Adequacy of the Comprehensive Clinical Evaluation Program: Nerve Agents (1997)

At the MTF level, the CCEP record should include all CCEP forms and relevant medical data to the program.

Blank forms included with this guide supersede previous editions of these forms and are intended to be used with the new CCEP.

All individual forms will be complete and legible.

Forms forwarded to NMIMC and maintained in the participant record shall be in the following order:

Phase I completed:

MTF Phase I Diagnosis Form

Patient Questionnaire

Provider-Administered Symptom Questionnaire

Information Release Form

Declination/Completion Form

Phase II completed:

RMC Phase II Diagnosis Form

Declination/Completion Form

The CCEP is based upon a thorough clinical evaluation which emphasizes comprehensive and continuous primary care. The local MTF primary care provider maintains responsibility for patient evaluation and care throughout the CCEP process.

Phase I will consist of a comprehensive history and medical evaluation with completion of Phase I questionnaires and related forms. The examination, both in content and quality, should parallel an in-patient admission work-up. The Phase I examination will include a complete medical history including: family, occupation, social (including tobacco, alcohol, and drug use), exposure to possible toxic agents, psychosocial condition and review of symptoms. The provider will specifically inquire about the symptoms listed on the CCEP Provider-Administered Patient Questionnaire. A comprehensive medical evaluation, with focused attention to the patients symptoms and health concerns, should be conducted.

Individuals who, after completing MTF Phase I evaluations do not have a clearly defined diagnosis which explains their symptoms should be reviewed by the CCEP designated physician for further evaluation and consultations needed and/or for referral to the RMC.

Phase II Level Evaluations are performed only after complete clinically indicated evaluations (including appropriate specialty consultations) are conducted at the MTF and the RMC.

Phase I Laboratory Tests

CBC

U/A

SMA-12

Regional Medical Center (Phase II):

Phase II evaluations consist of the following laboratory tests, consultations and as necessary, symptom-specific examinations. J Elements of the Phase II evaluation may be accomplished by the local MTF as needed in the comprehensive evaluation of the Phase I patient in order to obtain a definitive diagnosis.

Phase II Laboratory Tests

CBC

Sedimentation rate (ESR)

C-Reactive protein

Rheumatoid factor

ANA

Liver function

CPK

Urinalysis

TB skin test (PPD) with controls

Chest X-ray

Hepatitis serology

HIV testing

VDRL

B12 and folate

Thyroid function tests

Phase II Consults

(if not accomplished at MTF level)

Dental: Dental only if participant's annual screening not done

Infectious disease

Psychiatry: With physician-administered instruments: Structured Clinical Interview for DSMIII-Rcm (SCID) (delete modules for mania and psychosis) Clinician-Administered PTSD Scale (CAPS)

Neuropsychological Testing: Only as indicated by psychiatry consult

The RMC CCEP Physician ensures that Phase II patients with the following undiagnosed symptoms receive the tests and consultations listed below.

Diarrhea

GI consult

Stool for O and P

Stool Leukocytes

Stool culture

Stool volume

Colonscopy with biopsies

EGD with biopsies and aspiration

Abdominal

GI consult

EGD with biopsy/aspiration

Colonscopy with biopsy

Abdominal ultrasound

UGI series with small bowel FT

Abdominal CT scan

Headache

MRI—head

LP (glucose protein, cell count, VDRL, oligoclonal myelin, basic protein, pressure)

Neuro consult

Muscle Aches/Numbness

EMG/NCV

Chronic Fatigue

Polysomnography and MSLT

Chronic Cough/SOB

Pulmonary consult

Pulmonary function

Tests with exercise and ABG

Methacholine challenge

If PFTs are normal, consider bronchoscopy with biopsy/lavage

Memory Loss

(Only if verified by psych evaluation)

MRI—head

Lumbar puncture

Neuro consult

Neuro psych testing

Chest Pain/Palpitations

ECG

Exercise stress test

Holter monitor

Reproductive Concerns

Urology consult

GYN consult

Vertigo/Tinnitus

Audiogram

ENG

BAER

Skin Rash

Dermatology consult

Consider biopsy