Professional Documents
Culture Documents
IMMUNIZATION
1. PURPOSE
2. BACKGROUND
All immunobiologics have benefits and risks; no vaccine is completely safe or completely
effective.
Benefits of vaccination range from partial to complete protection against the
consequences of infection.
Risks of vaccination range from common, minor and inconvenient side effects to rare,
severe, and life-threatening conditions.
Recommendations for immunization balance the scientific evidence of benefits, costs, and
risks. The Peace Corps Medical Officer (PCMO) must be fully acquainted with all vaccines
administered and should consult the following publications for additional information:
VISs for all vaccines administered in the Volunteer health system can be found at
http://www.cdc.gov/vaccines/hcp/vis/current-vis.html.
Detailed information on immunization and specific vaccines is also published in the Red Book
published by the American Academy of Pediatrics and periodically in Morbidity and Mortality
Weekly Report (MMWR).
3. RECOMMENDED VACCINATIONS
4. VACCINE ADMINISTRATION
There are three main types of immunizations available. Live vaccines and inactivated
vaccines both provide immunity by stimulating the immune system whereas passive
vaccines contain antibodies and provide immediate immunity without stimulating an
immune response.
* indicates vaccines which are not indicated for use by Volunteers at this time
** indicates vaccines with very limited use
*** indicates vaccine approved for PC use, not licensed in the US
The PCMO should be familiar with the signs, symptoms and management of
anaphylaxis (see TG 615).
Anaphylaxis may occur with any vaccination, even if that vaccine has been given
before.
Wherever vaccinations are given, equipment and medication for emergency
treatment of anaphylaxis must be available for immediate use. The anaphylaxis
treatment protocol must be posted in any area where vaccines are administered.
Primary Immunization
Many vaccines require more than one dose to provide adequate immunity.
Interval between Doses (primary immunization series)
Decreased time between doses: Decreasing the time between doses may decrease
the antibody response. If a dose is given before it is due, PCMOs should not count it
as part of the immunization series and should continue the series as if it had not
been given, i.e., repeat the dose at the appropriate time.
Booster Doses
Booster doses are doses given after a completed primary immunization series, e.g.,
tetanus boosters every ten years for Volunteers. Some vaccines do not require
booster doses. For those that do, the booster will be effective if given anytime
within the recommended booster interval (within ten years for tetanus vaccine in the
preceding example). Exceeding the recommended interval could result in a decrease
in protection.
RECAP NOTE:
Vaccine doses for primary immunization must be given no sooner than the
recommended interval.
Booster doses should be given no later than the recommended interval.
In general, live vaccines produce more adverse reactions than inactivated vaccines.
Common symptoms include: low grade fever, headache, and myalgia. Acetaminophen
can be used to treat these adverse reactions.
Vaccine components cause allergic reactions in some recipients. These reactions can be
local or systemic, and can include life-threatening anaphylaxis. The components of the
vaccine responsible for these hypersensitivity reactions can be the vaccine antigen,
animal or egg protein, antibiotics, preservatives or stabilizers used in the vaccine.
Egg proteins
Egg proteins are found in MMR, influenza, yellow fever, and purified chick embryo
cell rabies vaccines. Persons who can eat eggs or egg-containing foods without
adverse effects can safely receive these vaccines. Persons with urticaria,
angioedema, throat swelling, or other reactions (even if mild) are at risk for severe
allergic reactions. PCMOs should consult OMS when considering vaccination of
persons who may be allergic to egg proteins.
Neomycin
Only if the Volunteer has had an anaphylactic reaction to neomycin in the past, s/he
should not receive the rabies vaccine, MMR, Varicella, or polio vaccine.
When logistically possible, PC should provide the primary series of vaccines, if those are
recommended by this guideline (see p.8 Technical Reference Information on individual
vaccines), to Volunteers who will be traveling outside their country during service. The
exception is pre-exposure rabies vaccination, which should not be given for short term
travel. Volunteers should be instructed on steps to take if a bite occurs in a rabies endemic
area (alter plans, go to travel clinic for treatment).
Booster doses of approved vaccines may be given to Volunteers at COS who do not plan to
return to the U.S. within 30 days of COS and who medically require the vaccine for travel
in a destination.
A primary series of an approved vaccine may be initiated for Volunteers at COS who do
not plan to return to the U.S. within 30 days of COS and medically require the vaccine for
travel in a destination country.
PCMOs should account for this when ordering vaccines, using historical data for
prediction. The vaccine should be available in the Health Unit or provided (reimbursed)
through another reliable local source, e.g., Department of State or Ministry of Health clinic
if those are available.
Yellow fever vaccine can only be given at official yellow fever vaccination clinics or
centers. If the clinic is not available, the responsibility lies with the Volunteer.
Note: Persons who have already COSed are not eligible to receive vaccines from
the PC Health Unit.
Minor illnesses such as mild upper respiratory infections are not a reason to delay.
Although a moderate or severe acute illness is sufficient reason to postpone
vaccination, minor illnesses (such as diarrhea, mild upper respiratory infection
with or without low-grade fever, other low-grade febrile illness) are not
contraindications to vaccination (CDC, 2016).
People with moderate or severe acute illness, with or without fever, should be
vaccinated as soon as the condition improves. This precaution is to avoid
superimposing adverse effects from the vaccine on underlying illness, or mistakenly
attributing a manifestation of underlying illness to the vaccine.
Live vaccines are generally not given to pregnant women (or women who may become
pregnant within three months of vaccination) as there is a theoretical risk to the
developing fetus.
The Vaccine Consent Form is found in this TG. The PCMO must complete section 3 of
this form for each Volunteer. The Volunteers must review the Vaccine Information
Sheet (VIS) (See section 4.9) for each vaccine and complete section 4 of the Vaccine
Consent form, prior to vaccination. Once the Vaccine Consent Form is completed, it
must be scanned and uploaded into the Volunteer Waivers/consents document folder in
PCMEDICS.
The National Childhood Vaccine Injury Act requires that federally developed Vaccine
Information Statements (VISs) be provided to vaccine recipients before vaccination.
VISs for all vaccines administered in the Volunteer health system can be found at
http://www.cdc.gov/vaccines/hcp/vis/current-vis.html. The PCMO must provide the
VISs to all Volunteers prior to immunization of any vaccine.
For detailed instructions on how to use these PCMEDICS immunization features, refer
to the PCMEDICS user scripts that can be found at:
https://in.peacecorps.gov/HQ/OHS/HIU/_layouts/15/start.aspx#/User%20Scripts
WHO Cards
Peace Corps no longer provides WHO cards. If a Volunteer presents a WHO Card to
the health unit requesting in-service vaccines be documented on it, the PCMO may
document the immunizations administered during service.
Host Country National (HCN) PCMOs who are traveling on temporary duty status (TDY)
and require immunizations for the TDY country of service will be reimburseed from
OHS for vaccination-incurred costs. Traveling (TDY) PCMOs should save vaccine
related receipts and submit them with the travel voucher after travel. If possible, vaccine
related costs should be added to the TA prior to travel.
The Vaccine Adverse Event Reporting System (VAERS) is a system designed for the
collection and analysis of reports of adverse events following use of any vaccine in the U.S.
In the U.S., all providers are required to report all vaccine adverse events using this system.
The VAERS is a passive reporting system.
Peace Corps works with the CDC to participate in the VAERS system. The VAERS accepts
all vaccine reports, including reports for non-U.S. licensed vaccines that have been
authorized by OMS for use overseas. Reports from Peace Corps are of special significance
due to the inclusion of vaccines that are not routinely used in the U.S. The PCMO should
consult OMS if a Volunteer has a medical contraindication to vaccination, i.e., history of a
significant reaction to a vaccine or vaccine component.
If adverse event suspected, review the VAERS resource and information below:
o Any event which is specifically required to be reported which occurs within the
specified time period or within seven days of vaccination as defined by the
table Reportable Events Following Vaccination found at:
http://vaers.hhs.gov/resources/VAERS_Table_of_Reportable_Events_Foll
owing_Vaccination.pdf
Contact the EPI Unit if you suspect an adverse reaction as it must be reported on a
VAERS form. The EPI unit will assist the PCMO with reporting adverse reactions.
Most vaccines, especially live vaccines, are sensitive to heat and light. Some are stable
enough to tolerate short periods of time without refrigeration, while others must remain
refrigerated (or in some cases, frozen) until use. Each manufacturer provides
recommended storage information for the vaccine in the package insert. See also TG 240
Attachment 4 Vaccine Temperature Requirements.
For maximum reliability of refrigeration, store all vaccines in the interior compartment of
the refrigerator or freezer, never in the doors. Remove only the vaccines necessary for
immediate use and return them to the refrigerator immediately after use.
This section addresses the most important aspects of individual vaccines included in the
Volunteer immunization program. Some of the vaccines are used on a worldwide basis,
others are used only in certain regions, countries, or areas.
Adverse Reactions
Local symptoms of pain and tenderness were the most commonly reported symptoms in a
safety study with 1,993 adult participants who received 2 doses of Ixiaro. Headache, myalgia,
fatigue, and an influenza like illness were each reported at a rate of >10%. Because Ixiaro was
licensed after the study in <5,000 recipients, the possibility of rare serious adverse events
cannot be excluded. Post licensure studies and surveillance are ongoing to further evaluate the
safety of Ixiaro in a larger population.
Primary Immunization
Ixiaro: 0.5 ml IM on days 0 and 28
Imojev: 0.5 ml IM single dose
Booster Doses
Ixiaro: If primary series >1 year then 0.5 ml booster may be given. See
http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseases-related-to-travel/japanese-
encephalitis for updated guidelines on boosters.
Imojev: no booster is needed for 5 years after receiving the Imojev live vaccine
Storage
Unreconstituted vaccine should be stored between 2-8C (36-46F). DO NOT FREEZE. The
reconstituted vaccine should be stored between 2-8C and used within 8 hours. DO NOT
FREEZE.
Vaccines
Two inactivated cell culture-derived TBE vaccines are available in Europe, in adult and pediatric
formulations: FSME-IMMUN/TicoVac (Baxter, Austria) and Encepur (Novartis, Germany). The
adult formulation of FSME-IMMUN is also licensed in Canada. Two other inactivated TBE
vaccines are available in Russia: TBE-Moscow (Chumakov Institute, Russia) and EnceVir
(Microgen, Russia). Immunogenicity studies suggest that the European and Russian vaccines
should provide cross-protection against all 3 TBEV subtypes. For both FSME-IMMUN and
Encepur, the primary vaccination series consists of 3 doses. The specific recommended intervals
between doses vary by country and vaccine. Although no formal efficacy trials of these vaccines
have been conducted, indirect evidence suggests that their efficacy is >95%. Vaccine failures
have been reported, particularly in people aged 50 years.
Indications in Volunteers
Vaccination is recommended for Volunteers residing in rural areas or who work outdoors in
endemic areas.*
All Volunteers should be advised to use insect repellent (DEET) and wear appropriate clothing.
Unpasteurized dairy products should not be consumed.
*Endemic areas are well defined in Central Europe. All forested areas in the former Soviet
Union should be considered to be endemic areas unless specific epidemiologic information is
available.
Contrindications
FSME-Immun (Baxter, Canada)
Persons with systemic allergies to eggs should not be vaccinated.
Adverse Reactions
Mild injection site reactions (>10%) and headache, nausea, myalgia, and fatigue (1-10%) may
occur.
Primary Immunization
0.5 ml intramuscularly in months 0, 1, and 10-12.
Booster Doses
0.5 ml intramuscularly three years after the last dose.
Accelerated Dosing
0.5 ml intramuscularly given on days 0, 7, and 21.
Storage
Store between 2-8C (36-46F). DO NOT FREEZE.
HEPATITIS A (HAV)
Distribution and Transmission
HAV infection is highly endemic throughout the developing world, where it is primarily a
childhood infection. Transmission occurs via person-to-person contact or from the ingestion of
contaminated food or water.
Vaccines
Inactivated vaccines are available in the U.S. from GlaxoSmithKline (Havrix) and Merck
(Vaqta). Havrix (GlaxoSmithKline) contains 1440 ELISA units (EL.U.) per dose and Vaqta
(Merck) contains 50 units (U.) per dose. Both vaccines are authorized for use as described
below. Less potent pediatric formulations (Havrix 720 EL.U./dose, Vaqta 25 U./dose) should
not be used.
One dose of vaccine produces high levels of antibody within four weeks. Immune Globulin
(IG) (see IG section below) may be given in addition to hepatitis A vaccine to provide
immediate protection. IG should be administered during the first month of service in settings
where Trainees will be at significant risk for acquiring hepatitis A before high antibody levels
are achieved from HAV vaccine. A second dose of vaccine is necessary to maintain protection
beyond one year (see below).
Indications in Volunteers
All Volunteers must be immunized against HAV infection. Hepatitis A vaccine should be
administered upon arrival unless proof of immunity is present, i.e., positive anti-HAV antibody
titer or documentation of prior vaccination with the hepatitis A vaccine (see above).
Contraindications
Persons allergic to vaccine or any of its components (e.g., alum, 2-phenoxyethanol for Havrix)
should not be vaccinated. IG should be used every four months in such persons.
Adverse reactions
Local pain and tenderness at the injection site, occasional mild systemic symptoms.
Primary immunization
1.0 ml intramuscularly in months 0 and 6. Volunteers should receive the second dose at the
first opportunity for vaccination (six to12 months after first dose).
(If IG is used, it is given 14 days after arrival in country to prevent interaction with MMR
vaccine and must be given at a separate injection site).
Booster Doses
The need for booster doses following the primary series has not been determined. Research has
shown the primary dose to be effective for >25 years (ACIP, 2006).
Storage
Store between 2- 8C (36-46F). DO NOT FREEZE.
Immune Globulin
IG, Gamma Globulin IG is a sterile solution of immunoglobulin (antibodies) prepared from
pooled human plasma. IG offers short-term protection against HAV infection for at least four
months. IG is available for intramuscular injection.
Indications in Volunteers
IG may be administered to provide protection during the first month after vaccination and for
person allergic to hepatitis A vaccine. See hepatitis A vaccine information above.
Contraindications
IG should not be given to persons with known immunoglobulin A deficiency. IG should not be
given in patients with a history of prior systemic allergic reactions to IG. IG for intramuscular
use should NEVER BE GIVEN INTRAVENOUSLY..
Adverse reactions
Local pain and tenderness at the injection site, urticaria, and angioedema may occur following
IG administration. Serious reactions are rare.
How Administered
Short-term protection (less than three months)
2.0 ml intramuscularly is effective for up to 3 months. (0.02 ml/kg)
Long-term protection (more than three months)
5.0 ml intramuscularly is effective for at least four months. (0.06 ml/kg)
Volunteers who cannot receive hepatitis A vaccine should receive IG every four months.
Interactions
IG must be given three months before, or two weeks after, MMR vaccine. IG does not interfere
with yellow fever or polio vaccines.
IG does not produce a clinically significant drop in the response to hepatitis A vaccine and may
be given before, with, or after vaccination.
Storage
IG should be refrigerated at 2- 8C (36-46F). DO NOT FREEZE.
HEPATITIS B (HBV)
Distribution and Transmission
Hepatitis B is a disease caused by hepatitis B virus (HBV), a small, circular, partially double-
stranded DNA virus in the Hepadnaviridae family.
HBV is moderately to highly endemic in most countries where Volunteers serve. Endemicity
can be classified based on the prevalence of HBV carriers (HBsAg positive) as:
High endemicity (HBsAg prevalence 8-15%)
SE Asia, Central Asia, China, Tropical Africa, Pacific Islands, Amazon Basin;
Intermediate endemicity (HBsAg prevalence 2-7%)
Central Europe, Mediterranean, Central and Tropical South America, Haiti, the
Dominican Republic, Middle East, India, Russia; Low endemicity (HBsAg prevalence <0-
2%)
North America, Western Europe, Australia, New Zealand, Temperate South America.
HBV transmission occurs via percutaneous or permucosal exposure to infected blood or blood-
derived fluid, especially occupational blood exposure, exposure to contaminated needles or
blood, and perinatal and sexual transmission.
Approximately 5% of U.S. residents become infected with HBV during their lives, most often
during young adulthood.
Vaccines
Recombinant hepatitis B vaccines are produced by yeast cultures into which the gene for
hepatitis B surface antigen (HBsAg) has been inserted. Vaccines are available in the U.S. from
Merck (Recombivax HB) and Glaxo SmithKline (Engerix-B). Additionally, a combined
hepatitis A and B vaccine is available from Glaxo SmithKline (Twinrix).
Protective antibodies are produced in more than 90% of healthy young adults. Vaccine
response rates decrease somewhat with age (see below).
Indications in Volunteers
Universal vaccination of all Volunteers is required. The majority of Volunteers serve in areas
of intermediate to high HBV endemicity*. In addition, sexually active adults benefit from
vaccination. Pre-service is required to document the status of anti-HBs. If it is negative, the
Volunteer should repeat the primary series (of 3 vaccinations) OR the PCMO may repeat the
sAB test one month after vaccination; if negative, continue the two shots to complete the
series.
Contraindications
Hypersensitivity to any component of the vaccine is a contraindication to its use. There is no
apparent risk of adverse events to developing fetuses when hepatitis B vaccine is administered
to pregnant women.
Adverse Reactions
Hepatitis B vaccines have been shown to be safe when administered to both adults and
children. The major side-effects have been soreness and redness at the site of injection.
Primary Immunization
Recombivax HB, Engerix-B
1.0 ml intramuscularly (deltoid only) in months 0, 1, and 6.
Accelerated: 1.0 ml IM months 0, 1, and 2 with a booster at 12 months
Recombivax HB and Engerix-B may be interchanged without affecting vaccine response.
Twinrix
1.0 ml IM in months 0, 1, and 6
Accelerated; 1.0 ml IM on days 0, 7, 21-30, and a booster at 12 months
Serologic testing one to two months after completing all doses to confirm vaccine response
(defined as antibody to hepatitis B surface antibody [anti-HBS] concentration > 10 mIU/mL) is
recommended by OMS for health care workers and others at occupational risk of HBV
infection. Additional doses of vaccine may be necessary. See CDC recommendations for more
information.
Booster Doses
Additional booster doses are not recommended for healthy adults for the standard dosing;
boosters necessary for accelerated dosing.
Storage
Vaccine should be refrigerated at 2- 8C (36-46F). DO NOT FREEZE. Freezing destroys the
potency of the vaccine.
INFLUENZA
Vaccines
In the Northern Hemisphere, an influenza vaccine (inactivated virus) is available each fall to
provide protective antibodies against the influenza subtypes most likely to be found the
following winter. Antigens from several influenza A strains and one influenza B strain are
generally included.
Vaccines appropriate for use in the Southern Hemisphere may differ from those distributed in
the U.S. Consult local health authorities for advice about the source and composition of
vaccine recommended for individual countries. Vaccines manufactured in the U.S. may be
used when a more specific vaccine is not available.
Indications in Volunteers
All volunteers should be vaccinated.
Adverse Reactions
Local reaction of varying degrees may occur. These range from burning or stinging on
injection to local induration, tenderness, and erythema lasting one to two days. Systemic
reactions of myalgia, fever, headache, and malaise also occur. Guillain-Barre syndrome has
been reported to be a rare complication of some influenza vaccines.
Primary Immunization
0.5 ml intramuscularly in the deltoid muscle. One dose is given each fall. A needle of length
one inch or more should be considered for adults, as needles < 1 inch may be of insufficient
length to penetrate muscle tissue.
Storage
Store between 2-8C (36-46F). DO NOT FREEZE.
MEASLES-MUMPS-RUBELLA
GHSP Volunteers: must provide documentation of two doses of MMR or provide serologic
proof of immunity
Contraindications
MMR should not be given to pregnant women and pregnancy should be avoided for three
months after vaccination. MMR contains small amounts of neomycin and should not be given
to persons who have had anaphylactic reactions to neomycin. Any person with reduced
immunity should not receive the vaccine. MMR should not be given to persons who have had
anaphylactic reactions to gelatin or gelatin-containing products. Individuals with a severe
hypersensitivity to eggs should not be given vaccine. Persons who can eat eggs or egg-
containing foods without adverse effects can be vaccinated safely.
Interactions
Immune Globulin
Immune Globulin (IG) must be given three months before, or two weeks after, MMR vaccine.
Repeat MMR vaccine if IG administered less than three months before, or less than two weeks
after, MMR vaccination.
Live Vaccines
MMR and yellow fever vaccines (and other live vaccines except oral typhoid vaccine) must be
given either on the same day or four weeks apart. Oral typhoid vaccine and all inactivated
vaccines may be given anytime before, with, or after MMR vaccine.
Adverse Reactions
Measles vaccine
Fever greater than 39C (103F) is seen in approximately 5-15% of those vaccinated, usually
beginning between the 5th and 12th days after vaccination and lasting for one to two days.
Transient rashes occur in approximately 5% of vaccines.
Up to 55% of persons who were vaccinated with killed measles vaccine during 1963-1967
experience a local or mild systemic reaction after live measles vaccination. Occasionally illness
may be more severe but is much milder than that seen with atypical measles (measles which
occurs in persons who are partially immune).
Mumps vaccine
Parotitis and encephalitis have been reported rarely. Revaccination is not associated with
increased adverse effects.
Rubella vaccine
Adverse events are only seen in persons without previous vaccination or natural infection (i.e.,
no rubella immunity). Up to 40% of susceptible adults experience joint pains in the small
joints, knees, or both. Women are more often affected than are men or children. Symptoms
appear one to three weeks after vaccination and generally persist for one day to three weeks.
Chronic joint complaints following vaccination are generally rare and occur at a rate
considerably less than that following natural infection. Transient peripheral neurologic
complaints are also reported rarely.
Primary Immunization
MMR 0.5 ml subcutaneously, two doses given at least one month apart.
Long lasting protection is obtained in 95% of vaccinated persons after one dose and 100% after
two doses of MMR.
Booster Dose
Immunity following two doses of MMR vaccine is long lasting. Additional doses are not
required.
Vaccine Storage
Store vaccine at 2-8C (36-46F). Protect from light. Store reconstituted vaccine at 2-8C,
protect from light, and use within eight hours.
MENINGOCOCCAL VACCINE
Distribution and Transmission
N. meningitidis is found worldwide. At any time, 5%10% of the population may be carriers of
N. meningitidis. Invasive disease is rare in nonepidemic areas, occurring at a rate of 0.510
cases per 100,000 population per year, but can occur at a rate of up to 1,000 cases per 100,000
population per year in epidemic regions. The incidence of meningococcal disease is several
times higher in the meningitis belt in Africa (stretching from The Gambia to Ethiopia) than in
the United States, with periodic epidemics during the dry season (DecemberJune). During
nonepidemic periods, the rate of meningococcal disease in this region is roughly 510 cases
per 100,000 population per year. During epidemics, the rate can be as high as 1,000 cases per
100,000 population. Serogroup A predominates in the meningitis belt, although serogroups C,
X, and W-135 are also found. Transmission is by direct person-to-person spread of bacteria
from nasal and pharyngeal secretions (most infected persons remain asymptomatic or have
only a mild respiratory illness).
Vaccine
Two quadrivalent meningococcal polysaccharideprotein conjugate vaccines are licensed for
use in the United States: Menactra (Sanofi Pasteur) and Menveo (Novartis). A 1-dose primary
series of Menactra is licensed for people aged 255 years; a 2-dose primary series of Menactra
is licensed for children aged 923 months. Menveo is licensed for people aged 255 years.
Quadrivalent meningococcal polysaccharide vaccine (Menomune, Sanofi-Pasteur) is licensed
for use among people aged 2 years. These vaccines protect against meningococcal disease
caused by serogroups A, C, Y, and W-135. A vaccine was licensed in the US (Trumenba) for
meningococcus B. Approximately 710 days are required after vaccination for development of
protective antibody levels. Either of the conjugate vaccines is preferred for people aged 255
years; polysaccharide vaccine should be used for people >55 years.
Indications in Volunteers
Volunteers serving in areas experiencing epidemic or highly endemic meningococcal disease in
Africa should be immunized. ACIP recommends that children previously vaccinated at ages 9
months through 6 years who remain at an increased risk for meningococcal disease receive an
additional dose of conjugate vaccine 3 years after their previous meningococcal vaccine and
every 5 years thereafter, if at continued risk. Likewise, people who were previously vaccinated
at ages 755 years and who remain at an increased risk for meningococcal disease should
receive an additional dose of conjugate vaccine 5 years after their previous dose and every
5 years thereafter, if at continued risk. Travelers aged >55 years should be vaccinated or
revaccinated with polysaccharide vaccine if it has been >5 years since their last meningococcal
vaccine. Previously unvaccinated travelers <56 years of age who have a history of complement
component deficiency (C3, properdin, factor D, or late component), functional or anatomic
asplenia, or HIV should receive a 2-dose primary series of conjugate vaccine, 812 weeks
apart. For those aged 56 years with these conditions, a single dose of polysaccharide vaccine
should be given before travel if possible.
Contraindications
People with moderate or severe acute illness should defer vaccination until their condition
improves. Vaccination is contraindicated for people who have severe allergic reaction to any
component of the vaccines. People with dry natural rubber latex allergy should not receive
Menactra. Polysaccharide vaccine is an acceptable alternative for protection against
meningococcal disease in these people. All meningococcal vaccines are inactivated and may be
given to immunosuppressed people.
Adverse reactions
Local reactions such as pain, tenderness, induration, and erythema may occur.
Primary immunization
0.5 ml subcutaneously (Menomune)/ 0.5 ml intramuscular (Menactra/ Menveo)
Booster Doses
A booster dose after 3 years is indicated if at continued risk.
Storage
Store freeze-dried and reconstituted vaccine between 2-8C (36-46F). Discard reconstituted
vaccine after 24 hours (single dose vial) or after five days (multi-dose vial).
PNEUMOCOCCAL VACCINE
Distribution and Transmission
Pneumococcal pneumonia is the most common post-viral bacterial pneumonia, and is a
significant cause of morbidity in areas where epidemic influenza or a high incidence of
respiratory diseases occurs.
Vaccine
A meta-analysis of 15 randomized controlled trials (RCTs) and seven nonrandomized
observational studies of PPSV23 efficacy and effectiveness suggested an overall efficacy of 74%
against IPD (CI = 56%--85%), based on pooled results of 10 of the RCTs.
Volunteers meeting any of the following criteria are to be vaccinated prior to PC service.
However, if a Volunteer is not able to be immunized prior to service, PC should provide the
vaccine for him/her:
>65 OR will be turning 65 during PC service
Chronic heart disease (excluding hypertension)
Chronic lung disease, including asthma
Diabetes Mellitus
Cochlear implant
Cigarette smoking
Sickle cell disease and other hemoglobinopathies
Congenital or acquired asplenia, splenic dysfunction, or splenectomy
Congenital or acquired immunodeficiencies
HIV infection
Diseases requiring treatment with immunosuppressive drugs, including long-term
systemic corticosteroids or radiation therapy
Contraindications
The safety of pneumococcal polysaccharide vaccine among pregnant women has not been
evaluated. Women at high risk of pneumococcal disease ideally should be vaccinated before
becoming pregnant.
Adverse Reactions
About half of persons vaccinated experience mild side effects such as erythema and pain at the
site of injection. Fever, myalgias and severe local reactions have been reported by <1% of
recipients. Anaphylactic reactions are rare.
Primary Immunization
0.5 ml subcutaneously or intramuscularly (one dose)
Booster Doses
Revaccination is recommended one time 5 years after the first dose for persons who are
asplenic and for chronic renal failure, nephrotic syndrome, and organ transplant recipients.
Revaccination is also recommended over age 65 if they were vaccinated when they were <65
years of age. An interval of at least five years should be maintained between doses of PPSV23.
Storage
Store between 2-8C (36-46F).
POLIO
Adverse Reactions
Inactivated Polio Vaccine (IPV)
IPV has had no serious side effects documented. IPV contains trace amounts of streptomycin
and neomycin and hypersensitivity reactions are possible among persons sensitive to these
antibiotics.
Oral Polio Vaccine (OPV)
There is a small (about two per million) risk of paralytic polio occurring in first-dose vaccine
recipients or their contacts.
Primary series
Volunteers whose primary immunization is in doubt should receive IPV, 0.5 ml
subcutaneously in months 0, 1, and 2.
Booster doses
One booster dose is required after the age of 18.
IPV 0.5 ml subcutaneously
(If OPV must be used, the booster dose is 0.5 ml orally)
Storage
IPV
Store between 2-8C (36-46F). DO NOT FREEZE.
RABIES
Distribution and Transmission
Rabies is endemic in most countries. Virus-infected saliva from a rabid animal may be
introduced through a bite wound, or very rarely through broken skin or through intact mucous
membrane exposure.
Vaccines
Human Diploid Cell Vaccine (HDCV), Rabies Vaccine Adsorbed (RVA), and Purified Chick
Embryo Cell (PCEC) vaccines are approved for use in the U.S. RVA or PCEC are appropriate
for persons allergic to HDCV. Verorab is a vaccine manufactured overseas that is approved for
use in PC. Intradermal vaccines are not approved for use by PC.
Indications in Volunteers
Pre-exposure Prophylaxis
Volunteers in countries where rabies is highly endemic are to receive pre-exposure
immunization (see below) in addition to instructions on cleansing wounds and on the need for
post-exposure prophylaxis with rabies vaccine.
Volunteers in countries with low rabies endemicity where contact with stray animals is
common are also recommended to receive pre-exposure prophylaxis to simplify post-exposure
treatment and to avoid use of potentially hazardous vaccines available locally.
Volunteers in countries with low rabies endemicity and little contact with stray animals and
where access to post-exposure rabies vaccine and rabies immune globulin (human) is reliable
do not need to be given pre-exposure vaccine. They must be instructed on cleansing wounds
and on the need for post-exposure prophylaxis (rabies vaccine and rabies immune globulin),
which must be stocked for at least two complete treatment doses (immune globulin + 4 IM
vaccines).
Post-exposure Prophylaxis
All animal bites and scratches should immediately be thoroughly washed with soap and water.
Many species of mammals have been documented to transmit rabies via bites and scratches
including bats, dogs, cats, skunks, foxes, coyotes, raccoons, bobcats, and other carnivores. In
endemic areas, if the animal is suspected to be rabid, the bitten Volunteer should be vaccinated
unless the animal is proven to be rabies negative by rabies testing. Vaccination should also
occur when a bite cannot be reasonably excluded; such as during sleep, when the victim is
intoxicated, or when the victim cannot clearly communicate, e.g., a child. Bites from livestock,
rodents, rabbits, and hares rarely require vaccination.
Contraindications
Persons with a history of hypersensitivity to eggs to PCEC. Persons with a history of
hypersensitivity to HDCV, RVA, or PCEC.
Adverse Reactions
Local reactions such as pain, erythema, and swelling or itching at the injection site are
frequently reported. Mild systemic reactions such as headache, nausea, abdominal pain, muscle
aches and dizziness also occur. Serious anaphylactic, systemic or neuroparalytic reactions are
extremely rare.
Up to 6% of persons receiving booster vaccination with HDCV experience urticaria, pruritus,
and malaise (immune complex-like reaction).
Interactions
Corticosteroids and other immunosuppressive agents can interfere with the development of
active immunity and should not be administered during pre-exposure therapy.
Pre-exposure immunization
HDCV/ PCEC/ RVA: 1.0 ml intramuscularly on days 0, 7, and 21* or days 0, 7, and 28.
Verorab: 0.5 ml intramuscularly on days 0, 7, and 21 or days 0, 7, and 28
*The 21 day schedule is preferred for Volunteers serving in highly rabies endemic areas.
Rabies vaccine is effective if intervals between doses are longer than those listed, however the
onset of an adequate response would be delayed. For this reason, all three doses should be
completed within 21-28 days whenever possible.
Booster Immunization
In general, OMS recommends rabies boosters for Volunteers 3-5 years once the primary series
has been completed. US DoS does not recommend a one year booster with Verorab.
Immunization of PCV animals
PCVs that possess animals should be highly encouraged to vaccinate their pet against rabies.
Post-Exposure Immunization
Completed 3-dose primary series (IM)
1.0 ml intramuscularly on days 0 and 3. Rabies immune globulin (RIG) should not be given.
Adolescents aged 11-18 years who have completed their childhood vaccination series with DT,
DTaP and/or DTwP should receive a single dose of Tdap instead of Td for booster immunization
against tetanus as well as diphtheria and pertussis. Adults aged 19-64 years who have not
previously received Tdap should receive a single dose of Tdap if their last dose of tetanus toxoid-
containing vaccine was administered more than 10 years prior. Tdap is not licensed or
recommended for adults older than 65 years, who should receive Td instead.
Anyone who has received only one or two prior doses of tetanus and diphtheria toxoids should
receive additional does to complete the three-dose series. A single dose of Tdap can be
substituted for any of the Td doses.
Contraindications
An immediate anaphylactic reaction to a prior dose of vaccine or vaccine component is a
contraindication to further vaccination with DTaP, DT, or adult Td or Tdap. Encephalopathy not
due to another identifiable cause within 7 days of vaccination is a contraindication to further
vaccination with a pertussis-containing vaccine. DT or Td may be substituted for DTaP or Tdap,
respectively. Moderate or severe acute illness is a precaution to vaccination. Mild illnesses, such
as otitis media or upper respiratory infection, are not contraindications. Anyone for whom
vaccination is deferred because of moderate or severe acute illness should be vaccinated when
the condition improves.
Adverse Reactions
Local reactions such as local redness, induration, and tenderness are common, particularly
among persons who have received multiple boosters of tetanus toxoid. Systemic reactions such
as malaise and fever are less common. Rarely, neurologic complications following
administration of tetanus toxoid have been reported.
Primary Immunization
Adolescents or adults who have never been immunized against tetanus, or whose immunization
history is uncertain, should receive a three-dose series of vaccinations. The preferred schedule is
a single Tdap dose, followed by a dose of Td 4-8 weeks after the Tdap dose, and a second dose
of Td 6-12 months after the first Td dose; however, a single dose of Tdap can be substituted for
any one of the three doses in the series.
Booster Doses
Anyone who has received only one or two prior doses of tetanus and diphtheria toxoids should
receive additional doses to complete the three-dose series. A single dose of Tdap can be
substituted for any of the Td doses. The Td or Tdap vaccine must be given stateside within the
past seven years prior to departure (will cover volunteer for up to ten years or three in service). ii
NOTE: Volunteers should be instructed during pre-service training never to allow any local
facility to administer any form of tetanus immunization. Several potentially dangerous vaccines
are routinely used abroad.
Storage
Tetanus diphtheria toxoid vaccine (Td) and Tetanus, diphtheria and pertussis (Tdap) should be
stored between 2- 8C (35- 46F). DO NOT FREEZE. Discard if the vaccine has been frozen.
Do not use after expiration date shown on the label.
TYPHOID FEVER
Distribution and Transmission
Typhoid fever is caused by infection with Salmonella typhi through exposure to contaminated
food and water. It is endemic throughout Africa, Asia, and Central and South America.
Vaccines
Two newer vaccines that are as effective and better tolerated than the older heat-phenol
inactivated vaccine are now available.
Vi capsular polysaccharide vaccine (ViCPS)
ViCPS vaccine is the preferred vaccine for overseas use because of the single dose
convenience, reasonable cost, and less stringent shipping requirements. Typhim Vi is
manufactured by Pasteur Merieux and distributed in the U.S. by Connaught.
Oral typhoid vaccine (Ty21a)
Ty21a is a live attenuated bacterial vaccine that is well tolerated; however in-country
vaccination is more difficult due to multiple dose issues, shipping requirements, and the need
to defer vaccination during episodes of acute gastrointestinal illness and antibiotic use.
Indications in Volunteers
All Volunteers should be vaccinated except those serving in countries without risk of typhoid
(i.e., most of Northern Europe).
Even after vaccination, food and water should be selected carefully. A large inoculum of
Salmonella typhi may overwhelm the protective effect of the vaccine.
Contraindications
Vi capsular polysaccharide vaccine (ViCPS)
Contraindicated in patients with a history of hypersensitivity to this vaccine.
Oral typhoid vaccine (Ty21a)
Not recommended for children under six years of age or immunocompromised persons
(including those with asymptomatic HIV infection). Vaccination should be deferred in
individuals with an acute febrile or gastrointestinal illness.
Adverse Reactions
Vi capsular polysaccharide vaccine (ViCPS)
Mild local reactions may occur. ViCPS vaccine is most often associated with headache (16%
20%) and injection-site reactions (7%).
Oral typhoid vaccine (Ty21a)
Adverse reactions to Ty21a vaccine are rare and mainly consist of abdominal discomfort, nausea,
vomiting, and rash.
Interactions
Oral typhoid vaccine (Ty21a)
VARICELLA VACCINE
Distribution and Transmission
Varicella occurs worldwide. In temperate climates, varicella tends to be a childhood disease,
with peak incidence among preschool and school-aged children and during late winter and early
spring. In tropical climates, infection tends to occur later during childhood and adolescence,
resulting in higher susceptibility among adults than in temperate climates.
Varicella vaccine is routinely used to vaccinate healthy children in only some countries,
including the United States. With the implementation of the varicella vaccination program in the
United States, substantial declines have occurred in disease incidence, and although varicella is
still endemic, the risk of exposure to varicella zoster virus is higher in most other parts of the
world than it is in the United States. Varicella-zoster virus is transmitted from person to person
by direct contact, inhalation of aerosols from vesicular fluid of skin lesions of varicella or herpes
zoster, or from infected respiratory tract secretions that might also be aerosolized. The varicella
zoster virus enters the host through the upper respiratory tract or the conjunctiva. The period of
communicability is estimated to begin 12 days before the onset of rash and ends when all
lesions are crusted, typically 47 days after onset of rash in immunocompetent people, but this
period may be longer in immunocompromised people. People with varicella should be isolated
for as long as lesions persist.
Vaccine
Evidence of immunity should be determined pre-service and includes any of the following:
Indications in Volunteers
All Volunteers should be vaccinated or demonstrate immunity to Varicella.
Contraindications
People with contraindications for varicella vaccine should not receive varicella vaccine,
including anyone who
has received blood products (such as whole blood, plasma, or immune globulin) during
the previous 3 to 11 months, depending on dosage
Adverse reactions
The most commonly reported health problems after vaccination were rash, fever, and pain,
redness, and soreness at the injection site
Primary immunization
Varicella vaccine contains live, attenuated varicella-zoster virus. CDC recommends varicella
vaccination for all people aged 12 months without evidence of immunity to varicella who do
not have contraindications to the vaccine: 2 doses for people aged 4 years. The minimum
interval between doses is 4 weeks for people aged 13 years. When evidence of immunity is
uncertain, a possible history of varicella is not a contraindication to varicella vaccination.
Booster Doses
Immunity following two doses of Varicella vaccine is long lasting. Additional doses are not
required.
Storage
For potency to be maintained, the lyophilized varicella vaccines must be stored frozen at an
average temperature of 5F (-15C) or colder. Diluent should be stored separately either at room
temperature or in the refrigerator. Vaccines should be reconstituted according to the directions in
the package insert and only with the diluent supplied with the vaccine, which does not contain
preservative or other antiviral substances that could inactivate the vaccine virus. Once
reconstituted, vaccine should be used immediately to minimize loss of potency. Vaccine should
be discarded if not used within 30 minutes after reconstitution.
YELLOW FEVER
Distribution and Transmission
Yellow fever occurs in sub-Saharan Africa and tropical South America, where it is endemic
and intermittently epidemic. Most yellow fever disease in humans is due to sylvatic (jungle) or
intermediate (savannah) transmission cycles. However, urban yellow fever occurs periodically
in Africa and sporadically in the Americas. In Africa, natural immunity accumulates with age,
and thus, infants and children are at highest risk for disease. In South America, yellow fever
occurs most frequently in unimmunized young men who are exposed to mosquito vectors
through their work in forested areas.
Vaccine
Yellow Fever vaccine is an attenuated live virus vaccine grown in chick embryos. Immunity is
induced by a single subcutaneous (SC) injection of 0.5 ml of reconstituted vaccine and persists
for at least ten years.
Yellow fever vaccines should be administered at an official yellow fever vaccination center
and validated by an official stamp. PCMOs may reimburse currently-serving volunteers who
go to local facilities to get vaccinated for the cost of the vaccine & visit only (not travel to
clinic). If a clinic is not available, the responsibility lies with the Volunteer.
Indications in Volunteers
(1) Volunteers serving in countries with a risk of yellow fever transmission (yellow fever
endemic areas).
(2) Volunteers who are required to have a certificate of vaccination for entry into their country
of service or are planning to travel to a country that requires the vaccine. PCMO should not
store YF vaccine. PCVs should receive the immunization in an approved facility, if available.
As proof of receipt of YF vaccine, all vaccinees should possess a completed International
Certificate of Vaccination or Prophylaxis (ICVP), validated with the provider's signature and
official YF vaccination center stamp. An ICVP must be complete in every detail; if it is
incomplete or inaccurate, it is not valid. Failure to secure validations can cause a traveler to be
quarantined, denied entry, or possibly revaccinated at the point of entry to a country.
Volunteers with either of these indications should be vaccinated unless they have been
vaccinated within the past seven years.
Contraindications
Allergy to vaccine component (eggs, egg products, chicken proteins, or gelatin.) The
stopper used in vials of vaccine also contains dry natural latex rubber, which may
cause an allergic reaction
Thymus disorder associated with abnormal immune function
Primary immunodeficiencies
Malignant neoplasms
Transplantation
Immunosuppressive and immunomodulatory therapies.
Precautions
Age > 60 years: assess Volunteer and give vaccine if healthy; defer if immune-
compromised
Asymptomatic HIV infection and CD4 T-lymphocytes 200-499/mm3
Pregnancy
Breastfeeding
Interactions
Yellow fever vaccine must be given simultaneously with, or more than four weeks before or
after MMR. It does not interact with OPV or oral typhoid vaccine.
Adverse Reactions
Common adverse reactions
Reactions to yellow fever vaccine are generally mild; 10%30% of vaccinees report mild
systemic adverse events. Reported events typically include low-grade fever, headache, and
myalgias that begin within days after vaccination and last 510 days. Approximately 1% of
vaccinees temporarily curtail their regular activities because of these reactions.
Severe adverse reactions
Hypersensitivity
Immediate hypersensitivity reactions, characterized by rash, urticaria, bronchospasm, or a
combination of these, are uncommon. Anaphylaxis after yellow fever vaccine is reported to
occur at a rate of 1.8 cases per 100,000 doses administered.
Yellow fever vaccineassociated neurologic disease (YEL-AND)
YEL-AND represents a conglomerate of different clinical syndromes, including
meningoencephalitis, Guillain-Barr syndrome, acute disseminated encephalomyelitis, and
rarely, bulbar and Bell palsies. Historically, YEL-AND was seen primarily among infants as
encephalitis, but more recent reports have been among people of all ages.
The onset of illness for documented cases is 328 days after vaccination, and almost all cases
were in first-time vaccine recipients. YEL-AND is rarely fatal. The incidence of YEL-AND in
the United States is 0.8 per 100,000 doses administered. The rate is higher in people aged 60
years, with a rate of 1.6 per 100,000 doses in people aged 6069 years and 2.3 per 100,000 doses
in people aged 70 years.
Yellow fever vaccineassociated viscerotropic disease (YEL-AVD)
YEL-AVD is a severe illness similar to wild-type disease, with vaccine virus proliferating in
multiple organs and often leading to multisystem organ failure and death. Since the initial cases
of YEL-AVD were published in 2001, >60 confirmed and suspected cases have been reported
throughout the world.
YEL-AVD has been reported to occur only after the first dose of yellow fever vaccine; there
have been no reports of YEL-AVD following booster doses. The median time from YF
vaccination until symptom onset for YEL-AVD cases was 4 days (range, 08 days). The case-
fatality ratio for all reported YEL-AVD cases worldwide is 63%. The incidence of YEL-AVD in
the United States is 0.4 cases per 100,000 doses of vaccine administered. The rate is higher for
people aged 60 years, with a rate of 1.0 per 100,000 doses in people aged 6069 years and 2.3
per 100,000 doses in people aged 70 years.
Primary Immunization
0.5 ml subcutaneously (one dose).
Booster Doses
Some countries consider one dose to be valid for a lifetime. See ATTACHMENT A for list of
countries. Others require a booster every 10 years.
Storage
Yellow Fever Vaccine must be stored frozen and used within 60 minutes of reconstitution.
REFERENCES
Centers for Disease Control and Prevention (CDC). Health Information for International Travel,
2016. Available online at: http://wwwnc.cdc.gov/travel/yellowbook/2016/table-of-contents
Centers for Disease Control and Prevention (CDC). Epidemiology and Prevention of Vaccine-
Preventable Diseases. 13th Edition. 2015; Available online at:
http://www.cdc.gov/vaccines/pubs/pinkbook/index.html
World Health Organization; Alert, response, and capacity building under the International Health
Regulations (IHR). Available online at: http://www.who.int/ihr/en/index.html
i
MMWR / June 14, 2013 Vol. 62 . No 4
ii
Hammerlund E, Thomas A, Poore EA, et al. Durability of vaccine-induced immunity against tetanus and
diphtheria toxins: a cross sectional analysis. Clin Infect Dis 2016;62:1111-1118.
IMMUNIZATIONS
Immunizations for Peace Corps Volunteers
Indications and Administration
Encephalitis, All Volunteers serving 0.5ml IM days 0,28 If primary series >1yr Delayed hypersensitivity
Japanese (JE) in endemic areas (see then 0.5 ml booster may may be seen up to 10 days
text) be given later
JE-VC
Local or mild systemic
Ixiaro reactions in 20%
Imojev
0.5 ml IM x 1 Every 5 years
Encephalitis, High risk of exposure to 0.5ml IM months 0, 1, 0.5ml IM every 3 years Egg anaphylaxis,
Tick-Borne ticks in an endemic area and 12 thimerosol anaphylaxis
(TBE) (see text)
Accelerated: 0.5 ml IM Immuno (Austrian) vaccine
IMMUNO
days 0, 7, and 21 is effective and well
tolerated
All Volunteers
Hepatitis A
Hepatitis A vaccine 1.0ml IM months 0, 6 None after 2nd dose; Prior allergy to hepatitis A
effective >25 years vaccine, alum, 2-
GLAXO-SMITH-KLINE (HAVRIX)
phenoxyethanol
MERCK (VAQTA)
Occasional local or mild
systemic reactions
Immune globulin (IG) 5ml (0.06ml/kg) IM Repeat every 4 months Prior allergy to immune
globulin; give more than 3
IG use in Peace Corps is limited to
months before, or 14 days
rapid protection for 1 month after
after, MMR
Hepatitis A vaccination in certain
individuals (see text) or for persons Mild local reaction
allergic to Hepatitis A vaccine, common
Prefer to complete 1.0ml IM (deltoid): None for standard Prior allergy to hepatitis B
Hepatitis B Preservice months 0, 1, 6 vaccine
12 months for
GLAXO- All Volunteers except: Occasional local or mild
Accelerated: 1.0 ml IM accelerated dosing
SMITHKLINE systemic reactions
Serologic evidence of months 0, 1, and 2 with
MERCK
immunity (see TG) a booster at 12 months
PASTEUR
Also: if occupational
risk of blood exposure,
measure antibody level
1-6 months after series
Measles- All Volunteers except: If never immunized and Give 0.5ml SC to all Pregnancy,
Mumps-Rubella Age 50 born in or after 1957: Volunteers except those immunosuppression,
(MMR) Documented 2 doses of 0.5ml SC months 0,1 meeting criteria listed. neomycin anaphylaxis,
gelatin anaphylaxis, egg
MMR no further boosters
anaphylaxis.
Serologic evidence of necessary
immunity (see text). Fever 5-12 days later in
15%. rash in 5%;
arthralgias or arthritis some
women
Meningococcal All Volunteers in 0.5ml SC (1 dose) Every 5 years Pregnancy (consider
Meningitis endemic or epidemic risk/benefit)
A, C, Y, areas.
Local mild reactions seen
W-135
Pneumococcal Dose given Pre-service 0.5ml IM (1 dose) Not recommended Pregnancy (consider
Pneumonia to cover: risk/benefit)
PPSV23
Age 65 Local reactions common,
Surgical or functional occasional mild systemic
asplenia.
PCV13 At risk for infection or 0.5ml IM (1 dose)
complication.
Immunocompromised,
cochlear implant,
smoking, heart disease,
pulmonary disease
Inactivated Polio Vaccine (IPV) 0.5ml SC months 0, 1, 0.5ml SC once as an Anaphylaxis to neomycin,
and 2 if prior adult for countries streptomycin, polymyxin
vaccination in doubt mentioned in TG
well tolerated
Rabies REQUIRED: HDCV/ PCEC HDCV/ PCEC: Every 3- Egg anaphylaxis for PCEC,
(preexposure) highly endemic areas Preferred: 1.0ml IM 5 years anaphylaxis or type II
and/or inadequate access only: reaction to prior vaccine
HDCV to post-exposure series days 0, 7, 21 Verorab: no booster
PCEC necessary despite Steroids and immuno-
OPTIONAL: (or days 0, 7, 28) supressives interfere with
package insert
VERORAB developed countries response
information (US DoS,
with adequate access to Verorab; 0.5 ml IM days 2016)
post-exposure series and 0, 7, 21 (or days 0, 8,
rabies immune globulin 28)
Tetanus- All Volunteers must Doses given at 0, 1, and Dose given every 5 Prior severe hypersensitivity
diphtheria (Td) have received Td or Tap 7-12 if prior vaccination years while in high-risk or neurologic reaction
Pre-service to last in doubt. Tdap can be areas
Tetanus- Local reactions common.
throughout their PC substituted for any one
Use Td in adults (not DT or
diphtheria- service; dosing q 5 years of the three Td doses in
tetanus toxoid alone)
pertussis (Tdap) to cover unsanitary the series.
wounds
ViCPS (Typhim Vi) 0.5ml IM (one dose) 0.5ml IM every 2 Hypersensitivity to ViCPS
years; optional for
Mild local reactions seen
PCVs completing
regular 27 month tour
Ty21a (oral typhoid vaccine) 1 capsule with cool repeat every 5 years Delay if experiencing GI
liquid on days 0, 2, 4, 6 illness or if on antibiotics;
give 24 hrs before or after
mefloquine or Diamox
Infrequent nausea, abd.
cramps
ENSURE COLD CHAIN;
DO NOT FREEZE
Heat/phenol killed vaccine 0.5ml SC days 0, 30 0.5ml SC every 3 years Prior severe reaction to
heat/phenol killed vaccine
Yellow Fever All Volunteers in 0.5ml SC (one dose) every 10 years Pregnancy, immuno-
endemic areas, those supression, egg anaphylaxis,
requiring vaccination age <6 mo. or >60
entry into country of
<5% mild systemic reactions
service, those volunteers
traveling to country STORE FROZEN- USE
where vaccine required* WITHIN 1 HOUR
Precautions: Do not administer this vaccine if any of the listed conditions are present. Consult OMS to review the
risks and benefits, which may include vaccination after informing the Volunteer of the risks and benefits or transfer
or medical separation to avoid exposure to this disease.
*Countries where YF/ Official certificate vaccine required: Coming from US: Benin, Burkina Faso, Cameroon,
Ghana, Liberia, Mali, Rwanda, Sierra Leone, Togo; Coming from country with transmission risk: Botswana, Cape
Verde, Ethiopia, Gambia, Guinea, Kenya, Lesotho, Madagascar, Malawi, Mozambique, Namibia, Senegal, South
Africa, Swaziland, Tanzania, Uganda, Zambia
PC-1562 (4/2014)
TG 300 ATTACHMENT E
Flu shots for staff
1. Presently the Peace Corps provides flu shots to all Volunteers and Washington staff but
not to overseas staff.
2. The Peace Corps has the legal authority to provide flu shots to both US and non-US
citizens and both direct-hire and PSC employees. Flu shots will be voluntary.
3. We propose a variety of options be made available to Posts and Posts be given the
discretion to choose one or more options.
4. OHS has informed State MED of Peace Corps intention to provide flu shots to host
country staff and State MED raised no objections. State MED has no overall policy for
flu shots for local staff. It is the decision of each US Embassy Medical Unit.
Options
1. PCMO gives flu shots to staff. The PCMO will order enough vaccine to cover the staff
members interested in having a flu shot as well as for the PCVs. (Note: the flu shot is
optional for staff but mandatory for PCVs). Therefore, most Posts will be covered by the
option of the PCMO then administering the vaccine. PCMOs will have liability under
local law for host country citizen employees, but the risk is minimal. The Peace Corps
has authority to indemnify PCMO for any damages and to pay attorney costs, but the
decision to do so is done after there is a claim. There may be some reluctance on part of
PCMOs as to increase liability and PCMOs will be permitted to opt out of administering
vaccine to staff at Post.
2. Reimbursement to private doctors in country to give flu shots. Posts set a fixed price and
determine if vaccine is available locally. Posts could contract directly with doctor;
reimburse employee; or reimburse doctor based on employees voucher. If the vaccine
is not available, Peace Corps will provide vaccine and syringes for administration to local
doctor if permitted by local law.
June 2016
320621 10/11/02 11:07 AM Page 1
1. State 2. County where administered 3. Date of birth 4. Patient age 5. Sex 6. Date form completed
M F
mm dd yy mm dd yy
7. Describe adverse events(s) (symptoms, signs, time course) and treatment, if any 8. Check all appropriate:
Patient died (date )
mm dd yy
Life threatening illness
Required emergency room/doctor visit
Required hospitalization (________days)
Resulted in prolongation of hospitalization
Resulted in permanent disability
None of the above
9. Patient recovered YES NO UNKNOWN 10. Date of vaccination 11. Adverse event onset
a.
b.
15. Vaccinated at: 16. Vaccine purchased with: 17. Other medications
Private doctor's office/hospital Military clinic/hospital Private funds Military funds
Public health clinic/hospital Other/unknown Public funds Other/unknown
18. Illness at time of vaccination (specify) 19. Pre-existing physician-diagnosed allergies, birth defects, medical conditions (specify)
20. Have you reported No To health department Only for children 5 and under
this adverse event 22. Birth weight 23. No. of brothers and sisters
previously? To doctor To manufacturer __________ lb. _________ oz.
21. Adverse event following prior vaccination (check all applicable, specify) Only for reports submitted by manufacturer/immunization project
Adverse Onset Type Dose no. 24. Mfr./imm. proj. report no. 25. Date received by mfr./imm.proj.
Event Age Vaccine in series
In patient
In brother 26. 15 day report? 27. Report type
or sister Yes No Initial Follow-Up
Health care providers and manufacturers are required by law (42 USC 300aa-25) to report reactions to vaccines listed in the Table of Reportable Events Following Immunization.
Reports for reactions to other vaccines are voluntary except when required as a condition of immunization grant awards.
Form VAERS-1(FDA)
320621.qxd5 10/3/02 10:29 PM Page 2
VAERS
P.O. Box 1100
Rockville MD 20849-1100
Use a separate form for each patient. Complete the form to the best of your abilities. Items 3, 4, 7, 8, 10, 11, and 13 are considered
essential and should be completed whenever possible. Parents/Guardians may need to consult the facility where the vaccine was
administered for some of the information (such as manufacturer, lot number or laboratory data.)
Refer to the Reportable Events Table (RET) for events mandated for reporting by law. Reporting for other serious events felt to be
related but not on the RET is encouraged.
Health care providers other than the vaccine administrator (VA) treating a patient for a suspected adverse event should notify the
VA and provide the information about the adverse event to allow the VA to complete the form to meet the VA's legal responsibility.
These data will be used to increase understanding of adverse events following vaccination and will become part of CDC Privacy
Act System 09-20-0136, "Epidemiologic Studies and Surveillance of Disease Problems". Information identifying the person who
received the vaccine or that person's legal representative will not be made available to the public, but may be available to the
vaccinee or legal representative.
Postage will be paid by addressee. Forms may be photocopied (must be front & back on same sheet).
SPECIFIC INSTRUCTIONS
Form Completed By: To be used by parents/guardians, vaccine manufacturers/distributors, vaccine administrators, and/or the person
completing the form on behalf of the patient or the health professional who administered the vaccine.
Item 7: Describe the suspected adverse event. Such things as temperature, local and general signs and symptoms, time course,
duration of symptoms, diagnosis, treatment and recovery should be noted.
Item 9: Check "YES" if the patient's health condition is the same as it was prior to the vaccine, "NO" if the patient has not returned
to the pre-vaccination state of health, or "UNKNOWN" if the patient's condition is not known.
Item 10: Give dates and times as specifically as you can remember. If you do not know the exact time, please
and 11: indicate "AM" or "PM" when possible if this information is known. If more than one adverse event, give the onset date and
time for the most serious event.
Item 12: Include "negative" or "normal" results of any relevant tests performed as well as abnormal findings.
Item 13: List ONLY those vaccines given on the day listed in Item 10.
Item 14: List any other vaccines that the patient received within 4 weeks prior to the date listed in Item 10.
Item 16: This section refers to how the person who gave the vaccine purchased it, not to the patient's insurance.
Item 17: List any prescription or non-prescription medications the patient was taking when the vaccine(s) was given.
Item 18: List any short term illnesses the patient had on the date the vaccine(s) was given (i.e., cold, flu, ear infection).
Item 19: List any pre-existing physician-diagnosed allergies, birth defects, medical conditions (including developmental and/or
neurologic disorders) for the patient.
Item 21: List any suspected adverse events the patient, or the patient's brothers or sisters, may have had to previous vaccinations.
If more than one brother or sister, or if the patient has reacted to more than one prior vaccine, use additional pages to
explain completely. For the onset age of a patient, provide the age in months if less than two years old.
Item 26: This space is for manufacturers' use only.
TG 300 ATTACHMENT G
1. Presently the Peace Corps provides flu shots to all Volunteers and Washington staff but
not to overseas staff.
2. The Peace Corps has the legal authority to provide flu shots to both US and non-US
citizens and both direct-hire and PSC employees. Flu shots will be voluntary.
3. We propose a variety of options be made available to Posts and Posts be given the
discretion to choose one or more options.
4. OHS has informed State MED of Peace Corps intention to provide flu shots to host
country staff and State MED raised no objections. State MED has no overall policy for
flu shots for local staff. It is the decision of each US Embassy Medical Unit.
Options
1. PCMO gives flu shots to staff. The PCMO will order enough vaccine to cover the staff
members interested in having a flu shot as well as for the PCVs. (Note: the flu shot is
optional for staff but mandatory for PCVs) 66% of posts have PCMOs licensed in host
country. Therefore, most Posts will be covered by the option of the PCMO then
administering the vaccine. PCMOs will have liability under local law for host country
citizen employees, but the risk is minimal. The Peace Corps has authority to indemnify
PCMO for any damages and to pay attorney costs, but the decision to do so is done after
there is a claim. There may be some reluctance on part of PCMOs as to increase liability
and PCMOs will be permitted to opt out of administering vaccine to staff at Post.
2. Reimbursement to private doctors in country to give flu shots. Posts set a fixed price and
determine if vaccine is available locally. Posts could contract directly with doctor;
reimburse employee; or reimburse doctor based on employees voucher. If the vaccine
is not available, Peace Corps will provide vaccine and syringes for administration to local
doctor if permitted by local law.
April 2014
ATTACHMENT G: US Department of State-MED Approved and Non Approved Non FDA Licensed Vaccines
Approved:
Vaccine Contents Manufacturer Comments
Equivalent FDA approved product from
Act-HIB HIB conjugate Sanofi-Pasteur
same company.
Equivalent FDA approved product from
Adacel Tdap Sanofi-Pasteur
same company.
Equivalent product from recognized
Avaxim Hep A Sanofi-Pasteur
multinational company.
Equivalent product from recognized
Avaxim Ped Hep A Sanofi-Pasteur MSD
multinational company.
Equivalent FDA approved product from
Covaxis Tdap Sanofi-Pasteur MSD
same company.
No US equivalent; product from
Encepur TBE Novartis
recognized multinational company
Engerix-B Equivalent FDA approved product from
Hep B GSK
(Erwachsene) same company.
Euvax B Hep B LG life Sciences WHO prequalified.
Trivalent seasonal FDA approved but limited to ages 9+
Afluria CSL Biotherapies
influenza years
FSME-Immune TBE Baxter Best alternative; no US vaccine.
Green Cross Japanese Best alternative; for countries where no
JEV Green Cross
Encepahalitis US vaccine is available.
Equivalent FDA approved product from
Havrix Hep A GSK
same company.
Havrix Jr. or Equivalent FDA approved product from
Hep A GSK
Havrix 720 Kinder same company.
Equivalent FDA approved product from
Gardasil HPV quadrivalent Sanofi-Pasteur MSD
same company.
Equivalent to approved components from
Hexavac DTaP/HepB/IPV/Hib Sanofi-Pasteur
recognized multinational company.
Equivalent to approved components from
Hexaxim DTaP/IPV/HepB/Hib Sanofi-Pasteur recognized multinational company
(Pentaxim plus Hep B)
Best alternative; for countries where no
IMOJEV Live attenuated JE vaccine Sanofi-Pasteur
US vaccine is available.
Imovax d.t. Td Sanofi-Pasteur WHO prequalified.
Imovax Polio IPV Sanofi-Pasteur WHO prequalified.
Inactivated Influenza
Trivalent seasonal Equivalent FDA approved product from
Vaccine (Split Virion) Sanofi-Pasteur MSD
influenza same company.
BP
Equivalent FDA approved product from
Infanrix DTaP GSK
same company.
GSK Equivalent to approved components from
Infanrix Hexa DTaP/HepB/IPV/Hib
GSK/Australia recognized multinational company.
Infanrix-IPV DTaP/IPV GSK Equivalent to approved components from
recognized multinational company and
WHO prequalified.
Equivalent to approved components from
Infanrix-IPV+Hib DTaP/IPV/Hib GSK
recognized multinational company.
Trivalent seasonal Equivalent product from recognized
Influvac Abbott
influenza multinational company.
Equivalent FDA approved product from
IPV Merioux Polio Sanofi-Pasteur
same company.
Biological Evans, Equivalent to FDA approved product
JEEV JEV
Ltd (Ixiaro), licensed by Intercell.
Equivalent FDA approved product from
JESPECT JEV Intercell
same company.
Equivalent product from recognized
Mencevax ACW135Y
Meningitis Polysaccharide GSK multinational company, components of
Mencevax ACWY
same strength FDA approved
Non Approved:
Safer options available. Monitoring of
CD.JEVAX JEV Chengdu Institute
safety and efficacy are not transparent.
Safer FDA approved options available;
Kuo Kwang JEV Adimmune different primary series schedule from
approved mouse brain products.
Denied; single dose preparation with
Okavax Varicella BIKEN
75% of US antigen.
1. PURPOSE
To provide guidance on initial clinical intake interview activities for Peace Corps Trainees and
Peace Corps Response Volunteers. Note: For purposes of this TG, Trainee can mean Trainee or
Response Volunteer.
2. BACKGROUND
The purpose of the initial intake interview is for the PCMO to:
Meet with the Trainee one-on-one
Review information from the Trainee Clinical Intake Questionnaire,
Provide the Trainee with a hard copy of the Continuous Care Document (CCD) to validate
information in the Trainees medical record
Update information in the Trainees medical record
Identify any non-disclosures
Briefly assess current health status of the Trainee
Determine required immunizations while in-country
Determine and dispense malaria prophylaxis (if applicable)
Discuss treatment plans for chronic and/or accommodated health issues
Obtain Volunteer Email Authorization form (TG 210 , Attachment G)
Obtain Volunteer Immunization Consent form (TG 300, Attachment D)
Obtain Volunteer Consent to Disclose to Family/Friends form (TG 301, Attachment B)
Reinforce health promotion and disease prevention activities
The initial clinical intake interview is critical in establishing clinician-patient rapport and
validating the basic clinical care needs of the trainee for his or her service. All Trainees must
undergo an initial clinical intake interview performed by the PCMO within 72 hours upon arrival
to country. The Trainee Clinical Intake Questionnaire (Attachment A) contains two sets of
questions: provider questions that are needed immediately for the PCMO to assume care of the
Trainee and screening questions that are needed for the PCMO to have a more holistic
understanding of the Trainees health, lifestyle, and prevention areas.
Time on the Pre-Service Training (PST) schedule must be provided to the PCMO and Trainees in
order to complete the Trainee Clinical Intake Questionnaire (Attachment A). Time may vary for
this interview depending on the health needs of the Trainee. A minimum of twenty (20) minutes
should be allotted per interview. Depending on the outcome of the initial interview and health
care needs of the Trainee, subsequent discussion(s) may be needed.
Steps:
1. Print out each Trainees individual Continuous Care Document (CCD) and take to PST site
where clinical intake interviews are taking place.
2. Sync the laptop so that you have a current instance of PCMEDICS to take to the PST site.
3. Ensure that you have the equipment and supplies for the Clinical Intake Interview:
a. Laptop with PCMEDICS
b. Electrical cord and plug
c. Extension cord
d. Handheld scanner (if applicable)
e. Paper copies of blank Clinical Intake Questionnaires (Attachment A)
f. Paper copy of each Trainees CCD
g. General medications and supplies
h. Immunization consent form
i. Email consent form (TG 210 G)
There are four basic components to an intake interview: Health Record Information and
Validation, Health Assessment, Healthcare Treatment Planning, and Documentation.
Steps:
1. Provide each Trainee with a hard copy of the CCD and ask them to review prior to the
interview.
2. Provide the Trainee the Clinical Intake Questionnaire (Attachment A) in paper form for
the Trainee to complete (both provider and screening questions) prior to the intake
interview.
3. Meet with each Trainee individually to discuss the information on Trainee Clinical Intake
Questionnaire.
4. Review with the Trainee his or her electronic medical record (CCD) to ensure data is
correct and to socialize the Trainee to his/her electronic medical record. The PCMO
edits/updates data directly into PCMEDICS based on the Trainee Clinical Intake
Questionnaire and discussion.
5. Discuss any discovered non-disclosed information with the Trainee. If non-disclosure
suspected, PCMO to follow TG 190, Medical Non-Disclosure.
Health Assessment
Steps:
Based on general appearance and basic questioning (e.g. How are you? Any current
health issues that need medical attention?), the PCMO should assess the current health
Steps:
1. Determine immunizations required for service (TG 300, Immunization) by reviewing any
immunization documentation in the medical record as well as presented by the Trainee
(e.g. WHO card, child immunization record, etc.)
2. Obtain Vaccine Consent Form signed by Trainee (TG 300, Attachment C)
3. Discuss and document malaria prophylaxis plan if applicable (TG 840, Prevention of
Malaria) and obtain consent form signed by Trainee
4. Discuss accommodation treatment/care plans outlined by Pre-Service
5. Discuss communication with the PCMO (Volunteer Email Authorization form) and obtain
signed form indicating Trainees preference (TG 210 Attachment G)
6. Discuss which information the PCV would like shared and with whom in the event of
illness and obtain signed form (TG 301 Attachment B)
7. Provide any preventative education pertinent at this time
Steps:
Note: The information may be entered directly into PCMEDICS at PST if connectivity exists or in
offline mode to be syncd once back at the medical office.
VOLUNTEER CONCERNS
1. PURPOSE
To provide a means for Volunteers to report concerns related to health care.
2. BACKGROUND
At Peace Corps we believe in creating a culture that embraces quality, Volunteer
safety, and service satisfaction. In order to ensure that we continue to provide
quality care, we offer the Volunteer the opportunity to express concerns if the
Volunteer is unsatisfied with the care received.
3. PROCESS
The Quality Improvement department receives and processes Volunteer concerns
regarding Peace Corps health care delivery systems; including but not limited to
Peace Corps Medical Officers (PCMOs), consultants, contracted facilities and
Volunteer Support.
Volunteers are encouraged to follow the process outlined below to express a
concern regarding their health care:
1. If comfortable, a Volunteer can inform the PCMO if they are dissatisfied with the
care they have received or
2. Follow the Post policy for reporting concerns or
3. File an email concern with the Quality Improvement (QI) Department at
headquarters QualityNurse@peacecorps.gov
The Volunteer can expect a response from headquarters within five (5) business
days.
______________________________________________________________________________
Office of Health Services January 2016 Page 1 of 2
Peace Corps staff may not retaliate against a Volunteer for reporting a concern. This
forum (email) is open to Volunteers only.
4. POST REPONSIBILITIES
All Posts are required to post the name, title, location, and telephone number of the
individual at Post who is responsible for receiving concerns and conducting
investigations, as well as the headquarters quality improvement email address and
instructions on how to file a concern.
5. HEADQUARTERS RESPONSIBILITIES
Maintain the email box
Respond timely and appropriately to the Volunteers concerns
Keep post involved in the problem solving process
Provide post with announcements to post in offices (contact QI unit for posters)
Trend Volunteer concerns
______________________________________________________________________________
Office of Health Services January 2016 Page 2 of 2
TG 302 Attachment A
Peace Corps
Office of Health Services
CONSENT/AUTHORIZATION FORM
1. PURPOSE
To provide an avenue through which Volunteers and trainees (together,
Volunteers) can give non-urgent feedback to Peace Corps Medical Officers
(PCMOs) or the Office of Health Services (OHS) regarding the health care
provided to them.
2. BACKGROUND
Peace Corps intent is to promote a medical culture that embraces Volunteer safety,
quality health care, and service satisfaction. As part of that effort, Volunteers are
offered the opportunity to provide input on health services received from outside
consultants and contracted facilities.
Aggregate data obtained from the survey will assist posts and OHS in assessing the
quality of care given by the health providers used by Volunteers. Peace Corps staff
may not retaliate against any Volunteer in relation to any feedback given.
B. For input on any provider, discuss with the PCMO directly about the care
received; and/or
C. For input on any provider, file an email concern with the headquarters Quality
Improvement (QI) department at QualityNurse@peacecorps.gov (Refer to TG
302).
______________________________________________________________________________
Office of Health Services December 2012 Page 1 of 3
A. For input on outside providers, complete a Health Care Consultant
Satisfaction Survey available online through Survey Monkey at website:
https://www.surveymonkey.com/s/surveyonhealthproviders
B. For input on any provider, discuss with your Volunteer Support International
Health Coordinator or RMO directly about the care received, and/or
C. For input on any provider, file an email concern with the headquarters Quality
Improvement (QI) department at QualityNurse@peacecorps.gov (Refer to TG
302)
______________________________________________________________________________
Office of Health Services December 2012 Page 2 of 3
o Display in the OHS HQ office instructions on how Volunteers may
access the online Health Care Consultant Satisfaction Survey
(Attachment A).
______________________________________________________________________________
Office of Health Services December 2012 Page 3 of 3
HEALTH CARE
CONSULTANT
SATISFACTION SURVEY
How was your recent Visit to a
Health Care Provider?
Question
Survey
1. PURPOSE
2. BACKGROUND
o PCMOs must have at least daily contact with the preapproved or other
designated provider at a hospital where a PCV has been hospitalized. The
frequency of contacts with the providers is dependent on the PCVs
condition with the expectation that the PCMO literally is up to the
minute on the PCVs status.
______________________________________________________________________________
Office of Health Services June 2016 Page 1 of 2
If the PCV is able to communicate, the PCMO must make contact with the PCV
at least daily.
Documentation of any contact with the PCV and/or providers caring for the PCV
must be noted in the health record (refer to TG 210).
The PCMO will notify the Country Director when any significant situations, such
as changes in the PCVs condition or need to medevac, arise.
______________________________________________________________________________
Office of Health Services June 2016 Page 2 of 2
Peace Corps
Technical Guideline 310
1. PURPOSE
To provide Peace Corps Medical Officers (PCMOs) and Peace Corps staff with guidance on
the health and safety training of Volunteers.
Comprehensive health training is a major part of the Volunteer health support program in
country. In addition to being one of the main components of Pre-Service Training (PST),
health training is continued and reinforced by the PCMO and staff throughout the
Volunteers tour.
The agencys approach to training mandates that training be organized around achievement
of Terminal Learning Objectives (TLOs). The TLOs describe the minimum content a trainee
must achieve during PST; posts can always choose to include additional post-specific
requirements and content. It is recommended for posts to use the Global Core medical
(curriculum) sessions to meet the TLOs.
Mid-Service Health Evaluation Usually takes place 12 months after PST. Required health
maintenance evaluation of each Volunteer, often
conducted in association with IST or in an All-Volunteer
Conference
The health training program provides health education and prevention concepts and materials
to Trainees as they enter the overseas environment and supports, reinforces, and expands on
their skills at every opportunity throughout Volunteer service. At close of service (COS), the
program ensures that Volunteers are informed of their rights and responsibilities with respect
to post-service benefits, continuing health maintenance and health care.
The PCMOs must remind the PC staff, Peace Corps Trainees, and Peace Corps Volunteers
that V/Ts are not authorized to participate in direct health care activities unless they are
participants in the Global Health Services Partnership (GHSP) and authorized by the Country
Director. These activities include, but are not limited to, participating in immunization
programs, attending or otherwise assisting with childbirths, performing phlebotomy, insertion
of intravenous catheters, and other activities that may place them at risk for exposure to
blood or body fluids.
3. SAFETY TRAINING
The Office of Volunteer Safety and Security (SS) in Washington provides leadership and
guidance that supports Country Directors (CDs), overseas staff and Volunteers in all aspects
of safety and security.
The safety training program is designed to prepare Volunteers for safe, healthy, and
productive service. Based on the unique circumstances under which Volunteers live and
work, the Agency has established the policy that:
Each post must provide Volunteers/Trainees (V/Ts) with a program of ongoing safety and
security training within the framework established by the Office of Safety and Security. The
training will be designed to increase V/Ts awareness of their in-country environment, build
their capacity to cope effectively with the many challenges they will face, and provide the
tools to adopt a safe and appropriate lifestyle. The training must promote a realistic
understanding of the possibility of accident, crime, disaster, injury, psychological trauma,
and loss of property during service. It must help V/Ts recognize factors that contribute to
those risks and encourage compliance with Peace Corps policy. The training must be
designed to instill attitudes consistent with adopting a culturally appropriate lifestyle and
practicing measures expected to reduce risk (Peace Corps Manual Section (MS) 270, 5.0).
Preparation for a PST or other health training is a complex task requiring considerable
advanced planning.
Posts must take an integrated approach to Global Core that includes medical, safety and
security, programming and training staff in order to provide training that supports the
achievement of the TLOs.
Peace Corps Office of Health Services website provides all necessary information, materials,
forms, instructions and links to sessions. The website also offers additional recourses to how
to train PCV/Ts.
The PCMO Handbook can also assist with PST planning. It is available on the Peace Corps
Office of Health Services Trainings website.
5. TRAINING MATERIALS
The Volunteer Health System is responsible for providing consistent and accurate health
education to all Volunteers using prevention strategies based on the best available
information and Volunteer needs. The Office of Health Services (OHS) in collaboration with
the agencys other offices (e.g. Overseas Program and Training Support Office) establishes
training standards for health education (see section 2 above) and provides training materials
for use by in-country health and safety training programs. These materials are available on
the Peace Corps Office of Health Services Trainings website.
Health Training/Sessions
In addition or as part of the listed sessions, PCMOs should include the following country-
specific health topics in training:
Orientation to in-country care, e.g., accessing the health unit, contacting the PCMO, in-
country medical facilities, and emergency preparedness;
Immunization program overview
Endemic disease overview
Environmental health overview
Use of the Volunteer health kits
PCMOs may develop and use pre- and post-tests and training evaluations to assess and
improve the effectiveness of the training. The Personal Health Plan is an assessment tool.
The sessions include the recommended time frame to complete the material and optimize
Volunteers success. Posts are, however, at liberty to adapt the training to meet the objectives
in a manner that best fits posts context. Consequently, posts, and medical units in particular,
may adjust the amount of time; and have control of sequence and approach of topics as well
as choices of available training resources such as PC/Washington, post-developed session
plans or other methods of learning.
Volunteers must assume considerable responsibility for their health during Peace Corps
service while working as partners with PCMOs. This Personal Health Plan allows trainers
and trainees to work towards reaching that goal.
The Personal Health Plan is a platform for trainees to demonstrate a synthesis of their
learning and to create personal strategies of how to manage their health and wellbeing in
service. The complete Personal Health document becomes part of the Volunteers medical
records and a tool for discussion when a Volunteer needs/seeks support. It can be referenced
at in-service trainings and during medical appointments.
Posts are responsible for assessing the trainees achievement of the TLOs using the Trainee
Assessment Portfolio (TAP). Medical/health content is evaluated through the development of
the Personal Health Plan (a component of the TAP). The plan is an integral part of the health
training process to ensure that Volunteers take responsibility for their health and well-being.
Each Volunteer must submit a completed plan by the end of PST which a PCMO will review
and subsequently provide feedback shortly after but no later than 45 days upon conclusion of
PST (Health Plan Instructions provide details as on how to accomplish both).
Submission of the Personal Health Plan to the PCMO is required prior to swearing in.
PCMOs must ensure scheduling of sufficient work time to support the development of the
Personal Health Plan. A PCMO will need to review each Volunteers Health Plan
individually and provide complete and timely feedback to trainees/Volunteers in a caring and
coaching manner to provide ample opportunities for achieving mastery of all TLOs. The
completed Personal Health Plan must be signed by the Volunteer and the PCMO.
The Volunteers Personal Health Plan is a living document and should be revaluated during
IST and utilized during medical encounters for updates and adjustments. E.g. the PCMO can
take a copy of the plan and update when performing site visits.
Health Handbook
The PCMO is responsible for updating a country-specific Volunteer health handbook. This
handbook should be distributed to all Volunteers at PST. A basic Volunteer health handbook
contains four elements:
Overview of Peace Corps health policies and any country-specific Volunteer health
support program policies;
Prevention and health maintenance strategies for Volunteers;
General health reference information on common illnesses and health conditions;
Country-specific information and materials such as medical emergency procedures,
approved local health providers, site evacuation plans, etc.
Information developed by OHS, including TGs and their attachments, may be used in
revising and updating the Volunteer Health Handbook at posts.
*Refer also to The Peace Corps Post: A Handbook for New Medical Officers.
Order supplemental items for Volunteer Health Kits, e.g. thermometers, MIF kits, antibiotics,
etc.
Order country-specific supplies, e.g., water filters, smoke alarms, CO2 detectors, bicycle
helmets.
Set up a meeting with the Program and Training Director to plan health training (content/ health
topics, sessions set up) and to set up schedule (tentative dates and times).
Set up a system for trainees to visit the health unit or see the PCMO privately at PST.
Determine appropriate site for giving immunizations and conducting intake interviews.
Inspect the training site for health hazards. Report recommendations to the Program and
Training Director and the Country Director.
Check water source at training site to ensure potability or determine method for supplying safe
water.
Check availability of electricity at training site for PP sessions and refrigerator for possible
vaccine storage.
Educate kitchen staff on proper food hygiene, water treatment, and diet. Perform stool testing
on kitchen staff if appropriate.
Educate host families on proper food hygiene, water treatment, and diet. Visit host family
homes as time allows.
Provide host family with training on care of a sick trainee. Medical kits to be only used by
trainees; PCMO notification (give written information in host language if indicated).
Train Language and Cross-Cultural Facilitators (LCF) on care of a sick trainee, when to
contact PCMO and how to deal with emergencies.
Use Global Core PST Medical Curriculum to prepare medical sessions. Collaborate and
coordinate with the PT staff to organize the training to meet TLOs.
As needed, schedule PC staff and/or current volunteers required to assist during PST activities.
Prepare a health plan form for trainees to work on their Personal Health Plan during PST.
Prepare training materials, e.g., make copies, prepare flip charts and schedule guest speakers
as needed.
Review charts and make lists of PMH, follow-up required, medications, allergies etc.
Set up an intake interview schedule to include tentative dates and times of interviews.
Review Technical Guideline (TG) 300 Immunization, and determine additional staffing needs.
Make copies of, PC-1634 Vaccine Consent Form (TG 300, Attachment C).
Make copies of, PC-1773 Immunization Record (TG 300, Attachment E).
Page 2
TG 310 Attachment A
Prepare immunization supplies for immunization site, e.g., vaccine, needles, syringes,
sharps disposal container, alcohol pads, gauze pads, cotton balls, Hand sanitizer, Band-
Aids, Tylenol, cooler and ice packs, Peace Corps forms, etc.
Prepare Mass Immunization Inventory Rosters (MS 734, TG 240 Attachment I).
8. COORDINATION
Page 3
Peace Corps
Technical Guideline 320
1. PURPOSE
2. BACKGROUND
All Volunteers should be seen at least one time 12 to 18 months after entry on duty. The
interim health evaluation can be performed concurrently with a medical visit for an acute
problem or separately with a scheduled visit.
The purpose of the interim health evaluation is to:
Evaluate and document the status of known chronic conditions, unresolved conditions,
and current medical problems including compliance and tolerance of prescribed
treatments by inviting the Volunteer to review the PCMEDICS Summary Page and
confirm/update: Allergies, Medications, Problems
Screen for asymptomatic health conditions, if indicated
Reinforce health promotion and disease prevention activities
Peace Corps Medical Officers (PCMOs) document the interim health evaluation on the
electronic Peace Corps Interim Health Evaluation form in PCMEDICS, based on a detailed
history provided by the Volunteer and history-guided examination.
Tuberculin skin testing or Interferon gamma releasing assay Volunteers at risk; see TG
(see 3.4) 645
Stool for Ova and Parasites If clinically indicated; see TG
815
Dental screening (see 3.5) When adequate dental care
exists; see TG 180
Arrange for evaluation of unresolved health problems (see All Volunteers
3.6)
3.1 Update the Health History (Section I of Interim Health Evaluation form)
PCMO reviews health history via the Volunteers PCMEDICS Summary Page to
determine status of unresolved problems and to identify new problems which have
not yet been addressed. The PCMO updates the summary page including allergies,
medications and problems as needed.
Immunization status
3.2 Weight, Vital Signs and History Guided Examination (Section II of Interim
Health Evaluation Form)
1. Weight and vital signs (temperature, blood pressure, respiratory rate, pulse and
last menstrual period) should be recorded for all Volunteers.
2. A history-guided physical examination should be completed and should
address:
Issues raised in the interim health history
Health conditions that have occurred during service
Other unresolved conditions
3. PCMO documents examination on the PCMEDICS Interim Health Evaluation
form.
4. All labs done including the PPD skin test should be ordered, and lab results
recorded via the PCMEDICS lab tracking feature.
5. Scan and upload any related dental, diagnostic, consultation, and/or laboratory
reports and images in the appropriate PCMEDICS document folders according
to TG 214 Attachment B.
Peace Corps follows the recommendations of the United States Preventive Services
Task Force (USPSTF)
The screening pelvic exams, including Pap test, are indicated for 1) low risk female
Volunteers who have not had routine cervical cancer screening within the previous 3
years or 2) high risk female Volunteers. (Refer to TG 705 Cervical Cancer
Screening)
Routine annual screening for Chlamydia and gonorrhea via urine or cervical swab is
recommended for all sexually active female Volunteers less than 25 years of age.
Screening for women 25 years and older is also recommended for those at increased
risk for infection. (Refer to TG 710 on annual STI testing)
Screening Mammography
Screening mammography is not available at all Peace Corps posts. Current USPSTF
recommendations are that women between the ages of 50 and 74 get screening
mammography every two years. Prior to service, female applicants age 50 and over
with previous normal mammograms are permitted to waive this recommendation.
(Refer to TG 355 Mammography sections 3 and 4)
Tuberculosis (TB) skin testing using the Intradermal (Mantoux) test is required for
Volunteers who have had contact with persons with known infectious TB or who live
or work in high risk settings. Results should read by the PCMO 48-72 hours after
placement. A reminder can be set up in the PCMOs PCMEDICS calendar to follow-up
for this purpose. If a Volunteer has a history of a positive intradermal test and
appropriate treatment at any time in the past, a new intradermal test is not necessary;
the Volunteer should be screened for symptoms of active Tuberculosis disease.
IGRA can be substituted for TST. FDA approved IGRAs include the T-Spot and
QuantiFERON-TB Gold. (Refer to TG 645 Pulmonary Tuberculosis)
If clinically indicated, stool examination for ova and parasites should be performed.
(Refer to TG 815 Stool Examination for Parasites)
Screening for other conditions is necessary only if risk factors or specific signs or
symptoms are present. Consult the Office of Health Services, Field Support Unit as
necessary.
In countries where adequate facilities and expertise exist, annual cleaning and scaling
should be performed. (Refer to TG 180 Dental Policy.)
Medevac is not authorized for the purposes of providing routine preventive dental care.
Volunteers who are returning to the U.S. on home leave may be authorized to have
dental care in the U.S. if adequate care is not available in country.
Follow-up for health conditions identified during the interim health evaluation should
be arranged and documented in PCMEDICS. PCMOs should consult with local
providers, RMO, Office of Medical Services, or Field Support Unit as appropriate.
Review the Volunteers current immunization status and provide any needed
vaccinations. (Refer to TG 300 Immunization)
1. PURPOSE
To describe the post-service health benefits infor mation that must be pr ovided to
Volunteers at Close of Service.
To outline the Peace Corps Medical Off icer (PCMO) responsibilities for conducting
Close of Service (COS) health eva luations.
To outline the PCMO respons ibilities for conducting Extens ion of Service (EOS) health
evaluations.
2. B ACKGROUND
Most Returning Peace Corps Volunteers (RPCVs) learn about the ir post-service health
benefits and begin COS hea lth eva luations dur ing COS conferences that occur roughly 60
days pr ior to the Volunteers actual COS.
Not all Volunteers COS with their or igina l tra ining c lass. However, Peace Corps and Cris is
Corps Volunteers must receive health benef its inf or mation and hea lth eva luations when they
leave service, regardless of the reasons or circumstances of COS.
Extens ion of Service (EOS) hea lth eva luations are conducted for Volunteers who wish to
extend the ir service for six months or more, or to transfer to another country program.
Returning Peace Corps Volunteers are covered by a three-tiered health benefit program.
These benefits are:
127C authorization. 127C author izations are used to authorize evaluation of Peace
Corps service-related hea lth conditions;
FECA be ne fits. FECA covers the cost of treatment for service-related health conditions;
and
Afte rCorps ins urance . Afte rCorps is a comprehe ns ive health insurance policy that
covers non-service-re lated medica l pr oble ms.
The following table is a synopsis of each tier of the benefit program. Detailed information
about each type of benefit appears in subsequent sections.
FECA Treatment for medical and Claims must be filed within 3 Claims are filed through
Benefits dental conditions related years of COS, or within 3 years the VS Post-Service
to overseas service. of recognition that a health Unit.
condition is service-related.
At COS the 127C author ization is used to author ize pa yment for :
3. Specif ic laborator y tests that were not accomplished pr ior to COS or are not
available in country, e.g., stools for ova and parasites, ma mmography, etc.;
A 127C author ization should be used in conjunction w ith a Peace Corps Health
Benefits ide ntif ication card (see TG 340 section 6 Peace Corps Health Benefits
Program Identif ication Card).
Only eva luations are covered, and only the spec if ic evaluation author ized will be
reimbursed. A 127C cannot be used for me dical treatment, w ith two exceptions;
first, it can be used to author ize a single course of treatment for parasites. In these
cases the author ization should read as follows :
Initial office visit and one follow-up. One course of treatment. Follow-up stool
exams for O & P x 3 post treatment. No further treatment authorized.
Second, it can be used to author ize presumptive antire lapse therapy (PART) for
malar ia. In these cases the author ization should read as follows :
A 127C must be issued and used w ithin s ix months of COS. It w ill not be honored
after that time has ela psed.
A 127C may be iss ued by a PCMO, RMO, or VS staff.
The 127C form has three parts. The origina l (hea lth recor d copy) is placed in the
Volunteers health record under In-Ser vice or COS/Post-Service care
depending on when it was issued. The f irst copy (provider copy) is given to the
provider by the Volunteer and the second copy (patie nt copy) is for the Volunteer's
persona l records. The PCMO should ensure that all three copies are legible pr ior to
issue.
After COS, if a Volunteer has questions or pr oble ms with his/her 127C
author ization, he/she should contact the Post-Service Unit in VS.
TG 340 PC-127C For m Author ization for Payment of Medical/Denta l Services
conta ins additiona l guidance on the use of 127C author izations.
FECA provides medica l and denta l treatment for health conditions re lated to
Volunteers overseas service.
FECA benef its are administered by the Office of Wor kers Compensation Programs
at the U.S. Department of Labor (DOL). The Post-Service Unit in VS ass ists
Volunteers in f iling c la ims with DOL.
FECA benef its are not guaranteed. The DOL must determine that a health condition
is service-related before a cla im for benef its is accepted.
DOL claims process ing usua lly takes from s ix to 12 weeks. This pr ocess can be
expedited if Volunteers contact the Post-Service Unit as soon as they be lieve they
have a service-related condition requir ing treatment and if they respond quickly to
requests for infor mation from the Post-Service Unit or DOL.
Cla ims must be made within three years of COS or within three years of recognition
of a service-related hea lth condition.
Health pr oble ms resulting from injur ies or illnesses that deve lop in the U.S. while
on vacation, home leave , emergency leave, or on medevac when the Volunteer is
not directly engaged in Peace Corps activity, are not eligible for FECA benef its (see
AfterCorps Insurance in section 3. 3 be low).
The PCMO or Post-Service Unit can provide inf or mation on FECA cla ims
processing and copies of The Post-Service Health Benefits at Glance inf ormation
sheet for Volunteers.
AfterCorps is a comprehens ive health insura nce policy des igned spec if ically for
returned Volunteers.
AfterCorps can be activated only at COS. It provides coverage for non-service-
related hea lth care needs. Specif ically:
2. Travel to the U.S. on personal business: After COS, AfterCorps will cover
health problems that deve loped while a Volunteer was on personal bus iness in
the U.S., e.g. vacation, home leave, e mergency leave, or while on medevac, but
not directly engaged in Peace Corps activity.
3. Healthcare after COS: Returned Volunteers need health ins urance for new
health problems that arise after COS.
Peace Corps pays the first months premium for every Volunteer or Tra inee who
leaves service, regar dless of the reason for COS.
At COS, Volunteers may elect to continue AfterCorps beyond the f irst month.
Volunteers are strongly encoura ged to s ign-up for extended Cor psCare coverage
before they leave countr y.
Payment for extende d coverage may be ma de by check, credit card or through a
deduction in the Volunteers readjustment a llowance.
Returning Volunteers may purchase up to 18 months of additiona l coverage for
themse lves and the ir qua lif ied depende nts when they leave service.
If this polic y lapses for even one month, Volunteers will not be e ligible to re join the
plan.
AfterCorps requires pre-certif ication for medical trans portation other tha n local
ground services and strongly advises Volunteers to conf ir m benef its pr ior to use of
(1) overseas healthcare and (2) U.S. healthcare expected to be more expens ive than
the cost of a phys ic ian off ice vis it.
AfterCorps insurance may not be used to cover medica l expe nses for service-related
conditions covered by 127Cs or FECA. Volunteers with questions on which be nefit
plan to use should contact the Post-Service Unit in VS.
Volunteers who are 65 years of age or older may be eligible for Medicare. They
may choose AfterCorps as their pr imary pla n, but before doing so s hould contact
the Soc ia l Secur ity Administration (SSA) , which coordinates Medicare, to obtain a
full understanding of Medicare coverage and enrollment options. If a Volunteer
who is eligible f or Medicare chooses Medicare as his or her pr imary coverage plan,
AfterCorps coverage will cease. Volunteers should contact AfterCorps Customer
Service for full inf ormation on AfterCor ps coverage issues.
The post staff member who pr ovides AfterCorps inf ormation to Volunteers at COS
should hold the AfterCorps broc hure/extens ion f orms. That person should ma intain
a one-year supply of br ochures. Brochures may be reor dered from Post Logistics
and Support D ivis ion (M/AS/PLS) in Washington, DC.
Because the AfterCorps brochure conta ins an AfterCorps Ins urance Identif ication
Card, the br ochures should not be distr ibuted f or inf ormationa l purposes. Persons
who request a brochure for inf ormationa l purposes should be given photocopies of
the brochure.
For questions regarding 127C author izations, FECA benef its, or other service-
related hea lth issues , returned Volunteers should contact the VS Post-Service Unit.
In the U.S., they may dia l 800- 424-8580 (extens ion 1500) , toll free. Outside the
U.S., they ma y call 202- 692-1500.
Volunteers with questions regarding the use of the Health Benefits identif ication
card should contact the Peace Corps Health Benefits Program at 800-544- 1802. For
infor mation on network providers in a particular geographic location, Volunteers
should contact Seven Corners at 800-544- 1802 or vis it Seven C orners online at
www.peacecorps.sevencorners.com.
PCMOs with questions regarding the Health Benef its ide ntif ication card should
contact VS by phone at 202- 692-1500 and ask to be transferred to the Health Care
Resources Program Manager, or by fax at 202-692-1541.
To extend AfterCor ps insura nce coverage, Volunteers should contact the pla n
adminis trator , Seven Cor ners. Their phone numbers are 800-544-1802 in the U.S.,
or 317-582- 2609 outs ide the U.S. Volunteers may use Seven Cor ners' web site to
see a copy of the AfterCorps policy or to check persona l coverage as follows. Go to
www.peacecorps.sevencorners.com; clic k the AfterCor ps button.
For inf ormation or assistance with a medical e mergency or a non-service-related
health problem, retur ned Volunteers enrolled in AfterCorps should contact
AfterCorps. In the U.S., they may dia l 800- 544-1802. Outs ide the U.S., they may
call 317-582- 2609.
Evaluate, document, and, where poss ible, complete treatment of curre nt medica l
proble ms;
Identify the need for additiona l evaluations after COS;
Provide 127C author izations for necessary post-service medical and denta l eva luations;
Provide doc umentation to support workers compensation cla ims;
Provide f ina l medica l c learance to COS.
COS health evaluation is not required for PCT who c loses service dur ing staging, unless
extenuating c ircumsta nces exist. VS will be consulted f or specia l s ituations where a COS
health evaluation may be necessary.
The PCMO is respons ible for completing the review and update of the Volunteers
health record, eve n if a loca l consultant is used to perfor m the phys ical exa mination.
Steps
2. PCMO reviews the health record and completes the health history w ith the
Volunteer in order to:
Clar ify and gather additiona l inf ormation on a ll unresolved medica l
proble ms;
Ask the Volunteer whether he/she has any other hea lth concerns; and
Review any additiona l spec if ic health r isks or exposures.
All required COS labs should be performe d no ear lier than 90 days and no later
than 7 days pr ior to COS.
All routine COS screening la bs/tests must be identif ie d as COS specimen on the
laborator y requis ition slip.
Whenever poss ible, lab results should be reviewed with the Volunteer at the time of
the phys ical exam, or pr ior to departure , so that further testing or referrals may be
performed before the COS date (see section 4.6 be low).
A clinica l breast exam (CBE) is indicated for a ll fema le Volunteers at COS. Pelvic
examinations should be cons idered for all fema le Volunteers whose last Pap smear
was norma l and was greater than 2-3 years pr ior to COS. Pelvic examinations are
indicated for a ll high r isk (See TG 705) fema le Volunteers whose last Pap smear
was one year or greater prior to COS. The pe lvic exam should include a bimanua l
pelvic exam, Pap smear, and GC/C hlamydia test.
For m PC-1790: COS/EXT section 2, parts D and E guide the PCMO when
performing la b tests. The require d tests are outlined in the chart below.
On a case-by-case basis, laborator y screening be yond the required tests is occasiona lly
indicated. Such screening may be warranted if there is a r isk of exposure to a particular
condition and early diagnos is of the condition would be be nefic ia l, e.g., STDs. Refer to
the appropr iate TG for advice on screening for s pecif ic conditions. Consult the RMO or
VS for questions regarding additiona l screening tests at COS.
HIV Testing
COS HIV testing can be accomplis hed us ing the rapid test kits or at a reputable medica l
laborator y.
If rapid test or screening test performed in country is indeterminate or pos itive for HIV,
medical off icers must inf or m and counse l the Volunteer and perfor m conf ir mator y HIV
test. Medical off icers should als o inf orm VS.
For ms 127C and PC-209B Author ization f or Medical Examination and Labs should
not be used to author ize HIV testing at COS unless it is impossible to obta in a sample
in country.
Schistosomiasis Testing
Use PC-1790 (COS/EXT) (ATTACHMENT C) for the COS phys ical exam.
Perform COS phys ica l examinations within 90 days of COS.
Perform a comprehens ive phys ica l examination. This should be performe d by the
PCMO (if the PCMO is a phys ic ian, nurse practitioner , or phys ic ian ass istant) or by
the RMO or a referral consultant. Referral consultants used for COS examinations
must pr ovide a thor ough eva luation.
Have the PC-1790 (COS/EXT) for m co-s igned by an RMO or a Medical Advisor in
VS if the phys ica l examination is perfor med by a Nurse Practitioner or Phys icia n
Assistant. The Department of Labor (DOL) requires all documentation submitted
for FECA cla ims to be s igned or co-s igned by a phys ic ian.
Steps
2. Address all items reported on the health his tor y dur ing the phys ical exam. For
example , if the Volunteer reports a histor y of thyroid abnorma lities, a thyr oid exa m
should be perfor med and documente d.
3. Provide treatment for any medica l pr oble m that needs immediate attention.
Whenever poss ible, establis h a treatment plan that a llows the pr oble m to be
addressed before the Volunteers departure.
4. Issue a 127C for any hea lth condition that w ill require post-service evaluation in the
U.S. Expla in the use of the 127C and the Health Benefits Program identif ication
card.
5. If a Volunteer is advised to return to the U.S. for additional eva luation or treatment
within a certain period of time after COS, docume nt this infor mation in PC-1790
(COS/EXT) section 2, Part F. Other travel recommendations or functiona l
restrictions should a lso be recorded.
Medications
Provide Volunteer with a 30 day supply of prescription medications and required
ove r-the -counte r (OTC) me dications for use following COS.
Immunizations
Booster doses of appr ove d vaccines ma y be given to Volunteers at COS who do not
plan to retur n to the U.S. within 30 days of COS and who me dically require the
vaccine for trave l in a destination countr y (see TG 300 Technical Reference
Infor mation on individua l vaccines).
A primary series of an approved vaccine may be initiate d for Volunteers at COS
who do not plan to return to the U.S. within 30 days of COS and medica lly require
the vaccine for trave l in a destination countr y. The vaccine must be ava ilable in the
Health Unit or thr ough another relia ble local source, e.g., Departme nt of State or
Ministr y of Health clinic.
Yellow fever vaccine can only be given at off ic ia l ye llow fever vaccination centers.
Peace Corps Health Units are not off ic ia l ye llow fever vaccination centers.
Malaria Prophylaxis/Suppression
For the Volunteer serving in a ma laria endemic area, PCMOs should pr ovide the
Volunteer with the follow ing:
In the rare circumstance that a COS phys ica l examination cannot be scheduled pr ior
to departure; a PC-209B (ATTACHMENT F) should be issued author izing a
complete history, phys ica l exam and appropr iate la b tests. A PC-209B must be
issued with a PC-1790 (COS/EXT), and must be used within 60 days of COS.
The denta l examination and any treatme nts provided should be recorded by the
examining dentist on the PC-1790 (Denta l) for m.
If qua lif ied dental care is not ava ilable in countr y, the denta l examination may be
author ized through a 127C. This author ization s hould read:
For dental examination and routine prophylaxis only (including bite-wing x-rays and
other views as indicated). Record the examination on the PC-1790 (Dental) form
attached. If dental treatment is indicated please describe in detail and estimate cost.
No treatment authorized at this time.
Volunteers should receive f ina l medica l c learance to COS within 72 hours of the ir
antic ipated COS date. At the fina l c learance, all Volunteers must complete, s ign,
and date the Volunteer Health Program COS Checklist (ATTACHMENT B ),
and the completed Checklist must be placed in the Volunteer health record.
Completion of the COS Checklist ens ures that the Volunteer has received the health
instruction and health benef it infor mation needed for the ir trans ition from Peace
Corps. It also conf ir ms that the Volunteer does not have any hea lth conditions that
require immediate medica l attention by Peace Corps.
PCMOs may modify the COS Checklist to facilitate their COS pr ocedures ,
however, no portion of the checklis t can be deleted when modifying the for m.
Volunteers who have an urgent need for medica l or ps ychiatr ic care, an unstable
medical condition, or a condition that cannot be managed by issuing a 127C , should
not be c leared to COS. The PCMO should contact VS to cons ider appropr iate
management of such cases. Consult VS for any unstable me dical or psychiatr ic
condition for which hospita lization, medevac or any immediate intervention may be
necessary.
Often, a Volunteer with an unresolved but stable medica l condition is advise d to
seek medica l attention pr omptly after COS. This may require modif ication or
cancellation of post-service trave l. The Volunteer can be given f ina l medical
clearance with recommendations for post-service trave l and medical care.
Health Benefits
Ensure that the Volunteer has been give n a copy of Post-Service Health I nfor mation
for Returning Volunteers (ATTACHMENT A).
Issue 127C author izations and expla in their use.
Ensure that the Volunteer has a Health Benefits identif ication card and understands
its use.
Ensure that FECA benef its are understood.
Ensure that the Volunteer has been give n a copy of the AfterCorps health ins urance
brochure/extens ion for m. Encourage the Volunteer to carefully cons ider extens ion
of AfterCorps health insurance coverage beyond the first month.
Ask the Volunteer whether he/she has any outstanding hea lth concerns.
Give the Volunteer copies of the results of any exam or test perfor med in country
that will require follow-up in the U.S.
Give the Volunteer all medica l x-rays , inc luding mammograms , in the Peace Corps
Health Unit records.
Update the Wor ld Hea lth Organization (WHO) Internationa l Certif icate of
Vaccination and return it to the Volunteer.
Obtain any medical equipment previous ly issued to the Volunteer.
Ensure the Volunteer has received a 30-da y supply of all prescription and required
OTC medications.
Ensure the Volunteer has received immunizations required f or post-service trave l
(see Section 4.4 above)
Ensure Volunteers serving in ma lar ia endemic areas have received me dications for
malar ia pr ophyla xis/suppress ion (see Section 4. 4 above)
If the Volunteer has refused to have blood drawn for HIV testing, this will be
documented in the hea lth record.
If the Volunteer has refused to undergo a COS health eva luation, he/she must read
and sign a copy of Ref usal to Undergo a COS Health Eva luation
(ATTACHMENT I).
If medically indicated, advise the Volunteer to return pr omptly to the U.S.
Document this advice in the health record.
Have the Volunteer read, complete, and sign a copy of V olunteer Health Program
COS Checklis t (ATTACHMENT B ).
Document pending la bs. Record where each specimen was sent and the date sent.
Document denta l exams , mammography, and other eva luations to be done after
COS.
Comment on all unresolved medical conditions requir ing f ollow-up in the U.S.
File the health record copy of a ll 127Cs and any 209B issued.
Update the problem list.
File the Volunteer Health Program COS Checklis t.
Document the dispos ition of medica l x-rays.
Return Health Record to VS
Within 30 days of COS, package health record, mark "Me dical Eyes Only," and
send to:
Peace Corps Office of Volunteer Support
Medical Records Department
1111 20th Street, NW
Washington, DC 20526
When laboratory test results are received after a Volunteer has closed service,
PCMOs should use the chart be low to determine how to document results and
initiate follow-up. When ava ilable , PCMOs should provide VS w ith the Volunteer's
SSN, home address, and te lephone number if follow-up is needed.
Post-COS Laboratory Health Record Is Still In the Health Record Has Already
Test Results Health Unit Been Returned to Medical
Records Department
Urgent Follow-Up Document in the health record. Fax the report with pertinent
Required Do not file the report in the medical history to VS at 202-
record. Fax it to VS at 202-692- 692-1541. Phone the Post-
1541. Phone the Post-Service Service Unit (Extension 1500) to
Unit (Ext.1500) to assure the fax ensure the fax has been
has been received. Place the received. Place the report in an
report in an envelope along with envelope marked "Attention
other late results. Mark the Post-Service Nurse." Address
envelope, "Attn. Post-Service the envelope of late results to
Nurse." Enclose the envelope of Medical Records as shown
late results with health records. below.
Address the package to Medical
Records as shown below.
Non-Urgent Follow - Document in the health record. Place the report in an envelope
Up Required Do not file the report in the marked "Attention Post-Service
record. Place the original report Nurse." Address the envelope of
in an envelope along with other late results to Medical Records
post-COS results. Mark the as shown below.
envelope, "Attention Post-
Service Nurse." Enclose the
envelope of late results with
health records. Address the
package to Medical Records as
shown below.
Extens ion of Service (EOS) hea lth eva luations are completed w ithin 90 days of the
PCVs original COS date for Volunteers who wis h to extend for s ix months or more , or
to transfer to another countr y pr ogra m. Volunteers extending for less than s ix months
should have a review of the ir medica l record to eva luate any outstanding issues (see
below) but the COS health eva luation can be completed as close as poss ible to the ir
actual COS date.
VS must be cons ulted for recomme ndations , not approva l, for any undia gnosed,
unresolved, or potentia lly recurrent health conditions that may interfere with the
Volunteers ability to rema in in countr y or transfer. This inc ludes conditions that would
benefit from additiona l eva luation or treatment in the U. S. by iss uing 127-C. Cons ult
VS if there are questions about the medica l f itness of the Volunteer to continue to
serve.
Receiving PCMOs/PCMCs are responsible for checking to make sure all me dical
accommodations ma de in or iginating countr y can be uphe ld/continued in receiving
countr y.
5.1 He alth His tory, Scree ning Labs and Phys ical Examination
Perform all screening labs and tests indicated in PC-1790 (COS/EXT) section 2, parts
D and E, except HIV. Some required screening tests, e.g., mammography, may not be
available in country. This may require issuing a 127C and having the Volunteer
complete a test while on home leave.
HIV testing is not required for extens ion or transfer. HIV testing at extens ion of service
follows the same criter ia as all in-service HIV testing, and should be cons idered based
on r isk factors or c linica l f indings (see TG 710 STD/HIV Prevention).
Medical approval f or extens ion or transfer uses criter ia establis hed in TG 160 Medica l
Separation. VS must be consulte d for any undia gnosed, unresolved, or potentia lly
recurrent health conditions that ma y interfere with the Volunteers ability to rema in in
countr y or transfer.
If a Volunteer is transferr ing to another country, the PCMO should disc uss with VS and
the receiving countrys PCMO any s ignif icant past me dical his tor y, spec ia l medica l
needs, or accommodation require ments.
Provis ional medica l approva l to extend is given by VS only, and ma y be give n pending
treatment or tests results if the Volunteer is asymptomatic and can complete all
screening tests in a reasonable per iod of time.
Provis ional medica l approva l may be rescinded if a screening test result requires
follow- up unava ilable in country or the result precludes medica l appr ova l to extend. In
this case, the Volunteer should be granted e ither a COS or a medical separation.
Consult VS for guidance.
Returning Volunteers are covered by a three-tiered health benefits program. Two mechanisms Peace
Corps authorizations (PC-127C) and Federal Employee Compensation Act (FECA) benefits cover
service-related medical expenses. The third AfterCorps insurance completes the benefit package by
giving you access to an affordable medical policy you can use to meet non-service-related health care
expenses while transitioning into private health insurance.
This table is a synopsis of your health benefits program. Detailed information about each mechanism
appears in sections below:
PC-127C Evaluation of medical and Must be issued and used May be issued by PCMOs or
Authorizations dental health conditions related within 6 months of COS. the Office of Health Services
to overseas service. Preferably used with a Peace (OHS) staff.
Corps Health Benefits
Identification Card.
FECA Treatment for medical and Claims must be filed within 3 Claims are filed through OHS
Benefits dental conditions related to years of COS or within 3 years Post-Service Unit.
overseas service. of recognition that a health
condition is service-related.
AfterCorps Non-service related medical Peace Corps pays one months Contact AfterCorps Customer
Insurance problems. premium for all Volunteers. Service for
Specifically: Volunteers may purchase an Emergency medical
Pre-existing conditions additional 2 (two) months of assistance
not covered by FECA coverage for themselves and Referrals to Network
Conditions that arose their qualified dependents hospitals,
while in the U.S. on while transitioning to private physicians, or other
vacation, home leave, insurance (Affordable Care health services
emergency leave or Act or parents private Insurance coverage
medevac insurance). extensions
New health problems
after COS
PC 127C Authorizations
A 127C is used to authorize payment of expenses for medical and dental evaluations of health
conditions that are related to your overseas service.
May 2015 1
TG 330 ATTACHMENT A
Only evaluations are covered, and only the specific evaluation authorized will be reimbursed. A 127C
cannot be used for medical treatment.
You must use a 127C within 6 months of your close of service (COS) date. It will not be honored
after that time has elapsed.
A 127C may be issued by a PCMO, a Regional Medical Officer (RMO) or Office of Health Services
(OHS) staff. The form has three parts. The one copy is kept with your Peace Corps health record. You
should give a copy to the healthcare provider with whom you consult and keep a copy for your
personal records.
For questions regarding 127C authorizations, FECA benefits or other service-related health issues,
you should contact the OHS Post-Service Unit at psu@peacecorps.gov. In the U.S., you may call (toll
free) 855-855-1961, extension 1540, option 7. Outside the U.S. you may call 202-692-1540, option 7.
A 127C authorization should be used in conjunction with your Peace Corps Health Benefits
identification card. For questions regarding the use of the Health Benefits ID card, you should contact
OHS Post-Service Unit at psu@peacecorps.gov or 855-855-1961, extension 1540, option 7. For
information on network providers in a particular geographic location, you should contact Seven
Corners at 800-544-1802 or visit their website at www.peacecorps.sevencorners.com.
To extend AfterCorps insurance coverage, you should contact the plan administrator, AfterCorps.
Their phone numbers are 800-544-1802 in the U.S. or 317-582-2609 outside the U.S. You may use
Seven Corners website to see a copy of the AfterCorps policy or to check personal coverage (go to
www.peacecorps.gov.sevencorners.com and click the AfterCorps button).
For information or assistance with a medical emergency or a non-service-related health problem, returned
Volunteers enrolled in AfterCorps should contact AfterCorps directly. In the U.S. they should call 800-
544-1802. Outside the U.S., they may call 317-582-2609.
FECA pays for medical treatment for health conditions related to your overseas service.
FECA benefits are administered by the Office of Workers Compensation Program at the U.S.
Department of Labor (DOL). The Post-Service Unit in OHS can assist you in filing claims for
benefits.
FECA benefits are not guaranteed. The DOL must determine that your health condition is
service-related before a claim for benefits is accepted.
DOL claims processing usually takes from six to twelve weeks. This process can be expedited if
you contact the Post-Service Unit as soon as you believe you have a service-related condition
requiring treatment and if you respond quickly to requests for information from the Post-Service
Unit or DOL.
Claims must be made within 3 years of COS or within 3 years of recognition of a service-related
health condition.
Health problems resulting from injuries or illnesses that develop in the U.S. while you are on
vacation, home leave, emergency leave or on medevac but not directly engaged in Peace Corps
activity are not eligible for FECA benefits (see AfterCorps insurance below).
The Post-Service Unit in OHS can provide information on FECA claims processing. You can get
additional information at www.peacecorps.gov/resources/returned/healthben/feca/
May 2015 2
TG 330 ATTACHMENT A
AfterCorps Insurance
Peace Corps pays only for the first months premium on your AfterCorps insurance. Before you leave
service, you will be given an insurance card and an application that allows you to purchase up to 2
(two) months additional coverage for yourself and for your qualified dependents.
Peace Corps strongly encourages you to sign-up for extended AfterCorps coverage before you leave
country. If this policy lapses, for even one month, you will not be eligible to rejoin the plan. You
may alternatively transition immediately into private insurance through the Affordable Care Act
(www.healthcare.gov) or your parents insurance plan (if eligible).
May 2015 3
TG 330 ATTACHMENT A
Before you leave country, you may ask your Peace Corps Medical Officer (PCMO) to let you review your
health record. You should confirm that all significant health problems you had in country are
documented. If you have a problem that cannot be resolved before you depart, the PCMO will give you a
127C authorization. This form authorizes and evaluation of your condition by a medical professional.
For questions regarding 127C authorizations, FECA benefits or other service-related health issues,
contact the Post-Service Unit in OHS at psu@peacecorps.gov. In the U.S. call 1-855-855-1961,
extension 1540, option 7 (toll free). Outside the U.S. call 202-692-1540, option 7.
For questions regarding the use of the Seven Corners Health Benefits identification card. Contact
the Peace Corps Health Benefits Program at 800-544-1802. For information on Network providers
in a particular geographic location, see www.peacecorps.sevencorners.com. Numbers are also
listed on the Health Benefits identification card and the Instructions for Use information sheet.
To extend AfterCorps insurance coverage, contact the plan administrator, Seven Corners. Their
phone numbers are 800-544-1802 in the U.S. or 317-582-2609 outside the U.S. You may use
Seven Corners website to see a copy of the AfterCorps policy or to check personal coverage. (Go
to www.peacecorps.sevencorners.com and click the AfterCorps button.)
For information or assistance with a medical emergency or a non-service-related health problem,
returned Volunteers enrolled in AfterCorps should contact AfterCorps Assistance at 800-544-1802
or 317-582-2609.
May 2015 4
TG 330 ATTACHMENT B
All Peace Corps and Peace Corps Response Volunteers and Trainees must complete, sign, and date the checklist below. This
must be done prior to leaving service, preferably within 72 hours of departure from country, regardless of reason for COS. Medical
Officers must place the completed checklist in the Volunteer's health record.
Name:
Remain in country for more than 30 days before returning to the US.
Between now and my return to the US, Peace Corps can leave messages for me at (phone and e-mail):
Health Information (please initial each statement and sign and date below)
I have received and reviewed Attachment A Post-Service Health Information for Returning Volunteers. I understand my post-
service health benefits.
I have been given PC-127C forms for medical/dental evaluations after return to the US. I understand that it is my responsibility
to have these evaluations performed within six (6) months of my close-of-service date.
I have received a Health Benefits Program identification card to be used with the PC-127C forms.
I have been shown the Post-Service/FECA video and/or have received information on Post-Service Health Benefits Program
available at the following internet address: www.peacecorps.gov/resources/returned/healthben/feca/
I have received an AfterCorps insurance card valid for the first 30 days after my close-of-service. I have had an opportunity to
extend my AfterCorps insurance for up to 2 additional months while transitioning to private medical insurance.
_____ If serving in a malaria endemic area: I have received and reviewed Attachment G Instructions for Volunteers: COS
Guidelines for Preventing Malaria. I have been instructed in, and understand, the necessity of continuing my malaria
prophylaxis after leaving malaria endemic areas:
Chloroquine, Doxycycline or Mefloquine: four weeks (28 days)
Malarone: one week (7 days)
In addition, I have been instructed in, and understand, the rationale for taking primaquine for two (2) weeks starting:
Chloroquine, Doxycycline or Mefloquine: fourteen days after leaving malaria endemic areas
Malarone: seven days after leaving malaria endemic areas
_____ If serving in a schistosomiasis endemic area: I have received and reviewed Attachment J Praziquantel Medication
Information Sheet. I have received and taken anti-schistosomal medication within 72 hours of my departure from country.
I have been given my yellow WHO International Health Card, and it is up to date.
I have not had a significant change in my health since my close-of-service health evaluation. (If change has occurred, please
check ____ and comment on the reverse of this form.)
May 2015
PC-1790 (COS/EXT)
Peace Corps
Name: (Last, First, Middle Initial Sex M F
Close-of-Service or
Extension-of-Service
Medical Evaluation Social Security Number Date of Birth (Mo/Day/Yr)
I. Health History
A. Instructions to Volunteer
Please answer each question by indicating if you have experienced any of the following during Peace Corps
service by checking No, Yes (Resolved), or Yes (Current). Comment in the space provided.
Symptoms or problems during Peace Corps service No Yes Yes Volunteer Comments
(Resolved) (Current)
Weight gain or loss of more than 10 pounds
Frequent or severe headaches
Fainting spells or blackouts
Vision problems, eye injuries or disorders
Hearing problems
Persistent cough
Chest pain or chest pressure
Shortness of breath or wheezing
Repeated episodes of indigestion, heartburn, or stomach pain
Frequent diarrhea
Frequent constipation
Frequent or painful urination
Blood in your urine
Repeated episodes of back or neck pain
Muscle, bone, or joint injuries
Painful or swollen joints
Breast lump or mass, or nipple discharge
Skin problems (e.g. eczema, dermatitis)
Change in color or size of a mole or other growth
A sore which does not heal
Frequent sadness or feelings of depression
Frequent or severe nervousness or anxiousness
Frequent sleeplessness or insomnia
Use of cigarettes or other tobacco products
(Females) Gynecologic symptoms or disorders
SSN
D. Laboratory Findings (PCMO: For any test not performed/ordered document rationale in Section F on page 4)
Urinalysis Hematocrit OR Hemoglobi G6PD Status Tuberculin Test (5 IU PPD)
n (check one)
Albumin If terminal prophylaxis with Date read mm of induration
primaquine is indicated.
Sugar Normal Deficient
Blood If deficient, do not dispense Do not report negative. Size of induration
primaquine. must be noted. Include
Other % Grams
Stool for ova and Schistosomiasis PAP smear Chlamydia/GC HIV serology
parasites (3x) serology cytology results
(check one) (check one) (check one) (check one) (check one)
If intestinal parasites are Indicated if PCV is leaving
endemic or has traveled to an
endemic area
Specimens to Specimens to CDC Specimens to Specimens to Specimens to
_____________________ _____________________ _____________________ _____________________
On Date:______________ On Date:______________ On Date:______________ On Date:______________ On Date:______________
127C issued 127C issued 127C issued 127C issued 127C issued
209B issued 209B issued 209B issued 209B issued 209B issued
Results attached Results attached Results attached Results attached Results attached
PCMO/Physician license number State 3 Appropriate laboratory studies have been performed
or ordered.
Medically cleared by PCMO for extension of service or transfer. No significant undiagnosed, unresolved,
or potentially recurrent health conditions.
Medically cleared or provisionally medically cleared by OMS for extension of service or transfer.
Consultation by PCMO with OMS is required for undiagnosed, unresolved, or potentially recurrent health
conditions.
Not medically cleared for extension of service or transfer due to significant unresolved or potentially
recurrent health conditions. Consultation by PCMO with OMS is required.
Peace Corps
Report of Name: (Last, First, Middle Initial) Sex M F
Dental Evaluation
Social Security number Date of birth (MO / DAY / YR)
/ /
PEACE CORPS USE ONLY Country of service Date of exam (MO / DAY / YR)
Check one:
/ /
Pre-service dental exam Home/permanent address
Post-service dental exam
Other (please specify)
Telephone No. ( )
OR
Comment on findings:
OR
Comment on findings:
Page 1 of 4
Applicant SSN:
Buccal
Lingual
Buccal
Lingual
Lingual
Buccal
Lingual
Buccal
C. Periodontal Classification:
No Disease Class I: Gingivitis
Class II: Early Periodontitis
Class III: Moderate Periodontitis
Class IV: Advanced Periodontitis
V. Bruxism
No history of bruxism
History of bruxism
Please describe any bruxism habit, presence of wear facets or need for occlusal guard:
VI. Prosthesis
No prosthesis present
Prosthesis present
Please describe the nature and extent of the prosthesis (e.g. full or partial dentures, bridge, etc.)
and the need for repair or replacement:
VII. Treatment
List all treatment completed after this examination. Do not include treatment planned but not yet completed.
Treatment Date Signature
* Important *
Dental examination is
INCOMPLETE FORMS WILL BE RETURNED
AND MAY DELAY PROCESSING!
Problems/Symptoms/HX:
Services Authorized:
Authorized by: Date: (dd-mon-yy)
Signature:
Date
TG 330 ATTACHMENT F
NOTE TO EXAMINING PHYSICIAN: This letter authorizes you to give the returned Peace Corps Volunteer
identified above a full medical examination and perform the lab tests indicated below. The examination must
be documented on PC-1790 "Peace Corps Close-of-Service or Extension-of-Service Medical Examination."
The Volunteer will complete Section One of that form. Please use Section Two of that form to document the
clinical examination, lab results and summary comments. For questions on the PC-1790 or authorized tests
contact the Peace Corps Post-Service Unit at 800-424-8580, extension 1540. The following tests are
authorized:
FEES FOR SERVICES: Peace Corps guarantees payment in accordance with its Health Benefits Program Fee
Schedule. Billing of Peace Corps Volunteers for any outstanding balance is not permitted under this plan. If
you have a question about the Health Benefits Program Fee Schedule please call1-800-544-1802.
NOTE TO VOLUNTEER: You may pay for authorized services out-of-pocket and request reimbursement
from Peace Corps. To receive reimbursement you must mail the following items to the address shown above:
White - Provider Copy Yellow - Health Record Copy Pink - Patient Copy
TG 330 ATTACHMENT F
(1) this authorization form; (2) a completed PC-1790; (3) bills for lab fees and test results; and (4) proof of
payment (i.e., a canceled check or receipt).
PRIVACY ACT NOTICE: The information requested is collected under authority of the Peace Corps Act for the purpose of documenting the basis
for requested payments. Disclosure of this information is voluntary. However, failure to disclose the information will make it impossible for Peace
Corps to pay for these services. This information will be maintained under the provisions of the Privacy Act for the routine uses described in the
Federal Register of August 27, 1984 (relating to Peace Corps Volunteer medical records).
White - Provider Copy Yellow - Health Record Copy Pink - Patient Copy
TG 330 ATTACHMENT G
As you finish your Peace Corps service and return to the United States, it is imperative that you
continue taking anti-malarial prophylaxis. The type of anti-malaria medications(s) you must take
and the duration of time you must take the medication(s) depends on the species of malaria in
your country of service and the specific anti-malarial prophylaxis medication you are currently
taking (see tables below).
Since few Volunteers serving in malarial areas can escape mosquito bites and no prophylactic
drugs prevent infection with malaria, it is assumed that you are infected, or have been re-
infected, with the malaria parasite. Fortunately, the anti-malarial medication you have been
taking during your tour has suppressed the parasites, thus preventing you from having any
signs or symptoms of malaria infection.
POST-DEPARTURE PROPHYLAXIS
Required For All Volunteers Serving in Malaria Endemic Areas
Continuing anti-malarial medication after your departure from a malarial endemic area (post-
departure prophylaxis) is necessary to eliminate the malaria parasite from your system. As long
as you remain or travel in a malarial area, you continue to be at risk of re-infection and the
medication will not eliminate the parasites from your system.
To eliminate these malaria species from your system, the parasite must have matured from the
liver stages (exoerythrocytic) into the blood stages (erythrocytic). Prophylactic drugs work most
effectively at the blood stages. Anti-malarials, such as chloroquine, mefloquine and
doxycycline, are effective against P. falciparum and P. malaria parasites in the blood stages.
Malarone is effective against P. falciparum parasites in both the blood and liver stages.
Maturation of P. falciparum from the liver stages to the blood stages takes approximately 28
days; this is why you must take chloroquine or mefloquine weekly for 4 weeks or
doxycycline daily for 4 weeks after leaving a malarial zone. Because Malarone acts against
the liver stages of P. falciparum, as well as the blood stages, the duration of taking this drug is
shorter; taking Malarone daily for 1 week is sufficient for post-departure prophylaxis.
If you plan to travel in a malaria endemic area following COS, you must take with you enough
anti-malarial medication for the duration of your travels and for post-departure prophylaxis.
During Peace Corps service, you may also have been infected with other, less virulent species
of the malaria parasite, including P. ovale and P. vivax. These species may reside harmlessly
in your liver for months or years without causing any symptoms, but they can cause malaria
months or years later (called relapsing malaria). Special prophylaxis called presumptive anti-
relapse therapy is required to eliminate these species from your system. While the malaria
infection these species cause is not as serious as malaria caused by P. falciparum, it can be
very uncomfortable.
Primaquine phosphate is the specific drug used to eliminate P. ovale and P. vivax parasites
from your liver. You have been given 28 Primaquine phosphate 15 mg. tablets by your PCMO.
You should take two tablets daily for 14 days. If your post-departure prophylaxis is
chloroquine, mefloquine or doxycycline, you should start taking the tablets 2 weeks (Day 15)
following your departure from the malaria area. If your post-departure prophylaxis is Malarone,
you should start taking the tablets 1 week (Day 8) following your departure from the malaria
area.
PART PROCEDURE
Before service you were tested for G6PD, an enzyme necessary to metabolize primaquine. If
your G6PD level is normal or adequate, your PCMO will give you primaquine and you may
commence terminal prophylaxis as outlined above. If your G6PD level is low or absent, you
should not take primaquine. You should contact your health care provider when you arrive
home. Individuals with low or absent G6PD levels should only take primaquine if
recommended, and supervised, by a medical professional.
Adverse effects of primaquine in individuals with normal levels of G6PD are infrequent.
However, if your urine becomes very dark or red while taking primaquine, stop taking the drug
and consult a physician. You may also contact the Peace Corps Office of Health Services at 1-
855-855-1961, extension 1540, option 7 for advice. Primaquine should not be taken during
pregnancy.
having a blood specimen drawn at completion of service for human immunodeficiency virus
(HIV) antibody testing. I fully understand that this may jeopardize my benefits under the
Federal Employees Compensation Act and AfterCorps insurance should I later be found to
(Volunteer Signature)
(Date)
Volunteer ID Number)
(Country of Service)
PCMO Signature:
March 2014
TG 330 ATTACHMENT I
having a Close of Service (COS) health evaluation. I fully understand that refusal of this
including those under the Federal Employees Compensation Act, AfterCorps, and Peace
(Volunteer Signature)
(Date)
- -
(Volunteer SSN)
(Country of Service)
PCMO Signature:
TG 330 ATTACHMENT J
Praziquantel (Biltricide)
(Schistosomiasis Medication)
Medication Information Sheet
What is praziquantel?
Praziquantel is a medication used to treat schistosomiasis (and infection with a type of worm
that lives in the bloodstream). It is a class of medication called anthelmintic which works by
killing the worms. Praziquantel is used for both treatment of individual patients and in mass
community treatment programs.
What is schistosomiasis?
Schistosomiasis, also known as bilharzias, is a disease caused by parasitic worms from the
Schistosoma genus. Schistosoma. mansoni, S. haematobium, S. japonicum, S. mekongi, and S.
intercalatum cause illness in humans. Different clinical complications are associated with the
various species. The clinical features also differ in acute and chronic infections.
Praziquantel may make you drowsy. Do not drive a car or operate machinery on the day you
take praziquantel and the day after you take it.
Page 1
December 2013
TG 330 ATTACHMENT J
Page 2
December 2013
TG 330 ATTACHMENT K
Primaquine Phosphate
(Anti-Malarial Medication)
Medication Information Sheet
I t is one of sev eral types of drugs used to prevent and treat malaria.
Primaquine phosphate is the specific drug used to eliminate P. ovale and P. vivax
parasites from your liv er. These species may reside harmlessly in your liv er for
months or years w ithout causing any symptoms, but they can cause malaria
months or years later (called relapsing malaria). Special treatment called
Presumptive Anti-Relapse Therapy (PART), formerly known as terminal
prophylaxis, is required to eliminate these parasites from your system. While the
malaria infection these species cause is not as serious as malaria caused by P.
falciparum, it can be v ery uncomfortable.
You hav e been giv en 28 tablets (15 mg) by your prov ider
Take tw o (2) tablets by mouth daily for 14 days
I t may be taken w ith food if stomach upset occurs, but not w ith antacids
For best results, take each dose at the same time ev ery day. This w ill
ensure a constant lev el of medication in your blood
Take this medication for the full time prescribed. Stopping therapy too
soon may result in a re-infection
Store at room temperature aw ay from sunlight and moisture
Do not share medications w ith others
PART
WHEN TO START PRIMAQUINE (30 MG)
POST-DEPARTURE PROPHYLAXIS (Following Departure from a Malarial
Endemic Area)
Mefloquine Start on Day 15 (2 w eeks follow ing
departure)
Chloroquine Start on Day 15 (2 w eeks follow ing
departure)
Doxycycline Start on Day 15 (2 w eeks follow ing
departure)
Malarone Start on Day 8 (1 w eek follow ing
departure)
1 12/2013
Are there any side effects (adverse reactions)?
You may hav e an upset stomach, stomach cramps, nausea, v omiting, loss
of appetite, or muscle w eakness, especially during the first several days as
you body adjusts to the medication. I f any of these symptoms persists or
become sev ere, inform your health provider.
Notify your health prov ider if you dev elop a rash, rapid heart rate,
changes in v ision, hearing trouble, ringing in the ears, or dark urine w hile
taking this medication.
I f your G6PD lev el is low or absent, you should NOT take primaquine.
I f your G6PD is low or absent, consult w ith your health care provider when
you arriv e home.
I ndividuals with low or absent G6PD levels should only take primaquine if
recommended, and supervised, by a medical professional
I f you hav e arthritis, psoriasis, lupus, liver disease or allergies to primaquine
I f you are pregnant or breast-feeding. Discuss the risks and benefits with
your Peace Corps health prov ider while in country or your health care
prov ider at home. The CDC recommends postponing primaquine until
after deliv ery or breast feeding (unless the infant has been tested for
G6PD deficiency).
I f you miss one or more doses for any reason, take ONE dose as soon as
possible and then continue on your usual dosing schedule. DO NOT
double-up the dose to catch up unless instructed to by a health care
prov ider.
2 12/2013
TG 330 ATTACHMENT L
PC-127c Authorization
Benefit Covers:
Authorizes payment for evaluation of medical and dental health conditions related to Volunteer service
Time Limit:
Must be issued and used within six months after service.
How Accessed:
May be issued by Peace Corps Medical Officers (PCMO) or the Peace Corps Office of Health Services
(OHS) Post-Service Unit
Call 855-855-1961, ext. 1540, option 7 or e-mail psu@peacecorps.gov
Additional information can be found at:
http://www.peacecorps.gov/resources/returned/benefits/healthben/medical/
FECA
Benefit Covers:
Treatment for most medical and dental conditions related to Volunteer service and conditions incurred or
contracted while overseas during service
Time Limit:
Claims must be filed within three years after service, or within three years of recognition that a health
condition is service-related.
How Accessed:
Claims should be filed through the OHS Post-Service Unit. Call 855-855-1961, ext. 1540, option 7 or
202-692-1540, option 7, or e-mail psu@peacecorps.gov
Additional information can be found at:
http://www.peacecorps.gov/resources/returned/benefits/healthben/feca/
February 2014
Peace Corps
Technical Guideline 340
1. PURPOSE
2. BACKGROUND
Form PC-127C (127C) authorizes payment of medical and dental services. The 127C is
designed for use in the U.S. For information on the use of the 127C outside of the U.S., see
Section 5 below.
Peace Corps utilizes a Health Benefits Program fee schedule. Peace Corps does not pay fees
in excess of this schedule and providers who accept the 127C have agreed to accept the Peace
Corps Health Benefits fee schedule as full payment for services. Providers may not bill
Volunteers for any fees in excess of the fee schedule. Volunteers are not expected to pay co-
payments charged by providers. The Health Benefits identification card is designed to
facilitate access to care and payment for services.
A 127C authorization should be used in conjunction with a Peace Corps Health Benefits
identification card (see section 6 below).
A 127C must be signed by both the Peace Corps medical staff member authorizing
service and the Volunteer seeking care. The staff member signature authorizes payment
of services and the Volunteer signature authorizes the release of medical and dental
reports to the Office of Medical Services (OMS) for the services associated with the
127C.
The 127C form has three parts. The original (health record copy) is placed in the
Volunteers health record under In-Service or Close of Service (COS)/Post-Service
care depending on when it was issued. The first copy (provider copy) is given to the
provider by the Volunteer and the second copy (patient copy) is for the Volunteer's
personal records. The Peace Corps Medical Officer (PCMO) should ensure that all three
copies are legible prior to issue.
A 127C may be issued by a PCMO, Area Peace Corps Medical Officer (APCMO), or
OMS staff.
A separate 127C authorization should be issued for each provider. A single authorization,
however, may request that one provider evaluate several conditions.
If a Volunteer has multiple conditions that require specialist evaluation, care should be
coordinated through a primary care physician (family practitioner or internist).
The 127C should be issued for an initial evaluation, to include diagnosis and management
recommendations, of the conditions. A 127C form may be used during service and at
COS (see sections 3.1 and 3.2 below).
* For use of the PC-127C outside the U.S.; see section 5 below.
PCMO will contact the Field Support Unit in OMS when Trainees and Volunteers
require evaluation and/or treatment for medical or dental conditions while they are
traveling to the U.S. 1 on home leave, emergency leave, or vacation. PCMOs in the
Africa Region should coordinate medical and dental care with APCMO before
contacting the Field Support Unit.
1 For information on the use of the 127C outside the U.S.; see section 5 below.
3. Specific laboratory tests which were not accomplished prior to COS, or are not
available in-country, e.g., stools for ova and parasites, mammography, etc.
5. At COS, 127Cs should be issued for evaluation only. Only the specific
evaluation authorized will be reimbursed. A 127C cannot be used for medical
treatment, with two exceptions; First, it can be used to authorize a single course
of treatment for parasites. In these cases the authorization should read as
follows:
Initial office visit and one follow-up. One course of treatment. Follow-up stool
exams for O & P x 3 post treatment. No further treatment authorized.
127Cs issued at COS should be issued for physicians, clinical psychologists, and
dentists only, i.e., Department of Labor (DOL) criteria of an authorized provider. A
127C may be issued at COS for other types of licensed healthcare providers;
however, if the medical problem results in a Federal Employees Compensation Act
(FECA) claim the evaluation will not be accepted by DOL and the Volunteer will
be required to obtain additional evaluation.
The Volunteer must have a 127C authorization prior to receiving medical or dental
evaluation or treatment.
For questions regarding 127C authorizations, FECA benefits, or other service-related
health issues, returned Volunteers should contact the OMS Post-Service Unit at 800-424-
8580 (extension 1500) or 202-692-1500.
The Volunteer should use the 127C authorization with his/her Health Benefits Program
identification card.
For questions regarding the use of the Health Benefits identification card, Volunteers
should contact the Peace Corps Health Benefits Program at 1-800-544-1802. For
information on network providers in a particular geographic location, Volunteers should
contact Health Systems International (HSI) at 800-726-0766. Numbers are listed on the
Health Benefits identification card and the Instructions for Use information sheet.
The International Health Coordinator(IHC) in the Field Support Unit will issue
127C for Volunteers requiring a medical or dental evaluation/treatment while they
are in the U.S.
The Volunteer is responsible for obtaining medical reports from his/her providers
and communicating medical information to the IHC. The Volunteer will also bring
a copy of the reports to post for inclusion in his/her health record.
The Volunteer must contact OMS if a new health problem develops or a previous
health problem becomes unstable while he/she is in the U.S. Evaluation and
treatment of illnesses or injuries that develop while a Volunteer is in the U.S. are
authorized and managed by OMS.
If the nature of the illness prevents the Volunteer from returning to country as
scheduled, OMS may place the Volunteer on medical hold status (see TG 370
Field Consultation section 13.3 Medical Hold) pending the outcome of the
evaluation and treatment.
Emphasize to the Volunteer that a 127C covers evaluation only, not treatment.
A 127C must be used within six months of the Volunteers COS date. It will not be
honored after that time has elapsed.
If, following an authorized evaluation, additional evaluation is necessary, the
Volunteer must contact the OMS Post-Service Unit.
If, following an authorized evaluation, treatment is necessary, the Volunteer must
contact the OMS Post-Service Unit for information on benefits under FECA. The
Post-Service Unit assists former Volunteers in filing claims for treatment with the
Department of Labor under FECA.
After COS, a Volunteer with questions or problems with his/her 127C authorization
should contact the Post-Service Unit in OMS.
Advise the Volunteer to retain a copy of the 127C for his/her records.
Obtaining routine health care outside the U.S. using a 127C is not encouraged. When
necessary, a 127C may be issued to a Volunteer for use outside of the U.S.
The Volunteer should be informed that providers in countries other than the U.S. may not
accept the 127C form. In these cases, the Volunteer will be required to pay for services at
the time of the visit and seek reimbursement from the Peace Corps Health Benefits
Program in a timely manner. The procedures for reimbursement are clearly outlined on
the 127C form.
During service and after COS, all 127Cs issued by post and used outside the U.S. should
be submitted to the Peace Corps Health Benefits Program for reimbursement (see section
7 below).
The Volunteer should be informed that he/she is responsible for obtaining all medical
reports for care received outside the U.S. During service, these reports should be brought
to post to be included in the Volunteers health record. For services received after COS, a
copy of all reports should be retained by the Volunteer as this information may be needed
to facilitate payment by the Health Benefits Program or to document eligibility for post-
service health benefits.
A Health Benefits identification card is issued in the medical record of all new Trainees. The
card and an Instructions for Use sheet are located on the left hand side of the medical
record on top of the blue COS/Post-Service divider. A sample card and instruction sheet are
included in ATTACHMENT B.
The Health Benefits identification card should be presented along with the 127C or 209B
whenever the Volunteer or RPCV seeks to access medical care in the U.S. Use of the
Health Benefits identification card in this manner will:
Ensure that the provider agrees to accept the Peace Corps Health Benefits
Program fee schedule as full payment for services;
Protect the Volunteer from having to pay for care at the time of service;
Protect the Volunteer from being billed directly by the provider for full or partial
payment of services, or for fees in excess of the fee schedule.
The Health Benefits identification card must only be used with a 127C or 209B
authorization. Use of the health benefit card without a 127C or 209B does not authorize
payment of medical services. Volunteers or RPCVs who obtain medical services in the
U.S. without a 127C or 209B authorization may not be reimbursed by Peace Corps.
Because Volunteers and RPCVs should present the Health Benefits identification card
whenever medical services are sought using a 127C or 209B, Volunteers must have the
card in their possession whenever they travel to the U.S., regardless of the reason, e.g.,
vacation, home leave, emergency leave, medevac, etc., and at COS.
At post, the PCMO is responsible for issuing the Health Benefits identification card and
ensuring that Volunteers understand its use.
The PCMO, and the post administrative staff, are responsible for ensuring that Volunteers
have their cards whenever a 127C or 209B is issued and when travel to the U.S. is
planned. Therefore, posts should treat the card like other important travel documents and
store the card with the Volunteers passport or in the Volunteers health record. In certain
circumstances, post may require Volunteers to be responsible for their own cards.
Volunteers and RPCVs may use a provider of their choice; however, in light of the
benefits outlined above, the OMS Health Benefits Program strongly encourages
Volunteers to use providers who are members of the network. For information on
network providers in a particular geographic location in the U.S., Volunteers should
contact HSI at 800-726-0766 or on the web at www.peacecorps.sevencorners.com.
The Health Benefits card is valid during Peace Corps service and up to the expiration
date on an accompanying 127C or 209B authorization.
The Health Benefits identification card is separate and distinct from the CorpsCare Post-
Service health insurance program and the CorpsCare insurance card.
Peace Corps utilizes a Health Benefits Program fee schedule that is consistent with
recognized fee schedules used by health care insurers in the U.S. Providers who accept
the 127C form agree to accept the Peace Corps Health Benefits Program fee schedule as
full payment for services (see information highlighted in red on the 127C form). Peace
Corps does not pay charges in excess of this schedule.
The standard method of payment of medical or dental care authorized by a 127C is for
the provider to accept the 127C, with the Health Benefits identification card, and to
submit a claim directly to the Peace Corps Health Benefit Program.
In the event that a Volunteer cannot locate a provider who will accept the 127C form, the
Volunteer may pay for the medical care at the time of service and submit a claim for
reimbursement to the Peace Corps Health Benefits Program. In most cases, the Volunteer
will be reimbursed according to the Peace Corps Health Benefits Program fee schedule.
Information, including all necessary documentation required for submitting a claim, is
highlighted in red bold type in the center of the 127C.
All 127C authorizations should be submitted to the Peace Corps Health Benefits Program
for payment or reimbursement. This includes 127Cs issued by post or by OMS, 127Cs
issued for use in the U.S. or overseas, and 127Cs issued for use during service or after
COS.
Prior to receiving care, the Volunteer should read and understand the information on the
127C, including the specific services authorized and bill payment information.
8. AUTHORIZING SERVICES
The specific services authorized must be clearly described in the section Services
Authorized on the 127C. Common examples include the following:
During Service
Evaluation by a Specialist
Dermatologist
At COS
Evaluation by a Specialist
Dermatologist
Services Authorized: Initial evaluation of diarrhea and one follow-up. One course of
treatment. Follow-up stool exams for O & P x 3 post treatment.
No further treatment authorized. If further treatment is
indicated Volunteer should contact the Peace Corps Post-
Service Unit for assistance.
Evaluation by a Dentist
Dentist
Services Authorized: For dental examination and routine prophylaxis only (including
bite-wing x-rays and other views as indicated). Record the
examination on PC-1790 (Dental) attached. If dental treatment
is indicated please describe in detail and estimate cost. No
treatment is authorized at this time.
Psychiatrist/Clinical Psychologist
The PCMO must complete every section of the 127C. If the name of the provider is not
known at the time of authorization, this line only may be left blank.
Service Level
Mark an X in the appropriate box. For Volunteers going to the U.S. on vacation, home
leave, or emergency leave, mark In-Service.
Provider
Print name of provider if known.
Specialty
Designate Primary Care Physician, Dentist or type of specialist.
Problems/Symptoms/HX:
Services Authorized:
Authorized by: Date: (dd-mon-yy) *PCEND127C*
Signature:
Date
Instructions for Use
HEALTH BENEFITS PROGRAM IDENTIFICATION CARD
PCMO INSTRUCTIONS: To ensure Volunteers understand the Health Benefits Program identification card and its proper use, please
verify that the Volunteer has reviewed the information below. Have the Volunteer sign for receipt of the card, and leave the signature in
the medical records.
I have read the instructions below and understand the use of my Health Benefits identification card.
MEMBER:
Provide you access to a network of medical/dental providers in the United States willing to accept a PC-127C Authorization
for Payment of Medical/Dental Services and/or a PC-209B Authorization for Volunteer Medical Evaluation and Labs form.
Facilitate proper and timely payment of medical bills associated with the medical services authorized on your PC-127C form
and/or your PC-209B form.
The Health Benefits identification card must only be used with a PC-127C or a PC-209B authorization. Volunteers or RPCVs
who obtain medical services in the US without a PC-127C or PC-209B may not be reimbursed by Peace Corps.
The card is valid during your Peace Corps service and up to the expiration date on your accompanying PC-127C or PC-209B
authorization form.
Present the Health Benefits identification card anytime you seek medical services using a PC-127C or PC-209B authorization
form.
Have the card on your person when traveling to the United States for any reason, e.g.,vacation, home leave, emergency leave,
medevac, and at Close of Service (COS)
You may use a provider of choice, however, in light of the benefits outlined above, the Peace Corps Health Benefits Program
strongly encourages you to use providers who are members of the network to avoid out of pocket expenses.
For information on Medical or Dental network providers in a particular geographic location in the U.S., you should contact
Equian at 1(800)726-0766 or on the website http://peacecorps.sevencorners.com.
The Health Benefits identification card is separate and distinct from the AfterCorps medical insurance program and the After-
Corps insurance card that is provided to you at COS.
Rev PC (04/14)
HEALTH BENEFITS PROGRAM IDENTIFICATION CARD
This health care plan requires authorization from Peace Corps for
medical, mental health and dental services. A signed PC-127C or PC-
209B form indicates authorization. Member must present this ID card
and signed authorization form at time of service.
Rev PC (04/14)
Peace Corps
Technical Guideline 355
1. PURPOSE
2. BACKGROUND
A mammogram is an x-ray picture of the breast. Screening mammograms are used to check
for breast cancer in women who have no signs or symptoms of the disease. Diagnostic
mammograms are used to check for breast cancer after a lump or other sign or symptom of
the disease has been found. A sonogram, also called an ultrasound, is a computerized picture
taken using sound waves.
3. SCREENING GUIDELINES
Routine annual mammograms are not recommended by the USPSTF, but the decision to
perform mammography is individual and should take patient context into account, including
the patient's values regarding specific benefits and harms.
Screening mammograms performed in-country may be sent to OHS for review by a U.S.
radiologist according to the procedures outlined in section 9 below. Any mammogram
reported through the Breast Imaging-Reporting and Data System (BI-RADS) as BI-RADS
Category 3, must be sent to OHS for a second read by a US radiologist.
A field consultation must always be obtained for the evaluation of an abnormal breast
finding, e.g., breast mass, nipple discharge, and skin changes. ATTACHMENT A is a
standard Mammogram Field Consult form. The PCMO, together with OHS/RMO, is
responsible for the evaluation, monitoring, and follow-up of women with any abnormal
breast findings.
4. DIAGNOSTIC MAMMOGRAPHY
Mammography is of limited usefulness in women under age 40 due to higher breast tissue
density. Ultrasound is preferred to evaluate breast lesions in younger women. Mammography
should only be performed in a woman younger than 40 if indicated by her particular
circumstances.
A diagnostic mammogram, in a woman older than 40 years, is indicated in women with the
following conditions:
Signs or symptoms of breast disease including, but not limited to, mass, induration, axillary
lymphadenopathy, some types of nipple discharge, skin changes, or persistent focal areas of pain
or tenderness.
Abnormal screening mammogram.
Follow up of previous mammogram with BI-RADS Category 3 Probably Benign Finding.
Asymptomatic women who have breast implants or who have a history of treatment for breast
cancer may have a screening mammogram, instead of diagnostic mammogram, at the discretion
of the mammography facility 1.
Diagnostic mammograms performed in-country may be sent to OHS for review by a U.S.
radiologist according to the procedures outlined in section 9 below. All mammograms reported
as BI-RADS 3 must be sent to OHS for a second read by a US radiologist.
A negative diagnostic mammogram does not rule out malignancy in the presence of a palpable
mass or other breast abnormality. The purpose of mammography in this setting is to further
define the mass and to rule out the presence of an unexpected nonpalpable breast cancer in the
ipsilateral or contralateral breast. PCMOs should ensure that a Volunteer with a palpable breast
mass understands the purpose of mammography.
5. MAMMOGRAPHY ACCOMMODATION
As of August 2012, screening mammography is required for women age 50 and over
prior to entering Peace Corps service.
All female applicants who will be 50 years or older during their service are offered an
accommodation to a country where screening mammography is available. They may
choose to waive this accommodation, however, if certain risk factors are present, the
applicant will be assigned to a country with access to mammography.
If an applicant has waived the mammogram accommodation, Peace Corps will not
medevac her for screening mammography or issue a PC-127C for screening
mammography in the US or another country. However, if a PCV who had waived the
1 American College of Radiology. ACR Practice Guideline for the Performance of Screening
and Diagnostic Mammography. 2008.
http://www.acr.org/~/media/ACR/Documents/PGTS/guidelines/Screening_Mammography.pdf
Mammography facilities in the U.S. must be certified by the Food and Drug Administration
(FDA). OHS strongly prefers the use of U.S. facilities or facilities that approximate this
standard.
The PCMO, together with OHS, is responsible for determining the adequacy of
mammogram facilities and services overseas. Although it may not be possible to obtain
or judge information related to many of the components of the mammographic unit,
when inspecting facilities, PCMOs should consider the following:
7. SPECIAL CONSIDERATIONS
8. MAMMOGRAPHY REPORTS
Mammography reports should include a brief statement about the reason for the
examination, a description of the breast composition, a description of significant
findings, and a statement regarding comparison with prior examinations. These reports
should be signed and dated by the consulting radiologist and translated into English if
necessary. The American College of Radiology promotes the use of a standardized
reporting system, the Breast Imaging-Reporting and Data System (BI-RADS). Peace
Corps requires that all mammograms are reported using the BI-RADS system. It
includes one of the following overall assessments and recommendations:
1. Obtain the original films or digital copy of the mammogram and the report from the local
radiologist;
2. Prepare a field consult using the Mammogram Field Consult form (see
ATTACHMENT A);
3. Send the mammogram image, the local radiologists report, any prior mammograms, and
the field consult to OHS via the most efficient route (generally DHL, FedEx or other
express mail service). Address the communication to the attention of the IHC at:
4. If previous mammogram films are not available in country, the Volunteer, together with
the PCMO, should make every effort to have previous mammogram films sent to OHS
from the Volunteer's home of record (HOR). Previous films are important for comparison
as they assist the radiologist in determining the significance of new or changed breast
findings. Medical records departments in the U.S. require a Records Release
Authorization signed by the patient prior to releasing mammogram films. A "Records
Release Request" (ATTACHMENT B) is included for this purpose. If the Volunteer or
PCMO experiences difficulty obtaining films or initiating the process, the PCMO should
contact OHS for assistance.
OHS will:
Ensure that the films are read by a U.S.-based radiologist;
Review all results and reports;
Fax stateside results and, if indicated, a field consult report to country within one week of
receipt of the field consult and mammograms if previous films are readily available.
Return the films and hard-copies of the reports to post;
When necessary, obtain previous mammogram films.
Patient complaints of a breast mass are common. Fibro adenomas and cysts are the most
common causes of benign breast masses. About 90% of palpable breast masses in women in
their 20s to early 50s are benign, but excluding breast cancer is a crucial step in the
assessment of these masses. Findings in benign breast disease can mimic those in cancer,
since normal breast tissue in women is often somewhat nodular.
10.1 History
Older age, previous history of breast cancer and family history in a first-degree relative have
all been shown to increase the chance that a palpable breast mass is cancerous on biopsy.
Physical findings individually do not distinguish well between cancers and benign lesions.
The first goal of the physical examination is to determine whether a dominant mass,
thickening, or asymmetry is present. This is particularly important in younger women, whose
breasts are more likely to be generally nodular than in older women. Some "classic"
characteristics of cancerous lesions include:
Single lesion
Hard
Immovable
Irregular borders
If the initial physical examination does not confirm the presence of a dominant mass,
thickening or asymmetry, close observation with a follow-up examination in two to three
months should be arranged to assure resolution or stability of findings. Alternatively, the
patient can be referred to a breast specialist, depending on the confidence and expertise of the
examiner.
If the initial physical exam indicates that further evaluation is indicated, then arrangements
should be made for breast imaging and OHS should be notified of the breast mass through a
field consult.
10.3 Imaging
A mammogram should be the first diagnostic test ordered in a woman over the age of 30 with
a new breast complaint. Even if the patient had a recent negative screening mammogram, if
she has a focal complaint, a diagnostic mammogram should be obtained. Mammography is
not routinely ordered in women under age 30 years. Ultrasound is the first line of imaging in
a woman who is pregnant or less than 30 years old with focal breast symptoms or findings.
However, it is not inappropriate to order a mammogram as part of a diagnostic evaluation of
a clinically suspicious mass in younger women.
Breast magnetic resonance imaging (MRI) is not indicated for the work-up of an
undiagnosed mass. MRI is best reserved for diagnostic dilemmas and used with discretion as
there is a significant false positive rate, which dramatically increases the rate of benign
biopsies. Diagnostic breast MRIs should only be performed in institutions that have capacity
for MRI directed biopsy, as lesions seen on MRI may not be visible on other imaging
modalities.
The findings of breast imaging will dictate the next steps in the evaluation of the breast mass.
OHS should be made aware of any imaging reports that indicate a finding of BI-RADS
category 3, 4 or 5.
REFERENCES
American College of Radiology. ACR Practice Guideline for the Performance of Screening and
Diagnostic Mammography. 2008.
http://www.uspreventiveservicestaskforce.org/uspstf09/breastcancer/brcanrs.htm
http://www.uptodate.com/contents/breast-masses-and-other-common-breast-
problems?source=search_result&search=breast+mass&selectedTitle=1%7E41#H19
Most major health organizations recommend that women over the age of 40 receive regular,
comprehensive screening for breast cancer, including mammography every one to two years.
The Peace Corps strongly supports these recommendations and is able to provide screening
mammography in some but not all of its overseas posts. The Peace Corps would like to
facilitate access to screening mammography by recommending an overseas assignment for
you in a country where you can receive a routine screening mammogram. After discussing
the matter with your phys ician, please choose one of the two options outlined below under
Instructions to Peace Corps Applicant.
I have discussed with the above-named person the consensus medical opinion that
regular, comprehensive screening for breast cancer, including screening mammography
every one to two years, is medically indicated for her age group and I concur with the
Peace Corps Office of Volunteer Support willingness to recommend that she serve in a
country where she can receive a routine screening mammogram for breast cancer.
I have reviewed and assisted in the completion of the Mammogram Health Assessment
Questionnaire with the above-named person.
I have discussed with the above-named person the fact that foregoing a routine screening
mammogram for more than two years may subject her to risk of delayed diagnosis of
breast cancer, which could cause major adverse health consequences, including death.
Instructions to Peace Corps Applicant: Please check one of the following and sign.
After discussing these matters with my doctor, I have decided that I wish to ensure that I
receive a routine screening mammogram during my 27 months of Volunteer service.
(You do not need to fill out the Mammogram Health Assessment Questionnaire)
After discussing these matters with my doctor, I have decided that I do not wish to
ensure that I receive a routine screening mammogram during my 27 months of Volunteer
service. You must complete the attached Mammogram Health Assessment Questionnaire.
Based on that information and/or your mammogram report, you may be given a
mammogram accommodation and will be considered for placement in a country where
this resource is available.
The questions below must be answered in order to make a general assessment of your
statistical breast cancer risk. These questions can be answered by you and do not require
additional medical tests or physician visits.
If you do not know the answer, you may consult with your physician or simply respond
no to questions that require a yes or no answer.
Yes No Do you have a personal history of breast cancer, ductal carcinoma in situ
(DCIS), or lobular carcinoma in situ (LCIS)?
In order to estimate your cancer risk:
____years At what age did you begin to have your menstrual periods?
____ years N/A At what age, if applicable, did you have your first child?
How many first-degree relatives (parent, sibling, child) have had
#_______ N/A breast cancer?
Yes No Have you ever had a breast biopsy?
#_______ N/A How many breast biopsies have you had (positive or negative)?
Yes No Have any of the biopsies shown atypical hyperplasia (check with your
N/A doctor if necessary)?
OPTIONAL Understanding that race and ethnicity factor into the estimation of breast
cancer risk, what is your race/ethnicity? (check all that apply)
White
African-American
Hispanic
Asian, Pacific Islander or Native Hawaiian
American Indian or Alaskan Native
Unknown
Prefer not to answer
TO:
FROM:
DATE:
CLINICAL EXAM:
LMP: ...........................................................................................................
On oral contraceptives or hormone replacement therapy .................... [ ] YES [ ] NO
Palpable lump or mass ............................................................................... [ ] YES [ ] NO
Breast tenderness or pain ......................................................................... [ ] YES [ ] NO
Nipple discharge......................................................................................... [ ] YES [ ] NO
Lymph nodes .............................................................................................. [ ] YES [ ] NO
If YES to any of the above, please describe below. For palpable abnormalities, include specific location,
i.e., breast (left or right), quadrant (upper outer, upper inner, lower outer, lower inner). A graphic
representation of the breast may be used.
RIGHT LEFT
PREVIOUS MAMMOGRAMS
Available in country .......................................................................... [ ] YES [ ] NO
If yes, send previous mammograms and report to VS with the current mammogram study.
If no, please initiate the process of having Volunteer's previous mammogram films sent from her HOR to VS
as soon as possible (see TG 355 section 6).
DATE OF REQUEST:
PATIENT INFORMATION:
Patient's name:
DOB:
Country of service:
Clinic name:
Address:
Telephone number: Fax number:
Date of last mammogram:
AUTHORIZATION:
Office of Volunteer Support. Please send original films and reports to:
Peace Corps
Office of Volunteer Support
1111 20th Street, N.W.
Washington D.C. 20526
Attn:
International Health Coordinator
(202) 692-1500
Privacy Act Statement: I understand that all information in my record will be released, including
dates, history of illness, and diagnostic and therapeutic information related to my condition.
Witness: Date
Peace Corps
Technical Guide line 3 60
1 . PURPOSE
2 . B ACKGROUND
The Office of Health Services (OHS) arranges and pays for laboratory serv ices for all P eace
Corps p osts at the laboratories referenced below (see section 3).
P CMOs may use local laboratory services when in-cou ntry facilities are adequate. The
P CMO together wit h the Regional Medical Officers (RMOs) are responsible for mak ing th is
determinat ion. Costs for in-country laboratory services are paid from the country bu dget.
Quest Diagnostics Nichols Institute (Quest) is the main U.S. lab oratory used by P eace Corps.
When request ing the services of a U.S. lab, unless otherwise ind icated , P CMOs shou ld send
all general p urpose labs to Quest . The Centers for Disease Control and Prevention (CDC)
laboratory provide P eace Corps with spec ia lty services. P CMOs should use the following
laborat ories and services according to the gu idance out lined below.
Quest Diagnostics Nichols Mic roscopic ex amination for Quest Diagnostics Nichols Institute
Institut e paras ites (stool, urine) 14225 Newbrook Drive PO Box 10841
Chantilly, VA 20153-0841
Note: The term container is u sed to d escribe the specimen packaging requiremen ts in section 4 .2 , a nd the
term bo x is u sed to des crib e the sh ipp ing requ iremen ts in section 4 .4 .
4 .1 Specimen Preservation
Due to the lon g transit t ime from post to the U.S., specimens requiring refrigerat io n
should only be sent to U.S. laboratories when no alter nat ive exists. If P CMOs send
specimens requiring refrigerat ion, they should send t hem directly to the lab oratory
via an express mail system, i.e., DHL or other. Specimens sent t hro ugh an express
mail system may be subject to delay at the U.S. port of entry f or custo ms clearance.
P CMOs should consult t he Quest Directory of Services for specific informat ion on
specimen preparation and preservat ion of indiv id ual tests (see section 5. 1 below).
By federal regulat ion, diagnostic specimens and bio logic products sh ip ped within the
U.S. must be packaged to withstand leakage of contents, sh ocks,pressure changes, and
ot her cond it ions incident to ordinary hand ling in transportation (42 Code of federal
Regulat ions (CFR) P art 72).
For addit io nal information, see also Technical Guideline (TG) 2 60 sect io n 5.2
S pecimen P ackaging and TG 2 60 Attachment A P ackaging Specimens.
Specimen Labels: P osts may create preprinted labels to be added to the chart
of incoming trainees. If labels are not availab le specimens and slides should be
labeled as follows:
Please note that use of adhesive labels is not acceptable for use on specimens that
are placed on slides. Information must be written in pencil on the frosted glass
portion of the slide.
Specimen Biohaza rd Labels: Specimens and ot her infectious material being sh ipped
to the U.S. must be appropriately labeled as a bio hazard.
Eit her the primary or t he secondary container describe d abo ve must have a
warning label that includes the universal biohazard symbol followed, by t he
term biohazard. A red bag or red container ma y be subst it uted f or a label.
P lastic specimen bags with the red biohazard symbol may also be used and
can be procured through OSD. See TG 260.5 f or add it ional information on
specimen handling and labeling.
The P CMO may label both the primary and secondary containers but is not
requ ired to do so.
Biohazard labels should also include Glass, Fragile, Refrigerate, or
Do Not Freeze designations as appropriate.
4 .4 Specimen Shipment
P rior to shipment, secondary container(s) must be placed inside one or two cardb oard
boxes as follows:
Double Box: Specimens sent b y diplo mat ic pouch or hand carried to the US mail
room for forwarding to U.S. laboratories must be do ub le boxed.The outer b ox
should be addressed to:
Each inner bo x must be accurately addressed to its final dest inat ion, e.g., Quest
Diagnostics ; CDC, etc. (see addresses in section 3 above). Each inner package must
contain specimens samples dest ined f or one and only one U.S. laboratory.
S ingle Bo x: Double boxing is not required if t he package is sent d irect ly from post
to a U.S. lab. A single cardboard box addressed directly to the reference lab (see
addresses in section 3 above) is sufficient.
Rigid mailing sleeves, if properly reinforced for o verseas shipment , may be used
instead of boxes for shipment of specimens.
Quest is the main U.S. laborat ory used by P eace Corps. P CMOs shou ld use Quest for any test
that is n ot availab le locally and when in-cou ntry laboratory facilit ies are not adequate or
reliab le. P CMOs use Quest most frequent ly for P ap smear cytology, urine and stool O&P
testing, pathology, and HIV tests.
Through PLS, Quest can supply posts with a current Quest Directory of S ervices.
The Directory contains a comp lete list of t he tests offered; information on how to order
and prepare specimens for submission; information on available lab supplies, shipp ing
materials, and profiles; and interpret ive information. The Director y shou ld be available
in t he healt h un it or it can be procured through PLS. The directory is also available on-
line via the Quest Care 360 system.
Quest also supplies posts with pre-printed Quest requisition forms. These forms are standard
test request forms that have been pre-printed with the headquarters address and a master
account number; there are a few high volume posts that do have individual sub-accounts
under the master account n umber. All other posts will access results under the
Quest Master account number. The number is located on the middle of the forms above
the headquarters address or it may be obtained t hrough the Internat ional Health Coordinator
(IHC). PCMOs should inform OHS if there is a change in the posts mailing address.
5 .2 Quest Supplies
Quest will provide to P eace Corps posts the following lab oratory su pp lies an d
shipping materials for ordering tests. There is no charge to post f or these Quest
supp lies.
Lab Supplies
Seru m separat or tu bes 15 ml Lav end er top tub es 5 ml
Gray top tub es 5 ml Blu e to p tu bes 4.5 ml
Seru m v ials Cu ltu rettes
Mu ltip le n eed les Va cut ainer ho ld ers
VCE slides Cy to logy b rush es
Sp ray fixat iv e Slid e ho lders
GC/ Ch lamy d ia DNA test p rob es ParaPak supplies for stool O&P testing
Shipping Supplies
Q u e s t mailers / Sty rofo am Cardboard bo xes
Plastic zip lo ck bags A bso rben t p ap er
Forms
Clien t Supp ly Order Re quest Fo rm General Requ est Fo rm
Cy to logy / His tology Request Fo rm Directo ry of Serv ices
These supp lies are provided only upon request from post to PLS. P CMOs shou ld order
Quest supplies through PLS using the Quest Supp ly Order Request For m or
by email request. Request forms can be obtained from PLS. Supp ly req uests sh ou ld not
b e sent directly to Quest.
Send specimens to the Centers for Disease Control and P revent io n. See section 3 above for
addresses.
P CMOs may use Quest for microscopic examinat ion of stoo l and urine specimens for
parasites. Quest will also performthese tests. See TG 815 Stool Test in g for P arasites
for addit ional information (Note: malaria slide stud ies should to be sent to t he CDC as
described in section 6 above.)
All resu lts fro m Quest will be available to P ost and OHS electron ically at
https://cas2.questdiagnostics.com/ . All ot her U.S. labs used by P eace Corps send
results t o the field, either t hrough OHS or d irect ly to the field.
In-service indeterminate or posit ive HIV results are received by the P CMO and reported
by the P CMO to OHS
COS lab reports are received, evaluated and filed in t he medical record by t he P CMO
prior to packaging of t he health record for shipment to P eace Corps headquarters
All medical records are required to be received at P eace Corps headquarters with in 30
days after COS
Any abn ormal COS test resu lts that are received after the Volunteer has closed serv ice
must be reported to t he P ost Service Un it (P SU) mailbox v ia secure file transfer (SFT) :
psu@peacecorps.gov
P CMOs should contact IHC if they have further prob lems obtaining laborat ory results from
Quest or other labs out lined in this guide line.
Page 1
TG 360 ATTACHMENT A
Page 2
TG 360 ATTACHMENT B
Name:_________________________________________________________________________________
Address:_______________________________________________________________________________
State,
City:__________________________________Province:___________________Zip:___________________
Country:________________________Phone/Fax:______________________________________________
Patient(s) Information:
Circle one: Date
Name Endpoint or Screen Sex Age Rabies Vaccination History of Draw
1.______________________________________________________________________________________________
2.______________________________________________________________________________________________
3.______________________________________________________________________________________________
4.______________________________________________________________________________________________
5.______________________________________________________________________________________________
6.______________________________________________________________________________________________
7.______________________________________________________________________________________________
8.______________________________________________________________________________________________
9.______________________________________________________________________________________________
10._____________________________________________________________________________________________
Signature of Submitter:_________________________________________Date:______________________
Opened by:____________ Processed by:____________ Computer Entry:____________ Verified by:____________ Reviewed by:____________
Peace Corps
Technical Guideline 370
1. PURPOSE
To provide guidance on the use of field consultation in the Volunteer Health System.
To outline the methods of communication between the Office of Medical Services (OMS)
and Peace Corps Medical Officers (PCMOs).
2. BACKGROUND
A field consult is a clinical inquiry by overseas medical personnel to OMS. OMS in turn
utilizes all necessary medical resources and specialists in the U.S. to inform and respond to
the inquiry. Field consultation is used when a medical condition: (1) involves the potential
for significant complications; (2) requires resources or expertise that exceeds the PCMO's
training, skills and qualifications; or (3) approaches the limits of diagnostic and/or
therapeutic care available in country. The field consultation process is an integral component
of the Volunteer Health System, and PCMOs should use the process when indicated.
Following are the main fax and telephone numbers for the Office of Medical Services. All
field consults and communications with OMS should be conducted through these numbers.
Routine Contact IHC through the main Contact IHC during regular
(Non-Urgent) OMS switchboard business hours
(202-692-1500)
OMS Fax
(202-692-1501)
Urgent Contact IHC through the main Contact the Medical Duty Officer
OMS switchboard (301-790-4749)
(202-692-1500)
These numbers are up to date as of the publication of this TG. Posts should ensure that their
contact information is accurate and up to date.
PCMOs should consult OMS in any clinical situation that requires information, resources, or
expertise that exceeds the training, skills, and qualifications of the PCMO and local
consultants.
Volunteer requests a second opinion and post does not have a qualified provider.
Local resources cannot provide safe, efficient, and timely care that conforms to U.S.
standards and norms.
To confirm or supplement a medical or dental opinion obtained locally.
To establish the technical merits or reliability of local resources including, but not
limited to radiology, laboratory, medical and dental facilities and personnel.
TGs specify OMS consultation.
In countries with Area Peace Corps Medical Officers (APCMOs), non-urgent field
consults should be directed to the APCMO with a copy to OMS. Urgent field consults
should be directed to both the APCMO and OMS for action.
All field consults should be organized in SOAP format (see TG 210 Health Records
section 7.1 SOAP Format) and submitted with the following supporting information:
Volunteer name, SSN, DOB, COS date;
Presentation of case and documentation of clinical care in SOAP format;
Copy of relevant diagnostic test reports, e.g., x-rays, laboratory studies, ECGs, etc.;
Copy of relevant chronological notes from the health record;
Radiographic studies and photographs if post has the ability to transmit digitally.
The IHC, in consultation with the Chief of Clinical Programs, reviews all field consults.
Following review, field consults are answered directly by medical professionals in
OMS or are referred to outside specialists in the Washington, DC area.
Urgent field consults for an acute medical problem or an urgent medevac consideration
are handled as an emergency, and a response is sent to post as quickly as possible.
Non-urgent field consults are answered within two business days. If outside specialist
consultation is required by OMS, a response will be sent to country within two days of
OMS receipt of the specialists opinion.
All consults are sent to post immediately via cable, fax or telephone. If PCMOs do not
receive a response from OMS within a reasonable time frame, they should follow-up
with their IHC directly.
6. METHODS OF COMMUNICATION
Field consults and other communication with OMS may be by fax, cable, or telephone. The
method of communication should be determined by the urgency of the medical problem, the
time of day, the day of the week, the confidentiality of the material being communicated, and
the reliability of communication services at post.
The health unit should maintain a log or tracking system for outgoing cables and faxes.
Health unit staff should be able to verify from their logs that a communication was
transmitted and the date of transmission.
Fax Transmissions
For non-urgent field consults, the preferred method of communication is by fax.
Faxes should be sent directly to the IHC via the main OMS fax number (202-692-
1501). This fax number is the designated destination for all medically confidential
information.
Faxes should indicate clearance by the originator and any clearing officials.
All faxes that identify an individual Volunteer and contain medical information
should be designated as Medical Eyes Only. A cover sheet indicating that the
information on the following pages is Medically Confidential should be used as a
safeguard when sending medically confidential information.
Health units should have a dedicated fax to which medically confidential
information can be sent at any time. If a dedicated fax is not available, each post
must establish procedures to assure that confidentiality is maintained when medical
information is transmitted to the fax. Such procedures include:
Notification to OMS that a Medical Eyes Only fax is not available;
Envelopes marked Medical Eyes Only convenient to the fax so that
documents can be sealed upon receipt;
Logs indicating non-medical staff who handled Medical Eyes Only
documents.
PCMOs should contact OMS if the health unit does not have a Medical Eyes Only
fax and there are concerns about the security of medically confidential information.
Telephone
The PCMO may obtain a medical consultation via telephone, i.e., a telcon.
All telephone consults about patient care must be documented. Documentation is
required to confirm the accuracy of the information exchanged and to protect the
parties involved in the consult from misunderstandings. The individual who
initiates the call is responsible for documenting the telcon and sending a summary
fax or cable to confirm the consultation.
PCMOs calling from overseas during business hours should use the main OMS
switchboard number (202-692-1500). The PCMO should identify him or herself as
a PCMO and indicate that he or she is calling from overseas. The administrative
assistant who answers the telephone will ensure that the call is transferred to the
appropriate OMS staff.
Email
All confidential information should be sent using Secure File Transfer Protocol
(SFTP). Contact OMS if there are any questions regarding use of SFTP.
Cable Transmissions
Cables are only used when fax or e-mail communication is not practical. Section 7
Cable Preparation below outlines the preparation of a cable. Routine cables take
12-24 hours to reach Washington.
Telephone: During business hours (7:30 a.m. to 5 p.m. eastern time Monday
through Friday).
For urgent concerns during business hours the PCMO should contact field support
directly through the main OMS switchboard (202-692-1500). When calling the
OMS switchboard, PCMOs should identify themselves, state the urgency of the
call, and state with whom they would like to speak. The administrative assistant
who answers the phone will ensure that the call gets to the requested OMS staff.
the PCMO does not receive a response within 20 minutes of the call, he or she
should contact the service again.
If Communication is Impossible.
Under extraordinary circumstances immediate communication with OMS may be
impossible. In these circumstances, PCMOs should use their clinical judgment and
all available resources to provide necessary care to an ill or injured Volunteer. In
these situations, the PCMO should contact OMS as soon as possible after
communication has been restored.
Equipment and procedures for cable transmission vary from one Embassy to another.
PCMOs should familiarize themselves with local embassy procedures.
General Information
Cable Preparation
Follow directions in the Peace Corps Cable Preparation Guide (1992) available from the
Office of Information Resources Management (M/IRM/CTIS). A summary of the parts of
a cable is provided in ATTACHMENT A.
Use Optional Forms 152(H) and 152a(H), continuation sheets, or the cable template
distributed by M/IRM/CTIS. The spacing between lines is critical as cables are optically
scanned for transmission. If the scanner can not find the information it is looking for, e.g.,
embassy city, on the correct line, the cable will be rejected.
REFERENCES
PARTS OF A CABLE
The following description of the basic parts of a cable may be used when preparing a cable. Medical
Officers should contact the Office of Information Resources Management (M/IRM/CTIS) in Washington
or the local U.S. Embassy for post-specific procedures.
The State Department in Washington and U.S. Embassies overseas use sequential numbering
systems during a calendar year. Thus,
LOME 1109
identifies this cable as the 1109th cable of the year to be sent from the Embassy in Lome.
Cables are usually dated and timed in the following sequence: DATE/TIME/MONTH/YEAR. For
example:
152025 MAY 94
This means that the cable was sent on the 15th of May 1994, at 2025, i.e., 8:25 p.m.. Times should
always be expressed using a 24-hour clock.
3. Originator Identification
4. Action Addressee(s)
The action addressee is the cable address of the person or office whom the writer of the cable
intends to take appropriate action on the contents of the cable. For example:
TO SEC STATE WASHDC
indicates that the cable address of the person for whom the cable is intended is the State Department
in Washington, which will forward the cable to Peace Corps (see 7, below).
5. Precedence Designation
Cable precedence governs the order in which cables are transmitted through the system and the
actions required for delivery at the receiving post. The following precedence is used by Peace
Corps:
Routine;
Priority: messages requiring rapid action and prompt delivery;
Immediate: limited to important matters that require immediate attention or action;
Page 1
TG 370 ATTACHMENT A
NIACT Immediate (or Night Action Immediate): the cable will be delivered to the addressee
without regard to the time of day or night.
6. Information Addressee(s)
An info addressee is the cable address of a person or office whom the writer wants to have
knowledge of the contents of the cable. It is the equivalent of a carbon copy of a memorandum.
For example:
TO SECSTATE WASH, IMMEDIATE
INFO AMEMBASSY BANJUL
This designation indicates a cable to Washington with an information copy to the American Embassy
in Banjul, Gambia.
P.C. is a cable abbreviation for to Peace Corps. It alerts Embassy and State Department
Communications Offices that the cable is intended for a person or office at Peace Corps.
MEDICAL EYES ONLY (Med Eyes Only) is a Peace Corps designation that ensures handling of the
cable in such a way that medical confidentiality will be preserved. Cables so designated have
distribution limited to medical personnel. They should be sent to and from the communication office
in a sealed envelope marked MED EYES ONLY.
Med Eyes Only should not be used for correspondence regarding policy, procedure, supplies, etc.
9. To
This is the specific person and/or office to which the cable is intended. Therefore,
TO: DGOOTNICK, VS/MS
indicates that the cable is intended for D. Gootnick, Director of Medical Services.
10. From
This is the specific person and/or office sending the cable. Thus,
FROM: DR. H. GLUCKSBERG, APCMO/LOME
indicates that the cable was sent by Dr. H. Glucksberg, the APCMO, in Lome, Togo.
This refers to an Executive Order which deals with declassification of materials. Since Peace Corps
cables are unclassified, it is not applicable (N/A). Therefore,
E.O. 12356: N/A
Page 2
TG 370 ATTACHMENT A
12. Tags
Tags are designations used by State Department for the filing and distribution of cables. Peace
Corps does not use this system. Therefore,
TAGS: N/A
13. Subject
The topic of the cable. Therefore, a specific PCV would be referenced as follows:
SUBJ: PCV JANE DOE SSN 123-45-6789
14. References
References are previous cable correspondence on the same subject. For example,
REF: LOME 0980
indicates Cable No. 0980 from Lome contains information on the same subject.
The message should be brief but clear. Repeat important information, especially numbers. For
example:
WORKING DX ICD-9-CM 002.0 RPT 002.0
the working diagnosis is ICD-9-CM 002.0 Repeat 002.0
16. Signature
All official cables bear the name of the Chief of the originating facility, e.g., the Ambassador, the
Charg, the Secretary of State, etc. In the example case,
BRAY
refers to Ambassador Bray. This does not mean these cables must be approved by the individual.
17. Classification
All Peace Corps cables are unclassified and are designated as such.
18. YY
YY indicates to the optical scanner that it has reached the end of the message.
Page 3
Peace Corps
Technical Guideline 380
MEDICAL EVACUATION
1. PURPOSE
2. BACKGROUND
The majority of medevacs are to the U.S. In certain circumstances, however, medevacs are to
a regional evacuation site or other non-U.S. location.
See Technical Guideline (TG) 385 Emergency Medical Evacuation for guidance on
medevac of an acute or life-threatening illness or injury that requires emergency air rescue by
a chartered aircraft to ensure timely delivery of care.
To ensure preparedness, each post must develop and maintain two documents: (1) a Medical
Evacuation P lan and (2) an Emergency Action Plan.
The Country Director (CD), with the assistance of Peace Corps staff and the
American Embassy, is responsible for developing, testing and periodically reviewing
the EAP. The PCMO typically participates as a member of the emergency planning
team.
Peace Corps Manual Sections (MS) 270 Volunteer/Trainee Safety and Security and
350 Emergency Action Plans provide guidance on the development of an EAP.
The Medical Evacuation P lan is a reference document for PCMOs and a resource for other
providers and staff who may not be familiar with the medevac process.
While the exact content of a Medical Evacuation Plan is specific to each post, each
plan should include the following information:
1. Medevac Procedures
Medevac checklist for the PCMO, CD and Director of Management Operations (DMO)
(see ATTACHMENT B)
TG 380 Medical Evacuation;
Peace Corps Manual Section (MS) on Medical Evacuation;
2. Emergency Contacts
4. Communication Systems
5. Transportation Systems
(continued)
Contact information for facilities and providers competent to perform emergency blood or
blood products transfusions;
U.S. Embassy walking blood bank procedures, if applicable;
Lists of Volunteers, staff and others and their blood type.
Accompaniment MS;
Accompaniment procedures and responsibilities (see section 9).
Useful sources for developing or updating a Medical Evacuation P lan may include:
The PCMO should update the Medical Evacuation P lan periodically to ensure that the
document is accurate and current. The PCMO should document the date(s) of the
annual review(s) in the plan.
Additionally, the PCMO should review the Medical Evacuation P lan annually with the
CD, DMO, and support staff who may be involved in a medevac, e.g., health unit
support staff, drivers, and translators. The purpose of this review is to educate Peace
Corps staff on the medevac process and ensure their participation as necessary.
The purpose of the site locator form is to assist the PCMO and the country staff with
locating a Volunteer in a medical or non-medical emergency. Forms should contain
contact, transportation, and communication information for the Volunteer including a
detailed map and directions to the Volunteer's home, work site, and nearest medical
facility. Volunteers should update the site locator form whenever the basic information
changes.
There is no Agency format or template for a site locator form. A sample site locator
form is included in ATTACHMENT A. The CD, together with the country staff, is
encouraged to develop a site locator form that meets the specific needs of the post.
The PCMO must have direct access to the site locator forms, either in the Medical
Evacuation P lan, or in another readily accessible location.
6. MEDEVAC DECISIONS
The decision to medevac a Volunteer to the U.S. is made by OMS, in consultation with the
PCMO and Regional Medical Officer. The decision to medevac a Volunteer to a regional
medical evacuation site is made by OMS, or the RMO in consultation with the PCMO.
PCMOs should inform OMS of all RMO medevac decisions.
This section describes standard procedures for the initiation, coordination and administration
of a medical evacuation.
6.1 Consultation
Medevac consultation is the dialogue between OMS and the PCMO in a setting
where medical evacuation is under consideration.
OMS consultation is required for medical evacuation to the U.S. OMS
consultation, or RMO is also required for medical evacuation to a regional
evacuation site or other non-U.S. site except where medical evacuation is a part of
routine health unit operations, e.g., routine access to medical or dental care in an
adjacent country.
Consultation may occur by cable, fax, or telephone and should include the
following information:
Volunteer's name, date of birth (DOB), social security number (SSN), and
Close of Service (COS) date;
Case summary in SOAP note format;
Anticipated time frame for medevac;
Transportation requirements;
Accompaniment requirements;
Special considerations.
Volunteers being medically evacuated often have medical problems other than the
condition necessitating the medevac. If these conditions require evaluation and
treatment beyond the scope of care available through the Peace Corps health unit,
the PCMOs should include this information in the medevac consultation
communication.
6.2 Concurrence
6.3 Authorization
7. MEDEVAC COMMUNICATIONS
Effective communication is essential for the timely management of a medevac. During the
medevac process, the PCMO will need to communicate with the Volunteer, Peace Corps staff,
local providers, local communication and transportation services, and OMS.
Post is required to establish 24/7 access to the PCMO or a qualified medical provider
in order to ensure 24-hour emergency medical assistance for Volunteers. The
emergency contact system varies by country and availability of services. PCMOs may
carry cell phones, pagers, hand-held radios, or other devices that allow immediate
contact. Where communications services are severely limited, some counties may
provide Volunteers with cell phones or other communication devices.
Communication between the PCMO and OMS regarding medical evacuation should
be conducted through the International Health Coordinator (IHC) (see section 6
above). See also TG 370 Field Consultation and Communication for detailed
information on communications with OMS during a medical evacuation.
The PCMO is required to notify the CD and the DMO upon OMS concurrence to
medevac. Notification should include the name of the Volunteer, the departure
information and specific transportation requirements. See section 9 below for the CD's
role in medical and non-medical accompaniment.
The PCMO is also encouraged to give the CD and the DMO preliminary notice when
medical evacuation of a Volunteer is likely or under active consideration.
Consistent with the Privacy Act and principles of medical confidentiality, OMS will
not, in general, notify family members or discuss the medevac with family members
unless permission from the Volunteer has been obtained.
The Volunteer may request that specific aspects of his/her current circumstances be
communicated or specifically withheld from family members. In general, the
information given to family members will be limited to pertinent facts associated with
the Volunteer's present condition.
The PCMO should send a final notification fax or cable to OMS or the medevac
coordinator at the regional destination when evacuation plans, transportation
arrangements, and other medevac logistics are final. This communication should
include the following:
Volunteer name, DOB, and SSN;
A brief statement of the reason for the medevac;
Flight schedule to include ETA and all transfer points.
Decisions about the method of transportation for a medevac are made by the PCMO and RMO
in consultation with OMS. Considerations when making transportation decisions include the
medical condition; health, safety, and comfort of the Volunteer; convenience; scheduling of
appointments; availability of Peace Corps vehicles and cost.
The PCMO may use local airline, train, bus, and taxi transportation systems to
transport an ill or injured Volunteer.
Local ambulance service is available in many Peace Corps countries and may be used
for transporting an ill or injured Volunteer. The PCMO should consider the following
when using local ambulance services:
Hours of operation;
Method of contact;
Availability of emergency equipment and medications in the ambulance;
Qualifications of ambulance crew;
Distance ambulance is willing to travel away from its base;
Ability to travel to remote Volunteer sites;
Reliability, e.g., is the vehicle frequently disabled from mechanical or fuel
problems;
Method of payment, e.g., cash at the time of transport.
Local government, military, and charter aircraft services are available in some Peace
Corps countries and may be used to transport an ill or injured Volunteer. Often these
organizations have various aircraft, e.g., helicopters that can be used to transport
Volunteers from remote sites.
The PCMO should be aware of security, customs and immigration procedures prior to
an urgent medical event. Airport security officials, customs officials, and immigration
officials are integral components of the evacuation process and post is encouraged to
develop relationships with these individuals.
Peace Corps vehicles are frequently used to transport an ill or injured Volunteer. MS
522 states:
The PCMO should review the Peace Corps vehicle use policy and post-specific
emergency use procedures with the CD prior to an urgent medical event. The CD,
together with the PCMO, is responsible for establishing a system of use consistent
with Agency policy. Considerations when developing a system of emergency vehicle
use include:
Vehicle access (24-hour access);
Need for a driver (24-hour access and method of contact);
Need for a translator;
Need for medical accompaniment;
Emergency equipment and medications (stretcher, back board, stiff cervical collar,
head stabilization equipment);
Need for seat removal to accommodate backboard or stretcher;
Travel documents (license, special permits, visas, proof of insurance).
In-country Volunteer travel for medical evaluation is authorized by the PCMO. Except
in extraordinary circumstances, Volunteers should contact the PCMO for authorization
prior to in-country medical travel and prior to seeking in-country health care.
9. MEDEVAC ACCOMPANIMENT
The policies for medical, non-medical and spouse accompaniment are outlined in MS
264.4.2.6 Accompaniment and MS 264.4.2.7 Accompaniment by V/T spouses,
Dependents, and Parents of Dependents. Medical judgments concerning the need for
accompaniment and the type of accompaniment required are determined by the PCMO in
consultation with OMS.
1. Medical Accompaniment
The PCMO, in consultation with OMS, determines that the medical condition of the
Volunteer requires accompaniment by a medically qualified individual. In these cases
the PCMO determines the most appropriate individual to accompany the Volunteer.
The PCMO should promptly notify the CD of these determinations so that post can
consider staffing and program needs. The most common medically qualified
accompaniments are the PCMO, a medical assistant, or a Peace Corps medical
consultant.
Medevacs that have been sexually assaulted or injured may require a same sex
accompaniment. Medevacs with a presumed or confirmed mental illness associated
with potential suicide may require same sex or a two-person accompaniment.
2. Non-Medical Accompaniment
The PCMO, in consultation with OMS, determines: (1) that the medical condition of
the Volunteer requires monitoring or support during travel; and (2) that monitoring
may be by a non-medically trained person. In these cases the PCMO, in consultation
with the CD, determines who will accompany the Volunteer. The accompaniment may
be a spouse, a staff member, or another Volunteer.
3. Spouse Accompaniment
Unauthorized Accompaniment:
The PCMO must ensure that the person providing accompaniment is fully informed
about the medevac process and the responsibilities of their assignment.
If the accompaniment is a family member, post should determine the length of stay in
consultation with OMS. In general, family member accompaniments who are
Volunteers are expected to return to country when the patients health status is no
longer serious and the CD determines that programmatic needs outweigh the
emotional needs of the patient.
The PCMO and the DMO collaborate on many aspects of administrative support for a
medevac.
The PCMO is primarily responsible for ensuring that all necessary and appropriate medical
care is provided in a timely and efficient manner. The DMO is responsible for providing the
necessary administrative support to accomplish these tasks.
DMOs should reference the Overseas Financial Management Handbook (OFMH), Trainee
and Volunteer Medevac and Emergency Leave for detailed information on DMO
responsibilities in the medical evacuation process. In the FY 99 edition, this information is
found on pages 233-36.
Until it is determined that a medevaced Volunteer will not return to country, the original
records must remain at Post. Only when the final decision has been made to medically
separate or COS the Volunteer should the original health record be sent to headquarters.
During a medevac, whether to the regional hub or to the U. S., copies of pertinent medical
information such as inservice notes, specialist reports, labs, CT/MRI films, etc. should be
given to the PCV or the accompaniment to hand carry. The copies of the record should be
placed in a sealed envelope and labeled as follows:
The copied health records should be given to the IHC or RMO when the Volunteer
arrives at the medevac destination.
Post will maintain the Volunteers original record and file information obtained from
headquarters or regional medevac hubs in the medevac section of the health record. If
the Volunteer does not return to country, the information should be added to the
original record before it is sent to Medical Records in OHS.
10.2 Medications
All Volunteers being medically evacuated must carry their personal passport,
visas, World Health Organization (WHO) vaccination card, and Health Benefits
identification card to the medevac destination. Local identification cards and other
forms of identification should also be carried if they are considered important
immigration documents in the host country or may be needed while on medevac.
These documents should be up to date prior to departure, and should be stored in a
location that permits both the PCMO and DMO to gain access to them in an urgent
situation.
If a passport is lost or stolen, the DMO should contact the Consular Officer at the
American Embassy and local immigration officials to assist Peace Corps with
obtaining a new passport and visa. Post should maintain a centrally located
photocopy of all passports, visas, WHO cards, and identification cards for use if
originals are lost or not available.
10.4 Medical Coverage for Health Conditions that Arise During Medevac
During Peace Corps service, Peace Corps will pay for all necessary medical care for a
Volunteer who develops an illness or becomes injured while on medevac. When
medically indicated, Volunteers may remain on medevac status for a maximum of 45
days. Peace Corps will not medically separate a Volunteer who has an urgent need for
medical or psychiatric care, or an unstable medical condition (see TG 160 Medical
Separation section 3.1).
After Peace Corps service, Federal Employees Compensation Act (FECA) will cover
service-related health problems that developed while a Volunteer was on medevac.
The contracted health insurance will cover non-service related health problems that
developed while a Volunteer was on medevac. Therefore:
Volunteers do not need short-term health insurance while in the U.S. during
service.
Volunteers do need to make an active, informed decision at COS or ET about
extending the contracted health insurance beyond the first month. See TG 330
Post-Service Health Benefits and Close of Service or Extension of Service Health
Evaluations for detailed information about the contracted health insurance.
The PCMO and the DMO should review the entire medevac process with the
Volunteer. If the Volunteer is coming to Washington, DC, the Volunteer should be
given a copy of the Peace Corps Medevac Guide to Washington D.C., and encouraged
to read the booklet prior to arrival in Washington. The booklet is available, and can be
ordered, through the Overseas Support Division in Administrative Services
(M/AS/OSD). Prior to departure, the PCMO should ensure the Volunteer understands
the following:
Transportation logistics;
What to do upon arrival at the medevac destination;
Medical clearance policy.
PCMOs, together with the DMO, should complete a Medevac Checklist and include it
in the Volunteer's health record. There is no single Agency format or template for a
medevac checklist. A sample checklist is included in ATTACHMENT B . This
document helps insure that all tasks have been completed prior to a Volunteers
departure.
The DMO arranges all logistics associated with transportation and travel of the
Volunteer being medically evacuated and the accompaniment. This includes:
Medevacs to the U.S. are issued a one-way ticket. Medevacs to a regional medevac
site may be issued either a round trip or a one-way ticket depending on the preference
of post and the regional site. Accompaniments to the U.S. or a regional medevac site
are generally issued a round trip ticket unless they have prior approval from the CD for
altering their itinerary.
Volunteers and accompaniments should be advised to: (1) retain a copy of their TA;
and (2) save receipts for all transportation lodging, tax, and other expenses. The TA
and receipts should be submitted to the Medevac Assistant in Washington, DC or
Honolulu, or to the DMO at the regional medevac site. Volunteers should contact these
same individuals if additional cash or a return travel advance is needed.
Volunteers receive cash advances and per diem sufficient to meet their needs while on
medevac. For medevacs to Washington DC or Honolulu, per diem for the first three
days of medevac are included in the Volunteers TA. Thereafter, OMS provides the
Volunteer with per diem.
The DMO should issue all medevacs to the U.S. copies of the following completed
forms:
Form PC-477: Certificate of Non-Indebtedness and Accountability for Property
(MS 223, Volunteer Trainee Readjustment Allowances Attachment I);
Power of Attorney;
Release of Medical Information.
If the Volunteer intends to resign or will be separated from service, the following form
should also be completed:
Form PC-1485: Report of Peace Corps Service (MS 284, Early Termination
paragraph 8, 12.2 and Attachment B).
When circumstances permit, the PCMO should instruct the Volunteer being medically
evacuated to attend to as much personal business as possible prior to departing from
site. The Peace Corps is not responsible for a Volunteers personal effects during their
absence from site. Volunteers should consider the following responsibilities:
If a medevac results in medical separation, the Volunteer is entitled to 100 lb. (45.5
kg) of unaccompanied baggage shipped to his/her home of record (HOR). This 100 lb.
limit includes the weight of packaging materials. The DMO should instruct the
Volunteer to make a list of personal effects, preferably prior to evacuation, clearly
identifying the items he/she wishes shipped from the remainder of his/her belongings.
The list is maintained by the DMO. Volunteers are responsible for all costs of shipping
beyond the 100 lb. limit and must arrange for payment prior to shipping. Peace Corps
is not responsible for lost or stolen items. Volunteers are encouraged to purchase a
personal property insurance policy.
11. FUNDING
Funding for international medical travel and accompaniment (U.S., regional, and other non-
U.S medical travel) is allocated to post budgets from the Office of Volunteer Support -
Centrally Managed Accounts at the beginning of each fiscal year. These funds may not be
reprogrammed for any other purpose. Additional funds for international medical travel, if
required, should be requested from the Office of Volunteer Support by the Region or the
Budget Implementation Team (BIT). Unused funds are returned to the agency. See the
Overseas Financial Management Handbook for more detailed information.
An OMS authorization number, or fiscal coding, is required for medical evacuations to the
U.S., and for any chartered or emergency air rescue authorized by OMS.
An OMS authorization number, or fiscal coding, is not required for regional medevacs or
other non-US medevacs.
Post is responsible for in-country travel expenses including those expenses for Volunteers
who are later transported outside the country.
Post is responsible for all travel expenses associated with accompaniments.
Logistical and emotional support from OMS or the staff at the regional medevac
destination.
Evaluation and treatment of health conditions unrelated to the reasons for medical evacuation
will be evaluated by OMS, or the regional site, on a case-by-case basis. In general, PCMOs
should continue to evaluate and treat routine and on-going medical conditions in country.
Medevac Orientation
All medevacs to Washington meet with the regional IHC and the Medevac
Program Specialist on the first business day after their arrival. The medical
evaluation process, appointment schedule, and relevant policies and procedures are
reviewed during this orientation. At this meeting, PC-127C Authorization of
Payment of Medical/Dental Services authorizations, which include a release of
medical information by consultants are also issued. Copies of the health record and
other case-related material are collected by the IHC from the Volunteer or the
accompaniment at this time. Copies of the health record are held and maintained
by the regional IHC throughout the medevac.
The IHC will provide the PCMO with weekly updates on the status of all
medevacs. This update may include a brief summary of the Volunteer's recent
history, current diagnosis, treatment plan, and prognosis; or may consist of a copy
of the medevac case management notes. At the conclusion of the medevac, the
IHC or the regional site coordinator will notify the PCMO of the outcome of the
medevac, including either the return ETA information or the anticipated separation
date. Within the parameters of medical confidentiality, the PCMO is responsible
for informing the CD and the DMO of the Volunteer's status.
Medical care for Volunteers evacuated to a regional medevac site or other non-U.S.
site is provided by local consultants. In certain circumstances, the PCMO or RMO at
the regional medevac site may provide direct patient care. Health unit staff at the
regional medevac site will monitor all care rendered to Volunteers through direct
contact with the Volunteer and frequent consultations with a Volunteers care
providers.
Procedures for managing medevacs at regional medevac sites and other non-U.S. sites
vary by regional location. The medical and administrative staff at the regional site and
at the sending posts will coordinate administrative procedures for regional medevacs.
Posts should consider the following when developing regional medevac procedures:
Arrival logistics;
Accommodation, transportation, per diem;
Medevac orientation;
Management of health records;
Case management, including consultant appointments, evaluation, and treatment;
Monitoring care;
Provision of medication and supplies;
Documentation and status reports;
Medical clearance and return to country.
Refer to MS 284, Section 3.0, Medical Separation and MS 220, Section 7.1, Medical
Hold for policies governing medical separation.
Volunteers may remain on medevac status for up to 45 days. The 45 day time frame begins
with the evacuee's departure from the country of assignment.
Volunteers within 90 days of COS are given an advanced COS date and do not
return to post unless the CD determines that the Volunteers absence would
adversely affect Peace Corps effectiveness in the host country (see MS 264).
A Volunteer on medevac at a regional medevac site must be medically cleared by
the providers at the regional site to return to post. When cleared, the Volunteer
returns to post only after the providers at the regional site have reviewed the case
with the PCMO at the sending post, and obtained his/her concurrence. If the
providers at the regional site and the sending post cannot reach a clear
determination on a Volunteers return to country, the providers should consult
OMS. The regional site should notify the sending post and OMS when a Volunteer
has been cleared to return to post.
Volunteers who have been medically cleared are expected to return to post
promptly. Generally, travel to post is initiated within 24 hours after medical
clearance unless the CD has authorized annual leave or absence from post.
Prior to departure, the PCMO should inform Volunteers that they must contact OMS if
they require medical or dental attention in the U.S. beyond that previously authorized
by the PCMO. Common situations that require OMS assistance include: an acute
illness requiring medical care; evaluations or treatments recommended as follow-up to
an initial consultation authorized by the PCMO; prolonged dental interventions such as
crowns.
When a Volunteer on personal business in the U.S. contacts OMS, the IHC works with
the individual to ensure that medical needs are resolved within the allotted leave time.
The IHC monitors care through direct contact with the Volunteer and consultation
with his/her care providers. When necessary, OMS staff issues additional 127C
authorizations for medical or dental care.
If the time required for resolution of a medical problem exceeds the Volunteer's leave,
the IHC will: (1) place the Volunteer on Medical Hold at HOR or (2) have the
Volunteer travel to Washington, DC for evaluation or care.
The field support staff maintains a record of all communication and 127C
authorizations for Volunteers on Medical Hold. This documentation is sent to post to
be included in the Volunteer's health record following the Volunteers return to
country. Volunteers are responsible for obtaining copies of their medical reports for
care received at their HOR and bringing them back to country to be included in their
health record.
The PCMO reports all regional medevacs to OMS in the Country-Sponsored Medevac
Form: (see TG 430 Case Notification section 3 Reporting of Country-Sponsored Medical
Evacuation).
The PCMO reports all medevacs, regional and U.S., to OMS in the monthly epidemiological
surveillance report (see TG 410 Epidemiological Surveillance System).
Prolonged immobility and venous stasis associated with long-haul flights are the major
promoting factor for venous thromboembolism. Risk increases with duration of flight (more
common in flight of >12 hours duration, whereas rarely occurring in flights of <4 hours
duration). Compression of the popliteal vein at the edge of a seat and hemoconcentration
associated with diminished fluid intake and increased insensible water loss may serve as
additional risk factors.
The risk of venous thrombosis is very low in travelers without pre-existing additional risk
factors. These additional risk factors include age above 50 years, clotting disorders,
cardiovascular disease, malignancy, recent major surgery or trauma, history of deep venous
thrombosis or pulmonary embolism, pregnancy, and use of oral contraceptives. Smoking,
obesity, and varicose vein may serve as additional risk factors.
Traveler's thrombosis is a potentially preventable hazard of air travel. Preventive efforts are
largely focused on stimulation of circulation to prevent venous stasis. Most travelers are at
low risk and only need to follow nonpharmacologic measures listed below.
The PCMO should consider the risk of thromboembolism for all Volunteers being medically
evacuated and use appropriate measures to minimize the risk of thromboembolism in
consultation with OMS.
4. Simple, frequent, isometric calf exercises, such as flexion and extension of foot and
ankle rotation exercises.
8. Avoid excess alcohol and caffeine-containing drinks because they may cause
dehydration.
9. Do not place hand-luggage where it may restrict movement of legs and feet.
10. Get off plane and walk around in air terminal at refueling stops.
2. Low-molecular-weight heparin.
i.e., Enoxaparin sodium, 30 - 40 mg, via subcutaneous injection
This form is required to ensure that in the event of an evacuation or medical emergency Peace Corps can contact
and, if necessary, locate you.
INSTRUCTIONS: Please complete this form and return it to the Peace Corps Medical Officer within 30 days of your arrival at
site. Please provide complete information utilizing your host institution, counterpart, and host family to obtain the information
requested. When your contact information, housing, or site assignment changes; it is your responsibility to ensure that an up-
to-date form is on file with the Peace Corps Health Unit
Name: DOB:
Location of Passport (if kept at site):
5) Contact person at site willing to go to your home in an emergency; name, address and telephone number:
6) Name, address and telephone number of the Volunteer who lives closest to you:
9) Name address and telephone number of Chief of Police, police station, or security official near your site:
Page 1
TG 380 ATTACHMENT A
10) Methods of transportation to the capitol available at site including procedures for use.
11) Communication options available at site including procedures for use, i.e., availability, hours.
12) Name and contact information for nearest airport or landing strip. Specify small or large aircraft capacity.
13) Name, address and telephone number of person to notify in case of an emergency. Please specify parent,
family member, or other.
Please use the space below or the back of this sheet to draw a detailed may to your site. Indicate the location of your
residence, work place, and nearest medical facility. Indicate north on your map and use descriptions and landmarks
that would assist us in locating you.
Page 2
TG 380 ATTACHMENT B
1. HEALTH OFFICE
o Medevac field consult sent; VS concurrence and/or authorization number received.
o Itinerary and ETA sent to VS or regional medevac site.
To Volunteer:
o Health record in sealed envelope addressed to VS
o X-rays and pertinent diagnostic studies
o Two week supply of routine medications and malaria prophylaxis, if indicated
o WHO vaccination card
o Health Benefits identification card
o Medevac instructions
o Explanation of medical separation and medical clearance policies
PCMO Signature
2. ADMINISTRATIVE OFFICE
To Volunteer:
o Transportation from post to medevac site, i.e., airline ticket, transportation to airport
o Travel Authorization (TA)
o Passport and visas
o Cash advance and per diem
o Prepare final termination document and explain any deductions that will be made from the Readjustment
Allowance for overpaid living allowance, leave allowance, or other indebtedness
o Form PC-477: Certificate of Non-Indebtedness and Accountability for Property
o Power of Attorney form signed by Volunteer
o Release of Medical Information form signed by Volunteer
o Explanation of personal effects shipment policy, i.e., weight limits, personal property insurance. Review
status of personal belongings left in country, i.e., secure, itemized list received?
1. PURPOSE
To establish procedures for the medical evacuation of Peace Corps Volunteers and Trainees
requiring emergency medical evacuation (medevac).
2. BACKGROUND
Emergency medical evacuation is used for acute, life- limb- and organ-threatening
emergencies that require emergency medical evacuation by a chartered aircraft to ensure
timely delivery of care. Such emergencies among Peace Corps Volunteers are rare.
Nevertheless, Peace Corps Medical Officers (PCMOs) must be prepared to manage these
emergencies. In these situations, Peace Corps will request the services of an international air
rescue company or the U.S. military to evacuate the Volunteer. Emergency air evacuations
require a coordinated effort between the post, the PCMO, the Office of Medical Services
(OMS), and the air rescue company.
The telephone numbers, fax numbers, email addresses, mailing addresses, and
other contact information listed below are up-to-date as of the publication of this
Technical Guideline (TG). Posts should ensure that their contact information is
accurate and up-to-date.
TG 380 Medical Evacuation section 5.1 identifies the organization and contents of a
Medical Evacuation Plan. In order to ensure preparedness for an emergency medevac, the
PCMO should ensure that the plan is current and contains the following information:
Emergency air rescue procedures;
Contact information for in-country and international air rescue services;
Emergency transfusion procedures;
Information on access to a local trauma facility, general surgeon, and cardiologist or
internist;
Capabilities of local operating suites, intensive care units, and emergency departments;
Location of emergency medical equipment and supplies in the health unit.
The PCMO should ensure that all individuals who may participate in an emergency medevac
are familiar with emergency medical procedures.
OMS will coordinate the logistics of an emergency medevac. Therefore, the PCMO should
contact OMS as soon as possible by telephone when an emergency medevac is being
considered. Procedures for contacting OMS in an urgent situation are as follows:
Telephone: During business hours (7:30 a.m. to 5 p.m. eastern time, Monday through
Friday)
For urgent concerns during business hours the PCMO should contact field support
directly through the main OMS switchboard (202-692-1500). When calling the OMS
switchboard, PCMOs should identify themselves, state the urgency of the call, and state
with whom they would like to speak. The administrative assistant who answers the
telephone will ensure that the call is transferred to the appropriate OMS staff.
During Business Hours Contact IHC through the main OMS switchboard.
(202-692-1500)
After Business Hours Contact the Medical Duty Officer
(weekends, holidays) (301-790-4749)
If Communication is Impossible:
When emergency air rescue is required, OMS is responsible for contacting the air rescue
company and requesting service. Decisions concerning which air rescue company to use are
made on a case-by-case basis by OMS. Unless authorized by OMS, PCMOs should not
contact or request service directly from air rescue companies.
PCMOs should be familiar with in-country air rescue services and international air rescue
companies servicing their country.
In the rare event that communication with OMS is impossible; the PCMO may contact an air
rescue company directly. MEDEX/On-Call International is the air rescue company that is
most accessible to Peace Corps posts overseas.
The PCMO is not responsible for coordinating the logistics of an emergency medevac.
The air rescue company, post administrative staff, and OMS are primarily responsible
for coordinating the logistics of the emergency evacuation process (see sections 7 and 9
below).
The PCMO should contact OMS as soon as possible when emergency air rescue is
being considered or if a patient is unstable.
A field consult is required for all emergency medevacs and should be conducted by
telephone directly with OMS or through the Area Peace Corps Medical Officer
(APCMO). When calling OMS, the PCMO should have available the following
information:
Patient information, i.e., Volunteer's name, date of birth (DOB), social security
number (SSN), and Close of Service (COS) date;
Return telephone and fax number of the PCMO;
Geographic location of the ill or injured Volunteer;
Name and telephone number of local attending physician;
Name and telephone number of hospital or clinic, if applicable;
Telephone and fax number of the American Embassy;
Case summary, i.e., patient status, presumptive diagnosis, and treatment initiated;
Volunteer permission to notify parents or next of kin, to include contact name and
telephone numbers.
The PCMO should give the CD and Administrative Officer (AO) preliminary notice
when an emergency medevac is likely or under active consideration.
PCMOs must notify the CD and the AO upon OMS concurrence to emergency
medevac.
The PCMO should provide the CD and the AO with periodic updates throughout
the emergency evacuation process.
After the emergency medevac has been initiated, the coordinating physician of the air
rescue company will usually contact the PCMO to verify contact information, obtain a
more detailed summary of the case, and assess the current status of the patient. Often
the air rescue company will also contact the attending physician managing the case.
OMSs primary responsibility is to identify and mobilize the most expeditious and
efficient air rescue service under any set of circumstances.
OMS will provide the air rescue company with the following information:
Patient information, i.e., Volunteer's name, DOB and SSN;
Telephone and fax numbers of the PCMO;
Geographic location of the ill or injured Volunteer;
Name and telephone number of the local attending physician;
Name and telephone number of the hospital or clinic, if applicable;
Telephone and fax number of the American Embassy;
Office of Medical Services July 2010 Page 5
TG 385
Emergency Evacuation
Once the air rescue has been initiated, OMS will relay the following information to
post:
Verification that OMS has obtained services of an air rescue company;
Confirmation of air rescue company's intent to contact post and name of their
coordinating physician;
Medevac destination, receiving facility and attending physician at the receiving
facility;
Flight estimated time of arrival (ETA).
The OMS regional International Health Coordinator (IHC) is primarily responsible for
maintaining and facilitating communication between the PCMO, OMS, and the
physician coordinator at the emergency air rescue company, throughout the evacuation
process.
OMS will provide interim case management direction to the PCMO throughout the
evacuation process. If needed, OMS will provide case consultation and interim
management advice to local physicians.
The air rescue company, in consultation with OMS and the PCMO, is primarily
responsible for the medical management of the case. Most air rescue services have a
consulting medical advisor who will provide case consultation and interim management
advice to the PCMO and local specialists.
The air rescue company is responsible for all transportation and logistics associated
with air evacuation. This includes:
Transportation of the Volunteer from the in-country site of stabilization to the
airport;
Facilitating passage of the Volunteer through immigrations and customs;
Transportation of the Volunteer from country to an appropriate medevac destination
and receiving facility.
Post staff involved with an emergency medevac should be prepared to assist the air
rescue company in obtaining the following logistical information. Posts should be
familiar with this information prior to an emergency medevac situation.
Local airport facilities, e.g., hours of operation, length of runway, runway surface,
availability of night lights.
Flight permission and landing rights, e.g., procedures for obtaining airspace,
immigration, and landing rights. Assistance from the U.S. Embassy may be
required if local government permission to land is required.
Landing fees, e.g., required landing fees at the national airport, required method of
payment.
Local refueling procedures, e.g., availability of aviation fuel, approximate cost of
refueling a small Lear jet, method of payment. Lear Jet 55 ambulance version and
Lee Jet 35/36 are the most common aircraft used by air rescue companies.
Ambulance protocols, e.g., procedures for getting an ambulance and attendants onto
the runway.
The air rescue company, in consultation with OMS, determines the medevac
destination and the receiving facility. They communicate directly with the receiving
facility to identify an attending physician and organize reception of the Volunteer.
The responsibilities of the air rescue company generally end when the Volunteer is
admitted to the receiving facility. At the request of OMS, the air rescue company will
monitor a patient on a daily basis until services are discontinued.
In general, Volunteers evacuated to a medevac destination other than the U.S. are
further evacuated to the U.S. when stable.
The air rescue team, in consultation with OMS and the PCMO, determines the medical
personnel and skill requirements of the flight crew, e.g., surgeon, anesthesiologist,
nurse, etc. They also determine the type of equipment needed in transport, e.g., oxygen,
medications, life support systems, etc.
8.5 Accompaniment
Medical judgments concerning the need for accompaniment and the type of
accompaniment are made by the air rescue company. Space on air rescue aircraft is
frequently limited and accompaniments cannot be accommodated.
The air rescue company is responsible for maintaining communications with the post,
the PCMO, and OMS throughout the air evacuation process.
In general, after the emergency medevac has been initiated, the coordinating physician
of the air rescue company will contact the PCMO to verify contact information, obtain
a more detailed summary of the case, and to assess the current status of the patient.
Often the air rescue company will also contact the attending physician managing the
case.
The air rescue company will provide OMS and the post with the following information:
Medevac destination, receiving facility, and attending physician;
Flight plan, ETA and periodic arrival updates;
Type of plane, plane tail sign, plane call sign;
Name and nationality of the crew.
Following departure:
Report of patient status following initial assessment;
Report of patient status following arrival at the destination facility.
9. ADMINISTRATIVE SUPPORT
In an urgent situation, post administrative staff should make every effort to accomplish as
many administrative support tasks as circumstances and time safely allow. These procedures
are outlined in the table below. As time permits, see TG 380 Medical Evacuation, section
10 Administrative Support for a more detailed description of medevac support procedures.
Post administrative staff is also responsible for providing logistical and communication
support during an emergency medevac. A special consideration is the Volunteers passport.
In an urgent situation, the Volunteers passport may not be in the same location as the ill or
injured Volunteer. Post should make an immediate effort to obtain the Volunteers passport
and ensure that it is available to accompany the Volunteer.
PCMO Prepares Volunteer health The health record is not sent with an
record. emergency medevac. A case summary, copies
of all case-related notes, x-rays and diagnostic
studies should be sent. The health record
should be prepared and kept at post until
requested from OMS.
As time permits.
Provides supply of As time permits.
medications.
Prepares WHO card.
On occasion, OMS may request the assistance of the Department of Defense aeromedical
evacuation units to evacuate a Volunteer. Military Airlift Command (MAC) flights are only
requested in life-threatening emergencies when no alternative to evacuation is available. In
general, MAC flights are made in cargo planes (C-141s) equipped with minimal medical
equipment. Physicians are not routinely assigned to the mission. Detailed procedures for
requesting a MAC flight are outline in MS 264.4 Emergency Military Airlift Command
Flights.
On occasion, Peace Corps may require the assistance of the U.S. Embassy Medical Unit at
post to expedite a medevac. Post should never hesitate to request the Embassys assistance if
it will improve the welfare of the Volunteer. Situations when Embassys assistance may be
necessary include:
Lost or expired passport or visa;
Customs, police or immigration issues;
Special airport privileges are needed for emergency air services;
Most requests for diplomatic assistance should go through the Consular Officer during
working hours or the Duty Officer after hours. The Consular or Duty Officer will notify other
American officials, if necessary, including the Ambassador. Generally requests for the
Embassys assistance should come from the CD.
OMS, together with the air rescue company, assumes all responsibility for the Volunteer
once the emergency transport departs post. OMS will:
Monitor care of the Volunteer at the medevac destination;
Provide PC-127C Authorization of Payment of Medical/Dental Services forms for
evaluation and treatment as needed;
Guarantee payment to hospitals and physicians;
Arrange repatriation of the Volunteer to the U.S. or return of the Volunteer to post;
Discontinue services of the air rescue company when appropriate.
The PCMO reports all emergency medevacs in the monthly epidemiological surveillance
report. (See TG 410, Epidemiological Surveillance System).
INSTRUCTIONS: This check list outlines the responsibilities of the PCMO, the air rescue company, OMS, and post during an
SOS medevac. The checklist may be used by the PCMO and other staff to organize the multiple tasks associated with an SOS
medevac, and to assist individuals who support an SOS medevac.
1. PCMO RESPONSIBILITIES
Obtain OMS field consultation and concurrence. Have the following information available prior to consult:
Return telephone and fax number of PCMO.
Geographic location of ill or injured Volunteer.
Name and telephone number of local attending physician.
Name and telephone number of hospital or clinic.
Telephone and fax number of American Embassy.
Case Summary.
Notify parents : Y ____ N ____ Name and contact information.
2. OMS RESPONSIBILITIES
Contact air rescue company. Provide post with the following information:
Verification that air rescue services have been obtained.
Name of air rescue company.
Name of coordinating physician at the air rescue company.
Medevac destination and receiving facility.
Name of attending physician at receiving facility.
Send itinerary and ETA to post.
Maintain and facilitate medevac communications between PCMO, OMS and the air rescue company.
Provide interim case management direction.
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TG 385 ATTACHMENT A
Following Departure:
Report of patient status following initial assessment.
Report of patient status following arrival at destination facility.
4. ADMINISTRATIVE RESPONSIBILITIES
PCMO
To SOS medical personnel: A case summary, copies of all case-related notes, x-rays and diagnostic
studies. The Volunteer Health Record does not accompany an SOS medevac.
Two week supply of routine medications and malaria prophylaxis, if indicated.
WHO vaccination card.
Health Benefits identification card.
Medevac instructions and While Youre Enroute to Washington D.C.
Explanation of medical separation and medical clearance policies.
ADMINISTRATIVE OFFICER
Passport, visas, other legal documents required by country for an emergency medevac.
Travel Authorization.
Cash advance and per diem.
Form PC-505: Volunteer Trainee Readjustment Allowance.
Form PC-477: Certificate of Non-Indebtedness and Accountability for Property.
Power of Attorney form signed by Volunteer.
Release of Medical Information form signed by Volunteer.
HOR address for Volunteer.
Explanation of personal effects shipment policy, i.e., weight limits, personal property insurance.
Review status of personal belongings left in country, i.e., secure, itemized list received?
Form PC-1485: Report of Peace Corps service completed if Volunteer intends to resign or be separated
from service.
Authorizations for leave or vacation following medical clearance.
Page 2
Peace Corps
Technical Guideline 390
1. PURPOSE
The purpose of this guideline is to provide the PCMO with information needed to safely and
effectively evacuate Volunteers from a country when Peace Corps operations are suspended.
2. BACKGROUND
Since its beginning, the Peace Corps has found it necessary on occasion to evacuate Volunteers
and staff from a country and to suspend Peace Corps operations. The evacuations have most
often occurred due to political unrest or civil war, and have generally been followed by the
indefinite suspension of the Peace Corps program in the evacuated country. On occasion,
however, a natural disaster or criminal activity has caused the Peace Corps to evacuate all or
some Volunteers from a country or withdraw Volunteers from their sites to another location in
country only to return and continue operations once the danger has passed. Evacuation Support
Guide, September 2004 (located on the intranet, Volunteer Safety and Overseas Security)
3. GENERAL CONSIDERATIONS
Emergency evacuation of a Peace Corps program during a period of unrest creates anxiety and
tension among Volunteers and staff alike. Every staff member has a multitude of tasks to
accomplish in a short period of time, so prioritizing is essential.
In preparation for an evacuation, the first step is to annually review the post Emergency Action
Plan (EAP). The EAP is a country-specific document that sets forth a detailed plan of action to
be followed by post in the event of various emergency situations, including an evacuation. See
(Peace Corps Evacuation Support Guide, September 2004).
With the decision to suspend, a transition conference is scheduled. The Country Director will
determine what information will be shared with the Volunteers regarding evacuation. For safety
reasons, it is not always possible to provide Volunteers with a full explanation of their status and
entitlements before leaving country. Volunteers should be assured, however, that their options
will be fully explained once they are all safely out of the country.
Once the evacuation decision is made, the central task is to inform and then evacuate the
Volunteers as fast and safely as possible. How that is accomplished will vary with the
circumstances; planning and decision-making at this stage requires flexibility and innovative
thinking. The EAP may not anticipate all the issues that arise. Events may be moving so quickly
that there is no time for consolidation. Missing, ill, or uncooperative Volunteers, failed
communications, unreliable modes of transportation, and unforeseen dangers are all potential
problems. For all of these events, the Close of Service (COS) health evaluations procedure is a
requirement that must be accomplished in a short amount of time and in a high stress
environment.
This TG uses the term Volunteer to refer to both Volunteers and Trainees for the purpose of evacuations.
____________________________________________________________________________________________________
Office of Medical Services September 2006 Page 1
4. OFFICE OF MEDICAL SERVICES
The Office of Medical Services (OMS) staff is an integral part of the Peace Corps process of in-
country closures, evacuations and suspensions. In order to ensure a smooth transition on
evacuating Volunteers, staff and PCMOs, OMS has designated a Lead Coordinator to implement
the process. The Lead Coordinator plans and implements the medical activities of the stateside
and/or overseas transition conference for OMS. This includes representing OMS in the
headquarters transition team meetings and serving as liaison between the post, PCMO, OMS and
headquarter/regions point-of-contact personnel.
The Lead Coordinator forms an OMS evacuation team that will be sent to assist in the transition
conference either stateside or overseas. The size and composition of the team is based upon the
number of evacuees and services provided by OMS. For evacuation to the U.S., the OMS
evacuation Standard Operating Procedures (SOP) will be implemented.
PRE-EVACUATION
Participate in country evacuation meetings to assist in coordinating evacuation efforts
It is strongly urged that the PCMO accompany the Volunteers to ensure that medical
records and medications are transported properly and Volunteer medical needs are
addressed promptly
Send a complete list of Volunteers who have priority medical, mental health and
medication needs to field support nurse and/or receiving PCMO
Communicate Volunteer medical, mental health and medication needs to OMS in
Washington
If evacuation is to a third country, communicate with receiving PCMO and OMS
Ensure safe and confidential transport of Volunteer medical records (health jackets and
WHO cards)
Provide for secure retention or destruction of other records as appropriate
Prepare to take to the evacuation site stocked medical kits that include standard Volunteer
medical supplies
Give all Volunteers their own prescription medications and an adequate supply of malaria
prophylactics (if applicable)
Take sufficient supplies of controlled drugs for transition, if the PCMO is accompanying
the evacuees. If not, destroy and document waste procedure. (MS 511, Property
Management at Overseas Posts, Section 8.8, TG 200, Overseas Health Units, Section 8)
Note: If a PCMO or Medical Assistant remains at post, medications not taken on the
evacuation should be inventoried and placed in proper custody
Continue providing mental and physical healthcare to the Volunteer
ARRIVAL
Provide receiving PCMO, field support or OMS nurse with any critical information on
Volunteers upon arrival
Relinquish ongoing responsibilities for clinical care to receiving PCMO and/or OMS
nurse (for third country evacuations)
Deliver medical records to PCMO or OMS designee
Plan time for own needs; rest and closure. If available, seek support from OMS and OSS
____________________________________________________________________________________________________
Office of Medical Services September 2006 Page 2
6. TASKS OF RECEIVING PCMO: THIRD COUNTRY
PRE-EVACUATION
Assign a lead PCMO to perform COS activities and work with OMS Lead Coordinator
Prepare to receive evacuated Volunteers and coordinate care with OMS Lead Coordinator
or designee
Cancel any non-emergent appointments for in-country Volunteers and encourage those
Volunteers to remain at their sites
Develop COS interview and physical exam schedule
Contribute to a safety-oriented country information packet for arriving Volunteers by
providing information related to medical needs and tasks
Create office space to secure incoming OMS documents (COS forms) and confidential
health records. Arrange for confidential space for COS interviews and exams
Alert consultants and lab facilities regarding the possibility of services that may be
required
Coordinate with country team in planning COS conference schedule
Consult with Administrative Officer and develop a separate tracking system for
evacuated Volunteer medical supplies and visits
ARRIVAL
Assist with safety briefing--other staff may be involved
Encourage Volunteers to discuss any medical issues with onsite medical providers or
receiving PCMO
Assess medical issues and provide needed medications and/or supplies
Arrange transition of care details from Evacuated PCMO to Local PCMO/local
healthcare provider
Take report and relieve evacuating PCMO of tasks as desired or necessary
If available, utilize Office of Special Services personnel for staff and Volunteer
counseling sessions
All Volunteers are required to attend and learn options available regarding either COS or transfer.
All Volunteers will close service with the exception of transfers (consult with region on
availability of transfers)
At the transition conference, the OMS evacuation team conducts interviews and provides
a session on post-service benefits and processes
Depending on the situation at the transition conference, either physical exams may be
done or authorizations may be given for COS exams to be performed at home of record
8. TRANSFERS
The region will decide if transfers are to be offered at the conference. The regional representative
at the transition conference will approve potential Volunteers for transfer. Medical concurrence
for these transfers is necessary from the evacuating and receiving PCMOs and/or OMS designee.
____________________________________________________________________________________________________
Office of Medical Services September 2006 Page 3
REFERENCES
Peace Corps Volunteer Safety Council, Evacuation Support Guide, September 2004
Laycock, Jane, Farmer, Bill. Evacuation Advice for PCMOs: A Fact Sheet of Suggestions, Peace
Corps, 2002.
____________________________________________________________________________________________________
Office of Medical Services September 2006 Page 4
Peace Corps
Technical Guideline 395
1. PURPOSE
The purpose of this guideline is to provide the PCMO with information needed to
effectively close a post health unit after the program is suspended.
2. BACKGROUND
Once a decision has been made to close a post, there are a number of activities that
must be completed to ensure a smooth exit from the country. This technical
guideline will assist the PCMO and health unit staff with accomplishing these tasks.
3. GENERAL CONSIDERATIONS
The areas for review and consideration when closing a health unit include
coordination of a timeline with post staff, notification of consultants, medical
facilities, laboratories, pharmacies, etc., proper disposal of medications, supplies,
office supplies, and durable equipment. This guidance will focus on each area and
list specific tasks to be performed.
Health Records
Volunteer/Trainee health records in PCMEDICS should be relinquished to OHS
in the same process as COS. Outstanding Volunteer/Trainee reports received
after the health record has been relinquished should be reviewed to assess the
need for follow-up, then, initialed and dated. Write no follow-up needed on
those that do not require further attention. Send all reports to the Post-Service
Unit via SFTP.
Vendor Notification:
Notify consultants and other vendors (i.e. pharmacy, laboratories, etc.) as soon as
possible to facilitate payment of any outstanding bills.
Medications:
Keep all medications, supplies, and equipment until the last volunteer has closed
service.
Destroy or transfer unexpired meds to the Embassy health unit or a neighboring
post (refer to MS 341: Non-emergency Post Closing, Section 7.3).
Narcotics should be transferred to the U.S. Embassy medical unit and transfer
should be done in the presence of a PCMO, CD or designee AND Embassy
medical personnel. The narcotics log should also be transferred.
Medications and supplies cannot be donated to non-US government agencies or
organizations.
Destroy all expired medications. Medications must be destroyed in the presence
of the PCMO and the CD, or designee, in accordance with local waste disposal
and air and water pollution control standards.
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Office of Health Services December 2015 Page 1 of 2
Document all medications destroyed on the Medical Supplies Disposal form, TG
240, attachment E.
Document and sign for all medications transferred on the Medical Supplies
Disposal form, TG 240, attachment E. Forward this form to the Director of OMS
through the Medical Inventory e-mail address:
medicalinventory@peacecorps.gov, and the Office of Administrative Services
through PLS: pls@peacecorps.gov. All controlled substance documents must
also be sent to the Controlled Substance Officer at PLS.
Per MS 734.10.1, all medical inventory records must be kept and available for
two years from the last entry date. Records must be disposed of in accordance
with the Guide to Peace Corps Records Schedules. Closing posts with inventory
records that have not reached their legal disposition dates should send these
records to Medical Records in OHS for storage.
Medical Supplies:
For perishable supplies with an expiration date (band aids, gauze, condoms, etc.)
offer to Embassy or neighboring post and document the disposition
Office Supplies:
Offer excess office supplies to Embassy or neighboring post
Destroy log books that contain non-narcotic documentation
Destroy outdated Peace Corps forms; send other forms to another post
__________________________________________________________________________________
Office of Health Services December 2015 Page 2 of 2