Peace Corps MTG 200 Health Unit OVERSEAS HEALTH UNITS

Peace Corps
Technical Guideline 200
OVERSEAS HEALTH UNITS
1. PURPOSE
To provide guidance to Peace Corps Medical Officers (PCMOs) on the operation of Peace
Corps health units including physical structure, clinical services, medical supply inventory,
and staffing.
2. BACKGROUND
While the components of the Volunteer Health Support program are the same worldwide, the
physical structure, clinical services, medical supply inventory, and staffing of health units
vary widely from country to country. It is the goal of this technical guideline to offer
guidance in the standardization of health units.
3. SPACE AND CONFIGURATION OF THE HEALTH UNIT
Major decisions concerning the space and configuration of the health unit begins with the
initial assessment of new space when decisions are made to enter a new country. The
physical environment of a health unit should be comfortable, efficient and effective to work
in. It should provide a space where Volunteers feel a sense of comfort and privacy.
3.1 Space
Adequate space for a health unit is necessary to provide quality health care to
Volunteers. At a minimum, a health unit should consist of the following.
1. An office or consultation room to include space for the following:

Desk
Chairs for PCMO and patient
Telephone (adequately placed to allow confidential conversations)
Medical Eyes Only fax machine
Computer (e-mail, Microsoft Office, laptop for PCMEDICS
recommended)
Filing cabinets (health records must be stored in a secure cabinet)
Photocopier (recommended)
2. An examination room to include space for the following:

Exam table and stool
Office of Health Services June 2015 Page 1
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Overseas Health Units
Medical illumination light suitable for pelvic exams

Sink with running water
Counter space for supplies for general examination
Storage space for supplies for examinations
Chairs for PCMO and patient
In addition, a health unit should include space for the following:
3. Work area* for basic laboratory operations to include space for the following:
Counter space for performing lab studies
Storage space for laboratory supplies
If other equipment (microscopes, centrifuges, autoclaves, etc. are present in
unit, remove if not used and/or routinely serviced
* To minimize the risk of contamination of patient care areas with potentially infectious
materials, the laboratory work area should not be located in the examination room
4. Waiting room or waiting area
5. Bathroom with toilet, sink and water supply
6. Adequate storage areas to include space for the following:

Climate controlled storage for pharmaceuticals
Secured appropriately for storage of controlled substances
Reliable refrigerator with minimum/maximum thermometer for storing
vaccines and drugs (backup generator may be required)
7. Office for administrative support (desirable)
8. Observation area/sick bay (desirable)
3.2 Configuration
The location and configuration of the health unit should facilitate Volunteer privacy
and comfort. PCMOs and country staff should consider the following when
determining the location and configuration of a health unit:
Number of rooms
Availability of utilities (water, heat, electricity, etc.)
Floor plan that allows Volunteer privacy and comfort
Adequate general lighting
Infection control

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Accessibility to all Volunteers, including the ill and disabled (sick bay, elevators,
wheelchair accessibility, etc.)
Medical staff access to administrative support
Integration of Volunteer health program with other post activities
Building security and surroundings
4. DRUGS, EQUIPMENT AND SUPPLIES
ATTACHMENT A is a standard drug formulary of oral, topical and parenteral medications

and vaccines for Peace Corps health units. ATTACHMENT B is a standard inventory of
equipment and supplies for Peace Corps health units. The standard formulary and inventory
are resources to assist PCMOs in maintaining a pharmacy and inventory that meet the
specific needs of their health unit.
Health Units are not required to stock all medications, equipment, and supplies in the
standard formulary and inventory.
Health Units may stock medications, equipment, and supplies not included in the standard
formulary and inventory.
Technical Guideline (TG) 240 Medical Supplies and Equipment also provides guidance on
planning and determining supply needs.
4.1 Overseas Sourcing of Medications and Vaccines
All medications and vaccines provided to Volunteers must be FDA-approved and

manufactured in the U.S. The exceptions are:
Drugs and vaccines recognized by experts in the U.S. and elsewhere as being safe
and effective for their prescribed or specific clinical use, e.g., tinidazole (Fasigyn),
proguanil (Paludrine). Such exceptions must be authorized by OHS or cited in the
Technical Guidelines and, in general, are only allowed when no similar drug is
available in the U.S.
Equivalent formulations of FDA-approved drugs and vaccines that are
manufactured and marketed for use in Canada, Western Europe, Australia, New
Zealand, and Japan, e.g., mefloquine manufactured in Switzerland.
Drugs and vaccines manufactured in countries other than those listed above may
lack adequate regulation and inspection of the manufacturing process and,
therefore, may not be as safe or reliable as those available from approved sources.
Approved drugs and vaccines (as defined above) may be obtained from vendors in
other countries who import their products from the countries listed (for example,
South African companies that import drugs and vaccines manufactured and

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marketed for use in the United States, Canada, Western Europe, Australia, New
Zealand, and Japan).
Drugs manufactured by following pharmaceutical companies are approved for use

regardless of place of manufacture:
Merck
Novartis
Aventis Pharma
Bayer
Schering
Glaxo Smith Kline
Pfizer
Any other drugs or vaccines that have been individually approved by OHS.
PCMOs should verify that medications procured locally or from overseas sources meet
the above criteria. Many drugs, some with U.S. brand names, are produced overseas
and sold for use outside of the U.S., Europe, or other countries that regulate the quality
of pharmaceuticals.
All drugs, vaccines, and suppliers that satisfy the criteria outlined above meet the
approval of OHS. To seek approval to buy a drug or vaccine from an unapproved
source, submit all available information about the manufacturer and product to OHS.
There are no such exceptions made for controlled substances, all of which must be
procured through PLS per MS 734 (controlled substances).
Nearly expired or excess inventoried drugs preauthorized by the vendor for return, must
contain the signatures of the PCMO, DMO and vendor verifying the drug and amount
of the return. Records of the transaction must be kept for auditing and tracking
purposes (MS 734.9.4-Return of Excess or Nearly Expired Medication).
4.2 Locally-prescribed Medications
Locally prescribed medications must meet the criteria identified in section 4.1 above.
Referral providers may recommend that Volunteers be placed on non-FDA approved
medications. These prescribed drugs may not provide any benefit or may prove
harmful. In these situations, PCMOs should substitute an equal or better FDA-approved
drug from the health unit. If packaging is in a foreign language, written instructions in
English should be provided to the Volunteer.
PCMOs are responsible for evaluating the safety and effectiveness of all prescribed or
recommended therapies and medications provided to Volunteers and should contact
OHS or the RMO for guidance if there are questions. PCMOs should be familiar with
the side effects of all prescribed medications and appropriately inform Volunteers about
the medications prescribed to them.

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4.3 Emergency Equipment and Supplies
Within the constraints of the local environment, all posts must have the capability to
respond to emergency or life-threatening conditions among Volunteers. All posts are
required to have a Grab and Go bag with all necessary emergency medication.
Where qualified professionals and facilities exist locally, the PCMO should be able to
access emergency services in a timely and efficient manner.
4.4 Medication Issues and Volunteers
OHS medically clears individuals who are on medications not listed in the standard
drug formulary. A list of the medications a Volunteer is taking at the time of his/her
medical clearance is included on the Volunteer problem list in the Health Record.
All Trainees are asked by OHS to arrive in-country with a three month supply of
their medications in order to provide post with sufficient time to procure additional
supply.
Occasionally the Trainee has made a sincere effort to bring this supply of
medications but health plans, physicians, or pharmacies are reluctant or unable to
provide a three month supply. In these cases Peace Corps will make every effort to
ensure the Volunteer maintains an uninterrupted supply of medications. The PCMO
should contact the Post Logistics and Support (M/AS/PLS) if procurement of
necessary medications requires expedited attention.
Trainees often arrive at post on "name-brand" medications. When a generic
equivalent is available at post, the PCMO is encouraged make substitutions as
appropriate. The Volunteer should be fully informed of any medication change to a
generic product.
Trainees often arrive at post on medications where a substitute medication is
available and may be appropriate, e.g., substituting Loratadine (Claritin) for
Fexofenadine (Allegra) for allergic rhinitis. Substitution of one medication for
another requires the evaluation of a provider with prescriptive privileges, generally
a physician, physician assistant, or nurse practitioner. The Volunteer should
understand and concur with any medication substitution.
4.5 Medications of Uncertain 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. Standard multi-vitamin
preparations may be provided and should be available in the health unit.
As such:
Medications that are elective or cosmetic should not, as a general rule, be prescribed
for Trainees or Volunteers. Examples include Viagra, hair loss preparations, or
Retin A for facial wrinkles. OHS will support the use of an elective or cosmetic

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medication only if it is found to be medically indicated and of clear benefit in a

particular case.
Homeopathic, naturopathic, or mega-vitamin treatments should not, as a general
rule, be prescribed for Trainees or Volunteers because they are of uncertain benefit.
PCMOs should consult OHS prior to prescribing these medications.
5. LABORATORY
Peace Corps health units should have a designated work area to perform basic lab
operations. This area should not be co-located with the examination room. This precaution is
necessary to minimize the risk of contamination of patient care areas with potentially
infectious materials.
Health units should have supplies on hand to do the following tests:

Urinalysis
Pregnancy testing
Blood glucose
Stool test for occult blood
Wet mounts
Peak flow meter
Malaria testing (if applicable)
STI testing (nucleic acid amplification test-NAATs)
Rapid test kits for strep, mono
Rapid test kit for HIV
Some test kits have a short shelf life and PCMOs should monitor their expiration dates
closely and conduct quality control testing according to manufacturer instructions.
Beyond the basic lab tests described above, PCMOs are encouraged to use local laboratory
services that have been reviewed and found to be of acceptable quality. PCMOs must not
perform lab tests for which they are not trained and granted privileges through the
credentialing committee.
6. INVENTORY MANAGEMENT AND CONTROL OF PHARMACEUTICAS
MS 734 establishes Agency procedures for inventory control of pharmaceuticals and

controlled substances. It states:

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Inventories of medical supplies must be completed on a quarterly basis. The CD should

appoint a member of staff from outside the Medical Unit, who is not the MSIC Clerk or
APC, to conduct the inventory. The CD may rotate the responsibility for the quarterly
inventory verification as he or she sees fit. During the quarterly inventory check, the
MSIC Clerk and the PCMO or a member of the medical staff must accompany the person
conducting the inventory check. After the physical inventory count, the MSIC Clerk
should reconcile and update the official inventory records with the PCMO records to
account for any discrepancies found during the physical inventory verification.
A complete inventory of controlled substances must be performed quarterly and

whenever a new PCMO first engages in the dispensing of controlled substances. There
should be two counts associated with a new PCMO: the first day of the new PCMO's
tenure and the last day of the outgoing PCMO's tenure.
MS 734 (controlled substances) establishes Agency procedures for the ordering of controlled
substances. It states:
The Peace Corps, through the Associate Director for Management (AD/M), is registered
with the U.S. Drug Enforcement Administration (DEA) to procure controlled medical
substances from designated vendors in the U.S. on behalf of the agency and to distribute
them to PCMOs posted overseas. The AD/M delegates the use of the Peace Corps' DEA
number to his or her Designated Officers (DO) in PLS, with the Controlled Substance
Officer (CSO) as the primary point of contact. Only a DO is authorized to procure
controlled medical substances for the agency. PCMOs do not have the authority to
procure controlled medical substances on behalf of the agency, and must request such
procurement support from M/AS. This includes purchasing controlled substances and
narcotics in-country or from a third-party vendor.
7. STORAGE
Peace Corps health units should have adequate storage areas for medical equipment and
supplies. Storage areas should be secure. Pharmaceuticals should be stored in climate
controlled conditions and temperature-sensitive vaccines should be stored in a reliable
refrigerator with minimum/maximum thermometer. If electricity is unreliable, a back-up
generator may be required to operate the refrigerator. Refrigerator temperature must be
checked and documented daily.
7.1 Storage of Controlled Substances
MS 734 establishes Agency procedures for storage of controlled substances. It states:

Country Directors must provide secure storage for all medical supplies that are specially
designated or controlled substances. Secure storage must provide effective controls and
safeguards against theft and diversion. Controlled substances must be kept in a securely-
locked substantially constructed cabinet. The cabinet must be placed in a locked room (such
as a medical supply closet) within a locked office building.

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8. DISPOSAL OF OUTDATED MEDICAL SUPPLIES
MS 734 establishes Agency procedures for disposal of outdated medical supplies. It states:
Medical supplies (medicines, dressing material, laboratory reagents, test kits, birth control
products, and vaccines, etc.) with expired shelf life must be destroyed in the presence of the
PCMO and the CD, in accordance with local waste disposal and air and water pollution
control standards. Disposal documentation must be retained in post files as per the Peace
Corps records schedule, and a copy provided to the MSICC.
Transfer or exchange of excess medical shelf life items, including controlled substances, is
authorized from a Peace Corps post to other posts or the U.S. Embassy. If a post cannot
transfer the items, then the items must be destroyed. Prior to transferring or exchanging any
excess medical items, post or PLS must agree to all terms and prices for the excess items. A
signed inventory receipt from the receiving agency must document transfer of medical
supplies and controlled substances to the Embassy. This document must be forwarded to
D/OMS and the M/AS. A copy of the transfer documents must be provided to the MSICC.
Under no circumstances must any medical supply be donated to organizations other than
U.S. government agencies.
MS 734 establishes Agency procedures for return of excess or nearly expired medication. It
states:
Peace Corps posts are authorized to return excess inventoried or nearly expired medications
(excluding controlled substances) that were purchased locally to a local vendor if the vendor
preauthorizes the return for exchange or credit. See TG 200 Section 4.1 for guidance
regarding drugs approved for purchase locally. Excess inventoried medications are those
items that will expire before anticipated use. Nearly expired medications are those items that
will expire 60 days before label expiration date.
9. REFERENCES AND RESOURCE MATERIALS
The materials listed in sections 9.1 - 9.3 are provided to each post by OHS. This material, in
addition to the material recommended in 9.4 - 9.5, constitutes a minimum medical resource
library and should be maintained in all health units.
9.1 Policy
Technical Guidelines, Volume I & II (Available through PC Intranet).

On-line educational resources such as Up-To-Date
9.2 Training and Other Resources
The Post-Service Health Benefits Program: A Handbook for Returned Volunteers

OHS, 2000. Available through PC Internet
Health of the Volunteer. Annual Report published by the Epidemiology Unit

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9.3 Videos
The Returned Volunteers Guide to FECA Benefits. OHS, 2014.
9.4 Medical Reference Books and Journals
Medical reference materials are available through internet service in order to assist in
medical management and in the production of training and educational materials.
9.5 Safety and Security Resources
The Office of Safety and Security has developed a variety safety training material and
resources. These materials should be available at post or they can be viewed on the Peace
Corps intranet at inside.peacecorps.gov. Other resources on safety and security include:
Health of the Volunteer. Annual Report published by the OHS Epidemiology Unit
Safety of the Volunteer. Annual Report published by the Office of Safety and
Security
Country-specific safety handbook
10. OFFICE SYSTEMS
PCMOs should establish the following organizational systems in the health unit. Computer
based systems are required
Electronic medical records
Scheduling appointments
Patient Log
Tracking laboratory tests and results
Tracking local consult, dentist, laboratory, and hospital bills
Tracking the medical budget
11. HEALTH UNIT STAFFING
11.1 Clinical Staff
Peace Corps does not have fixed staffing ratios of PCMOs to Volunteers. The range of
health unit staffing ratios depends on a number of factors, including:
Age of post (newly opened or established)

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PCMO training and qualification

Geographic distribution of Volunteers
Annual Trainee input
Use of community-based training
Availability of local medical resources
Availability of support staff
Patterns of Volunteer illness
PCMO participation in new site development
Use of part-time or seasonal clinical staff during Pre-Service Training or Close of
Service activities
PCMOs should inform the CD if they believe that additional clinical staff is required.
The CD will generally consult with the Region and OHS on the staffing plan for your
country.
11.2 Administrative Support
Adequate administrative support is often the key to a well-functioning health unit as

health unit operations involves many non-clinical tasks, e.g., inventory management,
supply procurement, and appointment scheduling. Such support allows the PCMO to
dedicate more time to clinical services, support counseling, training, and site support
visits to Volunteers.
The decision to add support staff is made in country by the CD with input from the
PCMO. Support staff may include a secretary or a medical assistant. Support staff is
generally hired locally and may or may not have clinical skills or experience in the
medical field. PCMOs should inform the CD if they believe there is a need for
additional support staff in the health unit. Contracted support staff may not function as
a PCMO even if they have the clinical training and skill.
11.3 Medical Officer Hiring
OHS determines the professional qualifications of the PCMOs necessary to meet the
health needs of Volunteers at that post (see MS 261 Medical Office and Peace Corps
Medical Officers)
When acceptable in-country health services are available, the health unit may use local
providers for primary medical care. When acceptable primary care services are limited
or unavailable, an advanced practice PCMO, e.g., a physicians assistant, nurse
practitioner or physician is generally required.

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OHS bases its determination on a number of factors including:
Consultation and input from the CD and PCMO

New country entry medical assessment
Country Health Surveys
OHS support/evaluation visits

Peace Corps
REGIONAL HOUSE MEDICINE CABINETS
1. PURPOSE
To ensure certain medications are available to Volunteers (PCVs) who serve in very rural
regions of Peace Corps countries.
To reduce the potential for fraud, waste and abuse while still providing those needed
medications to Volunteers.
2. B ACKGROUND
Some Regional Houses have medicine cabinets stocked with a variety of medications that
Volunteers may need, but because of the remoteness of their sites would not otherwise ha ve
easy access. These cabinets have historically been repositories for unused medications
from med kits left at the houses by departing Volunteers. The Peace Corps Volunteer
Leaders (PCVLs) usually kept the cabinets locked, but not always. Some Volunteers have
had free access to the medications. There is often no set inventory and very little
accountability.
Some PCVs have purchased needed medication on the open market rather than travel to the
Health Unit to get a prescription filled. Peace Corps cannot guarantee the efficacy of
medications purchased on the open market; many of them come from questionable sources.
3. PROCESS
A. Medications will be available at Regional Houses on a limited basis.

B. Medications will not be distributed to Regional houses that do not have the means to
ensure a controlled temperature environment.
C. PCMOs will submit a list of medications to be placed in the cabinets, using TG 202
Attachment B: Standard Medicine Cabinet Inventory as a template to HQ/OHS
Medical Director for approval prior to stocking the cabinets. Controlled substances will
not be available at the Regional Houses. Four Specially Designated medications will be
available (Albuterol Inhaler, Coartem, Malarone and Mefloquine); see # 17 for specific
instructions regarding inventory control of Specially Designated items.
D. All PCVLs agree to maintain the strictest level of confidentiality with respect to all
medical information and data to which he/she has access. A confidentially agreement
(TG 202 Attachment A: Confidentiality Agreement) will be signed and dated by the
PCVL and the PCMO assuring the PCVs that the limited information the PCVL has will
not be shared. This notice will be posted in a prominent place near the medicine cabinet
and kept on file in the Health Unit.
E. All PCVs are to be notified in writing by the PCMOs in the form of a blanket email of the
purpose of the Medicine Cabinets and that the PCVLs have all signed confidentiality
statements protecting the PCVs privacy and therefore are bound by confidentiality
standards.
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Office of Health Services October 2015 Page 1 of 2
F. PCVLs will not be notified of the medical conditions the PCVs are being treated for. The
only information they will receive from the PCMO regarding treatment is which
medication the PCV should be given.
G. PCMOs will assure that each PCV receives information regarding the purpose of the
medication, its expected benefits and side effects.
H. Cabinets are to remain locked in a locked room at all times; only the PCVL may have the
key.
I. All cabinets within the country are to be uniform: contain the same drugs, in the same
quantities; the shelves are to be labeled by the PCMO with the generic name, trade name
and strength of each medication.
J. The medications available are for emergency or urgent use only. PCVs on chronic
medications must order them from the Health Unit in a timely fashion so as not to run
short of meds.
K. All medications must be in bottles pre- labeled with instructions, expiration date, lot
number and include the generic and trade names.
L. No medications will be removed from the cabinet unless the PCVL receives a call from
the PCMO naming the individua l who needs the medication and the medication to be
dispensed.
M. The medication will be removed from the cabinet by the PCVL in the presence of the
PCV.
N. A form 202E: Record of Medication Dispensed from Regional House Medicine
Cabinet must be completed and signed in appropriate places by the PCVL and the PCV
when the PCV receives the medication.
O. Form 202Es will be returned to the Health Unit no later than the 1st and 15th of each
month to ensure the inventory is monitored by the PCMO. If no medications are
dispensed during any given reporting period the PCVL is to report this to the PCMO via
email or text message.
P. PCVL will submit inventory count on the 15th of each month to PCMO. PCMO will
cross reference the inventory count with 202Es to ensure accuracy of the count.
Q. PCMOs will record the dispensation of each Specially Designated medication on the
standard form 240D and submit to the MSICC as per TG240 guidance.
R. In addition to having a limited inventory available to PCVs at the Regional houses,
PCMOs may add a few medications to the standard med kit (see TG 202 attachment B:
Suggested Prescription Medications to add to Med Kit) for those Volunteers who are
in very remote regions without reasonable access to a reliable pharmacy or Regional
House.
S. All returned and/or expired medication and will be sent by the PCVL to the PCMO for
appropriate disposal. No used medical kits or contents are to be kept at the regional
houses.
T. To reduce frequent use of the Medicine Cabinet it is strongly suggested that PCMOs
establish a relationship, where possible, with reliable retail pharmacies that meet Peace
Corps standards and who can fill prescriptions on an as needed basis.
a. It is impe rative to note the PCVLs may not add or re move any drug from
the me dicine cabine t without approval from the PCMO.
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Office of Health Services October 2015 Page 2 of 2
Peace Corps Office of Health Services
Confidentiality Agreement
DATE:
Statement of Confidentiality:
In accordance with the Peace Corps Act and the Privacy Act,
, PCVL
Hereby agrees to maintain the strictest level of confidentiality with respect to all medical
information and data to which he/she has access.
_
PCVL Signature (Date)
_
PCVL Printed name
_
PCMO Signature (Date)
_
PCMO Printed name
Office of Health Services October 2015 Attachment A

OFFICE OF HEALTH SERVICES REGIONAL HOUSE MEDICINE CABINET STANDARD INVENTORY and ORDER FORM
Yellow Highlight indicates Specially Designated Medication
Me dica tions Possible Par Expire Amount Date/PCMO

Generic Name Trade Names Unit Stock Date Count Order Sent
Albuterol inhaler Ventolin 1 unit 1

Amoxicillin 500 mgm Amoxil 40 caps 2
Amoxicillin and clavulanate 875/125 mgm Augmentin 40caps 2
Artemether and Lumefantrine (Coartem) Coartem 24 tablets 2
Artificial Tears 1 bottle 2
Aspirin 325mg tablets Aspirin 24 tablets 2
Atovaquone/Proguanil Tablets Malarone 36tablets 2
Benzocain/Dextromethorphan Lozenges Cepacol 16 tablets 2
Benzocaine 20% Topical Oral Gel Orajel 1 tube 2
Cefalexin 500mg Keflex 20caps 2
Chlorhexidine Skin Cleanser Hibiclens 1 Bottle/Pkg 5
Ciprofloxacin 500mg caps Cipro 6 caps 2
Cough Drops Various box 2
Dextromethorphan Benylin 10 tablets 2
Dicyclomine Dilomine or Bentyl 6 tablets 2
Diphenhyramine 25mgm Benadryl 30caps 2
Doxycycline 100mg, 100s Vibramycin 100caps 2
Erythromycin 500mg Erythrocin 40 tablets 2
Fluconazole 150mg tablets Diflucan 1tab 2
Hemorrhoid Suppository or Ointment Preparation H or Anusol 1 pkg 2
Hydrocortisone 1% cream Cortizone 1 tube 2
Ibuprofen 200mg tablets Advil 24 tablets 2
Levofloxacin 500mg Levaquin 5 tablets 2
Meclizine 10 mgm tablet Antivert 10 tablets 2
Mefloquine 250mg Lariam 18 tablets 2
Me dica tions Possible Unit Par Expire Count Order Amount Date/PCMO
Generic Name Trade Names Stock Date Sent
Office of Health Services October 2015 Attachment B

OFFICE OF HEALTH SERVICES REGIONAL HOUSE MEDICINE CABINET STANDARD INVENTORY and ORDER FORM
Mupirocin Ointment Bactroban 1 tube 2

Omeprazole 20mg Prilosec 30 tablets 2
Oral Rehydration Solution ORS 1 pkg 10
Penicillin V-K 500mg tablets Pen VK 40 tablets 2
Polymixin ear drops Neomycin 1 bottle 2
Prednisone 10 mg Tablets Deltasone 20 tablets 2
Psuedoephedrine/Paracetamol Sinutab 30 tabs 2
Saline Spray (Nasal) Salex 1 bottle 2
Silver Sulfadiazine Cream Silvadene 1 jar 2
Tinidazole 500mg tablets Tindamax 4 tablets 2
Trimethoprim/Sulfa me thoxazole D/S 800mg/160mg Bactrim 10 tabs 2
_ ____________ _
PC VL Printed N ame/Initials PC VL Signature Date Submitted Date Receiv ed PC VL Initials
Office of Health Services October 2015 Attachment B

Suggested Prescription Medications to add to Standard Medical Kits:
One course of each of the following:

Coartem (malaria treatment)
Amoxicillin (strep, otitis)
Keflex (skin infections)
Erythromycin (PCN allergic)
Azythromycin (respiratory, dysentery)
Ciprofloxacin (dysentery, UTI)
Tinidazol (giardia)
Phenergan (nausea and vomiting)
Additional item:
Rapid Diagnostic Test (Malaria) (2)
Optional:
Digital thermometer
Office of Health Services October 2015 Attachment C

REGIONAL/PROVINCIAL HOUSE MEDICINE CABINET
_(Country) _(House Name)
Month/Year: _
Medication Cabinet Room Temperature Record
Day Morning Temperature Evening Temperature PCVL Initials

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Office of Health Services October 2015 Attachment D

RECORD OF MEDICATION DISPENSED FROM REGIONAL HOUSE MEDICINE CABINET
Us e of this form is required when dispensing a medication to the PCV from the Regional House Medicine Ca bi net. Medication ma y be
removed from the ca bi net only by the PCVL and only upon authorization from the PCMO. The original form is placed in the PCV Medical
Record in the Health Unit.
st th
Note: Forms a re submitted by the PCVL to the PCMO on the 1 and 15 of each month.
The PCMO uses this form to control medication inventory a t the Regional Houses only.
Medication Dispensed: to be completed by the PCVL
Sample Item 1 Item 2
Tinidazole 500mg/
Medication/ tablets
Dosage
Quantity
Dispensed 4 tablets
Volunteer Name
Date Item(s) Dispensed
PCVL Signature
PCV recipient of medications please complete and sign. Initials

The PCMO instructed me to pick up the medications from the Regional House.
The PCMO gave me instructions on how to us e this medication(s), the intended benefits and the possible side effects.
I witnessed the removal of the medication from the medicine ca bi net.
I received the medication directly from the PCVL.
I understand that I must contact the PCMO a s instructed if my condition does not improve or worsens
Name
Volunteer ID#
Date:
Signature
Office of Health Services October 2015 TG 202 Attachment E

Peace Corps
Peace Corps Volunteer Site Visits/Health Facility Assessment
1. PURPOSE
To provide guidance and structure for conducting Peace Corps Volunteer (PCV)
visits at their sites for clinical and non-clinical staff at post.
To provide requirement for PCMO Assessment of Health Facilities
2. BACKGROUND
A site visit is an opportunity to develop a better understanding of the Volunteers and their
individual experiences while in their respective communities. It allows staff to obtain
information about the Volunteers adjustment, health, environment, and safety. Peace Corps
Medical Officers (PCMOs) also have the opportunity to identify and evaluate local health
care resources while conducting the visit.
3. PROCESS
PCV Site Visits

Site visits are a shared and collaborative responsibility amongst staff at post. It is the
responsibility of post leadership to incorporate funding in the budget for Health Unit staff
(or other post staff) to conduct visits to assess PCV health and well-being at a minimum of
once per service. Realizing there may be extraneous circumstances limiting Health Unit
staff visits, OMS supports the concept of non-clinical staff performing site visits utilizing
TG 204 Non-PCMO Site Visit Checklist (TG 204 Attachment B). The process is as
follows:
1. PCMOs will prioritize PCV visits, but should coordinate and collaborate with other
non-clinical staff conducting visits whenever possible.
2. Clinical staff (PCMO or Medical Assistant) will assess PCV health and well-being
through the use of the PCMO Site Visit Checklist (Attachment A).
3. Non-clinical staff may assess PCV well-being through the use of Non-PCMO Site Visit
Checklist (Attachment B). The form should be completed by the non-clinical staff
member with the input of the PCV and submitted to the PCMO for action and
documentation as needed.
PCMO Assessment of Health Facilities:
1. The PCMO will visit all sites that have been selected to provide care to PCVs
(hospitals, clinics, private doctors, etc.) at a minimum of once every three years
utilizing the facility and provider assessment tools provided by OHS (TG 204
Attachments C-I).
2. Forms will be stored both electronically and in medical evacuation binder (see TG 380)
for easy access to staff.
______________________________________________________________________________
Office of Health Services January 2016 Page 1 of 1
Peace Corps
IDENTIFICATION CARDS
1. PURPOSE
To describe the preparation and use of Identification Cards for Peace Corps Health Unit staff
2. USE OF CARD
Identification cards are intended to assist and expedite passage of Peace Corps Health Unit
staff through official and non-official formalities when performing official Peace Corps
duties. The cards have been approved by the State Department and the Peace Corps Security
Office.
The PCMO identification card identifies the PCMO as the primary Peace Corps health care
provider in country.
The Peace Corps Health Unit Staff identification card identifies the Medical Secretary or
Medical Assistant as a member of the Peace Corps Health Unit team in country.
3. OBTAINING A CARD
Office of Health Services April 2015 Page 1

TG 205
Identification Cards
The Office of Health Services, Peace Corps headquarters in Washington, DC provides the
template to Post for identification cards.
Post (the CD or designee) is responsible for completing and issuing the cards to Health Unit
staff upon employment.
4. COMPLETING THE CARD

The identification card will include the following information:
Name and credentials the Health Unit staff
Name of the country of assignment. If the card holder covers more than one
country, issue only one card with all country names listed.
A current full-face photo of the card holder
Expiration date. Use the expiration date of the current appointment or contract
Card holder signature
CD signature
Laminate the card
Office of Health Services April 2015 Page 2

UNITED STATES OF AMERICA UNITED STATES OF AMERICA
PEACE CORPS PEACE CORPS
This is to certify that This is to certify that
__________________________________________________ __________________________________________________
Name, credentials Name, credentials
Whose photograph and signature appears hereon is Whose photograph and signature appears hereon is
employed / contracted as a employed / contracted as a
PEACE CORPS HEALTH UNIT STAFF PEACE CORPS HEALTH UNIT STAFF
__________________________________________________ __________________________________________________
PC Country of Assignment PC Country of Assignment

__________________________________________________ __________________________________________________
__________________________________________________ __________________________________________________

__________________________________________________ __________________________________________________
__________________________________________________ __________________________________________________

__________________________________________________ __________________________________________________
__________________________________________________ __________________________________________________
The Peace Corps Health Unit Staff is authorized The Peace Corps Health Unit Staff is authorized
to accompany Peace Corps Volunteers, carry to accompany Peace Corps Volunteers, carry
prescription medications, and use Peace Corps prescription medications, and use Peace Corps
equipment and vehicles in the execution of equipment and vehicles in the execution of
their official duties as Peace Corps Health Unit their official duties as Peace Corps Health Unit
Staff in accordance with the laws of the U.S. Staff in accordance with the laws of the U.S.
and Peace Corps regulations. and Peace Corps regulations.
By authority of the Peace Corps By authority of the Peace Corps
Country Director Country Director
________________________________________ ________________________________________
Signature of bearer Signature of bearer
________________________________________ ________________________________________ ________________________________________ ________________________________________
Peace Corps Expiration date Peace Corps Expiration date
If found, please return to Peace Corps, c/o U.S. Embassy If found, please return to Peace Corps, c/o U.S. Embassy
________________________________________ ________________________________________
________________________________________ ________________________________________ ________________________________________ ________________________________________
________________________________________ ________________________________________
________________________________________ ________________________________________ ________________________________________ ________________________________________
________________________________________ ________________________________________
________________________________________ ________________________________________ ________________________________________ ________________________________________
__________________________________________________ __________________________________________________
Name, Professional Certifications Name, Professional Certifications
PEACE CORPS MEDICAL OFFICER PEACE CORPS MEDICAL OFFICER
___________________________ ___________________________

__________________________________________________ __________________________________________________
___________________________ ___________________________

__________________________________________________ __________________________________________________
___________________________ ___________________________

__________________________________________________ __________________________________________________
___________________________ ___________________________
The PCMO is authorized to accompany Peace The PCMO is authorized to accompany Peace
Corps Volunteers, carry prescriptions and Corps Volunteers, carry prescriptions and
controlled medications and use Peace Corps controlled medications and use Peace Corps
their official duties as Peace Corps Medical their official duties as Peace Corps Medical
Officer in accordance with the laws of the U.S. Officer in accordance with the laws of the U.S.

Country Director ________________________________________ Country Director ________________________________________
________________________________________ ________________________________________ ________________________________________ ________________________________________

________________________________________ ________________________________________ ________________________________________ ________________________________________

________________________________________ ________________________________________ ________________________________________ ________________________________________

________________________________________ ________________________________________ ________________________________________ ________________________________________
TG 210
Health Records
Peace Corps
HEALTH RECORDS
1. PURPOSE
To provide information concerning the format, organization, records management, and

documentation of the Peace Corps health record.
2. BACKGROUND
It is extremely important that a complete, accurate, and legible medical record exist for each
Volunteer, documenting decisions made during his/her medical screening and Peace Corps service.
The Peace Corps health record documents chronologically all health services provided to the
Volunteer. The Volunteers health record forms the basis for adjudication of post-service medical
claims. See also Peace Corps Manual Section (MS) 267 Volunteer Medical Records.
3. HEALTH RECORD FORMAT AND ORGANIZATION
The health record has eight dividers, four on each side. The sections created by the dividers facilitate
access to medical information by organizing the documented information chronologically and by
type.
Table 1. Format of Health Record

(Thick lines indicate section dividers)
Left Side (Top to Bottom) Right Side (Top to Bottom)
Signature Page
Health Benefits Program ID card
Problem List
Pre Printed Specimen Labels
COS/Post-Service In-Service Notes
Medevac In-Service Communications
Pre-Service In-Service Diagnostics
Dental Records In-Service Consults and Reports
Office of Health Services September 2013 Page 1

TG 210
Health Records
3.1 Left Side of Health Record
The sections are presented as they appear in the health record from top to bottom. The
contents of each section are also listed from top to bottom.
Top Left Side
Signature Page (TG 240 Attachment D)

The Health Benefits Program identification card and an Instructions for Use sheet.
Pre-printed specimen labels.
Section 1: COS/Post-Service
This section includes all medical information generated at Close of Service (COS) and post-
service. COS dental evaluations, i.e., PC-1790 (Dental) should be filed under Dental Records.
Contents include:
Federal Employees Compensation Act (FECA) section (if applicable) to include:
Statement of facts,
CA-1 and/or CA-2
Post-Service Case Management System notes
COS or Extension-of-Service Medical Evaluation, i.e., PC-1790 (COS/EXT)
COS medical reports
COS laboratory reports
Authorization for Payment of Medical/Dental Services (PC-127C)
COS Checklist
Medical Separation Letter (if applicable)
Medical Separation Checklist (if applicable)
Consent for Release of Information
Requisition/Payment Voucher for Volunteer Medical Examination (PC-209B)
Section 2: Medical Evacuation (Medevac)
This section contains all case management documentation for Office of Medical Services
(OHS)-managed medevacs. Case notes related to the medevac are documented on PC-Patient
Encounter Form and are placed in section 5 In-Service Notes in reverse chronological order.
Contents include:
Medevac field consult
Medevac Checklist (see Technical Guideline (TG) 380 Medical Evacuation ATTACHMENT
B)
OHS Medevac Authorization Sheet

TG 210
Health Records
OHS Medevac Orientation Sheet

Medical reports, laboratory reports, and consultant reports, including those obtained
during the medevac and those obtained after the Volunteer returns to country or has
medically separated
Case related 127Cs
OHS Medevac Case Management notes
Medical Separation Letter (if applicable)
Medical Separation Checklist (if applicable)
Section 3: Pre-Service
This section includes all information obtained in the application and medical screening
process. Contents include:
Applicant Notification/Medical Qualification Letter
Report of Medical Examination (PC-1790-S)
Health Status Review (PC-1789-S)
Screening Review Board documentation
PC Patient Encounter Form in reverse chronological order
Correspondence
Pre-Service/Screening medical consults
Pre-Service/Screening laboratory reports
Preliminary medical information requested by OHS
Prescription for Eyeglasses (PC-116)
Pre-Service applicant information page
Section 4: Dental Records
This section includes all dental consults, field consults, reports, and dental x-rays. All x-rays
should be placed in the dental checklist envelope (PC-1482). Contents include:
In-service dental consults and reports filed in reverse chronological order on top of the
dental checklist envelope
If applicable, mid-service dental examination (see TG 180, section 4.2)
Pre-Service dental records: dental checklist envelope (PC-1482) including the Report of
Dental Examination, PC-1790 (Dental) and radiographic films
Post-Service dental records: Report of Dental Examination, PC-1790 (Dental), radiographic
films, and any other dental record documentation performed at COS or home leave
127Cs for dental evaluations

TG 210
Health Records
3.2 Right-Side of Health Record
The right-side of the health record contains the following four sections as they appear in the
health record, top to bottom.
Top Right Side
Problem List (PC-1773, Revised 9/2013) (ATTACHMENT A).
Section 5: In-Service Notes
This section contains documentation of all clinical care and other related contacts between
the Peace Corps Medical Officer (PCMO) and the Volunteer during his/her service. In-service
dental consults, dental field consults, and dental reports should be filed under Dental
Records.
PC-Patient Encounter Form and/or PC-Brief Encounter Form in reverse chronological order
Assault Case Notification reports (see TG 420 Attachment A)
Mid-Service Health Evaluation (see TG 320 Attachment A)
Immunization Record (PC-1756)
Vaccine Consent Form (PC-1634)
Pre-Departure Medical Questionnaire (PC-1564)
Section 6: In-Service Communications
This section contains all clinical faxes, field consults, correspondence (including emails and
texts to and from the PVCs) generated while in country or on medevac status. This
documentation is filed in reverse chronological order, with the most recent information on
top.
Section 7: In-Service Diagnostics
This section contains all radiology and laboratory reports generated during the Volunteers
service, including those generated during vacation or home leave. Reports are filed in reverse
chronological order, with the most recent reports on top. Diagnostics obtained during a
medevac are filed in section 2 Medevac.
Section 8: In-Service Consults and Reports
This section contains all consults and reports generated during the Volunteers service,
including those generated during vacation or home leave. Reports are filed in reverse
chronological order, with the most recent information on top. Consults and reports obtained
during a medevac are filed in section 2 Medevac.

TG 210
Health Records
4. RECORDS MANAGEMENT
X-rays: OHS has no facilities for storing or retrieving x-rays. X-rays should not be forwarded to
PC/Washington except for consultation. All x-rays, except dental x-rays, should be given to the
Volunteer when he/she completes or terminates service. The written x-ray report should remain
in the health record. Relevant x-ray records should accompany a medevaced Volunteer or a
Volunteer who transfers to another country. A statement that the Volunteer received the x-rays
should be documented on PC-Brief Encounter Form (BEF), dental x-rays are filed in the health
record in section 4 Dental Records.
Release of information: ATTACHMENT B presents the standard form to be used by a Volunteer
to authorize the release of information from his/her health record. When the standard form is
not available, the Volunteer may authorize the release of information by using a sheet of paper
that contains his/her name, social security number, the information to be released, and the
person to whom the information is to be released. The form is signed by the Volunteer and kept
in section 6 In-Service Communications of the health record. A PCMO must consult with OHS
before releasing information from a Volunteers health record to anyone other than another
health provider involved in the Volunteers care or someone authorized in writing by the
Volunteer.
Volunteer access to the Health Record: On request, a Volunteer may have reasonable access to
review his/her health record in accordance with appropriate medical care and in the presence of
the PCMO. The Volunteer may also request and be given copies of part or all of the health
record. PCMOs should consult with OHS about any medical information, e.g., psychological or
substance abuse reports, that they believe inappropriate to release to the Volunteer. Under no
circumstances should any part of the original health record be given to a Volunteer.
Volunteer request to remove information: No information may be removed from the health
record, and under no circumstances should original documentation be removed. Volunteers
may write addenda, or provide additional documentation for their file, which should be placed
in section 6 In-Service Communications. Volunteers or Returned Peace Corps Volunteers
(RPCVs) requesting to have material removed from their health records must submit a written
request and justification to the Office of the General Counsel.
Returned Volunteer requests for information: PCMOs should instruct RPCVs to write directly to
the Medical Records Department to obtain information from their health records.
5. STORAGE OF RECORDS
Health records must be stored in a bar-locked cabinet with a combination lock set by the PCMO.
Only the PCMO and authorized medical assistants should have access to the records and the
combination (see MS 261 Health Unit and Medical Officers/Contractors).
6. TRANSPORTING RECORDS
Prior to shipment, Peace Corps health records should be wrapped securely, sealed in an envelope or
box with tape, and marked Medically Confidential. Records should be sent via express delivery,
registered APO or registered pouch to:

TG 210
Health Records
Peace Corps Office of Health Services

Medical Records Department
1111 20th Street, NW
Washington, DC 20526
After COS, records should be sent to OHS within 30 days. Notification should be sent to OHS
stating that the records were sent. OHS will acknowledge receipt of the records.
During a medevac, copies of pertinent medical information such as specialist reports, labs,
CT/MRI films, etc. should be given directly to the PCV to hand carry. The original copy of the
Volunteers health record should be kept at post, until the medical status of the Volunteer has
been determined. In the event the Volunteer returns to country, the post will maintain the
Volunteers original record and will receive any information obtained from headquarters or
regional medevac hubs via SFTP. Only when the determination has been made to medically
separate or COS the Volunteer should the original health record be sent to headquarters.
PCMOs should notify the OHS Medical Records Department when a Volunteer and his/her
health record are transferred from one country to another.
If a health record arrives in country that cannot be associated with a Peace Corps Trainee, the
health record should be returned immediately to OHS. An Unusual Event form must be
submitted to the Quality Improvement Unit documenting the error and any corrective action.
7. DOCUMENTATION OF CLINICAL CARE
The PCMO provides and authorizes health care service to Volunteers. The PCMO is responsible for
managing and for documenting the decisions made in providing the care. Clinical care
documentation should provide a chronological record of decisions made, actions taken, and
resolutions reached. These decisions and actions are documented on the PC-Patient Encounter (PEF)
form or the PC-Brief Encounter (BEF) form only. The following procedures apply to health record
documentation:
All documentation in the Peace Corps health record must be recorded legibly (preferably type
written) on only one side of a standard A4 or 8 x11inch paper.
Chronological Record of Medical Care: Each Patient Encounter Form (PEF) or Brief Encounter
Form (BEF) must include the Volunteers name, sex, date of birth and social security number or
Volunteer ID number in the appropriate space at the bottom of each page. If page two of the
PEF is being used care must be given to include the same patient identifiers on this page.
Date Format: Dates are recorded sequentially as day, abbreviated month, and year (for
example, 3 Nov 2013.)
Corrections: Corrections may only be made by crossing out the material to be corrected with a
single line and inserting the corrected copy. Each change must be dated and initialed.
Correctional fluid or tape (white-out) must never be used in the health record.
Translations: All reports, consults, and lab results must be translated into English. Translations
should be typed. Translations legibly handwritten are acceptable.
Signatures: All entries must be dated and signed with a legal signature and professional title:
i.e., R.N., M.D., N.P., or P.A. Electronic signatures are acceptable, and encouraged. All providers

TG 210
Health Records
must sign and print their names and professional titles on the Signature Page located on the
top left hand side of the medical record.
Communications that include the names of several Volunteers: Names and information
concerning other Volunteers should be deleted before filing documents in an individuals health
record. Changes to the record should be dated and initialed.
Notes: All notes entered in the health record must be written on or affixed to standard-sized
paper.
Copies: Photocopies of consultation reports, etc., are acceptable and must be signed and dated
indicating they have been reviewed by the PCMO.
7.1 SOAP Format
The Patient Encounter Form (PC-PEF) and the Brief Encounter Form (PC-BEF) are laid out in
the SOAP format; entries should be made in the appropriate sections. See ATTACHMENT C for
SOAP/PEF and BEF examples.
The SOAP format includes the following items:
Date DAY / Month / YEAR (e.g., 6 Mar 95)
S Subjective Information: The problem as presented by the Volunteer, including

subjective symptoms and complaints. Also included are history of present
illness, past medical history, family history, and pertinent negative
information.
O Objective Information: The information observed by the PCMO during a
physical exam, including vital signs, laboratory or x-ray results, and findings of
a mental status exam. Includes any signs that can be observed.
A Assessment: The PCMOs impression or diagnosis of the problem. The first time
the Volunteer presents with the problem, the assessment may include several
working diagnoses. As the problem is more clearly defined, the diagnosis may
become clearer.
P Plan: A record of medications or treatments prescribed, further evaluations

and follow-up planned, and any instructions or health education given to the
Volunteer.
Legal Signature and Title
When subjective or objective information is lacking, S: N/A or O: N/A respectively should

be recorded.
7.2 Documentation of Case Management
The Medical Record must contain an easy-to-follow description of the Volunteers care during
his/her service. All patient problems must be addressed until resolved; initial encounters must

TG 210
Health Records
be documented on the PEF; subsequent related encounters, if brief, may be documented on

the BEF. All consultations or evaluations related to the problem, as well as its resolution, will
be noted in this record. All clinical notes should be written as soon as care is administered, but
no later than 72 hours after the clinical encounter. If medications are prescribed or tests
ordered during the clinical encounter, a brief note must be written and placed in the health
record by close of the business day to ensure continuity of care. If the medical problem is of
an urgent or acute nature and/or possibly requires a follow-up evaluation, the note must be
documented in the health record and the on-call PCMO notified of the situation before the
PCMO leaves the medical office for the day.
A format for documenting case management is suggested for the following situations:
Health Unit Visits: The SOAP format is used to document Volunteer health-unit visits. The
S entry represents the problem as presented by the Volunteer; O, the PCMOs findings
on examination; A, the PCMOs assessment of the problem; and P, the ensuing
problem management.
Consults, Evaluations, Laboratory Results: The SOAP format also is used to document
referral care and test results on the Brief Encounter Form (BEF). If recording a long
telephone consultation report the PC-600 Chronological Record of Medical Care may be
used (see special instructions below).
Special instructions include:
Record S: N/A if there is no subjective information, i.e., the Volunteer was not
interviewed and, therefore, did not provide any new information.
Record a summary of consultations or evaluations as O. The report may be
obtained verbally or in writing. When the report is taken verbally it may be filed in
the section six as a chronological record of the current problem. When the
written report arrives, the PCMO notes date and time on the consultation report
and files in section 8.
Record laboratory and other test results as O. The written report is filed in
section 7 In-service Diagnostics.
A is the PCMOs assessment of the evaluation, taking into account any new
information from the Volunteer, consultant, or laboratory report.
P is the management plan based on the discussion and analysis documented
above.
Note: Any new information for the medical history obtained by consultant is considered as
part of the objective section (O). An abbreviated example of this usage is:
S: Volunteer states pain is much less today since starting Maalox.

O: Consultant reports past history of gastritis. Epigastric tenderness on exam
yesterday. H/H 15/45. Consultant recommends trial of antacids.
A: Possible recurrence of gastritis.
P: Continue Maalox QID. Avoid caffeine, alcohol. Counseled to stop/reduce
smoking. Return to Health Unit Friday, sooner if pain worsens.

TG 210
Health Records
Telephone Conference with Volunteer: Telephone conversations between a PCMO and a

Volunteer regarding a problem are documented in the SOAP format using the PEF, if it is a
new problem, or the BEF if it is a brief follow up of any problem previously recorded on
the PEF. Subjective information can be documented under S, evaluation reports by
other providers as reported by the Volunteer, under O, PCMO assessments, under A,
and the plan, under P.
Resolution: If the PCMO is informed (either by phone call or letter) by the Volunteer that
the problem is resolved, the information is entered under S, O is N/A, A is the
PCMOs description that the problem has resolved; and P is any further follow-up or
management, if indicated. The Problem List should be updated to reflect the date that the
problem was resolved.
Volunteer Written Self-Reports: Volunteers should be encouraged to keep a descriptive,

chronological account of any illnesses or injuries incurred during service. These accounts
may be included in the Peace Corps health record in In-Service Communications. The
PCMO should indicate that it is a self-report, date and sign the document, and file it in the
In-Service Communications Section. Self-reports are subjective information.
Notations Not Requiring a SOAP Format: Some notations on the BEF (Brief Encounter
Form) do not require a SOAP format. These include the dispensing of medication or a
medication refill, notes documenting the receipt of consultant reports which have already
been received verbally, and notes documenting reminders sent to the Volunteer
concerning appointments.
7.3 The Problem List
ATTACHMENT A: Problem List (PC-1773, revised 9/2013). The Problem List provides a
summary of both acute and long-term health conditions. PCMOs should describe acute
problems in terms of the presenting problem and the date of onset. A diagnostic assessment
may be added to the same line. When the problem is resolved, the date resolved should be
placed in the last column. For example:
Presenting Problem Date of Onset Date Resolved

#3 Back Pain / muscle strain 3 Feb 2012 12 Mar 2012
A second episode would be entered as a new problem, for example:
#5 Recurrent Back Pain 4 Jun 2013
Long-term health problems should be listed by diagnosis rather than as a presenting problem,
since a more specific diagnosis is usually known. For example:
#1 Hypertension 1980
The Problem List must provide a list of all acute and chronic health conditions including Date
of Onset and Date Resolved to assure that the information remains current and relevant.
Unresolved problems should be addressed at each patient encounter.
When a Volunteer transfers from another country, a new Problem List should be created upon
their arrival. The PCMO should list all ongoing/current and unresolved health problems or
conditions, and all new problems as they develop. The previous Problem List should be filed
underneath the new Problem List for reference.

TG 210 ATTACHMENT A
PROBLEM LIST
NAME SSN: SEX:

COUNTRY: DOB: COS:
FOR PCMO USE:
PRESENTING PROBLEM OR DATE DATE

ONGOING HEALTH CONDITION ONSET RESOLVED
10
11
12
13
14
15
16
17
18
19
20
PC-1773 (5/2001)
TG 210 ATTACHMENT C
EXAMPLES OF SOAP NOTES
HEALTH UNIT VISIT
3 Nov 01 S: I dont feel well. I cant eat. Denies vomiting and diarrhea. Duration 3 days.
O: Temp: 100.2 Pulse: 80 Resp: 20 BP: 110/70
Lungs clear, bowel sounds normal, abdomen tender on palpation, no localized
tenderness, no rebound tenderness, sclera dont appear yellow, urine dark yellow in color,
mucous membranes appear somewhat dry.
A: Moderately ill, dehydrated Volunteer with fever. May be due to appendicitis, hepatitis, or
intestinal virus.
P: Obtain CBC and differential, urine dipstick, serum bilirubin.
Encourage PO intake of fluids, 8-10 glasses a day.
Encourage rest - will stay at health unit overnight.
Recheck temp every 4 hours while awake.
Examine again on 4 Nov 94.
Signature and Title
CONSULTS, EVALUATIONS, LABORATORY RESULTS
4 Dec 01 S: N/A.
O: Phone call from radiologist. Chest x-ray is negative.
A: TB converter (Mantoux skin test positive.) No signs of active TB.
P: Will ask Volunteer to return to Health Unit tomorrow.
Will check for contraindications to INH before beginning therapy.
Signature and Title
TELEPHONE CONFERENCE WITH VOLUNTEER
5 Dec 01 S: No history of using TB meds. feels well. Reports no alcohol abuse or other problems.
O: N/A.
A: No contraindications present for INH therapy (TB skin test converter.)
P: Made appointment for 10 Dec 94 at Health Unit.
Will dispense one months worth of INH 300 mg at this time and provide patient education
about side effects. Will reappoint monthly for follow-up.
Signature and Title
RESOLUTION
10 Oct 01 S: Volunteer states that diarrhea is much better. Stools are formed and frequency has
decreased to once a day.
O: N/A.
A: Diarrhea resolved.
P: Inactivate problem on Problem List.
Signature and Title

PEACE CORPS OFFICE OF HEALTH SERVICE
Medical Record Signature Page*
Date Printed Name and Credential Signature Initials
*All health care professionals are required to provide name, signature and initials on this form
one time only prior to recording in this medical record. The form should be filed on the left
side of the medical record as the top page.
Medical Technical Guideline 210: Attachment D April 2013
Peace Corps
CLINICAL ESCALATION POLICY
1. PURPOSE
The purpose of this policy is to provide guidance regarding Peace Corps Medical Officer (PCMO)
reporting of hospitalizations, critical injuries and illnesses to the Office of Health Services (OHS).
2. BACKGROUND
It is the responsibility of PCMOs to report by phone, the status of Peace Corps Volunteers (PCV) or
Peace Corps Trainees (PCT) to the Office of Health Services when a significant illness, injury, or
hospitalization occurs.
3. ESCALATION PROCESS
The PCMO should notify OHS/RMO if a PCV/T is experiencing a significant illness or has
sustained a significant injury as soon as possible. Notification should never delay care in a life
threatening situation. Situations in which OHS/RMO must be notified include, but are not limited
to:
Life threatening or potentially life threatening conditions.

Any condition likely to require emergency surgery or hospitalization.
Any condition accompanied by unstable vital signs, including significant tachycardia (>130
bpm) or bradycardia (< 45 bpm), symptomatic cardiac dysrhythmias, hypotension (< 90
mmHg systolic), hypertension (>200mmHg systolic), tachypnea (>26 breaths/min), hypoxia
(< 92% at sea level), or temperature greater than 39.5 C.
Any condition likely to require transfer to a higher level facility in-country or an emergency
medical evacuation.
Trainee or Volunteer with an acute psychiatric problem who is a threat to the PCV/T or
others.
Any Volunteer involved in a motor vehicle accident, motorcycle accident or pedestrian
accident involving a motorized vehicle.
Prior to any surgical procedure requiring anesthesia.
Prior to any blood or blood product transfusion.
Loss of consciousness.
When clinical presentation of uncertain etiology may represent a serious underlying
condition, e.g., chest pain, syncope, shortness of breath, altered mental state.
When a condition or diagnosis carries a possible prognosis of long term disability or
morbidity, e.g., traumatic injury with possible of loss of function.
When a condition may lead to significant cosmetic deformity, e.g., large facial lacerations,
facial leishmaniosis.
When a condition or diagnosis is associated with a significant radiographic abnormality.
After a physical or sexual assault where there is significant trauma or psychological issues.
______________________________________________________________________________
When reporting to OHS/RMO, the PCMO should have as much of the following information
available as possible:
o Recent and past medical history
o Mechanism of traumatic injury and status of anyone else involved in the trauma
o Working diagnosis
o Vital signs and any available laboratory or imaging studies
o Initial plan of care
o Location of PCV including the capabilities of the healthcare facilities
o Safety of PCV
o Potential need to move PCV and plan of action should this become necessary
o PCMO follow-up plan
o Determine if permission given to speak to family members
______________________________________________________________________________
TG 214
Peace Corps
TRANSITIONING FROM PAPER TO ELECTRONIC MEDICAL RECORDS
1. PURPOSE
To provide guidance on how the medical office will transition existing paper medical record
documents into electronic format for the PCMEDICS system and outline expectations on the time
frame of this effort.
2. BACKGROUND
The transition period is the time period in which a post is expected to convert to PCMEDICS. This
period is expected to temporarily increase workload on post and HQ clinical staff. The Office of
Health Services (OHS) has defined the transition period to be 90 days. The beginning day of the
transition period is called Go Live and the end date is 90 days after Go Live.
The goal of the transition period is to limit the potential for clinical errors due to simultaneous
paper and electronic records in use during the EMR adoption phase. This is a critical time period
where the potential for clinical errors increases. This plan is designed to minimize the period of
transition.
Peace Corps will deploy PCMEDICS globally during the summer of 2015. After deployment, clinical
staff will receive training on use of PCMEDICS. Every post will undergo a Transition Period after
PCMEDICS deployment and training.
3. GROUND RULES OF TRANSITION
HQ and Post will collaborate on Posts transition plans. Each post will submit to HQ a Paper
to Electronic Transition plan using an electronic template (Attachment A).
OHS has defined the transition period to be 90 days. The beginning day of the transition
period is called Go Live and the end date is 90 days after Go Live.
Before a post can Go Live, all medical staff at the post must have received training and
clearance at that training.
The optimal Go Live date should be in the following week after the last PCMO training (so as
not to lose skills) and right before a major event to decrease future scanning efforts. Post
does have the option to select a different Go Live date if post deems it too much for the
health unit to manage. However, post should analyze this carefully as the EMR may assist
post in these endeavors so that scanning the paper documents generated from such events
(PST intake, COS exams, Interim Health Evaluations) isnt required afterwards.
Health information of Volunteers received in country after the Go Live date will be in
PCMEDICS electronic format.
______________________________________________________________________________
Office of Health Services November 2015 Page 1 of 8
TG 214
All Volunteer paper medical records must be scanned into PCMEDICS within ninety (90) days
of the Go Live date at Post.
PCMOs will not have to scan in pre- service information as this information exists in
electronic format. For current Volunteers, electronic pre- service information will need to be
moved into appropriate PCMEDICS folders.
Optional scanning choice: PCMOs are not required to scan in close-of-service and Peace
Corps Response Volunteers that are scheduled to COS within the 90 day transition period.
Every post will be provided desk top scanner (s) (1 scanner for every 150 Volunteers) and a
handheld scanner.
We are using the metric of a minimum 15 charts scanned /day. The process for this metric is
as follows:
The average file cabinet is about 33 inches wide inside. If it were totally full of health records, about of that
space would be pre-service and the actual physical jacket. If the average file cabinet is 33 inches wide inside
and totally full of health records, then there is about 16.5 inches of scannable material.
The workhorse scanner scans 25 pages at a time (front and back) in three minutes. 25 pages is 1/8 of an inch
(or .125 inches). 16.5 inches/.125 = 132 units of 25 pages of scanning. 132 x 3 mins. per unit= 396 mins. 396
mins./60 mins.= 6.6 hours of scanning effort per 33 inches of health records. Files will need to be named and
uploaded. So, lets assume 8 hours per 33 inches of health records.
We measured how many records averaged in 33 inches of records space. Thirty-three (33) inches averaged 36
records. That would average 36 records per 8 hours (including naming and uploading). Because we know life is
not a formula, we are doubling the effort and assuming a 20% loss in an 8 hour day.
OHS proposes scanning a minimum of 15 charts per day. Here is a possible typical week of
scanning efforts:
Day Effort # of Charts

scanned
Day 1 1.5 hours of training; 5 hours of scanning, naming, and 11

uploading
Day 2 6.5 hrs. Scanning, Naming, Uploading 15
Day 5 6.5 hrs. Quality Assurance and Clean Up 0
Total 32 hours of scanning effort in a 40 hour week 56
______________________________________________________________________________
TG 214
4. DEPLOYMENT AND TRAINING OUTLINE
July 2014 Pilot at 6 posts + RMO (Vanuatu, Peru, Ethiopia, Burkina Faso,
Senegal, Armenia, and Thailand RMO)
Aug & Sept Tool introduced at 2014 CMEs; transition plan information
2014
Nov-Dec Posts work on paper to transition plans (Attachment A)
2014 EnSoftek EMR development complete
EMA GRID refresh complete
Jan 2015 Start AF GRID refresh

PCMEDICS quality testing
Posts submit paper to transition plans to OHS (Attachment A)
Super user training
Feb 2015 Release PCMEDICS to 30+ countries
June 2015 AF GRID refresh complete
Deployment to posts
OHS staff training
Training to posts on current paper chart preparation for electronic
transition
Jul 2015 Medical team training live at HQ in two groups (July 1a and 1b)
Support to Go Live groups
Aug 2015 Medical Team training live at HQ in two groups (Aug 2a and 2b)
Sept 2015 Medical Team training live at HQ in two groups (Sept 3a and 3b)
Oct 2015- On-going support
ongoing Start development of Version 2.0
5. 2015 PCMEDICS TRAINING AT HQ
July: 1A (July 13-21); 1B (July 27-Aug 4)
Aug: 2A (Aug 10-18); 2B (Aug 24-Sept 1)
Sept: 3A (Sept 14-22); 3B (Sept 28-Oct 6)
Posts are expected to choose one month for all medical staff at post to be trained at HQ. All training
costs will be covered by OHS/PCMEDICS.
Back-to-back, 7-day PCMEDICS (CME) training events allow for PCMOs to cover for each other and all
medical unit staff to be trained within a short period of time so as not to lose newly-learned PCMEDICS
skills.
______________________________________________________________________________
TG 214
PCMEDICS HQ Training Highlights:
All PCMOs will be REQUIRED to bring their PC- issued laptops (Lenovo). Medical Assistants and
Secretaries will use laptops from posts laptop pool (Lenovo or HP).
PCMEDICS Training will involve hands-on demonstrations and simulation training on how to use
PCMEDICS incorporating medical content and business process changes.
Prep reading on clinical topics will be provided to prep for the following days clinical scenarios
used in the PCMEDICS training.
CMEs will be provided to clinicians.
An individual capstone is required at the end of the training for every participant to ensure
competency in PCMEDICS skills. Dont worry, we are confident all will show basic competency by
the end of the training.
Opportunities for extra help throughout the week will be available should anyone feel that they
are falling behind and/or want more practice.
The last day of the training will be devoted to accessing PCMEDICS at post so that staff can
see/work with real PCV charts. This is to ensure the team can return the following week and get
started.
Preparation for the 2015 PCMEDICS Training:
Try out PCMEDICS prior to coming to HQ by participating in Pilot II.

Scan in Frequent Users, Complicated, and Large medical files on an encrypted thumb drive to
bring to the CME.
Bring 5-10 scanned records on an encrypted thumb drive from post. This is necessary in order
for each staff on the last day of CME training to start moving the records into the proper
PCMEDICS document files, assess their access and comfort level to PCMEDICS, and provide real-
time experience to prepare for their return to post. *Note: Each participant should bring a
different set of scanned Volunteer records.
Read clinical articles assigned as homework during the week of the CME.
Bring an open mind and willingness to adapt and learn.
Expected PCMEDICS Go Live Dates:
July training: Aug 10, 2015

August training: Sept 8, 2015
September training: Oct 13, 2015
6. EQUIPMENT FOR SCANNING PAPER RECORDS FOR PCMEDICS

Each post will be provided a multipage scanner for quick scanning of documents (Visioneer Patriot
430). Post is responsible for ensuring that the scanner stays dedicated to the medical unit for
secure scanning of electronic personal health information (ePHI).
7. STAFF FOR SCANNING PAPER RECORDS FOR PCMEDICS
All posts will need to support their medical units in the Volunteer paper record scanning process.
______________________________________________________________________________
TG 214
It is recommended that health unit staff perform the scanning effort, but some posts may require
temporary staff to perform this task. PC health unit staff (Medical Secretaries, Medical Assistants
and/or PCMOs) is able to perform this task. If post is opting to hire a temporary person to scan,
here are the following requirements for the position:
Read, write, and speaks English

Has had experience using a computer
Desired experience using Adobe Pro and scanning paper documents
Desired experience with medical terminology
Cannot be a currently serving Volunteer, Volunteer Leader, or Response Volunteer, and
Must adhere to agency HIPAA/Privacy regulations
8. HOW TO SCAN IN THE PAPER DOCUMENTS
Refer to Attachment B Scan Directory to determine where a current paper document should be
placed in the PCMEDICS folders. Do NOT shred the medical record documents that you are
scanning during the transition.
8.1 General scanning steps include:

Scan in document (s) and convert to PDF
o Scan Individual Documents (Best Practice) or
Rename according to name convention outlined in Attachment B
Last name, First Initial.Document Type. Date (YYYYMMDD)
No spaces in between words
o Scan Groups of similar Documents (e.g. all lab results; all consultant reports; all
PEFs/BEFs, etc.) or
Put in chronological order and put a start/end date in title
o Scan entire health record into one document
Group documents together as in the paper record
8.2 How to Prioritize the Scanning effort:
The following list in order of preference outlines when to scan in a Paper Volunteer record:
A. Frequent Users, Complicated , Large medical files (prior to CME training), Transferring
PCVs
B. Medevacs, Sexual Assaults, Major illness
C. Scheduled appointments (records scanned prior to medical visit)
D. Groups: Mid Service exams (records scanned prior to medical visit)
E. Non-scheduled appointments: These could include phone consults, medication refills, or
in-office visit (records are to be scanned on the day they are provided care)
F. Scan by most recent training class by alphabetical order
G. Optional scanning: Those COS or PCR Volunteers closing service within the 90 day
transition
H. Long serving Volunteers without MAXx pre-service electronic information
______________________________________________________________________________
TG 214
8.3 Volunteer Records without MAXx Pre-Service Records

Infrequently, there may be some Volunteers in country that precede the MAXx initiative and
do not have electronic pre-service records. These should be handled on a case by case basis.
PCMOs will need to hand key in all information.
9. DISCRETE DATA ENTRY FROM VOLUNTEER PAPER RECORDS INTO PCMEDICS

Certain discrete data must be hand keyed into PCMEDICS from a Volunteers paper record in
order to ensure continuity of current care.
Medications and Problem List

PCMOS must enter into PCMEDICS all current Medications and Problems into the appropriate
PCMEDICS fields by choosing edit and completing the information.
Allergies
PCMOs must validate/update all allergies noted in the Volunteers record.
Immunizations
It is recommended, but not required to enter ALL immunizations provided in service to date as
long as the PDF immunization record as been scanned into the appropriate PCMEDICS folder.
All immunizations provided by the PCMO after Go Live must be entered into the immunizations
section of PCMEDICS.
10. HOW TO TRACK RECORD SCANNING EFFORTS
During transition, the medical office will need to track their paper scanning efforts so that
clinical staff will know where to look for a medical file when needed and OHS will know
when a file is available electronically. There will be four types of records during the
transition period: Scanned, In Process, In the Scanning Queue, and No-Scan File.
Post should update the Country Scan Record weekly to OHS PCMEDICS SharePoint site to
indicate the status of records scanned and remaining records to be scanned.
11. HOW TO INDICATE SCANNING IS COMPLETE FOR A RECORD
PCMO or designee must review scanned record as a quality assurance measure to ensure all
paper documents scanned into PCMEDICS.
After scanning and internal review, place the Transition Scan Cover Sheet (Attachment C) on
the top of the right hand side of the paper copy of the medical record.
Update the Country Scan Record on the SharePoint PCMEDICS site
Note: Do NOT shred the medical record documents that you are scanning during the
transition.
12. FINAL STEPS BEFORE SCANNED PAPER RECORD DESTRUCTION
X-rays- Offer to PCV. Strongly encourage the Volunteer to take all x-rays (dental, MRIs, etc.)
If declined by PCV, document in PCMEDICS and shred the x-ray. Ensure that the report of
the x-ray/imaging is scanned into PCMEDICS.
Securely store scanned paper records in the health unit.
______________________________________________________________________________
TG 214
13. DESTRUCTION OF SCANNED PAPER RECORD AT POST
All scanned paper records should remain stored in a secure location in the health unit until
all transitional PCVs have closed service
After midnight of COS dates, posts have 30 days to destroy all paper records that have been
scanned into PCMEDICS; PCMEDICS is the final record.
Shred the paper records. Use shredders currently at post. Do not put full pages of records in
the trash.
14. RELINQUISHING THE ELECTRONIC MEDICAL RECORD
After midnight of COS dates, posts have 30 days to relinquish the electronic medical records
to OHS. Follow User Script 29 COS Encounter for instructions.
Posts should relinquish all electronic medical records that do not belong to your post. (e.g.
electronic medical records that have been inadvertently assigned to your post, of a
Volunteer that already COSd, or are remaining from a post closure)
If the medical record has been relinquished to Peace Corps and the health unit receives
lab/diagnostic reports, the health units are to send all unfiled lab/diagnostics from the field
to the Post Service general email address via SFTP
15. MANAGING COS PAPER RECORDS NOT SCANNED INTO PCMEDICS
Posts may opt to maintain the paper record (not scan into PCMEDICS) for those COS or PCR
Volunteers closing service within the 90-day transition period.
COS/Med Sep charts that are remaining a paper chart and are being prepared for mailing to
OHS Medical Records need to be marked in black marker on medical record cover as
COS/ Not Scanned
Post may continue to maintain the paper COS list document to send with COS/MED Sep
charts.
Update the HIU PCMEDICS SharePoint site during the transition to notify OHS of COS charts
being returned to HQ that have been left as a paper record
Perform a quality check on the paper file to ensure the record is in order and contains all
required information. Dental x-rays should be returned with these files.
After midnight of COS dates, posts have 30 days to return all unscanned COS paper records
to OHS per the posts usual route (dip pouch, APO, etc.).
16. TRANSITION TRAINING, RESOURCES, and SUPPORT
Medical Technical Guidelines (TGs) will be updated to reflect new business processes as a result
of EMR implementation.
Simple training and reference manuals with text/screen shots will be available on a thumb
drive and online. A one-time only collated user script manual will be provided to every
participant at the CME.
______________________________________________________________________________
TG 214
OHS Health Informatics Unit (HIU) will provide support for MAXx and PCMEDICS users through
a Track-It ticket system. Health unit staff will submit the tickets to protect PII and health
information. The tickets will be managed within the Health Informatics Unit to protect PII.
PCMEDICS Intranet Resource page will contain links to training user scripts, updates, and Track-
It access.
IT Specialists (ITS) will provide this assistance to health units regarding PCMEDICS:
a. Ensure the Posts server is operational
b. Provide Track-It Ticket training/assistance
c. Provide VMware token assistance
ITS will not provide assistance to the health unit for issues within the PCMEDICS application. If a
health unit staff member is having trouble within PCMEDICS, he or she will submit the Track-It
ticket to HIU.
______________________________________________________________________________
Transition Plan for _____________________
(Post)
The PCMEDICS team requests your posts Transition Plan. The PCMO, Country Director, DMO,
IT Specialist, and Medical Assistant/Secretary must collaborate and finalize the plan below. Refer
to TG Transitioning from Paper to Electronic Medical Records.
TRAINING GO LIVE
Training Dates (at HQ) - Go Live Dates (no earlier than)

July: 1A (July 13-21); 1B (July 27-Aug 4) July training group: Aug 10, 2015
August: 2A (Aug 10-18); 2B (Aug 24-Sept 1) Aug training group: Sept 8, 2015
September: 3A (Sept 14-22); 3B (Sept 28-Oct 6) Sept training group: Oct 13, 2015
1. Your posts health unit is are expected to attend training in the same month. Please refer to
Yes No
the 2015 PCMEDICS Training Roster and confirm that the assigned dates are feasible.
If No, explain & offer alternative: _____________________________________________________________
2. Will TDY coverage be required for CME? (OHS expects you to utilize backup providers primarily): Yes No
3. Confirm Go Live date: (Note: Go Live date is the commencement of scanning & use of PCMEDICS):
July training: Aug 10, 2015 August training: Sept 8, 2015 September training: Oct 13, 2015 Other
If Other, explain why Go Live date is not immediately after return from the training:
_________________________________________________________________________________________
CHARTS AND SCANNING
4. Who will perform the scanning? Select all applicable. (In office staff may earn credit hours for this effort):
PCMO Medical Assistant Medical Secretary Other in-office staff Outside contractor
5. Will local backup medical coverage be needed for the PCMO to fulfill scanning requirements? Yes No
6. Approximately how many charts need to be scanned? (Refer to Transition TG to determine): _______
7. Assuming at least 15 charts per day will be scanned, how many days of scanning do you anticipate? _______
BUDGETING
8. Approximate costs for TDY/backup provider for CME: $_______
9. Approximate costs for local/backup provider for scanning transition efforts: $_______
10. For outside contractor to scan: Actual costs: $ _______ Cost per hour for services: $_______
11. Costs for additional Ethernet port (one must be in every exam room): $_______
12. Other costs associated with transition (explain): ____________________________________________________
Name of PCMO submitting on behalf of post: ________________________________________

I confirm that this plan has been discussed and reviewed by the following persons at post:
Note: ALL required for submission.
All additional PCMOs Country Director DMO IT Specialist Med Secretary and/or Med Assistant
Submit
Submit
Medical Record Scan Directory Transition TG Attachment B
Instructions:
Make sure there are three forms of PII on each document before scanning (name, gender, DOB, Vol
ID, and/or SSN)
Convert to PDF
Rename according to name convention in chart below (far right column below)
o Last name,First Initial.Document Type.Date (YYYY.MM.DD)
No spaces in between words.
Place scanned documents on thumb drive. Suggestions on how to organize the thumb drive:
o Dedicate a folder to a PCV and within that folder put the PDFs named according to chart
below.
o You may also want to organize the scanned PDFs using folders within the PCV folder (e.g. all
immunization PDFs within the PDF folder)
To make it easier to perform an internal Post QI of documents scanned, it is suggested to make a word
document for an individual PCV and list the documents scanned using the doc name/date scanned.
Example below:
Place scanned, named documents in appropriate folder per the chart below:
Designated Folder Current Health Record Naming Convention applied to the PDF (typical
in PCMEDICS Documents examples)
Volunteer Photo Last Name,FI.photo.YYYY.MM.DD
Information ID Card Last Name,FI.IDCard.YYYY.MM.DD
Emergency Site Locator Last Name,FI.SiteLocator.YYYY.MM.DD
Form (TG 380 Att A)
Any EAP information Last Name,FI.EAP.YYYY.MM.DD
related to Volunteer
Volunteer Health Plan
Rights and Responsibilities
Volunteer Authorization for Release of Last Name,First Init.ReleaseInfo.YYYY.MM.DD

Consents/ Waivers Information
Notification Consent Form Last Name,First Init.Notificationconsent.YYYY.MM.DD
(TG 210 Att G)
Volunteer Concerns Consent Last Name,First
Form (TG 302 Att A) Init.VolConcernsconsent.YYYY.MM.DD
Record Release
Authorization-Mammogram Last Name, First Init. Mammorelease. YYYY.MM.DD
(TG355 Att C)
Consent for HIV Post
Exposure Prophylaxis (TG Last Name,First Init. PEPConsent.YYYY.MM.DD
712 Att A)
11/20/2015
Coartem Medication Guide

& Acknowledgement Form Last Name,First Init. Coartemconsent.YYYY.MM.DD
(TG 845 Att D)
Any other Signed
consent/waiver forms not
otherwise stipulated in other
folders
Volunteer Rights &
Responsibilities (if post
requires signature)
Volunteer Documents and Photos sent to Last name,First Init.dermphoto.YYYY.MM.DD

Uploaded Files the health unit via the
Volunteer Portal by the
Volunteer. They nay remain
here or you may move them to
a more appropriate folder.
MAXx Documents Pre-Service MAXx bundle Last name,First Init.Pre.YYYY.MM.DD
documents
Dental Pre Service, In Service and Last name,First Init.dentalxray.YYYY.MM.DD
Post Service dental exams, Last name,First Init.1790exam.YYYY.MM.DD
reports, and x-rays Last name,First Init.dentalCOS.YYYY.MM.DD
PC-OMS 1790 Dental
PST Intake Recent medical visit in US Last name,First Init.PSTMed.YYYY.MM.DD

Documents prior to departure
Prescriptions prior to Last name,First Init.PSTRx.YYYY.MM.DD
departure
Documents other than Last name,First Init.IntakeInterview.YYYY.MM.DD
immunizations provided at
intake interview in PST
including PST intake
interview
In-Service Notes Problem List Last name,First Init.Problist.YYYY.MM.DD

and Forms PEF Last name,First Init.PEF.YYYY.MM.DD
BEF Notes Last name,First Init.BEF.YYYY.MM.DD
Chron Notes
PC Medical Record
Signature Page Last name,First Init.Chron.YYYY.MM.DD
Eyeglass Order form (if not Last name,First Init.Sigpage.YYYY.MM.DD
initially in Pre Service
documents) Last name,First Eyeglassorder.YYYY.MM.DD
TB Medication Monthly
Symptom Checklist (TG
Last name,First Init.MonthlyTB(Sept).YYYY.MM.DD
645 Att A)
CIRS report not related to
sexual assault (not required
for file)
11/20/2015
Police report not related to

for file)
Patient Standing Orders for
RNs
Medication Standing Orders
for RNs
In-Service Letters, notes, texts, emails Last name,First Init.PCVNote.YYYY.MM.DD

Communications provided by the Volunteer Last name,First Init.PCVemail.YYYY.MM.DD
Last name,First Init.PCVtext.YYYY.MM.DD
Immunizations Vaccine Consent Form (PC- Last Name,First Init.VaccineConsent.YYYY.MM.DD
OMS 1634) Last name,First Init.WHO.YYYY.MM.DD
Immunization Records; Last name,First Init.Immunizations.YYYY.MM.DD
WHO card (use Scan date)
Medical Inventory Signed medical supply Last Name,First Init. AttD.YYYY.MM.DD

Documents forms (TG 240 Attachment
D)
Finalized medical supply
forms maintained by health
unit for individual PCV
Consultation All Consults from local Last Name,First Init. Consult.ortho.YYYY.MM.DD

Reports-Non providers in-country and Last Name,First
Mental Health on medevac (Regional, Init.MedevacConsult.gyne.YYYY.MM.DD
HOR, and HQ)
Correspondence to/from
local consults regarding
reports
Laboratory & Laboratory tests during Last Name,First Init.CBC.YYYY.MM.DD

Diagnostic service including Mid- Last Name,First Init.COS.O&P#1.YYYY.MM.DD
Service and COS exam labs Last Name,First Init.MS.pap.YYYY.MM.DD
and diagnostics
Malaria Case Record (TG Last Name,First Init.MalariaCaseRecord.YYYY.MM.DD
845 Att C)
Clinical Information for Last Name,First
Filaria Antibody Testing Init.FilariaAntibodyTest.YYYY.MM.DD
(TG 855 Att A)
X-rays & Imaging X-rays, Ultrasound, MRI, Last Name,First Init.COS.CBC.YYYY.MM.DD

CT Scan images and reports Last Name,First Init.abdUS.YYYY.MM.DD
during service including Last Name,First Init.headCT.YYYY.MM.DD
Mid-Service and COS exam Last Name First Init.LkneeMRI.YYYY.MM.DD
x-rays & imaging Last Name,First Init.mammoconsult.YYYY.MM.DD
Mammogram Field Consult
(TG 355 Att B)
11/20/2015
Photos of the PCV
Procedures & Procedure reports Last Name,FI.I&D.YYYY.MM.DD

Surgery surgical reports Last Name,FI.appendectomy.YYYY.MM.DD
Hospitalizations Any documents, reports, and Last Name,FI.hospnote.YYYY.MM.DD

notes related to a
hospitalization
Mental Health Assessment tools: e.g. AUDIT, Last Name,FI.Promis29.YYYY.MM.DD
Assessments & CAGE, GAFs, Beck Last Name,FI.AUDIT.YYYY.MM.DD
Consults Depression Inventory,
PROMIS 29
Medevac-Logistics Medevac itineraries, Last Name,FI.itinerary.YYYYMMDD
arrangements, TAs Last Name,FI.TravelAuth.YYYY.MM.DD
Medevac Checklist (TG 380 Last Name,FI.medevacchecklist.YYYY.MM.DD
Att B) Last Name,FI.SOSchecklist.YYYY.MM.DD
SOS medevac checklist (TG
385 Att A
Mid-Service/ Any documents provided to Last Name,First Init.MSrashphoto.YYYY.MM.DD

Interim Health the PCMO by the volunteer at
Exam time of the Mid-
Service/Interim Exam
Sexual Assault Sexual Assault Check List Last Name,FI.SAChecklist.YYYY.MM.DD
(TG540 Att M)
Copy of SAK exam Last Name,FI.SAK.YYYY.MM.DD
performed by outside
provider
Sexual Assault Consent Last Name,FI.SAConsent.YYYY.MM.DD
Form (TG 540 Att C)
Discharge Information Last Name,FI.SADischargeInfo.YYYY.MM.DD
Instructions for the PCV
(TG 540 Att I)
Primary Care PTSD (TG
545)
CIRS report related to
for file)
Police report related to
for file)
Sexual Assault exam photos
COS Exam COS or Extension exam Last Name,FI.COS.Section1.YYYY.MM.DD

(1790)Section 1 (Volunteer Last Name,FI.COS.PCVrefuse.YYYY.MM.DD
portion)
Refusal to Undergo COS
health exam (TG330 Att I)
11/20/2015
COS checklists
127C/209B 127C forms, Last Name,FI.127C.ortho.YYYY.MM.DD

209B forms Last Name,FI.209B.YYYY.MM.DD
Health Benefits Card Last Name,FI.HBCard.YYYY.MM.DD
Post Service CA1 Forms Last Name,FI.CA1.YYYY.MM.DD

DOL claim paperwork Last Name,FI.DOLclaim.YYYY.MM.DD
Notice of Medical Last Name,FI.DOLresponse.YYYY.MM.DD
Separation
Death Death Report Last Name,FI.deathreport.YYYY.MM.DD

Autopsy report Last Name,FI.autopsy.YYYY.MM.DD
11/20/2015
PCMEDICS TRANSITION SCAN COVER SHEET TG 214 Attachment C
HEALTH RECORD
SCAN
COMPLETED
On Date: ________________________
Volunteer ID: _____________________
Scanned PCMEDICS documents Reviewed by:
________________________________
PCMO Name
TG 215
Peace Corps
PCMEDICS Training For New Staff at Headquarters or in Overseas Health Units
1. PURPOSE
To provide guidance on how new Peace Corps Health Unit (Peace Corps Medical Officer, Medical
Assistant and Secretary) and Office of Health Services (OHS) staff are oriented and trained on how
to use the Peace Corps electronic medical record system, PCMEDICS. Peace Corps health units and
OHS staff will be termed end users for the purposes of this technical guideline.
2. BACKGROUND
PCMEDICS end users are required to undergo training on use of PCMEDICS before being allowed
to enter Volunteer health care data into the live system. New end user staff will be provided
access to a PCMEDICS training environment to practice learning through self-paced learning
modules identified as User Scripts.
An individual test with demonstration is required of every new end user to ensure competency in
PCMEDICS skills before access will be granted. Testing will be based on the user role.
PROCEDURE
a. Once the new staff member has been cleared and has access to the Peace Corps
intranet system, the PCMO Program Coordinator will submit a ticket to the Health
Informatics Unit (HIU) requesting PCMEDICS privileges and training for the staff
member.
b. PCMEDICS privileges will be granted by HIU.
c. The staff member will be contacted by the PCMEDICS HIU training staff and directed to
the PCMEDICS User Scripts and log on information for the PCMEDICS training
environment.
d. The staff member will have approximately two weeks to complete the User Scripts.
Health unit and OHS staff can be resources during this learning period. Questions may
also be directed to the PCMEDICS HIU training staff via a help desk ticket. The HIU
training staff may assist the staff member with one-on-one assistance as necessary.
e. At the end of the second week of User Script training, the staff member will undergo an
individual assessment to demonstrate basic competency of the PCMEDICS system. This
will be performed through tools that allow remote online testing with an HIU staff
member tester through desktop sharing.
f. Limited additional training will be provided if necessary.
g. Once the staff member demonstrates competency, he or she will be provided access to
PCMEDICS. The HIU tester will submit a help desk ticket for access to PCMEDICS.
h. The HIU tester will inform the OHS training unit of successful completion.
______________________________________________________________________________
Office of Health Services June 2015 Page 1 of 2
TG 215
3. TRAINING AND RESOURCES
PCMEDICS User Scripts are available on the HIU Intranet page.

OHS IT support unit will provide support for PCMEDICS users through a help desk ticket system.
Health unit staff will submit the tickets to protect electronic Personal Health Information
(ePHI). The tickets will be managed within the HIU to protect ePHI.
The PCMEDICS Intranet Resource Page will contain links to training user scripts, updates, and
help desk access.
______________________________________________________________________________
Peace Corps
TELEPHONE TRIAGE AND USE OF CHAM PROTOCOLS
1. PURPOSE
To provide a standardized protocol for conducting telephone triage of Volunteer calls.
2. BACKGROUND
Telephone triage is the management of Volunteer health concerns and symptoms via a
telephone interaction (telecommunications) by the PCMO. It is often the first line of
communication with Volunteers and is used by the PCMO to rank health problems
according to their urgency, educate and advise, and to make safe, effective, and appropriate
dispositions.
3. TELEPHONE TRIAGE PROCEDURE

Institute a daily call log (telephone log book) to capture each communication
between PCMO and Volunteer. This log will be used during on and off hours.
Collect as much clinical information as possible related to the complaint and

document all information in the telephone log book.
If the Volunteer makes reference to a life-threatening or emergency condition,

refer them to the nearest approved emergency provider according to their
individual Emergency Action Plan (EAP).
RN PCMOs who demonstrate competency in triage, will use the Community

Health Aide/Practitioner Manual (CHAM) protocols appropriate to the chief
complaint to assess the urgency of care using clinical judgment and the following
criteria:
o Emergent: Make arrangement for the Volunteer to seek medical

care immediately from the nearest Peace Corps approved emergency
provider
Acute chest pain possible cardiac etiology
Sudden change in mental state
Trauma resulting in deformity or heavy bleeding
Respiratory distress
Unstable vital signs
NOTE: PCMOs are reminded to follow the Escalation Policy
(TG 212) as appropriate.
o Urgent: Follow-up and/or see medical provider within 24 hours

Immediate need of essential medication
New onset: Moderate to severe pain, regardless of location (not
to include chest pain possible cardiac)
Acute diarrhea/vomiting
Temperature greater than 102 degrees
______________________________________________________________________________
Evaluation of trauma, lacerations
Sudden change in chronic symptom
o Non-urgent: See within one week

Decreased appetite
Depression (not suicidal)
Medication refill of essential medication (make sure the patient
has sufficient supply until appointment)
Productive cough for more than 2 weeks
o Elective: See medical provider at the next available appointment

Physical examination
Slow growing problems and complaints (i.e., symptoms present
for more than 2 months)
Lumps or swellings and low-grade pain present at least 4 weeks
Chronic skin changes
Request for vitamins
Trouble sleeping, chronic
Constipation, chronic
Chronic cough, present for 2 months
URI symptoms
Document call and intervention in the Volunteer health record. All notes should
be dated for the time it is actually written in addition to the name of person
documenting. Document the date and time of the call within the note.
If there is a transition in care, the PCMO should refer to the log book and health
record for clinical information and updates to ensure communication and care
continuity.
Communicate emergent situations to appropriate staff immediately (Country

Director and OMS as noted in TG 212 Escalation Policy).
______________________________________________________________________________
Medical Supplies
TG 240

MEDICAL SUPPLIES AND EQUIPMENT
1. PURPOSE
To provide guidance to posts on procedures in planning and implementing a procurement and

inventory system for medical supplies in Peace Corps medical offices.
2. BACKGROUND
It is the policy of the Peace Corps to maintain effective controls and procedures that govern the
procurement, receipt, storage, inventory, dispensation, disposal, and transfer of medical supplies
and to adopt and implement special standards applicable to controlled substances and other
designated items. Medications and vaccines purchased for, and provided to, Volunteers and
Trainees (V/Ts) must be FDA-approved and manufactured in the U.S. unless otherwise approved
by the Office of Health Services (OHS).
All staff involved with medical supplies and equipment should be familiar with Peace Corps
Manual Section (MS) 734 that sets forth policy addressing Medical Supplies and Equipment.
OHS provides the information herein as the Medical Inventory System to be used by all posts.
OHS recommends that all medical supplies and equipment be maintained within an inventory
system. Peace Corps requires that all controlled substances and other specially designated items
be tracked as directed in TG 240.
TG 240 describes the procedures in adherence to MS 734. This TG has the following
attachments:
Attachment 1 - Controlled Substances/Specially Designated Items List

Attachment 2 - Drug Formulary Guidance Attachment
3- Equipment and Supplies Guidance
Attachment 4 - Vaccine Temperature Requirement
Attachment 5 - PC10303 Specialty Supply Order Request Form
Attachment 6 - PC 891 Order Confirmation Form
Attachment A - PC-734A Receipt Confirmation for Controlled Substance
Attachment B - PC-734B Receiving Report/Transfer Record
Attachment C - Inventory Workbook (replaces PC-734C)
Attachment D - PC-734D Dispensing and Distribution
Attachment E - PC-734E Expired and Disposed
Attachment F - PC-734F PLS Purchase Request Form
Attachment I - MS 734 Attachment I Immunization Dispensing
Office of Health Services December 2015 Page 1

TG 240
Medical Supplies
3. DEFINITIONS
Medical supplies include all medicines, dressing material, laboratory reagents, test kits,
birth control products, vaccines, and small consumable medical equipment, as well as
controlled substances.
Controlled substances are federally-regulated medicines named on the

controlled substances schedules issued by the U.S. Drug Enforcement Agency
(DEA) (see Attachment 1).
Specially designated medical supplies are items that OHS deems to be high value,
pilferable, or otherwise deserving of special attention. Volunteer Support is responsible
for labeling particular medical supplies as specially designated (see Attachment 1).
Medical equipment includes basic medical office furnishings and diagnostic laboratory
equipment necessary to support the operations of the Medical Offices. Medical
equipment may be ordered from USPHS Perry Point, commercial sources, or Peace
Corps Headquarters. All Peace Corps-owned professional equipment is the property of
Peace Corps and must be managed according to MS 511, which addresses management
and disposition of Peace Corps personal property.
Medical Inventory System is the method and official record by which the post maintains
an accurate account of controlled substances and specially designated items via medical
supply receipt, distribution, disposal, and transfer.(see Attachment C).
4. ROLES AND RESPONSIBILITIES
Procuring and managing medical supplies overseas is a complex process that is supported
by several offices and individuals. Equipping and stocking overseas health offices is the
responsibility of the Peace Corps Medical Officer (PCMO), with oversight from the
Country Director (CD), and support from the Director of Management Operations (DMO),
the Post Logistics Support (PLS) Division of the Office of Administrative Services
(M/AS/PLS), and the Office of Health Services (OHS).
Office of Health Services

OHS is responsible for managing the health care system applicable to V/Ts and has overall
responsibility for managing and supervising the PCMO. OHS is responsible for
establishing standards for medical offices and for providing guidance on medical
procurement. The Director of the Office of Medical Services in the Office of Health
Services consults with the respective PCMO and CD when necessary, in order to
determine the medical needs of the V/Ts at the respective post and the type of medical
supplies and equipment necessary for the operation of the post medical office.
The D/OMS will appoint the OHS Inventory Monitor whose responsibilities include monitoring annual
inventory reports for compliance with this Technical Guideline and MS 734.
Peace Corps Medical Officer

The Peace Corps Medical Officer (PCMO) receives guidance from OHS regarding the
medical supplies that should be available at post. The PCMO is responsible for creating
TG 240
Medical Supplies
orders for maintaining and managing medical supplies and equipment in the medical
office. The PCMO is ultimately responsible for the maintenance of effective control over
medical supplies to ensure that such items are properly received dispensed or disposed, in
accordance with the law and Peace Corps documentation procedures. The PCMO must
adhere to an inventory system within the medical office that includes maintenance of the
DEA logbook. The PCMO is also responsible for maintenance of a binder containing all
medical purchase order receipts, disposal, and transfer documentation for all items. The
PCMO is responsible for the compliance of the medical supplies and equipment policy as
stated in Manual Section (MS) 734 Medical Supplies and Equipment.
PCMOs must conduct an inventory of controlled substances and specially designated

items identified at the post at the beginning and conclusion of their contract.
Country Director
The Country Director (CD) manages operations at post and is responsible for providing
an appropriate working environment for the operation of the post medical office. The CD
has day-to-day management and supervision responsibility of the PCMO in non-clinical
areas. The CD is responsible for the physical security of the medical office and to assure
that effective controls for medical supply management are in place through required
staff assignments, segregation of duties, secure storage, and quarterly inventories. The
CD is responsible for ensuring accuracy of quarterly inventory reports and submitting
reports annually to OHS.
Post Logistics and Support Division

Post Logistics and Support Division (PLS) is responsible for the procurement and
shipment of medical supplies and equipment from U.S. vendors on behalf of posts. PLS is
responsible for providing procurement and purchasing support.
Office of Acquisitions and Contract Management

Office of Acquisitions and Contract Management (OACM) is responsible for the policy
and operational management of Peace Corps acquisitions domestically and overseas,
including the acquisitions by authorized employees of medical supplies.
Director of Management Operations

The Director of Management Operations (DMO) at post is responsible for post
administrative operations, including budget formulation and execution, human resource
management, procurement, contracts, property management, supervising computer
system administration, and general services support. The DMO maintains and develops
responsive and effective administrative procedures and ensures there is ongoing evaluation
of their effectiveness.
This includes special actions for expedited medical supply requests and other
procurement practices. It is recommended that the DMO know the inventory process as
they often supervise the Acceptance Point Clerk (APC), Medical Supply Inventory
Control Clerk (MSICC), and Inventory Reconciliation Clerk (IRC).
Contracting Officer
The Contracting Officer (CO) at post is the individual who has received written authority
From OACM to enter into, administer, or terminate contracts and who can make related
determinations and findings. Contracting Officers are responsible for ensuring

TG 240
Medical Supplies
performance of all necessary actions for effective contracting and safeguarding the
interests of the United States in contractual relationships. The CO may provide support
for the DMO with any steps supporting the medical supply budget, reviewing orders,
creating commitments for generating funding transactions, entering funding data onto the
form PC-734F and forwarding the form PC-734F to PLS. The DMO may also be a
Contracting Officer.
Others
The CD shall appoint staff not assigned to the medical office into the following medical
supply inventory accountability roles:
Acceptance Point Clerk (APC)physically receives and documents medical
supplies.
Medical Supply Inventory Control Clerk (MSICC)maintains the official
Inventory
Workbook
Inventory Reconciliation Clerk (IRC)conducts and reports quarterly inventory
For a more detailed explanation of all roles and responsibilities in the Medical Inventory
System, see section 20.1.
5. PREPARATION AND PLANNING
To insure the availability of supplies and funds, careful procurement planning is required.
PCMOs should project their medical equipment and supply needs 12-18 months in
advance to inform the Peace Corps Integrated Planning and Budget System (IPBS.) Posts
generally submit written projections for both disposable supplies and durable equipment in
the second
quarter (March) for the upcoming fiscal year beginning in October. Major expenditures,
such as those for high-priced equipment, may need to be submitted earlier. Operations
Plans
(actual budgets) must reflect this information in approved form not later than August 1, for
the following fiscal year.
The PCMO is responsible for working closely with the DMO to provide timely
information required for budget planning, i.e., IPBS and Periodic Budget Reviews
(PBRs). PBRs
typically occur in January/February and May/June. When unexpected costs are incurred, such
as those resulting from a new immunization program or a significant increase in cost for
a regularly used item, administrative staff should be advised in advance and as soon as
possible.
Planning Considerations
PCMOs should consider the following when planning and determining the medical
budget and supply needs:
Previous years quarterly expenditures and spending trends;
Number of Trainees expected in-country in the upcoming fiscal year;
Number of Volunteers expected to extend;

TG 240
Medical Supplies
Number of Trainees and Volunteers expected to terminate early (ET);

Number of Peace Corps Response Volunteers expected;
Number and type of immunizations given in country;
Standard medical supplies and equipment given to each Volunteer, e.g., water
filters, bike helmets, medical kits, mosquito nets, books;
Medical equipment needs, e.g., centrifuge, exam table, refrigerator;
Cost and method of shipping supplies to post, e.g., air freight, pouch;
Major construction needs in the medical office, e.g., storage cabinets, laboratory
bench, shelves, fluorescent lighting, hot water system;
Administrative equipment needs, e.g., computer, printer, fax machine, photocopier.
6. DRUG FORMULARIES AND SUPPLY GUIDES
Attachment 2 is the suggested drug formulary of oral, topical, and parenteral medications
and vaccines for Peace Corps medical offices. Attachment 3 is the suggested inventory of
equipment and supplies for Peace Corps medical offices. These resources exist to assist
PCMOs in developing and maintaining a pharmacy and inventory that meets the specific
needs of the medical office.
Medical offices are not required to stock all of the medications, equipment and
supplies listed on the formulary and inventory lists. Likewise, medial offices may
stock medications, equipment and supplies not included in the standard formulary and
inventory. For specific questions, contact the PCMO Support Unit.
6.1 Determining What Supplies to Order
The PCMO, using the above resources, is responsible for determining what medical
supplies are needed and appropriate to procure for post. The PCMO should consider
the following when making these determinations:
Existing medical inventory;
Previous supply orders for the health office;
Medical facilities and equipment available locally;
Medical supplies and pharmaceuticals available locally;
Special medications or supplies needed for Volunteers;
Drug and equipment preferences;
Availability of funds.
6.2 Determining When to Order Supplies

The PCMO, using the above resources, is responsible for determining when to order
medical supplies to ensure supplies with acceptable expiration dates are received at
post in a timely manner. The PCMO should consider the following when making

TG 240
Medical Supplies
these determinations:
Existing medical inventory;

Number of training intakes per year and when;
Typical route that supplies are shipped;
Typical length of time to receive the supplies after order is placed;
Storage availability at post.
7. MEDICAL SUPPLY SOURCES AND PROCEDURES FOR USE
Medical supplies for V/Ts must be procured through PLS or directly by post from a
U.S. or approved overseas vendor. Exceptions can be made for one-time purchases to
maintain continuity of V/T health care at post. Medical supplies required on a regular
basis should be ordered through PLS or other approved overseas vendors. All
controlled substances MUST be purchased through PLS. PCMOs cannot procure
controlled substances locally.
7.1 Post Logistics and Support Division (PLS)
PLS in at Headquarters is the main provider of procurement support services to the field.
Regional Overseas Support Specialists are available five days a week during regular business
Hours (9 a.m.5 p.m. Eastern Standard Time) to provide assistance and advice.
PCMOs should direct all supply questions and concerns to PLS. PCMOs may contact
PLS by telephone, fax, or email. Current PLS contact information, common forms,
training modules, newsletters, and ordering and shipping guidance is located on the Peace
Corps Intranet.
7.2 Headquarters Sources of Medications and Supplies
A. Blanket Purchase Agreements (BPA)
The Office of Acquisitions and Contract Management (OACM) have established

Blanket Purchase Agreements with numerous vendors, domestically and
internationally. A BPA simplifies the fulfillment of recurring needs for supplies
or services, while leveraging a customers buying power by taking advantage of
quantity discounts and saving administrative time.
For a list of approved BPA vendors, contact your PLS specialist or review the PLS
Peace Corps intranet page.
Most Blanket Purchase Agreements and purchase card orders are subject to the fill or
reorder policy. This means that if an item is not in stock at the time the order is
received, the order will not be filled and the item must be reordered by post. PLS will
inform post of the need to reorder unfilled items.
For the most up-to-date list of current Peace Corps BPAs, contact PLS. PLS will
distribute copies of vendor catalogues where available. Many companies no longer
issue hard copy catalogs, but rely on internet-based catalog information. If you need
assistance identifying a vendor or product information, contact PLS.
TG 240
Medical Supplies
B. McKesson Corporation
McKesson is Peace Corps prime vendor for pharmaceutical and medical supplies. Supplies must be
ordered through PLS. Upon request to PLS, post can receive a user id and password to review the
McKesson website in READ ONLY mode.
C. Dept. of Health and Human Services Supply Service Center in

Perry Point, MD (Perry Point).
Orders may be placed via PLS or directly with Perry Point:

PERRY
POINT
Telephone: 410-642-2244
Fax: 410-642-6249
Contact PLS to set up a Perry Point account if your post does not have one.
Orders submitted directly to Perry Point should be shipped by Perry Point to

post either by APO, air freight or expedited (DHL/FedEx, etc.) service.
Shipping costs are paid by post.
This agreement is more beneficial to posts who are serviced by APO or

who traditionally air freight their medical supplies than for posts
which rely on diplomatic pouch shipping.
D. Other Medical Vendors
PCMOs may request medical supplies and equipment from a non-BPA vendor if the
item needed is: (1) not available locally; (2) not available through a BPA; or (3) is
available through a particular vendor at a substantially lower cost. Purchases from
these vendors must be procured using the government purchase card and are therefore
limited to $3, 000 per order.
E. Overseas Sources of Medications and Supplies
Overseas sources of medications and supplies include both local and third-country
sources. Obtaining medical supplies is an ongoing task. However, when opening a
medical office, TG 200 provides additional support to the PCMO.
Procedures for the procurement of medical supplies from overseas sources vary by post.
PCMOs should discuss post-specific procedures with their DMO, RMO, or PCMO
colleagues especially if in the same region.
Any discrepancies with medical supplies purchased directly by post from the
vendor and shipped directly to post must be handled between the post and the
vendor.
When submitting purchase card orders for vendors identified through independent
research, include full contact information i.e. vendor name, website or e-mail address
TG 240
Medical Supplies
and phone number on the form PC-734F.

F. Special Requests
If a particular item cannot be procured locally and cannot be found in one of the on-line
or hardcopy vendor catalogues, the PCMO should send a special request to PLS at
pls@peacecorps.gov. A PLS specialist will research how to obtain the item and provide
ordering information to post.
Requests for special items should be specific and should include a clear description of
the item, possible vendors and vendor contact information if available.
G. PLS Assistance
PLS assists only with orders placed with them. Placing orders directly with a vendor
requires that you follow-up and troubleshoot any procurement issues directly with
the vendor, independent of PLS.
8. ORDER AUTHORIZATION AND FISCAL CODING ASSIGNMENT
Procurement of non-controlled medical supplies is under the posts Contracting

Officers normal procurement authority. The PCMO, in coordination with the
Contracting Officer, must prepare all requisitions and submit them for procurement. All
procurement requests for controlled medical substances must be made through PLS.
PCMOs, as contractors, do not have procurement authority. Therefore, all supply orders
must be reviewed and approved by the CD or the DMO to ensure availability of funds.
After reviewing the form PC-734F, the Contracting Officer (CO) must create a
commitment. At most posts, order authorization and fiscal coding assignment are the
responsibilities of the CO.
When a CO records the value of the PC-734F as a single line commitment in FOR Post,
posts financial tracking software, the result is a commitment number. Entering a
commitment for funds into FOR Post also results in a unique set of numbers that
reserve
funds within a particular category of the posts budget. PLS obligates the funds identified by
this commitment number to the appropriate vendor and in the amount required. When
the invoice arrives at HQ, it is paid using the funds reserved in the creation of the
commitment.
9. PREPARING A SUPPLY ORDER
All supply orders should be prepared using the standard order format. Supply
orders must contain all of the information components described below and must
be sent via the DMO to PLS at Peace Corps headquarters. All orders should be
emailed to PLS at PLS@peacecorps.gov for processing rather than to an Overseas
Support Specialist (OSS). Using the PLS email address will ensure the ability to
process orders in the event of PLS staff absences or vacancies, and ensures the
order will be assigned to the correct regional Specialist or Assistant.
Separate orders must be prepared for each vendor. Orders containing requests

TG 240
Medical Supplies
for items from more than one vendor will be returned to post for resubmission.
To facilitate delivery, PCMOs are encouraged to place small, frequent orders (monthly or
quarterly) rather than large, infrequent orders (1-2 times /year).
For small orders, the form PC-734F will automatically add $100 to any order
funded for less than a $100. This is necessary because the 20% price fluctuation
contingency normally added is often not enough to cover price changes for very
small and/or controlled substances orders which are often submitted as
emergency requirements. The additional $100 enables PLS to continue with the
procurement rather than having to return urgent orders that are typically
underfunded by only very small amounts.
Posts can indicate on the order form that they do not wish to accept items with
less than a specified minimum shelf life (i.e. 12 months). Items not meeting
this requirement will be removed from the order before shipping. Limiting the
shelf life you are willing to accept could markedly reduce the fulfillment rate for
some items, however. Ordering smaller quantities more frequently is the best
method of ensuring the highest possible order fulfillment rate.
Most pharmaceutical distributors guarantee medication shelf life for six months
only. If post does not stipulate a minimum acceptable expiration date, products
will be shipped to post if there is 6 months shelf life available on the product at
the date of shipping. Items normally annotated as best available dating from
the manufacturer due to resource or production shortages, such as Synthroid, will
normally be shipped with less than 6 months expiration date if ordered in small
quantities (1-2 bottles). PLS will verify with post whether they want to receive
larger quantities before shipping.
10. STANDARD ORDERING PROCEDURE (per OFMH 53)
According to the Overseas Financial Management Handbook (OFMH), for procurement

from a US vendor, the following direction applies:
1. Up to $3,000 post may procure on its own or request procurement by PLS.
Controlled substances must be ordered through PLS.
2. Between $3,000 and $25,000 using a BPA vendor post must request procurement
by PLS using the process below. Posts PLS Overseas Support Specialist (OSS) can
provide a current list of BPA vendors.
3. Between $3,000 and $25,000 using a non-BPA vendor post must request procurement
from OACM, via posts OACM OSS.
4. Over $25,000 post must request procurement from OACM, via posts OACM OSS.
Note: For non-US vendors, posts may procure up to their procurement authority or
request that PLS or OACM procure, per the categories above.
A. Medical Staff at Post:
1. Develop the order on the newest version of the form PC-734F. It is the only
document that PLS will accept and can be found by following the Intranet

TG 240
Medical Supplies
pathway to PLS provided in section 7.1, or via:

http://inside.peacecorps.gov/index.cfm?viewDocument&document_id=23430&fil
etype=htm
2. Complete the blocks of the form PC-734F shaded in GREEN.
3. Forward the form to the CO for the assignment of funding information. Note:
Please do not assign a reference number in the FP REQ NUMBER block.
This information will be assigned by the CO.
The CO should provide an order copy with the number issued. Arrange
with your CO how to receive this information.
4. Request acceptable expiration dates the manufacturing standard for the industry is
six months.
5. Identify any special shipping/handling instructions per section 16 of the TG in
order to prevent PLS from returning the order request.
6. Reference the obligation/PR-Number and vendor name on all order

correspondence and orders. Locally assigned tracking numbers should not be
referenced. Note: the obligation number is not assigned until preceding steps
are completed.
7. Retain copies of each form PC-734F submitted to PLS.
8. Monitor for PLS order acknowledgement email within 5 days of PLS receipt of
form PC-734F.
9. Review carefully the PLS email confirming items shipped to post.
10. Reorder any items unable to be filled with this order.
B. Contracting Officer at Post
1. Receive completed form PC-734F from medical staff.

2. Complete the BEIGE blocks of the form PC-734F.
3. Create a commitment in U.S. dollars from the appropriate funds for the amount
identified in the grand total block (this amount should include the 20%
contingency for price variances) on the form PC-734F. If an obligation is created
rather than a commitment, PLS will be unable to process the order and will return
it. The DMO must cancel the obligation and recreate it as a commitment.
Charge object class 26021 to ensure that your post is assigned as the vendor
Check the RFQ block. If this block is not checked, PLS will not be
able to process the order and will return it to you.
4. Create an obligation for shipping requested or required by air freight or
expedited shipment (DHL, FedEx, etc.) because of the nature of the items.
(Per Section 16, PLS Air Freight Survey should be updated with any new
permanent shipping instructions.)
An obligation must be created in FOR Post for the shipping vendor and
amount identified by PLS.
Ensure that the funds are sufficient in this obligation to cover the
shipping costs.
Respond to each email request for an obligation number to fund the shipping costs to
document acknowledgment of the shipping expenses and vendor choice.
5. Enter the 11 digit FOR Post generated obligation /PR-Number in the FP

REQ NUMBER block.
6. Ensure that the name of the DMO or a designee with procurement authority

TG 240
Medical Supplies
is entered in the Administrative Officer block.

7. Email the individual with procurement authority who forwards the form PC-734F to
PLS.
8. Forward the form PC-734F to PLS only after the commitment is shown as
Approved at HQ. PLS cannot begin the ordering process until the commitment
is visible in the Procurement Request Information System (PRISM). Note: If
PLS receives an order without a commitment in PRISM, it will be returned to
post.
C. PLS Staff:
1. Complete the GRAY blocks of the form PC-734F. (For PLS use only.)
2. Review the order and acknowledge receipt with an email within 5 working days of
receipt of the form PC-734F. This email confirms that the order has been
received and can be processed by PLS or that a correction must be made before
PLS can process the order.
2. Verify and/or clarify any ordering/shipping instructions or concerns.
4. Complete procurement actions at Headquarters.

5. Provide an email or fax to post that identifies the expedited or air freight vendor
and costs in order for CO to generate an obligation to cover shipping costs.
6. Provide an email confirmation to post within 5 to 10 working days after the order
is received to acknowledge the order was placed successfully by PLS with the
vendor and/or to inform the post of any unavailable items.
11. ORDERING HAZARDOUS MATERIALS (HAZMAT)
In general, hazardous materials (HAZMAT) include anything aerosol, flammable,

containing alcohol, or with a distinctive odor.
Orders for HAZMAT require a separate form PC-734F order form and
funding requisitions.
Orders for HAZMAT items should not be mixed with orders for non-
hazardous items.
Orders which combine HAZMAT with non HAZMAT will be returned to post
for resubmission as separate orders.
Generally, HAZMATs cannot be returned.
A Perry Point List of HAZMAT and their National Stock Number and UN/ID Number
can be accessed on the Peace Corps Intranet
https://inside.peaceco rps. go v/inde x.c fm?bra nc h=516 or requested from PLS. Select items
are also identified on the Drug Formulary and Equipment and Supply Inventory for Overseas
Health Offices (see Attachments 2 and 3).
ORDERING CONTROLLED SUBSTANCES
The Peace Corps, through the Chief of Administrative Services, is registered with the
DEA to procure controlled medical substances from designated vendors in the U.S. on

TG 240
Medical Supplies
behalf of Peace Corps and to distribute them to PCMOs posted overseas. The AD/M
delegates the use of the Peace Corps DEA number to his or her Designated Officers (DO).
The Controlled Substance Officer (CSO) in PLS serves as the primary point of contact for
purchasing controlled substances. Only the CSO is authorized to procure controlled
substances for Peace Corps. PCMOs do not have the authority to procure controlled
substances on behalf of the Peace Corps, and must request procurement support from
M/AS.
PCMOs must not purchase controlled substances or narcotics in-country or from a third-
party vendor.
A controlled substance is, generally, any substance that contains a narcotic, or has addictive
or abuse potential. A list of commonly ordered Class II Controlled Substances is provided on
the PLS Intranet page https://inside.peaceco rps. go v/inde x.c fm?bra nc h=516 and are included
in the RPSO Frankfurt, Perry Point and McKesson catalogues (on-line). The PCMO may use
these lists as an ordering reference; however, all items must still be ordered through PLS.
All controlled substances must be tracked and inventoried in the Medical Inventory
System and the DEA logbook. This step begins with the procurement and receipt of
controlled substances.
Controlled Substances Ordering Protocol:
PLS will coordinate procurement and shipping instructions for the post.
Orders for Class II Controlled Substances require a separate PC-734F order
form (Attachment F); this form may be used for multiple Class II items, but
must not contain any other, additional items.
Orders for Classes III, IV, and V Controlled Substances may be combined on
one order form, but must not be combined with orders for routine medical
supplies, pharmaceuticals, or equipment.
Orders for controlled substances require a separate order (form PC-734F)
with separate funding requisitions.
Orders which combine controlled substances with non-controlled items will
be returned to post for resubmission as separate orders.
13. ORDERING VACCINES
Ordering and receiving vaccines overseas is one of the biggest supply challenges for
PCMOs and PLS staff and requires careful planning. Prior to ordering vaccines, PCMOs
should consider the following:
Refrigeration, i.e., cold chain requirements during shipment as described in

Attachment 4, Vaccine Temperature Requirements.
Reliability of transportation systems since unreliable flights can make tracking

the arrival of vaccines difficult.
Country-specific customs regulations and protocols for vaccines.
Cost: vaccines often comprise 50% of the medical supply budget so a broken
cold chain or lost box can have significant administrative consequences.
Clinical consequences of a lost, damaged, or destroyed vaccine order.
Vaccine Ordering Protocol:
TG 240
Medical Supplies
Identify a local or regional vendor or a vendor through PLS. Work with PLS if
uncertain about any aspects of vaccine procurement when procuring them from
sources other than PLS.
Provide the vendor with specific shipping instructions.
Request from the vendor when ordering outside of PLS:
Shipment date;
Flight numbers and flight schedule;
Estimated time of arrival;
Government Bill of Lading (GBL) number;
Airway Bill (AWB) number.
Provide the DMO with the expected arrival date of the shipment including
packaging and shipping information.
The DMO should notify customs officials, and Embassy General Services
Officer or brokers of the expected arrival date of the shipment, including
packaging and shipping information, and should make arrangements to pick
up the vaccine at the airport.
14. ORDERING LAB SUPPLIES AND EQUIPMENT
The PCMO is responsible for determining what lab supplies and equipment to order for
the medical office. Attachments 2 and 3 support the ongoing operation of the medical
office, while TG 200 Overseas Health Offices also provides guidance on opening and
medical office and identifies lab equipment and basic lab tests that should be available
in all medical offices, e.g., urinalysis, pregnancy test, blood glucose, hematocrit, stool
test for occult blood, wet mounts, and peak flow meter.
14.1 Quest Diagnostics

Upon request, Quest Diagnostics will provide to Peace Corps posts laboratory supplies
and shipping materials for tests ordered from Quest.. There is no charge to post for these
supplies.
Supplies may be ordered through PLS using form PC10303 (Attachment 5),
the Quest Supply Order Request Form or by email request. Request forms can
be obtained from PLS.
Supply requests should not be sent directly to Quest .
Specialty supplies will be shipped to post via diplomatic pouch or APO. If
supplies cannot be shipped through the diplomatic pouch or APO, fiscal
coding for shipping must be included with the order.
Quest Diagnostics Telephone: 1-800-336-3718 or
703-902-6900
14.2 Other Lab Supplies and Equipment
Limited lab supplies and equipment are available and may be procured from Perry
Point or McKesson. The majority of lab supplies and equipment, however, are

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Medical Supplies
procured from specific vendors specializing in laboratory supplies.
15. ORDERING SPECIAL PEACE CORPS SUPPLIES
15.1 Volunteer Medical Kits
Peace Corps supplies every Trainee with a Volunteer Medical Kit.
Volunteer Medical Kits are purchased from U.S. vendors at no cost to post and
are ordered through PLS.
New kits may be ordered for each Trainee or post may elect to collect used kits
and restock with the same supplies.
Each order for medical kits must be submitted on a separate PC-734F order form.
Medical kits should be the only item on the form because they are processed
differently, due to their being no cost to post. Therefore, do not add other items to
form PC-734F when ordering kits.
Since the kits are purchased at headquarters, there is no requirement for a FOR
Post commitment. The dollar value of the form PC-734F should be 0.
PLS funds for the purchase of health kits are based on the annual training input.
Posts should therefore limit their requests for health kits to that required to
support new volunteers. Posts are eligible for only five (5) additional kits per
training event.
Post will pay for shipping and handling costs only if the medical kits cannot be
sent through the diplomatic pouch or APO. If post requests an expedited
shipping method, they will receive a follow-up email from PC headquarters which
quotes the shipping costs for the medical kits and which will request a funded
FOR Post obligation number. Medical kits being sent by expedited mail will not
be shipped until an obligation number has been received unless the shipment is
being funded by the headquarters.
Medical kits require a 4-month lead time due to manufacturing requirements and
restrictions placed on the size of items shipped via the diplomatic pouch system.
Volunteers should return all medical kits to the health unit upon COS.
15.2 Merthiolate Iodine Formalin (M IF) Kits and Malaria Kits
MIF kits are used to preserve stool specimens for Ova & Parasites examination.
In general, Volunteers will use three to six kits per tour; three during service and
three at Close of Service (COS). The number will vary with the prevalence of
diarrheal illness in country.
MIF kits can be ordered from Perry Point.
MIF kits are also available, upon request, from the Parasitology Lab of
Washington (PLW). There is no charge to post for kits provided by PLW,
however, kits provided by PLW are assessed a hazardous materials shipping fee.
These kits must be returned to PLW for evaluation of samples not used in
country with local vendors.
MIF kits are considered a hazardous material because they contain formalin;
therefore, PCMOs must create a separate hazardous material order for MIF kits
or order them with other HAZMAT.

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Medical Supplies
Malaria kits contain supplies to make thick and thin blood smears for malaria diagnosis.
In malaria countries, PCMOs often dispense one to two kits during training and
use additional kits in the health office throughout the year.
Malaria kits may be ordered through Perry Point.
15.3 ThinPrep Pap Test

ThinPrep Pap Test kits are available through Quest. There is no charge to post for
kits provided by Quest. ThinPrep is considered a hazardous material; therefore,
PCMOs must create a separate hazardous material order for ThinPrep or order them
with other HAZMAT items per Section 11.
15.4 Mosquito Nets

Mosquito nets are available and may be ordered, through PLS. All mosquito nets
sent to post from PLS are pre-dipped in permethrin and have a 24-month shelf life.
The
mosquito nets are available in two different sizes (single and double) and two
different colors (green and white).
When placing an order for mosquito nets, post must submit the order
separately on a PC-734F order form and specify both size and color.
Since the mosquito nets are purchased at headquarters, there is no requirement
for a FOR Post commitment. The dollar value of the form PC-734F should be
0.
PLS funds for the purchase of mosquito nets are based on the annual training
input. Posts should therefore limit their requests for enough nets required to
support new volunteers or replace the nets of volunteers serving beyond the two-
year life of the net. Posts are eligible for five (5) additional nets per training
event.
Post will pay for shipping and handling costs only if the mosquito nets cannot be
sent through the diplomatic pouch or APO. If post requests an expedited shipping
method, they will receive a follow-up email from PC headquarters which quotes
the shipping costs for the mosquito nets and which will request a funded FOR
Post obligation number. Mosquito nets being sent by expedited mail will not be
shipped until an obligation number has been received unless the shipment is being
funded by the headquarters.
Mosquito nets require a 4-month lead time due to manufacturing requirements
and restrictions placed on the size of items shipped via the diplomatic pouch
system.
15.5 Water Filters and Distillers

The health office supplies water filters or distillers to Volunteers in many countries.
Numerous brands and models are available. TG 810 Acute Diarrhea Attachment A
Water Disinfection Methods provides information on water disinfection. The manual
Environmental Health: Answers to Volunteer and Staff Questions also provides
information on water purification methods.
PLS can provide the PCMOs with water filter vendors and information on the
water filters available to meet the needs of their country.
These devices are distributed to Volunteers during training and collected at COS.
All water filters, distillers and replacement components can be ordered through PLS.
Post is responsible for the cost of water filters and distillers and for the cost
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Medical Supplies
of shipping water filters and distillers to post when required.
15.6 Peace Corps Forms

Standard Peace Corps forms may be ordered and shipped to post through PLS.
PLS does not maintain the forms inventory and will provide delivery only if
stock is available at the time of order.
When placing an order for forms, posts should use the standard Task Order
Request form available from PLS. This document may be requested directly from
PLS or can be found on the Peace Corps Intranet on the Post Logistics Support
page https://inside.peaceco rps. go v/inde x.c fm?bra nc h=516. There is no
charge to post for Peace Corps Forms.
Post will pay for shipping and handling costs only if the forms cannot be sent
through the routine shipping methods such as the diplomatic pouch or APO.
If post requests an expedited shipping method, they will receive a follow- up
email from PC headquarters which quotes the shipping costs for the form and
which will request a funded FOR Post obligation number. Forms being sent
by expedited mail will not be shipped until an obligation number has been
received.
15.7 Carbon Monoxide Detectors
Medical Officers are required to determine whether Volunteers are at risk of exposure
to Carbon Monoxide (CO) by burning fuels such as natural gas, gasoline, oil, kerosene,
wood, or charcoals in an enclosed area that is not properly ventilated. Post is responsible
for procurement and distribution of CO detectors to the Volunteers at risk. PLS can
provide posts with vendors for carbon monoxide/smoke detectors that can be shipped via
diplomatic pouch, APO, or expedited delivery service.
15.8 Eyeglasses
TG 245 Eyeglasses outlines policies and procedures for ordering and replacing
eyeglasses. PLS replaces and pays for Volunteer eyeglasses that have been lost, broken,
or misplaced. PLS will arrange for lens replacement, i.e., new lenses put in old frames, but
will not arrange for the repair of damaged frames.
Eyeglasses for Volunteers are ordered through PLS. There is no charge to post for the
glasses or for shipping. All orders must include the following information.
Reference number
Volunteer name
Country name
Frame style and color
Lens prescriptions
Frame measurements
Prescription information can be found on Form PC-116 Prescription for Eyeglasses in

the Volunteer health record. A copy of the form may be attached to the order. Volunteers
should select the frame style and color from the current eyeglasses catalogue. The booklet
is updated periodically and sent to post by PLS.
Eyeglass orders should be emailed or faxed to PLS. Point of contact information for
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Medical Supplies
eyeglass orders is located on the PLS intranet site.
PLS also supports the procurement of replacement eyeglasses for active Volunteers who
are temporarily in the U.S. These individuals must have been issued a form PC-127C by
either their PCMO or the Office of Health Services authorizing an eye examination and
PLS will pay up to $199 of the cost of the replacement eyeglasses. The vendor providing
the service must bill PLS directly and be willing to accept the government purchase card
for payment. PLS cannot reimburse Volunteers for eyeglasses which they have
purchased.
PCMOs should not send damaged frames to Washington for repair. If a Volunteer
needs immediate eyeglass replacement, PCMOs should purchase a pair of glasses in
country or request a back up pair from PLS.
15.9 Sexual Assault Kits
PCMOs must ensure that they have an adequate supply of appropriate and unexpired
Sexual Assault Kits (SAKs) available for use by them or local examiners in the event of
an assault. Each post must maintain at least 1-2 unexpired SAKs from Sirchie
(www.sirchie. co m) #VEC100 and have them in stock at all times.
Regardless of the current local laws for state evidence collection, keeping SAKs in stock
allows Peace Corps the ability to provide an evidence kit to local authorities to assist in
evidence collection for a Volunteer case or in the event local laws change and the PCMO
is allowed to collect evidence. All medical staff at post must know where the SAKs are
stored and ensure that the kits have not expired. In addition, the CD should know where
the SAKs are stored.
SIRCHIE SAKs are recommended and can be ordered directly from SIRCHIE
(www.sirchie.co m). SAKs are also available from Peavey through the Overseas Support
Specialist in PLS or directly from Perry Point. In an emergency, SAKs may also be
available through the RSO or Health Office at the U.S. Embassy. Peace Corps posts are
responsible for the inventory and purchase of SAKs.
PEACE CORPS SUPPLIES SUMMARY
Peace Corps Supplies Order From

1. Volunteer Health Kits PLS
2. MIF Kits Perry Point / PLW
3. Malaria Kits Perry Point
4. Water Filters / Distillers B. David / Clean Water/
HTI / IPA
5. Mosquito Nets PLS
6. ThinPrep Pap Test Kit PLS
7. Peace Corps Forms PLS
8. Eyeglasses PLS
9. Carbon Monoxide Detectors PLS

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Medical Supplies
10.Sexual Assault Kit SIRCHIE / Peavey /

Perry Point
* Item will be shipped to post via diplom atic pouch or APO. If these services are not available le, item will be
shipped via expedited m methods. Post will be responsible for shipping costs associated with expedited shipping
services. Under certain circumstance s, water filters/distillers, medical k its, and mosquito net shipments may be
funded by the headquarters.
16. TRANSPORTING SUPPLIES TO POST
Successful shipment of supplies to overseas posts is dependent upon positive

communication between the posts and PLS staff. To ensure efficient transportation of
supplies to post, post responsibilities are to:
Update the air freight information survey whenever there are changes to a countrys
customs or shipping requirements. The link to the survey is located at:
http://inside.p eacecorp s. go v/ind e x.c fm? vie wDoc ume nt&doc ume nt_ id=25337 &file ty
pe=htm and the general pathway on the PC intranet is: Chief of Staff/Operations
> Office of Management > Office of Administrative Services > Post Logistics
and Support Division to PLS Intranet Page > Shipping Operations > Air Freight
Survey Information > Air Freight Survey.
Remain up-to-date on the international shipping customs rules and regulations
for their individual country.
Regularly communicate changes or needs to PLS.

Request special shipping requirements in the Special Instructions block of the
form PC-734F. This request is applied only to the order accompanying the form
PC-734F and will not be applied to future orders.
Maintain all documents associated with the original order in one secure location.
Most orders are sent to post in partial shipments. One order may be shipped
in separate boxes and may possibly have multiple invoices and shipping
charges associated with the original order.
Identify any special shipping/handling instructions in the PINK Special Instructions
block. Ensure that any special shipping/handling instructions do not conflict with the
shipping method identified in the shipment method block. If these two blocks do
not match, PLS will return the order.
16.1 Shipping Supplies via the Diplomatic Pouch
Posts with access to the diplomatic pouch may ship medical supplies to country through
the pouch. The diplomatic pouch is the official mail system for the U.S. Department of State.
Supplies shipped by the pouch are sent to the Department of State (DOS) Diplomatic
Pouch Facility (DPF) and then forwarded to the designated country. In general, the pouch
should be used for shipping medical supplies and equipment under 40 pounds. PCMOs
should consider the following restrictions when shipping supplies via the diplomatic pouch:
Transit time is 4 to 6 weeks.
Maximum weight limitation for a single package is 75 lbs.
Maximum size limitation for a single package is 24X19X19 inches in
any dimension.

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Medical Supplies
Packages that exceed the weight and size limitations may not be accepted and
may be returned.
Hazardous materials, aerosols, firearms, ammunition, liquid in a non-glass
container (anything that flows) exceeding 16 oz per box/container and
perishable items may not be shipped in the pouch.
Peace Corps use of diplomatic pouch is limited to shipments which have a

combined space requirement not exceeding 6 cubic feet (roughly the size of
five 8.5X11 copy paper boxes) per post. For that reason, large shipments
such as medical kits, mosquito nets or water filters must be released to the
pouch on a staggered basis and may take longer than normal to receive at post.
Alternative shipping methods may be used by PLS to expedite the delivery of
large shipments. This extended shipping time should be taken into
consideration when simultaneously placing orders for newly arriving
volunteer groups.
Post pays for shipment of supplies from the vendor to the DPF. Shipments
which have not been ordered through PLS and directed to diplomatic pouch for
transportation may be levied freight charges at the discretion of the pouch
facility.
16.2 Shipping Supplies via the Military Postal Service
Posts with access to an Air Force/Army Post Office (APO) may ship medical
supplies to country through the APO. Supplies shipped via the APO are sent
through the US postal service to a specified military base in the U.S. and then
forwarded to the designated country. In general, the APO should be used for
shipping generic medical supplies and equipment under 70 pounds. PCMOs
should consider the following restrictions when shipping supplies via the APO:
Transit time is 10 to 14 days.
In general, the maximum weight limitation for a single package is 70 lbs.
In general, the maximum size limitation for a single package is 108 inches in
length and girth combined.
Packages that exceed the weight and size limitations may not be accepted and
may be returned.
Food, flammable items, glass bottles or containers, perishables, and
hazardous materials may not be shipped the military postal system.
Post pays for shipment of supplies from the vendor to the U.S. APO point
of debarkation.
APO shipping regulations vary between posts. Each post needs to identify
any additional limitations for their own country and communicate these to
PLS.
16.3 Shipping Supplies via Air Freight

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Medical Supplies
Posts may have medical supplies shipped to country via air freight. In general,
air freight should only be used for perishable items, vaccines, time sensitive
items, and items too large to be shipped via pouch or APO. If post requests items
to be shipped by air freight, an up to date Air Freight Information Survey must
be held by PLS before the items can be shipped. These survey forms can be
requested from PLS or be found on the PLS information page on the Peace Corps
intranet
https://inside.peaceco rps. go v/inde x.c fm?bra nc h=516.
PCMOs should consider the following when shipping supplies via air freight:
Transit time is 2 to 5 days.

There are no weight or size limitations.
Item restrictions and customs rules and regulations vary between the countries.
There is an increased cost (post pays for shipment of supplies from the vendor or
HQ to country as appropriate).
There are paperwork requirements in order to clear customs.
16.4 Shipping Supplies via Sea Freight
Posts may have medical supplies shipped to country via sea freight. Sea freight is
rarely used and should only be used for large bulky or heavy items such as office
furniture, examination tables, etc. PCMOs should consider the following when
shipping supplies via sea freight:
Transit time is generally three to 6 months, but can take up to 1 year.
There are no weight or size limitations.
Hazardous materials may not be shipped via sea freight.
Post pays for shipment of supplies from the vendor or HQ to country as appropriate.
16.5 Air/Sea Freight Shipping Cost Estimates

If air or sea freight shipping is requested or required because of the nature of the
items purchased, the order will be processed and received here at headquarters.
The order will be packed to determine its weight and dimensions. Quotes will be
solicited from companies having cost effective and successful delivery service to
post. PLS will send the DMO a formatted email which identifies the shipping
company selected and the amount required for funding the shipment. The DMO
must respond identifying the obligation they have created in FOR Post to the
vendor identified. PLS cannot create the shipping documents required to release
the shipment until posts obligation number has been received.
16.6 Expedited (DHL, FedEx) Shipping Cost Estimates

If air freight or expedited (DHL, FedEx, etc.) shipping is requested or required
because of the nature of the items purchased, the order will be processed and

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Medical Supplies
received here at headquarters.

The order will be packed to determine its weight and dimensions and shipping
costs will be confirmed with the expedited vendor selected by post. The AO or
DMO at post will then be sent a formatted email which identifies the shipping
vendor
selected and the amount required for funding the shipment. Post must respond
to each email request for an obligation number to fund the shipping costs even
though they may have a standing obligation which they use for all expedited
shipments. This is necessary to document your acknowledgment of the shipping
expenses and vendor choice.
16.7 Shipping Hazardous Materials (HAZMAT)
All HAZMAT items are shipped via air freight and cannot be shipped via APO, DOS
pouch or the US Postal Service. The current minimum shipping charge is $775.00 for
up to two compatible product types. It is, therefore, financially prudent to order
compatible hazardous materials at one time and only when necessary. HAZMATs are
generally classified and shipped as follows:
Group I Group II Group III
Items can be shipped Items require different Items require shipping via
together without increasing classifications and will cargo aircraft only these
the costs for packing and therefore increase the cost if Group III items should not
fixed fees. they are shipped with any be ordered until post
Group I or Group III item. confirms that there is
Items should not be shipped Group II items should be cargo aircraft service into
with Group II items due to shipped together, and not their destination.
Group II item requirements. with any from Group I or
Group III.
Inhalers Thin preps Histofreeze

Non-aerosol insect repellentMercury thermometers Oxygen tanks
Correction fluid All types of lab stains
MIF kits Batteries
Non-aerosol lice spray Rubbing alcohol
One-step occult blood Kleenwise
Wart remover descaler Potassium
Hand sanitizer Nitrate Silver
Nitrate
All aerosols
Glucose Phosphate
Smoke detectors
HAZMAT shipping requirements are continually updated by the International Air
Transportation Agency (IATA) so the information provided above is subject to
change. Frequent embargos placed by host country governments may also prevent the
delivery of an ordered HAZMAT for extended periods of time. Consult with PLS for
current information.
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Medical Supplies
Posts that decline shipment of an ordered HAZMAT because of their high shipping
costs will be requested to fund all disposal costs. HAZMATs cannot be discarded at
HQ, but must be consigned to a vendor licensed to dispose of hazardous materials.
Disposal costs vary widely but in some cases can exceed the cost of shipping.
16.8 Insurance
Post should not purchase insurance on routine shipments of medical supplies and
equipment. Post may pay for additional insurance on high valued items and
vaccines after consulting with PLS. Some insurance may be included in freight
costs by the freight forwarder.
PCMOs should consult with the OHS Epidemiology & Surveillance Office
for information regarding temperature parameters for vaccines as
necessary.
17. TRACKING SUPPLY ORDERS
Tracking supply orders is essential for budget execution and inventory management.
The PCMO and the DMO are responsible for developing and maintaining a tracking
system for supply orders. Orders must be tracked to determine anticipated receipt,
confirmed receipt, and duty to reorder unfulfilled requests.
17.1 Components of a Tracking System
The following information should be included in any tracking system:

Vendor;
Date of the order;
Order reference number;
Date(s) order received;
Goods received;
Identification of specially designated items and controlled substances;
Obligated dollar amount for medical supplies, equipment, and shipping;
Actual dollar amount of medical supplies, equipment, and shipping;
Order balance, i.e., obligated costs minus actual costs;
Closing date on the order;
Obligation number.
17.2 Tracking Documents and Correspondence
Within 5 working days of receipt of your PC-734F form, PLS will review your
order and acknowledge receipt with an email. This email will confirm that either

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Medical Supplies
(A) your order has been received and can be processed by PLS or (B) that you must
take the corrective action specifically identified before PLS can process the order.
Please contact PLS if you do not receive confirmation that PLS received your order
within 5 days of submission.
Once the order has been placed and confirmed by the vendor, the PLS Specialist will
provide post with order (procurement) confirmation information which identifies
the items that were not procured and must be reordered. This information should
generally be received by post within 5 to 10 days of PLS receipt of the order. If posts
do not receive this information, they should contact PLS. Once an order is received
from the vendor, the PLS Overseas Shipping Department (OSD) staff will inventory
the items and check expiration dates. When the order is shipped, the Overseas
Support Assistant will complete a form PC-891 (Order Confirmation) and provide it
to post as an e-mail attachment. The shipment receipt confirmation will contain
tracking information and will be sent to all individuals listed in the Medical Office
Point of Contact and Administrative Point of Contact section of the original form
PC-734F. Form PC-734A (Receipt Confirmation of Controlled Substance) will be
provided for controlled substances.)
All tracking documents should be kept on file with the original order for a minimum
of two (2) years.
PLS may contact post if changes to an order are required.
Posts should receive all orders placed through PLS within 60 days of receipt of
the order. If post does not receive an order within 60 days, they should contact
PLS directly.
Upon receipt, post should confirm their delivery to PLS@peacecorps.gov.

The post Acceptance Point Clerk (APC)records receipt as part of the inventory
process once an order is received and the PCMO confirms.
The shipment is checked against the information on the emailed form PC-891
(Order Confirmation).
Once the inventory record is updated, post will complete the comments and
missing items section on the Order Confirmation Form and use the buttons on the
form by clicking on the button labeled Email to PLS to return the receipt
confirmation.
For controlled substances, post receives, completes, and submits the controlled
substances inventories on form PC-734A (Receipt Confirmation of Controlled
Substance).
17.3 Shipping and Packaging Documents

If items are shipped to post via air freight, the following shipping and packaging
documents will be received by post. These documents are often required for
customs. Post is responsible for ensuring that documentation requirements are up
to date on the air freight survey information provided to PLS. All shipping and
packaging documents should be kept on file with the original order.

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Medical Supplies
Government Bill of Lading (GBL): Tracking document sent to post before items
are shipped; contains the following information:
GBL number;
Estimated cost of shipping;
Number of containers;
Weight of each container;
Airway bill number;
Order reference number (optional);
Estimated time of arrival (ETA);
Carrier on which the item will be shipped.
Airway Bill (AWB): Tracking document that identifies the entire shipment and is required
for customs; contains similar information to that contained in the GBL.
Requests for additional shipping or vendor documentation required for customs

clearance may add substantially to the order processing timeline and should be taken
into consideration when placing orders. For example, requests for vaccine
production documents can add an additional 30 days to the customs clearance process.
All requests for additional documentation to meet customs clearance requirements

should be made when the order is placed.
18. PROCESSING RECEIVED ORDERS
All supply shipments received in the medical office must be carefully processed and
reconciled with the original order. The Acceptance Point Clerk (APC) documents
what has been received and transfers items to the PCMO to confirm the received items.
Processing and tracking supply orders is the joint responsibility of the PCMO and
DMO. Both should work together to confirm that all orders and order discrepancies are
reconciled.
Steps in processing medical orders include:

Reconciling the quantities ordered with the actual quantities received;
Reconciling the estimated item cost with the actual item cost;
Reconciling the estimated shipping costs with the actual shipping costs;
Reconciling all partial orders with the original order;
Informing the DMO of reconciled costs;
Informing the DMO of missing orders or items;
When an order is complete, the original order and all original invoices and tracking
documents should be given to the DMO so that appropriate payments and record
keeping can be maintained. A copy of the order and tracking documents may be kept
in the medical office.
18. 1 Fill or Reorder Policy

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Medical Supplies
Most orders placed through BPAs are filled on a fill or reorder basis. This means
that the vendor and therefore PLS will not fill an order if, at the time the order is
received, the item is not in stock or available for any reason, including for example,
if the expiration date stipulated by post is not available. When received by a
medical supply vendor, the order is typically considered to be either filled or ki
ed, the later requiring independent resubmission of the order to keep it active. No
killed orders will be automatically filled when supply becomes available. The PLS
Specialist will notify post of what items from an order are not available either
through a written email or by forwarding the vendors order confirmation to Post.
Post should carefully review this mail/vendor confirmation information forwarded
by PLS. Unavailable items must be reordered by the PCMO.
19. ORDERING PROBLEMS AND ISSUES
If a problem with an order occurs, PCMOs should:
1. Systematically review the order and trace the shipment to see if an error can
be identified;
2. Contact PLS for consultation and direction ASAP;
3. Not return any goods to the vendor prior to contacting PLS;
4. Inform the DMO of any potential cost implications;
5. Contact PLS if unordered items or excess quantities are received.
19.1 Delayed Orders
Posts should contact PLS if they do not receive a receipt confirmation within 5
working days after emailing an order to PLS. If an order is not received within 60
days, posts should contact PLS directly with a follow-up request. Posts should never
wait longer than 60 days to inquire about a missing order.
19.2 Wrong Item or Quantity Received
If an incorrect item or quantity is received, posts should first verify the ordering
number and information. If incorrect ordering information was used, post may be
responsible for the unwanted item or may be required to pay for return shipment of
the item. Some pharmaceutical distributors will accept returns up to 30 days after
the date of sale, but will levy a handling charge which is a variable percentage of the
original price of the item. If the correct ordering information was used, then the
vendor may be at fault. Post should then contact PLS with the PR-Number, vendor,
item number and description, and PLS will facilitate a return merchandise approval
with the vendor.
19.3 Damaged Goods or Broken Cold Chain
At the time the package is opened, APC must record the condition of the items if
they are damaged.

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Medical Supplies
Most refrigerated shipments come with a temperature indicator. The indicator

changes color if the perishable items have been exposed to temperatures in excess
of the allowed range. For any items requiring a cold chain, note observations such
as melted gel packs, and record the temperature registered on the temperature
indicator (see Attachment 4, Vaccine Temperature Requirements). The vaccines
must then be placed immediately in refrigeration. If a perishable order is received
outside the recommended cold chain guidelines, PCMOs must contact PLS
Shipping Operations immediately for further instructions.
20. INVENTORY MANAGEMENT AND CONTROL
It is recommended that all supplies in the medical office be part of a management and
inventory system. MS 734 establishes Agency policy for medical inventory and
management of supplies and equipment with specific requirements for controlled
substances and specially designated items. Controlled substances and specially
designated items must be included in inventory and management practices at all post
medical offices, and all other material items may be included as well. In addition,
controlled substances must be managed within local and U.S. laws and regulations.
MS 734 Section 3 states:

It is the policy of the Peace Corps to maintain effective controls and procedures that
govern the procurement, receipt, storage, inventory, dispensation, and disposal of
medical supplies and to adopt and implement special standards applicable to controlled
substances. Medications and vaccines purchased for, and provided to, Volunteers and
Trainees (V/T) must be FDA-approved and manufactured in the U.S. unless otherwise
approved by the Office of Health Services (OHS).
MS 734 Section 8.0 states:

A Medical Inventory System must be maintained by the MSICC at each post. It is the
official inventory record at the post. The Medical Inventory Systems must record all
specially designated and controlled substance medical supplies received, stocked, and
distributed at post.
At least quarterly, the CD must review the MSICCs Medical Inventory System for
specially designated and controlled substances to ensure accuracy.

Controlled substances must be dispensed only under the supervision of the PCMO.
Controlled substances listed on DEA Schedules II, III, IV, and/or V must be managed
within local and U.S. laws and regulations.

Nearly expired or excess inventoried drugs preauthorized by the vendor for return, must contain the
signatures of the PCMO, DMO and vendor verifying the drug and amount of the return.
Records of the transaction must be kept for auditing and tracking purposes.
20.1 Medical Inventory System Personnel

Section 4 of this TG outlines personnel roles and responsibilities regarding personnel
to plan, implement, and maintain an inventory system for medical supplies.

TG 240
Medical Supplies
Inventory management at post requires staff who belong to the medical office and
staff who specifically do not belong to the medical office. The PCMO is responsible
for inventory management, while the CD must provide a secure environment, and
oversee and participate in inventory accountability. The system at post must comply
with the requirements for inventory tracking, ordering, receipt, dispensing, disposal,
and transfer of controlled substances and specially designated items. OHS and the
Director of the Office of Medical Services provide guidance on the inventory items
necessary for a given post. All controlled substances and specially designated items
must be managed by all posts with the requirements provided in MS 734 and TG 240.
For purposes of managing the Medical Inventory System at post, below are the
expanded roles and responsibilities:
Peace Corps Medical Officer (PCMO):

The PCMO creates orders and manages medical supplies and equipment in the
medical office according to Agency policy as stated in Manual Section (MS) 734
Medical Supplies and Equipment. PCMOs must conduct an inventory of
controlled substances and specially designated items identified at the post at the
beginning and conclusion of their contract. This includes the DEA log (see Section
21).
The PCMO may be assisted by other members of the medical office to fulfill the
requirements of inventorying non controlled substances and specially designated
items. The ongoing physical receipt of controlled substances and specially
designated items, maintenance of the Inventory Workbook, and the quarterly
inventory must be performed by three different staff members not assigned to
the health unit and appointed by the CD. The PCMO is responsible for the
maintenance of effective control over medical supplies to ensure that items are
properly received, dispensed, disposed, and transferred. In addition, the PCMO is
responsible for record management of all attachment forms from TG240
(documentation for received, dispensed, disposed, and transfer of medical supplies).
Country Director (CD)

The CD provides oversight to the administration of the Medical Inventory System by
supporting an accountable process of dispense, receipt, disposal, and
transfer documentation of controlled substances and specially designated
items.
Manages operations at a post and is responsible for providing an appropriate
working environment for the operation of the post medical office including security
and operations that achieve an accountable inventory of medical supplies and
equipment.
Participates in the disposal of expired controlled substances/specially designated items and
medications that have been returned by V/Ts
Appoints the APC, MSICC, and IRC.
Implements a minimum of quarterly inventory exercises and reports at post.
Provides annual inventory report to OHS by October 15th, of each year,
Submission to: medicalinve ntory@peaceco rps. go v
Ensures post is MS734 compliant
Acceptance Point Clerk (APC)

Appointed by the CD and is responsible for physically receiving all medical supplies and

TG 240
Medical Supplies
equipment at post and for verifying order documentation by using form PC734B.The
APC must be a staff member who is not a member of the medical office staff, and
cannot serve in any other capacity related to the management, inventorying, or
delivering of medical supplies and equipment.
Medical Supply Inventory Control Clerk (MSICC)

Appointed by the CD and is responsible for maintaining the offices official Inventory
Workbook of the Medical Inventory System. The MSICC works with all staff to
ensure proper use of inventory forms, that specially designated items and controlled
substances are properly documented as dispensed, received, disposed, and transferred
in the offices Inventory Workbook of the Medical Inventory System. The MSICC
must not be a member of the medical office staff, and cannot serve in any other
capacity related to the management, inventorying, or delivering of medical supplies
and equipment.
Inventory Reconciliation Clerk (IRC)

Appointed by the CD and is responsible for the reconciliation of the recorded
inventory in the health office and the recorded inventory in the offices Inventory
Workbook. The IRC conducts a physical inventory of all controlled substances and
specially designated items quarterly. The IRC must conduct quarterly reconciliation
and report results to the CD. In addition, an annual inventory report addressing all
controlled substances and specially designated items must be conducted to document
the September 30th inventory level, and submitted to OHS no later than October 15th,
of each year. The IRC must not be a member of the medical office staff, and cannot
serve in any other capacity related to the management, inventorying, or delivering of
medical
supplies and equipment.
OHS Inventory Monitor
Monitors all annual inventory reports submitted to medicalinventory@peacecorps.gov for compliance with
TG 240/MS 734. Significant issues or discrepancies with medical supply policies are reported to the OHS
Quality Improvement Unit, the Office of the Inspector General (auditing section) and OGO/Regional
management for action as appropriate.
Post Logistics and Support Division (PLS)

Must be contacted when new items are not acceptable as stated in Section 19, and must
receive confirmation of receipt using either form PC-734A or form PC-891.
Contracting Officer (CO)

Responsible for providing guidance on planning and executing the medical
supply equipment contracts, blanket purchase agreements and other related
transactions, including entering funding data onto the form PC-734F and
forwarding the form PC- 734F to PLS. The CO may be the DMO.
Director of Management Operations (DMO)

Responsible for budget planning and execution at post, the DMO must be informed of
financial and logistical implications of medical supplies and equipment at post.
The DMO may also aide in the supervision and guidance of administering
procurement and Medical Inventory System practices.

TG 240
Medical Supplies
20.2 Medical Inventory System Forms
The Medical Inventory System utilizes standard forms and practices including a log of
controlled substances as required by the US Drug Enforcement Agency (DEA). The
tools to manage the system are:
PC-734A (Attachment A) Acceptance of controlled substances by the PCMO is

documented on this form and is part of standard communication with PLS. It is required
for acceptance of all controlled substances.
PC-734B (Attachment B) Better accountability starts with a receiving report for all items.
This PC-734B form is the receiving report used by both the PCMO and the Acceptance Point
Clerk (APC), who is appointed by the CD and is not from the medical office. A single form
is used to document the physical acceptance and/or rejection of goods. The information on
the form begins the documented inventory process. The information is filled in by the
APC while ideally working side by side with the PCMO on the physical receipt of goods.
The PCMO places the original in the medical inventory management binder and a copy is
provided to the MSICC.
PC-891 (Attachment 6) The Order Confirmation Form is part of standard

communication between post and PLS and must be used to confirm receipt with PLS.
Inventory Workbook (Attachment C) This Control Log is an electronic Excel

spreadsheet provided by OHS and is required to capture all documentation collected on the
forms PC-734A, PC-734B, PC-734D, and PC-734E. The Inventory Workbook is the official
inventory record for post and is maintained by the MSICC. This Excel spreadsheet may
track for which V/T an item was ordered, but must identify V/Ts by Volunteer number only
and not by name, in order to be compliant with PC
medical confidentiality policies (MS 268). Only the MSICC can edit this workbook.
PC-734D- (Attachment D) Dispensing of controlled substances and specially designated

items are documented on the form PC-734D and requires the V/Ts signature. This
dispensing form documents when the PCMO dispenses a controlled substance and specially
designated items received by the V/T. The original form is kept in the V/T medical chart
and a copy of the top portion is provided to the MSICC, who updates the Inventory
Workbook; and a copy is kept by the PCMO in a tracking binder or file. In cases of remote
delivery, such as sending supplies to a V/T, this form should be included inside the package
and the V/T should confirm receipt by providing documentation with signature and return
of the form to the PCMO.
PC-734E-(Attachment E) Expired drugs must be disposed of or transferred properly. All

Medications returned by Volunteers may not be returned to inventory and must be destroyed
according to standard disposal policy. The CD and PCMO must together dispose of controlled
substances, specially designated items, returned medications and any other medical supplies.
The PCMO and CD must document the disposal of expired and returned drugs and items on
the PC-7343E form. If excess inventory is an issue for a post, then form PC-734E is also used
to document transferring items to another Peace Corps post or US government agency.
A copy of the PC-734E form is provided to the MSICC, who updates the Inventory Workbook;
the original is then filed by the PCMO into the health offices tracking binder or file.

TG 240
Medical Supplies
PC-734F (Attachment F) For general procurement actions, the form PC-734F is

designed for use by post and the PLS office of Administrative Services. This form
is used to procure medical supplies and equipment.
PC-734I (Attachment I) Immunizations are frequently dispensed to multiple V/Ts at

the same time. This form captures the dispensing of immunizations in roster form instead
of requiring individual PC-734D forms for each V/T receiving immunizations (or
malaria prophylaxis) in a group setting.
20.3 Medical Inventory System Steps
The Medical Inventory System is comprised of a process that emphasizes separation

of duties between the medical office and administrative staff not working in the
medical office, followed by quarterly reconciliation and annual reporting. Various
forms, personnel, offices and procedures are necessary to maintain a medical
inventory system within a post. All staff at post are expected to support the Medical
Inventory System and should be familiar with Agency policy on the subject through
MS 734 and TG 240.
The documentation that comprises the Medical Inventory System can be used for
quality review, audit, or reconciliation with any V/T health record as necessary by the
Agency.
The Medical Inventory System at post must be comprised of the following

operational steps:
1. The APC (ideally jointly with the PCMO) receives and documents the supply
order on Attachment A. .The PCMO confirms the contents and signs
Attachment A. The APC sends a receipt confirmation by using form PC-891 to
PLS (see Section 17.2). A copy of the form is given to the MSICC and the
original is kept by the PCMO for record management.
1.1 Items that were not fulfilled in the order must be reordered by the PCMO.
2. Goods are accepted or rejected based on condition by the PCMO and the APC.
3. The PCMO uses form PC-734A to document receipt of controlled substances.
4. The MSICC enters the information from the form PC-734B form into the Inventory
Workbook.
5. When the PCMO dispenses controlled substances or specially designated items in

the medical office or in person, the top portion of form PC-734D must be filled out
by the PCMO using the recipients Volunteer ID number, and the recipient of the
item(s) must complete and sign the bottom portion of the PC-734D form confirming
that all items listed were received upon issuance. The original completed and
signed form must be placed in the V/T health record. Additionally, the PCMO
must maintain a tracking binder or file of all PC-734B, PC-734D, PC734E, and

TG 240
Medical Supplies
PC734I, forms.
5.1 The PCMO must reconcile dispensing all controlled substances or specially
designated items with receipt of the same items to the V/T to whom they were
dispensed. If the controlled substance(s) or specially designated item(s) were
dispensed in person, make two copies of the signed form and continue reading
by skipping to #7 below.
5.2 The preferred method of delivery of a controlled substance or specially

designated item should always be directly to the V/T while still at the Health
Unit; however, if a PCMO must send controlled substances or specially
designated items to a V/T instead of issue the items in person, the top portion
of the PC-734D form should be filled out by the PCMO and initially three
copies should be made in order to document the distribution and receipt as
follows:
5.2.1 The origina l form PC-734D should be placed with the supplies inside
an opaque medical supply or equipment package such as a paper bag or
box, for the V/T to complete, sign, and return.
Acceptable means of delivery to the V/T are
1) Official in country government mail system with return receipt
(if possible);
2) Peace Corps Staff delivers to V/T;
3) Private contractor delivers to V/T;
4) Package is given to site mate for delivery to V/T;
5) Package is given to the local bus driver for delivery to the V/T;
6) Package is delivered (by mail, bus, PCV, PC Driver or private
contractor) to the staffed regional house where the V/T has access to
pick up the medication.
In all instances the PCV/T who is to receive the package is notified
via text/call or email that the package has been sent and the mode of
delivery used. Upon delivery the V/T must confirm receipt by sending
a confirmation text, email or phone call to the PCMO in addition to
returning the signed copy of Attachment D (See section 6.2.7)
5.2.2 The first copy (top portion only) of PC-743D is given to the MSICC
once the inventory has been removed from stock (the MSICC does not
need to wait for the signature of the V/T on a completed form, but may
request to see a signed copy).
5.2.3 The second copy of PC-743D must be placed in the V/T health record.
5.2.4 Once the original form PC-734D is returned to the PCMO completed
and signed by the V/T, it should be filed in the V/T health record,
replacing the copy of the same unsigned form.
5.2.5 If the V/T does not return the form or send a text message/email or phone
call, confirming that all items were received within a reasonable amount
of time (which is dependent upon the shipping method), the PCMO or
designate must follow-up with the V/T to request either the form be
returned with the signature of the V/T or that an email be sent listing all
received items. A text message confirming receipt is acceptable only if it
names and quantifies all controlled substances and other specially
designated items received, and can be printed and filed in the tracking

TG 240
Medical Supplies
binder and V/T health record; a documented phone call is not

acceptable.
5.2.6 If the PCMO or designate determines that the V/T did not receive
a
controlled substance or specially designated item as expected, the CD
must be informed within 24 hours.
6. The original is placed in the V/T health record by the PCMO or designate.. Only
the top portion of the form is given to the MSICC to maintain the Inventory
Workbook.
7. When dispensing the same immunization to an entire group of V/Ts at the same
event, the PCMO should document the dispensing of the immunizations by
requiring all of the recipients to sign for receipt directly on a single copy of form
PC -734I. A copy of Attachment D is filled out for the group and provided to the
MSICC.
8. The MSICC enters the total number of immunizations given at the event (not
by individual name) from Attachment D into the Inventory Workbook.
9. When the PCMO disposes of controlled substances, specially designated items or

any other medical supplies and equipment, including those medications returned by
the V/Ts the CD must witness the actual disposal and follow local law to meet
Agency procedures (see section 23 below). In addition, the PCMO must document
all disposals of expired drugs on form PC-734E. The CD is always required to sign
form PC734E.
10. When the PCMO transfers any medical supplies and equipment to another
Peace Corps post or to another office of the US Government, the transfer must
be documented on form PC-734E.
11. The PCMO must provide a copy of form PC-734E to the MSICC following the
disposal of expired or returned controlled substances or specially designated
items.
12. The MSICC enters the information from the PC-734E form into the Inventory
Workbook.
13. The CD must require the IRC to conduct a physical inventory of

controlled substances and specially designated items each quarter.
14. The IRC must conduct a physical inventory and document the results on a
hardcopy of the master sheet of the Inventory workbook provided by the MSICC
on a quarterly basis. The PCMO, CD, and IRC are required to sign the master sheet.
(Regarding the discovery of loss or theft of controlled substances, see section 23
below.)
15. The MSICC must start a new Inventory Workbook for each quarter based on a
copy of the previous quarters physical inventory count provided by the IRC .

TG 240
Medical Supplies
16. The IRC must report to the CD the following:
a) The physical inventory count of all controlled substances and

specially designated items in the medical office for the quarter.
b) The recorded inventory and the actual count of all controlled substances and
specially designated items in the health office according to the Inventory
Workbook.
c) Any discrepancies in the Medical Inventory System regarding controlled
substances and specially designated items.
d) Reconciliation of any differences such as any errors identified in one
record or another, omissions of information from one record or another,
patterns of errors or omissions.
e) Recommendations on the operations of the Medical Inventory System at
post.
f) The IRC must maintain a file of the quarterly Medical Inventory System
reports at post, and a copy is provided to the MSICC. The PCMO is
responsible for maintaining the original for record management. Quarterly
inventory reports must be kept for two years at post.
17. The CD must require the IRC to conduct an annual physical inventory of controlled
substances and specially designated items on or about October first of each year as
an annual requirement. This annual inventory requirement shall count as one of the
four quarterly inventory requirements. (Regarding the discovery of loss or theft of
controlled substances, see section 23 below.)
18. The CD must report the following to OHS by October 15th of each year:
a) The physical inventory count of all controlled substances and specially

designated items in the medical office for the previous year (October 1st
September 30th).
b) The recorded inventory and the actual count of all controlled
substances and specially designated items in the health office
according to the Inventory Workbook.
c) Any discrepancies in the Medical Inventory System regarding
controlled substances and specially designated items.
d) Reconciliation of any differences such as any errors identified in one record
or another, omissions of information from one record or another, patterns of
errors or omissions.
e) Solutions implemented at the post that address any issues of the Medical
i. Inventory System with particular emphasis on controlled substances and
specially
ii. designated items.
The Agency may perform a spot check of Medical Inventory System practices at
any time. Spot checks may be performed by the CD, PCMO, OHS or the Office of
the Inspector General.
21. SPECIAL CONSIDERATION FOR CONTROLLED

SUBSTANCES: THE DRUG ENFORCEMENT AGENCY LOG

TG 240
Medical Supplies
The Inventory Workbook content is structured to adhere to the requirements of the

Peace Corps Medical Inventory System. However, the US Drug Enforcement Agency
(DEA) also requires maintaining a separate DEA logbook of controlled substances.
The PCMO and designate must therefore maintain a DEA logbook at post. MS 734
states:
Each Medical Office must maintain, on a current basis, a complete and accurate record
of each controlled substances dispensation or disposal. Records for all controlled
substances must also be maintained in a separate DEA Log with secure pages. The log
must reflect the following:
Name of substance;
Form of substance (e.g., 10 mg tablet);
Number of units on hand;
Amount dispensed or destroyed;
Name of person to whom dispensed;
Date of dispense;
Amount dispensed; and
Signature of dispenser
21.1 DEA Log Security
The DEA logbook must be comprised of pages that are sewn into the book
binder or are otherwise secure. A three-hole punch binder with removable
pages documenting the collection of the required data, or a card filing system,
does not meet the requirement of secure pages.
The DEA logbook must be stored securely such as with narcotics, as outlined in
Section 22.1.
The DEA logbook must be maintained and kept on an ongoing basis
without disposal for two years.
22. STORAGE
Peace Corps medical offices must have adequate storage areas for medical equipment and
supplies. Storage areas must be secure. Pharmaceuticals must be stored in climate-
controlled conditions and temperature-sensitive vaccines must be stored in a reliable
refrigerator with a minimum/maximum thermometer. If electricity is unreliable, a back-up
generator is required to operate the refrigerator. Refrigerator temperature should be
checked and documented daily. Specially designated and other items must be secured in a
separate room or container that can be locked when medical staff that have access to the
supplies are not present.
22.1 Storage of Controlled Substances and Other Medical Supplies at Post

MS 734, Section 8.6 Medical Supplies and Equipment states: Country Directors must
provide secure storage for all medical supplies that are specially designated or controlled
substances. Secure storage must provide effective controls and safeguards against theft
and diversion. Controlled substances must be kept in a securely locked substantially
constructed cabinet. The cabinet must be placed in a locked room (such as a medical
supply closet) within a locked office building.

TG 240
Medical Supplies
23. LOSS AND THEFT

If controlled substances are lost or stolen from a post, the post must immediately inform the
Regional Director, Director of the Office of Medical Services (D/OMS/OHS), Controlled
Substances Officer in PLS, Chief of Administrative Services (M/AS), Associate Director of
Management (AD/M), and the Inspector General by email. Specific reporting and follow-
up instructions will be sent by each respective party. An investigation of the incident must
be conducted and documented by the Inspector General or if not possible, by the Regional
Security Officer (RSO) attached to the U.S. Embassy.
24. DISPOSAL OF OUTDATED OR RETURNED MEDICAL SUPPLIES

All medications which have been returned by Volunteers must not be restocked and must be destroyed.
Controlled Substances and Specially designated items that are returned by PCV/Ts will be entered in to the
Workbook as returned and then documented as disposed on the PC-734E.
MS 734 section 9 establishes Agency procedures for disposal of medical supplies. It states:
9.1 Destruction of Medical Supplies
Medical supplies (medicines, dressing material, laboratory reagents, test kits, birth
control products, and vaccines, etc.) with expired shelf life or those that have been
returned to the Health Unit by V/Ts must be destroyed in the presence of the PCMO and
the CD in accordance with local waste disposal and air and water pollution control
standards. Disposal documentation (form PC-734E -- Attachment E) must be retained in
post files as per the Peace Corps records schedule, and a copy provided to the MSICC.
Under no circumstances should returned medications be returned to inventory stock.
9.2 Transfer of Medical Supplies
Transfer or exchange of excess medical items, including controlled substances, is

authorized from Peace Corps posts to other posts or the U.S. Embassy only. If a post
cannot transfer the items, then the items must be destroyed. Prior to transferring or
exchanging any excess medical items, post or PLS must agree to all terms and prices for
the excess items. A signed inventory receipt from the receiving agency must document
transfer of medical supplies and controlled substances to the Embassy. This document
must be forwarded to the Director of the Office of Medical Services, and the M/AS. A
copy of the transfer documents must be provided to the MSICC. Under no
circumstances must any medical supply be donated to organizations other than U.S.
government agencies.
9.3 Return of Excess or Nearly Expired Medication
Peace Corps posts are authorized to return excess inventoried or nearly expired
medications (excluding controlled substances) that were purchased locally to a local
vendor if the vendor preauthorizes the return for exchange or credit. See TG 200
Section 4.1 for guidance regarding drugs approved for purchase locally. Excess
inventoried medications are those items that will expire before anticipated use. Nearly
expired medications are those items that will expire 60 days before label expiration
date.

TG 240
Medical Supplies
Form PC734E is used to document the transfer of items from a post to either another post
or to another agency of the US government. A copy of the form must always be issued to
the MSICC to update the Invent1. PCMO identifies which drugs should be returned.
2. PCMO reviews and validates the credit receipt from the vendor with the Acceptance
Point Clerk (APC).
3. APC will submit a copy to the Collection Officer at post for creation of a bill of
collection (BOC).
4. Collection Officer will submit original documentation to the Medical Supply Inventory
Control Clerk (MSICC) for updating the inventory.
5. Vendor confirms receipt of returned drugs.
6. Credit receipt is filed in medical inventory manual.
7. Count is reconciled quarterly with routine medical inventory.
Disposal procedures vary from one post to another due to local laws. OHS prohibits the
disposal of drugs into any water supply. Drugs may not be disposed down a sink, flushed
down a toilet, discarded into a sewage system, discarded into any body of water, or
otherwise discarded via a water system. OHS recommends that drugs be disposed of, if
determined to be reliable by the PCMO, in collaboration with local medical facilities under
such practices as that which are applied to the disposal of used needles, sharps, or other
biologicals.
Nearly expired or excess inventoried drugs preauthorized by the vendor for return, must
contain the signatures of the PCMO, DMO and vendor verifying the drug and amount of
the return. Records of the transaction must be kept for auditing and tracking purposes (MS
734.9.4-Return of Excess or Nearly Expired Medication).

TG 245
Eyeglasses
Peace Corps
EYEGLASSES
1 . PURPOSE
The purpose of this guidance is to establish procedures for the replacement and repair of eyeglasses
for Volunteers. This Technical Guide line (TG) is based on P eace Corps Technical Guide line (TG)
240 Medical Supplies and Equipment section 15.9.
2. BACKGROUND
Trainees are instructed to bring two pairs of current prescription, good quality eyeglasses when they
enter service. Bringing two pairs of glasses into service ensures that a back-up pair is available in the
even the other pair is lost, stolen, or damaged.
P eace Corps will provide eye care during service in the case of eye injury or changes in visual acuity.
Routine eye care will not be provided unless noted and accommodated due to a medical condition
during pre-service clearance.
Volunteers may receive up to two pair of replacement glasses during Peace Corps Service. Exceptions
to this guidance are at the discretion of the PCMO. Examples of possible exceptions are: 1) a change in
prescription (requires lens replacement only), and 2) extension of service. Refer to section 8.0 below.
3. PRE-DEPARTURE
All applicants with corrected vision are required to have an eye exam and visual acuity testing
performed by an optometrist as part of pre-service medical screening. The optometrist records the
prescription (lens refractive data and frame measurements) on the P C-116 P rescription for
Eyeglasses form (ATTACHMENT A). The optometrist or Volunteer may forward the form to OHS for
inclusion in the Volunteers health record. The optometrist may retain a copy of the form if necessary.
4 . REFERRAL OPTOMETRISTS TO AND OPHTHALMOLOGISTS
An optometry evaluation is appropriate for refraction and the prescription of corrective lenses. If a
Volunteer complains of reduced visual acuity, visual acuity screening should be performed by the
PCMO using a Snellen chart or similar device. Volunteers who wear glasses should have visual
acuity checked wearing their glasses and not wearing their glasses. Reduced visual acuity is defined
as less than 20/20.
If the optometry evaluation determines that:
A Vo lunteer who wears glasses needs a new prescription: P eace Corps

will supply new lenses by one of the methods outlined in section 5 below.
A Vo lunteer who does not wear glasses needs corrective lenses: P eace Corps
will supply one pair of glasses by one of the methods outlined in section 5 below.
Examinations will not be provided f or non-medical reasons, i.e., renewal of drivers license.
Office of Health Services April 2015 1

TG 245
Eyeglasses
Referral to an ophthamologist is necessary for a complete eye examination when any symptom of
retina l damage or other significant eye problem is found, e.g., eye pain, flashes of light, blind spots,
sudden extreme changes in vision, or eye trauma. Evaluation by an ophthalmologist is also indicated for
follow-up on chronic eye conditions such as diabetic retinopathy or glaucoma.
If no reliable optometrist is available to perform vision testing and refraction, the Volunteer
should see an ophthalmologist for evaluation of decreased visual acuity.
5. REPAIR AND REPLACEMENT OF EYEGLASSES DURING SERVICE
5.1 Repair
The Volunteer should present the broken eyeglasses to the P CMO.

For simple repairs such as the replacement of screws, Eyeglass repair kits should
be ordered from PLS and available in each Health Unit.
For substantial repairs, the PCMO should identify a local repair facility.
PLS will replace damaged lenses; cost cannot exceed $199. The current frames and
prescription can be sent to PLS for new lenses. The volunteer should use his/her
back-up glasses during this period.
PLS will not repair damaged frames.
5.2 Re placement
If possible the Volunteer should present the damaged eyeglasses to the PCMO.
Lost, stolen, or irreparably damaged glasses should be replaced by purchase in country or

through PLS in Washington DC (see sections 5.3 and 5.4 below).
Volunteers may receive no more than two pair of replacement glasses from Peace Corps during
their service. If a Volunteer requires a third pair, they are responsible for the cost.
5 .3 Purchases in Country
Suitable eyeglasses are available in many countries. The P CMO should identify a reliable
source with reasonable prices. A contractual agreement or a discount for P eace Corps
business may be negotiated.
Local purchase is generally preferable as the Volunteer can select the frame style, be
fitted, and can get the new glasses in a timely manner.
The cost of eyeglasses purchased in country is charged to the country budget. Each post
may determine the process to provide eyeglasses for Volunteers based on a cost-benefit
analysis of purchase via a local provider versus a U.S. vendor (PLS).
No more than $199 can be spent on any one pair of eyeglasses; this is the maximum
amount pa id in the US through P LS. Generally posts specify a reasonable, much lower
maximum amount to purchase new eyeglasses in country. The Volunteer must select a

TG 245
Eyeglasses
frame style within the allocated amount (per country budget) or personally pay the
cost difference.
5.4 Purchases through Was hington DC (PLS)
When glasses cannot be reasonably obtained locally due to cost, quality, or other
factors, glasses should be purchased through PLS.
For Volunteers at post the following procedure is in place:
The attached form is filled out in its entirety by the optometrist or copied from
the information form PC-116 Prescription for Eyeglasses (located in the
Volunteer health record)
Volunteer chooses a frame from the eyeglass frame catalog which is found on
the Peace Corps intranet using the following path:
Home -> Office of Management -> Office of Administrative Services

-> Post Logistics and Support Division -> Eyeglass Frames
Catalogue 2012-2013
(Catalogue link is on right side of the page)
Once the form is filled out, send it via e-mail to the PLS inbox
PLS receives it and sends it to a vendor, the vendor fills the order and then the
glasses are sent to PLS to send to post. Once the glasses are received by post,
PLS asks that an order confirmation request form is filled out and sent back to
PLS.
Bifocal lenses should be procured for Volunteers as indicated by prescription. Obtaining

graduated or progressive lenses for a Volunteer requires full medical justification and
OHS concurrence.
Costs for glasses ordered through PLS are charged to the P LS budget, which has a
contractual arrangement with an optical supply fir m.
PLS also supports the procurement of replacement eyeglasses for active Volunteers
who are temporarily in the U.S. These individuals must have approval to from OHS
to receive glasses. OHS/FS IHC should authorize the glasses via e-mail to PLS. The
PCV should then e-mail the name of the vendor the glasses where the desired glasses
are available, the vendors phone number, and the name of the vendor staff that the
Volunteer spoke with regarding ordering the glasses.
Once PLS knows the price, PLS obligates the money and waits for approval. This
process may take 1-2 days.
PLS will pay up to $199 for eyeglasses. The vendor providing the service must bill
PLS directly and be willing to accept the government purchase card for payment. PLS
cannot reimburse Volunteers for eyeglasses which they have purchased.

TG 245
Eyeglasses
Upon approval, PLS will contact the vendor and provide the credit card information
over the phone. The vendor will fax or email the receipt to PLS at 202-692-1151(fax)
or pls@peacecorps.gov.
6. SUNGLASSES
Sunglasses (prescription or otherwise) or color changing (photo-gray or photo-sun) are supplied

by P eace Corps on ly when recommended by an ophthalmolog ist f or a specific medical condition
and approved by OHS during medical screening or field consultation. Volunteers in most countries
work in conditions of bright light and this alone is not justification for the additional expense of
sunglasses. If unsure about a medical justification, the P CMO should consult OHS. If authorized,
prescription sunglasses can be purchased through P LS.
7. CONTACT LENSES
Peace Corps will not supply or replace contact lenses or associated solutions unless their use has
been recommended by an ophthalmologist for a specific medica l condition and appro ved by
OHS during medical screening or field consultation. The PCMO should consult OHS in cases w
here such a recommendation is made. If authorized, contact lenses should be purchased through
PLS or procured locally.
PCMOs should strongly discourage Volunteers from wearing contact lenses while overseas.
Contact lenses, particularly extended use soft contacts, are associated with a variety of eye
infections and other inflammatory problems. One of the most serious risks is infectious keratitis
which can lead to severe corneal damage resulting in permanent blindness requiring corneal
transplantation. The risks of permanent eye damage are exacerbated in the Peace Corps
environment where the Volunteers ability to properly clean the lenses is compromised and
access to a competent ophthalmologist may be delayed during the critical first few hours after
the problem is recognized. Volunteers with a history of complications related to contact lenses
may be prohibited from using them while abroad.
8. COS EYE EXAM INATION
During the last three months of service (including the COS physical), in order to allow the
Volunteer to safely complete service, eyeglasses will only be provided for pre-existing or
newly diagnosed significant visual acuity changes. Repair or replacement of lost, stolen, or
damaged eyeglasses during this time period is at the discretion of the PCMO, and is dependent
on the number of glasses previously replaced during service. Replacement of eyeglasses is
considered treatment and is not covered after COS.
At the 72 hours close of Service (COS) checkout, the PCMO may authorize an optometry
evaluation for any Volunteer complaining of reduced vision or if reduced visual acuity is noted
when tested on a Snellen chart. The PCMO may issue a 127C authorization for evaluation in the
U.S. On the 127C, the PCMO should authorize only the cost of the examination. The cost of new
lenses or glasses is the responsibility of the Volunteer.

Peace Corps Eyeglasses Order Form
Contact Information
PC Point of Contact: Date:
Volunteer Name: Post:
Frame Measurements
Note: All frame measurements are required.
Eye Size Bridge Size Temple Length (Total) Pupillary Distance
Style of Frame (click here for catalogue)

1st Choice: 2nd Choice: 3rd Choice:
Frame Style Frame Style Frame Style
Frame Color Frame Color Frame Color
Lens Instructions
Dec.
Sphere Cylinder Axis Prism Base
In Out
R
Distance
L
Sphere Seg. Height Seg Width Seg. Inset Total Inset and Dec.
Add for R R MM R MM
MM MM
Reading
L L MM L MM
Sphere Cylinder Axis Prism Base Dec.
Total Reading R
(Near Lenses) L
Lens Styles
Single Vision Lenses Bifocal Lenses Trifocal Lenses
Single Vision Straight Top 28 Straight Top 7x28
Special Instructions by Prescriber / Post:
This prescription will be filled stateside without the Peace Corps Volunteer being present.
It is imperative that all required information is completed to avoid delays and inaccuracies.
Form PC-732 (Rev. 11/2013)

Peace Corps
HEALTH KITS
1. PURPOSE
To describe the purpose and contents of the health kits supplied to Volunteers. See also Peace
Corps Manual Section (MS) 734 Medical Supplies and Equipment.
2. BACKGROUND
Health kits are supplied to Volunteers to assist in health promotion activities including:
Disease prevention;
Management of common, uncomplicated medical problems;
Prompt management of potentially serious illnesses, e.g., severe diarrhea or malaria, until
the Volunteer can get to the health unit or other health care provider.
Peace Corps Medical Officers (PCMOs) should discuss the proper use of the items in the
health kit during Pre-Service Training (PST) and provide guidance for use and refill in the
Volunteer Health Handbook.
3. POLICY SUMMARY
Health kits consist of a defined core of supplies (Section 4 below) and optional additional
items as determined by the PCMO (Section 5 below).
Health kits may be issued by the PCMO to Volunteers any time after their arrival in
country.
The Post Logistics and Support Division pays for the core health kits. Post procures the
health kits and pays for shipping on their core health kit orders (see TG 240 Medical
Supplies Procurement for ordering information).
Optional items added by the PCMO in country are paid for by Post.
Health kits are for Volunteer use only. The contents are not to be redistributed.
Under the direction of the PCMO,health kits may be replenished from health unit stock
on a scheduled basis.
COSing Volunteers are encouraged to take their health kits and unused contents with them.
Contents of health kits cannot be redistributed. However, the PCMOs can donate the empty
health kit boxes provided they ensure the contents are properly destroyed and the box label
indicated it was a PC health kit is removed. No paperwork is needed as the item is
expendable and would be disposed of as trash or recycled material.
4. THE CORE HEALTH KIT
The following list of core contents should be included in all health kits:
TG 250
Health Kits
CORE HEALTH KIT
Medications
Acetaminophen tablets 325 mg, 50 each

Bismuth Subsalicylate tablets, 48 each
Bacitracin-Polymixin B ointment, 15 gm tube or packet
Cepacol throat lozenges, 18 each
Chlorhexidine detergent, 120 ml, 1 each
Clotrimazole cream 1%, 15 gm tube, 1 each
Dextromethorphan throat lozenges, 18 each
Antacid tablets (e.g., Tums, Mylanta, Di-Gel), 30 each
Diphenhydramine capsules or caplets 25 mg, 30 each
Hydrocortisone cream 1%, 30 gm tube
Ibuprofen 400 mg, 40ea or 200mg, 80 each
Iodine water purification tablets, 50 each
Oral rehydration salts (ORS), 10 packets each
Phenylephrine HCI tablets, 10 mg, 24 each
Non-medicated Normal Saline Eye Drops (5, 10, 20 or 30 cc bottle)
Loperamide 2 mg, 12 each
Caladryl cream, 15gm tube 1ea, or 1/16oz packets 8 each
Plan B One-Step (emergency contraception)
Health Supplies
Medical adhesive tape (1 X 10 yards) 1 each

Band-Aids (assorted sizes) 45 all together
Butterfly skin closures, 20 each
Condoms, lubricated, without Nonoxynol-9, 10 each
Dental floss, unwaxed (100 yds)
Elastic bandage (3 X 5 yards)
Gauze pads, sterile, (3 X 3),10 each
Gloves, non-sterile, Latex or non latex, 2 pairs each
Insect repellent , 30-35% DEET, item not considered a HAZMAT by international
shipping standards, e.g., Ultrathon 28gms, 1 each
Lip balm with sunscreen, SPF 15, 4.25 gms, 1each
First Aid Pocket Guide, 1 each
Safety Whistle, < 120 decibels 1 each
Bandage scissors, surgical, straight or angled, double-blunt, 5.5 1 each
Sunscreen cream, at least SPF 30, 105 ml, 1 each
Tweezers, splinter, 3.5, 1 each
Thermometer, oral disposable, 10 each

TG 250
Health Kits
5. ADDITIONAL ITEMS
The addition of optional items to the core health kit depends on the incidence of disease in
country, the degree of isolation of individual Volunteers, and the local availability of medical
evaluation and treatment. Any item not listed below will be the responsibility of the
Volunteer.
The following optional items may be added to the core health kit at the discretion of the
PCMO, and with OHS consultation as necessary:
Antibiotics
A broad-spectrum, oral antibiotic may be provided to treat simple skin and upper
respiratory infections, (see TG 635 Common Skin Infections and TG 640 Common
Respiratory Infections).
Choice of antibiotic depends on location (likely organism) and susceptibility pattern. The
PCMO will distribute the antibiotic of choice at PST (see TG 202 Attachment B for
suggestions).
When issuing any antibiotic, the PCMO must document the absence of known allergies in
the Volunteers health record and document that the Volunteer was instructed to report
any antibiotic use to the PCMO.
Anti-malarials
Volunteers are required to carry a Rapid Diagnostic Test for malaria and medication for self-
treatment of presumptive malaria in countries with chloroquine-resistant falciparum malaria
(see TG 202 Attachment B for specific information).
Vitamins
Research is inconclusive about the efficacy of a vitamin supplement in the diets of those
residing overseas. When there is concern about inadequate diet, regular multivitamin
supplementation may be indicated. In any case, multivitamin supplementation should be
considered for any female of childbearing age (for folate) and for Volunteers who are
vegetarian/ vegan (for B12).
If vitamin supplementation is required, a generic multivitamin with iron should be used.
A multivitamin without iron may be used if iron is not well tolerated by a Volunteer.
Additional vitamin and mineral supplements may be considered on an individual basis

only if a medical indication for such a supplement exists (such as for Vitamin D or
calcium).

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Health Kits
Toiletries
Toiletries such as shampoo, moisturizing lotion, toothpaste and feminine hygiene products
are not considered medically essential products which must be provided by the health unit.
However, each post may choose to provide feminine hygiene products and other toiletries
as a convenience to PCT/Vs. If a post chooses to provide such products, the PCMOs may
facilitate acquisition and distribution of these items.
Distribution of toiletries does not require clinical documentation in the Volunteers
medical record.
Resupply of health kits:

The PCMO, in collaboration with other key staff in the health unit, will determine the most
effective means of resupplying the health kit.
The PCVs will be notified by the PCMO about the frequency at which health kits will be
restocked/replenished
Non-prescription items
Allowing for PCMO discretion, OHS advises that refill of non-prescription medical
supplies found in health kits occur no more frequently than on a monthly basis.
Monthly (or on the schedule the PCMO has established), the medical secretary/assistant
will download the requests for resupply
Prescription medications
Any requests for refills of prescription medication routinely contained in the medical kit
must be approved and filled by the PCMO
The PCMO may give the completed prescription to the medical assistant/secretary for
inclusion in the refill order
The medical assistant/secretary will prepare the order for distribution.

Peace Corps
INFECTION CONTROL
1. PURPOSE
The purpose of this guideline is to provide guidance on infection control practices and
procedures for Peace Corps overseas health units.
Additionally, this guideline provides direction regarding appropriate post-exposure treatment and
counseling for staff exposed to blood borne pathogens.
2. BACKGROUND
The objective of infection control practice in the Peace Corps clinical setting is to protect
Volunteers, Peace Corps staff, and the community from exposure to blood and other potentially
The concept of infection control includes a series of workplace activities designed to reduce the
transmission of blood borne pathogens, reduce the likelihood healthcare acquired infections, and
ensure the safe management of medical waste.
Peace Corps Trainees and Volunteers are screened for, or vaccinated against, blood borne
pathogens and other transmissible diseases, e.g., HIV, hepatitis B, tuberculosis. As such, the risk
of patient-provider or patient-patient transmission of infectious diseases in the Peace Corps
health unit is significantly reduced, but not eliminated.
3. STANDARD PRECAUTIONS
The Centers for Disease Control and Prevention (CDC) recommends Standard Precautions which
are mandated in the Occupational Safety and Health Administration (OSHA) blood borne
pathogen standard. Both standards are designed to protect health care workers from exposure to
blood borne pathogens and are the focus of the Peace Corps infection control program.
Standard precautions are the minimum infection prevention practices that apply to all patient
care, regardless of suspected or confirmed infection status of the patient in any setting where
healthcare is performed. These practices are designed to both protect healthcare providers and
prevent healthcare providers from spreading infections among patients. These precautions should
be employed by all Peace Corps healthcare personnel when caring for patients
Standard precautions include hand hygiene, the use of personal protective equipment (e.g.
gloves, gowns, masks), safe injection practices, safe handling of sharp instruments, safe handling
of potentially contaminated equipment or surfaces in the patient environment, and respiratory
hygiene/cough etiquette.

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Infection Control
Standard precautions apply to:

(1) blood; (2) all body fluids, secretions, and excretions except sweat, regardless of whether or
not they contain visible blood; (3) non-intact skin; and (4) mucous membranes. Under
circumstances in which differentiation between body fluid types is difficult or impossible, all
body fluids should be considered potentially infectious. Examples include:
blood urine feces
semen vaginal secretions saliva in dental procedures
cerebrospinal fluid synovial fluid pleural fluid
pericardial fluid amniotic fluid human tissue
vomitus
3.1 Hand Hygiene
Good hand hygiene, including the use of alcohol-based rubs (ABHR) and handwashing with
soap and water, is critical to reduce the risk of spreading infections in ambulatory cares settings.
Use of alcohol-based hand rub as the primary mode of hand hygiene in healthcare settings is
recommended by the CDC and World Health Organization (WHO) because of its activity against
a broad spectrum of epidemiologically important pathogens, and because compared with soap
and water, use of ABHR in healthcare settings can increase compliance with recommended hand
hygiene practices by requiring less time, irritating hands less, and facilitating hand hygiene at the
patient bedside. For these reasons, ABHR is the preferred method for hand hygiene except when
hands are visibly soiled (e.g. dirt, blood, body fluids), or after caring for patients with known or
suspected infectious diarrhea (e.g. Clostridium difficile, norovirus) in which case soap and water
should be used.
Hand washing facilities (running water, sink and antibacterial soap) should be readily accessible
in the health unit and elsewhere at post where health workers are reasonably anticipated to
contact blood or other potentially infectious materials during the performance of their duties.
ABHR should be available in all areas where direct patient care is provided. ABHR should also
be carried in go bags and emergency response bags.
Hand-hygiene technique
When decontaminating hands with an ABHR, apply product to palm of one hand
and rub hands together, covering all surfaces of hands and fingers, until hands are
dry. Follow the manufacturers recommendations regarding the volume of
product to use.
When washing hands with soap and water, wet hands first with water, apply the
amount of product recommended by the manufacturer to hands, and rub hands
together vigorously for at least 15 seconds, covering all surfaces of the hands and
fingers. Rinse hands with water and dry thoroughly with a disposable towel. Use
towel to turn off the faucet. Avoid using hot water, because repeated exposure to
hot water may increase the risk of dermatitis. Multiple-use cloth towels of the
hanging or roll type are not recommended for use in health units.

TG 260
Infection Control
3.2 Personal Protective Equipment
Personal Protective Equipment (PPE) refers to wearable equipment that is intended to protect
healthcare providers from exposure to or contact with infectious agents. Examples include:
gloves, gowns, face masks, respirators, goggles and face shields. The selection of PPE is based
on the nature of the patient interaction and potential for exposure to blood, body fluids, or
infectious agents.
All healthcare personal should routinely wear PPE when the potential for contact with blood,
body fluids, secretions, excretions, and contaminated materials exist. The type and characteristics
of the barriers used depends upon the task and degree of exposure anticipated.
PPE should not permit blood or other potentially infectious materials to pass through to, or reach,
health workers clothes, undergarments, skin, eyes, mouth, or other mucous membranes under
normal conditions of use and for the duration of time that the equipment is being used. Hand
hygiene is always the final step after removing PPE.
PPE should be readily accessible in the health unit and should be removed after use and disposed
of in a plastic trash bag located in the work area.
PPE should be used by consultants and referral facilities when necessary.
Gloves
Disposable, single-use gloves should be worn when contact with blood, body
fluids, secretions, excretions, or contaminated items can be reasonably
anticipated. This includes wearing gloves when: (1) performing phlebotomy or
vascular access procedures; (2) processing laboratory specimens; (3) handling or
touching contaminated items or surfaces; and (4) cleaning spills or disposing of
infectious waste.
Gloves are not required when performing basic examinations that involve
touching intact skin or when giving injections as long as hand contact with blood
or other potentially infections material is not reasonably anticipated.
Gloves should be changed as soon as possible if they are torn, punctured, or their
ability to function as a barrier is compromised; after each patient contact; between
tasks and procedures on the same patient; after contact with material that may
contain a high concentration of microorganisms; and after processing specimens.
Gloves should not be washed and should not be used with petroleum-based hand
creams.
Sterile gloves should be used for procedures involving contact with normally
sterile areas of the body.

TG 260
Infection Control
Gowns and Aprons
Moisture-proof disposable gowns or aprons should be worn when contact with

large quantities of blood or body fluids can be reasonably anticipated, e.g.,
surgery, managing active bleeding, blood and body fluid exposure from
splashes, arterial bleeding, and vomiting. Clinical lab coats or jackets worn
over personal clothing for comfort and/or purposes of identity are not
considered PPE.
Face Protection: Masks Goggles and Face Shields
Masks are used for three primary purposes in healthcare settings: 1) placed on
healthcare personnel to protect them from contact with infectious material
from patients e.g., respiratory secretions and sprays of blood or body fluids,
consistent with Standard Precautions and Droplet Precautions; 2) placed on
healthcare personnel when engaged in procedures requiring sterile technique
to protect patients from exposure to infectious agents carried in a healthcare
workers mouth or nose, and 3) placed on coughing patients to limit potential
dissemination of infectious respiratory secretions from the patient to others
(i.e., Respiratory Hygiene/Cough Etiquette).
Masks may be used in combination with goggles to protect the mouth, nose
and eyes, or a face shield may be used instead of a mask and goggles, to
provide more complete protection for the face, as discussed below. Masks
should not be confused with particulate respirators that are used to
prevent inhalation of small particles that may contain infectious agents
transmitted via the airborne route as described below. The mucous
membranes of the mouth, nose, and eyes are susceptible portals of entry for
infectious agents, as can be other skin surfaces if skin integrity is
compromised (e.g., by acne, dermatitis). Therefore, use of PPE to protect
these body sites is an important component of standard precautions.
Procedures that generate splashes or sprays of blood, body fluids, secretions,
or excretions (e.g., endotracheal suctioning, bronchoscopy, invasive vascular
procedures) require either a face shield (disposable or reusable) or mask and
goggles. The wearing of masks, eye protection, and face shields in specified
circumstances when blood or body fluid exposures are likely to occur is
mandated by the OSHA Bloodborne Pathogens Standard 739. Appropriate
PPE should be selected based on the anticipated level of exposure.
The eye protection chosen for specific work situations (e.g., goggles or face
shield) depends upon the circumstances of exposure, other PPE used, and
personal vision needs. Personal eyeglasses and contact lenses are NOT
considered adequate eye protection.
Disposable or non-disposable face shields may be used as an alternative to
goggles 759. As compared with goggles, face shields provide protection to
other facial areas in addition to the eyes. Face shields extending from chin to
crown provide better face and eye protection from splashes and sprays; face

TG 260
Infection Control
shields that wrap around the sides may reduce splashes around the edge of the
shield.
Removal of a face shield, goggles and mask is performed safely after gloves
are removed, and hand hygiene performed. The ties, ear pieces and/or
headband used to secure the equipment to the head are considered clean and
therefore safe to touch with bare hands. The front of a mask, goggles and face
shield are considered contaminated
Two mask types are available for use in healthcare:
i. Masks in combination with eye protection devices (e.g., goggles or glasses
with solid side shields, or chin-length face shields): This type of mask
should be worn during activities that are likely to generate splashes, spray,
spatter, or droplets of blood or other potentially infectious materials. If
protection is not worn, eye, nose, or mouth contamination can be
reasonably anticipated. Examples include dental procedures, orthopedic
procedures, inserting arterial lines, and performing lumbar punctures.
ii. Standard face masks: Reduce the transmission of droplet aerosols but do
not provide complete protection from airborne organisms. They may not
filter tiny particles and may not fit the face tightly. For TB precautions see
section 4.1 below.
iii. Disposable CPR masks: Should be used when providing artificial mouth-
to-mouth resuscitation. Masks and ventilations bags, e.g., Ambu bags,
should be available in close proximity to areas where they are likely to be
used.
3.3 Safe Handling of Sharp Instruments
Sharps injuries are the primary mode of transmission of blood borne pathogens in the workplace.
Sharps injuries typically occur when a healthcare worker inadvertently punctures his or her skin
with a hypodermic needle or other sharp device that has been used on a patient and become
contaminated with the patient's blood or other body fluids.
Sharp Objects and Needles
Healthcare personnel are required to take precautions when handling needles,

scalpels, lancets, and other sharp instruments or devices. This includes using
special caution when handling instruments after procedures, when cleaning
used instruments, and when disposing of used needles.
Needles should never be recapped, purposely bent or broken, clipped, sheared,
replaced in the sheath, removed from disposable syringes, or otherwise
manipulated by hand. In circumstances where no alternative to recapping is
feasible, or such action is required by a specific medical procedure, a one-
handed scoop technique or a mechanical device designed for holding the
needle sheath should be used.
Needle sticks are prevented by using devices that have needles with safety
features or that eliminate the use of needles altogether, e.g., needleless IV

TG 260
Infection Control
connectors, self-sheathing needles, sharps with engineered sharps injury

protection devices, and blunted surgical needles. Peace Corps Medical
Officers (PCMOs) may use these devices if trained in their use.
If vacutainer needle systems are used in the health unit, posts should use a
specially designed needle disposal container designed to assist the health
provider in removing the vacutainer from the needle (twist hub). These
containers can be procured from most vendors or through the Office of
Administrative Services, Post Logistics and Support Division (PLS).PLS
Used laboratory blood tubes are considered sharp objects and should be
disposed of in puncture-proof leak-proof sharps containers.
Sharps Containers
Containers for contaminated sharps should be:
Closable, lockable
Puncture resistant;
Leakproof on sides and bottom;
Labeled with the universal biohazard symbol or color-coded red.
During use, sharps containers should be:
Easily accessible to personnel and located as close as is feasible to
the immediate area where sharps are used;
Maintained upright throughout use;
Replaced routinely and not be allowed to overfill.
After use, when container is full, sharps containers should be:

Closed and locked.
Disposed of as soon as possible (see section 7.1 below).
If immediate disposal is not possible, filled containers should be
stored in a designated secure area in the health unit.
4. TRANSMISSION-BASED PRECAUTIONS
In specific situations, measures beyond standard precautions are required to prevent the
transmission of infectious agents. These precautions are called Transmission-Based
Precautions. They are designed to reduce the risk of airborne, droplet, and contact transmission
of infectious agents.
Transmission-based precautions should be employed by all Peace Corps healthcare personnel

when caring for patients with documented, or suspected, highly transmissible or
epidemiologically important pathogens.
There are three types of transmission-based precautions; airborne, droplet, and contact
precautions. They may be used singularly or in combination, but must always be used in addition
to standard precautions.

TG 260
Infection Control
The following table summarizes infection control strategies for Transmission-Based

Precautions:
TRANSMISSION-BASED PRECAUTIONS
AIRBORNE DROPLET CONTACT

Transmission Microdroplets, airborne Large-particle droplets (> Direct hand or skin-to-skin
droplet nulei (< 5 um), 5 um) generated by contact; or indirect contact
dust particles with infected patient during (touching contaminated
infective agent. coughing, sneezing, surfaces or items).
talking, or procedures.
Organisms e.g.: TB, SARS, measles, e.g.: H flu, rhinoviruses, e.g.: herpes, MRSA,
varicella. influenza. enteric organisms.
Precautions N-95 respirator. Surgical masks if within If hospitalized, private
If hospitalized, private 3 ft. of patient. room whenever
room with adequate air If hospitalized, private possible.
exchanges. room or separation of 3 Gloves and gowns when
susceptible (non- ft. between patients. entering room if contact
immune) persons Cohort patients with the with patient or the
should avoid entering same disease. environment is likely,
room (measles, change goves after
varicella). handling infectious
material, remove when
leaving patient room and
dispose of properly.
5. SAFE HANDLING OF LABORATORY SPECIMENS
All laboratory specimens are potentially infectious and may be contaminated with blood borne
pathogens. Health care personnel should always use standard precautions when handling or
processing specimens (see section 3 above).
Persons processing blood and body fluid specimens should wear gloves, wash their hands before
and after completing laboratory activities and should remove protective clothing before leaving
the work area.
When possible, office lab areas should be located in a separate room from the patient care area.
If tests are performed in the same area as patient care, health care personnel should make an
extra effort to thoroughly clean spills and disinfect contaminated surfaces before and after use
(see section 6 below). To control aerosol contamination, PCMOs should not centrifuge
specimens in patient care areas.
5.1 Storage
Specimens of blood or other potentially infectious material should not be stored in the same
refrigerator as medications or food items. If refrigerator space is limited, specimens and
medications may be stored in the same refrigerator provided that the lab specimens are kept in a

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Infection Control
sealed plastic bag, stored in a rigid container such as a covered plastic box, and stored on the
bottom shelf. Food should not be stored with either medications or specimens.
5.2 Specimen Preservation
Unrefrigerated specimens: Unrefrigerated specimens may become contaminated by bacterial

growth, making the specimen unusable. The addition of an antibiotic to reduce bacterial growth
is recommended if cold packs or ice packs are not being used. The simplest method is to add a
gentamycin-impregnated paper disk to the serum sample. PCMOs can procure these disks (used
in antibiotic sensitivity testing of bacterial cultures) through the Post Logistics and Support
(PLS) Washington, DC.
Refrigerated or frozen specimens: Specimens sent refrigerated or frozen must be packed in a
Styrofoam container with cold packs. Cold packs remain active for approximately seven days.
See TG 360 Use of U.S. Laboratories section 4 for additional guidance on shipping
refrigerated specimens to U.S. laboratories.
Consult the Quest Laboratories reference manual for specific information on specimen
preparation and preservation of individual tests.
5.3 Specimen Packaging

Note: The term container is used to describe the specimen packaging requirements in section 5.3, and the term
box is used to describe the shipping requirements in section 5.4.
Specimens of blood or other potentially infectious material should be placed in containers that
prevent leakage during collection, handling, storage, transport, and shipping. Secondary
containers or bags are required if the primary container is contaminated or if there is the potential
for puncture or leakage of the primary container.
Transporting Specimens to the U.S.
PCMOs should package specimens of blood or other potentially infectious material being
shipped to the U.S. in the following way.
Primary container: Place the specimen in a watertight tube or container, e.g., plastic screw top
serum tube, specimen container, or slide holder. Place adhesive tape around all tops. Avoid
contamination of the outside of the container.
Requisition slip: Place the requisition slip in a ziplock bag. This protects the requisition slip from
leakage or contamination.
Secondary container: Place the primary container and the requisition slip inside the ziplock bag
in a second watertight container with absorbent material. A Styrofoam packing container,
malaria kit container, or other container placed in a leak proof (ziplock) bag is sufficient.
5.4 Specimen Shipping
Prior to shipment, secondary container(s) must be placed inside one or two cardboard boxes as
follows:

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Infection Control
Double Box: Specimens sent by diplomatic pouch or hand carried to the OMS mail room for
forwarding to U.S. laboratories must be double boxed. The outer box should be addressed to:
Peace Corps Mail Room
1111 20th Street, N.W.
Washington, D.C. 20526
Attention: Lab Specimens
Each inner box must be accurately addressed to its final destination, e.g., Quest, CDC, etc. Each
inner package must contain specimen samples destined for one and only one U.S. laboratory.
Single Box: Double boxing is not required if the package is sent directly from post to a U.S. lab.
A single cardboard box addressed directly to the reference is sufficient.
Rigid mailing sleeves, if properly reinforced for overseas shipment may, may be used instead of
boxes for shipment of specimens.
5.5 Labeling
Specimen containers for storage, transport, or shipping must be

appropriately labeled. A warning label that includes the universal
biohazard symbol, followed by the term biohazard is required. A red
bag or red container may be substituted for a label. Plastic specimen
bags with the red biohazard symbol are appropriate and can be
procured from most vendors or through PLS.
BIOHAZARD
Biohazard labeling is required on:
Refrigerators and freezers that are used to store blood and other pathologic specimens
Specimen containers used to store or transport blood and other pathologic specimens
Contaminated equipment that is to be serviced or shipped
Sharps containers
Bags and containers used to store, dispose of, or transport infectious waste (see
section 7 below)
Labeling is not required on:

Individual containers of blood or specimens that have been placed in a secondary
labeled container (see section 5.3 above)
Containers in the health unit that are labeled as containing biohazard material
6. HOUSEKEEPING
The PCMO is responsible for maintaining the health unit in a clean and sanitary condition. This
includes establishing procedures for the routine cleaning and decontamination of the health unit
and for ensuring staff compliance with these procedures. Decontamination refers to either
sterilization or disinfection.

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Standard housekeeping procedures include: (1) sterilization and disinfection of instruments and
equipment; (2) disinfection of environmental surfaces; (3) disinfestation (pest control); and (4)
disposal of waste (see section 7 below).
6.1 Principles of Sterilization and Disinfection
PCMOs must use disposable, single-use, instruments whenever possible. This includes
disposable needles and syringes, scalpels, probes, thermometers, speculums, anoscopes,
irrigation kits, suture kits, etc.
All non-disposable instruments and equipment must be sterilized or disinfected. The PCMO is
responsible for ensuring that reusable equipment is appropriately sterilized or disinfected prior to
reuse. Sterilized and disinfected instruments should be stored in clean, dry, airtight containers.
Instruments should not be overlapped or piled in a basin or container during the process of
disinfection or sterilization to ensure instrument surfaces contact disinfectant solution.
In order to ensure adequate results, all visible dirt, debris, blood, oils and other substances must
be removed from instruments or surfaces by scrubbing with hot soapy water prior to any
disinfection or sterilization procedure.
Standard precautions, PPE and sharps precautions must be used when handling patient-care
equipment and instruments that have been contaminated with blood, or other body fluids.
STERILIZATION AND DISINFECTION SUMMARY
DEFINITION DEVICES APPROVED METHODS OF

(Instruments/Surfaces) DECONTAMINATION
Sterilization Complete elimination Instruments, devices and Single use
of all microbial life, equipment that enter or Heat (autoclave)
including viruses and contact sterile tissue or the
spores. vascular system, e.g.,
needles, surgical or dental
tools.
High-Level Elimination of all Instruments, devices, and Heat (autoclave,
Disinfection microorganisms, equipment that contact pasteurization)
except for bacterial mucous membranes or non- Bleach (1:10 dilution)
spores intact skin, e.g.,
Chemical germicides
thermometers, vaginal
speculums, endoscopes.
Intermediate- Use of a chemical to Blood and body substance Alcohol
Level eliminate vegetative spills. Chlorine compounds, e.g.,
Disinfection microorganisms, Environmental surfaces bleach (1:10 or 1:50
including dilution)
contaminated with blood or
mycobacteria, most
body substances. Some phenolics
viruses, but not
bacterial spores Some iodophors
Low-Level Reduction or Instruments, devices, and Bleach (1:100)
Disinfection elimination of most equipment that contact intact Liquid disinfectants or
microorganisms skin, e.g., stethoscopes, chemical germicides
exam table, and
environmental surfaces.

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6.2 Sterilization
Sterilization is a process that destroys all microorganisms, including viruses and spores.
Sterilization should be used for instruments or devices:
That enter sterile tissue, e.g., surgical instruments, suture kits, irrigation kits,
dressings and drapes
That enter the vascular system, e.g., needles or IV catheters
Through which blood flows, e.g., intravenous supplies
That contact mucous membranes or non-intact skin (may also receive high-level
disinfection if they cannot tolerate high heatsee section 6.2 below)
Methods of Sterilization:
Autoclave
Autoclaving is the only method of sterilization endorsed by OHS. Sterilization is
achieved with a steam or moist heat autoclave at temperatures of 250-270F (121-
132C). Posts should procure or have access to an autoclave if non-disposable
sterile instruments are required in the health unit.
PCMOs should follow the manufacturers instructions supplied with the autoclave
to ensure proper results. For most small autoclaves, unwrapped instruments are
autoclaved for 20 minutes and small wrapped packages for 30 minutes at the target
temperature. The timer should be set only after the appropriate target temperature
has been reached. A steam or moist heat autoclave should be used with distilled
water to prevent scale deposits on the instruments, and should only be used for heat
resistant items.
The sterilization process must be monitored. Manual indicators on the machines,

such as time, temperature, and pressure gauges, should be observed and recorded. If
possible, biological indicators should be used with each load to ensure sterilization
is achieved. Chemical indicators, such as tape that changes color, placed on
wrapped packages may be used to distinguish between processed and unprocessed
items.
Sterilized instrument packs should be carefully stored in a clean, dry, dust-free area.
If the integrity of the package is maintained, plastic instrument packs may be stored
for a maximum of one year. Muslin or crepe-wrapped packs may be stored for a
maximum of two months. Unwrapped instruments should be used immediately or
aseptically placed in a sterile container.
Liquid and Gas Sterilants

The use of liquid or gas sterilants is impractical and may be dangerous in the Peace
Corps environment. PCMOs must contact OHS before using these methods.
Liquid sterilization uses a 2% solution of glutaraldehyde. Liquid sterilants are

extremely irritating to mucous membranes and require careful time, temperature,
and pH monitoring. Many also require the use of hazardous substances to inactivate
the chemicals.

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Gas sterilization uses ethylene oxide in a high concentration. Gaseous sterilants

require careful temperature, time and humidity monitoring and treated materials
need to air for varying periods of time depending on the composition.
6.3 High Level Disinfection
High-level disinfection is a procedure that kills all forms of microorganisms but may not kill
large numbers of bacterial spores.
High-level disinfection methods are used for:
Disinfecting equipment, instruments, and devices that come into contact with mucous
membranes or non-intact skin, e.g., thermometers, vaginal speculums, endoscopes,
and other devices that cannot be sterilized by heat.
In general, PCMOs should not use high-level methods of disinfection for instruments that can be
sterilized.
High-level disinfectants should not be used for cleaning environmental surfaces or for cleaning
spills.
Methods of High Level Disinfection:

Moist Heat Pasteurization (Boiling)
Moist heat pasteurization or boiling is an excellent method of disinfection and is
a good method of disinfecting stainless steel instruments. Moist heat pasteurization
requires that instruments or devices be boiled at a rolling boil, 212F (100C), for at
least 20 minutes. The PCMO should ensure that all parts of the instruments are in
contact with boiling water, e.g., open scissors, forceps. A descaling agent may be
added if scale develops on the instruments.
Hydrogen Peroxide
A 6% hydrogen peroxide solution is safe and effective to use on medical
instruments. However, it will damage the external surface of rubbers and plastics
and will corrode copper, zinc, and brass instruments after prolonged use.
Chemical Germicides and Disinfectants

High level disinfection with chemical germicides or chemical disinfectants,
sometimes referred to cold sterilization may be used to clean instruments and
disinfect areas of blood and body fluid spills after the organic matter is removed. To
ensure proper results, PCMOs should follow the manufactures instructions for
dilution and length of time for germicide to remain in contact with contaminated
area. . Liquid disinfectants, e.g., glutaraldehyde (Cidex), may be procured through
PLS and are usually considered a hazardous material.
6.4 Intermediate-Level Disinfection
Intermediate level disinfection is the use of a chemical to eliminate vegetative microorganisms,

including mycobacterium, most viruses, but not bacterial spores.
Intermediate-level disinfection methods are used for:

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Disinfecting blood and body substance spills (see Section 6.7 below)
Disinfecting environmental surfaces that have been contaminated with blood or
body substances (see Section 6.6 below)
Methods of Intermediate-Level Disinfection

Bleach
For disinfecting large spills or spills of cultured microorganisms in lab areas, use
bleach (5.25% sodium hypochlorite), diluted 1:10 with water (see section 6.7 below
for additional information on cleaning spills).
For disinfecting small spills in general patient care areas and environmental
surfaces that have been contaminated with blood or body substances, use bleach
(5.25% sodium hypochlorite), diluted 1:50 with water (see section 6.6 below for
additional information on cleaning environmental surfaces and ATTACHMENT B
for guidance on the preparation of chlorine disinfectants).
Alcohol
A 70-90% alcohol solution may be used for cleaning smooth hard surfaces and
instruments or devices that contact intact skin. Contact time: 10 minutes.
Peroxide
A 3% peroxide solution may be used for cleaning smooth, hard surfaces, rubber
tubing, and catheters. Contact time: 20 minutes.
6.5 Low Level Disinfection
Low-level disinfection is a procedure that reduces or eliminates most microorganisms.

Low-level disinfection methods are used for:
Disinfecting equipment, instruments, and devices that come into contact with
intact skin, e.g., stethoscope, blood pressure cuff, scales.
Disinfecting environmental surfaces and work surfaces that have not been
contaminated with blood or body substances, e.g., exam table, faucets, bed rails,
floors.
Methods of Low Level Disinfection

Bleach
For disinfecting equipment, instruments, devices and environmental surfaces that
have not been contaminated with blood or body substances, use bleach (5.25%
sodium hypochlorite), diluted 1:100 with water.
Bleach should be in contact with any instrument for at least 20 minutes, thoroughly
rinsed with sterile water following disinfection, and air dried or dried using a sterile
cloth. Bleach compounds will corrode stainless steel instruments after prolonged
use. See ATTACHMENT B for guidance on the preparation of chlorine
disinfectants.

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Phenolics
Phenolics, e.g., Lysol, may be substituted for bleach and may be used to disinfect
smooth hard surfaces. It is a skin irritant and should not be used on linens or on
surfaces that contact skin. It is also corrosive to metal. Contact time: 10 minutes.
Quaternary Ammonium Compounds (QUATS)

Quaternary ammonium products may be used for general housekeeping procedures
that do not involve the cleanup of contaminated items or surfaces. Dilution and
contact time depend on the manufacturers instructions.
Antiseptics and Antimicrobial Solutions

Antiseptics and antimicrobial solutions, e.g., Iodophors (betadine) or Chlorhexadine
(Hibiclens) are generally used to disinfect skin. These solutions should not be used
on objects and may be ineffective if used on instruments.
6.6 Environmental Surfaces
All equipment surfaces, working surfaces, and environmental surfaces, e.g., counter tops, exam
tables, bed rails, carts, faucets, door knobs, toilets and other frequently touched surfaces in the
health unit should be cleaned on a routine basis (at a minimum every week) and decontaminated
after contact with blood or other potentially infectious materials.
Surfaces should be regularly decontaminated with an appropriate intermediate- or low-level

disinfectant after the completion of work activities. For example, a 1:50 bleach solution may be
used for cleaning surfaces contaminated with blood or other potentially infectious materials and
a 1:100 bleach solution may be used for all other surfaces.
Bins, pails, cans, and similar receptacles intended for reuse, that have a reasonable likelihood of
becoming contaminated with blood or other potentially infectious materials, should be inspected
and decontaminated on a regular basis and cleaned and decontaminated immediately or as soon
as feasible upon visible contamination.
6.7 Spills
Spills of blood or body fluids or excreta, should be decontaminated as soon as possible with a
high level disinfectant. A 1:10 dilution of bleach or a chemical germicide should be used for this
purpose. When cleaning up a spill PCMOs should use the following procedures:
Always wear gloves
Apply absorbent material, e.g., paper towels, directly to the spill
Remove all visible organic matter and debris from the spill area
Flood the area with 1:10 dilution of bleach or other disinfectant
Allow to stand for 10-15 minutes
Remove and discard the toweling with the spill material in a plastic bag properly
labeled with the biohazard sign
Clean the surface with a detergent or soap and water
Terminally disinfect the surface with a 1:10 dilution of bleach

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6.8 Disinfestation (Pest Control)
Insects and rodents are known carriers of disease. Effective control measures should be instituted
to avoid infestation of the health unit. Windows should be screened or covered with mosquito
netting, drains should be plugged when not in use, and other insect avoidance measures should
be used in the health unit.
Peace Corps posts may consult the Occupational Safety and Health Officer at the U.S. Embassy
if necessary. This individual should be familiar with locally available, safe, appropriate, and
effective pest control measures.
7. DISPOSAL OF INFECTIOUS WASTE
Infectious waste is defined as:

Any blood, body fluid, excreta or other potentially infectious materials
Contaminated items that would release blood or other potentially infectious materials
in a liquid or semi-liquid state if compressed. e.g., operative sponges, culture plates
Items that are caked with dried blood or other potentially infectious materials and are
capable of releasing these materials during handling, e.g., dressings, IV tubing
Contaminated sharps
PCMOs should set up a waste disposal process in the health unit to facilitate the safe
management of infectious waste. This includes the separation of infectious waste from general
health unit trash.
Standard Precautions and disposal methods must be used when handling and disposing of
infectious waste. These disposal methods are discussed and summarized in the table and text
below.
INFECTIOUS WASTE DISPOSAL METHODS SUMMARY
TYPE OF WASTE RECOMMENDED METHODS OF DISPOSAL*

SHARPS High temperature incineration (in-country hospital,
(Section 7.1) medical facility or commercial facility)
Barrel incineration (see Appendix C & D)
Shipment of special sharps containers to appropriate
facility in the U.S
Medical Waste Processing Unit (sec. 7.4)
SOLIDS High temperature incineration (in-country hospital,
(Section 7.2) medical facility or commercial facility)
Barrel incineration (see Appendix C & D)
Medical Waste Processing Unit (sec. 7.4)
LIQUID Substance poured down isolated drain or toilet.
(Section 7.3)
* See section 7.4 for additional disposal options

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7.1 Sharps Disposal
Standard precautions should always be used when handling and disposing of sharps.
Prior to disposal, disposable needles, syringes, scalpels, and other sharp items should be placed
intact into puncture-resistant leak-proof sharps containers (see section 3.3 above). PCMOs
should prepare sharps containers for disposal in the following way:
Place a puncture resistant lid on the container when it is two-thirds full
Secure the lid with duct tape or other adhesive material. The duct tape may not serve
as a lid itself
Seal the container prior to removal to prevent spillage or protrusion of contents
during handling, storage, transport, or shipping
Place the container in a secondary container if leakage is possible
Do not reuse, open or manually clean sharps containers
Recommended Method of Disposal:
High temperature incineration is the recommended method of disposal for sharps and
sharps containers. If possible, PCMOs should attempt to locate an in-country hospital,
medical facility or commercial facility with an incinerator and arrange for incineration
locally.
In most cases a local incinerator can be identified. Frequently, incinerators are not
available in Peace Corps countries. If a commercial incinerator is not available locally,
an incinerator may be constructed from a 220-litre (55 gallon) oil or fuel drum. Peace
Corps posts may arrange to have this type of incinerator constructed for disposal of
infectious waste. See ATTACHMENT C for instructions on how to construct an
incinerator. See ATTACHMENT D for instructions on burning waste in an
incinerator.
Sharps containers may also be shipped back to the U.S. for incineration. This is
accomplished by procuring special sharps containers that are addressed to an
appropriate facility in the U.S. and labeled for U.S. disposal. The price of the container
includes the cost of incineration. These containers may be procured through PLSPLS.
Some posts may be able to arrange for the transportation of sharps to an appropriate
facility for disposal through the Department of Defense. PCMOs should discuss this
option with the Defense Attach at the U.S. Embassy.
If these options are not available the PCMO may consider using one of the disposal
options outlined below (see section 7.4).
7.2 Solid Infectious Waste Disposal
Solid infectious waste includes disposable supplies, dressings, gowns, gloves, gauze, bandages,
drapes, etc., that have been contaminated with blood or other potentially infectious material. It
also includes pathological and microbiological waste that contains blood or body fluids,
specimen containers, and used test kits that are not considered sharps.

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Recommended Method of Disposal:
Prior to disposal, solid infectious waste should be placed in a sturdy, impervious bag to
prevent leakage of the contained items. The bag should be closable and must be clearly
labeled with the universal biohazard symbol followed by the word biohazard. Red
bags or containers may be substituted for the label. Standard biohazard bags can be
procured from most vendors or through PLS.
Prior to removal from the area of use, the bag should be closed to prevent spillage or
protrusion of the contents during handling, storage, or transport. A secondary container
or bag should be used if the outside of the primary bag is contaminated, if the items are
heavily soiled, or if there is the potential for puncture or leakage.
Incineration is the recommended method for disposal of infectious waste bags. If these
options are not available the PCMO may consider using one of the disposal options
outlined below (see section 7.4).
7.3 Liquid Waste Disposal
Liquid infectious waste includes, but is not limited to, blood, blood products, suctioned fluids,
excretions, secretions, and used disinfectants. Liquid waste should be poured carefully down an
isolated drain or toilet.
7.4 Other Options to Dispose of Infectious Waste

Note: Items 2, 3 and 4 below are options to be used only when other options are not available.
1. Sharps and infectious waste should be placed in a Medical Waste Compactor or

Medical Waste Processing Unit designed to sterilize and destroy sharps and
infectious medical waste. Most units are electric. The process creates a non-
biodegradable plastic puck that completely encloses the processed sterile waste
material. These devices can be procured directly from most Peace Corps vendors or
through PLS.
2. In the absence of other alternatives, Peace Corps recognizes that it may be

necessary to bury sharps. If this option is chosen, sharps and infective waste should
be autoclaved and then buried in a sanitary landfill. To autoclave sharps, an
autoclavable sharps container and a large autoclave is required. Autoclavable
sharps containers can be procured directly from most Peace Corps vendors or
through PLS.
3. Non-sharp infective waste may be burned in an open pit and then disposed of in a
sanitary landfill. See ATTACHMENT D for how to burn waste in a pit. In general,
open burning is not a reliable method of treating infectious waste and should only
be used as a last resort.
4. Non-sharp infectious waste may be soaked in a solution of 1:50 solution of bleach

(see ATTACHMENT B) for 20 minutes and then disposed of in a sanitary landfill.

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Treating infective waste is accomplished by soaking the waste in a leak proof

container or bag prior to disposal. In general, this is not a reliable method of
treating sharps and infective waste and should only be used as a last resort.
7.5 Linen
Contaminated linen, e.g., non-disposable gowns, drapes, bedding, etc., should be handled,
transported, and processed in a manner that prevents contamination of the person handling the
linen and the environment. Linen should be sealed in a plastic bag with a biohazard label until
laundered and not mixed with other household laundry.
Standard precautions should be used when handling linen soiled with blood or other potentially
Linens should be washed in a washing machine with hot water, detergent, and one cup of
household bleach. Items may be washed by hand after soaking at least ten minutes in hot water,
detergent, and 2 oz (4 tablespoons) of household bleach per gallon of water (5% solution).
8. MANAGEMENT OF EXPOSURES IN THE WORKPLACE
When caring for Peace Corps Volunteers, PCMOs and other health care personnel are at low risk
of exposure to blood borne pathogens due the fact that (1) the HIV status of Volunteers is known
at the time of medical clearance; (2) the rate of HIV seroconversion of Volunteers is roughly
1.5/10,000 Volunteer/Trainee years; and (3) all Volunteers are vaccinated for Hepatitis B.
Additionally, according to the 2011 CDC report, Occupational HIV Transmission and Prevention
among Health Care Workers, Through December 2001, there were 57 documented cases of
occupational HIV transmission to health care workers in the United States, and no confirmed
cases have been reported since 1999.
All posts, however, are required to have in place a program for reporting, evaluating, testing,
treatment and follow-up of exposure incidents that occur in the workplace. The PCMO, together
with the Country Director (CD), is responsible for implementing this program.
Peace Corps staff includes post employees or contractors, who may be U.S. or
host-country nationals. Any staff member may experience an occupational
exposure. As such, their individual health benefits will vary, and the authority for
Peace Corps to provide or pay for management of an occupational exposure
must be worked out on a case-by-case basis. In these situations, OHS will work
with the Office of Contracts, Region, and the Office of the General Counsel to
ensure that the necessary authorities and services are provided in a timely
fashion.
An occupational exposure is defined as contact with blood or other potentially infectious

materials that results from the performance of job duties and may place the healthcare worker or
other staff member at risk for acquiring a blood borne infection, including HIV. Exposures may
occur through:
Percutaneous injury, e.g., a needlestick or cut with a sharp object

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Mucous membrane contact, e.g., eye or mouth contact

Nonintact skin contact, e.g., when the exposed skin is chapped, abraded, or afflicted
with dermatitis
Contact with intact skin when the duration of contact is prolonged or involves an
extensive area with blood, tissue, or other body fluids
Posts are responsible for identifying and training staff holding positions or job classifications in
the workplace that may place them at risk for exposure to blood borne pathogens or other
potentially infectious materials regardless of whether protective equipment is used by the
employee. Jobs and tasks at Peace Corps posts that may have occupational exposure to blood
borne pathogens include, but are not limited to:
PCMO
Health unit personnel
Drivers transporting blood, or specimens
Cleaning staff
8.1 Hepatitis B Exposure Prevention Strategy
All Peace Corps staff at risk of occupational exposure to blood or other potentially infectious
materials should be strongly encouraged to obtain the Hepatitis B vaccine series. Prior to
vaccination staff members should be (1) educated on the modes of transmission of Hepatitis B;
(2) instructed on methods that will prevent or reduce exposure of Hepatitis B, e.g., use of
personal protective equipment; and (3) given information on the efficiency, safety, and benefits
of vaccination. Post is responsible for providing this education.
Staff members should obtain the vaccine locally from a health care provider with access to a
reliable source of vaccine. Post is encouraged to assist eligible staff members who desire
vaccination with the vaccination process. If vaccination can not be obtained locally, the PCMO
or the CD should contact OHS for guidance.
Staff members may or may not have to pay for the vaccine depending upon their
employment/contract status.
8.2 Immediate Management and Reporting of Exposure Incidents
All Peace Corps staff who may encounter blood borne pathogens as a part of their work
responsibilities should be educated and instructed on immediate management of an exposure.
Specifically, if an exposure occurs, staff members should:
Flush eyes and mucous membranes with clean water for at least five minutes
Wash all cuts, wounds, and abrasions with soap and water; apply first aid
Report the incident to the PCMO or the CD
The PCMO or the CD is then responsible for conducting a confidential investigation of the
incident, completing an incident exposure report (see ATTACHMENT E), and contacting OMS
for guidance on appropriate evaluation and testing.

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8.3 Post-Exposure Evaluation, Testing, Post-Exposure Prophylaxis and Follow-Up
Appropriate post-exposure evaluation, testing, prophylaxis and follow-up for the source
individual and the exposed employee are determined on a case-by-case basis by by post in
consultation with OHS. After completing the incident exposure report, the PCMO should inform
the CD and contact OHS for guidance and management recommendations.
Testing the Source Individual
The source individual is the person whose blood or body fluids are the source of an
occupational exposure. The management of PCMO or other healthcare worker needle
sticks or other exposure incidents in the Peace Corps workplace relies primarily on
testing the source individual for Hepatitis B, Hepatitis C, and HIV to evaluate the
possibility of transmission.
Post may be asked to: (1) identify the source individual; (2) counsel the source
regarding the need for testing; (3) obtain consent for testing; (4) make arrangements to
have the source individual tested as soon as possible for HBV, HCV, and HIV
infection; and (5) report the results of the testing to the source individual, the exposed
staff member, and to OHS.
In most cases the source individual is a Volunteer and testing is done through the Peace
Corps health unit. If the source individual is a staff member, post may be asked to
facilitate testing locally. If reliable testing cannot be obtained locally, post should
contact OHS for guidance.
Evaluation and Testing the Exposed Employee
Post may be asked to offer prompt evaluation and baseline testing for HBV, HCV, and
HIV infection to the exposed staff member. The staff member has the right to refuse
either or both. If the staff member desires evaluation and testing post may be asked to
facilitate arrangements.
In most cases, the evaluation is done locally by a health care professional with access to
reliable testing facilities. Evaluation should include counseling regarding the possible
use of prophylactic treatment after HIV exposure. If reliable evaluation and testing
cannot be obtained locally, post and OHS will collaborate to make other arrangements.
Post should contact OHS for assistance.
Posts should provide the evaluating health care professional with the following
information:
A copy of the Incident Exposure Report to include a description of the
exposed staff members duties as they relate to the exposure incident and a
description of the route of exposure
Results of the source individuals blood testing, if available
Medical records or findings relevant to appropriate treatment of the staff
member, including vaccination status

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Health Care Providers Opinion
Under certain circumstances, OHS may ask post to obtain a written opinion from the
evaluating health care professional that includes the following information:
Recommendations for Hepatitis B vaccine and documentation if the employee
received the vaccine
Recommendations for HIV post-exposure prophylaxis and documentation of
any treatment initiated
Statement that the exposed staff member has been informed of the results of
the evaluation and recommendations about any exposure-related conditions
that require further evaluation and treatment
Hepatitis B Post-Exposure Prophylaxis
In most cases, if post-exposure prophylaxis for Hepatitis B is indicated, e.g., if the

source Volunteer has hepatitis, the staff members local health care provider is
responsible for providing post-exposure management and treatment. Post may be asked
to ensure that current CDC guidelines for post-exposure Hepatitis B prophylaxis are
followed. If the staff member cannot obtain post-exposure prophylaxis locally, post
should contact OHS for guidance. In general, if the source patient is seronegative, no
additional follow-up is necessary.
Hepatitis C Counseling and Follow-Up
In most cases, if the source Volunteer has hepatitis C, post is asked to arrange for
counseling and follow-up for the staff member by the employees local health care
provider.
HIV Post-Exposure Prophylaxis
In most cases, if post-exposure HIV prophylaxis is indicated, e.g., if the source

Volunteer is positive for HIV or if the source person has recently engaged in behaviors
that are associated with a risk for HIV transmission, the staff members local health
care provider is responsible for providing post-exposure management and treatment.
Posts may be asked to ensure that current CDC guidelines for post-exposure HIV
prophylaxis are followed. If the staff member can not obtain post-exposure prophylaxis
locally, post should contact OHS for guidance.
Follow-up of possible HIV exposure is determined on a case by case basis. For

example, if the source patient is seronegative and low risk, no other follow-up may be
necessary. However, if the source patient is seronegative and is at high risk of HIV
infection, the exposed staff member may be retested at intervals of six weeks, 12
weeks, six months, and 12 months after exposure to determine whether transmission
has occurred.

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9. EXPOSURE CONTROL PLAN
TG 260 Infection Control serves as a standard exposure control plan for overseas posts.
PCMOs are encouraged to modify the plan to include post-specific practices and procedures.
The PCMO, with support from the country staff and OMS, is responsible for implementing and
assisting post personnel in maintaining compliance with the plan. The plan should be reviewed
and updated whenever necessary to reflect new or modified tasks and procedures that affect
occupational exposure, and to reflect new or revised employee positions with occupational
exposure.
Implementing a successful infection control program requires identifying job

classifications/positions and tasks and procedures in which occupational exposure to blood borne
pathogens or other potentially infectious material may occur in the workplace/during the
performance of duties. PCMOs should provide infection control training to new health unit staff
during orientation and annual infection control training to health unit staff and post personnel
with the potential for occupational exposure.
REFERENCES:
Centers for Disease Control and Prevention: Guidelines for Transmission Precautions, 2007.
Centers for Disease Control and Prevention: Guide to Infection Prevention for Out Patient
Settings, 2014.
Centers for Disease Control and Prevention: Guideline for Disinfection and Sterilization in
Healthcare Facilities, 2008
Occupational Safety and Health Administration, Occupational Exposure to Blood borne

Pathogens; Final Rule, 29 CFR Part 1910.1030.
Infection Control for Viral Hemorrhagic Fevers in the African Health Care Setting. World
Health Organization, CDC, US DHHS, December 1998.

TG 260 ATTACHMENT A
PACKAGING SPECIMENTS
Packing and Labeling of Etiologic Agents

TG 260 ATTACHMENT B
PREPARATION AND USE OF CHLORINE DISINFECTANTS
PREPARATION
Chlorine Product 1:10 Solution 1:50 Solution 1:100 Solution (low-

(intermediate-level (intermediate-level level disinfection)
disinfection) disinfection)
Household bleach 1 liter of bleach per 200 ml of bleach per 100 ml per 10 liters
5.25% sodium 10 liters of water 10 liters of water or water or 1 liter
hypochlorite 1:10 bleach solution
per 9 liters of water.
Household bleach 16 grams or 1 32 grams or 2 16 grams or 1
30% sodium tablespoon per 1 liter tablespoons per 10 tablespoon per 10
hypochlorite of water liters of water liters of water
Calcium 7 grams or 14 grams or 1 7 grams or
hypochlorite tablespoon per 1 liter tablespoon per 10 tablespoon per 10
powder or granules of water liter of water liters of water
70% (HTH)
USE
1:10 Solution 1:50 Solution 1:100 Solution (low-

(intermediate-level (intermediate-level level disinfection)
disinfection) disinfection)
Used for Large spills or spills Small spills in patient Instruments, devices,
Disinfecting: of cultured care areas. and equipment that
microorganisms in contact intact skin,
lab areas. Environmental e.g., stethoscope,
surfaces that have blood pressure cuff,
been contaminated scales.
with blood or other
body substances. Environmental
surfaces not
contaminated with
blood or other body
substances, e.g.,
exam table, faucets,
bed rails, floors.
Bleach solutions should be prepared weekly.

Bleach solutions should always be discarded if the odor of chlorine is not present, or if
they become cloudy or bloody.
Bleach solutions should be stored at room temperature in an opaque container.
TG 260 ATTACHMENT C
BUILDING AN INCINERATOR
Steps for Building an Incinerator

TG 260 ATTACHMENT D
BURNING WASTE
TO BURN WASTE IN AN INCINERATOR
Place the incinerator far from the normal traffic flow of the health facility.
Place the infectious waste inside the top of the drum.
Soak the waste in one liter of fuel.
Light the fire carefully.
Watch the fire and frequently mix the waste with the metal
bars to be sure all the waste is burned.
When the fire has gone out, empty the ashes into a pit.
TO BURN WASTE IN A PIT
Locate the pit far from the normal traffic flow of the health facility.
Dig a pit that is 2 meters deep. It should be wide enough to hold all
contaminated waste material.
Place the disinfected waste in the pit.
Pour fuel (such as diesel fuel) on the waste.
Start the fire carefully.
Watch the burning to make sure all the waste is completely destroyed.
When the fire has gone out, if any waste remains, repeat the steps for
burning.
When no waste remains and the fire is out, cover the ashes with soil.
Before the pit becomes completely full, cover it with soil so that no
pieces of waste are visible or are too close to the surface. The pit
should be closed when it is covered by one-half meter of soil.
Dig a new pit.
Never leave unburned waste in an incinerator or burning pit.
Reference: Centers for Disease Control and Prevention and the World Health Organization. Infection
Control for Viral Haemorrhagic Fevers in the African Health Care Setting. Atlanta, Centers for Disease
Control and Prevention, 1998: 1-198.
TG 260 ATTACHMENT E
INCIDENT EXPOSURE REPORT
INSTRUCTIONS: To be completed by the PCMO, or other qualified individual. When complete, fax one copy
to the Office of Medical Services and file the original report in the Health Unit.
Date of incident: Time of incident:

PC staff notified: Date: Time:
Name of individual exposed:
Name of source individual:
Other persons involved:
Location of incident:
Describe in detail how the incident occurred. Include type and brand of devices involved:
Route of exposure, e.g., needlestick:
Immediate management of exposure incident:
Personal protective equipment being used at the time of the incident:
Actions taken to prevent recurrence, e.g., suggested changes in post procedures:
Name and contact information of health professional evaluating source individual:
Prior Hepatitis B Vaccination of source individual: Y: N:

Consent obtained from source individual for blood testing: Y: N:
Results of source individuals blood testing: HIV: HBV: HCV:
Source individuals test results conveyed to exposed employee: Y: N:
Treatment received, if any, e.g., Hepatitis B vaccine, HIV post-exposure prophylaxis, HCV
exposure counseling. Include follow-up and outcome:

Peace Corps MTG 200 Health Unit OVERSEAS HEALTH UNITS

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Peace Corps MTG 200 Health Unit OVERSEAS HEALTH UNITS

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Peace Corps

Technical Guideline 200

OVERSEAS HEALTH UNITS

3. SPACE AND CONFIGURATION OF THE HEALTH UNIT

1. An office or consultation room to include space for the following:

2. An examination room to include space for the following:

Medical illumination light suitable for pelvic exams

In addition, a health unit should include space for the following:

4. Waiting room or waiting area

5. Bathroom with toilet, sink and water supply

6. Adequate storage areas to include space for the following:

7. Office for administrative support (desirable)

8. Observation area/sick bay (desirable)

Office of Health Services June 2015 Page 2

4. DRUGS, EQUIPMENT AND SUPPLIES

ATTACHMENT A is a standard drug formulary of oral, topical and parenteral medications

4.1 Overseas Sourcing of Medications and Vaccines

All medications and vaccines provided to Volunteers must be FDA-approved and

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Drugs manufactured by following pharmaceutical companies are approved for use

4.2 Locally-prescribed Medications

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4.3 Emergency Equipment and Supplies

4.4 Medication Issues and Volunteers

4.5 Medications of Uncertain Benefit

Peace Corps does not provide prescription or over-the-counter medications or other

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medication only if it is found to be medically indicated and of clear benefit in a

Health units should have supplies on hand to do the following tests:

Malaria testing (if applicable)

STI testing (nucleic acid amplification test-NAATs)

Rapid test kits for strep, mono

Rapid test kit for HIV

6. INVENTORY MANAGEMENT AND CONTROL OF PHARMACEUTICAS

MS 734 establishes Agency procedures for inventory control of pharmaceuticals and

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Inventories of medical supplies must be completed on a quarterly basis. The CD should

A complete inventory of controlled substances must be performed quarterly and

7.1 Storage of Controlled Substances

MS 734 establishes Agency procedures for storage of controlled substances. It states:

Office of Health Services June 2015 Page 7

8. DISPOSAL OF OUTDATED MEDICAL SUPPLIES

9. REFERENCES AND RESOURCE MATERIALS

Technical Guidelines, Volume I & II (Available through PC Intranet).

9.2 Training and Other Resources

The Post-Service Health Benefits Program: A Handbook for Returned Volunteers

Office of Health Services June 2015 Page 8

The Returned Volunteers Guide to FECA Benefits. OHS, 2014.

9.4 Medical Reference Books and Journals

9.5 Safety and Security Resources

10. OFFICE SYSTEMS

11. HEALTH UNIT STAFFING

11.1 Clinical Staff

Age of post (newly opened or established)

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PCMO training and qualification

11.2 Administrative Support

Adequate administrative support is often the key to a well-functioning health unit as

11.3 Medical Officer Hiring

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OHS bases its determination on a number of factors including:

Consultation and input from the CD and PCMO

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A. Medications will be available at Regional Houses on a limited basis.

Office of Health Services October 2015 Attachment A

Me dica tions Possible Par Expire Amount Date/PCMO

Albuterol inhaler Ventolin 1 unit 1