Appendix B Outline of the CCEP Medical Protocol
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
Provider-Administered Symptom Questionnaire
Information Release Form
Phase II completed:
RMC Phase II Diagnosis 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.
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 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
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
Sedimentation rate (ESR)
TB skin test (PPD) with controls
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
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.
Stool for O and P
Colonscopy with biopsies
EGD with biopsies and aspiration
EGD with biopsy/aspiration
Colonscopy with biopsy
UGI series with small bowel FT
Abdominal CT scan
LP (glucose protein, cell count, VDRL, oligoclonal myelin, basic protein, pressure)
Polysomnography and MSLT
Tests with exercise and ABG
If PFTs are normal, consider bronchoscopy with biopsy/lavage
(Only if verified by psych evaluation)
Neuro psych testing
Exercise stress test