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Append& B
Outline of the Standardized Medical Protocol:
Selected Pages from the
Comprehensive Clinical Evaluation (CCEP) Gliide,
January 5, 1995, U.S. Department of Defense
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48 EVALUATION OF THE U.S. DEPARTMENT OF DEFENSE PERSIAN
GULF COMPRElIENSI1lE CLINICAL EVALUATION PROGRAM
FORM REQUIREMENTS
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
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 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
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APPENDIX B
49
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
UIA
SMA-12
Regional Medical Center (Phase II)
Phase II evaluations consist of the following laboratory tests, consultations
and as necessary, symptom-specific examinations. 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
. .
c .lagnosls.
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 & Folate
Thyroid Function Tests
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50 EVALUATION OF THE U.S. DEPARTMENT OF DEFENSE PERSL'4N
GULF COMPREHENSIVE CLINICAL EVALUATION PROGRAM
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-R
(SCID) (delete modules for mania and psychosis)
Clinician Administered PTSD Scale (CAPS)
Neuropsychological Testing: Only as indicated by psychiatry consult
SYMPTOM SPECIFIC EXAMINATIONS
The RMC CCEP Physician insures that Phase II patients with the following
undiagnosed symptoms receive the tests and consultations listed below.
Diarrhea
Abdominal
Headache
GI consult GI consult MRI - head
Stool for O&P EGD with biopsy/aspiration LP (glucose
Stool Leukocytes Colonoscopy with biopsy protein,
Stool Culture Abdominal ultrasound cell count,
Stool Volume UGI series with small VDRL,
Colonoscopy with bowel FT oligoclonal
biopsies Abdominal CT Scan myelin, basic
EGD with biopsies protein,
& aspiration pressure)
Neuro consult
Muscle Aches Memory Loss Vertigo/
/Numbuess (Only if Tinnitus
verified by psych Audiogram
evaluation) ENG
EMG/NCV MRI - Head BAER
Lumbar Puncture
Neuro consult
Neuro Psych Testing
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APPENDIX B
Chronic Fatigue
Polysomnography & MSLT
Chronic Cou~h/SOB Chest Pain/Palpitations Skin Rash
Pulmonary Consult ECG Dermatology
Pulmonary Function Exercise Stress Test consult
Tests with Exercise Hotter Monitor Consider biopsy
& ABG
Methacholine Challenge
if PFTs are Normal
Consider Bronchoscopy
with biopsy/ravage
Reproductive Concerns
Urology consult
GYN consult
51
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Representative terms from entire chapter:
clinical evaluation
