USMEPCOM MEDICAL PRESCREEN PROGRAM

Transcription

1 HQ USMEPCOM J-7 Medical Plans & Policy Standard Operating Procedures USMEPCOM MEDICAL PRESCREEN PROGRAM J-7 Medical Plans & Policy STANDARD OPERATING PROCEDURES USMEPCOM Medical Prescreen Program (Effective June 1, 2018) Version

2 The Medical Prescreen Process Standard Operating Procedures Purpose: The purpose of the Standard Operating Procedures (SOP) is to establish policies and procedures for the USMEPCOM Medical Prescreen Program. The Medical Prescreen Program is executed at USMEPCOM Military Entrance Processing Stations (MEPS) and remote processing sites. This SOP applies to Prescreens only and not to Medical Reads. References: 1. USMEPCOM Regulation 40-1, Medical Qualification Program, Dec 10, DoDI Medical Standards for Appointment, Enlistment, or Induction in the Military Services, Mar 30, USMEPCOM Regulation , Enlistment Processing, Jun 30, USMEPCOM Regulation 680-3, USMEPCOM Integrated Resource System (USMIRS), Feb 19, 2014 Applicability: This SOP applies to all USMEPCOM personnel and associated activities. Policy: Medical prescreening requires the completion of the DD Form , Accessions Medical Prescreen Report, by each applicant who requires medical processing in accordance with (IAW) Department of Defense Instruction (DoDI) Accordingly, applicants are required to fully disclose all medical history and submit all related medical documentation requested including the names of their medical insurer and past medical providers. The questions on the DD Form are intended to provide MEPS Medical Departments with health history information necessary to determine if a MEPS medical examination is warranted and if an applicant does not meet Department of Defense (DoD) accession medical standards. The medical history information is used to facilitate efficient and timely medical processing of applicants for service in the United States Armed Forces. Thus, accurate and complete responses to all questions on DD Form is critical. The MEPS Medical Department will require the applicant to provide supporting documentation regarding the applicant s health history in the form of health records in conjunction with the DD Form as specified in the USMEPCOM Medical Prescreen Documents List and all other documentation requested by the MEPS provider. Medical Providers are the designated DoD medical authority that determine if an applicant meets the requirements of Title 10 to be considered medically qualified, effective, and able-bodied for enlistment in the Service. This SOP presents the standardized Medical Prescreen Processing conducted at the MEPS and is used in conjunction with UMR

3 Definitions: Prescreen: A Prescreen refers to any applicant medical documentation that has been requested and/or supplied prior to the initial medical examination. Medical Read (Med Read): A Med Read refers to any applicant medical documentation that has been requested and/or supplied following the initial medical examination. Note: MEPS will continue to use their current Medical Read process per UMR 40-1, Paragraph Responsibilities: 1. J-7 Medical Plans and Policy, (J-7/MEMD) will: a. Ensure the executing and quality of the USMEPCOM Medical Prescreen Program IAW DoD and USMEPCOM policies. b. Provide a single point of contact for all applicant daily medical Prescreen issues to facilitate standardized applicant medical processing, services and decisions. c. Ensure policies set forth in the SOP are complied with across the Command. d. Provide daily applicant medical Prescreen processing mission support. e. Manage systematic feedback and support to Sector and Battalion Commanders on the USMEPCOM Medical Prescreen Program. 2. Sector Medical Officers will: a. Collaborate with J-7/MEMD to ensure the quality and standardization of the USMEPCOM Medical Prescreen Program. b. Ensure MEPS comply with the execution and quality of the USMEPCOM Medical Prescreen Program. c. Forward new or further interpretation questions/issues to J-7/MEMD for resolution. d. Advise Sector Commanders and J-7/MEMD Director on implementation and execution of the USMEPCOM Medical Prescreen Program. 3. MEPS Commanders will: a. Ensure MEPS personnel comply with this SOP. b. Ensure any deviation from the Prescreen Process SOP has an approved exception to policy (ETP) signed by the J-7/MEMD Director (or designated representative). c. MEPS Commanders and other non-medical personnel cannot reverse the professional accession medical decisions of CMOs/ACMOs and contract physicians working as Fee Basis Provider-CMOs (FBP-CMOs). The only authorities who may reverse a professional medical determination made by a 3

4 profiling physician are the J-7/MEMD Director, Clinical Operations Division Chief, and Accession Medicine Branch Chiefs. 4. MEPS Operations Officers (OPSOs): a. Monitor the workflow of the Prescreen Program. b. Keep the MEPS Commander abreast of the MEPS Prescreen Program workflow and current processing concerns. 5. MEPS Chief Medical Officers (CMOs): a. Supervise and manage the MEPS Medical Department and execution of the Medical Prescreen Program to ensure program quality. b. Serve as the principal MEPS medical officer and local authority in requesting and reviewing applicant s medical documents. c. Train profiling Fee Basis Providers on medical prescreening. d. Establish their MEPS Medical Prescreen Program with Medical Non- Commissioned Officers in Charge (NCOICs)/Supervisory Medical Technicians (SUP MTs) and provides them the support to execute Prescreen policy decisions IAW this SOP. e. Ensure medical staff (government/contracted providers and paraprofessional staff) are fully trained in conducting all aspects of the Medical Prescreen Program. f. Ensure applicant medical documents are obtained and appropriately reviewed for completeness and accuracy. 6. MEPS Medical NCOICs/SUP MTs will: a. Support and follow through with CMO-directed medical Prescreen decisions and policy. b. Ensure that the Medical Department is properly staffed for the efficient processing of Prescreens. c. Act as the primary trainer for the Medical Department and ensure Medical Technicians are thoroughly trained and capable in all phases of the Medical Prescreen Program. d. Coordinate with the other MEPS Departments and Service Liaisons (SLs)/Guidance Counselors (GCs) on medical and/or administrative matters impacting the Prescreen process. e. Aid the Commander and the CMO in the requirements of the Prescreen Program SOP. f. Ensure Quality Review Program (QRP) processes for Medical Prescreens are accomplished before the applicant processes at the MEPS. g. Ensure that all required tasks IAW the Prescreen SOP is accomplished within established time period. h. Ensure accuracy of all USMIRS data entries. 4

5 7. MEPS Lead Medical Technicians (LMTs) will: a. Support and follow through with CMO and Medical NCOIC/SUP MT directed Prescreen Program decisions and policies. b. Lead all Medical Technicians to ensure the quality of the USMEPCOM Medical Prescreen Program in the absence of a Medical NCOIC/SUP MT. c. Assist the Medical NCOIC/SUP MT with the duties outlined in the preceding section. d. Ensure accuracy of all USMIRS Prescreen data entries. 8. MEPS Medical Technicians (Med Techs) will: a. Support and follow through with CMO and NCOIC/SUP MT/LMT directed Prescreen Program decisions and policies. b. Ensure that DD Form are completed in timely and accurate manner and are tracked accordingly. c. Perform accurate and daily Prescreen USMIRS entries. d. Ensure QRP of projected applicants Prescreens are reviewed before the applicant processes at the MEPS. e. Ensure accuracy of all USMIRS Prescreen data entries. 9. Fee Basis Providers (FBPs) will: a. Review Prescreens at the MEPS IAW this SOP, DoD, USMEPCOM and accession medical policies implemented by the MEPS CMO. The Medical Prescreen Process Standard Operating Procedures Instructions Section 1: A Simple Prescreen is defined as DD Form with NO responses to all questions except for items 9, 11, 20, and 138 (except if the arrest or law enforcement encounter indicates a behavioral health issue requiring a prescreen review by a MEPS medical provider as defined below), and supporting medical documents are not required as referenced in UMR Note: A Prescreen Cover Sheet is not used for simple Prescreens. Note: Guidance to SLs/GCs in regards to question 138 on the DD Form : When the applicant checks YES to question 138, and the corresponding description raises concerns of a behavioral health condition per DoDI , the Prescreen should be submitted as a complex Prescreen and requires review by Medical Provider. When the applicant checks YES to question 138 and the corresponding description requires a moral waiver, the Prescreen will be submitted as a complex Prescreen and requires review by Medical Provider. 5

6 1. Service Liaisons (SLs)/Guidance Counselors (GCs): a. Ensures all questions on processing forms DD Form , UMF 680-3A-E, and DD Form 1966/5, if a minor, are accurate and complete. b. Ensures processing forms are signed by the applicant and legal guardian(s), if a minor. c. Submits simple Prescreen, which includes completed DD Form and other processing forms to the Files Room with projections NLT 1100 to give Files Room personnel time to prepare for the MEPS QRP. 2. Files Room: a. Establishes a specified location in a secure area for the submission of simple Prescreens to protect Personally Identifiable Information (PII) and Protected Health Information (PHI). b. Upon receipt of the DD Form , UMF 680-3A-E and DD Form1966/5 (if a minor), an applicant packet will be created or retrieved, if a record already exists on the same day. If required forms are not present or the forms are inaccurate or incomplete, the Files Room will use Appendix F ( N Status Codes) to select the appropriate "N" Status, and notify the applicant's sponsoring Service. The applicant s sponsoring Service has until QRP to provide the documentation otherwise the projection will be deleted during QRP. c. Maintains accountability of all applicant packets by using proper packet charge-in and charge-out procedures in accordance with UMR , Chapter 4 and UMR d. Forty-eight hour projections will not be accepted after 1100 cutoff. 3. Medical Technician: a. Works with the CMO to understand when Prescreens may not qualify as simple and should be referred to the CMO. b. Reviews simple Prescreens during QRP. c. Indicates Prescreen meets the requirements for further medical processing by documenting printed name/stamp, signature of the Medical Technician, and date underneath Item 3c in Section VII of DD Form , to include the reviewer s title (i.e. Medical Technician). d. Enters the appropriate USMIRS N status codes using the Administrative Hold N Status screen (OQ03). Reference Appendix F ( N Status Codes). 4. Quality Review Program (QRP): a. The MEPS QRP will be conducted IAW UMR 680-3, paragraph 6-6a. b. Ensures the applicant is eligible to process IAW UMR c. If the DD Form is missing at QRP, the applicant's projection will be deleted. d. Conducted in a location IAW UMR 680-3, paragraph 6-6a that will limit interruptions, minimize loss of applicant packets, and protect PII/PHI. e. Implements the following actions accordingly: 6

7 i. Prescreens without discrepancies: If the applicant has a Prescreen that meets the requirements for projection, the applicant is scheduled for a MEPS medical examination within 2 business days. For example, a simple Prescreen that is submitted to the Files Room NLT 1100 on Monday and is without discrepancies when reviewed during QRP, is scheduled for medical examination at the MEPS on Wednesday. ii. Prescreens with discrepancies: If the applicant s Prescreen has deficiencies or errors that have not been rectified by 1100 the day before scheduled processing, the projection will be deleted in accordance with UMR , 2-2, para b. Note: For MEPS processing to continue, all medical N status codes must be closed by the Medical Technician. iii. Prescreens with YES response to question 138 on DD Form : (1) Prescreen remains simple if: (a) Applicant disclosure does not raise concerns of a behavioral health condition per DoDI (b) QRP will continue and question 138 will have no impact on projection status. (2) Prescreen becomes complex if: (a) Applicant disclosure raises concerns of a behavioral health condition per DoDI (i) Medical technician will discuss with CMO to determine if the Prescreen is a complex Prescreen. 1) If complex Prescreen: a. UMF , QRP Discrepancy List will be completed accordingly. b. Projection will be deleted. c. SL/GC will be notified via the UMF QRP Discrepancy List. d. SL/GC is required to submit as a complex Prescreen with a Prescreen Cover Sheet. 2) If the Prescreen remains simple per CMO feedback, then QRP process continues (refer to Section 1(e)(i)). f. QRP personnel: i. Processing Section personnel are responsible for annotating deficiencies or errors that require corrections by the SLs/GCs on the UMF , Quality Review Program Discrepancy List based on input provided by medical staff during QRP. ii. Enters the appropriate USMIRS N status codes using the Administrative Hold N Status screen (OQ03). Reference Appendix F ( N Status Codes). 5. Actions after QRP: a. Processing Section: i. All applicant packets are secured in the Files Room immediately after QRP. 7

8 ii. Immediately following QRP, provides each SL/GC with a copy of the completed UMF , Quality Review Program Discrepancy List. iii. Receives submitted correction of deficiencies and errors from the Files Room NLT 1100 the following day. iv. SLs/GCs may charge-out applicant packets from the Files Room to assist them in correcting discrepancies. b. Projection Reconciliation: i. Corrections to the discrepancies must be submitted by SLs/GCs to the Files Room the following day NLT 1100 for the applicant to process as scheduled. ii. Medical Department will make the final decision on whether to delete the projection for medical discrepancies or errors. iii. If the discrepancies or errors are not rectified the day before scheduled processing, the projections will be deleted. 6. No-Shows/Walk-Ins: a. For every applicant no-show, the SLs/GCs can replace with an applicant walk-in that meets simple Prescreen definition. For example, if the Service has 3 applicants who no-show, then the SLs/GCs can substitute 3 walk-ins, as long as they meet the definition of a simple Prescreen. MEPS Commanders need to ensure that their Recruiting partners understand that if walk-ins disclose a medical history at the time of the MEPS examination IAW UMR 40-1, Section 3-6, the MEPS Medical Department is authorized to stop MEPS processing. b. Recruiting SLs/GCs may barter unused walk-in allocations with another SL/GC office as long as the applicant walk-in meets the definition of a simple Prescreen. c. Ultimately, walk-ins are at the discretion of the local MEPS Commander based on medical resources available however, all walk-ins must be simple prescreen applicants. Section 2: A Complex Prescreen is defined as DD Form with YES answers to questions other than 9, 11, 20, and 138 as referenced in the UMR If there is a YES to question 138 that indicates a behavioral health issue requiring a prescreen review by a MEPS medical provider, this is also a complex prescreen. Note: DD Form must have Processing Authorized (PA) by Medical Provider or Processing Requested by SMWRA (PRW) Medical Processing Status (DD Form Section VII) to be eligible for QRP. 1. Service Liaisons (SLs)/Guidance Counselors (GCs): a. Completes Section 1 (including circling of initial submission) of Prescreen Cover Sheet using Appendix B (Maximum Number of Business Days to Complete Review of Complex Prescreens). b. Completes Section 2 of Prescreen Cover Sheet and places it on top of each new Prescreen submission. c. Initial Prescreen: i. Prescreen review timeline begins the following day for applicant packets submitted NLT Example: For Prescreens submitted on Monday NLT 8

9 1100 (Day 0), the Prescreen review timeline begins the next day, Tuesday (Day 1). ii. Submit supporting medical documents as follows: 1. IAW Reference Appendix A (Minimum Prescreen Requirements List). 2. Chronologically, in order, with oldest records on top. 3. Duplicates and blank pages are removed. 4. Dates of medical care are highlighted in orange or circled. 5. Pages are numbered as follows: Page # / total # of pages of supporting medical documents. iii. Date of Prescreen review completion is calculated as follows, reference Appendix B (Maximum Number of Business Days to Complete Review of Complex Prescreens). 1. For complex Prescreens with 5 pages or less of supporting documents, the maximum number of business days for Medical Provider review is 2 business days. Example: For Prescreen that is submitted on Monday NLT 1100, the Prescreen review is completed NLT than Wednesday by Close of Business (COB). Prescreens annotated with Processing Authorized (PA) can project on Thursday (See Table). Maximum Number of Business Days to Complete Review Mon Tue Wed Thurs Fri Sa Su Mon Submission by SL/GC to Files Room; Med Tech Review Day (0) CMO distribution of Prescreens to Providers Day (1) Provider Review: Processing Authorized (PA) Day (2) Project/ submit to QRP Floor Submission by SL to Files Room; Med Tech Review Day (0) 2. For complex Prescreens with more than 5 pages of supporting medical documents, the Prescreen review will be completed according to the # of pages of supporting medical documents / 6 pages per business day = number of business days to complete Prescreen review. Example: For complex Prescreen that is submitted on Monday NLT 1100 with 23 pages of supporting medical documents, the Prescreen review is completed NLT Friday. Prescreens annotated with Processing Authorized (PA) can project on the following Monday (See Table). Maximum Number of Business Days to Complete Review Mon Tues Wed Thurs Fri Sa Su Mon Tue Wed Provider Provider Provider Floor Review Review Review Day (1) Day (2) Day (3) Provider Review: Processing Authorized (PA) Day (4) Project/ submit to QRP 9

10 Note: The minimum number of business days for initial review of complex Prescreens is 2 business days. The maximum number of business days for initial review of complex Prescreens is 30 business days. If upon review of complex Prescreens, additional supporting medical documents are required, see paragraph d below on resubmission instructions. Reference Appendix B (Maximum Number of Business Days to Complete Review of Complex Prescreens). d. Resubmission of additional supporting medical documents: i. Prescreens expire after 90 days from date of applicant s signature (120 days for overseas physicals). If the Prescreen has expired, a new DD Form and Prescreen Cover Sheet must be completed and submitted. ii. New medical conditions may be discovered during initial Prescreen reviews. In such cases, supporting medical documents are requested, and the Prescreen review timeline starts over again. iii. Calculate the new timeline based on the total number of pages of medical documents, to include initial and resubmission(s). For example, if the initial complex Prescreen has 30 pages of supporting documentation and the resubmission has 24 pages, then the total # pages for calculation is 54. Use Reference Appendix B (Maximum Number of Business Days to Complete Review of Complex Prescreens). In this example, the Medical Provider has a maximum of 9 business days to complete medical review. iv. For resubmissions, SL/GC will complete a New Prescreen Cover Sheet: 1. Completes Section 1 including the circling of the Resubmission number (for example 1 st, 2 nd, etc.) and complete Section Places the New Prescreen Cover Sheet on top of requested supporting medical documents and submits to the Files Room. 3. Submits supporting medical documents as follows: (a) Chronologically, in order with oldest records on top. (b) Duplicates and blank pages are removed. (c) Dates of medical care are highlighted in orange or circled. (d) Pages are numbered as a continuation of the previous submission. In the above example, the page numbering begins with 31/54. v. Resubmit new Prescreen Cover Sheet, with additional supporting medical documents to the Files Room NLT 1100 to restart medical Prescreen review process. e. Request for courtesy review by the SMWRA of a complex Prescreen open for records: i. If the SLs/GCs submit a request for a courtesy review of a complex Prescreen to the SMWRA, while the Prescreen is open for records (METR), the applicant will not be authorized to process, even if processing is requested by the SMWRA (Medical Processing Status PRW) was the outcome. ii. Under these circumstances, the CMO will call the SMWRA to discuss the open status of the complex Prescreen and reversal of PRW status. f. Request for courtesy review by SMWRA with a Prescreen Medical Processing Status of PNJ: 10

11 i. If the complex Prescreen review by the Medical Provider results in a medical disqualification during prescreening and the Medical Processing Status is Processing Not Justified (PNJ), and the Service requests a courtesy review by the SMWRA that subsequently results in a request for processing by the SMWRA (Medical Processing Status of PRW), then the applicant will be scheduled for a MEPS examination only after all of the requested medical records have been received and reviewed by the Medical Provider, if applicable. 2. Files Room: a. Establishes a specific location for the submission of complex Prescreens with supporting medical documentation in a secure area to protect PII/PHI. b. Upon receipt of the DD Form , UMF 680-3A-E and DD Form1966/5, if a minor, an applicant packet will be created or retrieved if a record already exists, the same day. c. Maintains accountability and location tracking of all applicant packets by using proper packet charge-in and charge-out procedures in accordance with UMR , Chapter 4 and UMR d. Completes Section 3 of the Prescreen Cover Sheet. e. For resubmissions, retrieves applicant s record and places resubmission Prescreen/Cover Sheet/supporting documentation into the record and has the record ready for the Medical Technician to pick up at 1100 or shortly thereafter. 3. Medical Technician: a. Creates a secure filing system in the Medical Department for complex Prescreens that is accessible to Medical Technicians and the Medical Providers only IAW UMI b. Maintains accountability and location tracking of all applicant packets within the Medical Department. c. Coordinates with the Files Room for transfer of medical records to the MEPS Medical Department to pick up complex Prescreen at 1100 or shortly thereafter. d. Completes received Date & Time received FROM Files Room in Section 4 of Prescreen Cover Sheet. e. Records the transfer of medical records into the Medical Department: i. Enters newly designated N status codes into USMIRS. 1. VA: Prescreen Received, No Med Records 2. VB: Prescreen Received, Med Records 5 pages or less 3. VC: Prescreen Received, Med Records 6-32 pages 4. VD: Prescreen Received, Med Records pages 5. VE: Prescreen Received, Med Records pages 6. VF: Prescreen Received, Med Records 93 or more pages f. Reviews Prescreen for completeness by Close of Business (COB) day 0. g. If Prescreens meet criteria for Medical Provider review: i. Completes Section 4a: 1. Checkmarks Prescreen meets criteria for Medical Provider review. 11

12 2. Enters Date & Time Reviewed. 3. Enters name on Technician Reviewing Prescreen line. ii. Removes the VX- Prescreen Received, Med Records XX-XX pages N status code from USMIRS. iii. Enters newly designated N status code VH: Prescreen In Review into USMIRS. iv. Arranges packets by calculated date of completion NLT COB on the day of receipt (Day 0). h. Establishes a specified process with the CMO for the transfer of Prescreens to the CMO. i. If Prescreen packet is incomplete, not numbered, or dates of medical care are not highlighted in orange or circled: i. Completes Section 4a of the Prescreen Cover Sheet: 1. Checkmarks Prescreen Incomplete box. 2. Annotates why Prescreen is incomplete in Section 4a in space provided. 3. Enters Date & Time Reviewed in the space provided. 4. Enters name on Technician Reviewing Prescreen line. ii. Removes N status code VX: Prescreen Received, Med Records XX-XX pages from USMIRS. iii. Enters newly designated N status code VG: Prescreen Incomplete/Not Reviewed by Medical Provider into USMIRS. iv. Scans and sends completed Prescreen Cover Sheet via encrypted to SLs/CGs, ensuring protection of PII/PHI in accordance with UMI Reference Appendix E (Establish an Encrypted Exchange). v. Completes Section 4e of the Prescreen Cover Sheet: 1. Date & Time Returned to Files Room 2. Enters name on Returned by line vi. Ensures that Prescreen Cover Sheet is secured and remains in the medical record. vii. Returns applicant packets to the Files Room and has Files Room complete the Received by entry in Section 4e of the Prescreen Cover Sheet. j. To avoid and manage spillage of PII/PHI, follows established procedures in accordance with UMI k. When notified by the CMO that prescreen reviews are complete, the Medical Technician takes the following actions the same day: i. If Prescreen Cover Sheet is illegible, it is returned to CMO for immediate correction. ii. Completes the Prescreen Review Time Line MET on the Prescreen Cover Sheet (YES / NO question, Section 4e) by comparing Calculated Date of Completion (in Section 1) with Date & Time Completed in Section 4e. iii. Scans and sends completed Prescreen Cover Sheet via encrypted to SLs/GCs, ensuring protection of PII/PHI in accordance with UMI Reference Appendix E (Establish an Encrypted Exchange). iv. Enters newly designated N status codes for Prescreen processing and/or Open For Records (METR), Temporary Disqualifying Conditions (TDQ) and Permanent Disqualifying (PDQ) codes into USMIRS: 12

13 1. VI: PR Complete; Processing Authorized, Time Line Met 2. VJ: PR Complete; Processing Authorized, Time Line Not Met 3. VK: PR Complete; Processing Not Justified, Time Line Met 4. VL: PR Complete; Processing Not Justified, Time Line Not Met 5. VM: PR Complete; PNJ, SMWRA Requested Exam, Time Line Met 6. VN: PR Complete; PNJ, SMWRA Requested Exam, Time Line Not Met 7. B030L Incomplete Medical /Medical Evaluation and/or Treatment Records (used exclusively for METR decisions). 8. B030J Temporary Disqualifying Condition (TDQ) with Returned Justified (RJ) date. 9. B030R Permanent Disqualifying Condition (PDQ). 10. B030F Processing Authorized; Note B030F is not available at this time. MEPS will be notified with an update message and new SOP once B030F is to be used. v. Completes Section 4e of the Prescreen Cover Sheet. 1. Date & Time Returned to Files Room. 2. Enters name of the Returned by line. vi. Ensures that the Prescreen Cover Sheet remains with medical records. vii. Returns applicant packets to the Files Room and completes the Received by entry in Section 4e of the Prescreen Cover Sheet. viii. To avoid and manage spillage of PII/PHI, follow established procedures in accordance with UMI Chief Medical Officer: a. Complete the Prescreen medical records review NLT the calculated date of completion (by COB), in accordance with this policy. b. Executes the completion of Prescreen reviews with designated resources and has the option to request additional FBPs as needed for this purpose. c. Train all FBPs on the Prescreen review process and requires all FBPs to participate in the Prescreen review process. d. Completes Section 4b of Prescreen Cover Sheet as applicable: i. Date and Time given to CMO/ACMO. ii. CMO/ACMO/FB-CMO distributes the complex Prescreens to FBPs on day 1. iii. The reviewing provider enters the date/time they received the complex prescreen in the space provided and print/stamp and sign their name in the Provider Reviewing the Prescreen line in Section 4b (page 2) of the Prescreen Cover Sheet. iv. Upon completion of complex Prescreen review, the reviewing provider completes one of the following Sections: 1. Section 4c: Medical Information has been reviewed by a Medical Provider and is complete. 2. Section 4d: Medical Information has been reviewed by a Medical Provider and is not complete and requires. e. Requires reviewing provider to complete Section 4e of the Prescreen Cover Sheet i. Completes Date & Time Completed line. 13

14 ii. Print/stamp and sign their name on the Reviewing Provider line. iii. Requires all Reviewing Providers to return the completed Prescreens to the CMO immediately (for the efficiency of further processing) on the day the Prescreen review is completed. If CMO position is vacant, the MEPS Medical Department will determine who will receive completed Prescreens each day. 1. Ensures Prescreen Cover Sheets are completed legibly by Reviewing Providers. (a) CMO will utilize the Prescreen Continuation Sheet (Appendix C) to make corrections if more space is needed. 2. CMO notifies the Medical Technician that the Prescreen is complete and Prescreens are transferred to the Medical Technician on the same day. f. If the SLs/GCs submit a request for a courtesy review of a complex Prescreen to the SMWRA while the Prescreen is open for records (METR), the applicant will not be authorized to process even if the SMWRA requests further medical processing. g. Under these circumstances, the CMO will call the SMWRA to discuss the open status of the complex Prescreen and will notify the Sector Medical Officer (SMO). 5. Quality Review Program (QRP): a. The MEPS QRP will be conducted IAW UMR 680-3, Paragraph 6-6a. b. Ensures the applicant is eligible to process in accordance with UMR c. DD Form must be physically present, complete, and reviewed by a Medical Provider with a status of Processing Authorized (PA) or Processing Requested by SMWRA (PRW). d. Conducted in a location IAW UMR 680-3, paragraph 6-6a that will limit interruptions, minimize loss of applicant packets, and protect PII/PHI. e. Implements the following actions accordingly once the applicant is projected: i. Applicant packet without discrepancies: If the applicant meets the requirements for further medical processing, the applicant can be brought to the MEPS for a MEPS medical examination within 2 business days. ii. Applicant packet with discrepancies. If the applicant s packet has administrative deficiencies or errors, the Service will have until 1100 the next business day to correct the deficiencies/errors. If the deficiencies or errors are not rectified by 1100 the day before scheduled processing, the projection will be deleted IAW with UMR , 2-2, paragraph b. Note: For MEPS processing to continue, all medical N status codes must be closed by the Medical Technician. iii. QRP personnel 1. Processing Section personnel annotate deficiencies or errors on the UMF Quality Review Program (QRP) Discrepancy List (DL) based on input provided by medical staff during QRP. 2. Enters the appropriate USMIRS N status and codes for using the Administrative Hold N Status screen (OQ03). Reference Appendix F ( N Status Codes). 3. Provides the UMF Quality Review Program (QRP) Discrepancy List (DL) to the sponsoring SLs/GCs immediately following QRP, to allow 14

15 for timely correction of identified discrepancies NLT 1100 the following day. f. Actions after QRP. i. Processing Section representative: 1. All applicant packets are secured in the Files Room immediately after QRP. 2. Directly provides each SL/GC with a copy of the completed UMF Quality Review Program (QRP) Discrepancy List (DL). 3. Corrections to the discrepancies must be submitted to the Files Room the following day NLT 1100 for the applicant to process as scheduled. ii. SLs/GCs may charge-out applicant packets from the Files Room to assist them in correcting discrepancies on DD Form s. g. Projection Reconciliation. i. SLs/GCs will submit corrections of the deficiencies and errors NLT 1100 the next business day. ii. The Medical Department will make final decision on whether to delete the projection for a medical reason. iii. If the deficiencies or errors are not corrected the day before scheduled processing, the projections will be deleted. 15

16 APPENDIX A Minimum Prescreen Requirements List NOTE: The list of conditions that do not need additional records is not absolute. CMOs/ACMOs are authorized to result medical records at their discretion that will inform their medical qualification decisions. The current list has not been updated since the publication of the new accession medical standards in DoDI Services are required to follow Minimum Prescreen Requirements List when submitting supporting medical documents to facilitate faster turnaround of Prescreen review. Applicant medical records will be returned if they are not submitted correctly: Purpose: Serves as a guide to the MEPS CMOs. MEPS profiling physicians are the designated DoD authority that determines if the applicant meets requirements of Title 10, to be considered medically qualified, effective, and able-bodied for enlistment in the Service. The MEPS CMOs are authorized to generate a local MEPS Prescreen Requirements List which must include the contents of Appendix A and can exceed the request for supporting documentation contained therein. NOTE: The list of conditions that do not need additional records is not absolute and may result in a request for records at the discretion of the CMO/ACMO. a. Medical Records: All recruiting services have been given a list of medical records for common issues which require records to be submitted with the DD Form Prescreen. Failure to submit these specific records will delay applicant processing. b. All Requested Documents: Do not submit incomplete Prescreens. You must include all requested items together. Example: The CMO requested a current orthopedic evaluation with a current x-ray report showing complete healing of the fracture and a current cardiology consultation. Do not submit the x-ray report until you have all three items to submit together. c. Legibility: Every page of outside applicant's medical record must be of good copy quality. This does not mean you have to be able to read the outside doctor's handwriting. It means faxed copies should be legible and not too dark or too light to read. This is especially true for prior service documents (i.e., DD Form 214s). MEPS doctors MUST be able to read the dates of service, the RE Code, and the narrative reason for separation. d. Dates: The date of medical care must be highlighted with a highlighter on each page or clearly circled. (Do not circle the applicant's birthday or date of the fax.) The orange highlighter is used so that the highlighted dates are clearly visible on the faxed copy of medical records. e. Order: Medical documents must be submitted in chronological order with the oldest record on top and most recent on the bottom. f. Numbering of Pages: The SL/GC must number each page. Also include the total number of pages. For example: 1/13, 2/13, 3/13, etc. 16

17 g. Duplications: Do NOT submit records that are a duplicate of records previously submitted. h. X-rays: Submit a copy of the paper x-ray report. Do not submit the actual x-ray film or a DVD of the x-rays. i. Doctors Notes: When doctors notes or other Primary Care Provider (PCP) notes are requested, do not submit a summary or To Whom It May Concern letter from the physician. l) All actual doctor records are required. Doctor's summaries alone are never an acceptable substitute for the actual records. 2) When doctor s notes from an emergency room visit are requested, do not submit the handout given to patients from the emergency room or just nursing records. It must include the doctor s records. 3) If a request is made for all doctor visits over a specific period of time make sure there are no gaps in the records. Example: ''Need all doctors' notes for all doctor visits for any reason between 1/1/08 and 11/21/13" means ALL records for this time period are to be submitted. If the applicant states that he or she has not seen a doctor, have him or her submit a statement in writing to that effect. These statements must include date ranges. Example: "I certify that I have not seen a doctor for any reason between 1/1/08 and 11/21/13." Please note that "any reason" means ANY reason. This includes school physicals. j. VA Records: When VA records are requested submit all of the actual doctors notes. If the applicant has been evaluated by the VA for disability, whether granted or not, include the actual physician s disability evaluation, not just the letter the VA sends to the service member telling him or her they received disability and for how much. k. Psychiatric Records: Be especially careful with psychiatric records. Patients have a legal right to their psychiatric records. Summary letters will never be accepted as a substitute for the actual counseling notes. Failure to submit requested psychiatric records will result in an indefinite delay in the applicant's processing and may result in a disqualification. These applicants then will not be processed unless the service waiver authority agrees to consider a waiver without the psychiatric records. l. Prior Service: A signed Memorandum for Record (MFR) on Service letterhead stating that the Service understands they are assuming responsibility for processing an applicant with a pre-existing disqualifying condition. This MFR will become a permanent document in the applicant s medical record. Request all documentation related to the reason for discharge, including, but not limited to, counseling memos, narrative summaries, and records from the Medical Treatment Facility (MTF) to include discharge physical, if obtainable. Medical Evaluation Board (MEB) and Physical Evaluation Board (PEB) documentation (if applicable). m. Single-Sided Copies: Submit single-sided copies only. 17

18 List of Medical Conditions that Do Not need Supporting Medical Records The following is a list of medial issues for which you do not need to submit medical records. Merely list the problem on the DD Form 2808: 1. Uncomplicated appendectomies more than six months ago 2. Records for Lazy eye surgery in childhood 3. Uncomplicated tonsillectomy, if performed more than 30 days ago 4. Uncomplicated hernia surgery, if performed more than 6 months ago 5. Uncomplicated wisdom teeth extraction, if it occurred more than 30 days ago 6. Pyloric stenosis surgery performed in childhood 7. PE tubes placed in childhood because of ear infection 8. Fractures that occurred more than one year ago that did not require surgery, unless, the fracture was caused by motorcycle accident, All Terrain Vehicle (ATV) or Motor Vehicle Accident (MVA) 9. Premature termination of pregnancy that occurred more than 1 year ago 10. Pregnancy ending with normal delivery, even by C-section that occurred more than one (1) year ago. Note the date the applicant s last child was born on the List of Medical Conditions that Require Supporting Medical Records Always obtain Medical Records and submit them for prescreen in the following cases. For the situations described below just submit the records. It is not necessary to call the Dial/ -A-Medic line. MEPS CMOs may locally modify the above instructions and instruct recruiters on what supporting medical documents they require to complete the DD Form medical prescreen review, if doing so enhances the efficiency of medical processing and is consistent with DoDI and USMEPCOM guidance. If all attempts to obtain required substantiating and supporting medical documents fail, the recruiter must contact the MEPS Medical Department for guidance prior to submitting an incomplete medical prescreen packet. Note: This list is not all inclusive. The scenarios below are commonly recurring ones for which we always need records. Medical documents will be required in many cases not covered by this list. If you have questions, call the Dial/ -A-Medic line. General: 1. Any MVA or motorcycle (including dirt bikes), or ATV accidents within the last 5 years if the applicant was not kept overnight in the hospital. In all such cases we need the doctor s notes from the ER or urgent care. Note: The patient information handout and/or patient discharge instruction are not adequate. Submitting this is a waste of your time. 2. Any MVA or motorcycle (including dirt bikes) or ATV accidents ever, if the applicant was 18

19 admitted to the hospital. In these cases, we need the doctors ER notes, the Discharge Summary and all other records. Note that there is no time limit in these cases. If records are not available, submit a written letter from the hospital saying that they are not available. Head and Neck, ear, nose and throat: 3. Submit all records on any applicant who has had a broken nose or facial fracture within the last 5 years. Be sure to include the ER Doctor s notes. 4. Submit records for all applicants who have had surgery on their ears for any reason, except putting tubes in their ears. 5. Submit all records on any applicant who has had surgery for a cleft lip or palate. If the records are not available, submit a written statement from the hospital confirming that records do not exist. 6. Submit records on any applicant who has had sinus surgery within the past 5 years. 7. Submit records on any applicant with a known hearing loss. Note: Do not send records on applicants who wear a hearing aid. Do not send these applicants to the MEPS. Hearing aids are disqualifying and services will not waiver hearing loss requiring hearing aids. Eyes: 8. For applicants who have had eye surgery to correct their vision (PRK or LASIK) submit two things: a. All actual eye treatment records. b. A completed MEPS Refractive eye surgery worksheet. Note that the applicant must take this worksheet to his or her ophthalmologist and have them complete the worksheet. SLs/GCs have copies of the worksheet. Note: This requirement does not apply to applicants who have had surgery for strabismus ( lazy eye ) in childhood. Records are not required in these cases. 9. All records on any applicant with a history of an eye injury or any eye surgery other than strabismus (lazy eye surgery). 10. All records for treatment of any eye problem except strabismus ( lazy eye ) or the need for glasses or contacts. Chest: 11. For applicants with any history of asthma or inhaler use (except nasal), submit all records, all doctor visits for any reason for the past 5 years. 12. For applicants who have ever had a positive test for tuberculosis (a positive PPD), we need the records showing that they completed drug treatment. Records showing that they started but did not complete treatment are not adequate. If the applicant was never treated, submit the 19

20 records of the initial test and indicate on the that they were never treated. If the applicant has had a blood test called Quantiferon TB Gold, submit the result of this test. 13. Submit all records for any applicant with a history of a collapsed lung. 14. Submit all records for any applicant who has been treated for pneumonia within the last 5 years. 15. Submit records on any applicant who has had chest or chest wall surgery (except breast). If the records are not available, submit a written statement from the hospital confirming this. 16. Submit records on any applicant that has had breast surgery in the past 12 months, including ALL follow-up doctor visits. Heart: 17. Submit records on any applicant who has ever had heart surgery. There is no time limit on this requirement. If the records are not available, submit a written statement from the hospital confirming this. All applicants with a history of cardiac surgery must have a current evaluation by a Cardiologist at their expense and these records must be submitted as well. 18. Submit all records of any applicant who has seen a cardiologist for palpitations, extra beats, irregular heartbeat, high blood pressure or any other reason. There is no time limit on this requirement. If the records are not available, submit a written statement from the hospital confirming no availability. When records are not available in these cases, all such applicants must have a current evaluation by a Cardiologist at their expense and these records must be submitted. 19. Submit records for any applicant who has seen a doctor because of a fainting spell or passing out (syncope). Abdomen: 20. Submit all records on any applicant who has been seen by a physician (in an ER or office) for abdominal or pelvic pain within the last 5 years. 21. Submit all records on any applicant who has had any abdominal surgery except for pyloric stenosis or an uncomplicated appendectomy more than 6 months ago. 22. Submit records on any applicant with a history of GERD (Gastroesophageal Reflux Disease) or who has been given anti-reflux medication by a physician. 23. Submit records on any applicant who has been treated for irritable bowel syndrome. 24. Submit all records on any applicant who has ever had gastrointestinal or rectal bleeding for any reason, including bleeding from hemorrhoids. If the records are not available, submit a written statement from the hospital confirming no availability. 25. Submit all records on any applicant who has been treated by a physician for 20

21 lactose intolerance. 26. Submit records on any applicant with a history of hepatitis. Urinary System: 27. Submit records for any applicant with a history of kidney stones. 28. Submit records for any applicant who has had any surgery on the urinary system (kidneys, bladder, ureters). Even if done in childhood, attempt to get the records because most of these applicants require a waiver. If the records are not available, submit a written statement from the hospital confirming no availability. Also, if the records are not available, the applicant should see a Urologist at their expense and have a current evaluation of the urinary system that includes some type of imaging of the kidneys, bladder, and ureters. 29. Submit records for any applicant who has seen a doctor for blood in their urine (hematuria). 30. Submit records for any applicant who has seen a doctor for protein in their urine (proteinuria). 31. Submit records on any FEMALE applicant who has had more than two bladder infections (cystitis) or any MALE applicant who has had EVEN ONE bladder infection, ever. 32. Submit records on any applicant who has ever had a catheter placed in their bladder. Female genitalia: 33. Submit all PAP smears records on female applicants who have ever had an abnormal PAP smear or any surgical procedure for an abnormal PAP smear. We need all the PAP smear reports (the actual reports, not a letter sent to the applicant) for all normal and all abnormal PAP smears in these applicants. Including all follow up tests/procedures (eg. Colposcopy, LEEP, Cone, Hysterectomy, HPV related testing, etc.) 34. Submit all records, including the pathology report, for any female with a history of an ovarian cyst within the last 6 months. 35. Submit all records on any applicant treated for genital herpes. 36. Submit records for any applicant who has had a premature termination of pregnancy within the last year. It is not necessary to obtain medical records on applicants who have had a normal delivery more than one year ago, even if it was by Cesarean section (C-section). Merely note the date of the delivery on the Reminder: Do not send female applicants to the MEPS if their delivery was within the last 6 months. Do not send female applicants to the MEPS if they are breast feeding. These applicants cannot be qualified. 37. Submit records on any female applicant who has been treated for endometriosis. 21

22 Male genitalia: 38. For male applicants who have had a surgery procedure on a testicle, including removal of a testicle, exploration for an undescended testicle, torsion of a testicle, or surgery to bring down a testicle, or for any other reason, submit medical records, including the operative report and any pathology reports. 39. Submit all records on any applicant treated for genital herpes. Skin: 40. Submit the PATHOLOGY report for any mole, cyst, or anything else removed from the applicant s body within the last 5 years. 41. If the applicant has ever had a lymph node biopsied or removed, or if there was any suspicion of cancer (melanoma, squamous cell or any other type) from a mole removed, submit the pathology report. There is no time limit on this requirement. If the records are not available, submit a written statement from the hospital or physician confirming this. 42. Submit all records on any applicant who has a history of eczema, atopic dermatitis, psoriasis, other dermatologic disease. This does not include mild acne (see 43). 43. Submit records for any applicant that has had acne requiring treatment with isotretinoin (accutane), antibiotics, or any other pills in the past year. Note: It is not necessary to submit records on ringworm. 44. Submit all records on any applicant who has had skin grafts or been hospitalized for burns. 45. Submit all records on any applicant who has been treated with medicines or surgery for excessive sweating (hyperhydrosis). 46. All records on any applicant who has had treatment for a pilonidal cyst, including operative reports and all follow-up visit notes. Orthopedics: 47. For applicants who have had a fracture (broken bone) that required any form of surgery, including pinning, even if the pins or hardware was later removed, submit the orthopedist s operative report and the doctor s notes from all follow-up visits after surgery. If the broken bone was not due to a sports injury but happened due to an MVA, ATV or motorcycle accident, also submit records according to item number 1 or 2 above as appropriate. 48. For applicants who have had a fracture (broken bone) within the last 1 year, submit the records along with a recent x-ray report that shows COMPLETE HEALING of the fracture on x-ray. 49. For applicants who have had surgery on a joint (shoulder, elbow, wrist, hip, knee, ankle) submit all records including the pre-operative record of the injury (ER or Urgent Care report), 22

23 the operative report, and all doctor follow-up records and unrestricted release. There is no time limit on this requirement. If the records are not available, submit a written statement from the hospital confirming this. 50. For any applicant who has had a shoulder, elbow, wrist, hip, knee or ankle injury WITHOUT surgery in the last 5 years submit all records. 51. Submit records on any applicant who has ever had a dislocation of the shoulder, knee, or hip. 52. Submit all records of any applicant who has had surgery on one or both feet. 53. Submit records on any applicant who has had plantar fasciitis. Spine: 54. Submit all records on any applicant who has been evaluated for, diagnosed with, or treated for scoliosis (spinal curvature). 55. Submit all records for any applicant who has been treated by a physician or chiropractor for back pain within the last 5 years. Neurological: 56. Submit records on any applicant who has ever had brain or spinal cord surgery. There is no time limit on this requirement. If the records are not available, submit a written statement from the hospital confirming this. If records are not available, these applicants must see a submitted. 57. Submit records on any applicant who has had meningitis, encephalitis, or any infection of the central nervous system within the past 5 years. 58. Submit all records on all applicants who have had a concussion or loss of consciousness within the last 5 years if they were NOT KEPT OVERNIGHT in a hospital. Be sure to include the ER or Urgent Care Doctor s notes and any copies of imaging (e.g. CAT scan) reports. Do not submit the patient information handout given to the applicant by the ER or Urgent Care staff 59. Submit all records on all applicants who have had a concussion or loss of consciousness, EVER, if they were kept overnight in a hospital. There is no time limit on this requirement. If the records are not available, submit a written statement from the hospital confirming no availability. 60. Submit all records on any applicant who has ever been diagnosed or treated for epilepsy or seizures after age Submit records on any applicant who has been treated for back pain or a slipped disc in the spine (herniated nucleus pulposus) with either medicines or surgery or chiropractic or physical therapy. 23

24 62. Submit all records on any applicant who has been treated by a physician for headaches within the last 5 years. If the records are not available, submit a written statement from the hospital confirming no availability. Behavioral Health: 63. For applicants with a history of ADD/ADHD submit the following records: a. All medical records of the treatment of ADD/ADHD. If medical records are not available, a statement from the hospital or physician indicating that they have been destroyed. b. All Individualized Education Plans or special accommodations from high school or a statement from the applicant or the applicant s parent if the applicant is younger than 18, that the applicant has never required an Individualized Education Program or work accommodation; c. A statement from a parent giving the date of the last use of medication for ADD/ADHD. d. High school transcripts (and college transcripts if the applicant has attended college). These transcripts MUST show the GPA (on 4.0 scale). e. A CURRENT letter from the applicant s physician CLEARLY stating that continued medication is not required for acceptable occupational or work performance and date of last prescription or refill or pharmacy records. 64. With regard to counseling: a. For applicants who have had counseling (parent directed or court ordered) only for the purpose of ADJUSTMENT TO PARENTAL DIVORCE, and who had TEN OR FEWER TOTAL SESSIONS, counseling records are not needed. If there were more than ten total counseling sessions, submit the actual counselor s notes for each session. b. For applicants who have had counseling only for MARRIAGE COUNSELING, and who had TEN OR FEWER TOTAL COUNSELING SESSIONS, counseling records are not needed. If there were more than ten total counseling sessions, submit the actual counselor s notes for each session. c. For all other counseling, submit the actual counselor s notes for each session. 65. For any applicant who has ever been given a medication for any psychiatric problem or had any psychiatric treatment, inpatient or outpatient, submit all of the actual treatment records. NOTE: A summary letter from the psychiatrist will not be accepted as a substitute for the actual treatment records. 66. Submit all records on any applicant who has ever been treated for a sleep problem of any kind including sleep apnea and insomnia. If the records are not available, submit a 24

25 written statement from the hospital confirming this. 67. Submit records on any applicant who has ever been evaluated for drug or alcohol abuse or dependency. 68. Submit all records on any applicant who has a history of an eating disorder. Endocrine: 69. Submit all records on any applicant who has ever been treated for a thyroid problem, diabetes, or any other endocrine problem. 70. If the applicant is taking thyroid medication, submit the results of TWO measurements of TSH (thyroid stimulating hormone) done within the last 6 months. The measurements of TSH must be at least 6 weeks apart from one another (if applicant has one TSH result in the past 6 months, MEPS may obtain the second TSH on the day of physical if at least 6 weeks after the first). Allergy: 71. Submit all records on any applicant who has a history of latex allergy or contact dermatitis to metal (such as a belt buckle), or who has been treated by a doctor for any allergic reaction. 72. Submit all records for any applicant who has been treated by a doctor for bee sting allergy. Other: 73. Submit records on any applicant treated for anemia; this must include a CBC (blood count) or hemoglobin hematocrit showing resolution of the anemia. 74. Submit all records for any hospitalization for more than 24 hours for any reason within the last 5 years. 75. Submit the operative report and all records for any surgeries within the last 5 years except as noted on page 1 of this list. 76. Submit all records on any applicant who has ever been treated for any form of cancer. In addition to old medical records, the applicant must go to a cancer specialist (oncologist) and have a current evaluation for cancer. These records must be submitted as well. (Dermatologist for skin cancer or Gynecologist for CERVICAL cancer is acceptable) For Prior Service Applicants: 77. If they are receiving disability from the VA submit all ACTUAL PROVIDER S records from the VA. DO NOT submit the summary letter sent to the service person explaining the VA s decision regarding disability. ALSO submit a copy of the service member s military health record. 78. For any applicant who has an RE Code that may indicate a service medical 25

26 disqualification, have recruiting service submit a written explanation as a Memorandum For Record (MFR) explaining the condition and authorizing them to process. 79. For prior service applicants who received an Entry Level Separation (ELS) submit all medical and psychiatric records from the training base where they were separated. Final Notes: 1. A scribbled note by a physician written on a prescription pad is never adequate. Obtain the relevant actual doctors records for all visits that the applicant made to the doctor. 2. All records must be submitted as prescreen. Applicants who attempt to walk-on unread medical records will be turned away and allowed to return to the MEPS after their records have been reviewed as a prescreen IAW USMEPCOM policy. 3. A summary letter (To Whom) is not acceptable for prescreens; the actual medical records need to be provided including actual provider s notes, billing records and codes. 26

27 APPENDIX B Maximum Number of Business Days to Complete Review of Complex Prescreens Number of Pages of Supporting Medical Documents Maximum Number of Business Days to Complete Review of Complex Prescreens by COB or > 30 Note the maximum number of days starts with Day 1 27

28 APPENDIX C Prescreen Cover Sheet Page 1 28