Corps health system unique, and should be taken
into consideration as medical decisions are made.

4. COUNTRY-SPECIFIC RULES AND REGULATIONS


Each Peace Corps country has a unique environment of prevalent diseases (e.g., malaria,
chikungunya), resources and laws that affect clinical decision-making. It is imperative that medical
decisions for PCVs take these factors into consideration. For example, if a Peace Corps country
requires a Yellow Fever vaccine prior to entry, an applicant that is allergic to the Yellow Fever
vaccine cannot be vaccinated against Yellow Fever and therefore cannot be granted entry into the
country, regardless of the medical services that may be provided by Peace Corps within country,
and regardless of the otherwise medical fitness of that potential Volunteer. Another example is the
inability of Peace Corps to provide amphetamines for the treatment of Attention Deficit
Hyperactivity Disorder (ADHD) in some countries. If amphetamines are strictly illegal in a Peace
Corps country, Peace Corps is unable to provide this medication and therefore cannot provide a
reasonable accommodation for the Volunteer in that country.
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Cultural standards for Peace Corps countries must also be taken into consideration, as all countries
vary, sometimes significantly, in their expectations of Volunteers. Public behavioral expectations
and sexual mores are two examples of areas where Peace Corps country standards may differ
significantly from U.S. standards. Peace Corps provides all Volunteers with cultural expectations
in writing and Volunteers must comply with these expectations; cultural training is provided to all
Volunteers. PCMOs play a role in ensuring that Volunteer behavior aligns with local expectations,
especially if inability to comply with expected behavior leads to medical issues.

Country resources also affect medical considerations. For example, if a vaccine must be
transported via cold chain shipping and refrigerated upon arrival for the duration of storage, a
country that cannot provide such refrigeration services cannot provide the vaccine.

5. PEACE CORPS MANUAL


The Peace Corps Manual is the compendium of agency policies. Manual Sections mandate specific
actions and behaviors on the part of Peace Corps personnel and Volunteers. Some Manual Sections
are specifically related to health and medical care. For example:

 Whereas in the U.S., patients are afforded the ability to accept or reject medical advice,
MS262 Part 3.2 requires Volunteers to follow Peace Corps medical policies and the
medical advice of their PCMO; those who refuse to take required immunizations,
vaccinations and medical prophylaxis and/or consistently fails to follow other medical
advice or policies may be administratively separated.

 Whereas in the U.S., the Health Insurance Portability and Accountability Act (HIPAA)
ensures that health care providers maintain the confidentiality and privacy of protected
health information, MS294 Guidance Section 4.1.4 allows a PCMO to disclose protected
health information to Peace Corps staff on a need-to-know basis if the PCMO believes that
disclosure of that information might be necessary in order to prevent or lessen a threat to
the health, safety or well-being of the Volunteer or others, or a risk to the reputation of the
Peace Corps program in country.

 One example where patient expectations and policy requirements may conflict is sexual
behavior. Whereas patients in the U.S. expect complete confidentiality with regards to
sexual behaviors that may be divulged in a medical setting, MS204 Part 3.14 requires
Volunteers to follow certain legal and policy requirements (failure to do so may be grounds
for disciplinary action up to and including administrative separation) and Country Directors
shall ensure that Volunteers understand host country sexual mores and the consequences
for Volunteers and the Peace Corps program if these mores are violated (post guidance in
this area should be provided in writing to Volunteers). PCMOs may be in a position that
requires them to disclose such information about a Volunteer to Peace Corps staff in the
interest of the agency.

Given the combination of the above Manual Sections, PCMOs may be expected to perform certain
roles that would not otherwise be expected of a personal health care provider in the U.S. The
PCMO is expected to provide high quality medical care, adhere to current standards of professional
behavior, but also to comply with all Peace Corps policies. The combination of the three may result

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in required actions that may conflict with expected actions of a practitioner not bound by Peace
Corps policy.

6. PEACE CORPS ACT


The Peace Corps Act is the federal law that authorizes Peace Corps, and specifically the type of
health and medical care that Peace Corps is to provide. The Peace Corps Act, specifically 22 U.S.
Code § 2504(e), states that Peace Corps shall provide the following services to the various
categories of recipients:

A. All necessary and appropriate health care for Volunteers and Trainees during their
service;
B. Health examinations for applicants;
C. Immunizations and dental care for invitees;
D. Health examinations for former Volunteers within six months after termination of
their service.

Note that health “care” is not authorized for applicants, invitees or returned Volunteers, but that
immunizations and dental care are authorized for invitees. Note also that health examinations are
limited to within 6 months after termination of service for former Volunteers. The Office of
Health Services and the Peace Corps medical system are carefully structured to comply with the
authorizations provided in the Peace Corps Act and developed in the Peace Corps Manual.

Given the various layers of laws, regulations, policies, practices, and expectations for Peace Corps
Medical Officers, FIGURE 1 depicts graphically the context in which clinical decisions are made
for Peace Corps Volunteers. This context must be taken into consideration when clinical decisions
are made, when these clinical decisions are evaluated for quality purposes, and when additional
policies are made that affect the Peace Corps medical system.

FIGURE 1: Peace Corps Clinical Decisions in Context

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Peace Corps
Technical Guideline 110

VOLUNTEER HEALTH PROGRAM

1 . PURPOSE

To define the purpose of in-country Volunteer health programs and outline the roles and
responsibilities of Peace Corps overseas staff–Country Director (CD); Peace Corps Medical Officer
(PCMO); Medical Assistant (MA); Medical Secretary (MS); and Regional Medical Officer (RMO)–
toward the in-country health program.

2. PURPOSE OF THE IN-COUNTRY VOLUNTEER HEALTH PROGRAM

The Volunteer Health System has two principal components: (1) the Office of Health Services
(OHS) and (2) in-country Volunteer health programs. The core functions of OHS are detailed in
Technical Guideline (TG) 100 “Office of Health Services”.

The core functions of the in-country Volunteer health program are to:
• Support Volunteers in assuming responsibility for their own health.
• Promote the health of Volunteers and prevent disease.
• Provide health services to Volunteers overseas in as safe, efficient, and timely a manner as
possible within the particular host-country environment.
• Provide medical evacuation (medevac) to Volunteers who require medical care beyond the care
available in-country.

3. COMPONENTS OF THE IN-COUNTRY VOLUNTEER HEALTH PROGRAM

The in-country Volunteer health program is an essential part of the Peace Corps post. The
program has five components:
• Program Management and Administration
• Prevention and Health Education
• Clinical Care
• Mental Health Support and Counseling
• Quality Improvement

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4. ROLES AND RESPONSIBILITIES OF THE COUNTRY DIRECTOR

The Country Director has responsibility for the day-to-day management and
supervision of each PCMO based at the post on non-clinical issues, including
all routine administrative matters such as time and attendance, scheduling of
leave and customer service.

The responsibilities of the CD towards the in-country health program include the following:

4.1 Program Management and Administration. In consultation with OHS and consistent
with MS 261, the Country Director:

• Ensures appropriate staffing of the health unit and participates in the


hiring of PCMOs and other health unit staff.

• Provides administrative and programmatic supervision to the PCMO.

• Participates with OHS on PCMO hiring.

• Collaborates with OHS, the Region and Contracting Officer on renewing,


extending or terminating PCMO contracts.

• Ensures that new PCMOs receive orientation to country


programs, policies, procedures, and post operations.
• Ensures that PCMOs are full members of the Peace Corps post's senior
staff and are included in staff meetings.
• Ensures that the location and configuration of the health unit meets the
needs of the in-country health program and is conducive to Volunteer
health care.
• Ensures that PCMOs receive necessary administrative and clerical support.
• Ensures that health unit staff has appropriate computer and
communications equipment.
• Ensures that PCMOs have access to safe, reliable, and timely
transportation for job- related travel as described in Agency vehicle
policies.
• Ensures PCMO involvement in the Integrated Planning and Budget
System (IPBS) planning process and ensures budget resources are
adequate to cover essential health support activities.

• Ensures that medical confidentiality is understood by all staff and Volunteers.


Ensures that the PCMO and CD have a common understanding about extending
medically confidential information to the CD (see TG 150 “Medical Confidentiality”).

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• Ensures that all PCMOs attend annual Continuing Medical Education


(CME) courses and that new PCMOs attend Overseas Staff Training
(OST) in Washington.
• Assures health unit coverage during PCMO absences from post, e.g.,
during attendance at medical conferences, vacations, etc.

• Facilitates periodic visits by RMOs and support/evaluation visits from OHS


staff and responds to actions recommended by those visits.

4.2 Prevention and Health Education

• Ensures adequate time for the health component of Pre-Service Training


(PST) and adequate attention to health promotion activities during PST,
In-Service Training (IST), and other Volunteer training events.
• Encourages the production of health newsletters and supports other health
education initiatives.
• Supports PCMO participation in site development and site visits.
Ensures that site development includes a thorough health and safety
assessment.

4.3 Quality Improvement

• Supports and participates in quality improvement efforts initiated in country and by OHS
or the Region.
• Addresses issues or concerns identified during quality improvement efforts.

5. ROLES AND RESPONSIBILITIES OF THE PCMO

The PCMO, as assigned by OHS in collaboration with the CD, is responsible for
providing the medical and administrative services described in MS 262 and in the
Medical Technical Guidelines. The PCMO acts as both a program manager and a
clinician. The program management responsibilities of the PCMO are similar in all
countries, but clinical responsibilities vary depending on the country and on the
PCMO’s training and expertise. CDs and PCMOs should also be familiar with the
duties and responsibilities as outlined in the PCMOs’ individual personal services
contracts.

Responsibilities of the PCMO include the following functions:

5.1 Program Management and Administration

• Operates the in-country Volunteer health program in compliance with


Peace Corps policies and procedures as outlined in the Peace Corps
Manual and the Technical Guidelines.
• Establishes and operates a health unit.
• Maintains supplies of medications and medical equipment to manage

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anticipated routine and emergency health needs.


• Advises the CD and OHS of needed support, including administrative
assistance, equipment, and additional clinical staff, when applicable.
• Trains administrative and clinical support staff in the health unit.
• Maintains administrative records and planning systems, and participates in the IPBS
planning and budget process.

• Maintains clinical records that ensure medical confidentiality and


compliance with the provisions of the Privacy Act, Peace Corps Manual
Section and Technical Guideline.

• Establishes in-country, regional, and U.S. medevac plans, and


educates in-country staff on urgent and non-urgent medevac
procedures.
• Assists the CD in ensuring the availability and accessibility of health care services.

 Coordinates and ensures 24/7 coverage for the health unit by a


medically qualified individual.
• Provides the CD with periodic status reports on in-country health and
safety concerns, identified in-country health risks, and the objectives
of the health care program.
• Informs the CD of major health and safety problems that may have a
programmatic impact, including assaults or illnesses that interfere with
Volunteers’ activities or that require medevac.
• Provides OHS with required reports, i.e., monthly epidemiological
surveillance reports, regional medevac reports and in-country
hospitalization reports.
• Attends annual CME courses and OST in Washington for new PCMOs.

5.2 Prevention and Health Education

• Plans, coordinates, and provides health education to Volunteers during


PST, IST, COS, and throughout their tours through the use of
newsletters, health handbooks, individual health education sessions,
and other activities.
• Provides preventive health services, including immunizations,
periodic health evaluations, and preventive treatments.
• Participates in the process of site selection including the evaluation of
Volunteers’ living, work, and training sites; makes professional
recommendations for site improvements or changes if indicated.
• Conducts ongoing site evaluation visits to identify potential health or
adjustment problems.

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5.3 Clinical Care

• Provides clinical care, including the assessment and management of


Volunteer health problems, either directly through the services of the
health unit or through referral to in-country health care providers and
facilities.
• Establishes and maintains an in-country referral network of health
care providers through the identification and evaluation of consultants
and services.
• Documents all care provided to Volunteers, including counseling,
referrals, and individual health education.
• Seeks consultation with the RMO or OHS to assist with case
management and referrals; seeks prompt consultation with OHS for all
health conditions that may place a Volunteer at high risk of morbidity
or mortality.

5.4 Mental Health Support and Counseling

• Provides emotional support and short-term counseling services to


Volunteers.
• Provides clinical assessment and management of psychiatric
emergencies either directly through the services of the health unit,
regional mental health professionals or through referral to in-country
health care providers and facilities.
• Provides clinical care and counseling support to victims of physical
and sexual assault.
• Remains alert for signs and symptom of emotional disorders and
substance abuse, and evaluates those who may need support or referral.
• Establishes a referral care network and oversees referral care
provided by local providers.

5.5 Quality Improvement

• In collaboration with OHS, implements quality improvement activities


for the in-country health program, including monitoring, evaluation,
and problem-solving activities.
• Participates in process improvement initiatives in collaboration with OHS and the
region.

6. ROLES AND RESPONSIBILITIES OF THE MEDICAL ASSISTANT

The Medical Assistant (MA) performs a variety of clinical and administrative duties in support
of the health unit. The MA reports to the Country Director (CD) for administrative issues and
works under the direction of the Peace Corps Medical Officer (PCMO).

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The MA is responsible for providing administrative support, and to the extent credentialed,
clinical support, including but not limited to; working as the health unit receptionist, actively
assisting the PCMO in clinical procedures (*), screening all phone calls, taking messages,
maintaining records of all international phone calls and faxes, coordinating requests, medical
appointments, distribution of medicines to PCV’s (includes Peace Corps Trainees and Response
Volunteers) under PCMO oversight, and other clerical and administrative functions in support
of the PCMO(s).
(*) Clinical duties will be performed as approved by the Medical Director/Chief of Clinical
Programs with clinical oversight by the PCMO. See Statement of Work (Attachment A).
Responsibilities of the medical assistant include the following functions:
6.1 Support to the Health Unit

 The MA coordinates responsibilities directly with the PCMO. Must maintain medical
confidentiality regarding PCV medical issues consistent with the Privacy Act and
Peace Corps policy. Must possess excellent interpersonal skills.

6.2 Clinical Support

 Serves as chaperone when necessary for medical evaluations and procedures.


 Responsible for sterilization of equipment.
 Responsible for follow up on results and consultation forms from medical service
providers. Ensures this information is relayed to the PCMO for review.
 Conducts follow up with laboratories when results are not received. Files and documents all
results in the electronic health record when requested by the PCMOs. Coordinates with non-
medical support staff to pick up PCV laboratory results and delivers PCV laboratory samples
to ensure a smooth processing of required tests.
 Performs clinical privileges as approved by the Chair, Credentialing Committee,
OHS, with oversight by the PCMO (Attachment B).
 Annual review of skills checklist to document proficiency (Attachment C).
6.3 Administrative Support

 Screens all phone calls and takes messages when PCMO is unavailable.
 Places and returns telephone calls for the health unit, including scheduling,
modifying, and canceling appointments in coordination with PCV’s, PCMO and
other personnel, such as clinicians and laboratories.
 Drafts correspondence such as letters, memos, fax covers, etc. at the request of the
clinical staff to PCV, laboratories, hospitals, etc.
 Routes incoming correspondence to PCMO, stamps and files routine
correspondence.
 Prepares envelopes and packages, including laboratory samples and medical
supplies to be sent to PCV, training sites and other destinations and forwards them
to the appropriate administrative staff for mailing by courier or ground
transportation.
 Responsible for photocopying health forms, medical presentation materials and other
related documents.
 Responsible for requesting office supplies and materials for use at the health unit.

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 Regularly updates the list of medical facilities and medical service providers under
the instruction and oversight by PCMO.
 Assists PCMO in reviewing the PCV handbook sections relating to medical
information given to PCVs during Pre-Service Training (PST). Updates medical
facilities and medical providers’ addresses, contact information and any other
information required in this handbook.
 Manages the medical library in the health unit and keeps media materials current
such as CDs, DVDs, patient handouts, etc.
 Responsible for the receipt and tracking of all medical bills submitted by PCV and
local medical service providers. Submits bills to PCMO for approval, verifying name
of Volunteer, date of services rendered and that services were requested by PCMO.
 Keeps updated files of all medical bills presented by PCVs and others.

6.4 Medical Supply and Inventory Duties

 Ensures an adequate supply of disposable materials, maintains inventory, and keeps


PCMO informed.
 Responsible for updating medical inventory when medication/supplies are delivered:
 Provides documentation to the Medical Supply Inventory Control Clerk
(MSICC)/General Services Manager (GSM) on receiving, dispensing,
and disposing of required inventory items.
 Keeps an accurate record of the expiration dates of all medicines.
 Responsible for organization and re-shelving of supplies.
 Remains present when medical supplies are received from the
Acceptance Point Clerk. Ensures that the appropriate forms are available
for signature and provides the General Services Officer (GSO) with the
controlled substance form (after removing confidential information).
 Drafts and prepares orders for medical supplies based on need, historical
data, and inventory availability. Works with the PCMO to order medical
supplies from PC/HQ.
 Prints completed form and files with all completed PL 2006 forms according to fiscal
year. Assists medical staff in the monitoring of the medical supplies budget. Files a
copy of each transfer form from APC to the health unit in accordance with the
corresponding order.

6.5 Other Duties

 Attends staff meetings, in-service trainings, and retreats when indicated.


 Understands and complies with Peace Corps safety and security policies and procedures.
 Complies with Peace Corps code of ethics, privacy and confidentiality policies.
 Files all documents produced by the position in accordance with the Peace Corps rules
and regulations.
 Performs other assignments considered as necessary by the supervisor.

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6.6 Qualifications for effective performance

 Successful completion of a nursing school (technical/university degree), general medical


school, medical assistant program, and valid registered clinical licensure/diploma or,
 Applicable knowledge and experience obtained through on-the-job training or under the
direct guidance of a provider (supporting documentation must be submitted).
 Two years progressively responsible related experience with knowledge of administrative
medical duties related to health services. Clerical and secretarial experience desirable.
 English fluency required.
 Basic knowledge of administration of health units/facilities, including procurement of
medical supplies and inventory control. Knowledge of Microsoft Office programs (Word,
Power Point, Access, and Excel).

6.7 Credentialing Process. The candidate must submit the following for review by the
credentialing committee:

 Current resume
 A reference from current or previous employer.
 Valid, active license appropriate to the scope of practice, or a statement issued from the
appropriate regulatory authority.
 Diploma or degree from a professional school, or a statement of qualifications from
previous employer(s) describing on the job training and skills.
 Completed privilege form (Attachment B)
 Completed skills survey (Attachment C)
 The candidate is invited to interview by post. If found acceptable, post forwards all
candidate documentation to credentialing specialist for review.
 Final approval for hire is given by the OHS credentialing committee and post is notified.

7. ROLES AND RESPONSIBILITIES OF THE MEDICAL SECRETARY

This position performs administrative duties in support of the health unit. The Medical Secretary
(MS) reports to the Country Director (CD) for administrative issues and works under the
guidance of the Peace Corps Medical Officer (PCMO).

The MS is responsible for providing administrative support, including but not limited to; working
as the health unit receptionist, screening all phone calls, taking messages, maintaining records of
all international phone calls and faxes, coordinating requests, medical appointments, and other
clerical and administrative functions in support of the PCMO(s). See MS Statement of Work,
attachment D.

Responsibilities of the medical secretary include the following functions:


7.1 Support to the Health Unit
 The MS coordinates responsibilities directly with the PCMO. Must adhere to
confidentiality regarding PCV medical issues consistent with the Privacy Act and
Peace Corps policy. Must possess excellent interpersonal and administrative skills.

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7.2 Administrative Support

 Screens all phone calls and takes messages when PCMO is unavailable.
 Places and returns telephone calls for the health unit, including scheduling,
modifying, and canceling appointments in coordination with PCV, PCMO and
other personnel, such as clinicians and laboratories.
 Drafts correspondence such as letters, memos, fax covers, etc. at the request of the
clinical staff to PCVs, laboratories, hospitals, etc.
 Routes incoming correspondence to PCMO, stamps and files routine
correspondence.
 Prepares envelopes and packages, including laboratory samples and medical
supplies to be sent to PCV, training sites and other destinations and forwards them
to the appropriate administrative staff for mailing by courier or ground
transportation.
 Responsible for photocopying health forms, medical presentation materials and other
related documents.
 Responsible for requesting office supplies and materials for use at the health unit.
 Regularly updates the list of medical facilities and medical service providers under
the instruction and oversight by PCMO.
 Assists PCMO in reviewing the PCV handbook sections relating to medical
information given to PCV during Pre-Service Training (PST). Updates medical
facilities and medical providers’ addresses, contact information and any other
information required in this Handbook.
 Manages the medical library in the health unit and keeps media materials current
such as CDs, DVDs, patient handouts, etc.

 Responsible for the receipt and tracking of all medical bills submitted by PCV and
local medical service providers. Submits bills to PCMO for approval, verifying name
of Volunteer, date of services rendered and that services were requested by PCMO.
 Keeps updated files of all medical bills presented by PCV and others.

7.3 Medical Supply and Inventory Duties


 Ensures an adequate supply of disposable materials, maintains internal medical inventory
and keeps PCMO informed.
 Responsible for updating internal medical inventory when medication/supplies are
delivered:
 Provides documentation to the Medical Supply Inventory Control Clerk
(MSICC)/General Services Manager on receiving, dispensing, and disposing of
required inventory items.
 Keeps an accurate record of the expiration dates of all medicines.
 Responsible for organization and re-shelving supplies.
 Drafts and prepares orders for medical supplies based on PCMO guidance on need,
historical data, and inventory availability. Works with the PCMO to order medical
supplies from PC/HQ.
 Prints completed form and files with all completed PL 2006 forms according to fiscal
year. Assists medical staff in the monitoring of the medical supplies budget. Files a copy
of each transfer form from APC to the health unit in accordance with the corresponding
order.

Office of Health Services September 2015 Page 9


TG 110
Overseas Staff

7.4 OTHER DUTIES


 Attends staff meetings, in-service trainings, and retreats when indicated.
 Understands and complies with Peace Corps safety and security policies and procedures.
 Complies with Peace Corps code of ethics, privacy and confidentiality policies.
 Files all documents produced by the position in accordance with the Peace Corps rules
and regulations.
 Performs other assignments considered as necessary by the supervisor.

7.5 Qualifications for effective performance


 Two years related experience with clerical and/or secretarial knowledge of administrative
medical duties.
 English fluency required.
 Knowledge of Microsoft Office programs (Word, Power Point, Access, and Excel).
 Knowledge of medical terminology desirable.

8. ROLES AND RESPONSIBILITIES OF THE RMO

RMOs are assigned to provide clinical and programmatic support to the in-country
Volunteer Health programs. RMOs are based in a host country and are responsible
for providing assistance to the Volunteer Health program in each country of their
sub regional area. The following are the responsibilities of an RMO:

8.1 Program Oversight and Support to PCMOs

Provides medical and administrative support and oversight to PCMOs and


Peace Corps medical programs in each country of the sub-region. Through
assessment, training and performance feedback, assists PCMOs in fulfilling
their responsibilities to the health program. Ensures that PCMOs and health
units operate in a manner consistent with the Peace Corps Manual and the
Technical Guidelines. Maintains lines of communications with PCMOs at
sub-regional posts at all times. Specific responsibilities include:

• Clinical Consultation: Provides direct clinical care and/or medical


consultative services to Volunteers at the home post and sub-
regional posts as needed and appropriate.
• Volunteer Site Visits: Conducts periodic field visits to Volunteer sites to
assess local living and health conditions with the goal of becoming
familiar with conditions representative of each country within the sub-
region.

• Evaluation of Local Resources: In conjunction with PCMOs, identifies


and evaluates best local medical resources in each country of the sub-
region; establishes and maintains a network of consultant physicians
throughout the sub-region; assists PCMOs in developing skills in
assessment of local resources.
• PST and Other Training Opportunities: Assists with health training
for Trainees and Volunteers and assists, whenever possible, in
periodic in-service health education programs.

Office of Health Services September 2015 Page 10


TG 110
Overseas Staff

• Mid-Service and COS evaluations: Assists, whenever possible, in the


performance of periodic health status reviews and examinations for
Volunteers at mid-service and COS.
• PCMO Performance Evaluation: Provides observation and feedback to
OHS and the CD on PCMO performance. Provides annual and mid-
year performance evaluations for the PCMO in their areas of
responsibility.
• Travel Schedules: In consultation with CDs and PCMOs
determines schedule for periodic visits within the sub-region.
• Establish Relationships with Embassy Health Unit: Works with the
Embassy Health Unit and State Department Regional Medical Officers as
appropriate to expedite the delivery of medical care to Volunteers in those
countries where the Post and the Embassy have an Implementing
Agreement under a State Department – Peace Corps Memorandum of
Agreement.
• Senior Staff Member: Participates as a senior member of the Country
staff at the home post and, when appropriate, at sub-regional posts;
works with the CD and PCMOs to manage or mediate conflict that may
affect the health program. Advises country staffs on local public health
issues and assists in the formulation and implementation of country
specific health policies. Advises posts on budget and fiscal issues as
they pertain to local health care.
• Medevac and Medical Accompaniment: Assists PCMOs with
medevacs. In consultation with PCMOs and OHS, determines
appropriate accompaniment and, when necessary, accompanies
Volunteers who require medevac to a regional medical evacuation site
or to the United States. Advises OHS on all aspects of the medical
status of the evacuated Volunteer and, when appropriate, shares such
information with the country staff and the Africa Region.
• OHS Representation: Represents OHS and Volunteer Health System
policies and procedures in the sub-region. When necessary, provides
liaison between the country staff and OHS.

 Conducts new country entry assessments: Serves as the OHS


representative on new country entries and provides written reports and
feedback on health resources.

8.2 Management of Regional Medical Evacuation Site

Oversees care provided to Volunteers medically evacuated to a


regional medical evacuation site if such a site exists as the RMO’s
home post. Specifically, the RMO:

• Develops regional medevac procedures for health unit staff and


referral providers.
• Refers Volunteers/Trainees to providers and medical facilities, as needed.

Office of Health Services September 2015 Page 11


TG 110
Overseas Staff

• Acts as the primary liaison between the Volunteer and local providers.
• Monitors care provided by local consultant physicians and other providers.
• Participates in the clinical management of PCVs.
• Communicates with referring post/PCMO.

8.3 Headquarters Liaison

• Regional Liaison: Maintains active communication with the Region,


reporting on all relevant health and safety matters, as well as other
administrative matters.
• Periodic Reporting: Reports quarterly to the OHS Chief of Clinical
Programs on activities, country visits, and observations on the health
programs in the sub-region. The RMO should keep CDs, PCMOs, and
OHS field support informed regarding specific findings and
recommendations from country visits.

9. SUPERVISION AND PERFORMANCE EVALUATION

9.1 Performance Evaluation of PCMOs

TG 112 “PCMO Performance Evaluation Program” describes the PCMO


performance evaluation program.

9.2 Performance Evaluation of RMOs

The RMO is supervised by the Associate Director of Volunteer Support


(AD/OHS or designee) with the Chief of Clinical Programs providing
clinical and programmatic oversight. The Chief of Clinical Programs
provides performance feedback and discusses a work plan with each RMO
on a quarterly basis. The Chief of Clinical Programs is responsible for the
annual RMO performance evaluation.

9.3 Performance Evaluation of the Medical Assistants

The performance evaluation is the responsibility of the CD or designee with input


provided by the PCMO.

9.4 Performance Evaluation of the Medical Secretary

The performance evaluation is the responsibility of the CD or designee with input provided
by the PCMO.

Office of Health Services September 2015 Page 12


TG 110 Attachment A

Peace Corps
Office of Health Services

MEDICAL ASSISTANT STATEMENT OF WORK

Position Function
The Medical Assistant (MA) performs a variety of clinical and administrative duties in support of the health unit. The
MA reports to the Country Director (CD) for administrative issues and works under the direction of the Peace Corps Medical
Officer (PCMO).
The MA is responsible for providing administrative support and, to the extent credentialed, clinical support, including
but not limited to; working as the health unit receptionist, actively assisting the PCMO in clinical procedures (*),
screening phone calls, taking messages, maintaining records of all international phone calls and faxes, coordinating
requests, medical appointments, distribution of medicines to PCVs (includes Peace Corps Trainees and Response
Volunteers) under PCMO oversight, and other clerical and administrative functions in support of the PCMO(s).

(*) Clinical duties will be performed as approved by the Medical Director/Chief of Clinical Programs, Volunteer
Support, with clinical oversight by the PCMO.

M AJOR DUTIES AND RESPONSIBILITIES


Support to the Health Unit

The MA coordinates responsibilities directly with the PCMO. Must adhere to confidentiality regarding PCVs medical issues
and possess excellent interpersonal skills .

I. Clinical Support
◆ Serves as chaperone.
◆ Responsible for sterilization of equipment.
◆ Responsible for follow up on results and consultation forms from medical service providers. Ensure this
information is relayed to the PCMO for review.
◆ Conducts follow up with laboratories when results are not received. Files all results in corresponding medical
charts when requested by the PCMOs. Coordinates with support staff to retrieve PCV laboratory results and
delivers PCV laboratory samples to ensure smooth processing of required tests.
◆ Performs clinical privileges as approved by the Medical Director/Chief of Clinical Programs

II. Administrative Support


◆ Screens office phone calls and takes messages when PCMO is unavailable.
◆ Places and returns telephone calls in the health unit, including scheduling, modifying, and canceling
appointments in coordination with PCVs, PCMO and other personnel, such as clinicians and laboratories.
◆ Drafts correspondence such as letters, memos, fax covers, etc. at the request of the clinical staff to PCVs,
laboratories, hospitals, etc.
◆ Routes incoming correspondence to PCMO, stamps and files routine correspondence.
◆ Prepares mailings, including laboratory samples and medical supplies to be sent to PCVs, training sites
and other destinations and forwards them to the appropriate administrative staff for mailing by courier or ground
transportation.
◆ Responsible for photocopying for the health unit.
◆ Responsible for requesting office supplies and materials for use at the health unit.
◆ Regularly updates the list of medical facilities and medical service providers under the instruction and oversight by PCMO.
◆ Assists PCMO in reviewing the PCV handbook in the areas corresponding to medical information given to
PCVs during Pre-Service Training (PST). Updates medical facilities and medical providers’ addresses, contact
information, and any other information required in this Handbook.

December 2015 1
TG 110 Attachment A
◆ Manages the medical library in the health unit. Maintains a detailed list of all books and media materials
such as CDs, DVDs, etc.
◆ Responsible for the reception, registration, and filing of all medical bills submitted by PCVs and local
medical service providers. Submits bills to PCMO for approval, verifying name of Volunteer, date of services
rendered, and that services were requested by PCMO.

III. Medical Supply Duties


◆ Ensures an adequate supply of disposable materials, maintains inventory within the medical unit, and keeps PCMO
informed.
◆ Responsible for updating medical inventory when medication/supplies are delivered:
 Routinely informs the Medical Supply Inventory Control Clerk (MSICC)/General Services
Manager (GSM) of any updates or modifications to the medical supply inventory in order to
maintain the Medical Inventory Workbook.
 Keeps an accurate control of the expiration dates of all medicines and alerts the PCMO of
upcoming expired medications.
 Upon receipt of ordered medicines, medical kits, and vaccines by Acceptance Point Clerk (APC)
ensures their transfer to the health unit by the APC.
 Responsible for organization and re-shelving.
◆ Drafts and prepares orders for supplies based on needs, historical data, and inventory availability. Collaborates
with the PCMO to order medical supplies from PC/HQ.
◆ Prints completed form and files with all completed PL 2006 forms according to fiscal year. Assists medical staff
in the monitoring of the medical supplies budget. Files a copy of each transfer form from APC to the health unit in
accordance with the corresponding order.

IV. . Other Duties


◆ Attends staff meetings, in-service trainings, and retreats when indicated.
◆ Understands and complies with Peace Corps safety and security policies and procedures.
◆ Complies with Peace Corps code of ethics.
◆ Files all documents produced by the position in accordance with the Peace Corps rules and regulations.
◆ Performs other assignments considered as necessary by the supervisor.

QUALIFICATIONS REQUIRED FOR EFFECTIVE P ERFORMANCE


a. (1) Successful completion of a nursing school (technical/university degree), general medical school, medical
assistant program, and valid registered clinical licensure/diploma or,
(2) Applicable knowledge and experience obtained through on-the-job training or under the direct guidance of a
provider (supporting documentation must be submitted).
b. Two years progressively responsible related experience with knowledge of administrative medical duties
related to health services. Clerical and secretarial experience desirable.
c. English fluency required.
d. Basic knowledge of administration of health units/facilities, including procurement of medical supplies and
inventory control.
e. Knowledge of Microsoft Office programs (Word, Power Point, Access, Outlook, and Excel).

December 2015 2
TG 110, Attachment B

Clinical Privileges for Medical Assistants

Name:
Please Print Your Name and Credentials Country

CLINICAL PRIVILEGES REQUESTED


These clinical privileges are granted at the discretion of the PCMO, the Director of Management and
Operations/Country Director, with clinical oversight by the PCMO.

QUALIFICATIONS FOR CLINICAL PRIVILEGES


To be eligible for core clinical privileges, the applicant must meet the following qualifications:
 Successful completion of a nursing school, medical school, or medical assistant program and valid clinical
licensure/diploma, or
 Applicable knowledge and experience obtained through on-the-job-training or under the direct guidance of a
provider (supporting documentation must be submitted).

CLINICAL CORE PRIVILEGES

Core Clinical Privileges – Privileges to perform duties that fall within the typical scope of a Medical Assistant (MA).

Clinical privileges that fall within the typical scope of*These privileges will be granted pending
MA demonstration of competency under the direct order
and approval of the PCMO
 Initiate life support when necessary (BLS) Peripheral venipuncture
 Assist with maintaining an adult immunization Gross vision check with Snellen Eye chart
program PPD test placement
 Assist in the filing and management of current, Stool for occult blood testing
complete clinical records
Urine dipstick testing
 Adhere to Peace Corps Medical Technical Guidelines
Thick and thin malaria smear preparation
 Accompany PCVs/Ts to medical appointments
 Assist in providing health education to Office testing of HIV, strep, mono, pregnancy using
Trainees/Volunteers commercial kits
 Measure height, weight, vital signs, and Pulse oximeter and peak flow meter readings
record chief complaints ECG lead placement
 Serve as a chaperone Glucose testing (fingerstick)
 Assist with office procedures Administer vaccines

February 2013 Page 1 of 2


Peace Corps Office of Health Services
Medical Assistant Clinical Privileges

ACKNOWLEDGEMENT

I have requested only those clinical privileges for which, by education, training, current experience, and
demonstrated performance, I am qualified to function as a Medical Assistant.

I understand that in conducting any clinical privileges granted, I am constrained by the Peace Corps Office of Health
Services policies and rules.

Applicant Signature:
Please Sign Your Name Date

PCMO Signature:
Please Sign Your Name Date

CLINICAL SERVICE RECOMMENDATION


Core Clinical Privileges
I have reviewed the requested clinical privileges and supporting documentation for the above named medical
assistant and recommend action on the privileges as noted below:

Provisional approval pending proof of competency under the supervision and observation of the PCMO

Signature Date
Chair, Credentialing Committee


Approved

Signature Date
Chair, Credentialing Committee


Denied

Signature Date
Chair, Credentialing Committee

Comments

February 2013 Page 2 of 2


Peace Corps/Office of Health Services
MEDICAL ASSISTANT SKILLS CHECKLIST

INSTRUCTIONS
Please check the level of experience and expertise you have in each skill category, using the following scale:
#0= Not #1= Familiar with #2= Competent and #3= Very competent: #4= Competency
Applicable procedure but will usually familiar with procedure: I have at least 12 months Confirmed by
(N/A) or almost always require I can perform this experience and can perform PCMO
some assistance. procedure with this procedure with (initials required
excellence, usually excellence and without after observation)
without assistance. assistance.

CLINICAL SKILLS 0 1 2 3 4
Basic Office Skills/Procedures
Basic Life Support (BLS)
Chaperone
Aseptic Technique
Measure height, weight, vital signs, record chief
complaints
Wound care and dressing change
Filing/managing medical record
Injections
Intramuscular
Intradermal
Subcutaneous
PPD test placement
Specimen Collection
Stool
Capillary Blood
Malaria Smears (thick and thin)
Urine
Throat Swab
Peripheral venipuncture
Wound swab Collection
Administer Vaccines
Peace Corps Office of Health Services
Medical Assistant Skills Checklist

In Office Testing (Point of Care/Commercial


Tests)
Rapid Strep
HIV
Mono
Stool for Occult Blood testing
Glucose testing (fingerstick)
Pregnancy (urine using commercial kits)
Urine dipstick
Health Screening
ECG lead placement
Gross vision check tests with Snellen or equivalent
Hearing Screening
Peak Flow Meter Readings

Pulse Oximetry Readings

Certification:
I hereby certify all statements and claims as true and that any misrepresentation of the facts on this
skills checklist is sufficient cause for dismissal at any time without prior notice.

Medical Assistant Full Name (print) Date

Medical Assistant Signature

Reviewed by (PCMO’s Signature) Date

February 2013
Peace Corps/Office of Volunteer Support
Statement of Work

MEDICAL SECRETARY

PositionFunction

This position performs administrative duties in support of the health unit. The Medical Secretary (MS)
reports to the Country Director (CD) for administrative issues and works under the guidance of the Peace
Corps Medical Officer (PCMO).
He/she is responsible for providing administrative support, including but not limited to; working as
the health unit receptionist, screening all phone calls, taking messages, maintaining records of all
international phone calls and faxes, coordinating requests, medic al appointments, and other cleric al and
administrative functions in support of the PCMO(s).

MAJOR DUTIES AND RESPONSIBILITIES

SUPPORT TO THE HEALTH UNIT


The Medical Secretary coordinates responsibilities directly with the PCMO. Must adhere to
confidentiality regarding PCVs medic al issues and possess excellent interpersonal and administrative
skills.

I. Administrative Support
◆ Screens all phone calls and takes messages when PCMO is unavailable.
◆ Places and returns telephone calls in the health unit, including scheduling, modifying and
canceling appointments in coordination with PCVs, PCMO and other personnel, such as
clinics consultants and laboratories.
◆ Drafts correspondence such as letters, memos, fax covers, etc. at the request of the clinical staff to PCVs,
laboratories, hospitals, etc.
◆ Routes incoming correspondence to PCMO, stamps and files routine correspondence.
◆ Prepares envelopes and packages, including laboratory samples and medical supplies to be sent
to PCVs, training sites and other destinations and forwards them to the appropriate
administrative staff for mailing by courier or ground transportation.
◆ Responsible for photocopying health forms, medical presentation materials and other related
documents.
◆ Responsible for requesting office supplies and materials for use at the health unit.
◆ Updates regularly the list of medical facilities and medical service providers under the
instruction and oversight by PCMO.
◆ Assists PCMO in reviewing the PCV handbook in the areas corresponding to medic al
information given to PCVs during Pre-Service Training (PST). Updates medical facilities and
medical providers’ addresses, contact information and any other information required in this
handbook.
◆ Manages the medical library in the health unit. Keeps a detailed list of all books and media
materials such as CDs, DVDs, etc.

Page 1 of 2
December 2015
◆ Responsible for the reception and registration of all medical bills submitted by PCVs and local
medical service providers. Submits bills to PCMO for approval, verifying name of volunteer, date of
services rendered and that services were requested by PCMO.
◆ Keeps updated files of all medical bills presented by PCVs and others.

II. Medical Supply Duties


◆ Ensures an adequate supply of disposable materials, maintains internal medical inventory,
and keeps PCMO informed.
◆ Responsible for updating internal medical inventory system (as determined by the PCMO)
when medication/supplies are delivered.
 Provides documentation to the Medical Supply Inventory Control Clerk
(MSICC) on receiving, dispensing, and disposing of required inventory
items
 Keeps an accurate control of the expiration dates of all medicines.
 Responsible for organization and re-shelving.
◆ Drafts and prepares orders for medical supplies based on PCMO guidance on needs, historical data,
and inventory availability. Works with the PCMO to order medic al supplies from PC/HQ.
◆ Prints completed form and files with all completed PL 2006 forms according to fiscal year.
Assists medic al staff in the monitoring of the medic al supplies budget. Files a copy of each
transfer form from APC to the health unit in accordance with the corresponding order.

III. Other Duties


◆ Attends staff meetings, in-service trainings, and retreats when indicated.
◆ Understands and complies with Peace Corps safety and security policies and procedures.
◆ Complies with Peace Corps code of ethics, privacy and confidentiality policies
◆ Files all documents produced by the position in accordance with the Peace Corps rules and
regulations.
◆ Performs other assignments considered as necessary by the supervisor.

QUALIFICATIONS REQUIRED FOR EFFECTIVE PERFORMANCE


a. Two years related experience with clerical and/or secretarial knowledge of
administrative medical duties.
b. English fluency required.
c. Knowledge of Microsoft Office programs (Word, Power Point, Access, and Excel).
d. Knowledge of medical terminology desirable.

Page 2 of 2
December 2015
Peace Corps
Technical Guideline 112
Peace Corps Medical Officer Performance Evaluation

1. PURPOSE

To provide guidance to Peace Corps Medical Officers (PCMOs), country and regional staff
on the PCMO performance evaluation process.

2. BACKGROUND

The PCMO performance evaluation program is consistent with the agency’s personnel
standard of required annual performance appraisals and is a key component of the Volunteer
Health System's ongoing quality improvement activities. The performance evaluation
program was developed with input from PCMOs, Regional Medical Officers (RMOs),
Country Directors (CDs) and the Office of Health Services (OHS)

The performance evaluation form (ATTACHMENT A) reflects the roles and responsibilities
of PCMOs as outlined in Technical Guideline (TG) 110 “Roles and Responsibilities.” The
evaluation process reflects the overall responsibility of the CD, RMO, and OHS for PCMO
performance.

3. PURPOSE OF THE PERFORMANCE EVALUATION

The purpose of the PCMO performance evaluation is to:


 Maintain high quality of care through systematic assessment of individual PCMO
competencies and expertise
 Provide a basis for identification of specific PCMO training interventions
 Identify and analyze quality-of-care issues
 Provide feedback to PCMOs to enhance professional satisfaction and to help mitigate the
effects of professional isolation commonly experienced in Peace Corps settings
 Provide consistency in the assessment of PCMO performance
 Provide a basis for decisions about contract renewal

Annual evaluation will be performed on PCMOs who work more than 20 hours/week and
serve as PCMO for longer than 6 months.

Office of Health Services December 2014 Page 1


TG 112
PCMO Performance Evaluation

4. PROFESSIONAL OVERSIGHT

The performance evaluation process reflects the shared authority and professional oversight
responsibilities for PCMO performance amongst the Office of Health Services, the Country
Director and the Regional Medical Officer (if applicable).

CD responsibilities include:
 Provides administrative and programmatic supervision of the PCMO
 Participates with OHS on PCMO hiring
 Collaborates with OHS and the region on renewing, extending, or terminating PCMO
contracts
RMO responsibilities include:
 Provide observations and feedback to OHS and the CD on PCMO performance

 Provide annual performance evaluations for the PCMOs in their area of responsibility

OHS responsibilities include:


 Provides professional and clinical oversight of PCMOs and provides consultation to the
CD and if applicable, the RMO on issues related to clinical performance
 Administration of the PCMO contract and the authority to hire, renew, extend, or
terminate the contract (see Peace Corps Manual Sections (MS) 743 “Personal Services
Contracts with Host Country Residents”; MS 743a “Personal Services Contracts with
Host Country Residents-After Kate Puzey Act”; MS 744 “Personal Services Contracts
with Non-Host Country Residents”; and MS 744a “Personal Services Contracts with
Non-Host Country Residents -After Kate Puzey Act.

 Participates with the CD on PCMO hiring:

 The Associate Director of OHS is the selecting official for all PCMOs contracted at
post (see MS 743 and 744 as described above).
 Provides the CD with a roster of qualified and ranked applicants for all U.S.
contracted PCMOs.
 Provides input to the CD and the region on renewing, extending, or terminating
PCMO contracts.

5. PCMO PERFORMANCE EVALUATION PROCESS

The evaluation process will be based upon objectives met during the previous calendar year.
The PCMO will be evaluated on his or her overall performance, which will include a self-
evaluation of professional accomplishments; the CD’s assessment of first-hand daily
interaction; and OHS assessment of healthcare performance.

Office of Health Services December 2014 Page 2


TG 112
PCMO Performance Evaluation

The CMEs, site assessments or any other face-to-face (FTF) interaction can provide the
opportunity for OHS staff to obtain first-hand experience of the PCMOs performance. This
information can be factored into the official evaluation during the formal evaluation review
period of January 1-March 30th.

The process is outlined below:


 All PCMOs, CDs and involved OHS/RMO staff will be notified simultaneously prior to
the evaluation period.
 The evaluation period will be the previous calendar year (January 1 st -December 31st ).
 PCMOs and CDs will have an assigned evaluator for all communications.
 The process is as follows:

 All participants in the evaluation process (OHS/RMO, CD and PCMOs) will receive
a copy of TG 112, the evaluation tool (attachment A) and a list of assigned
OHS/RMO evaluators.
 ALL EVALUATIONS MUST BE COMPLETED ON THE WRITABLE PDF
FORM. FAXED OR SCANNED COPIES WILL NOT BE ACCEPTED.
 It is the responsibility of all evaluators to schedule time to discuss the evaluation face-
to-face or other communication method agreed upon with the PCMO. This is a
requirement.
 The evaluation can be completed in any order agreed upon by the PCMO, CD and
OHS/RMO evaluator.
 If there are questions/concerns with what is written in either section, it is the
responsibility of the person with the question/concern to contact the appropriate
person to discuss.
 Evaluations may be updated based upon the exchange of sections. The evaluator in
OHS/RMO will be responsible for incorporating the updates.
 The OHS/RMO evaluator is responsible for ensuring completion of all sections and
distribution to CD and PCMO before returning to the Quality Improvement (QI)
department for review and filing. Evaluators can copy the QI department on the email
when completed evaluations are distributed.
 All evaluations must be signed by PCMO, CD and OHS/RMO. Typed signatures are
acceptable with an email.

A copy of the PCMO performance evaluation will be maintained in the PCMO’s personnel
file at post. The completed original evaluation is kept in the PCMO’s personnel file in OHS.
All information related to performance evaluations is considered confidentia l.

6. MID-YEAR REVIEW
A mid-year review is the optimal time to check in with the PCMO regarding movement
towards attaining annual goals. This can be conducted between the PCMO and the RMO or
CD.

7. DEFINITIONS

Exceeds Requirements
A rating of exceeds requirements indicates exceptional and extraordinary performance. At
this level, performance is clearly unique and the PCMO has excelled due to effort, expertise,

Office of Health Services December 2014 Page 3


TG 112
PCMO Performance Evaluation

and sacrifice. Organizational goals have been achieved that would not have been otherwise.
The PCMO exerts a major positive influence on management practices, operating procedures
and/or program implementation. Extraordinary performance should be described in the
comments for each section.

Meets Requirements
A rating of meets requirements indicates good, sound, consistent performance at an
acceptable level. All critical activities are generally completed in a timely manner and
supervisor is kept informed of work issues, alterations and status. The PCMO successfully
carries out regular duties, plans and performs work according to priorities and schedules.

Needs Improvement
A rating of needs improvement indicates performance that falls below acceptable level. A
rating of needs improvement warrants follow up action by the evaluator to determine the
basis for the rating, its underlying cause, and possible OHS, RMO and/or CD intervention.
The specific problem or concern must be described in the comments section.

8. PROTECTION OF INFORMATION
For American citizens, performance evaluation information is protected by the Privacy Act,
and may be disclosed only to Peace Corps staff with a need to know the information to
perform their official duties.
Performance evaluation information, including performance evaluation forms, for all PCMOs
should, as a matter of practice, be handled in a manner consistent with the protection of
personnel or sensitive information.

9. KEY PARTICIPANTS
The responsibilities of key participants in the PCMO Evaluation Program are as follows:
Chief of Quality Improvement
The Chief of Quality Improvement (QI) is the overall manager of the PCMO performance
evaluation program. In that role, the Chief of QI is responsible for making refinements to the
evaluation program, and maintaining close liaison with medical advisors, Field Support
manager/staff, RMOs, PCMO program coordinator, and CDs to encourage their full
participation in, and support of, the program.

Peace Corps Medical Officers


PCMOs participate in the evaluation program: (1) by bringing their accomplishments to the
attention of evaluators through performance discussions; and (2) by completing PART III
“PCMO Self-Evaluation”.

Country Directors
Country Directors conduct discussions with PCMOs about performance expectations in
relation to non-clinical issues. CDs also inform OHS/ RMOs (if applicable) on an on-going
basis on PCMO performance matters.

Office of Health Services December 2014 Page 4


TG 112
PCMO Performance Evaluation

Regional Medical Officers


RMOs are responsible for conducting PCMO performance evaluations in their respective
countries.

Office of Health Services

The OHS staff members will conduct performance evaluations for PCMOs in areas not
covered by a RMO.

Credentialing Staff

OHS credentialing staff will maintain the database to ensure that annual performance
evaluations are completed and filed in the credential folders for all PCMOs.

Office of Health Services December 2014 Page 5


Peace Corps
Technical Guideline 113
Clinical Documentation Standards

1. PURPOSE

The purpose of this guideline is to establish clinical documentation standards which


assure accuracy, timeliness, and quality in the recording of clinical data and the provision
of care. These standards assist in establishing criteria for review of clinical documentation,
identification of provider educational needs, and support the performance evaluation
process.

2. BACKGROUND

Clinical documentation ensures that a complete, accurate, clear, consistent, and secure
record of health care is created. It substantiates decisions and management plans; supports
continuity of care; facilitates proactive and reactive risk management strategies, and
provides useful information for quality improvement and data gathering for research
purposes. Medical records are viewed as foundations of professional healthcare which
makes crucial the evaluation processes.

3. PROCESS

PCMEDICS is the Peace Corps electronic medical record. Most of the necessary
documentation forms/tools are located within PCMEDICS. The forms assist the provider to
meet documentation standards and provide a standardized template to facilitate the clinical
management of the patient.

To ensure standard documentation practices and support appropriate care, the following
standards are implemented:

A. ROUTINE ENCOUNTER DOCUMENTATION TOOLS


1) Summary Page is the screen or “page” that opens when a Volunteer’s
name is selected and his/her PCMEDICS record is opened. The page
contains numerous informational data fields. The PCMO is required to
review medications, allergies, and active medical problems with each
Volunteer during every encounter and document updates to the
corresponding fields as necessary.
2) New Encounter Form is located in PCMEDICS in the Encounter History
dropdown box in the Volunteer name banner. This form is used to document
the Consultation/Brief Description/Reason for Visit, Visit Category, Record
Sensitivity, Facility, Date of Service, and Issues (Injuries/Medical/Allergies).
Completing/Saving this form is required in order to open the PEF and
document an encounter.
3) Vital Signs Form is located in the Clinical Tab. Vital Signs including blood
pressure must be taken at every encounter.
a. LMP must be documented for all female Volunteers in the
appropriate field.

b. If the PCMO is not seeing the Volunteer face to face, temperature


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Technical Guideline 113
Clinical Documentation Standards

should be taken by the Volunteer, conveyed to the PCMO and


documented by the PCMO.
4) Patient Encounter Form (PEF) is the primary documentation form for the
majority of patient encounters. It is located in PCMEDICS under the Clinical
Tab. The PEF is used to document the following Visit Categories: Office Visit,
Telephone Consult, E-mail/Text/Portal Communication, Supply Refill,
Immunization Only, Lab/Diagnostics Only, Local Consultant Visit, Training Event
Consultation, Mental Consultation (HQ), Hospitalization, Medical
Accompaniment, Health Unit Observation, Initial Clinical Intake Interview,
Interim Health Evaluation, 72 Hour COS Checkout. The PEF should also be used
for Sexual Assault Follow-Up visits in conjunction with the Sexual Assault Follow
Up form. The PEF should not be used to document other Sexual Assault Visit
Categories.

B. SEXUAL ASSAULT DOCUMENTATION TOOLS


In addition to the Summary Page, New Encounter Form, and Vital Signs Form
specialized forms are used to document Sexual Assault Encounters. These forms are
located under the Sensitive Tab in PCMEDICS.
1) Volunteer Reporting Preference Statement (VRPS), also known as the
Volunteer Preference Statement (VPS) is located in MS 243 “Procedures
for Responding to Sexual Assault”, Annex II. A prior version is also
located within PCMEDICS, however, because Volunteers are not always
available to sign the document at the time it is explained to them,
complete the paper form of the document, obtain Volunteer signature,
and then scan the document into the SA Folder in PCMEDICS. This form
must be completed for all Volunteers who are Sexually Assaulted.
2) Sexual Assault Clinical Exam Authorization is found in PCMEDICS,
however, at this time, use the paper form located in TG540, Attachment
C, obtain the Volunteer signature, and then scan the document into the
SA Folder in PCMEDICS. This form must be filled out for all Volunteers
who require or desire a physical exam.
3) Female and Male Sexual Assault Exam Forms are found in PCMEDICS under
the Sensitive Tab. This form must be used to document the Initial Evaluation
for ALL Sexually Assaulted Volunteers. It may also be used if the Initial
Evaluation is split between two separate encounters. Some Volunteers may
want to have the physical exam done during one visit and the history taken
during a second encounter. Use one form for the first encounter and open a
second form for the second encounter, annotating on the form in the VS Notes
box that it is a continuation of the Initial Evaluation. Ensure all unused blanks
are filled out or populated with N/A if not applicable.
a. Tabs A-F must be completed to the fullest extent possible as
appropriate for the history of the assault.
b. Sections E and F must be completed on all Volunteers who have
been Sexually Assaulted.
c. The Summary Note at the end of Section I must be completed on
all Initial Evaluation encounters.
d. If the Volunteer chooses a Restricted Report, the Assessment in
the Summary Note is not selected via SNOMED but is
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Technical Guideline 113
Clinical Documentation Standards

documented.
e. If the Volunteer chooses a Standard Report the Assessment in the
Summary Note is selected via SNOMED and is therefore
automatically placed on the Problem List located on the Summary
Page.
4) Sexual Assault Standing Orders and Treatment Plan and Sexual Assault
Discharge Instructions Forms are located within PCMEDICS under the Sensitive
Tab. Both of these forms are completed during the Initial Evaluation. Orders
are automatically populated onto the Discharge Instructions. Ensure all unused
blanks are filled out or populated with N/A if not applicable. The Volunteer
must sign the Discharge Instructions and is to be given a copy of the form so
that he/she can reference it for information and the follow-up appointment
schedule. The signed Discharge Instruction form is then scanned into the SA
Folder in PCMEDICS.
5) Sexual Assault Follow-Up Form is located at the Sensitive Tab in PCMEDICS.
This form is used at every Sexual Assault Follow-Up appointment or telephone
call. The form is a Mental Health Evaluation and STD/ASD Screening, identical
to Section E and F of the Sexual Assault Exam Form. In addition to using the
Sexual Assault Follow-Up Form for follow-up appointments or contacts, the
PCMO must also open a PEF and use it to complete the encounter including
other pertinent history elements, a physical exam as necessary, and required
elements of assessment, medications, labs, and patient education.

C. CLINICAL DOCUMENTATION STANDARDS— ROUTINE ENCOUNTERS


All Routine Patient Encounters must include the following elements:
1) A problem list is in use, completed appropriately and current
2) Medications are reconciled/updated
3) Allergies, including reactions (Document NKA or list Allergy and reaction)
4) Chief complaint is identified
5) (S) Encounter contains problem-focused medical history (HPI)
6) (S) Volunteer safety is documented
7) (O) Complete vital signs for each visit (including LMP)
Note: Phone consult must have temperature and/or assess fever
8) (O) Problem focused physical exam
9) (A) Assessments are consistent with findings
10) (P) Plans of action/treatment are consistent with assessment; see
following:
9A. Appropriate consultation with OHS/RMO/In- Country Consultants
9B. Diagnostic and Lab testing is appropriate to assessment
9C. Patient Education documented
9D. Medications are appropriate to assessment and prescribed correctly
9E. Patient follow-up documented and appropriate
11) Unresolved problems from previous visits are addressed
12) Three patient identifiers on each scanned page (name, DOB, gender or
SSN/ID)
13) Consultant reports and/or diagnostic testing results are reviewed,
translated, initialed, dated and scanned into PCMEDICS
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Technical Guideline 113
Clinical Documentation Standards

14) Continuity and coordination of care between PCMO and consultants


15) Care is medically appropriate
16) Provider signature and date within 72 hours

D. CLINICAL DOCUMENTATION STANDARDS—SEXUAL ASSAULT


ALL Sexual Assault, Aggravated Sexual Assault, and Rape patient encounters must
include the following elements:
1) The problem list is complete and updated appropriately per Volunteer
Preference Statement
2) Medications are reconciled/updated
3) Allergies, including reactions (Document NKA or list Allergy and reaction)
4) Sexual Assault Encounter Form (SAEF) is used for documentation of the
encounter & signed by PCMO
5) (S) Sexual Assault history (HPI) is completed (SAEF, Section C, boxes 1-3 and
others completed as indicated)
6) (S) PCV safety is documented
7) (O) Vital Signs obtained and LMP documented (SAEF Section B, box 1)
8) (O) Mental Health Status is documented (Sections E & F completed)
9) (O) Problem focused physical exam documented (Sections G-I as appropriate)
10) (A) Assessments are consistent with findings (Section L Summary note)
11) (P) Sexual Assault Standing Orders & Treatment Plan are initiated (button @
top right of form) & signed by PCMO
10A. Appropriate consultation and follow-up with OHS/RMO/In-Country
Consultants
10B. Diagnostic and Lab testing is appropriate for the assessment (Standing
Orders)
10C. Sexual Assault Discharge Information /Instructions are implemented,
signed by Volunteer & PCMO and scanned into PCMEDICS
10D. Medications are appropriate for the assessment and prescribed correctly
(Standing Orders)
12) Three patient identifiers on each scanned page (name, DOB, gender or SSN/ID)
13) Consultant reports & test results are reviewed, translated, initialed, dated and
scanned into PCMEDICS
14) Volunteer Preference Statement is signed by Volunteer & PCMO and scanned
into PCMEDICS
15) Sexual Assault Clinical Exam Authorization is completed and signed by
Volunteer & PCMO and scanned into PCMEDICS
16) Care is medically appropriate
17) Sexual Assault Forensic Exam (SAFE) if performed is documented on medical
forms in Sexual Assault Kit (SAK) per TG 542

E. DOCUMENTATION REVIEW
1) Routine Encounters
a. During each quarter of the fiscal year, the Quality Improvement Unit
will review the PCMEDICS documentation of 10 Volunteer encounters
completed by each PCMO.
b. Quality Improvement Nurses will select encounters for review from

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Technical Guideline 113
Clinical Documentation Standards

the PCMO list of completed encounters during the specified


scheduled review quarter.
c. Selected encounters will represent and reflect clinical management.
Encounters documenting medication pick-up, COS physical forms, IST
or mid-service evaluations or immunization updates will not be
selected for review.
d. If available within the review period, at least one encounter
documenting each the following types of illness will be reviewed:
Gastrointestinal
Respiratory
Mental Health
Sexual Assault
e. Chart reviews are an important element in PCMO annual
performance review and scores will be utilized in this process.
2) Aggravated Sexual Assault and Rape Encounters
a. SNOMED Codes are not used to document the
Assessment/Diagnosis on Restricted Report Sexual Assaults;
therefore, for all Aggravated Assault and Rape encounters
PCMOs must send the Volunteer’s name and DOB to the Quality
Improvement Unit via SFTP e-mail with the subject line: “SA
(country) for Review”.
b. The Quality Improvement SARRRP Nurse will review the
encounter(s) as they are reported by the PCMO.

F. SCORING STANDARD
95-100%: Excellent (E)

90-94%: Meets Standards (MS)

Less than 90% does not meet standards: Needs Improvement (NI)

G. SCORING GUIDELINES AND INTERVENTIONS


1) Charts will be reviewed by clinicians who are knowledgeable in Peace Corps
documentation standards and current clinical practice standards.
2) PCMOs will receive appropriate and timely feedback.
3) PCMOs who consistently score 95% and above for a period of one year
(four submissions) will be assigned a two times per year submission
schedule (this rule does not pertain to Aggravated Sexual Assault and/or
Rape Charts).
4) All Aggravated Assault and Rape charts must be reviewed. PCMOs will notify
Quality Improvement Unit via SFTP e-mail message when Aggravated Sexual
Assault and/or Rape charts are ready for review.
5) If at any time the PCMO review scores fall below 90%, OHS reserves the
right to place PCMO on remediation
6) Reviewer must notify OHS Clinical Director when a PCMO is
placed on remediation.

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Technical Guideline 113
Clinical Documentation Standards

H. MONITORING, EVALUATION, AND REPORTING


1) The Quality Improvement Unit will present QI quarterly and annual reports
to the Quality Council regarding the status of clinical oversight/chart
reviews and interventions; these reports will include a separate section on
the results of the aggravated sexual assault and rape cases.
2) The Quality Improvement Unit will submit the results of the clinical
oversight/chart reviews and interventions regarding aggravated sexual
assault and rape cases to the Sexual Assault Risk Reduction and Response
Program (SARRRP) on a quarterly and annual schedule.

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Technical Guideline 113
Clinical Documentation Standards

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Clinical Documentation Standards Criteria TG 113 Attachment A
Physician & Mid-Level PCMO Review Form

Country: PCMO Name: Reviewer Name: Date: _____________

Clinical Documentation Standards Criteria Score 1 2 3 4 5 6 7 8 9 10


Patient Initials
1. A problem list is in use, completed appropriately and current 3
2. Medications are reconciled/updated 5
3. Allergies, including reactions 4
Note: Document NKA or list Allergy and reaction
4. (S) Chief complaint is identified 3
5. (S) Encounter contains problem-focused medical history (HPI) 5
6. (O) Complete vital signs for each visit (including LMP) 4
Note: Phone consult must have temperature and/or assess fever
7. (O) Problem focused physical exam 5
8. (A) Assessments are consistent with findings 5
9. (P) Plans of action/treatment are consistent with assessment; see following:
9A. Appropriate consultation with OHS/RMO/In- Country Consultants 4
9B. Diagnostic and Lab testing is appropriate to assessment 4
9C. Patient Education documented 4
9D. Medications are appropriate to assessment and prescribed correctly 5
9E. Patient follow up documented and appropriate 3
10. Unresolved problems from previous visits are addressed 4
11. Three patient identifiers on each scanned page (name, DOB, gender or SSN/ID) 3
12. Consultant reports and/or diagnostic testing results are reviewed, translated, 3
initialed, dated and scanned into PCMEDICS
13. Continuity and coordination of care between PCMO and consultants 4
14. Care is medically appropriate 5
15. Provider signature and date within 72 hours 2
Total 75

TG 113 Attachment A September 2015


Clinical Documentation Standards Criteria TG 113 Attachment A
Physician & Mid-Level PCMO Review Form

Scoring Guidelines

Directions:

1. Score indicated/weighted points if criterion is met. Score zero points if criterion is not met. Do not score partial points for any criterion.
2. Reviewers have the option to request additional records to review, but must calculate scores accordingly.

Scoring: Score is based on a review standard of 10 records per individual provider per quarter. Peace Corps minimum standard is 90% compliance.

Not applicable (“N/A”) applies to any criterion that does not apply to the medical record being reviewed and must be explained in the comment section.

Step 1: Add points given for all criteria.

Step 2: Subtract the “N/A” points from the total points possible.

Step 3: Divide total points given (from Step 1) by the “adjusted” points (from Step 2), then multiply by 100 to calculate the percentage rate.

Grading: Providers will be graded on the following scale.


Excellent (E) =scores >95%
Meets Standards (MS) =scores >90-94%
Needs Attention (NA) =scores <89%
Scoring and Grading Example:
 Pt #1 70 points;
 Pt#2: 78 points;
 Pt #3: 74 points;
 Pt#4: 70 points, 2 N/A scored at 3 pts each;
 Pt#5: 74 points, 1 N/A scored at 3 pts.

Step 1: Add points given. Total = 366.

Step 2: Subtract the “N/A” points from the total points possible.

390 (Total points possible)


–9 (N/A points)
381 (“Adjusted” total points possible)

Step 3: Divide total points given by the “adjusted” points, and then multiply by 100 to calculate the percentage rate.

Total points 366


Adjusted points 381=0.961 X 100=96% Grade: E

TG 113 Attachment A September 2015


Clinical Documentation Standards Criteria TG 113 Attachment B
PCMO Review Form (Registered Nurse)

Country: PCMO Name: Reviewer Name: Date: _____________

Clinical Documentation Standards Criteria Score 1 2 3 4 5 6 7 8 9 10


Patient Initials
1. A problem list is in use, completed appropriately and current. 3
2. Medications are reconciled/updated 5
3. Allergies, including reactions 4
Note: Document NKA or list Allergy and reaction
4. (S) Chief complaint is identified 3
5. (S) Encounter contains problem-focused medical history (HPI) 5
6. (O) Complete vital signs for each visit (including LMP) 4
Note: Phone consult must have temperature and/or assess fever
7. (O) Problem focused physical exam 5
8. (A) Assessments are consistent with findings (CHAM assessment is documented) 5
9. (P) Plans of action/treatment are consistent with assessment; see following:
9A. REPORT (Appropriate consultation with OHS/RMO/MDPCMO/Consultants is 4
documented and appropriate per CHAM standards)
9B. SPECIAL CARE (Diagnostic/Lab protocols followed per CHAM standards) 4
9C. PATIENT EDUCATION (Patient education documented and appropriate per 4
CHAM standards)
9D. MEDICINE (Appropriate medication per CHAM Standards) 5
9E. RECHECK (Pt. follow up documented and appropriate per CHAM standards) 3
10. Unresolved problems from previous visits are addressed 4
11. Three patient identifiers on each scanned page (name, DOB, gender or SSN/ID) 3
12. Consultant reports and/or diagnostic testing results are reviewed, translated, 3
initialed, dated and uploaded.
13. Continuity and coordination of care between PCMO and consultants 4
14. Prescribing provider is documented (if no standing order) 5
15. Provider signature and date within 72 hours 2
Total 75

TG 113 Attachment B September 2015


Clinical Documentation Standards Criteria TG 113 Attachment B
PCMO Review Form (Registered Nurse)

Scoring Guidelines

Directions:

1. Score indicated/weighted points if criterion is met. Score zero points if criterion is not met. Do not score partial points for any criterion.
2. Reviewers have the option to request additional records to review, but must calculate scores accordingly.

Scoring: Score is based on a review standard of 10 records per individual provider per quarter. Peace Corps minimum standard is 90% compliance.

Not applicable (“N/A”) applies to any criterion that does not apply to the medical record being reviewed and must be explained in the comment section.

Step 1: Add points given for all criteria.

Step 2: Subtract the “N/A” points from the total points possible.

Step 3: Divide total points given (from Step 1) by the “adjusted” points (from Step 2), then multiply by 100 to calculate the percentage rate.

Grading: Providers will be graded on the following scale.


Excellent (E) =scores >95%
Meets Standards (MS) =scores >90-94%
Needs Attention (NA) =scores < 89%
Scoring and Grading Example:
 Pt #1 70 points;
 Pt#2: 78 points;
 Pt #3: 74 points;
 Pt#4: 70 points, 2 N/A scored at 3 pts each;
 Pt#5: 74 points, 1 N/A scored at 3 pts.

Step 1: Add points given. Total = 366.

Step 2: Subtract the “N/A” points from the total points possible.

390 (Total points possible)


–9 (N/A points)
381 (“Adjusted” total points possible)

Step 3: Divide total points given by the “adjusted” points, and then multiply by 100 to calculate the percentage rate.

Total points 366


Adjusted points 381=0.961 X 100=96% Grade: E

TG 113 Attachment B September 2015


Clinical Documentation Standards Criteria TG 113 Attachment C
Sexual Assault Documentation Review Form

Country: PCMO Name: Reviewer Name: Date: _____________

Clinical Documentation Standards Criteria Points Score

Patient Initials
1. The problem list is complete and updated per Volunteer Preference Statement (Restricted Report ≠SNOWMED code| Standard Report=SNOWMED code) 3
2. Medications are reconciled/updated 5
3. Allergies, including reactions (Document NKA or list Allergy and reaction) 4
4. Sexual Assault Encounter Form (SAEF) is used for documentation of the encounter & signed by PCMO 5
5. (S) Sexual Assault history (HPI) is completed (SAEF, Section C, boxes 1-3 and others completed as indicated) 5
6. (S) PCV safety is documented 5
7. (O) Vital Signs obtained and LMP documented (SAEF Section B, box 1) 4
8. (O) Mental Health Status is documented (Sections E & F completed) 5
9. (O) Problem focused physical exam documented (Sections G-I as appropriate) 5
10. (A) Assessments are consistent with findings (Section L Summary note) 5
11. (P) Sexual Assault Standing Orders & Treatment Plan are initiated (button @top right of form) & signed by PCMO 5
11A. Appropriate consultation and follow-up with OHS/RMO/In-Country Consultants 4
11B. Diagnostic and Lab testing is appropriate for the assessment (Standing Orders) 4
11C. Sexual Assault Discharge Information /Instructions are implemented, signed by Volunteer & PCMO and scanned into PCMEDICS 4
11D. Medications are appropriate for the assessment and prescribed correctly (Standing Orders) 5
12. Three patient identifiers on each scanned page (name, DOB, gender or SSN/ID) 3
13. Consultant reports & test results are reviewed, translated, initialed, dated and scanned into PCMEDICS 4
14. Volunteer Preference Statement is signed by Volunteer & PCMO and scanned into PCMEDICS 5
15. Sexual Assault Clinical Exam Authorization is completed and signed by Volunteer & PCMO and scanned into PCMEDICS 5
16. Care is medically appropriate 5
17. Sexual Assault Forensic Exam (SAFE) if performed is documented on medical forms in Sexual Assault Kit (SAK) per TG 542 5
Total 95
Comments:

TG 113 Attachment C December 2015


Clinical Documentation Standards Criteria TG 113 Attachment C
Sexual Assault Documentation Review Form

Scoring Guidelines

Directions:

1. Score indicated/weighted points if criterion is met. Score zero points if criterion is not met. Do not score partial points for any criterion.
2. Reviewers have the option to request additional records to review, but must calculate scores accordingly.

Scoring: Score is based on a review standard of 10 records per individual provider per quarter. Peace Corps minimum standard is 90% compliance.

Not applicable (“N/A”) applies to any criterion that does not apply to the medical record being reviewed and must be explained in the comment section.

Step 1: Add points given for all criteria.

Step 2: Subtract the “N/A” points from the total points possible.

Step 3: Divide total points given (from Step 1) by the “adjusted” points (from Step 2), then multiply by 100 to calculate the percentage rate.

Grading: Providers will be graded on the following scale.


Excellent (E) =scores >95%
Meets Standards (MS) =scores >90-94%
Needs Attention (NA) =scores <89%
Scoring and Grading Example:
 Pt #1 70 points;
 Pt#2: 78 points;
 Pt #3: 74 points;
 Pt#4: 70 points, 2 N/A scored at 3 pts each;
 Pt#5: 74 points, 1 N/A scored at 3 pts.

Step 1: Add points given. Total = 366.

Step 2: Subtract the “N/A” points from the total points possible.

390 (Total points possible)


–9 (N/A points)
381 (“Adjusted” total points possible)

Step 3: Divide total points given by the “adjusted” points, and then multiply by 100 to calculate the percentage rate.

Total points 366


Adjusted points 381=0.961 X 100=96% Grade: E

TG 113 Attachment C December 2015


PCMO Standard Chart Submission Schedule

Standard Three Month Chart Submission Schedule


10 Charts must be received by the 10th of the month listed below
Submissions are to include encounters from the previous three months

Region Submission Month


Submission 1
Africa January
EMA February
IAP March
Submission 2
Africa April
EMA May
IAP June
Submission 3
Africa July
EMA August
IAP September
Submission 4
Africa October
EMA November
IAP December

TG 113 Attachment D April 2014


Peace Corps
Technical Guideline 114

PEACE CORPS MEDICAL OFFICER SCOPE OF PRACTICE

1. PURPOSE
To define the scope of practice for Peace Corps Medical Officer (PCMO)
according to their clinical credential of registered nurse (RN), certified nurse
practitioner (NP), physician assistant (PA), and physician (MD/DO).

2. BACKGROUND
The PCMO, as delegated by the Office of Health Services (OHS), is
responsible for providing support in the establishment and management of the
in-country Volunteer Health Support Program. The PCMO acts as both a
health program manager and clinician.

Peace Corps Medical Officers provide ambulatory and emergent healthcare,


health education and training to Peace Corps Trainees and Volunteers.
Administrative duties are required to maintain the in-country health unit. In
order to provide safe and effective care to Trainees and Volunteers, the
PCMO must work within his or her scope of practice and adhere to the clinical
privileges outlined in their respective technical guidance.

3. REGISTERED NURSE (RN) SCOPE OF PRACTICE


 Provide ambulatory care by performing basic consultation, comprehensive
nursing assessment, nursing diagnosis, and SOAP-format documentation
that require the knowledge and skill obtained from a formal nursing
education program.
 Collaborate with peer PCMOs, consultants and OHS to develop and
continuously evaluate an integrated Volunteer-centered health care plan.
 Develop a strategy of nursing care to be integrated within the Volunteer-
centered health care plan that establishes nursing diagnoses, sets goals to
meet identified health care needs; prescribes nursing interventions; and
implements nursing care through the execution of independent nursing
strategies and regimens requested, ordered or prescribed by authorized
health care prescribers.
 Administer medication and treatment as prescribed by a physician,
physician assistant, dentist or advanced registered nurse practitioner and as
further authorized or limited by the U.S. Peace Corps Medical Technical
Guideline Treatment Protocols and Standing Orders for Registered Nurse
(RN) PCMOs (TG 605).
 Administer over-the counter medications and treatment in accordance
with U.S. and/or internationally recognized registered nurse rules and
standards outlined in the National Council of State Boards of Nursing
(NCSBN, 2006).
 Provide mental health counseling to Trainees and Volunteers.

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Office of Health Services October 2015 Page 1 of 3
 Promote health and prevent illness and injury by providing health
information and training to Trainees and Volunteers.
 Promote a safe and therapeutic environment through a quality
improvement (QI) program.
 Acquire and apply critical new knowledge and technologies to the practice
domain.
 Accept responsibility for knowing the legal, ethical, and professional
parameters of practice, maintain those boundaries and acknowledge when
a decision or action has not been in the best interest of a Volunteer while
taking corrective action in the Volunteer’s behalf.

4. CERTIFIED NURSE PRACTITIONER (NP) SCOPE OF PRACTICE


 Provide diagnostic, therapeutic, and preventative ambulatory healthcare
services to Volunteers (includes assessment, diagnosis and management of
acute episodic and chronic illness) under the supervision of a practicing
physician. Supervision may consist of concurrence by the Regional
Medical Officer (RMO), the Chief of Clinical Programs in the Office of
Health Services or another identified community physician.
 Perform comprehensive physical exams for close of service and health
status.
 Order, conduct, and interpret diagnostic and laboratory tests.
 Prescribe pharmacologic agents and non-pharmacologic therapies that
comply with the Medical Technical Guidelines. Serve as a medical
prescriber for RNs.
 Provide mental health counseling to Trainees and Volunteers.
 Collaborate with peer PCMOs, consultants and OHS to develop and
continuously evaluate an integrated Volunteer-centered health care plan.
 Promote health and prevent illness and injury by providing health
information and training to Trainees and Volunteers.
 Promote a safe and therapeutic environment through a QI program.
 Acquire and apply critical new knowledge and technologies to the practice
domain.
 Accept responsibility for knowing the legal, ethical, and professional
parameters of practice, maintain those boundaries and acknowledge when
a decision or action has not been in the best interest of a Volunteer while
taking corrective action in the Volunteer’s behalf.

5. PHYSICIAN ASSISTANT (PA) SCOPE OF PRACTICE


 Provide diagnostic, therapeutic, and preventative ambulatory healthcare
services to Volunteers (includes assessment, diagnosis and management of
acute episodic and chronic illness) under the supervision of a practicing
physician. Supervision may consist of concurrence by the Regional
Medical Officer (RMO), the Chief of Clinical Programs in
OHS or another identified community physician.

______________________________________________________________________________
Office of Health Services October 2015 Page 2 of 3
 Perform comprehensive physical exams for close of service and health
status.
 Order, conduct, and interpret diagnostic and laboratory tests.
 Prescribe pharmacologic agents and non-pharmacologic therapies that
comply with the Medical Technical Guidelines. Serve as a medical
prescriber for RNs.
 Provide mental health counseling to Trainees and Volunteers.
 Collaborate with peer PCMOs, consultants and OHS to develop and
continuously evaluate an integrated Volunteer-centered health care plan.
 Promote health and prevent illness and injury by providing health
information and training to Trainees and Volunteers.
 Promote a safe and therapeutic environment through a QI program.
 Acquire and apply critical new knowledge and technologies to the practice
domain.
 Accept responsibility for knowing the legal, ethical, and professional
parameters of practice, maintain those boundaries and acknowledge when
a decision or action has not been in the best interest of a Volunteer while
taking corrective action in the Volunteer’s behalf.

6. PHYSICIAN (MD/DO) SCOPE OF PRACTICE


 Provide diagnostic, therapeutic, and preventative ambulatory healthcare
services to Volunteers which includes assessment, diagnosis and
management of acute episodic and chronic illness.
 Perform comprehensive physical exams for close of service and health
status.
 Order, conduct, and interpret diagnostic and laboratory tests including, but
not limited to EKGs, x-rays, spirometry.
 Prescribe pharmacologic agents and non-pharmacologic therapies that
comply with the Medical Technical Guidelines. Serve as a medical
prescriber for RNs and advisor to NPs and PAs.
 Provide mental health counseling to Trainees and Volunteers.
 Collaborate with peer PCMOs, consultants and OHS to develop and
continuously evaluate an integrated Volunteer-centered health care plan to
include further testing, specialist referral, medication, therapy, diet or life-
style changes.
 Promote health and prevent illness and injury by providing health
information and training to Trainees and Volunteers.
 Promote a safe and therapeutic environment through a QI program.
 Acquire and apply critical new knowledge and technologies to the practice
domain.
 Accept responsibility for knowing the legal, ethical, and professional
parameters of practice, maintain those boundaries and acknowledge when
a decision or action has not been in the best interest of a Volunteer while
taking corrective action in the Volunteer’s behalf.

______________________________________________________________________________
Office of Health Services October 2015 Page 3 of 3
Peace Corps

Technical Guideline 114 Attachment A

Glossary/Definitions related to Nursing Scope of Practice

Expected outcome—a measurable individual, family, or community state, behavior, or perception that is
measured along a continuum and is responsive to nursing interventions.

Medical diagnosis—a medical determination of disease or syndrome performed by a physician. The


focus is on the disease process and the physical, genetic, or environmental cause of that process.

Nursing assessment—the way in which a nurse gathers and evaluates data about a client (individual,
family, or community). The assessment includes a physical examination, interviewing, and observations.
Assessment is also the first step in the nursing process.

Nursing diagnosis-"A clinical judgment about individual, family, or community responses to actual or
potential health problems/life processes. Nursing diagnoses provide the basis for selection of nursing
interventions to achieve outcomes for which the nurse is accountable." (As defined by NANDA-I
(Nursing Diagnosis Association-International).

Nursing diagnostic statement—the formal, written documentation of a nursing diagnosis. It includes the
label or diagnosis, the etiology, and the indicators. In the statement, the etiology is preceded by the phrase
"related to." The indicators are the assessment data that led to the diagnosis. They are preceded by the
phrase, "as evidenced by."

Nursing intervention—any treatment that a nurse performs on a patient in response to a nursing


diagnosis to reach a projected outcome.

Risk diagnosis—a nursing diagnosis that recognizes a potential problem not an existing problem. The
indicators for risk diagnoses are risk factors that are identified through assessment.

North American Nursing Diagnosis Association-International (NANDA-I); 2006


Peace Corps
Technical Guideline 114 Attachment B

NURSING SCOPE OF PRACTICE: STANDING ORDERS/PROTOCOLS FAQS

CAN A NURSE WHO IS NOT AN APRN (Advanced Practice Registered Nurse) PRESCRIBE?

No. Registered nurses (RNs) may not prescribe and may not:
• Write the drug, dosage and directions for use on a prescription form that has been pre-signed
by an authorized prescriber.
• Sign or stamp an authorized prescriber’s name on a prescription form followed by the nurse’s
signature or initials.
• Call a prescription, including a prescription to refill/extend a prescription, to a pharmacy that
has not originated with an authorized prescriber for a specific patient or client.

CAN A NURSE IMPLEMENT STANDING ORDERS OR PROTOCOLS WHICH RESULT IN A


PRESCRIPTION?

Yes. However, because a standing order may be “patient-specific” or “condition-specific,” it is necessary


to differentiate between the two before proceeding.

Patient-specific protocol- A protocol or standing order that is a part of a specific Volunteer’s medical
plan of care. An RN PCMO may carry out the directions of a patient-specific protocol (i.e. medication
monitoring for a specific condition related to the Volunteer’s medical plan of care).

Condition-specific protocol -A condition-specific protocol differs from the patient-specific protocol in


that Peace Corps does not require the condition-specific protocol to be written for a specific
patient/Volunteer, but rather, for a group of patients whose medical condition falls within the
guideline/protocol (i.e. Malaria, URI, UTI, Otitis Media, etc).

RNs may implement a condition-specific protocol. The authorized prescriber delegates to the RN to
determine if a particular patient fits the identified criteria established for the group and whether the
predetermined prescription originated by the authorized prescriber should be implemented.

Authorized prescribers-Legally authorized prescribers are doctors of medicine, osteopathy, and


optometry; podiatrists; veterinarians; physician assistants; and advanced practice registered
nurses (APRN).

Source: Minnesota State Board of Nursing, 2010; New York State Board of Nursing, 2010
Peace Corps
Technical Guideline 116

CREDENTIALING POLICY FOR PEACE CORPS MEDICAL OFFICERS

1. PURPOSE
The credentialing policy establishes processes for the review and verification of the
training, expertise, and license of Peace Corps Medical Officers selection criteria and
standards to assure appropriate credentials; and ongoing evaluation and monitoring of
PCMOs’ medical and technical competency. Credentialing includes continual
monitoring and assessment of the PCMO’s performance through quality and
outcomes review. PCMO credentials are reviewed annually based on professional
performance, quality and outcomes review, and clinical and technical skills.

2. BACKGROUND
PCMOs are subject to credential review during the application process and will be
granted clinical privileges by the Associate Director, Office of Health Services or
designee after review and approval by the Credentialing Committee (CC).

3. CREDENTIALING COMMITTEE (CC)


 The Credentialing Committee is a standing OHS committee
 Membership is rotated through OHS healthcare professionals familiar with
Peace Corps credentialing/privileging policies
 Quorum: Five members, must include one physician

4. PCMO Criteria:
 Evidence of completion of educational requirements for the professional skill
level required at post, as designated by the Associate Director Office of Health
Services or designee.

 License, registration or certificate from the United States, host country or the
provider's country of training to practice their profession.

 Recent, relevant clinical experience in primary care

 Clinical judgement

 Independent, minimally supervised, clinical experience within one’s level of


training

 Experience in basic counseling and in providing preventive health/wellness


education

 Knowledge of infectious/tropical diseases

 Program management/administrative experience

 Professional comportment and demeanor

______________________________________________________________________________
Office of Health Services October 2015 Page 1 of 4
 English fluency and comprehension

5. PCMO Selection and Credentialing Process


A. A PCMO application package is sent to the applicant.

B. Upon receipt of the submitted application, the CC reviews the application for
completeness of the following:

 Current resume. Gaps in the work history exceeding six months must be
clarified.

 PCMO application form (includes information on licensure revocation,


suspension, voluntary relinquishment, and other licensure conditions or
limitations).

 PCMO application skills survey.

 Application for core privileges. Request for additional privileges if desired.

 At least two peer references who have directly observed the applicant in a
clinical setting.

 A license, registration or certificate in the host country, the United States or the
provider’s country of training to practice their profession. In circumstances where
licensing requirements are unclear, a statement from the Ministry of Health
establishing that the candidate is properly credentialed is required.

 License requirements are listed below:

o Registered Nurses must maintain a valid nursing license

o Nurse Practitioners must maintain an Advance Practice Nursing valid


license

o Physician Assistants must hold a current, active physician assistant’s


license

o Doctor of Medicine or Doctor of Osteopathy must maintain a current


valid license

o For physicians who received their medical education overseas: Education


Commission Foreign Medical Graduate (ECFMG) certification and/or
graduate from a school listed in the Foundation for Advancement of
International Medical Education and Research (FAIMER).
http://www.faimer.org/resources/imed.html

 Post graduate training certificates (residency, internship, fellowship).

______________________________________________________________________________
Office of Health Services October 2015 Page 2 of 4
 Diploma or degree from a professional school relevant to medical practice and
primary source verification of the diploma or degree.

 Documentation of current board certification. Nurse practitioners must


maintain certification by the American Academy of Nurse Practitioners
(AANP) or the American Nurses’ Credentialing Center (ANCC). Physician
assistants must maintain certification by the National Commission on
Certification of Physician Assistants (NCCPA).

C. The CC will utilize the following data banks to perform queries on American
MDs, PAs, and NPs:

 National Practitioner Data Bank (NPDB) to determine if there are any


outstanding issues, i.e. lawsuits, malpractice claims, loss of license, etc.

 Healthcare Integrity and Protection Data Bank (HIPDB) to receive


information on healthcare practitioners, providers and suppliers regarding criminal
convictions, civil judgments, exclusion from government healthcare programs,
state and federal licensure actions, as well as other adjudicated actions.

D. The PCMO applicant is invited for an interview conducted by the CC and OHS
staff. Clinical competence and professional conduct will be assessed.

E. Final approval is given by the Associate Director Office of Health Services or


designee and privileges are granted.

F. Contract is awarded that includes the Scope of Practice and privileges. A copy of
the privileges is placed in the PCMO personnel file.

G. Security and medical clearance are obtained.

H. PCMO enters on duty.

6. PCMO Evaluation
Quality and outcomes review will be performed on an ongoing basis and will include
the following:

 Three month mentorship of all new PCMOs. The mentor will submit a report at
the completion of the mentorship to include assessment of performance,
identification of deficiencies, and follow- up plan

 Medical Record review will be conducted every two weeks for three months on
all new PCMOs

 Annual PCMO evaluations

 Quarterly focused chart reviews will be scored, tracked and trended

______________________________________________________________________________
Office of Health Services October 2015 Page 3 of 4
 Sentinel event evaluation

 Resource utilization review

 Annual Volunteer Survey review

 Continuing Medical Education (CME) credits. PCMOs must obtain and provide
documentation of at least twenty CME hours annually.

 Attendance at Office of Health Services sponsored annual CMEs

 License and certification verification tracked in a database maintained by


Office of Health Services

 Adherence to the Medical Technical Guidelines (TGs)

 Triennial medical unit site assessments by Office of Health Services staff

______________________________________________________________________________
Office of Health Services October 2015 Page 4 of 4
TG 116 Attachment A

Host Country Resident and Third Country National Peace Corps


Medical Officer (PCMO) Selection Process

1. The Country Director (CD) requests a Host Country or Third Country National
PCMO to the Associate Director Office of Health Services (AD/OHS or designee).

2. The AD/OHS or designee collaborates with the Country Director on the specific
needs of the post. The professional credential and number of clinicians are
determined. It is the Peace Corps' policy that contracts for medical services be
executed in-country unless it can be shown that no suitable candidates can be found
or that special conditions exists which can be met by a U.S. national or Third
Country National (TCN) as determined by the AD/OHS or designee. The AD/OHS
or designee may transfer existing PCMOs from other posts if he/she determines it is
in the best interest of Peace Corps. Transfers and PCMOs assigned on temporary
duty do not require competition as they are already on contract.

3. The AD/OHS or designee advises the PCMO Program Coordinator of the post’s
needs.

4. PCMO Program Coordinator sends a sample PCMO advertisement and required


application materials to the Country Director. The advertisement will describe the
position and direct interested applicants to the Administrative Officer (AO) or
Country Director at post for the application materials. The advertisement should be
placed for a minimum of two weeks.

5. Post arranges for interested applicants to be interviewed in person to assure


minimum standards are met. The minimum standards include adequate English
language and interpersonal skills and a graduate of a FAIMER-listed school
(http://www.faimer.org/resources/imed.html. A notation of any disqualifying
factors must be made in the applicant’s file.

6. Within 10 days of close of the advertisement, post submits the completed


application packets of qualified applicants to the AD/OHS or designee (preferred
electronically with originals sent by pouch mail).

Office of Health Services December 2015 1


7. The AD/OHS or designee reviews the applicant files, prepares a shortlist of
candidates, and sends the shortlist to post. Application materials for review include,
but are not limited to:

 A resume or Curriculum Vitae (CV)

 Application form

 Skills Survey

 At least three professional references

 Copies of academic diplomas

 Copies of professional licenses or written confirmation directly submitted


from the issuing authority if the diploma is considered the license or if no
license expiration date

 Copies of professional certifications of all post graduate training,


internships, residencies, fellowships

 Application for core and any supplemental privileges

 For U.S. - based applicants: National Practitioner Data Bank (NPDB) and
Healthcare Integrity and Protection Data Bank (HIPDB) background checks
8. The Country Director, PCMOs, and Regional Medical Officer (RMO), if applicable
interview the candidates on the shortlist. Following the interviews, the Country
Director rates each candidate as “desirable,” “acceptable,” or “unacceptable” based
on the selection criteria (other than medical training and experience and cost) and
provides the ratings, along with any other comments on the candidates, to the
AD/OHS or designee. For any candidate rated as “unacceptable,” the Country
Director makes a detailed notation in the candidate’s file of the reasons for such
rating.

9. The AD/OHS or designee interviews the candidates on the shortlist. A rank score is
awarded based on established interview criteria.

10. The AD/OHS or designee recommends the preferred candidate, taking into
consideration input from post.

11. The candidates are presented to credentialing committee for a vote. Final selection
and privileging recommendations are based on application materials, skills and
abilities responses, professional skill level, references, and interview responses.

12. Credentialing staff prepares the Summary Evaluation/Competition Sheet and


presents it to the AD/OHS or designee for approval.
Office of Health Services December 2015 2
13. All documentation is forwarded to the Office of Acquisitions and Contracts
Management (OACM or Post’s Overseas Contracting Officer (to begin
negotiations). Upon successful negotiations, the designated Contracting Officer
awards the contract. Contract awarded includes the scope of practice and
privileges. If negotiations are not successful, Post or OACM will contact the
AD/OHS or designee to advise her/him of the situation. AD/OHS can offer
negotiation options or offer an alternative candidate. If a qualified candidate cannot
be secured, OHS has the discretion to declare a failed search, reevaluate Post needs
and reinitiate the process or consider alternatives.

14. PCMO qualification and privileging documents will be sent to the Country Director
with a copy placed in the PCMO’s personnel file.

15. Security clearance documents are submitted to the local U.S. Embassy.

16. Medical clearance documents are submitted to the PCMO Program Coordinator.
Medical clearance is granted or denied by the credentialing committee.

17. The AO sends a copy of the PCMO signed contract to the PCMO Program
Coordinator to be filed in the Office of Health Services.

18. PCMO enters on duty.

Office of Health Services December 2015 3


TG 116 Attachment B

Peace Corps Medical Officer (PCMO) Selection Process: U.S. Hire

1. It is the Peace Corps' policy that contracts for medical services be executed in-
country unless it can be shown that no suitable candidates can be found or that
special conditions exists which can be met by a U.S. national or Third
Country National (TCN) as determined by the Associate Director of Office of
Health Services (AD/OHS) or designee. The AD/OHS or designee in
consultation with the relevant Country Directors, the Regional Director (s) and (in the
case of a PCMO who is a personal service contractor) the cognizant Contracting
Officer, transfer a PCMO from another Peace Corps post if (1) the PCMO consents to
the transfer, and (2) the AD/OHS determines that such a transfer will be the most
effective means of securing the needed professional skills or will otherwise promote
the efficiency and effectiveness of the Peace Corps medical service. Transfers and
PCMOs assigned on temporary duty do not require competition as they are already
on contract.

2. The Country Director (CD) sends a request to the AD/OHS or designee for a PCMO.

3. The AD/OHS or designee collaborates with the Country Director on the specific
needs of the post. The professional credential and number of clinicians are
determined.

4. The AD/OHS or designee advises the PCMO Program Coordinator of the post’s
needs if it is determined that the needs of post are best served by a U.S. trained
provider. Steps 5-16 are followed.

5. PCMO Program Coordinator reviews the required qualifications for post and
advertises for the position and/or contacts the currently-serving PCMOs and
approved PCMO candidates. Candidates are approved through the process outlined in
Attachment C (U.S. Peace Corps Medical Contractor (PCMO) Credentialing Unit
Selection Process).

6. The credentialing staff ranks the candidates based on the paper review and interview
results.

7. The PCMO Program Coordinator presents the AD/OHS or designee with the names
and ranking of all candidates.

Office of Health Services December 2015 1


8. The PCMO Program Coordinator sends the top three candidates for input to be sent
to the AD/OHS or designee and credentialing committee.

9. The AD/OHS or designee chooses the candidate and grants privileges.

10. The PCMO Program Coordinator presents the Country Director with the AD/OHS or
designee’s preferred choice. Concurrence is requested from the Country Director.

11. PCMO qualification and privileging documents will be sent to the Country Director
by the PCMO Program Coordinator with a copy placed in the PCMO’s file.

12. Security clearance documents are submitted to the Office of Safety and Security by
the Office of Acquisitions and Contracts Management (OACM).

13. Medical clearance documents are submitted to the PCMO Program Coordinator.
Medical clearance is granted or denied by CU.

14. The OACM awards the contract to include the scope of practice and privileges.

15. The OACM provides a copy of the PCMO signed contract to the PCMO Program
Coordinator to be filed.

16. PCMO enters on duty.

Office of Health Services December 2015 2


TG 116 Attachment C
U.S. Peace Corps Medical Officer (PCMO) Candidates
Credentialing Unit Selection Process

1. Interested candidates apply on line through FedBizOps. All application materials are
available at this site.

2. All application materials are sent to the PCMO Program Coordinator.

3. Credentialing staff reviews the application packets to assure completion.

4. Credentialing staff performs a paper panel review of the application materials and
applicant responses to skills and abilities. Qualified candidates will be ranked based
on selection criteria outlined in TG 116. Top applicants will be interviewed.
Application materials for scoring include:

 A resume or curriculum vitae (CV)


 Application form
 Skills Survey
 At least three professional references
 Copies of academic diplomas
 Copies of professional licenses or written confirmation directly submitted from
the issuing authority if the diploma is considered the license or if no license
expiration date
 Copies of professional certifications of all post graduate training, internships,
residencies, fellowships
 Application for core and any supplemental privileges
 National Practitioner Data Bank (NPDB) and Healthcare Integrity and Protection
Data Bank (HIPDB) background checks

5. Credentialing staff interviews all qualified candidates. A rank score is awarded based
on established interview criteria.

6. Credentialing committee reviews documents and votes whether to hire based upon
application materials, skills, abilities responses, professional skill level, references,
and interview responses.

Office of Health Services December 2015 1


Privileges for Peace Corps Medical Officers-- Physicians

Name:
Please Print Your Name and Credentials Country

PRIVILEGES REQUESTED
 Core Privileges – Privileges to perform duties that fall within the typical scope of a MD or DO.

QUALIFICATIONS FOR PRIVILEGES


To be eligible for core privileges, the MD or DO applicant must meet the following qualifications:

 Doctor of Medicine or Doctor of Osteopathy degree from a school in the United States or Canada approved by
a recognized accrediting body in the year of the applicant’s graduation; OR
 A Doctor of Medicine or equivalent degree from a foreign medical school that provided education and medical
knowledge substantially equivalent to accredited schools in the United States, plus Education Commission
Foreign Medical Graduate (ECFMG) certification and/or graduation from a school listed in the Foundation for
Advancement of International Medical Education and Research (FAIMER)
http://www.faimer.org/resources/imed.html
 Validation of foreign medical school accreditation
 Valid clinical MD or DO licensure
 Applicable knowledge and experience

CORE PRIVILEGES
Privileges included in the Core: **
Privileges that fall within the typical scope of a MD or DO practice include:
(**Please strike out any non-proficient privileges)

 Patient triage  Serve as a clinical prescriber for PCMO-RNs


 Initiate life support when necessary  Serve as a clinical advisor for PCMO-NPs or PAs
 Maintain an adult immunization program  Peripheral venipuncture for lab work and IV
 Maintain current, complete clinical records in SOAP administration of meds
 Adhere to Peace Corps Medical Technical Guidelines  PPD placement and reading
 Accompany medevacs when indicated  Preparation of thick and thin malaria smears
 Provide emotional support and short-term counseling  Pulse oximeter and PEAK flow reading
 Provide health education to Trainees/Volunteers  EKG tracing and interpretation
 Perform administrative functions of the health unit  Office diagnostics including commercial testing kits for
 Accrue 20 or more hours of continuing education HIV, urine dips, HCG, etc.
annually  Basic microscopy including UAs, wet mounts, stool
 Perform comprehensive patient history taking and  Urethral catheterization
physical exams including pelvic exams/ pap smears  Local infiltration anesthesia
 Assess, diagnose, and manage acute and chronic  Simple laceration repair/I & D’s
clinical issues  Punch/Excisional/Shave biopsy
 Toenail Removal  Needle aspiration for culture
 Anoscopy  Wart ablation on extremities
 Prescribe pharmacologic agents including controlled  IUD removal
substances according to the Medical Technical
Guidelines

November 2015 Page 1 of 2


Peace Corps Office of Health Services
PCMO Privileges: MD/DO

** On a separate sheet of paper, please describe any major, unexpected complications you
have encountered for any of the Core Privileges you are requesting.

ACKNOWLEDGEMENT OF PRACTICIONER
I have requested only those clinical privileges for which, by education, training, current experience, and
demonstrated performance, I am qualified to function as a Peace Corps Medical Officer and a MD or DO.

I understand that in conducting any clinical privileges granted, I am constrained by the Peace Corps Office of Health
Services policies and rules.

Applicant Signature:
Please Sign Your Name Date

CLINICAL SERVICE RECOMMENDATION


Core Clinical Privileges
Approved with modification(s) (specify below)
Approved as requested
Denied

I have reviewed the requested clinical privileges and supporting documentation for the above named practitioner
and recommend action on the privileges as noted above:

Signature Date
Chair, Credentialing Committee

Signature Date
Medical Director, Office of Health Services

November 2015 Page 2 of 2


Privileges for Peace Corps Medical Officers – Registered Nurses

Name:
Please Print Your Name and Credentials Country

PRIVILEGES REQUESTED
 Core Privileges – Privileges to perform duties that fall within the typical scope of a RN.

QUALIFICATIONS FOR PRIVILEGES


To be eligible for core privileges, the applicant must meet the following qualifications:
 Successful completion of a three year diploma or four year bachelor of science in nursing degree
 Valid clinical RN licensure
 Applicable knowledge and experience

CORE PRIVILEGES
Privileges included in the Core: **
Privileges that fall within the typical scope of a RN privileges include:
(** Please strike out non-proficient privileges)

 Patient assessment and triage  Focused physical exam appropriate to presenting


 Initiate life support when necessary complaints to provide information to the clinical
 Work collaboratively with a clinical advisor in-country advisor as well as these clinical skills:
re: clinical diagnoses and patient management o Peripheral venipuncture
 Maintain an adult immunization program o Whisper/Gross Hearing Test
 Maintain current, complete clinical records in SOAP o Gross Vision with Snellen Eye Chart
format o PPD test placement and reading
 Adhere to Peace Corps Medical Technical Guidelines o Stool for occult blood
 Accompany medevacs when indicated o Urine dipstick
 Provide emotional support and short-term counseling o Thick and thin malaria smear preparation
 Provide health education to Trainees/Volunteers o Office testing of HIV, strep, mono, pregnancy using
 Perform administrative functions of the health unit commercial kits
o Intravenous therapy for hydration and to
 Accrue 20 or more hours of continuing education
administer medications under the presence of the
annually
clinical advisor
 Perform comprehensive patient history taking
o Hematocrit
 Measure Height, Weight, Vital Signs
o Pulse oximeter and PEAK flow meter readings
 Perform a general patient survey: overall status
o ECG tracings
 Basic wound care, suture removal, dressing change o Urethral catheterization

** On a separate sheet of paper, please describe any major, unexpected complications you
have encountered for any of the Core Privileges you are requesting.

November 2015 Page 1 of 2


Peace Corps Office of Health Services
PCMO Privileges: RN

ACKNOWLEDGEMENT OF PRACTITIONER
I have requested only those clinical privileges for which, by education, training, current experience, and
demonstrated performance, I am qualified to function as a Peace Corps Medical Officer and a RN.

I understand that in conducting any clinical privileges granted, I am constrained by the Peace Corps Office of Health
Services policies and rules.

Applicant Signature:
Please Sign Your Name Date

CLINICAL SERVICE RECOMMENDATION


Core Clinical Privileges
Approved with modification(s) (specify below)
Approved as requested
Denied

I have reviewed the requested clinical privileges and supporting documentation for the above named practitioner
and recommend action on the privileges as noted above:

Signature Date
Chair, Credentialing Committee

Signature Date
Medical Director, Office of Health Services

November 2015 Page 2 of 2


Privileges for Peace Corps Medical Officers – Registered Nurses

Name:
Please Print Your Name and Credentials Country

PRIVILEGES REQUESTED
 Core Privileges – Privileges to perform duties that fall within the typical scope of a RN.

QUALIFICATIONS FOR PRIVILEGES


To be eligible for core privileges, the applicant must meet the following qualifications:
 Successful completion of a three year diploma or four year bachelor of science in nursing degree
 Valid clinical RN licensure
 Applicable knowledge and experience

CORE PRIVILEGES
Privileges included in the Core: **
Privileges that fall within the typical scope of a RN privileges include:
(** Please strike out non-proficient privileges)

 Patient assessment and triage  Focused physical exam appropriate to presenting


 Initiate life support when necessary complaints to provide information to the clinical
 Work collaboratively with a clinical advisor in-country advisor as well as these clinical skills:
re: clinical diagnoses and patient management o Peripheral venipuncture
 Maintain an adult immunization program o Whisper/Gross Hearing Test
 Maintain current, complete clinical records in SOAP o Gross Vision with Snellen Eye Chart
format o PPD test placement and reading
 Adhere to Peace Corps Medical Technical Guidelines o Stool for occult blood
 Accompany medevacs when indicated o Urine dipstick
 Provide emotional support and short-term counseling o Thick and thin malaria smear preparation
 Provide health education to Trainees/Volunteers o Office testing of HIV, strep, mono, pregnancy using
 Perform administrative functions of the health unit commercial kits
o Intravenous therapy for hydration and to
 Accrue 20 or more hours of continuing education
administer medications under the presence of the
annually
clinical advisor
 Perform comprehensive patient history taking
o Hematocrit
 Measure Height, Weight, Vital Signs
o Pulse oximeter and PEAK flow meter readings
 Perform a general patient survey: overall status
o ECG tracings
 Basic wound care, suture removal, dressing change o Urethral catheterization

** On a separate sheet of paper, please describe any major, unexpected complications you
have encountered for any of the Core Privileges you are requesting.

November 2015 Page 1 of 2


Peace Corps Office of Health Services
PCMO Privileges: RN

ACKNOWLEDGEMENT OF PRACTITIONER
I have requested only those clinical privileges for which, by education, training, current experience, and
demonstrated performance, I am qualified to function as a Peace Corps Medical Officer and a RN.

I understand that in conducting any clinical privileges granted, I am constrained by the Peace Corps Office of Health
Services policies and rules.

Applicant Signature:
Please Sign Your Name Date

CLINICAL SERVICE RECOMMENDATION


Core Clinical Privileges
Approved with modification(s) (specify below)
Approved as requested
Denied

I have reviewed the requested clinical privileges and supporting documentation for the above named practitioner
and recommend action on the privileges as noted above:

Signature Date
Chair, Credentialing Committee

Signature Date
Medical Director, Office of Health Services

November 2015 Page 2 of 2


Peace Corps
Technical Guideline 118

License Renewal Policy for Peace Corps Medical Officers

1. PURPOSE
The license renewal policy establishes processes for the maintenance of current
clinical licensure of Peace Corps Medical Officers (PCMOs).

2. BACKGROUND
A PCMO is required to provide Volunteer Support (VS) with a current clinical
license in order to perform his or her duties as a PCMO. The PCMO is to maintain
his or her own licensure. Peace Corps does not provide funds for license renewal,
board re-certifications, or educational degree requirements for licensure. VS will
provide several reminders to the PCMO to update his or her license to assist in the
process. Failure to maintain clinical licensure can subject the PCMO to restricted,
non-clinical duties and termination. The PCMO license database is maintained in the
Quality Improvement Unit, Office of Volunteer Support (QI/VS).

3. PCMO License Renewal Process


1) PCMO applicant provides a current license copy during the application process. All
original documents must be translated into English. Translation must be performed
at post and signed and dated by a Peace Corps staff member.

2) QI/VS will maintain the license copy on file.

3) About 60 days prior to clinical license expiration, QI/VS will notify the PCMO by
email of the pending license expiration and that a current license is expected by
license expiration.

4) A second reminder at 30 days prior to license expiration may be sent by QI/VS to the
PCMO if the PCMO fails to provide a current license or respond to the first reminder.
The second reminder shall include a copy of the Technical Guideline (TG). The
Country Director (CD), Director of Office of Medical Services (D/OMS), and
Manager, Quality Improvement shall be copied on the e-mail.

5) If the PCMO fails to provide a renewed license by clinical license expiration, the
D/OMS informs the PCMO and CD that the PCMO has not provided QI/VS with a
copy of a current license. The PCMO will be placed on administrative leave without
pay (LWOP) for up to a maximum of 30 days until the PCMO provides the medical
license. The PCMO is also ineligible to attend any VS-funded training activities
during this time. The Office of Acquisitions and Contract Management (OACM) will
be notified.

6) The contract with the PCMO is terminated if the PCMO fails to provide a current
license by the end of the administrative LWOP.

______________________________________________________________________________
Office of Volunteer Support January 2011 Page 1 of 2
7) In the event that a PCMO submits his/her renewal application and is able to provide
QI/VS with a valid receipt from the licensing board or body, the PCMO shall
continue to perform his/her duties for up to a maximum of 45 days. If at that time, the
PCMO is unable to provide either a current clinical license or written explanation
from the licensing board justifying the licensing delay, then the PCMO will be placed
on administrative leave without pay for up to a maximum of 30 days and subsequent
termination if unable to provide license after administrative LWOP.

8) PCMOs may appeal administrative actions in regard to failure of license renewal to


the Associate Director/Volunteer Support or designee.

______________________________________________________________________________
Office of Volunteer Support January 2011 Page 2 of 2
Peace Corps
Technical Guideline 120

MEDICAL BENEFITS FOR TRAINEES,


VOLUNTEERS AND RETURNED VOLUNTEERS

1. PURPOSE

To describe the medical benefits available to Peace Corps Trainees, Volunteers and returned
Volunteers, including:
• Benefits provided by the Volunteer Health System;
• Benefits provided under the Federal Employees' Compensation Act (FECA);
• Benefits provided by AfterCorps post-service health insurance;
• Responsibilities of the Peace Corps Medical Officer (PCMO) and the Volunteer.

2. BACKGROUND

Medical benefits for active duty Volunteers are defined in Peace Corps Manual Section (MS)
262 “Peace Corps Medical Services Program”. Medical benefits for former Volunteers are
defined in MS 266 “Post-Service Medical Benefits for Trainees, Volunteers and
Dependents.” ATTACHMENT A summarizes the medical benefits provided to Volunteers
and Returned Peace Corps Volunteers (RPCVs).

Guidance on benefits for spouses and minor dependents of Trainees, Volunteers, and
returned Volunteers is presented in Technical Guideline (TG) 122 “Medical Benefits for
Dependents of Trainees, Volunteers and Returned Volunteers.” See also MS 262, 266, and
263 “Volunteer Pregnancy”.

3. BENEFITS FOR ACTIVE DUTY TRAINEES AND VOLUNTEERS

Peace Corps provides medical services to Trainees and Volunteers through:

1. PCMOs or authorized referral providers at post;

2. Referral providers in the U.S. or other non-Peace Corps countries when a Volunteer is on
medical evacuation (medevac) or medical hold status.

The essential elements of medical care for Trainees and Volunteers include:
• A comprehensive immunization, prevention, and health maintenance program.
• Health support in country, including all necessary care, for new conditions and accepted
pre-existing conditions exacerbated or aggravated by Peace Corps service.

Office of Health Services June 2014 Page 1


TG 120
Medical Benefits

Pre-existing conditions known to the Office of Health Services (OHS) and documented in
the health record at the time of initial medical clearance will be managed by the Peace
Corps under the Volunteer Health System. Conditions not disclosed or not documented in
the health record during pre-service medical clearance may not be covered and may be
cause for medical or administrative separation.

• Emergency medical services anywhere in the world at any time.


Peace Corps requires pre-authorization for all care except emergencies. In an emergency,
the PCMO and OHS must be notified at the earliest opportunity.

• Short term care for diagnosis and stabilization prior to medical separation when the
Volunteer will be unable to return to duty within 45 days of a medevac or when the
condition cannot be accommodated overseas.
In general, medical separation is required for a Volunteer unable to perform his/her
Volunteer assignment within 45 days of being placed on medevac status or whose
condition cannot be accommodated at post. With OHS concurrence, a Volunteer may be
medically separated overseas (see TG 160 “Medical Separation”).

• All prescription and over-the-counter medications and health supplies that are clearly
medically indicated and of certain benefit. Peace Corps does not provide prescription or
over-the-counter medications or other health supplies that are not medically indicated, are
of uncertain benefit, or for which the underlying health condition is poorly documented.
Also, Peace Corps does not provide medications for treatment of erectile dysfunction.
See TG 200 “Overseas Health Units” for additional guidance on medications of uncertain
benefit.

4. BENEFITS FOR RETURNED VOLUNTEERS

Returning Peace Corps Volunteers are covered by a three-tiered health benefit program.
These benefits are:

1. PC-127C authorizations. 127C authorizations are used to authorize evaluation of Peace


Corps service-related health conditions.

2. Federal Employees’ Compensation Act (FECA) benefits. FECA covers the cost of
treatment for service-related health conditions.

3. AfterCorps insurance. AfterCorps is a comprehensive health insurance policy that


covers non-service-related medical problems.

The following table is a synopsis of each tier of the benefit program. Detailed information
about each type of benefit appears in TG 330 “Post-Service Health Benefits and Close of
Service or Extension of Service Health Evaluations.”

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TG 120
Medical Benefits

POST-SERVICE HEALTH BENEFITS

Benefit Covers Time Limit How Accessed


Mechanism

PC-127C Evaluation of medical and Must be issued and used May be issued by PCMOs or
Authorization dental health conditions related within six months of close OHS.
to Volunteer service. of service (COS).

FECA Treatment of most medical and Claims must be filed within Claims should be filed through
Benefits dental conditions related to 3 years of COS, or within 3 the Post-Service Unit.
Volunteer service and/or years of recognition that a
incurred or contracted while health condition is service-
abroad during service. related.

AfterCorps Non-service-related medical Peace Corps pays one Contact AfterCorps Customer
Insurance problems. Specifically: month's premium for all Service for:
Volunteers and their minor
 Most pre-existing conditions children (less than 18  Emergency medical
not covered by FECA; years of age) who are assistance;
living with the Volunteer at
 Conditions that arose during  Referrals to network
service that are not covered the time of service hospitals, physicians, and
termination. Volunteers
by FECA, e.g., while in the may purchase up to 2 other health services;
U.S. on vacation, home  Insurance coverage
leave, emergency leave, or months of additional
coverage for themselves, extensions.
medevac; their spouse, and all
 Health problems that arose qualified dependents.
after Volunteer service.

4.1 PC-127C Authorizations

• At close of service (COS) a 127C is used to authorize payment for:

1. Evaluation of ongoing or unresolved medical and dental problems.

2. Dental examination as per TG 180 “Dental Policy.”

3. Laboratory tests not completed prior to COS or not available in-country. TG


330 “Post-Service Health Benefits and Close of Service or Extension of Service
Health Evaluations” section 4.2 identifies the routine screening tests required
for Volunteers at COS.

• Only evaluations are covered, and only the specific evaluation authorized will be
reimbursed. A 127C cannot be used for medical treatment, with one exception: it
can be used to authorize a single course of treatment for parasites (see TG 340 “PC-
127C Form ‘Authorization for Payment of Medical/Dental Services’ ”).
• A 127C must be issued and used within 180 days of COS. It will not be honored
after that time has elapsed.

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TG 120
Medical Benefits

• TG 330 “Post-Service Health Benefits and Close of Service or Extension of Service


Health Evaluations” and TG 340 contain additional guidance on the use of 127C
authorizations.

4.2 Federal Employees’ Compensation Act (FECA)

SUMMARY OF FECA BENEFITS

 Post-service medical and dental care for service-related illnesses or injuries;


 Compensation for lost wages due to service-related illnesses or injuries;
 Death benefits;
 Schedule awards for the service-related loss of organs or other body parts;
 Rehabilitation services.

• FECA benefits are administered by the Office of Workers’ Compensation Programs


(OWCP) at the U.S. Department of Labor (DOL). The Post-Service Unit assists
Volunteers in filing claims with DOL.
• FECA benefits are not guaranteed. The DOL must determine that a health condition
is service-related and compensable before a claim for benefits is accepted.
• Claims must be made within three years of COS or within three years of recognition
of a service-related health condition.
• Health problems resulting from injuries or illnesses that develop in the U.S. while a
Volunteer is on vacation, home leave, emergency leave, or on medevac, but not
directly engaged in Peace Corps activity, are not eligible for FECA benefits (see
AfterCorps Insurance below).
• Documentation in the Volunteer’s in-service health record, which includes medical
reports from health care received after COS, is the primary source of information
used to determine the service-related nature of a condition.
• A returned Volunteer may file for pre-natal, delivery, and post partum care under
FECA when the pregnancy began during service.
• Under the OWCP regulations, benefits will not be provided for conditions caused
by: 1) willful misconduct; 2) the Volunteer’s intention to bring about injury or
death to him/herself or another; or 3) intoxication of the injured Volunteer.
• TG 330 “Post-Service Health Benefits and Close of Service or Extension of Service
Health Evaluations” contains additional information about the FECA program.

4.3 AfterCorps Post-Service Health Insurance

• AfterCorps is a comprehensive health insurance policy designed specifically for


returned Volunteers.
• AfterCorps can be activated only at COS. It provides coverage for non-service-
related healthcare needs. Specifically:

Office of Health Services June 2014 Page 4


TG 120
Medical Benefits

1. Pre-existing conditions: Health conditions that existed prior to Peace Corps


service that were not affected by Peace Corps service.

2. Travel to the U.S. on personal business: After COS, AfterCorps will cover
health problems that developed while a Volunteer was on personal business in
the U.S., e.g., vacation, home leave, emergency leave, or while on medevac but
not directly engaged in Peace Corps activity.

3. Healthcare after COS: Returned Volunteers need health insurance for new
health problems that arise after COS.
• There are no pre-existing condition exclusions or other medical restrictions on
eligibility for this health insurance plan.
• The AfterCorps policy contract provides detailed information on the benefits
structure of the program.
• Peace Corps pays the first month’s premium for every Volunteer or Trainee who
leaves service, regardless of the reason for COS.
• At COS, Volunteers may elect to continue AfterCorps beyond the first month.
Volunteers are strongly encouraged to sign-up for extended AfterCorps coverage
before they leave country.
• Returning Volunteers may purchase up to 2 months of additional coverage for
themselves and their dependents when they leave service.
• If a Volunteer’s policy is allowed to lapse, even for one month, the Volunteer will
not be eligible to rejoin the plan.
• AfterCorps insurance may not be used to cover medical expenses for service-related
conditions covered by 127Cs or FECA. Volunteers with questions on which benefit
plan to use should contact the Post-Service Unit in OHS.
• Volunteers who are 65 years of age or older may be eligible for Medicare. They
may choose AfterCorps as their primary plan, but before doing so should contact
the Social Security Administration, which coordinates Medicare, to obtain a full
understanding of Medicare coverage and enrollment options. If a Volunteer who is
eligible for Medicare chooses Medicare as his or her primary coverage plan,
AfterCorps coverage will cease. Volunteers should contact AfterCorps Customer
Service for full information on AfterCorps coverage issues.
• TG 330 “Post-Service Health Benefits and Close of Service or Extension of Service
Health Evaluations” contains additional information about AfterCorps.

5. RESPONSIBILITIES OF THE PCMO

In order to ensure that Trainees, Volunteers, and RPCVs have full access to their medical
benefits, the PCMO should:

• Provide clinical care in accordance with Peace Corps guidelines and professional
standards;

Office of Health Services June 2014 Page 5


TG 120
Medical Benefits

• Inform Volunteers of their in-service and post-service benefits;


• Accurately and fully document Volunteer care;
• Inform Volunteers and Trainees of their health care rights and responsibilities. Post
ATTACHMENT B “Health Care Rights and Responsibilities of Trainees and
Volunteers” in the health unit.
• Second opinions are a mainstay of medical practice in the United States. They can
prevent errors and unnecessary tests or procedures, contain costs and increase patient
satisfaction and confidence.

• Upon request, PCV/Ts are entitled to a second medical opinion. The PCMO should facilitate
these appointments with a qualified medical provider or facility in the country of service. If an
in-country second opinion is not available, or as an alternative to obtaining a second opinion in
country, the second opinion may be provided by the RMO, OHS, COU or U.S. consultants
coordinated through OHS. A PCV/T will not be medevaced out of the country of service for a
second opinion for non urgent medical issues. In rare circumstances, a PCV/T may be authorized
to obtain a second opinion while on vacation or home leave in the United States. The PCMO in
collaboration with OHS and/or the RMO have final responsibility for decision making in all
PCV/T treatment recommendations.

5.1 Informing Volunteers of their Post-Service Health Benefits

All Peace Corps Trainees and Volunteers must receive health information and health
evaluations when they leave service, regardless of the reasons, timing, or circumstances
of COS. The PCMO is responsible for informing Volunteers of their post-service
medical benefits and should:
• Ensure that the Volunteer has been given a copy of Post-Service Health Information
for Returning Volunteers (TG 330 “Post-Service Health Benefits and Close of
Service or Extension of Service Health Evaluations” ATTACHMENT A).
• Ensure that the Volunteer has completed and signed the Volunteer Health Program
COS Checklist (TG 330 ATTACHMENT B).
• Ensure that the COS history, physical examination and lab evaluation have been
completed consistent with the guidance in TG 330.
• Issue 127C authorizations when necessary and explain their use.
• Ensure that the Volunteer has been given a copy of the AfterCorps health insurance
brochure/extension form. Encourage the Volunteer to carefully consider extension
of AfterCorps health insurance coverage beyond the first month.
• Ensure that the Volunteer has received information regarding post service benefits
located on the Peace Corps website..
• Ensure that the Volunteer has viewed the Post-Service health benefits video.

Office of Health Services June 2014 Page 6


TG 120
Medical Benefits

5.2 Documentation

• Document all medical information in the Volunteer’s health record using SOAP
(Subjective Information; Objective Information; Assessment; Plan) notes. Translate
all reports into English. Document any ongoing or unresolved aspects of illness or
injury (see TG 205 “Health Records”).
• Use black ink for all documentation.
• Sign all entries in the health record. Signature should include appropriate degree or
credential, e.g., M.D., PA-C., NP, or RN. Volunteer notes and statements may be
included in the health record as self-reported documentation if they are signed by
the PCMO.
• Ensure that the Volunteer completes a CA-1 “Federal Employee’s Notice of
Traumatic Injury” form for all injuries sustained during service. This form is used
to document all service related injuries. It does not initiate a worker’s compensation
claim. The PCMO should sign the back of the form and file the form in the
Volunteer’s Health record.
• At COS the PCMO should review the health record with the Volunteer to make sure
that it is complete and issue any necessary 127C authorizations for evaluation of
specific medical conditions that require follow up.
• Return all health records to OHS as soon as possible within 30 days of COS.
Returned Volunteer claims cannot be processed until the health record has been
returned to OHS.

6. RESPONSIBILITIES OF THE VOLUNTEER

ATTACHMENT B “Health Care Rights and Responsibilities” summarizes the responsibilities


of the Volunteer during service. This document must be posted in a visible area within the
health unit.
Responsibilities of Volunteers applicable to FECA and other post-service benefits are as
follows:

Prior to COS:
• Inform the PCMO of any injury or illness during service.
• Document any injury on Form CA-1, “Federal Employee’s Notice of Traumatic Injury”
and give it to the PCMO.
• Keep a log of all injuries and illnesses and give this to the PCMO.

At COS:
• Carefully review the “Post-Service Health Information for Returning Volunteers” (TG
330, ATTACHMENT A).
• Make an active, informed decision at COS or ET about extending AfterCorps beyond the
first month.

Office of Health Services June 2014 Page 7


TG 120
Medical Benefits

After COS:
• Contact OHS as soon as possible after return to the U.S. to obtain worker’s compensation
forms to initiate a claim if you have a service-related injury or illness that requires
medical care or is disabling from work. Completion of a CA-1 form in-service does not
initiate a claim.
• Apply for FECA benefits within three years of COS or of learning that an illness or injury
is, or may be, related to Peace Corps service.

Office of Health Services June 2014 Page 8


TG 120 ATTACHMENT A

SUMMARY OF MEDICAL BENEFITS FOR


TRAINEES, VOLUNTEERS AND RPCVs

Medical Benefits for Volunteers and Trainees Provided by:

A comprehensive immunization, prevention, and health maintenance Peace Corps


program.
Health support in country, including all necessary care for new conditions
and accepted pre-existing conditions that are exacerbated or aggravated
by Peace Corps service. †
Emergency medical services anywhere in the world at any time
Short term care for diagnosis and stabilization prior to medical separation
when the Volunteer will be unable to return to duty within 45 days of a
medevac or when the condition cannot be accommodated overseas.


Peace Corps pro vides initial care for all medical conditions. Trainees or Volunteers with pre-
existing conditions not disclosed to Peace Corps as part of medical clearance process are
sub ject to medical or administrative separation. FEC A b enefits ma y not b e a vailab le for these
conditions.

Medical Benefits for Returned Volunteers Provided by:

PC-127C Authorization: Evaluation only of medical and dental health Peace Corps
conditions related to Volunteer service.
Must be used within six months of close of service.

Treatment of most medical and dental conditions related to Volunteer FECA


service and conditions incurred or contracted while abroad during service.
Claims must be filed within 3 years of close of service or within 3 years of
recognition that a health condition is service-related.

Non-service-related medical problems. Specifically: AfterCorps


• Most pre-existing conditions not covered by FECA;
• Conditions that arose during service that are not covered by
FECA,e.g., while in the U.S. on vacation, home leave, emergency
leave, or medevac;
• Health problems that arose after Volunteer service.
Peace Corps pays one month's premium for all Volunteers. Volunteers may
purchase up to 2 months of additional coverage.
TG 120 Attachment B
Health Care Rights and Responsibilities
YOU HAVE THE RIGHT: YOUR RESPONSIBILITIES INCLUDE:
 To receive all necessary medical care in the event of an illness or  Treat all staff with respect, dignity and consideration.
injury including medical evacuation if needed.
 Reporting all significant health problems to the PCMO.
 To be treated with respect, consideration and dignity regardless of
 Providing complete information to the PCMO about your past
your race, color, religion, sex, national origin, age, disability, sexual
medical history and current health problems to allow proper
orientation, gender identity, gender expression, genetic
evaluation and treatment.
information, marital status, parental status, political affiliation or
your participation in any authorized complaint procedure.  Except in an emergency, obtaining PCMO authorization prior to
receiving any medical or dental care.
 To privacy, security, and medical confidentiality for your health
information and records.  Complying with all medical policies and practices of the Volunteer
Health Program. For example, you must:
 To privacy during the physical exam. You will be offered a
chaperone and a gown or drape for all exams that require exposing · Take disease prevention medication as prescribed;
all or part of your body. · Follow all prescribed therapies and other medical
 To be informed about the diagnosis, treatment, and prognosis of an recommendations carefully;
illness or injury. · Not wear contact lenses;
 To be informed about the credentials and qualifications of your · Engage in responsible and safe sex if you choose to be
health care providers. sexually active;
 To be informed about the scope and availability of healthcare · Keep up to date on your immunizations;
services in your country.
· Drink alcohol only moderately, if at all, and do not use
 To receive individual health information regarding personal illegal drugs;
wellness and illness.
· Sleep with a mosquito net in malarious areas;
 To receive health education/training on the prevention of illness
and injury specific to your country. · Drink safe water and buy and prepare food carefully;
 To receive immunizations and malaria prophylaxis according to · Swim only in places that are unquestionably safe.
Peace Corps protocols.  Doing all within your power to assure your own well-being and
 To refuse all or part of your care subject to the conditions imposed safety. For example, you must:
by law and Peace Corps policy. · Write a detailed emergency plan for your site;
 To be informed about your post-service benefits, including the · Wear a seat belt, if available, when riding in a vehicle;
Federal Employees' Compensation Act (FECA) program and post-
service health insurance. · Wear a helmet when on a bicycle or motorcycle;
 To bring a complaint or concern regarding your health care · Avoid all dangerous areas, especially at dusk and at night;
services to the attention of the appropriate Peace Corps officials. · Refrain from riding on or operating a motorized two wheel
vehicle unless it is allowed in your host country.
PEACE CORPS VOLUNTEERS’ HEALTH CARE
RIGHTS & RESPONSIBILITIES
YOU HAVE THE RIGHT
• To receive all necessary medical care in the event of an illness or injury, including medical evacuation if needed
• To be treated with respect, consideration, and dignity regardless of your race, color, religion, sex, national origin, age,
disability, sexual orientation, gender identity, gender expression, genetic information, marital status, parental status,
political affiliation, or your participation in any authorized complaint procedure
• To privacy, security, and medical confidentiality for your health information and records
• To privacy during the physical exam. You will be offered a chaperone and a gown or drape for all exams that require
exposing all or part of your body
• To be informed about the diagnosis, treatment, and prognosis of an illness or injury
• To be informed about the credentials and qualifications of your health care providers
• To be informed about the scope and availability of health care services in your country
• To receive individual health information regarding personal wellness and illness
• To receive health education/training on the prevention of illness and injury specific to your country
• To receive immunizations and malaria prophylaxis according to Peace Corps protocols
• To refuse all or part of your care subject to the conditions imposed by law and Peace Corps policy
• To be informed about your post-service benefits, including the Federal Employees' Compensation Act (FECA) program an
post-service health insurance
• To bring a complaint or concern regarding your health care services to the attention of the appropriate Peace Corps
officials

YOU ARE RESPONSIBLE FOR


• Treating all staff with respect, dignity, and consideration
• Reporting all significant health problems to the Peace Corps medical officer (PCMO)
• Providing complete information to the PCMO about your past medical history and current health problems to allow
proper evaluation and treatment
• Except in an emergency, obtaining PCMO authorization prior to receiving any medical or dental care

Complying with all medical policies and practices of


the Volunteer Health Program. For example, you must
• Take disease prevention medication as prescribed
• Follow all prescribed therapies and other medical
recommendations carefully
• Not wear contact lenses Doing all within your power to assure your own
• Engage in responsible and safe sex if you choose to be well-being and safety. For example, you must
sexually active
• Write a detailed emergency plan for your site
• Keep up to date on your immunizations
• Wear a seat belt, if available, when riding in a vehicle
• Drink alcohol only moderately, if at all, and do not use
illegal drugs • Wear a helmet when on a bicycle, horse, or motorcycle

• Sleep with a mosquito net in malarious areas • Avoid all dangerous areas, especially at dusk and at night

• Drink safe water and buy and prepare food carefully • Refrain from riding on or operating a two-wheeled
motorized vehicle unless it is allowed by your host county
• Swim only in places that are unquestionably safe

TG 120 Attachment B
Peace Corps
Technical Guideline 122

MEDICAL BENEFITS FOR DEPENDENTS


OF TRAINEES, VOLUNTEERS AND RETURNED VOLUNTEERS

1. PURPOSE

To describe the medical benefits available to spouses and minor dependents of Peace Corps
Trainees, Volunteers and returned Volunteers, including:
• Benefits for spouses of Trainees and Volunteers (Section 3);
• Benefits for spouses of returned Volunteers (Section 4);
• Benefits for minor dependents of Trainees and Volunteers (Section 5);
• Benefits for minor dependents of returned Volunteers (Section 6).

2. BACKGROUND

This guideline summarizes the benefits for spouses and minor dependents as outlined in
Peace Corps Manual Section (MS) 262 “Health Services for Trainees, Volunteers and
Dependents,” and MS 266 “Post-Service Medical Benefits for Trainees, Volunteers and
Dependents,”

ATTACHMENT A summarizes the medical benefits provided to spouses and minor


dependents of Trainees, Volunteers, and returned Volunteers.

3. BENEFITS FOR SPOUSES OF TRAINEES AND VOLUNTEERS

Non-Volunteer spouses of Volunteers are not entitled to Peace Corps health care or benefits.
The only exception is prenatal and birth-related care for the pregnant spouse of a Volunteer,
which will be provided in order to support the health of the unborn child.

3.1 Eligibility

The non-Volunteer spouse becomes eligible for prenatal and birth-related care to
support the health of the unborn child when all of the following criteria are met:

1. The Volunteer has taken action to acknowledge paternity which, under local law,
will make the Volunteer financially and legally responsible for the care and
support of the child.

2. The child will reside with the Volunteer .

Office of Health Services June 2014 Page 1


s
TG 122
Medical Benefits

3. The Country Director (CD) gives programmatic approval for the Volunteer to
continue service.

A Volunteer who fathers a child by a woman to whom he is not married may be


administratively separated if the CD determines that the Volunteer's action has
impaired his ability to perform in his assignment, impaired the credibility of the Peace
Corps program, or has violated host country law or custom.

Refer to Technical Guideline (TG) 170 “Pregnancy” for medical clearance and
management guidance for pregnant non-Volunteer spouses.

4. BENEFITS FOR SPOUSES OF RETURNED VOLUNTEERS

• Peace Corps does not provide medical care or health benefits for the non-Volunteer
spouse of a Returned Peace Corps Volunteer (RPCV).
• Peace Corps does not provide medical care or health benefits to a pregnant non-Volunteer
spouse (or the unborn child) after the date the Volunteer leaves service.
• Legally married spouses are eligible for AfterCorps. The Volunteer must pay for all
monthly premiums for a spouse, including the first month.

 AfterCorps provides benefits to enrolled non-volunteer spouses. Consult the


AfterCorps policy contract for detailed information on benefits.

 AfterCorps does not provide pregnancy benefits for enrolled non-volunteer


spouses.

• TG 330 “Post-Service Health Benefits and Close of Service or Extension of Service


Health Evaluations” section 3.3 contains additional information about AfterCorps.
• Spouses of returned Volunteers are not eligible to receive PC-127C “Authorization of
Payment of Medical/Dental Services” forms for evaluation of service-related medical
conditions.
• Spouses of returned Volunteers are not eligible for Federal Employees’ Compensation
Act (FECA) benefits.

5. BENEFITS FOR MINOR DEPENDENTS OF TRAINEES AND VOLUNTEERS

All minor dependents must be medically cleared by the Office of Health Services. A minor
dependent of a Trainee or Volunteer is:
• any child born during a Volunteer's service;
• any child who accompanies a Volunteer overseas (extremely rare).

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s
TG 122
Medical Benefits

5.1 Eligibility

In order to be eligible for the health benefits outlined below, a minor dependent must
meet all of the following criteria:
• Natural offspring or legally adopted child of the Volunteer;
• Unmarried;
• Under 18 years of age;
• Permanently living with the Volunteer in a parent-child relationship.

5.2 Benefits for Minor Dependents

Peace Corps provides all necessary medical services to eligible minor dependents
through:
• Peace Corps Medical Officers (PCMOs) or authorized referral providers at post;
and
• Referral providers when a Volunteer’s minor dependent is on medical evacuation or
medical hold status in the U.S. or other non-Peace Corps country.

During the Volunteer's service, eligible minor dependents are entitled to all necessary
medical care. Benefits are similar to the medical benefits of Trainees and Volunteers as
outlined in TG 120 “Medical Benefits for Trainees, Volunteers and Returned
Volunteers.” In most instances the PCMO will refer an eligible minor dependent to the
most qualified pediatric care setting in country. The essential elements of health care
for minor dependents include:
• Medically indicated, age appropriate immunizations and medical prophylaxis.
• Routine well child care.
• Necessary care for acute or ongoing illness or injury.
• Emergency medical services.
• Medical evacuation for conditions that require medical care beyond the care
available in-country.
• Short-term care for diagnosis and stabilization prior to medical separation if the
dependent has a medical condition that cannot be accommodated overseas or one
that will prevent the Volunteer from returning to duty within 45 days of a medical
evacuation (medevac) (see TG 160 “Medical Separation”).
• Age-appropriate Close of Service (COS) medical and dental evaluations.
• Eligible minor dependents are entitled to receive 127C authorization forms for
evaluation of medical conditions that occur during their parent’s service, home
leave, vacation or emergency leave. Minor dependents are also eligible for 127Cs at
COS.
• Peace Corps does not provide minor dependents with prescription or over-the-
counter medications, other health supplies, therapies, or treatments that are not

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s
TG 122
Medical Benefits

medically indicated, are of uncertain benefit, or for which the underlying health
condition is poorly documented.

6. BENEFITS FOR MINOR DEPENDENTS OF RETURNED VOLUNTEERS

6.1 AfterCorps

• Minor dependents are eligible for AfterCorps. Peace Corps will pay the first
month’s premium for minor dependents.
• Minor dependents are not automatically enrolled in AfterCorps. At COS, the
Volunteer must identify and enroll minor dependents in the program. The
AfterCorps brochure provided to all Volunteers at COS has instructions on
enrollment of minor dependents.
• TG 330 “Post-Service Health Benefits and Close of Service or Extension of Service
Health Evaluations” section 3.3 contains additional information about AfterCorps.

6.2 Evaluation and Treatment of Service-Related Illness or Injury

• Within 180 days of a Volunteer's COS, minor dependents are eligible to receive
127C Authorizations for evaluation only of service-related medical conditions.
• Minor dependents of Volunteers are not eligible for FECA benefits. However, in
accordance with Section 5(m)(2) of the Peace Corps Act, Peace Corps may provide
minor dependents with limited health care for illness or injury incurred during their
parents' service.

Under this provision, Peace Corps may provide minor dependents of RPCVs with
medical care for service related conditions that is similar to the benefit available to
Volunteers and Trainees under FECA. Minor dependents are not eligible for
compensation for lost wages or care for congenital defects (MS 266).

MS 266 governs the process of review and evaluation of requests for health care
under Section 5(m)(2). Parent(s) of the dependent child should submit requests for
health care on Form PC 1736 (MS 266, ATTACHMENT A) to the Post-Service
Unit in the OHS.

It is the responsibility of the PCMO and the Volunteer to ensure that any medical
problems that occur overseas during service are appropriately documented in the
child’s medical records.

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s
TG 122 ATTACHMENT A

SUMMARY OF MEDICAL BENEFITS FOR SPOUSES AND


MINOR DEPENDENTS OF TRAINEES AND VOLUNTEERS

Medical Benefits for Spouses

Beneficiary Benefit Provided by

Spouse of a Non-Volunteer spouses are not entitled to Peace Corps health care or Peace Corps
Volunteer benefits.
The one exception is prenatal and birth-related care for the pregnant
spouse of a Volunteer, which will be provided in order to support the
health of the unborn child. The eligibility criteria in TG 122, section 3
must be met in order to access this benefit.
Non-Volunteer spouses are eligible for AfterCorps after the Volunteers
COS (see “Spouse of a Returned Volunteer” section below).

Spouse of a Peace Corps does not provide medical care or health benefits to a AfterCorps
Returned pregnant non-Volunteer spouse (or the unborn child) after the date the
Volunteer Volunteer leaves service.
Non-Volunteer, legally married spouses of Volunteers are eligible for
AfterCorps. The Volunteer must pay for all monthly premiums for a
spouse, including the first month.
AfterCorps provides benefits to enrolled non-volunteer spouses. Consult
AfterCorps policy contract for detailed information on benefits.
AfterCorps does not provide pregnancy benefits for enrolled non-
volunteer spouses.
Spouses of returned Volunteers are not eligible for 127C evaluations of
service-related medical conditions.
Spouses of returned Volunteers are not eligible for FECA benefits.

Page 1
TG 122 ATTACHMENT A

Medical Benefits for Minor Dependents

Beneficiary Benefit Provided by

Minor Age appropriate immunizations and medical prophylaxis. Peace Corps


Dependent of a
Routine well child care.
Volunteer
Necessary care for acute or ongoing illness or injury.
(residing with the
Volunteer) Emergency medical services.
Medical evacuation for conditions that require medical care beyond the
care available in-country.
Short term care for diagnosis and stabilization prior to medical separation
if the dependent has a medical condition that cannot be accommodated
overseas or one that will prevent the Volunteer from returning to duty
within 45 days of a medevac.
Age appropriate COS medical and dental evaluations.
Eligible minor dependents are entitled to 127Cs for medical care on
home leave, vacation, or emergency leave, and 127Cs at COS.

Minor Minor dependents are eligible for AfterCorps. Peace Corps will pay the AfterCorps
Dependent of a first month’s premium for eligible minor dependents.
Returned
Volunteer Minor dependents are not automatically enrolled in AfterCorps. At COS,
the Volunteer must identify and enroll minor dependents in the program.
(who resided
with the Minor dependents are eligible for 127C evaluations of service-related
Volunteer during medical conditions.
service)
Minor dependents of Volunteers are not eligible for FECA benefits.
Peace Corps
Peace Corps may provide minor dependents of returned Volunteers with
limited health care for illness or injury incurred during their parents'
service in accordance with Section 5(m)(2) of the Peace Corps Act.
Under this provision minor dependents are not eligible for compensation
for lost wages or care for congenital defects.

Page 2
Peace Corps
Technical Guideline 127

PEACE CORPS RESPONSE VOLUNTEERS

1. PURPOSE

To describe the health support program for Peace Corps Response Volunteers.

2. BACKGROUND

The Peace Corps Response program is a program that mobilizes Returned Peace Corps
Volunteers (RPCVs) and Peace Corps Volunteers (PCVs) completing their tours to help
countries address critical needs on a short-term basis. Peace Corps Response Volunteers
(PCRVs) are posted throughout the countries in which they serve. Assignments typically
range from three to six months up to 1 year.

The Peace Corps Response Program Office notifies posts when they will be receiving
PCRVs. In advance of their arrival, posts will know the number of PCRVs anticipated in
country and their projected arrival date. Peace Corps Medical Officers (PCMOs) should work
with the country staff in the initial planning for PCRVs and should order medical supplies,
schedule in-country medical orientations, and prepare for other administrative needs
accordingly.

PCRVs receive medical support and health benefits similar to the Volunteer health system
benefits provided to PCVs (see section 5 below).

PEACE CORPS RESPONSE CONTACT INFORMATION

Peace Corps Response Program Office (202) 692-2250


Peace Corps Response Screening (202) 692-1500
Nurse

3. MEDICAL SCREENING

 All Peace Corps Response candidates must be medically and dentally qualified by the
Peace Corps Office of Health Services (OHS).
 OHS takes into consideration the three- to six-month duration of a PCRV assignment
when making medical clearance determinations for PCR applicants. Through their prior
Peace Corps service, most PCRVs have demonstrated their ability to live and work in

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TG 127
Peace Corps Response Volunteers

challenging environments without undue disruption of their service or adverse


consequences due to preexisting health problems.
 For the Peace Corps Response candidates currently serving in Peace Corps at the time of
their application, the PCR Screening nurse will contact the PCMO to arrange for medical
clearance. The PCMO should coordinate with the PCR Screening nurse for processing of
the Volunteer’s health record. If time is short however, the PCR nurse may ask the
current PCMO and the receiving PCMO to treat the applicant like a transfer (or an
extension if staying in the same country)and to forward the health record directly to the
next assignment.
 RPCVs who completed their Peace Corps service less than twelve months prior to their
Peace Corps Response application may submit their COS physical to OHS for medical
clearance to the PCR program. OHS reviews the COS physical, as well as any
undiagnosed, unresolved, or potentially recurrent health conditions that might interfere
with the Volunteer’s ability to serve with the program. This includes conditions that
would benefit from additional evaluation or treatment in the U.S.
 RPCVs who completed their Peace Corps service more than twelve months and less than
two years prior to their Peace Corps Response application may submit their COS physical
to OHS for medical clearance to the PCR program. OHS reviews the COS physical and
associated completed PC-127C “Authorization of Payment of Medical/Dental Services”
forms. OHS may request updates on conditions that were evaluated post-service and may
request an updated dental exam or a full dental evaluation (PC-1790 (Dental)).
 RPCVs who completed their Peace Corps service more than two years prior to their
Peace Corps Response application are required to complete a new Report of Medical
Examination (PC-1790-S) and a dental evaluation (PC-1790) if indicated for medical
clearance.
 A dental exam, cleaning and x-rays are not required for an assignment 6 months or less;
therefore a PCRV should not be offered an in service or close of service dental exam,
cleaning, and/or x-rays. If dental issues should occur during service, OHS should be
notified and a determination will be made at that time whether to terminate service or
offer treatment if available and/or indicated.
 When medical clearance is complete, the OHS Screening Unit notifies the PCMO by
email that the PCR applicant has medically cleared. This notification is also sent to the
recruiter who then coordinates with the Post, the date and time of arrival.
 Due to the nature of the Peace Corps Response program, in most cases OHS is not able to
clear applicants requiring specific in-country site placement for medical reasons.

4. PRE-DEPARTURE SUPPORT

Unlike Peace Corps Trainees, PCRVs do not participate in a U.S.-based staging event prior
to arrival at post.

Most PCRVs travel directly from their home of record to their country of assignment.

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TG 127
Peace Corps Response Volunteers

5. IN-COUNTRY HEALTH SUPPORT

Peace Corps Response Volunteers receive medical support and health benefits similar to the
Volunteer Health System benefits provided to PCVs. This support includes:
 Routine and urgent care through the Peace Corps health unit;
 PCMO consultation with OHS for case management;
 Medevac;
 COS health evaluation;
 Post-Service benefits.

Peace Corps Response Volunteers do not receive:


 Pre-Service health training (PST);
 Mid Service health evaluations;
 Site assessment by the PCMO.

5.1 In-Country Health Briefing

Although PCRVs do not participate in formal PST, they should receive a country-
specific health briefing from the PCMO upon their arrival. This briefing should include
information on:
 Personal safety;
 Food and water preparation;
 Malaria prevention;
 Local endemic health risks;
 Role of the PCMO and health unit in coordination of medical care (see section 5.5
below).

5.2 Immunization

Prior to their departure, OHS reviews the immunization history of all PCRVs and
makes a case-by-case determination on the primary series and booster vaccinations
necessary for the individual’s assignment. PCRVs are required to obtain all necessary
immunizations in the U.S. prior to their departure for country. On occasion, a PCRV
will not be able to complete required immunizations or a booster prior to departure. In
these cases the PCMO should provide the necessary immunizations in country.

PCRVs are required to bring their World Health Organization (WHO) card or
immunization record with them to post.

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TG 127
Peace Corps Response Volunteers

5.3 Medical Records

A standard Peace Corps health record containing medical clearance information and a
problem list are prepared by OHS for all PCRVs and forwarded to post by SFTP. The
PCMO should maintain the record in the health unit according to the standard guidance
on health records outlined in Technical Guideline (TG) 210 “Health Records.”

5.4 Medical Kits and Malaria Prophylaxis

The PCMO should provide PCRVs with a Medical Kit and, if indicated, appropriate
malaria prophylaxis.

5.5 Case Management and Medical Evacuation for Significant Medical Problems

For significant medical problems, PCRVs receive the same services provided to all
Trainees and Volunteers. This includes PCMO case management through the health
unit, referral to local resources, OHS consultation, and, if required, medical evacuation
(medevac).

5.6 Close of Service Evaluation

All PCRVs must be fully informed of their post service health benefits and receive a
COS physical exam and health evaluation according to the guidance outlined in TG 330
“Post-Service Health Benefits and Close of Service or Extension of Service Health
Evaluations.”

The COS examination may be performed by the PCMO (if the PCMO is a physician,
nurse practitioner, or physician assistant) or by the Area Peace Corps Medical Officer
(APCMO). If the PCRV has served less than 1 year, a COS dental is not included.

For PCRVs, PCMOs have liberal authority to issue PC-209B authorizations (see TG
330, ATTACHMENT F). The PC-209B “Authorization for Volunteer Medical
Examination and Labs” authorizes a complete history, physical exam and appropriate
lab tests in the U.S. The form must be issued with a PC-1790 (COS/EXT), and must be
used within 60 days of COS.

A complete COS exam is required to insure eligibility for Federal Employees’


Compensation Act (FECA) benefits and AfterCorps coverage (see Section 8 below).

6. MEDICAL SEPARATION

PCRVs will be medically separated by Peace Corps when a medical condition arises that
precludes continued service. Criteria for medical separation of a PCRV are identical to the
criteria for a PCV as outlined in Peace Corps Manual Section (MS) 284 and TG 160
“Medical Separation.”

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TG 127
Peace Corps Response Volunteers

7. PEACE CORPS RESPONSE EXTENSIONS AND TRANSFERS

Medical clearance by OHS is required for all extending PCRVs and for PCRV transfer to a
second country.

8. POST-SERVICE BENEFITS

Returning PCRVs receive the same allowances and benefits as Peace Corps Volunteers (see
TG 330 for additional information).

PCRVs are covered by the three-tiered health benefit program available to all Peace Corps
Volunteers. These benefits are:

1. PC-127C authorizations. 127C authorizations are used to authorize evaluation of Peace


Corps service-related health conditions.

2. FECA benefits. FECA covers the cost of treatment for service-related health conditions.

3. CorpsCare insurance. AfterCorps is a comprehensive health insurance policy that


covers non-service-related medical problems.

The PCMO is responsible for providing PCRVs with information about their post-service
health benefits.

9. CARE FOR PCRVs IN COUNTRIES WITH NO PEACE CORPS POST

PCRVs may serve in countries with no Peace Corps post. In this situation, the Peace Corps
Response program office will collaborate with OHS to design a program to support the health
needs of the PCRVs. Most commonly, PCR and OHS will make arrangements with the U.S.
Embassy or a sponsoring non-governmental organization to ensure access to primary care,
medical records management and emergency case management.

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Peace Corps
Technical Guideline 130

MEDICAL CARE TO NON-VOLUNTEERS

1. PURPOSE

• To provide guidance to Peace Corps Medical Officers (PCMO) on care of non-


Volunteers.
• To provide a framework for Joint Medical Unit (JMU) agreements.

2. BACKGROUND

The Peace Corps Act authorizes Peace Corps to provide medical care for Volunteers and
Trainees. Peace Corps does not authorize medical care for non-Volunteers. Care to non-
Volunteers is provided only in exceptional circumstances.

PCMOs may provide care to non-Volunteers through specific arrangements, such as


agreements with the U.S. Department of State (DOS) i.e., the U.S. Embassy (see sections 5
and 6 below).

3. MEDICAL CARE TO RETURNED VOLUNTEERS

Returned Peace Corps Volunteers (RPCVs) are not eligible to receive medical care from the
PCMO. RPCVs who remain in country after service and those who travel after Close of
Service (COS) are expected to access local health care. In these situations, PCMOs should
support and assist RPCVs in obtaining necessary medical care. This may involve a referral to
a qualified local provider or directing the RPCV to consular affairs at the U.S. Embassy.

CorpsCare post-service health insurance will reimburse Volunteers for care rendered outside
the U.S. RPCVs should review the CorpsCare contract for details of their coverage and
contact the insurance company, Clements and Co. for assistance. Contact information for
Clements and Co. is provided in Technical Guideline (TG) 330 “Post-Service Health
Benefits and Close of Service or Extension of Service Health Evaluations” section 3.4 and
ATTACHMENT A.

The PCMO should consult OMS if a returned Volunteer is requesting evaluation of a service-
related injury or illness within six months after COS.

See TG 120 “Medical Benefits for Current and Former Trainees and Volunteers” for
additional information on post-service benefits.

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TG 130
Non-Volunteers

4. MEDICAL CARE TO U.S. GOVERNMENT EMPLOYEES

4.1 Peace Corps Staff

U.S. direct-hire Peace Corps staff and dependents receive care through the DOS
medical program. They are also covered by one of the group health insurance plans
available to U.S. Government employees. When no DOS medical provider exists in
country, employees should contact the DOS Regional Medical Officer assigned to the
post for assistance.

Locally hired employees and contractors generally access the local health care system
for care. In some cases, host country law requires the Embassy medical unit to provide
care to locally hired employees and contractors of U.S. Government agencies.

4.2 Employees and Contractors of Other U.S. Government Agencies

Employees of other U.S. Government agencies, e.g., USAID, USIA, etc., and their
dependents receive care under the DOS Medical Program. As with Peace Corps staff,
locally hired employees and contractors generally access the local health care system
for care.

Health care benefits for contractors are specified in their contracts and are not generally
provided by the Embassy medical unit. In some cases, contractors may be authorized
by the DOS to receive care in the Embassy medical unit.

5. JOINT MEDICAL UNITS

ATTACHMENT A establishes Agency policy on Joint Medical Units (JMUs).

Under certain limited circumstances, Peace Corps may enter into an agreement whereby
Peace Corps and the DOS share the services and/or facilities of their respective medical
units. In very limited circumstances, where DOS does not maintain a medical unit, Peace
Corps may extend the services of its PCMO and the facilities of its medical unit to persons
eligible for health coverage under the DOS medical plan.

Peace Corps will consider requests for provision of joint medical services on an individual,
country by country basis, and will agree to make such services available when Peace Corps
can do so without impairing its ability to meet its primary responsibility of providing services
to Peace Corps Trainees and Volunteers.

No JMU agreement or any other arrangement to share medical unit resources shall be
established without the approval of the Peace Corps Chief of Staff and the Director of the
Office of Medical Services (OMS) in accordance with the procedures established in the
Peace Corps’ Policy Statement on Joint Medical Units dated May 1, l995 (revised July, 2000)
(see ATTACHMENT A).

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TG 130
Non-Volunteers

Informal collaboration between Peace Corps and Embassy health units at post is common.
These forms of collaboration do not typically involve formal JMU agreements. Examples
include:

Cross-Coverage Arrangements

The PCMO and the Embassy provider often cover for each other in situations where the
Medical Officer at one of the units is absent. Such arrangements do not require a JMU
agreement. However, as with JMU agreements, professional liability or indemnification
should be established between the PCMO and the Embassy.

Sharing of Medical Supplies and Drugs

Medical supplies and drugs purchased with Peace Corps funds are for Volunteer use only.
However, the PCMO and the Embassy provider may loan urgently needed medications or
other supplies to each other when reimbursement or replacement can be arranged.

Peace Corps funds may not be used to pay medical bills of individuals other than Peace
Corps Volunteers and their minor dependents.

Laboratories

Unlike the DOS medical program, Peace Corps does not employ Regional Medical
Technologists. In larger programs, Peace Corps and State Department may set up a joint
laboratory under the supervision of a State Department Regional Medical Technologist.

See TG 200 “Overseas Health Units” for additional information on Peace Corps health unit
laboratories.

6. LIABILITY COVERAGE FOR PCMOs

Peace Corps indemnifies PCMOs for care provided to Trainees, Volunteers, and minor
dependents. Indemnification means that in the event of a medical malpractice action against a
PCMO or the Peace Corps, the U.S. Department of Justice will provide legal representation
and the U.S government will pay any monetary settlement of that action. In the 40-year
history of the Peace Corps, no Volunteer has ever brought a medical malpractice action
against a PCMO or the Agency.

Peace Corps does not indemnify PCMOs for care to non-Volunteers, including Peace Corps
staff and Embassy personnel. When the PCMO provides care to non-Volunteers through an
agreement with the U.S. Embassy, professional liability or indemnification should be
established between the PCMO and the Embassy (see ATTACHMENT A).

7. EMERGENCY MEDICAL CARE FOR NON-VOLUNTEERS

In a life-threatening situation, the PCMO may be asked to provide emergency care to a non-
Volunteer, including Peace Corps staff, Embassy personnel or an RPCV. If the PCMO is the

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TG 130
Non-Volunteers

most qualified provider at the scene of an emergency, providing care until the individual can
be stabilized and transferred to an appropriate facility is appropriate.

Office of Medical Services March 2001 Page 4


TG 130 ATTACHMENT A

JOINT MEDICAL UNITS


Peace Corps' Policy Statement
May 1, l995 (revised July 2000)

I. Introduction.

It has generally been understood that a Peace Corps Medical Officer ("PCMO") is not responsible
for the medical care of non-Peace Corps Volunteers, including former Volunteers, Peace Corps
staff, Peace Corps contractors, and other U.S. Federal employees and their dependents. In
certain countries, however, where adequate medical resources have not been available, Peace
Corps and the Department of State ("State") have successfully carried out reciprocal
arrangements for back-up support, coverage during absences and the sharing of medical facilities
(outside an embassy). In recognition of these past successes and current similar such
circumstances, and in the spirit of cooperation and the principles underlying the Administration's
reinventing government plan, Peace Corps herein sets forth its policies and procedures with
respect to entering into "Joint Medical Unit" ("JMU") agreements with State.

II. Background.

Section 5(e) of the Peace Corps Act, as amended, (22 U.S.C. § 2504(e)) requires that Peace
Corps Volunteers be furnished such health care during and after service as the President deems
"necessary and appropriate." To fulfill this mandate, the Peace Corps administers a health-care
program that includes a health unit at each overseas post, the sole purpose of which is to provide
needed preventive, curative, and referral services to Peace Corps Volunteers. Accordingly, the
primary responsibility of a PCMO is to implement and administer the health-care program for the
benefit of Trainees and Volunteers.

In addition to the aforementioned statutory-mandated obligations, a 1991 General Accounting


Office report on the Volunteer healthcare system identified areas for improvement in the Volunteer
Health System. Legislation subsequently enacted in section 3 of Public Law 102-565, mandates
that Peace Corps contract for bi-annual evaluations of "the health-care needs of the Peace Corps
Volunteers and the adequacy of the system through which the Peace Corps provides health-care
services in meeting those needs." Two such evaluations have been completed and submitted to
the Congress, with an agency report, as required.

The December 28, 1994, Report by the Joint Commission on Accreditation of Healthcare
Organizations ("JCAHO Report") recommended, among other things, that the Peace Corps and
State "seriously reconsider the current practice of using one provider to serve the needs of both
health units." The Report noted that some PCMOs "are on call 24 hours a day, 365 days a year."
When the PCMO is the health care provider for non-Volunteers, "the PCMO is unable to fill many
of the broader functions of the position," including but not limited to, participation in site visits, new
site selection, Peace Corps training, counseling, etc. "This situation [of covering both Volunteers
and State personnel] can place added stress on the PCMO and Peace Corps staff, lead to
dissatisfaction, increased turnover, and affect the overall quality of care provided to both groups."
JCAHO Report at page v. For these and other reasons, Peace Corps considers the prospect of
JMU agreements cautiously.

Peace Corps' consideration of JMU agreements is also made within the parameters of its
personnel practices for medical services. Every PCMO provides service to the Peace Corps
pursuant to a personal services contract. Under the provisions of § 10(a)(5) of the Peace Corps
Act, as amended, personal service contractors are not considered officers or employees of the
U.S. Government for any purpose. As a result, the PCMO may not perform governmental
functions, and Peace Corps does not have the authority to direct or otherwise require a PCMO to
carry out activities beyond the scope of a PCMO's (personal services) contract. For instance, the
"statement of work" of existing contracts may not include providing services to anyone other than
Volunteers.

Page 1
TG 130 ATTACHMENT A

III. Policy.

In light of Peace Corps' statutory obligations to provide health and medical care for all Trainees,
Volunteers, and their dependents during overseas training and service, and to ensure continued
compliance with recommendations made in the first two evaluations required by Congress, Peace
Corps generally will not establish joint medical units. However, under certain limited
circumstances, Peace Corps may enter into an agreement whereby Peace Corps and State share
the services and/or facilities of their respective medical units (e.g., Type 1 and 2 arrangements;
see section IV below) or, in very limited circumstances, where State does not maintain a medical
unit, Peace Corps may extend the services of its PCMO and facilities of its medical unit to
persons eligible for health coverage under State's Medical and Health plan (e.g.. a Type 3
arrangement; see section IV below )

Peace Corps will consider requests for provision of joint medical services on an individual, country
by country basis, and will agree to make such services available when Peace Corps can do so
without impairing its ability to meet its primary responsibility of providing service to Peace Corps
Trainees and Volunteers.

No JMU agreement or any other arrangement to share medical unit resources shall be
established without the written approval of the Peace Corps Chief of Staff and the Director of the
Office of Medical Services ("D/OMS"), in accordance, with the procedures set forth in section V.
below.

A. Conditions.

1. Where Peace Corps would be the sole provider of medical services pursuant to a
JMU agreement (e.g., Type 3), Peace Corps generally will not consider a request to
establish a JMU:

a. for the first 24 months of a new Peace Corps program, due to the extraordinary
challenges in establishing and implementing a successful Volunteer health unit at
a new post, or

b. at a post with more than:

i. 30 Volunteers; or

ii. 20 non-Volunteers who are eligible for State Medical and Health care through
1
the embassy.

2. Peace Corps will not enter into a JMU agreement for any of the possible
arrangements contemplated under this policy statement if State would not agree to
the following principles that shall be specified in each JMU agreement:

a. Scope and coverage. Peace Corps will provide or make available a PCMO and
services only to the extent that Peace Corps can do so without impairing its ability
to meet its primary responsibility of providing service to Peace Corps Volunteers.

i. Medical services provided pursuant to a JMU agreement shall be limited in


scope and nature to those provided to Peace Corps Volunteers.

ii. Peace Corps assumes no responsibility for providing a full program of


benefits, care, and services of the State Department Medical Program post
health unit, nor does Peace Corps assume any responsibility for any
obligation which the State Department may have pursuant to its medical and

1
The figures in Condition A.l.b are not absolute limits, and may be adjusted depending on the
circumstances and conditions of a particular post. However, amounts exceeding the figures specified
herein would generally establish a condition at post that would preclude the execution of the
Volunteer/Trainee Health Program where only one (e g., PCMO) provider is present.

Page 2
TG 130 ATTACHMENT A

health plan to ensure access to adequate medical and health service for
personnel covered under such a plan.

iii. Under no circumstances will Peace Corps be required to increase its medical
support staff beyond what is required for Volunteer medical support.

iv. The type of "direct" care to be provided pursuant to a JMU agreement may be
limited by the training and experience of the PCMO and/or the medical
facilities of Peace Corps at a particular post. Such limitations shall be
specified, to the extent known and possible, in respective JMU agreements.
Thus, for instance, if certain types of direct care are not possible, a PCMO
will make appropriate referrals.

v. The embassy shall advise all eligible personnel of the scope of the services
contemplated under a JMU agreement. The PCMO cannot provide care
beyond the professional capability of the PCMO, or the Peace Corps medical
facility. The most common requirements where a PCMO could have limited
or no specific capabilities include pediatric or prenatal care, and complex or
high risk medical conditions. The PCMO's determination of whether treatment
is within the scope of his/her clinical skills is final.

vi. Peace Corps will not furnish hospitalization, consulting physician fees,
consulting laboratory fees, pre-departure or end-of-service examinations to
eligible personnel under a JMU agreement.

vii. The embassy shall also be informed of and respect those times during the
year when it is anticipated that a PCMO will have an increased workload due
to special cycles of the Peace Corps' schedule, including, but not limited to,
pre-service training, in-service training and close of service sessions.

b. Costs and Expenses. State will provide:

i. a percentage of the PCMO's salary and the overhead costs associated


with operating the Peace Corps medical facility; and

ii. full reimbursement for any direct costs of items such as medicines,
vaccines, disposable equipment, etc.

The procedures, basis of the percentage, and expense estimates related to


costs and expenses will be set forth in respective JMU agreements .

c. Management and Supervision.

i. Peace Corps is solely responsible for decisions regarding the overall


management of the Peace Corps health unit, and OMS, the PCMO and
the Country Director shall consult with one another to determine the
priorities and availability of the PCMO for purposes of a JMU Agreement.
Peace Corps may consult the Area Peace Corps Medical Officer
("APCMO") and/or the State Regional Medical Officer ("RMO") for
guidance, if necessary.

ii. Peace Corps, through the Country Director and OMS, will supervise the
PCMO and operate its health unit in accordance with pertinent Peace
Corps standards, regulations, policies, guidelines and procedures. Such
oversight and supervision shall not, however. directly include care
provided pursuant to a JMU agreement to eligible non-Volunteers.
Respective JMU agreements shall include procedures whereby State,
through an RMO, provides or otherwise assumes responsibility for
supervision of care of persons made eligible for care as a result of a JMU
agreement.

Page 3
TG 130 ATTACHMENT A

iii. The qualifications of a PCMO, and/or any other representative of a Peace


Corps medical unit, will be determined solely by Peace Corps.

iv. It is understood that a JMU agreement that provides for extending the
services of the PCMO and/or sharing Peace Corps and State medical
providers must be accompanied by a personal service contract between
the PCMO and State to obtain the medical services and to ensure that
the PCMO is covered by State's medical indemnification policy.

IV. JMU types and considerations related thereto.

If the aforementioned conditions are met, then Peace Corps will consider a request in light of the
type of JMU proposed and specific conditions and requirements of the post. In addition to the
principles and procedures set forth herein, consideration shall be given to the past experience in
that country with regard to endemic diseases, serious illnesses, medical evacuations and
environmental hazards, the medical delivery system available to eligible non-Volunteers in
country, i.e., whether State already employs a medical officer and maintains health facilities of its
own at post, and any other factor relevant to a particular post. Different types and factors related
thereto include the following:

• Type 1: "Common facility, shared staff." Under this circumstance, the PCMO and an
embassy would share health facilities, and the PCMO and an embassy medical provider each
see both Volunteers and Trainees and non-Volunteers. To the extent a facility is to be used
by both Peace Corps and State, it may be located at the Peace Corps office or some neutral
site, but it shall not be located in an embassy or within an embassy compound. An embassy
and Peace Corps would each contribute medical personnel to the unit.

• Type 2: "Common facility, separate staff." Under this circumstance, within one health unit
facility, the PCMO would see only Trainees and Volunteers and the Embassy provider would
see only non-Volunteers. Sharing medical facilities (equipment and supplies) is preferable to
sharing joint medical personnel. As with a Type 1 arrangement, if a facility is to be used by
both Peace Corps and State, it may be located at the Peace Corps office or some neutral site,
but it shall not be located in an embassy or within an embassy compound

• Type 3: "Access agreement." In certain, limited situations (see, e.g., "Conditions," above),
where Peace Corps is the primary American presence or the only other presence besides
State, Peace Corps will consider providing care by the PCMO for both Volunteers and non-
Volunteer eligible personnel through use of the Peace Corps medical facilities.

V. Procedures.

The Peace Corps and the requesting embassy shall follow the procedures listed below when a
joint medical unit is under consideration, or when an embassy has an interest in utilizing the
services of a PCMO or Peace Corps' medical facilities:

A. The embassy, through its ambassador, should submit a request to the Country Director in
writing outlining the posts' medical needs. The request should specify:

1. the number of persons eligible for coverage under the State Medical and Health Plan,
2
including non-official Americans such as Fulbright scholars, etc.;

2. whether and how State has provided medical services to eligible personnel prior to
the request for a JMU;

3. the embassy's express recognition of the conditions and principles set forth in this
policy statement; and

2
Such persons shall be identified on a list attached as an addendum to the JMU agreement. Such list shall
be updated from time to time, as specified in the JMU agreement.

Page 4
TG 130 ATTACHMENT A

4. any other information related to the anticipated workload or other special


considerations that Peace Corps should consider to determine whether it may offer
quality medical services pursuant to a JMU agreement.

(NOTE: Upon receiving such a request, the Country Director should inform the embassy
of the process set forth herein and that the Country Director does not have authority to
enter into a joint medical unit agreement without the written approval of IO/AD pursuant to
such procedures).

B. The Country Director, with assistance from the PCMO, should forward the embassy's
request, and the following information, to the Regional Director and the D/OMS: the
number of Volunteers and Trainees currently in country, and the anticipated trainee input
in the current and subsequent year;

1. the number of Volunteers and Trainees currently in country, and the anticipated
trainee input in the current subsequent year;

2. the anticipated number of medical personnel needed to staff the medical facilities
(including during pre-service training or other peak periods);

3. a description of the proposed arrangement with the embassy regarding staffing and
use of facilities; any current or anticipated arrangements between the PCMO and the
State provider regarding provision of backup medical coverage during annual leave,
CME or other absences;

4. any current or anticipated arrangements between the PCMO and the State provider
regarding provision of backup medical coverage during annual leave, CME or other
absences; and

5. the anticipated expenses associated with Peace Corps providing the PCMO and/or
medical facilities to non-Volunteers (direct costs for medicines, vaccines, travel, etc.,
and a portion of salary and overhead, e.g., rent).

The Country Director and the PCMO should also include a statement expressing their
opinion of whether the proposed arrangement would adversely affect Peace Corps' ability
to provide quality health care to Volunteers. If there is only one PCMO at the post, it
should indicate how and whether the PCMO would cover site visits, escort medevacs,
pre-service training, annual leave, CME, any other training events, and other official
travel. The Country Director should include any other relevant information related to the
embassy's proposal that would help Peace Corps/Washington make an informed decision
about the request.

C. The Regional Director and D/OMS shall consider the request in light of the policies,
conditions and principles set forth herein, and any other relevant consideration. Upon
completion of their review, the RD and D/OMS will forward all information from the post,
along with a written recommendation, to the Peace Corps Chief of Staff.

D. The Peace Corps Chief of Staff shall review the request, all information related thereto,
and the recommendation by the Region and OMS, and after consulting with the General
Counsel and the Office of Contracts, determine whether to enter into a joint medical unit
pursuant to the request from country.

E. If Peace Corps Chief of Staff declines to approve the request, the Peace Corps Chief of
Staff shall promptly inform the ambassador and the country director of the decision in
writing.

Page 5
TG 130 ATTACHMENT A

F. If Peace Corps Chief of Staff approves the request, the General Counsel will draft an
agreement based on the information submitted with the request. The draft agreement
shall be sent to post for discussions with the embassy.

G. After any and all discussions with the embassy are completed, the Country Director shall
submit the proposed JMU agreement to the Peace Corps Chief of Staff and the OGC for
3
final approval. Copies of such agreements shall be maintained in OMS, the Region
(e.g., Chief Admin. Officer) and the post.

3
The Office of Contracts shall also review and approve the PCMO's contract with State and the cost-
sharing component of a JMU agreement.

Page 6
Peace Corps
Technical Guideline 150

MEDICAL CONFIDENTIALITY

1. PURPOSE

This Technical Guideline (TG) discusses Peace Corps policy on medical confidentiality and
indicates when medically confidential information should be shared with non-medical staff.
This guideline is based on Peace Corps Manual Section (MS) 268 “Medical Confidentiality.”

2. BACKGROUND

Peace Corps policy in this area is based on two important, but different, goals:

Ensuring that Trainees and Volunteers can be completely open with their health care
providers and not withhold important medical information for fear that it will be released to
others or used for non-medical reasons;
Ensuring that Peace Corps Medical Officers (PCMOs), as members of the senior
management team at post, cooperate with Country Directors (CDs) and the Inspector
General(IG) by sharing with them information that is relevant to the performance of their job
responsibilities.

Maintaining Volunteers’ trust that their medical information will be handled appropriately is
a critical part of an effective Volunteer health care program. Volunteers should understand
Peace Corps policy on medical confidentiality, including the circumstances under which
information they provide to their PCMO may be shared with non-medical staff.

Volunteer medical information overseas is protected by the Privacy Act. Office of the
General Counsel is available to handle inquiries concerning the Privacy Act.

3. PEACE CORPS MEDICAL CONFIDENTIALITY POLICY

Medical information is confidential and private, and the release of this information is closely
controlled. Medically confidential information may not be released without the Volunteer’s
written consent except as outlined in MS 268 and this TG.

PCMOs may disclose medically confidential information to individuals and entities outside
of Peace Corps only for purposes of medical treatment and/or care. For other disclosures
outside of Peace Corps, contact the Office of General Counsel prior to disclosure.

4. MEDICALLY CONFIDENTIAL INFORMATION

Medically confidential information is oral or written information, directly relating to the past,
present or future health condition, care or treatment of a Volunteer contained in the

Office of Health Services July 2015 Page 1


TG 150
Confidentiality

Volunteer’s Peace Corps health record or provided by the Volunteer to the Office of Medical
Services or the Counseling and Outreach staff, a PCMO, or another health care provider.
The term Volunteer includes a Trainee, Volunteer, Returned Volunteer, and an applicant for
Peace Corps service.

5. NON-MEDICALLY CONFIDENTIAL INFORMATION

The following information is not considered medically confidential:

 Non-medical information not directly related to the individual's medical care or treatment
that is provided to the PCMO or other health care provider;

 Medical information voluntarily provided by the individual to non-medical Peace Corps


staff or others; (Although not medically confidential, the information may need to be
handled with discretion.);

 Information about the impact of an individual's medical condition on his or her ability to
be at site, perform work assignments, or engage in other Peace Corps-related activities,
without describing the underlying conditions; e.g.; the fact that a Volunteer will be absent
from site and the period of expected absence; the fact that a Volunteer requires medevac
and the likely duration; limitations on the ability to perform particular tasks because of
medical conditions for which the individual is being accommodated;

 Statistical information related to the occurrence of diseases, injuries or other medical


conditions among Volunteers that may be relevant to the conduct of the Peace Corps
program;

 Routine individual immunization information;

 Behavior problems that may arise that can be discussed without revealing the underlying
condition; and

 Information about sexual harassment by any Peace Corps staff, Volunteers, or anyone
else associated with the Peace Corps.

6. SHARING MEDICALLY CONFIDENTIAL INFORMATION WITH NON-


MEDICAL STAFF

Medical confidentiality may be extended to, and medically confidential information shared
with, non-medical Peace Corps staff that has genuine “need to know” medically confidential
information in order to perform their jobs. When medically confidential information is
disclosed, the person disclosing the information is responsible for letting the recipient know
that he or she is responsible for keeping the medical information confidential.

A CD’s job responsibilities are broad, including ultimate responsibility for the safety,
security, and support of all of the Volunteers in country; for Volunteer programming and
training; for representing the Peace Corps to host government and non-governmental officials

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TG 150
Confidentiality

and to the U.S. mission; and for administration of the overall Peace Corps program in
country. He or she has a need to know medically confidential information if it is important in
performing any of these responsibilities.

The following are examples of medically confidential information that must be disclosed by
the Peace Corps Medical Officer (PCMO) to the Country Director or designee:

 The existence of a medical condition that requires accommodation, and the nature of the
accommodation.

 Evidence of use of drugs by a Peace Corps Volunteer in a manner not authorized for
medical purposes.

 Information relating to a serious threat to the health or safety of the Volunteer or to any
other person.

The IG is authorized to have access to all records, reports, audits, reviews, documents,
papers, recommendations, or other material in order to carry out their responsibilities.
PCMO must provide medical information required by the IG in the performance of their
duties.

In cases where non-medical staff and PCMOs cannot in good faith agree upon whether, or
how much, medically confidential information should be shared, they should contact the
Office of General Counsel. The Office of General Counsel will review the underlying
information and the circumstances of the case and in consultation with the Office of Health
Services (OHS), determine what information should be shared.

It should be understood that PCMOs are not breaching medical confidentiality by sharing
medically confidential information with non-medical staff that have a specific need to know
that information. Rather, they are extending medical confidentiality to a particular staff
member, who, like the medical professional, is then obligated to handle the information
confidentially.

The following are examples of information that may be disclosed on a specific need-to-know
basis to non-medical Peace Corps staff:

 Information about a Volunteer's non-compliance with medical advice or policies that


pose a serious risk of harm to the Volunteer or others (e.g., failure to use malaria
prophylaxis);

 Information relating to a Volunteer's provision of misleading, inaccurate, or incomplete


medical information to the Peace Corps during the application process;

 Medical information relating to a medevac, if the information is necessary to ensure


proper arrangements for the medevac;

 Information about a Volunteer's medical condition if it is necessary to ensure the safety


or security of the Volunteer or other person. (For example, if the Volunteer's medical

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TG 150
Confidentiality

condition might affect the ability to evacuate the Volunteer in an emergency, or may
require additional assistance from another person);

 Information about a Volunteer's medical condition that is affecting the


Volunteer's performance, or wellbeing; and

 Information relating to risky sexual or other behavior that may be putting the health of
the Volunteer or another person at serious risk.

7. INQUIRIES FROM FAMILY MEMBERS AND OTHERS

The confidentiality of Volunteer medical information must be respected, even when faced
with concern expressed by family members and friends. Notification or discussion of a
Volunteer’s condition without the Volunteer’s written consent may be made by OHS or
PCMO only in cases where a Volunteer is incapable of providing consent and is considered
to have a serious or life threatening condition. In such cases, notification is made to the
individuals whom the Volunteer designated as emergency contacts on the Trainee/Volunteer
Registration Form.

8. TRANSMITTING MEDICALLY CONFIDENTIAL INFORMATION

Fax

A cover sheet indicating that medically confidential information follows should be used with
all fax transmissions. Transmission of medically confidential information should be
authorized by the PCMO and, in cases where the health unit does not have a confidential fax,
post should have procedures to protect confidential information from being disclosed.

Telephone

Medical Officers should be able to conduct telephone conversations without being overheard
so that Volunteers’ privacy and confidentiality can be maintained.

E-Mail

Use Secure File Transfer Program (SFTP) when transmitting medically confidential
information using an e-mail.

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Peace Corps
Technical Guideline 152

BUSINESS ASSOCIATE STATEMENT OF CONFIDENTIALITY

1. PURPOSE
To enter into a business agreement with any entity that creates, receives, maintains or
transmits protected health information. Such an agreement will provide satisfactory
assurances that the business will properly safeguard such information.

2. BACKGROUND
All staff that receives, create, use, disclose or otherwise transmit protected health
information is required to comply with the policies of maintaining confidentiality. Peace
Corps staff includes all employees and personal services and other contractors. Any
Peace Corps staff or contractor, who fails to comply with the provisions of this technical
guideline or any other Peace Corps operating procedure (Manual Section), is subject to
action consistent with the terms of the relevant contract.

3. STATEMENT OF CONFIDENTIALITY
The Statement of Confidentiality (Attachment A, see page 2 below), should be used when
access to confidential information is needed by a Business Associate.

Source: Manual Sections 268 “Medical Confidentiality and 269 “HIPAA Administration

____________________________________________________________________________________________

Office of Health Services December 2015 Page 1


Technical Guideline 152
Attachment A

Memorandum

DATE:

TO:

RE: Statement of Confidentiality

In accordance with the Peace Corps Act and the Privacy Act, _________hereby agrees to maintain the
strictest level of confidentiality with respect to all medical information and data to which he/she has
access.

This memo authorizes the named individual to have access to all medical information and data
appropriate for the performance of their duties.

_________________________________________ _____________________________
Business Associate Signature (Date)

_________________________________________
Business Associate Print

_________________________________________ _____________________________
Witness Signature (Date)

_________________________________________
Witness Print

Confidentiality Statement 9/2010, Reviewed 12/2015


Peace Corps
Technical Guideline 155

NON-COMPLIANCE WITH
MEDICAL POLICIES OR INSTRUCTIONS

1. PURPOSE

The purpose of this guidance is to establish the procedures to follow when a Volunteer or
Trainee does not comply with Peace Corps’ medical policies or instructions.

2. BACKGROUND

Volunteers face significant health risks and immediate access to health care is often limited.
Volunteers are expected to follow both Peace Corps’ medical policies and the medical
instructions of Peace Corps Medical Officers (PCMOs) regarding prevention and treatment
of illness and injury. Non-compliance may result in serious consequences.

Volunteers who do not comply with medical policies or instructions subject themselves and
others to unnecessary risk of harm. The Peace Corps is committed to ensuring that
Volunteers stay healthy during their service; non-compliance may adversely affect the
Agency and/or other Volunteers.

Therefore, in certain circumstances (see section 4 below), it may be appropriate for a PCMO
to report a Volunteer’s non-compliance to the Country Director (CD) for possible
administrative action, including administrative separation in accordance with Peace Corps
Manual Section (MS) 284. This usually requires that the PCMO extend medical
confidentiality to the CD (see TG 150 “Medical Confidentiality”).

3. MANAGING THE NON-COMPLIANT VOLUNTEER

The PCMO response to non-compliance with medical policies or instructions depends on the
degree of increased risk to the Volunteer or others. For example, the PCMO may choose any
of the following options:
 Provide or reinforce relevant health education with the Volunteer. Follow-up on
compliance when feasible or develop a contract with the Volunteer regarding compliance.
 Educate the Volunteer of the need to modify behavior or comply with instructions.
 Inform the Volunteer of the risk severity and the possible medical and
administrative consequences of continued non-compliance.
 Review the case with the Office of Health Services (OHS), including Regional Medical
Officers (RMO) and Regional Medical Officer-Psychologist (RMO-P).
 Refer the case to the CD for consideration of administrative separation.

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TG 155
Non-Compliance

The PCMO should fully document in the Volunteer’s health record the non-compliant
behavior, the actions taken, and the instructions given to the Volunteer.

Administrative action by the CD should not interfere with the provision of medical care to
the Volunteer. For example, a PCMO should evaluate and treat a Volunteer for suspected
drug abuse while the CD is simultaneously reviewing the case for possible administrative
action. In some cases it may be necessary to medically evacuate a Volunteer prior to any
administrative action. The PCMO should contact OMS for assistance in such cases.

4. WHEN TO REFER NON-COMPLIANCE TO THE COUNTRY DIRECTOR

If a Volunteer’s non-compliance poses a serious risk of harm to the Volunteer or others,


the PCMO should promptly refer the non- compliance to the CD. Due to the extremely
serious consequences that might follow non-compliance, the PCMO should always refer
the following actions to the CD:

 Violation of the Peace Corps motorcycle policy, including failure to wear a helmet while
driving or riding a motorcycle (see MS 523 “Motorcycles and Bicycles”).
 Use of drugs or medications in violation of PC policy.
 Refusal to receive required immunizations and/or prophylaxis.

The PCMO may also refer cases to the CD when a Volunteer’s consistent or repeated non-
compliance or other behavior against medical advice or policies creates a significant risk of
harm. Some common examples include:
 On-going participation in risky behavior or activities despite repeated counseling,
education, and support efforts, e.g., repeated and negligent exposure to STIs or HIV.
 Failure to take malaria prophylaxis reliably, especially if a documented case of malaria
has occurred (see TG 840).
 Failure to attend medical follow-up appointments or poor compliance with a
treatment plan.

 Excessive alcohol use.

In such cases, PCMOs must use their judgment to assess the seriousness, in terms of the
potential for harm, caused by the non-compliance and determine the appropriate course of
action.

Instances of Volunteer non-compliance or incomplete compliance that do not raise a serious


risk of harm to the Volunteer or others (such as missing occasional doses of medications or
lapses in food or water precautions) usually do not warrant referral to the CD, but they do
require continued education and reinforcement of healthy behaviors as described in section 3
above.

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TG 155
Non-Compliance

5. COORDINATION WITH THE COUNTRY DIRECTOR

It is the authority and responsibility of the CD, not OMS or the PCMO, to evaluate the
particular facts of each case and make a determination regarding disciplinary action. In cases
of administrative separation, it is also the CD’s responsibility to ensure that the procedures
set out in MS 284 are followed correctly.

PCMOs are strongly encouraged to discuss the procedures to be followed in cases of


Volunteer non-compliance with their CDs. It is important that PCMOs and CDs have a
common understanding of their respective responsibilities and authorities in this area prior to
any actual cases that require referral for possible administrative action.

Office of Health Services April 2015 Page 3


Peace Corps
Technical Guideline 160

MEDICAL SEPARATION

1. PURPOSE

To describe the standards and procedures to be followed for medically separating a


Volunteer.

2. BACKGROUND

The Office of Medical Services (OMS), in consultation with the Peace Corps Medical Officer
(PCMO) and other medical consultants as appropriate, is responsible for making the
determination of whether a Volunteer should be medically separated.

The OMS makes every effort to maintain Volunteers’ health in country so that they can
complete their tours of duty. However, in certain cases, OMS must medically separate a
Volunteer because of a medical condition (see Peace Corps Manual Section (MS) 284 and
section 3 below).

Medical separation may take place either in the Volunteer’s country of service (“field
medical separation”) or following a medical evacuation (medevac) to the United States or a
third country.

3. CRITERIA FOR MEDICAL SEPARATION

A Volunteer or Trainee will be medically separated if he or she develops a medical condition


that, within 45 days, cannot be: (1) satisfactorily resolved or (2) reasonably accommodated in
the Volunteer’s or Trainee’s country of service (see MS 284).

3.1 Application of the Criteria for Medical Separation

Following are situations where medical separation might be appropriate:


• The condition has a high risk of being aggravated by or recurring during continued
Peace Corps service, and such a condition would significantly jeopardize the
Volunteer’s health and ability to successfully complete service.
• The treatment and/or follow-up of the health condition requires facilities or
resources that are not available in the Volunteer’s country of service.
• Even with reasonable accommodations, the Volunteer can no longer perform the
essential functions of his or her assignment.

Office of Medical Services March 2001 Page 1


TG 160
Medical Separation

Each case is assessed individually to determine whether the criteria for medical
separation are met. OMS may refer to the standards for medical qualification and
clearance (the Screening Guidelines) when making medical separation decisions.

Volunteers who have an urgent need for medical or psychiatric care, an unstable
medical condition, or a condition that cannot be managed by issuing a PC-127C
“Authorization for Payment of Medical/Dental Services,” will not be medically
separated (see TG 330 “Post-Service Health Benefits and Close of Service or Extension
of Service Health Evaluations” section 4.6). In these cases, most Volunteers will be
medically evacuated to the U.S. or a regional evacuation site for further evaluation and
treatment.

See also TG 170 “Pregnancy” for medical clearance to continue service in the setting of
Volunteer pregnancy.

4. ADMINISTRATIVE PROCEDURES FOR MEDICAL SEPARATION

Although not always possible, every effort should be made to reach a medical diagnosis prior
to medical separation. A diagnosis expedites the Department of Labor’s ability to process a
Volunteer’s claim for post-service benefits under the Federal Employees’ Compensation Act
(FECA).

All Volunteers being medically separated must complete the Close of Service (COS) process
in accordance the procedures outlined in TG 330 “Post-Service Health Benefits or Close of
Service and Extension of Service Health Evaluations.”

Volunteers who have been medically separated have the right to appeal (see MS 284).
Appeals should be made in writing to the Director of Medical Services.

4.1 Field Medical Separation

Field medical separations must be authorized by OMS.

In general, a field medical separation is appropriate only when the Volunteer’s medical
condition meets all of the following conditions:
• has a clear diagnosis;
• meets the medical separation criteria outlined in section 3 above;
• does not require immediate medical or psychiatric attention.

Prior to field medical separation, the PCMO should do the following:


• In conjunction with OMS, ensure that the Volunteer has timely access to medical
care upon return to the U.S.;
• Complete the COS process as outlined in TG 330 “Post-Service Health Benefits or
Close of Service and Extension of Service Health Evaluations”;

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TG 160
Medical Separation

• Forward the Volunteer’s departure date and home-of-record address to the


International Health Coordinator (IHC);
• Send the Volunteer’s health record to OMS by express delivery.

The PCMO should advise OMS if the Volunteer plans to appeal the medical separation
decision.

4.2 Medical Separation Following Medevac

If OMS determines that a Volunteer should be medically separated after a medevac, the
IHC will inform post, by fax, of the medical separation and the termination date. If the
health record is in country, the PCMO should send it immediately to OMS by the
fastest means possible (see TG 380 “Medical Evacuation” section 13.2 for additional
guidance on medical separation following a medevac).

5. REINSTATEMENT OR REENROLLMENT FOLLOWING MEDICAL


SEPARATION

Following every U.S. medevac that results in a medical separation, OMS sends the returned
Volunteer a letter documenting the decision and informing him or her of the procedures to
follow to be considered for reinstatement or reenrollment in the future. OMS and the PCMO
must provide similar documentation with each field medical separation. ATTACHMENT A
is a sample of the medical separation letter from OMS.

A Volunteer whose medical condition improves within twelve months of separation may be
eligible for reinstatement. If resolution of the medical condition takes longer than one year,
the medically separated Volunteer may be eligible for re-enrollment. (see MS 282
“Transfers/Reassignments, Reinstatements and Reenrollments of Trainees and Volunteers”).

Office of Medical Services March 2001 Page 3


TG 160 ATTACHMENT A

MEDICAL SEPARATION NOTIFICATION

Dear :

The primary goal of your medical evacuation was to resolve your medical condition in order to allow you
to return to country to continue your Peace Corps service. Unfortunately, your medical condition cannot
be resolved or safely managed in your country-of-service within the maximum-allowable 45 days.

Your current diagnosis is: .

Specifically, at this time we are unable to medically clear you to return to country because:

Your medical condition has a high risk of being aggravated by or recurring during continued
Peace Corps service, which would jeopardize your health.
We are unable to provide adequate follow-up for your condition in your country of service.
Even with reasonable accommodations you would not be able to perform the essential functions
of your Volunteer assignment.
Other:

If your medical condition improves within one year, you may be eligible for reinstatement. To apply for
reinstatement, call the Country Desk Unit at Peace Corps headquarters in Washington, D.C. at 800-424-
8580. The Desk Officer will contact the Office of Medical Services (OMS) to request your medical
clearance. Prior to determining medical clearance for reinstatement, OMS will need to review the
following information from your physician:
• Dates, frequency and duration of treatment;
• Diagnosis;
• Current medical status, identifying any limitations;
• Medical management plan and recommended follow-up.

You have the right to appeal the decision on your separation, in writing, to the Director of Medical
Services.

Medical Separation Date:

Reviewed by:
IHC/PCMO: Date:

Chief of Clinical Programs: Date:

Volunteer: Date:

NAME

SSN COUNTRY
Peace Corps
Technical Guideline 165

VOLUNTEER/TRAINEE DEATH

1. PURPOSE

To provide guidance to Peace Corps Medical Officers (PCMOs) in the event of a Volunteer
or Trainee death overseas.

2. BACKGROUND

There have been approximately three to four Volunteer deaths per year over the past ten
years, primarily the result of unintentional injuries, i.e., accidents.

Peace Corps Manual Section (MS) 265 "Death of a Volunteer” contains administrative
information concerning the death of a Volunteer as well as check lists of responsibilities of
select staff members at Post and at headquarters (HQ).

3. NOTIFICATION OF VOLUNTEER DEATH

The initial report to headquarters of a Volunteer death is made by the Country Director (CD)
by telephone, to the Counseling and Outreach Unit (COU). Notification of family members
in the event of a Volunteer death is made by the Peace Corps Director or her designee after
being informed by COU. In most cases, Peace Corps staff at post must identify the remains
of the deceased before the family will be notified.

4. ADVANCE PREPARATION

Country staff must be able to respond immediately in the event of a Volunteer death. This
requires advance preparation (e.g., annual tabletop exercises with Post staff) and cooperation
with the U.S. Embassy or Consulate. If there is no Embassy or Consulate in country, staff
should contact the appropriate Consular Officer for additional assistance with Department of
State requirements.
 ATTACHMENT A, a checklist for the “Autopsy, Preparation, Casketing and Shipment of
Remains of a Volunteer” taken from MS 265 “Overseas Disappearance and Death” can
be used for such preparation.
 Country staff should use plans developed for emergency communication and
transportation when preparing for the response to a death.
 The PCMO should identify in-country facilities for performing an autopsy.

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TG 165
Volunteer Death

In coordination with the U.S. Embassy Consular Office, Peace Corps is responsible for
handling the remains of all Peace Corps Volunteers/trainees who die overseas. The
Consular Officer can assist with local regulations, procedures and the identification of
mortuaries. The Consular Officer has been trained to witness autopsies and embalming
and may accompany Peace Corps staff involved in these procedures. The Embassy can
also advise on the purchase of appropriately sealed caskets and casket-length American
flags to drape the casket for transport.

5. MORTUARY, AUTOPSY, AND EMBALMING

When a Volunteer death occurs, immediate concerns are the management of the remains and
addressing grief in the Peace Corps community.

5.1 Preserving the Remains


Most deaths occur outside the capital city. Therefore, in advance, country staff should
identify refrigeration facilities in various parts of the country. The body should be
refrigerated as soon as possible following death.

The PCMO or other staff member may need to travel to the location, identify the body
and transport the body back to the capital city. Post should consult the Embassy
Consular Officer for assistance.

When transporting a body, post should consider the following:


 Supplies to wrap and preserve (chill) the remains, e.g., cold packs, ice, sheets,
gauze rolls, body bag, gloves; Ice should not directly come in contact with the
remains. Ice should always be in waterproof bags when used to preserve the body
during transport.
 Method of transportation and official documents to expedite the trip
 Advance arrangements for admittance to a mortuary in the capital city

5.2 Autopsy
OHS encourages the performance of an autopsy on all deceased Volunteers even if the
cause of death appears obvious. Many host country laws require an autopsy prior to
removal of a body from the country. The next-of-kin must give permission for an
autopsy unless it is required by local laws. If the host country does not require an
autopsy, it is preferred that it be performed in the U.S. by the Armed Forces Medical
Examiners System (AFMES) at Dover Air Force Base, Delaware. In the rare
circumstance that the family wishes to have the examination done in the host country,
the PCMO is responsible for identifying a qualified pathologist and an in-country
facility capable of performing an autopsy if the country does not have specifically
designated pathologists required to perform such autopsies. Whichever location is
chosen for the autopsy, COU will obtain that consent from the family and inform post
of the family's wishes.

Office of Health Services January 2016 Page 2


TG 165
Volunteer Death

If an autopsy is to be performed in country the PCMO, or another representative of


Peace Corps, should attend the autopsy and record all significant findings. Prior to the
autopsy, the handling of blood, fluid, and tissue specimens and/or slides should be
discussed with OMS. In most circumstances, OMS will arrange for one of the
pathologist from AFMES to contact the PCMO directly prior to the autopsy to educate
the PCMO on what to look for and how to collect and handle body fluids for further
testing.

In the event that the autopsy (primary or secondary examination) is done at AFMES,
the AFMES pathologist will also give guidance on the desired embalming techniques.
Information on AFMES services, forms for body fluid analysis, consent forms and
releases are attached.

Basic information about autopsies:


Gross Autopsy: A gross autopsy entails inspection of the body and the internal organs
so that any structural abnormalities can be ascertained. The cause of death in cases of
disease can sometimes be determined on the basis of the “gross autopsy.”

Microscopic Examination: At the time of the gross autopsy, specimens of all body
tissues are prepared using a fixative. After fixation, sections are taken and placed on
microscope slides. Microscopic examination reveals abnormalities in the histologic
patterns of the various tissues. These abnormalities can help pinpoint the cause of death
in many cases.

Toxicologic Studies: Specimens for biochemical analysis are extremely important in


cases where toxic substances may have contributed to the death, either accidentally or
with suicidal intent.

5.3 Embalming
Embalming is always required by U. S. and U.S. code-share commercial air carriers
before accepting a body for transport. If autopsy is performed in-country, or if an
autopsy will not be performed, embalming prior to repatriation is appropriate.

Embalming prior to autopsy limits the information that can be obtained as it makes
microscopic and toxicologic analyses more difficult or impossible. Therefore, if an
initial or a secondary autopsy is to be performed in the U.S., a limited embalming is
used.

Customs, laws, and procedures regarding embalming vary widely from country to
country. These laws should already be in your Post's HANDBOOK. The Consular
Officer can also provide more information on local procedures.

Office of Health Services January 2016 Page 3


TG 165
Volunteer Death

5.4 Shipment of Remains


The Peace Corps Director of Management and Operations (DMO) will coordinate the
shipment of remains with COU. The body is usually accompanied during transportation
to the U.S. by the CD personally or by a staff escort chosen by the CD. The
responsibilities of the escort are detailed in MS 265, attachment A.

The PCMO should assist in the transfer of the remains as follows:


 Provide dental records as needed to assist in identifying the remains.
 Write a report on the death. The report should include:
 Description of the incident
 Description of the first contact with the remains
 Comment on the escort of the remains
 Comment on the release of the remains to a mortuary
 Description of the autopsy and any findings
 Description of the embalming
 Method of sealing of the casket
 Comment on appropriateness of family members viewing the body
 Comment on memorial service that was held

 A medical report concerning the death of a Volunteer must be sent separately by the
PCMO to OMS

6. ADDRESSING GRIEF

Attending to the distress of Volunteers is an urgent need. Post should assign Peace Corps
staff members to brief Volunteers about the death as they come into the capital city.
Information should be given to the Volunteers frankly and openly. Staff should acknowledge
feelings of anger, guilt, and frustration, and make sure that any Volunteer who was involved
with the death comes to the capital city as soon as possible. Post will involve COU in
planning the events following a death.

The transfer of the remains from country should not be delayed. If time allows, a memorial
service may be held before the body leaves country. A brief ceremony or service (possibly at
the airport, if necessary) can be held if a more formal memorial service cannot be organized
in a timely fashion. In all cases, it is important for staff to assist Volunteers with their
grieving. COU will send a clinician to Post as quickly as possible unless specifically
requested not to by the CD.

As Volunteers arrive in the capital city it may be helpful to give them tasks, such as:
 Ask the Volunteers to write cards, letters or short remembrances for the family of the
deceased Volunteer.

Office of Health Services January 2016 Page 4


TG 165
Volunteer Death

 Ask the Volunteers to help with bouquets of flowers, candles, or remembrances of the
Volunteer for the memorial service.
 Ask Volunteers to keep a visual record of the service, by taking photos and organizing a
video recording of the service.

7. PSYCHOLOGICAL NEEDS
The PCMO and other country staff may ask COU for assistance in meeting the psychological
needs of Volunteers. COU is s available by telephone for consultation until a COU clinician
arrives in country.

A period of mourning is important for the Volunteer community. During this time the
Volunteers should be allowed to put everything else aside. A memorial service will allow the
expression of grief. Some Volunteers may have difficulty sleeping and may lose interest in
food. Volunteers who were especially close to the Volunteer or who were in the same
accident may need to be medically evacuated for counseling to the U.S. In most cases, this
will be a shared decision among COU, the PCMO and the Volunteer.

Other Volunteers may be fearful and vulnerable particularly in the case of a violent or
accidental death. They may think, “This could have been me.” They may be afraid to take
public transportation, for example, and may be fearful of their own safety. One area to
explore is how this death may make a difference to them.

The death may trigger other losses or past trauma and increase vulnerability. This
vulnerability may be expressed as depression, anxiety, or emotional withdrawal. The
Volunteer may experience loneliness, a sense of abandonment and separation. For assistance
with short term counseling, refer to TG 510 “Mental Health Assessment and Support.”

The Peace Corps host country staff may have their own way of marking a death. Be sensitive
to their needs and include them in the memorial service as they are willing to participate.
Allow them the opportunity to grieve.

The CD will generally keep the Volunteer community updated about the death. The COU
family liaison, the representative of Peace Corps at the funeral in the U.S., will be asked to
bring back any pictures or announcements of the service as well as those from the Post's
memorial service, plus any of the Volunteer's belongings specifically requested by the family
to make it more real.

Expect that there will be a ripple effect in the Peace Corps community from the death for six
months to one year. Volunteers who are completing their service within this time frame may
benefit from a referral a mental health clinician in the US using the 127Cs that you will
provide.

The death of a Volunteer is a difficult experience for all staff, and can be particularly difficult
for the PCMO. He or she may need some time to recuperate. Know that you are encouraged
to take some time off to be scheduled with your CD. Funds are available for you to see a
local mental health provider should you wish (see MS 682). PCMOs are also welcome to
speak with COU at any time.

Office of Health Services January 2016 Page 5


TG 165 ATTACHMENT A

CHECKLIST FOR AUTOPSY, PREPARATION,


CASKETING, AND SHIPMENT OF REMAINS
(Manual Section 265)

This checklist must be used by each Country Director in preparing a country specific written
procedure for handling death cases (see paragraph 4.5).

1. Is the Peace Corps Medical Officer familiar with simple basic practices in handling remains?
What should or should not be done?
a. Are rubber/plastic disaster disposal bags available?
b. Are rubber goods, such as gloves, sheets and underclothes available?

2. If for any reason the PCMO is unavailable (for example, on vacation in the United States or
a third country), is there a physician (Embassy physician?) who could assume his or her
responsibilities?

3. Do facilities exist to refrigerate the remains pending autopsy prior to embalming? Is there a
pathologist available in the host country to perform an autopsy? Where would the autopsy
be performed? If a pathologist is unavailable for any reason, could a pathologist (with
credentials acceptable to the host country) be flown in from a third country to perform the
autopsy? If not, could the remains be removed from the host country without embalming for
an autopsy in a third country? What logistical support or permits would be required to
facilitate any of the above? How would you accomplish it?

4. What facilities, if any, exist for embalming remains in the host country?
a. Local mortuary/hospital; private or government-owned?
b. At what cost?
c. Would there be a shortage of preservative chemicals in the host
country (formaldehyde, etc.)?
d. Are all supplies or equipment needed by a mortician available and
on hand?
e. Is there a local mortician with whom the PCMO and Country Director
can work to develop host country mortician instructions for immediate body preparation?

5. If no embalming facilities are available within the host country, where can the nearest
mortuary support be obtained and how quickly can its use be arranged for?
a. Through the State Department?
b. Through the Armed Services?

6. Are caskets available through U.S. Embassy, USAID, the Armed Services, a hospital, etc.?
a. What kind - hermetically sealable or other?
b. Are sealed casket inserts available?
c. Are metal transfer cases available?

January 2016 Page 1


TG 165 ATTACHMENT A

7. Are facilities available for cremation in the host country?

8. What is stated in the burial laws, regulations and practices of the host country?
a. How long after burial may remains be exhumed?
b. Who is authorized to issue death certificates and transit permits?

9. What is stated in the shipping laws, regulations, and practices of the host country?
a. What method of preservation is required, if any, for shipment from the host country?
b. Would there be problems in removing remains from the host country, either embalmed
or unembalmed, if placed in a hermetically sealed shipping case?
c. Is removal of remains in a sealed metal shipping case permissible in lieu of a casket and
wood outside shipping case?
d. How long does it take to process shipping documents? Have local holidays, weekend
delays, etc. been considered?

10. Do the commercial aircraft operating in the area have the capacity (dimensional/weight) to
transport a casket or other type container? If not, what special arrangements (charter) are
possible? Has a contingency plan for these special arrangements been formulated?

11. Could Post handle all details of autopsy, preparation, casketing, and shipment, or would
some operations have to be shared with another United States Government or host country
Agency?

12. Will third country support be necessary to accomplish any of the above? If so, what kind?
Have contingency arrangements been made?

13. Estimate the length of time between your actual receipt of the remains and when the
remains could be aboard a plane leaving the host country:
a. For mortuary support in a third country;
b. For the United States.

14. Finally, who should be contacted to assist with any of the above matters at night or on
weekends or local holidays, and, of course, how can they be reached? Are there any local
authorities who can act to facilitate matters if complications arise?

January 2016 Page 2


THE ARMED FORCES MEDICAL EXAMINER SYSTEM

115 Purple Heart Drive


Dover AFB DE 19902

TEL: (302) 346-8648


DSN: 366-8648
FAX: (302) 346-8766
THE ARMED FORCES MEDICAL EXAMINER SYSTEM

FREQUENTLY ASKED QUESTIONS


ABOUT MEDICAL-LEGAL EXAMINATIONS

The Armed Forces Medical Examiner System (AFMES) offers you our deepest
condolences on the loss of your loved one.

Q: Why is the AFMES involved?

A: The AFMES performs medical-legal examinations on service members and


American citizens who die in a combat zone and certain individuals who are killed or die
within the United States or abroad. The AFMES positively identifies decedents and
issues death certificates that state the cause and manner of death.

Q: Under what circumstances would the AFMES conduct a medical-legal


examination if an individual died within the United States?

A: The Armed Forces Medical Examiner, under federal law, has the authority to
perform a medical-legal examination when a death occurs under federal jurisdiction.
Cases typically involve a violent or unnatural death and/or may be suspicious in nature
or possibly involve a threat to the health of the military community.

Q: Why is the AFMES performing a medical-legal examination?

A: The examination helps determine the cause and manner of death as well as confirm
the identity of your loved one by scientific means. These investigations can assist in
identifying potential public health issues. Please be assured that this examination will
be carried out with the utmost dignity and respect.

Q. What is the Armed Forces Medical Examiner’s legal authority to perform


medical-legal examinations?

A: The AFMES legal authority comes from Title 10 United States Code, Section 1471
(Forensic Pathology Investigations).

Q. What does the medical-legal examination entail?

A: A medical-legal examination entails reviewing the circumstances of the death,


scientifically identifying the decedent, performing an autopsy and writing a report. The
circumstances of the death are provided to the AFMES by the local commanders or
investigative agencies such as the U.S. Army Criminal Investigation Command, U.S.
Naval Criminal Investigative Service, U.S. Air Force Office of Special Investigations, and
the Federal Bureau of Investigation. Scientific identification is made by performing
fingerprint, dental and/or DNA analyses. During the autopsy, photographs of the
Page 2 of 4
decedent are taken, physical characteristics are noted and any natural disease or
trauma is documented. Selected fluids and small sections of organs are retained for
microscopic, toxicological and/or DNA analyses. These body fluids and tissue samples
are similar to those taken at a hospital laboratory for evaluation and are treated in the
same manner. In rare instances, it is necessary to retain selected whole organs, such
as the heart and/or brain, for expert consultation. If this is required, the person
authorized to determine disposition (PADD) or next-of-kin (depending on the
circumstance) is notified that these organs are being retained by the AFMES and
disposition instructions are obtained.

Q: When will the AFMES perform the medical-legal examination?

A: Your casualty assistance officer (CAO), or casualty assistance calls officer (CACO),
will obtain the date and location of the medical-legal examination and provide you this
information.

Q: What are the qualifications of the physician performing the medical-legal


examination?

A: All medical examiners working for the Office of the Armed Forces Medical Examiner
are physicians who are either board-certified in the field of forensic pathology by the
American Board of Pathology or work directly under the supervision of a board-certified
forensic pathologist.

Q: How long does a normal medical-legal examination take?

A: For cases arriving from overseas, the medical-legal examination usually takes 24
hours from the time the remains arrive at Dover AFB, DE. For cases within the United
States, the medical examiner team usually deploys within 24 hours of notification and
the examination is usually complete within 24 hours of the arrival of the team at the local
facility. If identification is in question, it may take up to five days to complete DNA
analysis, assuming a suitable reference is available.

Q: What happens after the autopsy is complete?

A: The AFMES will retain custody of the decedent until they are positively identified and
all required paperwork has been received from the PADD or next-of-kin. Once the
AFMES has released the decedent, mortuary services are initiated by the Dover AFB
Port Mortuary, the respective casualty/mortuary offices, or contract funeral home,
depending on the situation.

Q: When will I know the results of the medical-legal examination?

A: In most cases a final report will be issued in approximately 6 to 8 weeks. A copy of


the final report is available upon request.

Page 3 of 4
Q: Will the final autopsy report contain pictures of the autopsy?

A: The photographs taken at the time of the autopsy are not normally included with the
report. These photographs will be provided with the report if specifically requested.

Q: Are there any portions of the final autopsy report that are not provided to the
family, if so why not?

A: All information generated by the Armed Forces Medical Examiner in connection with
the medical-legal examination is available upon request, unless release of said
information would compromise a continuing legal investigation into the fatal incident.
The autopsy report summarizes all pertinent findings and answers most questions.
Additional documents such as toxicology and DNA reports are summarized in the final
autopsy report. If you would like copies of these additional documents they will be
provided, but we ask for the opportunity to review them with you, either in person or
over the telephone.

Q: How do I get a copy of the final report?

A: Attached is an autopsy request form. The form is also available at www.afmes.mil.


You may submit your request via one of the following:

Email afmes.ops@amedd.army.mil
Fax (302) 346-8767
Mail Armed Forces Medical Examiner System
Attn: Division of Operations
115 Purple Heart Drive
Dover AFB DE 19902

We value the privacy of you and your loved ones, so we ask that your request for the
report be in writing and accompanied by a copy of a government-issued photo ID (e.g.,
driver’s license, family member identification card) so that we may comply with the
Health Insurance Portability and Accountability Act (HIPAA) of 1996.

Q: May I talk to the medical examiner?

A: The staff of the Armed Forces Medical Examiner System is available to discuss its
findings with you. If you would like to speak with a medical examiner, we may be
reached at (302) 346-8648. You may be asked for some personal information so that
we may verify your identity, and that of your loved one, in order to protect your privacy
and comply with HIPPA regulations.

2 Attachments:
1. Autopsy request form
2. Frequently asked questions acknowledgement form

Page 4 of 4
REQUEST FOR AUTOPSY REPORT AND SUPPLEMENTAL INFORMATION
DATA REQUIRED BY THE PRIVACY ACT OF 1974
Authority: Title 10 USC, Section 1471
Principal Purpose: To obtain records/reports/photos of remains by persons legally authorized access to this information.
Routine Uses: By Department of Defense and other agencies to document and authorize actions necessary obtain post‐autopsy supplemental information. 
Disclosure: Disclosure of requested information is voluntary.  Without disclosure your desires may not be recorded and accommodated.
NAME OF DECEASED (Last, First, Middle Initial)                                       IF HAND‐WRITTEN, PLEASE USE BLACK OR BLUE INK SERVICE / RANK OF DECEASED  SSN OF DECEASED 

TYPED OR PRINTED NAME  OF REQUESTOR REQUESTOR DAYTIME PHONE NUMBER(S)

RELATIONSHIP TO DECEASED / REASON FOR NEED TO KNOW REQUESTOR EMAIL

FOR AFMES USE: RECEIPT DATE / INITIALS

I, the undersigned, am requesting to receive a copy of the official autopsy report written and maintained by the 
Armed Forces Medical Examiner System and/or the official photographs taken during autopsy.
I wish to receive the following (select one or both):
I would like to receive a copy of the official autopsy report written by the Armed Forces Medical 
Examiner System.
Initials

I would like to receive the photographs taken by the Armed Forces Medical Examiner System 
documenting the autopsy.
Initials

I understand official federal business requests will be sent via a secure DoD file sharing system unless otherwise 
specified.  I understand I may elect to receive materials requested for personal reasons at my home address or 
choose another individual (such as a casualty assistance officer, family member, counselor, etc.) to whom the 
requested information is sent on my behalf.
Please send the requested information to the following (select one):
Official Business Request.  Send via SAFE ACCESS email (unless otherwise specified) :
Initials OFFICIAL GOVERNMENT EMAIL (MANDATORY)

Please deliver the requested material to my home address:
Initials SHIPMENT ADDRESS (NOTE: FEDEX DOES NOT DELIVER TO P.O. BOXES)

Please deliver the requested material to the following individual on my behalf:
Initials TYPED OR PRINTED NAME  OF ADDRESSEE ADDRESSEE DAYTIME PHONE NUMBER(S)

SHIPMENT ADDRESS (NOTE: FEDEX DOES NOT DELIVER TO P.O. BOXES) RELATIONSHIP TO ADDRESSEE

SIGNATURE OF REQUESTOR  DATE 

IF YOU ARE A FAMILY MEMBER, PLEASE INCLUDE A PHOTOCOPY OF A CURRENT GOVERNMENT‐ISSUED PHOTO ID 
WITH YOUR REQUEST.  We cannot process your request without verification of your identity and your legal right to this 
information, in accordance with Health Insurance Portability and Accountability Act (HIPAA) regulations.   IF YOU ARE 
REQUESTING THIS INFORMATION FOR OFFICIAL BUSINESS, PLEASE INCLUDE A COPY OF YOUR APPOINTMENT LETTER 
OR A MEMORANDUM OF JUSTIFICATION ON FORMAL LETTERHEAD CITING YOUR NEED TO KNOW.  If you have 
questions, please contact the Armed Forces Medical Examiner System at (302) 346‐8648.

Submit this request form and a copy of your ID or letter of justification via one of the following modes:
Email: afmes.ops@amedd.army.mil
Fax: (302) 346‐8767
Mail: Attn: AFMES Autopsy Report Request
115 Purple Heart Drive
Dover Air Force Base, DE  19902
AFMES Form 3 (Revised May 2012)  

FOR OFFICIAL USE ONLY      
Acknowledgment of Receipt of AFMES Frequently Asked Questions Document 
DATA REQUIRED BY THE PRIVACY ACT OF 1974 
NAME OF DECEASED      RANK OF DECEASED  SSN OF DECEASED 

TYPED/PRINTED NAME OF PERSON AUTHORIZED TO DIRECT DISPOSITION (PADD) OR  RELATIONSHIP  
NEXT OF KIN (NOK) 

 
I, the undersigned, do hereby acknowledge receipt of the Armed Forces Medical Examiner System 
(AFMES) Frequently Asked Questions About Medical‐Legal Examinations document.  I understand that 
should I have any questions about medical‐legal investigations or my loved one’s autopsy, I may obtain 
additional information via the AFMES website at www.afmes.mil or I may contact the AFMES directly via 
the contact information provided on the cover sheet and page 4.  

 
 
ARMED FORCES MEDICAL EXAMINER SYSTEM 
 
www.afmes.mil 
 
Main Office 
(302) 346‐8648 
 
Division of Operations 
afmes.ops@amedd.army.mil 
 
24 hours a day, 7 days a week 
 
 
PADD ACKNOWLEDGMENT SIGNATURE 
TYPED/PRINTED NAME OF PADD or NOK  SIGNATURE OF PADD or NOK  DATE 
   
   
AFMES Form 8 (Revised May 2012) 
DD Form 2064 – Certificate of Death (Overseas) Information Form

Please provide the following information in order to expedite the issuance of the DD Form 2064 – Certificate of
Death (Overseas) issued by the Armed Forces Medical Examiner System.

DECEASED BIOGRAPHICAL INFORMATION


FIRST NAME: ____________________________________________________

MIDDLE NAME: ____________________________________________________

LAST NAME: ____________________________________________________

SOCIAL SECURITY NUMBER: ________-__________-___________

DATE OF BIRTH: Month: ______________ Day:_________________ Year: _______________

RACE: ___________________________________RELIGION: ____________________________

CITIZENSHIP: ____________________________

MARITAL STATUS: SINGLE MARRIED WIDOWED DIVORCED SEPARATED

DECEASED EMPLOYER INFORMATION


ORGANIZATION: ________________________________RANK/GRADE (if applicable) _____________

BRANCH OF SERVICE (if applicable) ______________________________________

NEXT OF KIN INFORMATION Relationship to Deceased: _______________

FIRST NAME: ______________________________

MIDDLE NAME: ______________________________

LAST NAME: _______________________________

FULL ADDRESS: (No P.O. Box Numbers please, Death Certificates are delivered via FEDEX)

STREET: ____________________________________

CITY: ________________________________ STATE: ____________ ZIP: ________________

TELEPHONE: (_______) _________-___________(for use for FEDEX shipment point of contact only)

_________________________________________ _____________________

SIGNATURE (Next of Kin) DATE

_________________________________________

PRINTED NAME (Next of Kin)


FUNERAL HOME RELEASE FORM
CIVILIAN CONTRACTOR

I ______________________________________ of ______________________________
(Spouse / Primary Next of Kin) (Name of Deceased)
authorize the Armed Forces Medical Examiner System to release his/her remains to
______________________________ Funeral Home , ____________________________,
(Complete Address)
Dover, DE _____________, ______________________ .
(Zip Code) (Phone)

I hereby release the Armed Forces Medical Examiner System and its personnel of any
liability with regard to the release of remains.

Signed:

_____________________________ ____________________ _________________


(Spouse / Primary Next of Kin) (Relationship to the Deceased) (Date)

As Witnessed By:

_____________________________________ __________________
(Date)
AUTHORIZED FOR LOCAL REPRODUCTION

MEDICAL RECORD AUTHORIZATION FOR AUTOPSY

In the event authorization for autopsy is obtained by letter, telegram, voice recorded or monitored telephone call, paragraphs 1, 2, and 3
shall be completed by medical facility authorities and the letter, telegram, voice recording or memorandum confirming telephone call of
authorization attached to this form for permanent file.

1. NAME AND LOCATION OF MEDICAL FACILITY DATE AND TIME

DOVER PORT MORTUARY / DOVER AFB, DE 19902

2. I(We) request and authorize the physicians in attendance at the above named medical facility to perform a complete autopsy on the
remains of

I(We) understand that a complete autopsy may include, but not be limited to, examination of the head, eyes, spinal cord, chest, abdomen and
extremities unless excluded under restrictions hereinunder, and I(We) authorize the removal and retention or use for diagnostic, scientific, or
therapeutic purposes any parts, tissues, or organs as such physicians or their designees may deem proper, and the final disposal thereof in such
manner as may be prescribed by competent authority (Commanding Officer, Medical Director, etc.) in this facility.

This authority is granted subject to the following restrictions:

(If No Restrictions, Write "None")

The following special examinations are requested:

3. I(We) represent that I am (we are) the


(Relationship/Authority)
of the deceased and entitled by law to control the disposition of the remains.

Signed
WITNESSES (medical facility staff members):
Signed

Signed
(Name and Title)

Signed
(Name and Title)

FOR ADMINISTRATIVE USE ONLY


Case falls within jurisdiction of Medical Examiner/Coroner . . . . . . . . . . . . . . . . . . . . . . YES NO
Medical Examiner/Coroner released remains from his jurisdiction to this authority . . . . . . . . . . . YES NO

SIGNATURE TITLE DATE

PATIENT'S IDENTIFICATION (For typed or written entries give: Name - last, first, middle; grade, date; hospital or REGISTER NO. WARD NO.
medical facility)

AUTHORIZATION FOR AUTOPSY


Medical Record

STANDARD FORM 523 (REV. 12-93)


Prescribed by GSA/ICMR, FIRMR (41 CFR) 201-9.202-1
REQUEST FOR AUTOPSY REPORT AND SUPPLEMENTAL INFORMATION
DATA REQUIRED BY THE PRIVACY ACT OF 1974
Authority: Title 10 USC, Section 1471
Principal Purpose: To obtain records/reports/photos of remains by persons legally authorized access to this information.
Routine Uses: By Department of Defense and other agencies to document and authorize actions necessary obtain post‐autopsy supplemental information. 
Disclosure: Disclosure of requested information is voluntary.  Without disclosure your desires may not be recorded and accommodated.
NAME OF DECEASED (Last, First, Middle Initial)                                       IF HAND‐WRITTEN, PLEASE USE BLACK OR BLUE INK SERVICE / RANK OF DECEASED  SSN OF DECEASED 

TYPED OR PRINTED NAME  OF REQUESTOR REQUESTOR DAYTIME PHONE NUMBER(S)

RELATIONSHIP TO DECEASED / REASON FOR NEED TO KNOW REQUESTOR EMAIL

FOR AFMES USE: RECEIPT DATE / INITIALS

I, the undersigned, am requesting to receive a copy of the official autopsy report written and maintained by the 
Armed Forces Medical Examiner System and/or the official photographs taken during autopsy.
I wish to receive the following (select one or both):
I would like to receive a copy of the official autopsy report written by the Armed Forces Medical 
Examiner System.
Initials

I would like to receive the photographs taken by the Armed Forces Medical Examiner System 
documenting the autopsy.
Initials

I understand official federal business requests will be sent via a secure DoD file sharing system unless otherwise 
specified.  I understand I may elect to receive materials requested for personal reasons at my home address or 
choose another individual (such as a casualty assistance officer, family member, counselor, etc.) to whom the 
requested information is sent on my behalf.
Please send the requested information to the following (select one):
Official Business Request.  Send via SAFE ACCESS email (unless otherwise specified) :
Initials OFFICIAL GOVERNMENT EMAIL (MANDATORY)

Please deliver the requested material to my home address:
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Please deliver the requested material to the following individual on my behalf:
Initials TYPED OR PRINTED NAME  OF ADDRESSEE ADDRESSEE DAYTIME PHONE NUMBER(S)

SHIPMENT ADDRESS (NOTE: FEDEX DOES NOT DELIVER TO P.O. BOXES) RELATIONSHIP TO ADDRESSEE

SIGNATURE OF REQUESTOR  DATE 

IF YOU ARE A FAMILY MEMBER, PLEASE INCLUDE A PHOTOCOPY OF A CURRENT GOVERNMENT‐ISSUED PHOTO ID 
WITH YOUR REQUEST.  We cannot process your request without verification of your identity and your legal right to this 
information, in accordance with Health Insurance Portability and Accountability Act (HIPAA) regulations.   IF YOU ARE 
REQUESTING THIS INFORMATION FOR OFFICIAL BUSINESS, PLEASE INCLUDE A COPY OF YOUR APPOINTMENT LETTER 
OR A MEMORANDUM OF JUSTIFICATION ON FORMAL LETTERHEAD CITING YOUR NEED TO KNOW.  If you have 
questions, please contact the Armed Forces Medical Examiner System at (302) 346‐8648.

Submit this request form and a copy of your ID or letter of justification via one of the following modes:
Email: afmes.ops@amedd.army.mil
Fax: (302) 346‐8767
Mail: Attn: AFMES Autopsy Report Request
115 Purple Heart Drive
Dover Air Force Base, DE  19902
AFMES Form 3 (Revised May 2012)  

FOR OFFICIAL USE ONLY      
Peace Corps
Technical Guide line 167

SENTINEL EVENT PROCEDURE

1. PUR POSE
To describe the process for investigating and reporting on any Peace Corps medical
sentinel event. A sentinel event is defined as an unexpected occurrence involving
death, serious physical or psychological injury, or a significant risk thereof in a Peace
Corps Volunteer or a Returned Peace Corps Volunteer w hose event w as related to
their Peace Corps service.

2. BACKGRO UND
Such events are called “sentinel” because they signal the need for investigation and
possible response. Investigating and analyzing these phenomena allow for
opportunities to improve program processes.

The terms “sentinel event” and “medical error” are not synonymous; not all sentinel
events occur because of an error and not all errors result in sentinel events.

3. PROCED UR E SUMMARY
A sentinel event meets all the following criteria:

• An unexpected occurrence involving death or serious medical or


psychological injury or a significant risk thereof.

AND
• The sentinel event falls within the responsibility of the Volunteer Health
Program.
• The sentinel event is potentially medically avoidable.

Certain health outcomes are automatically defined as sentinel events:


These include:
• HIV infection acquired during Peace Corps Service
• Malaria infection with medical evacuation which w as acquired during Peace
Corps service
• Any mental health conditions that require hospitalization
• PCV death during Peace Corps service
• RPCV death probably related to Peace Corps service
• A condition that requires medevac or air ambulance out of the Peace
Corps host country for medical care will be evaluated as a possible sentinel
event on a case by case basis

Certain health outcomes do not meet sentinel event criteria, including:


• Minor, temporary illness less than 72 hours in duration
• Assaults or rapes-these are reported per TG-540
• Medevacs for administrative issues
• Unplanned pregnancy, unless there is a related adverse health outcome that
falls within the sentinel event definition.

Office of Health Services June 2014 Page 1 of 2


4. PROCESS
The following process will be followed w hen a sentinel event has occurred:

a. After learning about a sentinel event, the reporting individual should complete
the “Sentinel Event Report” (Attachment A) and submit it to the Quality
Improvement unit for review by the sentinel event review committee.

b. A sentinel event investigation will include the following:


• Initiated by the Quality Improvement (QI) department.
• Documents may include the following:
o Sentinel Event Report (Attachment A)
o Root Cause Analysis Reporting Form (Attachment B)
o Fish Diagram or other tool (Attachment C), if indicated
o Copies of relevant policies, guidelines, manual sections and
pertinent communications
o Sign off sheet by reviewing committee to determine if a root cause
analysis is indicated. (Attachment D).

c. The review committee w ill complete review of investigative materials within 45


days of the receipt of the report.

d. A confidential database will be kept of all sentinel events.

e. The naming convention will be two numeric sequential increases for the sentinel
event in a year, then the country of service, and finally the four digit year. For
example the 3rd. sentinel event worldwide that occurred in Togo in 2010 would
be: 03-Togo-2010.

5. ROOT CAUS E ANALYSIS


• Root Cause Analysis is a process for identifying the basic or causal factor(s)
that underlies a variation in performance, including the occurrence or possible
occurrence of a sentinel event. A root cause analysis focuses primarily on
systems and processes, not individual performance.

• The focus of a root cause analysis is to look for potential improvements in


processes or systems that reduce the risk of similar incidents in the future.

6. ACTION PLAN
• Where indicated, a n action plan shall be developed. The action plan shall
identify the strategies that OHS intends to address the causal factors that
have been identified and therefore reduce the risk of possible similar
incidents occurring in the future. The plan should address responsibility for
implementation, oversight, pilot testing as appropriate, time lines, and
strategies for measuring the effectiveness of the actions.

7. REPORTING
 Sentinel event reporting will be routinely shared with the Quality Council. Action
plans and improvement areas will be communicated to Peace Corps Medical
Officers and Office of Health Services Staff by the Quality Improvement
Unit, and other units as indicated.

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Peace Corps
Technical Guide line 168

UNUSUAL EVENT/INCIDENT REPORTING

1. PUR POSE
Unusual Event Reports (incident reports) are used as an aid in identifying problems/situations that
could result in Volunteer injury or as a means to identify any deviation from policy. Unusual event
reporting is an integral part of any risk management program.

2. BACKGRO UND
Risk management in health care considers patient safety, quality assurance and patients' rights. The
potential for risk permeates all aspects of health care.
The Joint Commission, which accredits and certifies more than 17,000 health care organizations and
programs in the United States, defines risk management in health care as "clinical and administrative
activities undertaken to identify, evaluate, and reduce the risk of injury to patients, staff, and visitors
and the risk of loss to the organization itself." (Source: Joint Commission, 2010)
Risk management may be proactive or reactive. Proactive is avoiding/preventing risk. Reactive is
minimizing loss or damage after an adverse event.
3. POLICY
The Unusual Event reporting form (attachment A) is a confidential document intended to
be used solely for assurance of quality care, trending risk and identifying educational needs. The form
does not at any time become part of the Volunteer’s health record or PC staff’s personnel record.

4. USEOF THE UNUS UAL EVENT R EPORTING FOR M (INCIDENT


R EPOR T) Re port initiation and follow through:
• The staff member that identifies t he real or potential risk is responsible for initiating the
reporting form (Attachment A).
• The reporting person completes all pertinent areas of the form.
• The form is forwarded to the Quality Improvement Unit via SFTP at HQ-OMS-QI.
• The form is numbered and logged by the QI nurse.
• The Chief, Quality Improvement, or designee review s the form and determines an
appropriate action plan.
• The action plan is implemented and any process changes identified are carried out.
The completed report is copied back to the reporting person, the supervisor or other
pertinent parties.
• The form is routed to the QI nurse for filing, trending, recordkeeping and follow - up.

5. ANALYSIS

Unusual Events trends are reviewed by the Quality Improvement Unit and presented quarterly at the Health
Care Quality Council. Repeated events or clear trends will be addressed and discussed for changes or
modifications to current processes. Quality Improvement will provide the oversight for the recommended
changes.

Office of Health Services March 2014 Page 1


Peace Corps
Technical Guideline 170

PREGNANCY

1. PURPOSE

To provide guidance to Peace Corps Medical Officers (PCMOs) on Peace Corps policies
relating to Volunteer pregnancy. To outline the PCMO’s role in the management of
Volunteer pregnancy.

2. BACKGROUND

Medical clearance to continue service during pregnancy is approached like any other health
condition requiring medical attention. Specifically, if the pregnant Volunteer's health needs
can be safely and reasonably supported in country, the Volunteer may continue service.
However, due to the risks associated with pregnancy and the absence of appropriate obstetric
and perinatal medical care at many posts, it is common for a pregnant Volunteer to be
medically separated.

ATTACHMENT A summarizes health benefits relating to pregnancy and childbirth. See


also Technical Guideline (TG) 122 “Medical Benefits for Dependents of Trainees,
Volunteers and Returned Volunteers” for benefits for spouses and minor dependents of
Volunteers and Returned Peace Corps Volunteers (RPCVs).

3. DIAGNOSIS OF PREGNANCY AND INITIAL COUNSELING

Early signs and symptoms of pregnancy include a missed menstrual period, nausea, breast
tenderness, and frequent urination. Pregnancy can be confirmed by urine or blood pregnancy
tests (at around four weeks), detection of fetal cardiac motion on ultrasound (six to eight
weeks), or the presence of a fetal heart beat on Doppler examination (ten to 12 weeks).

The urine and blood pregnancy tests detect human chorionic gonadotropin (hCG) which is
produced by the placenta. Sensitive urine tests can identify pregnancy several days before a
menstrual period is missed, e.g., Kodak SureCell hCG, Clearview hCG.

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TG 170
Pregnancy

Indications for Pregnancy Testing


 Missed menstrual period in a woman of reproductive age.
 Unexplained vaginal bleeding in a woman of reproductive age.
 Lower abdominal pain of uncertain etiology in a woman of reproductive age.
 Prior to abdominal or pelvic x-ray studies in a woman of reproductive age, if indicated by history.
 Prior to the administration of emergency post-coital contraception.
 Prior to prescribing or administering a medication that is contraindicated during Pregnancy.
 After a sexual assault (see TG 540 “Clinical Management of Sexual Violence”).

If a pregnancy test is positive, the PCMO should confirm the result using a blood hCG test (if
available locally) or repeat the urine test in 24-48 hours.

When pregnancy is confirmed, the PCMO should inform the Volunteer and provide initial
support and counseling. An unintended pregnancy can produce conflict and distress for a
Volunteer. The goal of counseling is to help the pregnant Volunteer address her feelings,
learn about her alternatives and begin to make decisions about her pregnancy. See Section 10
below for guidance on pregnancy counseling in country.

Prevention of unintended pregnancy

Contraception and STI prevention are important aspects of the Volunteer health program (see
TG 700 “Contraception” and TG 710 “Unprotected Intercourse and STI Prevention”). A
Volunteer with an unintended pregnancy, or one who unintentionally fathers a child, may
have been at risk of contracting STIs, including HIV. Counseling and appropriate evaluation
should be performed and documented. Continued risk taking should be identified and
managed as described in TG 155 “Non-Compliance with Medical Policies or Instructions.”

4. MANAGEMENT OF VOLUNTEER PREGNANCY

In the setting of Volunteer pregnancy, the PCMO should work with the Volunteer to clarify
her options and proceed with an appropriate management and care plan according to her
desires (see the following flow diagram “Volunteer Pregnancy”).

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TG 170
Pregnancy

MANAGEMENT PLAN: VOLUNTEER PREGNANCY

Pregnancy confirmed NOTE: Excludes pregnancy


Two positive pregnancy tests related emergencies
(e.g., ectopic pregnancy)
Provide initial counseling and support

Will PCV be exposed


to malaria?
YES NO

Does PCV want


1. Change to, or maintain, to continue
mefloquine prophylaxis. pregnancy to
NOT SURE term?
2. Arrange for departure from or NO
country within 1 week

YES

YES Are risk factors


present?
NOT SURE (Attachment B)
Does PCV want
or NO
to continue
pregnancy to
term?
NO

NO Is there
adequate
prenatal care for
1st trimester?
Offer/arrange MEDEVAC
(Washington or HOR) for
continued counseling
YES regarding options YES

NO Is program able
to support PCV?

MEDICAL SEPARATION:
1. Arrange for prenatal care for 1st
1. Complete procedures for medical trimester YES
separation including physical
st
examination 2. Consideration for care after 1
trimester is made on a case by
2. Provide OB 127C authorization case basis

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TG 170
Pregnancy

There are four possible scenarios in the setting of Volunteer pregnancy:


 The Volunteer may know that she does not want to carry the pregnancy to term, or be
undecided about carrying the pregnancy to term (see section 5below for care plan).

 The Volunteer may seek medical clearance and programmatic approval to remain at
post for the first trimester (see section 6 below for care plan).

 The Volunteer may seek medical clearance to remain at post through the pregnancy,
child birth, and the perinatal period (see section 7 below for care plan).

 The Volunteer, in order to continue her pregnancy at home of record may choose to
be medically separated (see section 8 below for care plan).

4.1 Pregnancy in Areas with Malaria

 A pregnant Volunteer must leave an area with malaria within one week of the
diagnosis of the pregnancy.
 Pregnancy alters the immune system and severe cases of malaria during pregnancy
can occur. The Centers for Disease Control and Prevention (CDC) has issued the
following guidance for pregnant women regarding areas with malaria:
Pregnant women are advised to avoid travel to areas with malaria.i
 The American College of Obstetricians and Gynecologists (ACOG) concurs that
while pregnant, women should not travel to areas where there is a risk of malaria,
including Africa, Central and South America, and Asia. ii
NEW ACOG AND CDC RECS
 In areas with malaria, a pregnant Volunteer should take weekly mefloquine prior to
departure. Doxycycline, malarone and primaquine are contraindicated during
pregnancy. The Volunteer should discuss the continuation of mefloquine
prophylaxis throughout the pregnancy with their HOR obstetrician. The PCMOs
should consult OHS in situations where a pregnant Volunteer is unable or unwilling
to take mefloquine.

5. MEDEVAC TO WASHINGTON OR HOR FOR COUNSELING

If the Volunteer knows that she does not want to carry the pregnancy to term, or is undecided
about the future of her pregnancy, she should be medically evacuated to Washington, DC or
HOR for further counseling. Prior to evacuation the PCMO should do the following:

 Inform OHS that a Volunteer will be medically evacuated (medevaced) to


Washington or HOR to receive additional counseling and to discuss her options,
including abortion.

 Once pregnancy has been confirmed, schedule the evacuation as soon as possible so
that, if the Volunteer chooses to have the pregnancy terminated, all termination
options will be available to her and she can have the procedure done within the

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TG 170
Pregnancy

optimal time frame. Pregnant Volunteers in areas with malaria or those experiencing
pronounced emotional distress should be promptly evacuated.

 Inform the Volunteer that, following counseling, if she chooses to carry the
pregnancy to term, she may be medically separated to her home of record or may seek
medical clearance for continued Peace Corps service (see Sections 6 and7).

 Inform the Volunteer about the medical expenses of an abortion. Peace Corps
provides all necessary medical and psychological care associated with a Volunteer
pregnancy, with the exception that Peace Corps cannot pay for abortion services
except, “where the life of the mother would be endangered if the fetus were carried to
term, or the pregnancy is the result of an act of rape or incest.”
On arrival in Washington or HOR, a Volunteer may request a withdrawal from her
readjustment allowance. The request takes approximately one week to process.

 A medically evacuated Volunteer who will need funds immediately on arrival in the
U.S. may request money from post funds. The Volunteer should talk with her post
DMO about the procedures needed to obtain money in this manner.

 Follow-up. When a Volunteer returns to country following an abortion, the PCMO


should talk with the Volunteer about her experience, assess her current emotional
well-being, and discuss her plans to avoid unintended pregnancy in the future.
PCMOs should also maintain contact with any Volunteer who has ongoing emotional
conflict about her decision to have an abortion.

6. MEDICAL CLEARANCE AND FIRST TRIMESTER CARE

A Volunteer who intends to continue her pregnancy and seeks to continue Peace Corps
service must first obtain medical clearance to remain in country. The PCMO must consult
OHS in this situation.

The first trimester is defined as the period before the fourth month of pregnancy. Medical
clearance to remain in country during the first trimester requires that all of the following
conditions are met:

1. The Volunteer will not be exposed to malaria.

2. An initial obstetrical evaluation reveals no medical or obstetrical history or current


clinical findings that would suggest the possibility of a high-risk pregnancy.
ATTACHMENT B “Pregnancy Risk Identification” is a worksheet to be completed by a
qualified obstetrician (see section 6.1 below).

3. Country must be able to provide all ACOG recommended options for prenatal testing and
care. ATTACHMENT C “Prenatal Care Plan” contains a list of standard prenatal
surveillance activities (see section 6.2 below).

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TG 170
Pregnancy

ATTACHMENT B should be completed prior to OMS consultation. ATTACHMENT


C should be reviewed by the PCMO and the local obstetrician to ensure all standard
prenatal assessment and surveillance activities are available, and can be completed in
country.

6.1 Risk Factors during the First Trimester

The Volunteer should undergo a thorough assessment for risk factors of pregnancy as
described in ATTACHMENT B “Pregnancy Risk Identification.” This assessment
should be completed by a qualified obstetrician and reviewed by the PCMO. If risk
factors associated with the pregnancy are identified medical separation may be
necessary. In addition, pregnant women are more susceptible to the effects of parasitic
diseases. Consult ATTACHMENT D to assess if the women are at risk for any.

6.2 Adequate First Trimester Prenatal Care

The PCMO should assess the level of prenatal care available in country. Adequate first
trimester prenatal care is defined as:

Single intrauterine pregnancy confirmed by ultrasound, and


 Twenty four hour access to a hospital able to management first trimester emergency
complications.
 A U.S. or western-trained and licensed obstetrician qualified to provide all
necessary prenatal care.
 Volunteer must live and work within 1 hour of the hospitals and providers
identified above. Have a first trimester prenatal care plan consistent with
ATTACHMENT C.
 These requirements commence when the pregnancy is confirmed by the PCMO.

6.3 Programmatic Clearance

 Under most circumstances the Volunteer will be medically separated after the first
trimester (see section 8 below). Continuation of a pregnancy in country past the first
trimester may be considered in consultation with OHS on an individual basis and in
coordination with programming’s ability to support the Volunteer (See section 7
below).

6.4 First Trimester Prenatal Care

 If cleared, the PCMO must ensure that the Volunteer is referred for ongoing
prenatal care for the remainder of the first trimester and that a first trimester
prenatal care plan, consistent with ATTACHMENT C, is established. The PCMO
should consult OMS immediately if risk factors or complications develop during
the first trimester of pregnancy.

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TG 170
Pregnancy

7. MEDICAL CLEARANCE BEYOND THE FIRST TRIMESTER

OHS must be consulted in all cases where medical clearance beyond the first trimester is
under consideration. Medical clearance for a pregnant Volunteer to remain in country beyond
the first trimester requires that all of the following conditions are met: The Volunteer:
 Meets all of the conditions required of first trimester medical clearance.

 Has access to a U.S. or western-trained and licensed obstetrician qualified to provide all
necessary second and third trimester care.

 Has access to a qualified neonatologist who is U.S. or other western-trained and licensed.

 Has access to a qualified pediatrician. The pediatrician must be U.S. or other western-
trained and licensed practitioner.

 Has 24 hour access to a hospital able to manage emergency complications of second and
third trimester pregnancy including premature labor, placenta previa, placental abruption,
preeclampsia, and eclampsia. The hospital must have 24-hour obstetrical and neonatal
intensive care capability and expertise.

 Must live and work within 1 hour of the hospitals and providers identified above. This
restriction applies from confirmation of the pregnancy by the PCMO through the end of
the neonatal period (normally two months after delivery).

8. MEDICAL AND ADMINISTRATION SEPARATION PROCEDURES

A pregnant Volunteer who does not meet medical clearance criteria is medically separated.
The PCMO should take the following actions:
 Consult MS 284 “Early Termination” and TG 160 “Medical Separation” as applicable.

 Ensure that all COS procedures are completed (see TG 330 “Post-Service Health Benefits
and Close of Service or Extension of Service Health Evaluations”).

 Ensure that the Volunteer has received information on available post-service insurance
offered by Peace Corps and has made an informed decision on extension of that plan. .

 Issue a PC-127C “Authorization of Payment of Medical/Dental Services” for obstetrical


assessment.

 Instruct the Volunteer to discuss continued malaria prophylaxis with her HOR obstetrical
provider.

 Do not issue primaquine for terminal malaria prophylaxis. Instruct the Volunteer to
discuss the risks of relapsing malaria with her obstetrician in the U.S. She may be advised
by her physician to continue antimalarials until after delivery and then to take primaquine
(see Health Information for International Travel 2014published by the CDC).

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TG 170
Pregnancy

 Instruct the Volunteer to contact OHS for assistance with her post-service benefits for
pre-natal and obstetrical care. Return her health record promptly to facilitate claim
processing.

9. MANAGEMENT OF NON-VOLUNTEER PARTNER PREGNANCIES

The Volunteer and the PCMO must inform the CD in the event of a non-Volunteer
pregnancy (spouse or unmarried partner). Refer to the flow diagram “Non-Volunteer Partner
Pregnancy” below. The non-Volunteer spouse or partner becomes eligible for prenatal and
birth-related care to support the health of the unborn child if all of the following criteria are
met:

1. The Volunteer has taken action to acknowledge paternity which, under local law, will
make him financially and legally responsible for the care and support of the child (MS
262.8.0).

2. The child will reside with the Volunteer (see MS 262.8.0).

3. The CD gives programmatic approval for the Volunteer to continue service.


A Volunteer who fathers a child with a woman to whom he is not married may be
administratively separated if the CD determines that the Volunteer's action has impaired
his ability to perform in his assignment, impaired the credibility of the Peace Corps
program, or has violated host country law or custom (see MS 204 “Volunteer Conduct”).

4. Any medical risk factors associated with the pregnancy have been evaluated and
appropriate prenatal care has been identified. PCMOs should do the following:
 Assess individual risk factors for pregnancy as described in ATTACHMENT B
“Pregnancy Risk Identification.”
 If there are no risk factors present, determine the best available prenatal and delivery
care in country and refer the non-Volunteer partner to this care. If risk factors are
present, contact OMS for guidance.
 Provide post-partum care through the best available in-country resources as long as
the Volunteer remains in service.

TG 122 “Medical Benefits for Dependents of Trainees, Volunteers and Returned Volunteers”
section 5 describes the medical benefits for minor dependents of Volunteers. TG 122 section 6
describes medical benefits for minor dependents or returned Volunteers. See also TG 122
ATTACHMENT A for a summary of medical benefits for spouses and minor dependents.

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TG 170
Pregnancy

MANAGEMENT PLAN :
NON-VOLU NTEER PARTNER PR EGNANC Y

CD informed of preg nancy


(by PCV or by PCMO)

Meets
Meetseligibility criteria
elig ibility criteria
per
per MS 262.8.0
M S 263

Are risk factors


Refer to best available prenatal
present? NO
and delivery care (in country)
(Attachment B)

YES

Consult OM S

10. RECOMMENDATIONS FOR PREGNANCY COUNSELING IN COUNTRY

The goal of counseling is to help the pregnant Volunteer address her feelings, learn about her
alternatives and begin to make decisions about her pregnancy. When counseling a pregnant
Volunteer:
 Do not, in any way, impose personal feelings, religious beliefs, or philosophical ideas
about pregnancy and abortion on the women you are counseling.

 Make every effort to understand and empathize with the Volunteer’s situation. Some
women feel self-critical about unintended pregnancies. A blaming and judgmental
attitude will heighten this feeling of self-criticism.

 Avoid making assumptions about the woman’s feelings or beliefs.

 Choose words and terms carefully until you have a good understanding of her beliefs and
attitudes.

In general, pregnancy counseling sessions should begin with general questions and gradually
move to more sensitive areas that help the Volunteer clarify her feelings and enable her to
reach decisions that are right for her. For example, begin with:
 How long have you suspected you might be pregnant?

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TG 170
Pregnancy

 How did you feel when you began to suspect you were pregnant?

 What opportunities have you had to talk with someone about this?

When some rapport has been established, begin to gather more information. For example:
 Were you using birth control at the time?

 What about your partner? Is he an important person in your life?

 Have you ever been pregnant before?

 How did you deal with the situation at that time?

When the Volunteer appears comfortable, discuss the following issues:


 Options the Volunteer has considered. Often a woman will feel she has no options.
Emphasize that she does have choices. It is frequently helpful to have the woman write
down her feelings for and against each option.

 Medical concerns in managing pregnancy during Peace Corps service, as some of these
may affect her decision- making process.
 The availability of counseling in the U.S. and the possibility of referral to other services
such as adoption services, abortion agencies, etc.

If the Volunteer is considering an abortion, the PCMO should:


 Recognize that PCV may fear the abortion process.

 Be aware of possible PCV guilt issues (religious, societal, familial).

 Discuss with her what she will tell other Volunteers.

 Discuss with her whether or not she wants to contact her family and what she is going to
tell them.

If the Volunteer is considering continuing the pregnancy, consider exploring the following:
 Relationship with partner.

 Emotional support available from partner, friends and family.

 Financial support, e.g., willingness to pay for medical care, support of the child, etc.

 Decision to keep the child or place the child up for adoption.

 Impact on career, future education, getting married.

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TG 170
Pregnancy

 Community and family reactions, including attitudes toward single parents, intercultural
relationships or children, etc.

If counseling couples about pregnancy, be aware of:


 Differing preferences and acceptability of the options. Encourage the couple to voice
their feelings. Individual and joint interviews are useful.

 While there is often a sense of “peer” acceptance in the decision of a single Volunteer to
have an abortion, this is not necessarily true for couples. There may be additional
emotional issues for couples considering abortion.

 Provide support for the male partner if he remains in country during a medevac or
medical separation.

i
Centers for Disease Control and Prevention. Pregnant travelers. Reviewed April 21, 2013. Accessed November
8, 2013; Available at: http://wwwnc.cdc.gov/travel/page/pregnant-travelers
ii
The American College of Obstetricians and Gynecologists. Frequently asked questions: Travel during
pregnancy.2011. Accessed November 8, 2013; Available at:
http://www.acog.org/~/media/For%20Patients/faq055.pdf?dmc=1&ts=20131118T1755091793

Office of Health Services June 2015 Page 11


TG 170 ATTACHMENT A

SUMMARY OF MEDICAL BENEFITS


OF PREGNANCY AND CHILDBIRTH

Beneficiary Benefit Provided by

Pregnant  Prenatal care in country until separation from service or Peace Corps
PCV/T COS (subject to medical and program approval to continue
at post).

 Pregnancy benefits for returned Volunteers who are FECA


pregnant at separation from service or COS.

 Returning Volunteers may purchase up to 3 months of post- Post-service


service health insurance when they leave service for insurance plan
themselves and their dependents. Newborns may be added
to the post-service insurance policy.

 Pregnancy benefits for returned Volunteers who become


pregnant after COS.

 Returning Volunteers or RPCVs who become pregnant after HealthCare.gov


COS may also obtain health insurance coverage through
the Affordable Care Act via their state or federal health
insurance exchange at HealthCare.gov

 COS from Peace Corps service is considered a “Qualifying


Life Event” making the RPCV eligible to apply for coverage
up to 60 days after COS from HealthCare.gov.

PCV with  Reimbursement for expenses directly related to prenatal, Peace Corps
pregnant non- delivery, and post-partum care in country (subject to
PCV partner medical and program approval)
TG 170 ATTACHMENT A

 Legally married spouses are eligible for post-service Post-service


insurance plan. The Volunteer must pay for all monthly insurance plan
premiums for a spouse, including the first month.

 Post-service insurance plan provides benefits to enrolled


spouses that are identical to the benefits provided to
returned Volunteers.

 Post-service insurance plan provides pregnancy benefits for


enrolled spouses who are pregnant at COS or who become
pregnant after COS.

Spouses of  Spouses of returned Volunteers are NOT eligible for 127C HealthCare.gov
Returned authorization forms for evaluation of service-related medical
Volunteers conditions.

 Spouses of returned Volunteers are NOT eligible for FECA


benefits.

 Spouses of returned Volunteers may obtain health


insurance coverage for themselves through the Affordable
Care Act via their state or federal health insurance
exchange at HealthCare.gov

 Returned Volunteers may obtain health insurance coverage


that covers their spouse through the Affordable Care Act via
their state or federal health insurance exchange at
HealthCare.gov. COS from Peace Corps service is
considered a “Qualifying Life Event” making the RPCV
eligible for coverage up to 60 days after COS from
HealthCare.gov
TG 170 ATTACHMENT A

Newborn  Neither Peace Corps nor FECA provides coverage for the HealthCare.gov
newborn.

 You may obtain health coverage through the Affordable


Care Act via your state or federal health exchange at
HealthCare.gov to obtain coverage for you and your
newborn. COS from Peace Corps service is considered a
“Qualifying Life Event” making the RPCV eligible for
coverage up to 60 days after COS from HealthCare.gov

See also Technical Guideline 122, Attachment A: Summary of Medical Benefits for Spouses and Minor
Dependents of Trainees and Volunteers

Revised June 2015


TG 170 ATTACHMENT B

PREGNANCY RISK IDENTIFICATION


INSTRUCTIONS: To b e completed b y a qualified ob stetrician and reviewed b y the PCMO.

Name: SSN: DOB: LMP:


Yes No
 Age > 35 at delivery  
 Drug or alcohol use  
 Family history of genetic problems (Downs syndrome, Tay-Sachs)  
MEDICAL
 Autoimmune Disorder (SLE)  
 Congenital/Chromosome Anomalies  
 Diabetes  
 Hypertension  
 Heart Disease  
 Hemoglobinopathy (sickle cell disease or trait, thalassemia)  
 Hepatitis/Liver disease  
 Kidney Disease/UTI  
 Neurologic Disease/Epilepsy  
 Psychiatric Illness  
 Pulmonary Disease (asthma, TB, prior PE, DVT)  
 Thyroid Dysfunction  
 Varicosities/Phlebitis
 At risk of contracting parasitic disease (see ATTACHMENT D)  
OBSTETRIC AND GYNECOLOGIC
 Incompetent cervix  
 History of genital herpes, STD, GC, chlamydia, HPV
 Prior cesarean delivery, classical or vertical  
 Prior fetal structural or chromosomal abnormality  
 Prior neonatal death  
 Prior preterm delivery or preterm rupture of membranes  
 Prior obstetrical hemorrhage  
 Prior low birth weight (<2500 gm)  
 Recurrent pregnancy loss or stillbirth  
 Second trimester pregnancy loss  
 Uterine leiomyomata or malformation  
CLINICAL AND LABORATORY FINDINGS
 Abnormal pap smear  
 Anemia (Hct <28% unresponsive to iron therapy)  
 Condylomata (extensive)  
 HIV  
 D (Rh) sensitized  
Please detail any positive remarks. Include dates and treatment

Signature Examining Physician: Date:

Revised June 2015


TG 170 ATTACHMENT C

PRENATAL CARE PLAN

All pregnant women should have access in their community to readily available and regularly
scheduled obstetric care, beginning in early pregnancy and continuing through the postpartum
period. Pregnant women also should have access to unscheduled or emergency visits with a
trained obstetrician on a 24 hour basis.
Some of the recommendations for evaluation are below, and this list is not all inclusive.

FIRST VISIT ASSESSMENT


 History and physical to include pap smear
 High risk pregnancy assessment as per ATTACHMENT B
 Initial labs (recommended)
 blood type
 Rh type
 If Rh negative: Rh antibody screen
 Hct/Hgb
 VDRL
 urine culture / screen
 HBsAg
 HIV counseling / testing
 Optional labs
 Hgb electrophoresis
 PPD
 chlamydia
 GC
 Cystic Fibrosis screening
 Tay-Sachs

 Fragile X syndrome

FIRST TRIMESTER CARE


 Routine prenatal visits every four weeks to include evaluation of the following:
 gestational age (best estimate)
 fundal height
 presentation
 fetal heart rate
 fetal movement
 preterm labor signs /symptoms
 cervix exam (dilated, effaced, sta.)
 blood pressure
 weight
 urine (glucose/albumin)
 discussion on screening for aneuploidy

 8-18 week labs (when indicated/elected)


 MSAFP/multiple markers
 Aneuploidy screen (including access to nuchal translucency ultrasound, pregnancy
associated protein A, and beta HCG screen); if positive, this may require a referral for
amniocentesis or chorionic villus sampling
 OB ultrasound

Revised: April 2015


TG 170 ATTACHMENT C

SECOND AND THIRD TRIMESTER CARE


 Routine prenatal visits every two weeks from 28-36 weeks; every week after 36 weeks.
 Cervical check every visit
 24-28 week labs (when indicated)
 Hct/Hgb
 diabetes screen
 GTT (if screen abnormal)
 D (Rh) antibody screen
 D Immune Globulin (RhG) given @ 28 weeks (Rhogam)

 32-36 week labs (when indicated)


 Hct/Hgb (recommended)
 ultrasound
 VDRL
 GC
 chlamydia
 group B strep (35-37 weeks)
ATTACHMENT D: Parasitic infections affecting the pregnant woman and fetus

Parasite Maternal symptom Treatment Pregnancy effects


Schistosoma Anemia, granuloma Praziquantel Placental
formation, inflammation and
pulmonary and infection,
hepatic fibrosis intrauterine growth
restriction
Babesia Fever, myalgias, Clindamycin and quinine Hemolytic anemia,
malaise, fatigue low platelets,
jaundice
Leishmania Fever, weight loss, Amphotericin B Neonatal infection,
(visceral) anemia sepsis, death
Trypanosoma Skin necrosis, fever, Nifurtimox-eflornithine or Neonatal sepsis,
malaise, central suramin coma
nervous system
depression
Toxoplasma Often asymptomatic Spiramycin early in Chorioretinal
pregnancy, pyrimethamine lesions, learning
and sulfadiazine disabilities
cyclospora Diarrhea, Sulfamethoxazole/trimethoprim Severe dehydration
dehydration (not in third trimester) leading to preterm
labor
cryptosporidium Diarrhea, Fluid replacement, nitazoxanide Severe dehydration
dehydration leading to preterm
labor
Giardia Diarrhea, abdominal Metronidazole Severe dehydration
pain, fever leading to preterm
labor

Adapted from Dotters-Katz S, Kuller J, Henie PR. Parasitic infections in pregnancy. Obstetrical
and gynecological survey 2011. 66(8); 515-525.

1
Peace Corps
Technical Guideline 180

DENTAL POLICY

1. PURPOSE

The purpose of this guideline is to outline the pre-service, in-service and post-service
components of the Peace Corps dental program.

2. BACKGROUND

Dental problems are one of the most common in-service health problems for Volunteers and
are a leading cause of medical evacuations (medevacs) and post-service Federal Employees’
Compensation Act (FECA) claims. Many Volunteers serve in areas with limited or no access
to dental facilities.

The pre-service dental evaluation is designed to:


 Establish a baseline dental health status prior to Peace Corps service
 Identify dental problems that need to be corrected prior to Peace Corps service
 Determine if an individual's dental health requires a country assignment that can support
an anticipated dental or periodontal need

The in-service dental program will provide:


 Support for preventive dental hygiene to maintain dental health
 Restorative care for dental problems that arise during service
 A dental exam at Close of Service (COS)
 Routine dental prophylaxis (dental cleaning) at COS

The post-service dental program will provide:


 Evaluation of service-related dental conditions
 Treatment for service-related dental conditions under FECA

3. PRE-SERVICE

3.1 Pre-Service Dental Clearance

The applicant is examined by a dentist of his/her choice and any recommended dental
treatment is performed. The dentist then completes the Report of Dental Examination, Form
PC-1790 (Dental) ATTACHMENT A and sends it with a complete set of dental x-rays to
the Office of Health Services (OHS).

Office of Health Services June 2014 Page 1


TG 180
Dental Policy

The pre-service unit reviews the documentation submitted by the applicant from their dentist
of choice. The Peace Corps dental consultant is available if questions arise from the pre-
service nurse review. The Report of Dental Examination and x-rays are maintained in the
Volunteer’s health record.

3.2 Accommodation of Special Dental Needs

If an applicant’s dentist recommends in-service preventive dental care due to a pre-


existing condition, e.g., periodontal disease requiring in-service periodontal therapy, the
case will be reviewed by the Peace Corps dental consultant. If the need for in-service
preventive dental care is confirmed and can be supported overseas, the applicant will be
assigned to a country that has dental facilities that can provide the anticipated need.

4. IN-SERVICE DENTAL PROGRAM

4.1 Prevention

Good dental hygiene is known to reduce the incidence of decay. Dental hygiene must
be emphasized in both initial and continuing health education programs. The following
dental hygiene techniques should be stressed to Volunteers:
 Brush at least twice daily with good quality fluoride toothpaste.
 Floss at least once daily.
 Exercise caution when eating foods that may have foreign objects that could chip or
otherwise damage teeth.

Toothpaste, toothbrushes, and dental floss are provided either through the Volunteer
living allowance or supplied through the health unit.

4.2 Mid-Service Dental Examination and Prophylaxis

Peace Corps supports an annual dental check-up (including prophylaxis and bitewing x-
rays) when there is a qualified dentist or dental hygienist identified at post. The mid-
service dental examination has two objectives:

1. Routine dental cleaning;

2. Identification and treatment of early disease.

Medical evacuation (medevac) is not authorized for the purposes of providing an


annual dental check-up. However, dental care, including an annual check-up, while in
the U.S. on personal business may be authorized through the use of the PC-127C
“Authorization of Payment of Medical/Dental Services” (see section 6 below). The
rationale for annual versus semiannual dental examination and prophylaxis is outlined
below.

Office of Health Services June 2014 Page 2


TG 180
Dental Policy

Many dentists in the United States recommend a dental examination and


prophylaxis every six months. However, professional dental organizations
do not specify the frequency of prophylaxis for individuals with healthy
periodontia. The American Dental Association (ADA) recommends
“periodic dental examinations.” The ADA has no policy regarding the
frequency of those exams. The U.S. Preventive Services Tasks Force, the
preeminent source of preventive health recommendations in the US, states
that “there is little evidence that annual or semiannual dental check-ups
are necessary for persons without clinical evidence of dental disease.”

Additionally, there is no scientific evidence to support the premise that


semi-annual prophylaxis verses less frequent prophylaxis has any long-
term benefit on dental health. Multiple studies have shown that in
individuals with healthy periodontia, annual scaling is as effective as
more frequent scaling in maintaining periodontal health.

There is strong evidence that tooth brushing and flossing are effective
means of maintaining periodontal health.

Individuals with active periodontal disease identified by a dentist may require more frequent
exams and scaling. In these cases Peace Corps supports and provides all necessary care.
However, for Volunteers in good dental health, the Peace Corps dental policy of annual
examinations and prophylaxis, where available, is medically sound.

Dental examinations and preventive care (cleaning and scaling) offered in country are often
limited. However, most dentists are able to identify and treat asymptomatic caries. When
available, cleaning and scaling should be performed annually.

Unless the local dental care is unacceptable for even simple examination and treatment, all
Volunteers should have a mid-service dental examination.

4.3 In-Country Management of Dental Problems

General Principles

The dental care available in country is frequently limited and restorative work may
need to be redone after COS. This is particularly true for crowns, root canal fillings,
and bridge work. It is often in the Volunteer's interest to delay treatment until after
COS (see section 8 below).

Peace Corps does not provide dental care to treat aesthetic conditions, e.g. orthodontia,
dental veneers, or whitening procedures, or to correct pre-existing structural problems,
e.g., malocclusion.

Office of Health Services June 2014 Page 3


TG 180
Dental Policy

Authorizing Dental Care

 All treatments except for routine check-ups, cleaning, and small fillings require
prior authorization from the OHS dental consultant.
 In general, the minimum restorative dental work possible should be done in
country.
 Non-destructive, temporary procedures should be used whenever possible, thereby
allowing definitive treatment to be carried out after COS. For example, it may be
preferable to have a large filling done in country rather than a crown. A crown
could be applied after return to the U.S.
 Treatment to correct a pre-existing aesthetic problem is not authorized by Peace
Corps and is not allowed in country.
 Treatment to replace pre-existing missing teeth is not authorized by Peace Corps
and is not allowed in country.
 Medevac is not authorized for the purposes of providing routine preventive dental
care.
 If a PCV prefers to have additional cleaning outside of what is recommended, they
will have to pay all costs (out-of-pocket) associated with the cleaning
(transportation, dental fees, vacation time, etc.).

Management of Dental Problems

 A Volunteer who requires, or is requesting, dental treatment may be referred to a


local dentist. The dentist will provide a diagnosis, treatment plan and estimated cost
of the treatment in writing.
 In all cases, except when a small filling is required, details of the treatment plan and
cost should be sent, via a field consult through the IHC, to the OHS dental
consultant who will advise on the best course of action.
 The dental consultant will advise one of the following three options:
 Treatment can be deferred until COS.
 A temporary procedure should be carried out.
 A restorative procedure is required. The dental consultant will determine if
the procedure can be done in country or requires medevac (regional or U.S.)

How to Contact the OHS Dental Consultant

In urgent cases, e.g., trauma, dental infections or unremitting pain:


 Send a consult through SFTP that includes the patient’s symptoms, the treating
dentist’s diagnosis, treatment plan and estimated cost of the treatment, as well as
expected COS date.

Office of Health Services June 2014 Page 4


TG 180
Dental Policy

In non-urgent cases:
 Send consult through SFTP as outlined above. Mail or pouch the pre-service x-rays,
current x-rays and a copy of the pre-service Form PC-1790 (Dental) to OHS. This
provides the dental consultant with adequate information to evaluate the case.

Except in emergencies, the dental consultant’s response is required before authorizing


treatment.

5. ASSESSING IN-COUNTRY DENTAL SERVICES

Volunteers must only be sent to a dentist whose services have been assessed by the PCMO.
In addition to obtaining reports from previous patients, a visit to the dental office is generally
required. The PCMO should consider the following factors when assessing dental services.

Sterilization and Anti-Sepsis Practices

 New disposable gloves, mask, needles and syringes and anesthetic ampules must be used
for each patient. An adequate stock must be seen.
 Instruments must be autoclaved between patients.
 All surfaces must be disinfected between patients.
 Shielding for dental x-rays should be available (see TG 350 “Use of Medical X-Rays”).
 See TG 260 “Infection Control” for additional information on infection control practices.

Dental Technique

 Look at x-rays of previous root canal treatments. The tooth should be filled to within one
millimeter of its tip.
 Assess how crowns fit on a dental model, the crown should be flush with the finish line
of the prepared tooth.
 Ask previous patients if they are satisfied with the service they received.
 A thorough dental cleaning and scaling by a skilled dental technician typically takes 30-
45 minutes. In most Peace Corps countries, only limited dental cleanings are performed.

6. DENTAL EXAMS AND TREATMENT IN THE U.S. WHILE ON LEAVE

 Volunteers may have elective dental work done in the U.S. while on leave. A PC-127C
may be issued by the PCMO as per Technical Guideline 340 “PC-127C Form
‘Authorization for Payment of Medical/Dental Services’.” Unless previously authorized
by the OHS dental consultant, only evaluation and simple treatments should be
authorized. PCMOs should instruct the Volunteer to contact OHS if more complex care is
required.
 For mid-service dental examinations the 127C should read:

Office of Health Services June 2014 Page 5


TG 180
Dental Policy

“For dental examination, routine prophylaxis, and treatment of caries only. Contact the
Office of Medical Services if additional dental treatment is required.”

 There are two options for payment/reimbursement for care authorized by a 127C:

1. The dental provider accepts the 127C and submits a claim to the Peace Corps Health
Benefit Program. This is the preferred method.

2. The Volunteer pays for the medical care and submits a claim for reimbursement to the
Peace Corps Health Benefits Program.

This information, including all necessary documentation for submitting a claim, is


highlighted in red, bold type in the center of the 127C.

 Claims submitted to the Peace Corps Health Benefits Program will be reimbursed
according to the Peace Corps Health Benefits fee schedule only.
 Prior to receiving care, the Volunteer should read and understand the information on
payment/reimbursement for medical care authorized by a 127C.
 All 127C authorizations should be submitted to the Peace Corps Health Benefits Program
for payment or reimbursement. This includes 127Cs issued by post or by OHS, 127Cs
issued for use in the U.S. or overseas, and 127Cs issued for use during service or after
COS.

7. COS EXAMINATIONS

 Refer to TG 330 “Post-Service Health Benefits and Close of Service and Extension of
Service Health Evaluations.”
 Dental examinations and bite-wing x-rays are provided for all Volunteers if 12 or more
months have elapsed since their pre-service dental examination.
 Dental examinations should be performed in-country, whenever possible. Simple dental
treatments, such as fillings and cleanings, can be performed at this time. More complex
procedures should generally be done after COS, unless excellent and affordable in-
country services are available.
 The dental examination and any treatments provided should be recorded by the
examining dentist on form PC-1790 (Dental).
 If qualified dental care is not available in country, a dental examination may be
authorized through a 127C. This authorization should read:

“For dental examination and routine prophylaxis only (including bite-wing x-rays and
other views as indicated).”

Office of Health Services June 2014 Page 6


TG 180
Dental Policy

Note: If dental treatment is indicated please describe in detail and estimate cost or
write on authorization “No treatment is authorized at this time.”

8. DOCUMENTATION OF DENTAL CARE

The PC-1790 (Dental) form must be used for all pre-service and COS dental examinations.
Mid-service use of the PC-1790 (Dental) form is encouraged but not required. The dentist’s
office documentation of the mid-service exam is acceptable if it is accurate and complete.

9. POST-SERVICE DENTAL BENEFITS

9.1 Evaluation

Evaluation of service-related dental conditions are authorized using a 127C. This


authorization is valid for 180 days post-service and does not authorize treatment. If
indicated at COS, PCMOs may issue a 127C for specific dental evaluation. When a
service-related dental problem arises within 180 days after COS the Post-Service Unit
will also issue an authorization.

9.2 Treatment

Dental benefits are available under FECA. The Department of Labor (DOL)
administers FECA. The DOL authorizes the OHS Post-Service Unit to manage claims
less than $1,000. Both the DOL and the Post-Service Unit use dental x-rays and
documentation maintained in the Volunteer health record to process claims.

Office of Health Services June 2014 Page 7


Applicant Name ______________________________________________________________________________________________________________________ Report of Dental
(Last, First, Middle Initial)
Examination
Date of Birth__________ /__________ /___________ Medical Case Number:________________________________________________ OMB No.: 0420-0546
(Mo/Day/Year) Expiration Date: 9/30/2014

Report of Dental Examination


The Dental Examination is one of the final pre-service requirements for individuals applying for Peace Corps service. Applicants
must undergo a dental examination to meet this requirement. If your dentist determines that you dental treatment, submit the
dental evaluation form and X-rays only after this dental treatment is complete. Please be aware that dental services available
in Peace Corps are limited. Peace Corps volunteers only receive a mid-service dental examination and close of service dental
examination. Additionally, Peace Corps is unable to provide specialist dental care. Therefore any treatments (i.e. orthodontics—
braces, symptomatic gum disease) must be completed to be cleared dentally. Please discuss with your primary dentist or specialty
dentist any treatments you are currently undergoing and the timeline for completion. Peace Corps volunteers who have dental
issues that arise between dental exams during their Peace Corps service are evaluated on a case by case basis.

Privacy Act Notice


This information is collected under the authority of the Peace Corps Act, 22 U.S.C. 2501 et seq. It will be used primarily for the purpose of determining your eligibility
for Peace Corps service and, if you are invited to serve as a Peace Corps Volunteer, for the purpose of providing you with medical care during your Peace Corps
service. Your disclosure of this information is voluntary; however, your failure to provide this information will result in the rejection of your application to become
a Peace Corps Volunteer.

This information may be used for the purposes described in the Privacy Act, 5 USC 552a, including the routine uses listed in the Peace Corps’ System of Records.
Among other uses, this information may be used by those Peace Corps staff members who have a need for such information in the performance of their duties.
It may also be disclosed to the Office of Workers’ Compensation Programs in the Department of Labor in connection with claims under the Federal Employees’
Compensation Act and, when necessary, to a physician, psychiatrist, clinical psychologist or other medical personnel treating you or involved in your treatment
or care. A full list of routine uses for this information can be found on the Peace Corps website at http://multimedia.peacecorps.gov/multimedia/pdf/policies/
systemofrecords.pdf.

Burden Statement:
Public reporting burden for this collection of information is estimated to average one hour and 45 minutes per applicant and one hour per physician per response.
This estimate includes the time for reviewing instructions and completing the collection of information. An agency may not conduct or sponsor, and a person is not
required to respond to, a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any
other aspect of this collection of information, including suggestions for reducing this burden, to: FOIA Officer, Peace Corps, 1111 20th Street, NW, Washington, DC
20526 ATTN: PRA (0420 - 0546). Do not return the completed form to this address.

Peace Corps · Report of Dental Examination PC-OMS-1790 Dental (Revised 08/2012) Page 1 of 5
Medical Case Number:

I. General Dental Evaluation


Date of exam (mo /day /yr)______________________________________________

A. Chart existing restorations, missing teeth, and


endodontically treated teeth 
h Check here if no existing restorations, missing
teeth or endodontically treated teeth
OR
Comment on findings:______________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________

II. Periodontal Evaluation


A. Chart periodontal probings, gingival recession, and mobility

Buccal Pocket Depth


Lingual Pocket Depth

Buccal Recession

Lingual Recession

Lingual Recession

Buccal Recession

Lingual Pocket Depth


Buccal Pocket Depth

Calculus Deposits: ❏ Light ❏ Moderate ❏ Heavy

Peace Corps · Report of Dental Examination PC-OMS-1790 Dental (Revised 08/2012) Page 2 of 5
Medical Case Number:

B. Identify by number all teeth with:


Areas of bleeding upon probing h None h Affected teeth: _________________________________________________________________________________________________
Areas of suppuration h None h Affected teeth: ___________________________________________________________________________________________________________________
Furcation involvement h None h Affected teeth: _________________________________________________________________________________________________________________
Insufficient attached gingiva h None h Affected teeth: _______________________________________________________________________________________________________

C. Periodontal Classification:
h No Disease
h Class I: Gingivitis h Class II: Early Periodontitis
h Class III: Moderate Periodontitis h Class IV: Advanced Periodontitis

D. Recommended periodontal therapy:___________________________________________________________________________________________________________________________


____________________________________________________________________________________________________________________________________________________________________________________________________________

III. Third Molar Evaluation


h Third molars present and asymptomatic
h Third molars not present (previously removed or the rare case of having never had them)
h Third molars were symptomatic at time of this exam and removal was completed on Date:_______________________________________________________________

IV. TMJ Evaluation


h No history of TMJ h History of TMJ symptoms____________________________________________________________________________________________________________________
Please describe treatment provided, dates, and if symptoms are present at this time:___________________________________________________________________
____________________________________________________________________________________________________________________________________________________________________________________________________________

V. Bruxism
h No history of bruxism h History of bruxism
Please describe any bruxism habit, presence of wear facets or need for occlusal guard:_______________________________________________________________
____________________________________________________________________________________________________________________________________________________________________________________________________________

VI. Prosthesis
h No prosthesis present h Prosthesis present
Please describe the nature and extent of the prosthesis (e.g., full or partial dentures, bridge, etc.) and the need for repair or
replacement:_______________________________________________________________________________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________________________________________________________________________________________________

Peace Corps · Report of Dental Examination PC-OMS-1790 Dental (Revised 08/2012) Page 3 of 5
Medical Case Number:

VII. Treatment
List all treatment completed after this examination. Do not include treatment planned but not yet completed.
Treatment Date Completed Signature of Dentist
_______________________________________________________________________________________________________________________ _ ____________________________ _ _____________________________________________
_______________________________________________________________________________________________________________________ _ ____________________________ _ _____________________________________________
_______________________________________________________________________________________________________________________ _ ____________________________ _ _____________________________________________
_______________________________________________________________________________________________________________________ _ ____________________________ _ _____________________________________________
_______________________________________________________________________________________________________________________ _ ____________________________ _ _____________________________________________
Ensure the entire form is completely filled out and each box below is checked prior to returning to the Peace Corps. Incomplete
exams will be returned. After examination of this Peace Corps applicant, review of radiographs and treatment rendered as
necessary, I attest that the applicant’s current condition meets the following requirements:
h Decayed teeth have been restored or extracted.
h Fractured teeth have been restored or extracted.
h Fractured restorations have been repaired with a new restoration or the tooth has been extracted.
h Advanced periodontal disease that is likely to become symptomatic has been corrected.
h Abscessed teeth have been treated with root canal therapy or extraction.
h Teeth with irreversible pulpitis have been treated with root canal therapy or extraction
h Teeth with previous root canal therapy that is failing have been retreated (either conventionally or surgically) or extracted.
h Temporary restorations (including stainless steel crowns) have been replaced with permanent restorations.
h Active orthodontic therapy has been completed and the bands removed. Retainers (either fixed or removable) are acceptable.
h Third molars, if any, are asymptomatic at time of exam.
h TMJ disorder, if present, is asymptomatic at time of exam.

Important: Dental examination is complete only when:


 1 The dentist has completed all sections of the charting form.
2 The dentist has attested that by checking each box above, that the applicant has met all the requirements for dental
qualification.
2 The dentist has signed and dated the form.
3 The dentist has listed all treatments completed in Section VII.
4 The dentist has included one of the following sets of X-rays:
1) A full mouth series, or
2) A Panorex with bitewing X-rays.
· Periapical or Panorex films must be less than 2 years old.
· Bitewing X-rays must be less than 1 year old.
· All films must be original films, not duplicates.
Note: High quality digital X-rays can be accepted. All CDs must be submitted in a protective cover.
Close-of-service only: The dentist has included bitewing X-rays.

Peace Corps · Report of Dental Examination PC-OMS-1790 Dental (Revised 08/2012) Page 4 of 5
Medical Case Number:

Dentist’s signature________________________________________________________________________________________________________________Date______________________________________________
Dentist’s license number_______________________________________________________________________________________________________State_____________________________________________
Dentist’s name, address and phone number_____________________________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________________________________________________________________________________________________

For Peace Corps Use Only h Dental clearance has been completed h Dental X-rays have been submitted as required

Peace Corps · Report of Dental Examination PC-OMS-1790 Dental (Revised 08/2012) Page 5 of 5
Peace Corps
Technical Guideline 185
CREDENTIALING OF BACK-UP HEALTHCARE PROVIDERS

1. PURPOSE
To define the purpose of back-up healthcare providers and outline their responsibilities in providing
temporary coverage of the health unit.

2. BACKGROUND
A back-up provider is a local healthcare provider (physician, nurse practitioner, or physician assistant)
who offers temporary coverage of the health unit during the Peace Corps Medical Officer’s (PCMO)
absence.

3. DUTIES
Back-up providers provide direct patient care, referrals to outside medical consultants or facilities;
assist with administrative and health education tasks during high volume times, i.e. during COS or
PSTs; and may provide consultative and prescriptive services to RN PCMOs. While serving as a
PCMO, the back-up provider shall be available 24/7 by telephone or on the premises of the health unit.

4. CREDENTIALING
 All health care personnel must be credentialed and granted privileges by the Credentialing
Committee within the office of Health Services (OHS).
- In order to satisfy this requirement, all prospective providers must submit a current
Curricula Vitae (CV), current license and one reference letter from a current clinical
colleague to OHS.
- The CV must specify all training, work experience, licenses, diplomas and certifications.
All periods of unemployment greater than three months should be accounted for.

Registered nurses cannot be back-up primary providers as the position responsibilities fall outside
the RN scope of practice. RNs who have been PCMOs and have maintained CHAM competency,
may serve as a back-up provider as outlined in TG 605-Teaching Protocols and Standing Orders for
Registered Nurse (RN) PCMOs.

 A Physician Assistant (PA) can act as a back-up provider only if a PSC contract is established. In
doing so, the PA back-up provider and Chief, Office of the Medical Services will be covered by the
malpractice indemnity provisions.
 Healthcare personnel with outstanding documentation(s) and/or information may be granted
provisional clearance if their services are urgently needed by post. Upon receipt of the missing
documentation(s) and/or information, recommendation will be changed to full approval.
If outstanding documentations are not received within thirty days, clinical privileges will be
suspended.
5. RESPONSIBILITES OF THE COUNTRY DIRECTOR OR DESIGNEE
The Country Director (CD) or designee is responsible for:
• Advertising the vacancy
• Interviewing all candidates
• Forwarding completed credentialing materials of the final candidate to the PCMO Program
Coordinator
• Arranging compensation for services (refer to agency policies for procurement and/or
contracting of services)
Office of Health Services July 2015 Page 1 of 2
6. RESPONSIBILITES OF THE OFFICE OF HEALTH SERVICES
• Receive and review credentialing package
• Credentialing and privileging of all healthcare providers who provide care to Peace Corps
Volunteers

7. RESPONSIBILITIES OF THE PCMO


 Maintain an “on-call” book or binder with Volunteer contact information, Peace Corps staff, local
and regional providers/consultants, medical facilities, including clinics, hospitals, laboratories,
imaging centers and pharmacies.
 Maintain the community back-up provider information sheet (attachment A). This document must
be completed with country specific information, reviewed with and given to the back-up provider.
 Provide to the backup provider a PCMEDICS Cheat Sheet which is an up-to-date summary of
every Trainee’s/Volunteer’s healthcare data (e.g. name, DOB, accommodations, problem list,
allergies, current medications). This must be kept in a secure manner because it contains medically
confidential health care data.
 Provide to the backup provider a PCMEDICS immunization roster which is an up-to-date
summary of every Trainee’s/Volunteer’s immunization status. This must be kept in a secure
manner because it contains medically confidential health care data.
 Perform an official handover with the backup provider to review the above information prior to
relinquishing PCMO duties to the backup provider. Review with the backup provider all
consultations and events that occurred during the PCMO’s absence.

Office of Health Services July 2015 Page 2 of 2


TG 185-Attachment A

Back-up Provider Information


(General Information)
Thank you for assisting in the care of our Peace Corps Volunteers in (Insert country)

Peace Corps Office of Health Services in Washington, DC must be contacted in the event of any significant illness. Notification should
occur as soon as possible, preferably before a decision is made to admit or transfer the Volunteer, but should not delay care in a life
threatening situation. These situations include, but are not limited to:
 Life or potentially life threatening conditions or condition likely to require emergency surgery or hospitalization.
 Conditions accompanied by unstable vital signs including tachycardia (> 130 bpm), bradycardia (< 45 bpm),
symptomatic cardiac arrhythmias, hypotension (< 90 mmHg systolic), hypertension (> 200 mmHg systolic),
tachypnea (> 26 breaths/min), hypoxia (< 92% at sea level) or temperature greater than 39.5⁰ C.
 Any conditions likely to require transfer to a higher level facility or an emergency medical evacuation
 Any Volunteer with an acute psychiatric problem that is a threat to themselves or others
 Any Volunteer involved in a motor vehicle/motorcycle accident or pedestrian accident involving a motorized vehicle
 Prior to any surgical procedure or blood product transfusion
 Any loss of consciousness
 When the clinical presentation of uncertain etiology may represent a serious underlying condition (e.g.,
chest pain, syncope, shortness f breath, altered mental state)
 When there is a possibility of long term disability or morbidity (e.g., traumatic injury with possible loss of
function) When a condition may lead to significant cosmetic deformity (e.g., large facial laceration or
facial leishmaniasis) When a condition or diagnosis is associated with a significant radiographic
abnormality
 After a physical assault
For Sexual Assault instructions please refer to TG 540 Attachment L (which is also page 2 of this document)

When reporting to the Office of Health Services, please have as much information available as possible, including:
Recent history and working diagnosis
 Vital signs, laboratory and imaging studies
 Initial plan of care
 Safety and location of Volunteer, including capabilities of the health care facilities
 Potential need to move Volunteer and plan of action if necessary
 Follow-up plans

PCMO Expectations
Examine all medically unstable Volunteers as soon as possible, even if you must travel to them
Oversee the care provided to Volunteers
All hospitalized Volunteers must be accompanied by a Peace Corps staff member as soon as practical
Notify the Country Director when any significant situations arise

IMPORTANT CONTACT INFORMATION

Peace Corps Office of Health Services


During office hours (8 am to 5 pm EST Monday thru Friday) – 202-692-1500
 Ask to speak with an International Health Coordinator (IHC)
Outside office hours (nights, weekends, holidays) answering service – 301-790-4749
 Tell them you have an emergency and will hold for the IHC on call

Peace Corp – (Insert country)


(Telephone number)
Post Medical Duty Phone
Post Duty Officer (Telephone number)

Post Country Director (Telephone number)

Post Safety and Security Coordinator (Telephone number)

Peace Corps Regional Medical Officer, (Telephone number)


(Insert RMO name & count ry)
Office of Health Services January 2015
TG 185-Attachment A

A STEP-BY-STEP GUIDE TO A SEXUAL ASSAULT REPORT BY A VOLUNTEER


TO THE MEDICAL DUTY PHONE (Back-up Provider)
TG 540 Attachment L
By following this outline exactly as presented here, a back-up provider will be able to help stabilize the situation, begin
providing effective support to the Volunteer and gather critical information to help post respond. Please take notes of
the Volunteer’s answers. All notes and information collected from the call must be given to the Safety and Security
Manager (SSM).

1. The first goal is to ensure that the Volunteer's urgent medical needs are addressed and that they are in a safe place.
“I am so sorry this has happened to you.”
“In case we get disconnected how can I call you?”
Contact Information
“Are you injured? Do you need immediate medical care?” (If the Volunteer says yes, contact local emergency services
and notify the International Health Coordinator (IHC) at OHS/OMS/HQ immediately.
“Are you safe” (If the Volunteer says no, discuss how to get to a safe place. Call emergency services or a trusted
community member if necessary.)

2. Inform the Volunteer what is going to happen next:


“I am going to call the SSM who will contact you at the number you just gave me (repeat the number to the PCV) and
help guide you through this process. If you do not hear from the SSM within 10 minutes, please call me back.”

3. Immediately after hanging up with the Volunteer notify the SSM at the number below. If you are unable to reach the
SSM call the OMS Medical Duty phone.

4. Maintain medical confidentiality. This is a restricted report; do not disclose to any other person that a sexual
assault has taken place. DO NOT NOTIFY THE COUNTRY DIRECTOR (CD).
IMPORTANT CONTACT INFORMATION (To be provided by the PCMO)
OMS Medical Duty Phone Number: 202-369-3744
SSM Name: Contact information:
Forensic Facility In-Country: Contact Information:

Call from PCV to Back-Up Provider

Back-Up Provider follows script

Assess for needs (medical, emotional) SSM contacted

Yes No
Volunteer Reporting Preference
Statement completed
No further action required
Contact Medical Duty Phone
(202)-369-3744

Provide care (in consultation with


OMS/IHC)

Office of Health Services January 2015


TG 185-Attachment B

Peace Corps
Office of Health Services
Back-up Provider Statement of Work

POSITION FUNCTION:

The required skill level for the back-up provider shall be a physician, physician assistant or nurse
practitioner and will provide clinical care for Peace Corps Volunteers and Trainees in overseas
posts in the absence of a Peace Corps Medical Officer (PCMO).

RESPONSIBILITIES:

The back-up provider shall provide direct patient care, referrals to outside medical consultants or
facilities, i.e. hospital or emergency department, depending on the specific in-country
arrangements, and assist with administrative duties and health education when indicated. The
back-up provider shall be available around-the-clock by telephone or be present in the Health
Unit. He/she may also be required to provide consultative or prescriptive services to RN
PCMOs.

Written documentation that describes the consultation with a Trainee or Volunteer, care and
treatment prescribed/provided, and diagnoses must be provided to the Health Unit.
Peace Corps
Technical Guideline 187

MENTORING OF NEW PEACE CORPS MEDICAL OFFICERS


____________________________________________________________________________

1. PURPOSE

The purpose of this guidance is to provide orientation and assistance to the new PCMO who is
unfamiliar with the management and administration of the Peace Corps Volunteer Health System,
the Peace Corps Manual Section and the Office of Volunteer Support Technical Guidelines. It
will also serve as guidance to the mentor in assisting with the orientation and mentoring process.

2. BACKGROUND

The services to be performed will be subject to the ultimate responsibility and authority of the
Peace Corps Country Director in conjunction with medical supervision and guidance from the
Peace Corps Office of Volunteer Support. At the completion of the mentoring period, a mentor
report shall be submitted to the Country Director, the new Peace Corps Medical Officer (recipient
of the training), and Associate Director of Volunteer Support, Chief of Quality Improvement,
Peace Corps Support Unit Manager, and the PCMO Program Coordinator.

3. MENTOR RESPONSIBILITIES

The PCMO mentor shall provide on-the-job training in all roles and responsibilities of the position
within their scope of practice. The mentor shall make use of the following educational documents:

 Technical Guidelines, the Pre-Service Training Modules:


(http://inside.peacecorps.gov/index.cfm?viewDocument&document_id=18922&filetype=
htm)
 Violent Crimes Against Volunteers:
(http://inside.peacecorps.gov/index.cfm?branch=194)
 OHS training videos (Come Back Healthy, A Slice of Life,
serving Safely, FECA video)
 Peace Corps Manual
 E-learning programs
 Volunteer Support web pages on Intranet

The mentor shall provide orientation in the following areas and document completion in TG
187, Attachment B:

A. Administration

1. The daily routine, including office hours and on-call requirements of the Peace
Corps Medical Officer. (Review these together with the Country Director.)

2. The PCMO’s expected professional relationship with the Country Director,


the Administrative Officer and other Peace Corps staff members. Provide
guidance on participation as a member of the Peace Corps country staff.

________________________________________________________________________________________________________
Office of Health Services July 2015 Page 1 of 4
Discuss participation in meetings and collaboration on formulation and
revision of policies affecting the health and safety of Volunteers.

3. Post policy regarding credit or compensatory time for after hours and week-end
work. The policy should be reviewed with the Country Director. Discuss
benefits, including policies for annual, sick and home leave. Arrange a meeting
for the PCMO with the Administrative Officer to ensure that the new PCMO
understands the mechanism(s) in place to insure electronic transfer of
compensation into the PCMO’s bank account (biweekly submission of
timesheets). Ensure that the PCMO is cognizant of Post policy for use of official
vehicles.

4. Procedures for inventory and ordering of medical supplies and equipment (TG
240, MS 734). Orient the PCMO to his/her role in managing the medical budget
and participating in the budgetary process. Discuss the importance of working
together with the Country Director and the Administrative Officer in reviewing
the medical budget on an established periodic schedule.

5. Assist the PCMO in assessing office equipment requirements, such as the need
for computers, file cabinets, locks for confidential medical records and for
controlled substances, refrigerator for vaccines and other biological.

6. Together with the Country Director, review and assess the emergency
evacuation plan.

7. Orient to the Peace Corps Communications system, including medically


confidential transmissions, i.e. cables, faxes, e-mail and telephones.

8. Computer orientation to include setting up a file system, use of calendar, Power


Point. Review Secure File Transfer Protocol (SFTP).

9. Orient to the Peace Corps Medical Electronic Documentation and Inventory


Control System (PCMEDICS), Peace Corps’Medical Records system (TG 210),
to include contacting the Health Informatics Unit to gain access to PCMEDICS
training materials and set up a PCMEDICS competency test; PCMEDICS
protocols; and eSignature of PCMEDICS forms within 72 hours of initial
documentation.

10. Introduce the PCMEDICS encounter system, in which each Volunteer contact is
recorded (to include telephone contacts, emails, text messages, letters to and from
Volunteers and site visits).

11. Explain Interim Health and Close-of-Service requirements for Trainees and
Volunteers (including lab tests) with special attention to instructions for use
of the Health Benefits Identification Card.

________________________________________________________________________________________________________
Office of Health Services July 2015 Page 2 of 4
B. Disease Prevention/Health & Wellness Training

12. Explain preparations for Trainee intakes (TG) and Pre-Service Training
(PST),including the use of a timeline to guide preparations (TG 310,
Attachment A). Emphasize the importance of working closely with Peace
Corps staff colleagues in planning and implementation of PSTs.

13. Discuss In-Service Training (ISTs) newsletters and other opportunities for
prevention wellness and safety raining.

14. Review HIV prevention/PEP program (TG 712).

C. General Overview of Peace Corps Policies and Procedures

15. Conduct an overview of the management of the Volunteer Health System and
delivery of health care to Volunteers in accordance with the policies
and procedures articulated in the Technical Guidelines and Peace Corps Manual
Sections to include but not be limited to a review of policy on:

 Roles and responsibilities of the PCMO (TG 110)


 Medical care to non-Volunteers (TG 130)
 Medical confidentiality (TG 150)
 Non-compliance issues (TG 155)
 Volunteer pregnancy (TG 170)
 Dental care (TG 180)
 Non-disclosure (TG 190)
 Medical accommodation (TG 195)
 COS HIV testing process (TG 715)
 Mammography (TG 355)
 U. S. laboratories (TG 360)
 Recommended procedures for field consultations (TG 370 including the use
of SFTP)
 Recommended procedures for medical evacuation (TG 380) and emergency
medical evacuation (TG 385)
 Epidemiological Surveillance (TG 410)
 Basic psychological counseling (TG 510) and use of Office of Special
Services (OSS)
 Alcohol abuse and alcoholism (TG 520)
 Emergency psychiatric care (TG 530)
 Personal safety & life style adaptations appropriate to country-specific safety
issues, Crime Incident Reporting Form (CIRF)
(http://inside.peacecorps.gov/index.cfm?branch=33)
 Site development and criteria for determining site safety
(http://inside.peacecorps.gov/index.cfm?branch=33)
 Physical and sexual assaults (TGs 540 & 545), Violent Crime Protocol:
(http://inside.peacecorps.gov/index.cfm?branch=194)

________________________________________________________________________________________________________
Office of Health Services July 2015 Page 3 of 4
 Sexual practices as related to risk perception and risk reduction behaviors. (See
Pre-Service Training Modules for STIs and Avoiding HIV Infection and TG
710/712.)
 Contraception, including post-coital contraception (TGs 700 and 540)

D. Site Visits

16. Discuss the goals, importance and logistics of Volunteer site visits. Improve or
develop site visit check list and report forms. Include the assessment of the
Volunteer’s physical and mental health status and living conditions.
Assessment of locally available physicians, clinics, hospitals and laboratories
should be conducted with use of tools provided by Volunteer Support.

17. Assist in assessing the professional qualifications of local health care


professionals and resources (hospitals, clinics, laboratories and other facilities)
and in establishing a professional relationship with locally available medical
consultants (physicians, dentists, etc.). Emphasize the importance of periodic
monitoring and assessment of locally available resources utilizing the documents
provided by the Office of Volunteer Support.
Orient to Country Health Resources Survey.
(http://inside.peacecorps.gov/index.cfm?branch=210)

E. Clinical Skills

Together with the PCMO, review clinical skills and complete the PCMO Skills Survey
(Attachment A). Identify areas in need of additional practice/training. Devise a plan on how
to address any areas of improvement and include it in the ‘Comments’ column. Submit the
PCMO Skills Survey, Orientation checklist (Attachment B) with the Mentor Report
(Attachment C).

F. Reporting

Upon completion of the mentoring program, the mentor shall prepare a written report,
detailing the training provided. The report shall include a statement on each of the
following:

• Professional strengths of the PCMO; suggested areas for improvement that includes
review of clinical skills
• Assessment of the in-country Volunteer Health Care System
• Assessment of available health/medical care providers and facilities
• Assessment of the mentorship

________________________________________________________________________________________________________
Office of Health Services July 2015 Page 4 of 4
PCMO NAME: TG 187
MENTOR NAME: Attachment A
DATE OF COMPLETION:

PCMO SKILLS SURVEY (to be completed with the mentor)

Indicate the skill competency or comfort level for each of the skills listed below by typing or
printing an X in the appropriate column. Mark not observed (N/O) if you did not have the
opportunity to observe the skill. If the skill is not within the PCMO scope of practice, please
indicate in the comments column. Use the comments column to address how areas of low
competency will be addressed. Submit the PCMO Skills Survey with the Mentor Report and
the Mentoring Checklist.

SKILL LEVEL OF SKILL

I. Health Education and Pre vention High Mode rate Low N/O Comme nts
Individual patient education
Planning and conducting group health education
sessions (PST , IST , COS)
Development of health education handouts and
newsletters
Administration of immunizations (IM, SC)
Indications and contraindications for
immunization for:
MMR, polio, tetanus (T d or T dap)
Hepatitis A and B
Typhoid, meningitis, rabies
Administration and interpretation of PPD skin test
(intra-dermal)
INH therapy for PPD converters
Selection of malaria prophylaxis

II. Clinical Care


SOAP note/patient encounter form (PEF)
documentation
Medical history for common health problems
Comprehensive medical history and review of
systems
Comprehensive physical examination
Monitoring and management of stable, chronic
conditions
Coordinate referrals to specialist(s)
Evaluation and stabilization for acute, severe
illnesses
Evaluation and stabilization for major trauma

1
TG 187, Attachment A, PCMO Skills Survey, November 2012
PCMO NAME: TG 187
MENTOR NAME: Attachment A
DATE OF COMPLETION:

SKILL LEVEL OF SKILL

Spe cific Exam / Proce dure Skills: High Mode rate Low N/O Comme nts
Retinal (ophthalmoscope)
Ear canal and drum
Oral exam (acute dental pain)
Chest (percussion and auscultation)
Cardiac (murmurs)
Breast
Abdominal tenderness or masses
Rectal and prostate
Vaginal - visualization of cervix, PAP
Vaginal - uterus, tubes, ovaries
Basic exam of major joints (shoulder, knee, etc.)
Neurologic status
Mental status
Phlebotomy (venous blood samples)
Administer IM medications
Administer IV medications
Insert IV catheters
Select and administer IV fluids
Insert urethral catheters
Incision and drainage of abscesses
Basic suturing
Biopsy (simple) of skin lesion
Application of casts and splints
Record ECGs
Contraceptive counseling
ST D/HIV risk counseling
Inte rpretation of:
Lab reports (chemistry, serology, hematology)
Chest X-ray films
X-ray films of common fractures/etc.
ECG tracing

2
TG 187, Attachment A, PCMO Skills Survey, November 2012
PCMO NAME: TG 187
MENTOR NAME: Attachment A
DATE OF COMPLETION:

SKILL LEVEL OF COMFORT

Clinical management of: High Mode rate Low N/O Comme nts
Common skin disorders
Abrasions and burns
Upper respiratory tract infections
Allergic rhinitis
Asthma (outpatient)
Pneumonia
Hypertension
Diarrhea
Gastroenteritis/gastritis
Urinary tract infections
Menstrual disorders
Prenatal care (uncomplicated)
Vaginal discharge
ST Is
Forensic evidence collection post sexual assault
Musculoskeletal back pain
Minor orthopedics
Anemia
Diabetes
Hypothyroidism
Seiz ure disorders
Acute febrile illness
Pulmonary T B (active)
In gene ral, provides or pre scribe s
me dications for the above conditions through:
written guidelines
consultation with MD
personal knowledge and experience

III. Mental He alth Support


Evaluation/limite d counseling for:
Interpersonal problems
Anxiety
Depressed mood
Alcohol or drug abuse

3
TG 187, Attachment A, PCMO Skills Survey, November 2012
PCMO NAME: TG 187
MENTOR NAME: Attachment A
DATE OF COMPLETION:

SKILL LEVEL OF COMFORT

High Mode rate Low N/O Comme nts


Acute depression
Panic attacks
Suic idal ideation
Psychosis

IV. Administration and Program


Management
Maintaining medical confidentiality
Planning and budgeting
Medical supplies and pharmacy inventory
management
Hospital/clinic assessment
Physician/consultant assessment
Planning and conducting prevention programs
(screening programs, smoking cessation, etc.)
Reporting of cases for epidemiological/public
health analysis

Additional comme nts:

4
TG 187, Attachment A, PCMO Skills Survey, November 2012
PCMO MENTORING CHECKLIST
PCMO XXX
(Use to document completion of orientation as outlined and described in TG 187.
Submit with the Mentoring Report.)

ORIENTATION AREA DATE OF COMMENTS


COMPLETION
General
Review TG 100 Office of Health Services
Review TG 110 Volunteer Health Program
Administration
Discuss daily routine, office hours, on-call requirements, benefits,
use of official vehicles, compensatory time , assessment of office
needs, etc.
Professional relationship with staff:
 Meet with CD, DMO and other staff
 Participate in meetings and collaborate on policy
discussions
Peace Corps Communication System (phones, fax, e-mail, cables)
Computer Orientation ( Outlook, PowerPoint, Intranet, SFTP,
VIDA)
Medical budget process and management and relationship with
DMO
Overseas Health Unit (TG 200)
 Configuration of the Health Unit
 Health Unit laboratory
 Documenting contacts with the Health Unit (Daily PCV
Log)
 Tracking events/cases for the monthly epidemiology

1
TG 187 Attachment B, PCMO Mentoring Checklist, July 2015
report
 Tracking labs performed in the Health Unit
 Maintaining logs of outside consultant, laboratory,
imaging facility and hospital visits
PCMEDICS (TG 210), including:
 PCMEDICS User Scripts and Training assistance from HIU
 PCMEDICS competency Test with HIU
 PCMEDICS Encounter definition
 Patient Encounter Form (PEF)
 Recording Volunteer name , gender, and DOB or Volunteer
ID on all documents scanned into PCMEDICS
 eSign each form within 72 hours of initiating the form
(except lab and COS forms)
 Relinquish PCMEDICS medical record within 30 days of
Volunteer COS
Ordering of medications and medical supplies (TG 240)
Inventory management (TG 240 and MS 734)
Interim Health Evaluations (TG 320)
Close of Service requirements (TG 330, 340), including:
 COS physical exam and forms
 Required laboratory testing
 Post Service Health Benefits
 Use of the form PC-127 C
 Health Benefits Identification Card
Medical Evacuation (TG 380)
Emergency Medical Evacuation (TG 385)
 Created a Country Medical Evacuation plan or reviewed
the existing plan
Emergency Country Suspension (TG 390)
Post Protocol on Crimes Against Volunteers
General Overview of Peace Corps Policies and Procedures
2
TG 187 Attachment B, PCMO Mentoring Checklist, July 2015
Overview of the management of the Volunteer Health System and
delivery of health care to Volunteers in accordance with the
policies and procedures articulated in the Medical Technical
Guidelines and Peace Corps Manual sections:
 Roles and Responsibilities of the PCMO (TG 110)
 Clinical Documentation and Chart Review Process (TG 113)
 Medical Care to Non-Volunteers (TG 130)
 Medical Confidentiality (TG 150)
 Non-Compliance Issues (TG 155)
 Volunteer Death (TG 165)
 Unusual Event Reporting (TG 168)
 Sentinel Event Reporting (TG 167)
 Dental care (TG 180)
 Non-Disclosure (TG 190)
 Medical Accommodation (TG 195)
 Clinical Escalation (TG 212)
 Health Kits (TG 250)
 Infection Control (TG 260)
 US Laboratories (TG 360)
 Field Consult Procedures including PCMEDICS & SFTP (TG
370)
 Epidemiological Surveillance (TG 410)
 Mental Health Assessment and Support (TG 510)
 Alcohol Abuse (TG 520, MOST materials)
 Psychiatric Emergencies (TG 530)
 Management of Sexual Violence (TG 540), within one
month of hire
 Sexual Assault Counseling (TG 545), within one month of
hire
 Role of the Counseling and Outreach Unit (COU)
 STD/HIV prevention, testing and counseling(TG 710, 715)
3
TG 187 Attachment B, PCMO Mentoring Checklist, July 2015
Disease Prevention/ Health and Wellness Training
Pre-Service Training (PST) (TG 310)
PST Health sessions (Pre-Service Training Modules)
Post Health Handbook
Immunizations (TG 300)
In-Service Training (IST) (TG 310)
Health articles in post newsletter
HIV prevention/PEP (TG 710)
Volunteer Site Assessment-Health Facility/Consultant Assessment
Importance and logistics of site visits, site development and the
site visit report forms
Assessment of local health care professionals and resources
(including hospitals, clinics, laboratories and other facilities)
Annual Accommodations/Country Resource Survey
Clinical Skills
PCMO Skills Survey (TG 187, Attachment A)

4
TG 187 Attachment B, PCMO Mentoring Checklist, July 2015
PCMO Mentoring Report Template

PC XXX

__/__/201_ thru __/__/201_ (include dates of mentorship)

MEMO:
TO: Marty Leishman, Office of Health Services

CC: Country Director; New PCMO

FROM: XXX, PCMO, Peace Corps XXX

DATE:

RE: PCMO XXX, Peace Corps XXX Health Unit

Per Peace Corps Office of Health Services Support request, I provided orientation and assistance
to the new PCMO, XXX. Our work focused on management and administration of the Peace
Corps Volunteer Health System, Peace Corps policies and the Office of Health Services Medical
Technical Guidelines.

Overall assessment of mentorship (provide summary of mentorship including strengths):

Areas for improvement/recommendations:

1
TG 187, Attachment C, Mentoring Report Template, November 2012
Peace Corps
Technical Guideline 190

MEDICAL NON-DISCLOSURE

1. PURPOSE

To provide guidance to Peace Corps Medical Officers (PCMOs) on identification, evaluation


and reporting of cases of medical non-disclosure.

2. BACKGROUND

During the medical clearance process, all applicants are required to provide the Office of
Medical Services (OMS) with a complete medical, dental, and mental health history.
Applicants complete the Health History Form. Upon completion of the form, the applicant
signs the following statement:

I certify that all of the above information is true and complete. I understand that
giving false or incomplete information will delay processing my application and
may result in withdrawal of my Peace Corps nomination or invitation or in
separation from Peace Corps service.

All applicants also sign a similar statement upon completion of the self-reported health
evaluation on the Report of Medical Examination (PC-1790-S).

After medical qualification and prior to entry on duty, all applicants are required to inform
OMS of any significant changes in their medical or mental health status. This includes any
new conditions; changes in current medical, dental, or surgical conditions; and changes in
their medications. This requirement is communicated to all invitees in their letter of medical
qualification.

Applicants who are discovered to have failed to disclose significant medical information may
be disqualified. These decisions are made by the Pre-Service Manager and the Director of
the Office of Medical Services.

Trainees and Volunteers who have failed to disclose significant medical information are
subject to administrative action, including Administrative Separation from Peace Corps. Per
Peace Corps Manual Section (MS) 284 section 7.2, the deciding official for all administrative
action in these cases is the Field Support Manager in the Office of Medical Services (OMS)
(see section 4 below).

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Medical Non-Disclosure

3. MEDICAL NON-DISCLOSURE: RESPONSIBILITIES OF THE PCMO

3.1 Discovery

Discovery of a non-disclosed medical condition can occur at staging or at any point in a


Trainee’s or Volunteer’s service. PCMOs often become aware of non-disclosure of
medical conditions in the following circumstances:

• During the initial medical intake interview


• When a projected medical need, such as a prescription refill occurs
• During a work-up for a current illness
• When a Volunteer presents with complications of a previously undisclosed medical
condition

The PCMO may learn of a non-disclosed condition from other Volunteers or Peace
Corps staff.

3.2 Evaluation

All cases of medical non-disclosure that would have been medically relevant to the
OMS screening process must be reported to the Field Support Manager. The Director of
the Office of Medical Services in consultation with the PCMO, is responsible for
determining if a case of medical non-disclosure is, or is not, medically relevant.

A non-disclosed medical condition is considered medically relevant when


that condition, if disclosed during the medical clearance process, would
have caused the Preservice Unit
to request further information in order to reach a medical clearance
determination for the Trainee or Volunteer.

A non-disclosed medical condition is clearly medically relevant if it would have:


• deferred medical clearance
• led to medical disqualification from Peace Corps service
• led to a country assignment or site placement designed to support the individual’s
medical condition

Other situations are less clear. Because PCMOs do not routinely apply the standards of
the medical clearance process, the determination that a case of non-disclosure is
medically relevant requires consultation with OMS. OMS is responsible for
determining that the standard for medical relevance is applied in a uniform and
consistent manner.

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Medical Non-Disclosure

3.3 Reporting

The PCMO is responsible for reporting all cases of non-disclosure that meet the
threshold standard identified in section 3.2 above to OMS.

Notification by the PCMO should be directed through the International Health


Coordinator (IHC) to the Field Support Manager. The communication should include:
• A statement of the newly discovered medical information
• Copies of all pertinent supporting documents, e.g., the Health Status Review
• Report of Medical Examination and any relevant in-country progress notes
• If necessary, a written statement from the Trainee or Volunteer authorizing OMS to
contact the Volunteer’s U.S.-based provider to obtain additional medical
information about the case
• Any other relevant medical information

4. MEDICAL NON-DISCLOSURE: HEADQUARTERS EVALUATION

The Office of Medical Services will review the notification from the PCMO and determine
the impact and seriousness of the medical information in question.

Headquarters procedures for evaluation of a report of non-disclosure is described in MS 284


section 7. Specifically:

Before taking any action to administratively separate a V/T under these provisions, the
Deciding Official must consult with OGC and notify the Country Director (or if the Trainee
has not left the United States, the appropriate Regional Director) of the current action and
provide the Country Director an opportunity to comment on the V/T's conduct and
performance.

The Deciding Official will inform the V/T orally or in a brief "consideration of administrative
separation memo" that administrative separation is being considered, explain the reasons for
the action and provide any relevant information to the V/T for review. The Deciding Official
will inform the V/T of the option to resign in lieu of administrative separation at any time
before a final administrative separation decision is made.

The Deciding Official will give the V/T a reasonable period to respond, considering the V/T's
ease of access to information the V/T requires for such a response. A Trainee who has not
left the U.S. may be required to remain in the U.S. until a final decision is made.

If, after considering the V/T's response, the Deciding Official decides to separate the V/T, the
Deciding Official may do so only with the concurrence of the Concurring Official(Director of
the Office of Medical Services). In order to insure an informed concurrence, the Deciding
Official must provide the Concurring Official, either orally or in writing, with the reasons for
the decision and the V/T's response.

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Medical Non-Disclosure

If the Concurring Official concurs, the Deciding Official will inform the V/T of the final
decision to administratively separate the V/T and give the V/T an opportunity to resign within
24 hours, in lieu of being administratively separated.

If the V/T does not resign within 24 hours, the Deciding Official will sign and provide to the
V/T a written notification that he or she has been separated from service pursuant to 22
U.S.C. 2504(i).

The Deciding Official will notify the CD of the outcome of the process.

If the V/T resigns in lieu of administrative separation, the Deciding Official must forward to
the Office of Volunteer Recruitment and Selection (VRS) a memo (which can be the
"consideration of administrative separation memo") that states that the V/T resigned in lieu
of being administratively separated, and sets out the grounds for the action and the
information in support of those grounds.

If the Trainee or Volunteer is allowed to continue Peace Corps service, a determination


regarding the need for medical or programmatic accommodation for the non-disclosed
medical condition is made by the PCMO and OMS in consultation with the CD as
appropriate (see Technical Guideline (TG) 195 “Volunteers with Medical Conditions That
Require Special In-country Placement or Support”).

5. MEDICAL CARE IN CASES OF NON-DISCLOSURE

When a medically relevant non-disclosure is discovered, two distinct activities are triggered:
medical care and an administrative process.

These two activities should begin promptly upon discovering the non-disclosure and they
proceed at the same time, each along its own track.

The PCMO should continue to provide all necessary medical care and continue to ensure the
health and safety of the Volunteer, regardless of whether the medical condition has been
previously disclosed or not.

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Peace Corps
Technical Guideline 195

MEDICAL CONDITIONS THAT REQUIRE


SPECIAL IN-COUNTRY PLACEMENT

1. PURPOSE

To communicate Agency policy and procedures for inviting applicants to serve as Peace
Corps Volunteers who, for medical reasons, may be assigned only to certain sites in-country,
or otherwise have some special in-country requirements.

These policies and procedures do not apply to applicants who have received country-wide
medical qualification by the Office of Medical Services (OMS) e.g., medical clearance to
serve in a country with a cardiologist. Unless otherwise determined by post, such applicants
do not require a special site assignment or restriction once they are in country.

2. BACKGROUND

The standards for medical qualification for Peace Corps service are articulated in Peace
Corps Manual Section (MS) 201 “Eligibility and Standards for Peace Corps Volunteer
Service.” This regulation states:

The applicant must, with reasonable accommodation, have the physical and
mental capacity required of a Volunteer to perform the essential functions of the
Peace Corps Volunteer assignment for which he or she is otherwise eligible, and
be able to complete an agreed upon tour of service, ordinarily two years, without
unreasonable disruption due to health problems.

The Peace Corps has developed procedures for placing Volunteers who require in-country
site assignments or other support from post to accommodate their medical needs.

3. AGENCY POLICY

ATTACHMENT A is a reprint of a November 1999 Agency policy directive by Charles R.


Baquet III, Acting Peace Corps Director (APCD). The policy directive responds to questions
and concerns about Peace Corps procedures for inviting applicants to serve as Peace Corps
Volunteers when, for medical reasons, they may be assigned only to certain sites in country,
or will require support from post that is different from the support generally provided to other
Volunteers. These restrictions and special support needs are referred to collectively as
“special in-country requirements.”

3.1 Summary

In summary, the policy contains guidance on the following:

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TG 195
Special Medical Conditions

• Part I: Headquarters and post procedures for addressing special in-country


requirements that are identified during the medical screening process. This part
contains sections that address each step of the process. Specifically:
Ø Section A: Medical Assessment by OMS.
Ø Section B-C: Exchange of information among OMS, Placement and post.
Ø Section D: Post’s review and assessment of the information provided by
headquarters.
Ø Section E: Post decision and review of that decision by headquarters staff.

• Part II: Procedures for addressing special in-country requirements that are
identified after Trainees or Volunteers have arrived at post.
• Part III: Background information about the Peace Corps’ legal obligations to make
reasonable accommodations for qualified disabled individuals.
• Part IV: Issues of medical confidentiality and the policy and procedures that permit
disclosure of medical information to non-medical staff who need that information to
perform their jobs.

4. OMS PLACMENT COORDINATOR

When an applicant who is otherwise medically qualified requires an in-country site


assignment or other in-country support, the OMS Placement Coordinator coordinates the
exchange of information between OMS, Placement, and post.

CONTACT INFORMATION

OMS Placement Coordinator (202) 692-1500


OMS Medical Fax (202) 692-1501

The OMS Placement coordinator will fax to the Peace Corps Medical Officer (PCMO) and
the Country Director (CD) a “Request to Approve Invitation” (ATTACHMENT B). This
form includes a complete description of all known medical conditions and physical
limitations that would affect the applicant’s ability to serve in an assignment or location, and
special placement and support needs. Detailed clinical information is included for the PCMO
only.

5. POST DECISION

The CD, PCMO and, if necessary, the APCD, respond to the “Request to Approve
Invitation” on the “Approval/Disapproval of Request” form (ATTACHMENT C). Approval
or disapproval of a request should be based on the guidance outlined in Part I, Section D of
the Agency Policy. The Agency can not extend an invitation to a Volunteer to serve in that
country until post has determined that it can satisfy the in-country requirements.

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Special Medical Conditions

All requests that are denied by post are reviewed by the Coordinator in consultation with the
Office of the General Counsel to ensure that it conforms with the Peace Corps’ legal
obligation to make reasonable accommodation for qualified disabled individuals.

Office of Medical Services March 2001 Page 3


TG 195 ATTACHMENT A

November 19, 1999

TO: All Country Directors, PCMOs, APCMOs, Placement Officers, and Screening
Nurses

FROM: Charles R. Baquet III, Acting Director

SUBJECT: Volunteers with Medical Conditions That Require Special In-country


Placement or Support

This memorandum responds to questions and concerns about our procedures for inviting
applicants to serve as Peace Corps Volunteers when, for medical reasons, they may be
assigned only to certain sites in country, or will require support from post that is different
from the support generally provided to other Volunteers. For convenience, these restrictions
and special support needs will be referred to collectively as “special in-country
requirements.”

As you know, many considerations go into the process that culminates in matching an
applicant with a particular Volunteer assignment. In general, posts make a programmatic and
administrative determination regarding the total number of Volunteers they will be able to
place and support and the particular projects and sites to which those Volunteers will be
assigned. Placement assesses each applicant’s suitability, interests, and technical skills and
attempts to match that applicant with an appropriate Peace Corps program. The Office of
Medical Services (OMS) determines whether applicants are medically qualified to serve as
Volunteers, with or any restrictions. Finally, during training, posts assess the Trainee class
and try to match individual Trainee preferences and strengths with available site assignments.

This process works reasonably well when posts have the programmatic flexibility to assign a
Trainee to any of the sites developed for that Trainee’s program and the ability to budget and
plan accurately for Volunteer support needs. The process breaks down, however, when posts
discover only after a Trainee has arrived in country that, for medical reasons, the Trainee
cannot be assigned to certain sites in that country or the Trainee requires a different level or
type of support from that which the post is accustomed to providing for Volunteers. In such
cases, finding an appropriate site assignment at such a late date may be difficult, changing the
original assignment may have an adverse programmatic impact, or providing the special
support required may place unanticipated burdens on the post’s staff or budget. Under certain
circumstances, it may not be reasonable or even possible to satisfy the special in-country
requirements. For these reasons, the placement process must assure that both medical and
programmatic needs are given full and careful consideration before an applicant is invited to
serve in a particular Peace Corps program. The policies and procedures described in this
memorandum are designed to achieve this goal. As explained in detail below, an individual
will be designated to serve in a new position, called the OMS-Placement Coordinator, who
will play an important role in implementing these policies and improving the coordination
and communication among Placement, OMS, and posts in this area.

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TG 195 ATTACHMENT A

Part I of this memorandum discusses applicants and the procedure for addressing special in-
country requirements that are identified during the medical screening process. Part II
discusses Trainees (or Volunteers) and the procedure for addressing such requirements that
are identified after the Trainee has arrived in country. Part III provides background
information about the Peace Corps’ legal obligations to make reasonable accommodations for
qualified disabled individuals. Finally, Part IV addresses questions about medical
confidentiality and the policy and procedures that permit disclosure of medical information to
non-medical staff who need that information to perform their jobs.

I. Applicants

Through the medical screening process, OMS assesses an applicant’s physical and mental
capacity to perform the essential functions of a Peace Corps Volunteer without unreasonable
disruption or unreasonable risk to the applicant’s health. Frequently, OMS determines that an
applicant is medically qualified only if special in-country requirements can be satisfied. Thus,
for example, an applicant may be medically qualified for service only if placed at a site below
an altitude of 5,500 feet, or where the temperature remains above 40 degrees F, or where
medical resources are accessible within a certain number of hours. Applicants with impaired
sight or mobility, or extreme sensitivity to certain environmental conditions, may also have
special in-country requirements. This Part describes the policy and procedures that OMS,
Placement, and post should follow for applicants whose medical qualification is conditioned
on satisfying special in-country requirements.1

When OMS determines that an otherwise qualified applicant has a medical condition that
may restrict his ability to serve in any particular assignment or location within a country, or
that may seriously affect his daily life as a Volunteer, OMS will provisionally qualify the
applicant pending confirmation that a post can provide an appropriate placement and
adequate support. It is Peace Corps policy that, before Placement extends an invitation to
such an applicant, (1) PC/Washington must fully inform the post about the nature and extent
of the applicant’s placement and support needs, and (2) the post must confirm that it can
provide an appropriate placement and adequate support for that applicant.

The OMS-Placement Coordinator will coordinate the exchange of information among OMS,
Placement, and post in accordance with the procedure described below.

A. Medical Assessment by OMS

The Office of Medical Services is responsible for determining whether an applicant is


medically qualified for Peace Corps service and for identifying any special in-country
requirements or ways in which the applicant’s medical condition may seriously affect his
daily life as a Volunteer. If any such requirements or conditions are identified, OMS will
inform Placement that the applicant has been provisionally qualified pending confirmation

1
The policies and procedures set out in Part I of this Memorandum apply only to applicants who are medically
qualified on condition that certain “in-country” requirements are satisfied, e.g., an asthmatic who is medically
qualified for service only at a site that is within one hour of a 24-hour medical facility. In such cases, an
invitation to serve in that country cannot be extended until post has determined that it can satisfy the in-country
requirements. These policies and procedures do not apply to applicants who are medically qualified to serve
only in certain countries, but without any restrictions once they are in one of those countries.

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TG 195 ATTACHMENT A

that a post can provide the placement and support necessary to satisfy the in-country
requirements.

B. Coordination with Placement

A Placement Officer seeking to invite such a provisionally qualified applicant must advise
the OMS-Placement Coordinator in writing, and include (i) the name and social security
number of the applicant, (ii) the applicant’s assignment area(s), (iii) the country or countries
for which the applicant is being considered, and (iv) the applicable last invitation date(s).
This notice should be sent as early as possible in the process, but normally at least three
weeks prior to the last invitation date(s).

C. Coordination with Post

The OMS-Placement Coordinator, in consultation with the Screening Nurse, will review the
relevant medical information and transmit a written “Request To Approve Invitation” to both
the CD and PCMO. The Request will state that OMS has medically qualified the applicant
for service on condition that certain in-country requirements are satisfied. It will include a
detailed and complete description of all known physical or other limitations upon the
individual’s ability to serve in any particular assignment or location, any other placement or
support needs, and may include a general description of the type of medical condition at
issue, e.g., “asthmatic” (see Part IV below on medical confidentiality). It will request that
post determine whether it can appropriately place and adequately support the applicant, and it
will indicate whether there is a specific deadline for a response.

D. Assessment by Post

Upon receipt of the Request To Approve Invitation, the PCMO and CD, and, if appropriate,
the responsible APCD, will review the information provided in the request in light of the
resources and demands of the post, country, and potential Volunteer sites and assignments.

The review should first confirm that available medical facilities and resources are adequate to
meet the applicant’s health care needs.2

The next step is for the CD and/or APCD to assess whether an appropriate Volunteer site and
assignment exist and whether post can adequately support the Volunteer from a
programmatic perspective. Due consideration should be given to the financial, administrative,
programmatic, and other ramifications of making the placement.

In assessing a particular placement, it is important to think broadly about the possible


implications a given medical condition or requirement may have upon daily life as a
Volunteer. For example, an asthmatic may be qualified on condition that he be at a site within
one hour of an emergency room, and post may have one such site available. If, however, the
individual has found that pollution is one of his triggers for asthma, and if the available site is
in a heavily polluted industrial zone, post may not be able to accept that applicant.
2
If a required medical resource is no longer available in country and the applicant’s health care needs cannot be
met satisfactorily, the PCMO should immediately contact the Chief of Clinical Programs and advise him of this
change in country conditions.

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TG 195 ATTACHMENT A

A seemingly minor issue of an individual who wears a metal leg brace may raise a host of
daily living concerns: the brace may cause the individual to have to disrobe to use the
bathroom, thus a site with only squat toilets may not be appropriate because there will be no
place to hang clothes; the brace may be susceptible to rust and decay, thus a site in a climate
with very salty air may not be appropriate; or the brace may be very bulky, thus a site where
the Volunteer would depend upon very crowded buses with tiny seats may not be appropriate.
Likewise, if an applicant must be near a certain town, post should determine if an established
site is viable or, if not, assess the feasibility of developing a new site.

As these examples illustrate, a successful review process will involve collaboration among
the CD, PCMO, OMS-Placement Coordinator, and if appropriate the APCD, each of whom
may have different information that is relevant to the issue. In addition, it frequently may be
helpful for post and/or the OMS-Placement Coordinator to contact the applicant directly to
elicit more information concerning the nature of his requirements, and to communicate the
realities of the placement for which he is being considered. The Office of the General
Counsel (OGC) is also available to assist throughout this process. It is essential that posts
complete the review process and communicate their response within the time period specified
on the “Request to Approve Invitation.”

E. Decision Whether To Approve Invitation

After the review is complete, the CD is responsible for deciding whether post can
appropriately place and adequately support the applicant. If the CD approves the Request To
Approve Invitation, the CD will notify the OMS-Placement Coordinator and Placement
Officer in writing, and the Placement Officer may then send the applicant a letter of invitation
to serve in that country. If the CD concludes that the applicant cannot be appropriately placed
or adequately supported in country, the CD must contact the OMS-Placement Coordinator,
who will review the matter in consultation with OGC to ensure that it comports with Peace
Corps’ legal obligations (see Part III below).

II. Trainees and Volunteers

Occasionally special in-country requirements are not identified until after the Trainee or
Volunteer has been in country for some time. This is not necessarily due to any intentional
failure to disclose information.3 Because applicants are not examined by Peace Corps medical
staff during medical screening, training is the Peace Corps’ first opportunity to assess the
health and functionality of Trainees based on direct observation and examination.
Accordingly, PCMOs may quite appropriately determine that a Trainee should not serve in a
particular assignment or location even when OMS had cleared the Trainee without any
special in-country requirements. This Part describes the policy and procedures that PCMOs,
posts, and PC/Washington should follow in such circumstances.

3
In some cases, however, applicants fail to disclose material information about their health during the medical
clearance process, and OMS clearance was based on intentionally false or incomplete information. When
PCMOs learn significant information about medical histories, health conditions, medications or symptoms that
do not appear in a Trainee’s medical chart, they should promptly notify the Chief of Clinical Programs of the
possible non-disclosure, who will forward all significant non-disclosures to Volunteer Recruitment and Selection
for appropriate action.

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TG 195 ATTACHMENT A

A PCMO may determine that a Trainee or Volunteer has a medical condition that restricts
his/her ability to serve in any particular assignment or location within the country, or that
otherwise may seriously affect his/her daily life as a Volunteer. In such cases, it is Peace
Corps policy that: (1) the PCMO must report to the CD the nature and extent of the Trainee’s
or Volunteer’s placement and support needs and (2) the CD must determine whether post can
adequately place and appropriately support the Trainee or Volunteer. This process is
described more fully below.

A. PCMO Recommendation of Special Placement or Support

The PCMO should promptly notify the CD if the PCMO determines that a Trainee or
Volunteer has medically-based placement requirements or other support needs that were not
previously identified by OMS. The PCMO should explain that it is the PCMO’s own
recommendation, and that the need for special placement or support was not identified by
OMS during screening. The PCMO should always communicate to the CD complete
information about the nature and extent of any physical or other limitations upon the
individual’s ability to serve in any particular assignment or location, or otherwise conduct
daily life. In addition, as discussed in more detail in Part IV below, PCMOs should
communicate to CDs appropriate medical information about a Trainee or Volunteer if CDs
have a legitimate need to know that information to perform their jobs.

B. Assessment by Post

The CD will review whether the post can adequately support and appropriately place the
Trainee or Volunteer in accordance with the PCMO’s recommendation. This review process
is identical to the one described above for applicants, except that posts have the benefit of
being able to observe how the individual functions in country. If the Country Director
determines that more information is needed about the nature of the restrictions or underlying
medical condition to make a decision, the CD should inform the PCMO, and, in accordance
with the procedures set out in Part IV below, together they will determine the scope of the
extension of medical confidentiality to the CD.

C. Decision Whether To Provide Special Placement or Support

After the review is complete, the CD is responsible for making the decision whether post can
appropriately place and adequately support the Trainee or Volunteer in accordance with the
PCMO recommendation.

If the CD determines that post can provide the necessary placement and support, the PCMO
will send a memorandum to the Chief of Clinical Programs in OMS stating that an in-country
requirement has been approved that had not been identified by the screening process. The
memorandum should include a brief description of (i) the medical condition giving rise to the
requirement, (ii) the nature of the requirement agreed to in country, and (iii) whether the
requirement is based on medical information that was not disclosed during the medical
screening process. This information will be used by OMS to improve the screening process.
(As noted above, PCMOs should promptly notify the Chief of Clinical Programs whenever

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TG 195 ATTACHMENT A

they determine that a Trainee or Volunteer may have failed to disclose significant medical
information during the screening process. See note 3, above.)

If the CD determines that the Trainee or Volunteer cannot be appropriately placed or


adequately supported in country, the PCMO will send a memorandum to the Chief of Clinical
Programs stating that the PCMO has recommended certain medically based in-country
requirements that had not been identified by the screening process, and that the CD has
determined that post cannot satisfy the requirements. The memorandum should state (i) all
relevant information about the medical condition(s), (ii) the nature and extent of the in-
country requirements recommended by the PCMO, and (iii) whether the requirements are
based on medical information that was not disclosed during the medical screening process.

D. PC/Washington Review

The Chief of Clinical Programs will promptly review the memorandum, determine whether
the requirements are medically indicated, and communicate his decision to the PCMO, CD,
and OGC. If, after consultation with the PCMO, OMS determines that the proposed
requirements are not medically indicated, post need not implement them. If OMS concurs
with the PCMO’s recommendation, OGC will review the facts supporting the CD’s
determination that the Trainee or Volunteer cannot be appropriately placed and adequately
supported in country and assess whether that determination comports with the Peace Corps’s
legal obligations. Depending upon this assessment, OGC may counsel post or the Region to
provide the necessary support and placement, or to transfer the Volunteer or Trainee to
another post, or, under certain circumstances, to separate the Volunteer or Trainee from Peace
Corps service.

III. Peace Corps’ Legal Obligations

In general, the Peace Corps is legally required to make reasonable accommodations for
disabled individuals who, with such accommodations, are qualified to be Volunteers. As the
senior agency official at post, the CD is responsible for ensuring that the agency meets its
legal obligation to provide such accommodations. Although the question whether a given
accommodation is required under the law will necessarily depend upon the particular facts of
each case, there are a few basic principles that should inform posts’ approach to the issue.

The law does not require an accommodation if it is incompatible with the essential mission
and operations of the Peace Corps, or with the essential functions of the Volunteer’s
assignment, or if it would endanger the individual or others. In short, the law recognizes that
there are limits to the accommodations that it is reasonable or feasible to make. For example,
we may not be able to require a host country to build ramps to make a given Volunteer site
wheelchair accessible, but we may be required to make such changes to Peace Corps
facilities. At bottom, whether the Peace Corps is required to make a given accommodation is
a legal determination; thus when a post decides that it cannot place a Volunteer with
identified limitations or medical needs, that decision may raise a legal issue and must be
reviewed by OGC.

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TG 195 ATTACHMENT A

IV. Medical Confidentiality

This memorandum is not intended to alter established Peace Corps policies governing
medical confidentiality. Instead, it is intended to highlight the types of information that, under
current policy, it is appropriate for PCMOs to share with CDs in the context of Volunteers
with special in-countries requirements.

Peace Corps policy on medical confidentiality is set out in Peace Corps Manual Section 268,
OMS Technical Guideline 150, and in an April 1996 Memorandum from the AD for
International Operations and the Director of OMS. That policy draws a clear distinction
between non-confidential information that may be related to a health condition and
confidential information about the underlying medical condition itself.

The fact that an individual has limited ability to serve at a given site, perform a given job, or
otherwise conduct daily life as a Volunteer—as distinct from the underlying condition that
may cause such a limitation—is not medically confidential information. PCMOs should
discuss the details of such limitations without hesitation with CDs and program staff when
Trainees are being assigned to their particular projects or when otherwise relevant.

Peace Corps policy also recognizes that CDs have a need to know the underlying medical
condition of applicants, Trainees, and Volunteers, when that information is necessary for the
CDs to perform their job responsibilities. For example, a CD may need to know underlying
medical information about a Volunteer’s condition if it “would prevent a Volunteer from
performing his or her duties or from serving at a particular site.” Peace Corps Manual Section
268, ¶ 3.2; see also April 1996 Memorandum at 2.

It should be stressed that PCMOs are not breaching medical confidentiality by sharing
medically confidential information with CDs who have a particular need to know that
information. Rather, they are extending medical confidentiality to CDs, who are then bound
by the same strictures of medical confidentiality as medical professionals. Thus, when CDs
obtain medically confidential information about Volunteers or Trainees because they have a
need to know that information, they, like PCMOs, are legally obligated to maintain the
confidentiality of that information, and they, like PCMOs, may be subjected to severe
employment sanction, including separation from the Peace Corps, and civil and criminal
penalties under the Privacy Act, if they violate this duty. If a CD determines that another non-
medical Peace Corps staff member, such as an APCD, has a particular need to know certain
information to perform his job, the CD may extend medical confidentiality to that individual,
who would then be bound by the same rules of confidentiality.

We acknowledge that it may be difficult to determine the precise level of medical


information that should be shared in a given case. It is easier to point out what would
probably never be appropriate: a CD’s request for blanket review of a Volunteer’s entire
health record purely for background or curiosity, or a PCMO’s insistence on a site restriction
without providing any additional information to the CD. PCMOs and CDs are expected to
work collaboratively to resolve these issues, and to arrive jointly at the type and level of
information that is appropriate for the PCMO to share with the CD in a given case. The
operative test is whether the information is needed to perform the CD’s job; accordingly, in

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TG 195 ATTACHMENT A

the first instance, the responsibility and authority rests with the CD to determine whether the
information provided by the PCMO is sufficient.

In those rare cases where the CD and PCMO cannot in good faith come to an agreement, they
should contact OGC, which will confidentially review the underlying medical information
with OMS and determine, in light of the CD’s rationale for needing to know the information,
what information should be communicated to the CD.

CONCURRENCE:

Patrick Fn’Piere, Regional Director for IAP


David Gootnick, Director of OMS
Nancy H. Hendry, General Counsel
Monica Mills, Associate Director for VRS
Ellen Paquette, Regional Director for EMA
Thomas Tighe, Chief of Staff
Earl Yates, Regional Director for Africa

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TG 195 ATTACHMENT B

REQUEST TO APPROVE INVITATION FAX FORM

From: Medical Placement Coordinator, OMS


To:

Applicant Name: AA:

SSN (Last 4 digits) : COI:

INSTRUCTIONS: This applicant has been medically qualified for Peace Corps Service on condition
that certain in-country placement or support requirements are satisfied. In accordance with the
November 19, 1999 Memorandum regarding “Applicants with Medical Conditions that Require Special
In-country Placement or Support”, please consider the information contained in this Request to Approve
Invitation and decide whether an invitation should be extended.
Following your discussions, please complete and return the attached form (Approval/Disapproval of
Request) as soon as possible but no later than [date]. If you cannot meet this deadline, please submit a
request for an extension. If you have any questions about this case, please contact the OMS Medical
Placement Coordinator by e-mail, fax, or telephone. Thank you for your response and your assistance
with this request.

Clinical Presentation:

Description of Limitations/Special Support Needs:

For PCMO Only: Confidential clinical information is attached.


TG 195 ATTACHMENT C

APPROVAL/DISAPPROVAL OF REQUEST FAX FORM

From:

To: Medical Placement Coordinator, OMS

Applicant Name: AA:

SSN (Last 4 digits): COI:

INSTRUCTIONS: To be completed by the Country Director (CD) and the Peace Corps Medical Officer
(PCMO). In your reply, please address each limitation and support need, and any other concerns you
have. If additional space is needed for your reply please use an additional page.

We have completed our review of this case, and, in response to your Request to Approve
Invitation, we have determined the following:

θ Yes θ No ____________________________________________________
Limitation/support need #1

θ Yes θ No ____________________________________________________
Limitation/support need #2

θ Yes θ No ____________________________________________________
Limitation/support need #3

Other concerns about placing and supporting this applicant? Please explain:

θ Invitation Approved θ Invitation Disapproved

Signature (Country Director) Date

Signature (PCMO) Date