Phase II completed:

RMC Phase II Diagnosis Form

Declination/Completion Form

MEDICAL PROTOCOLS

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.

Medical Treatment Facility (Phase I)

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 inpatient 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



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