MEDICAL LABORATORY SCIENTIST PROFESSIONAL ADVISORY GROUP OF THE US PUBLIC HEALTH SERVICE MLSPAG NEWSLETTER I Volume 3, Issue 1 SUMMER 2010 Inside This Issue: 1 Note from the Chair 3 MT Focus 4 2010 Voting Members 5 My Experience as an Aide de Camp 6 In the Wake of the Disaster in Haiti 7 Medical Technology Scholarships 8 Annual Conference in San Diego, CA 10 The Importance of Participating in the Billet Collection Process 11 SAFMLS 12 Job Opportunites 13 Stay Connected 14 Newsletter Submission Criteria 15 MLSPAG Coin Order Form This newsletter was created by the MLSPAG Communications Sub-Committee: LCDR Cara Nichols (Chair) LCDR Julie Morris LCDR Jeri Coats LCDR Lisa Flores Proofread by: CDR Ali Danner LCDR Michael Clay, MPH, MT (ASCP) MLSPAG Chair 2010 enjoying some summer fun! Summer s here! The kids are out of school, the pool is open, and barbecues are emitting those cherished aromas we ve all come to love. Vacation, suntans, family reunions, and kids activities to keep us busy all the season long. For the PAG, busy is just a matter of degree. My address to you in the spring newsletter was filled with a quick background of where I m from and why I am the way I am. But that s old news and I want us to focus on the way ahead and explain how the PAG is working hard for you. The Billet Transformation process was of paramount importance this past winter and spring. A working group was assembled that created 17 billets specifically for the laboratory discipline. One mission focus of this group was to create billets that were specific for various areas, such as research, clinical, regulatory, and consultative, yet flexible enough to work for nontraditional laboratory positions. Another important mission focus was looking at the big picture of career advancement and developing billets that allow an officer to grow in a specific area. Lastly, billets were created to motivate officers into positions not typically reserved for laboratory personnel, including infection control and quality management. One billet was even created for future COSTEP positions. The working group was highly successful in accomplishing this monumental task. Yet, not all the billets are going to be simply for the taking by all. To create a billet structure that allows for career advancement and ensures the inclusion of senior level billets, the group had to evaluate the requirements for each of the billets. Continued on page 2 Page 1 of 15 NOTE FROM THE CHAIR Submitted by: LCDR Michael Clay, MPH, MT (ASCP)
Continued from page 1 Experience and level of education became key components. Therefore, for the O-6 level billets, a master s degree and/or 10 years of experience will be required. For some, the requirement to possess a master s may seem insurmountable; yet it is important to remember that an advanced degree will provide you with numerous opportunities to grow both professionally and personally. With technology and the evolution of online training, a master s degree is now obtainable in the most remote of locations. From the reports I have received, the COF Symposium was well planned and provided many of our laboratory officers to meet for the first time in person. It was disappointing for me to miss this event as I experienced an unfortunate ankle sprain during a softball game for which I am still recovering. Yet, the PAG s own Chair-Elect, CDR Clyde Darrah and others represented the PAG well and planned for an evening social which from all accounts was a big hit. Plan now for next year s symposium in New Orleans for the week of June 19 to experience the camaraderie and establish networks which prove vital for a successful career. The Membership Subcommittee did provide me with a list of all the successful promotions for the laboratory community. I want to congratulate Captains Pearl Dry and Delois Jackson, Commanders Clyde Darrah, Steven Higgins and Debra King, Lieutenant Commanders Vicki Ezzell and Docia Sampson, Lieutenant Commanders select Andrea Peay and Katrina Redman, and Lieutenant Renae Hill. We celebrate the success of our laboratory officers and it is the PAG s desire to see more of our laboratory officers experience successful promotion opportunities. In fact, the PAG is so committed to this desire, that they are creating for the first time ever a group to assist laboratory officers who were unsuccessful in the recent promotion cycle. If you happen to be one of these officers, please contact the PAG leadership including me if you prefer for this group to review your promotion file and provide recommendations. Please take advantage of this free service! I want to take this opportunity to highlight the work of the MLSPAG for these first six months of 2010. This fantastic group of officers has done a tremendous amount of work including the revision and creation of billets for the transformation office, revised and implemented new By Laws, reviewed and worked with the PAC on issues such as our name change and appointment standards, sent out welcome letters to new laboratory accessions, created SOPs for each subcommittee, and improved many processes throughout. I have to thank all the voting members, the subcommittees, the subcommittee chairs, and leadership for being a wonderful supporting cast. In my experience, being a leader is always easier when you have hard working people behind you that you can trust. For all your hard work and having to put up with me, I sincerely say, Thank you to each and every one of you. You have done so well that the MLSPAG leads the way in the HSPAC! Finally, I challenge my fellow laboratorians who are not a part of this superb organization to begin participating with us on our monthly teleconferences and become involved in one of our subcommittees. We are constantly looking for fellow laboratorians who are motivated to improve our standing in the Commissioned Corps, serve fellow laboratory officers, and represent our category with distinction. Page 2 of 15
MT Focus: CDR Todd Alspach, MSHS, MT (ASCP) Education: 1995: University of Pittsburgh, Pittsburgh, PA; BS in Medical Technology 2006: Columbia Southern University, Orange Beach, AL; MS in Occupational Health and Safety Background: Born in Lititz, PA Raised in Orwigsburg, PA Prior Places of Residence: Fayetteville, NC; Mesa, AZ; Arlington, TX; Stratford, CT; Raleigh, NC Current residence: Cumming, GA Family: I have been married for almost 9 years to my wife DeShong, who is definitely the better half. We have two children: Audrey age 8 and Kyle who turned 4 in June. Hobbies: I am a sports fanatic and watch entirely too much ESPN, an avid movie watcher, have the occasional camping trip, and enjoy spending time with the family. Agency: Centers for Disease Control and Prevention in the Division of Laboratory Systems, Laboratory Practice Standards Branch, located in Atlanta, GA Current Assignment and what you like most about it: I am currently assigned to CDC s Laboratory Practice Standards Branch as a Health Scientist. This mainly entails being a technical consultant to CMS for CLIA related issues, as well as collaborating with other program staff, CDC centers, institutes, and offices, federal, state, and local agencies, as well as private and non-profit organizations. One of the aspects I enjoy most is the projects I get to work on. These projects can have a significant impact on the national laboratory system if they come to fruition. The fact that the work we do, no matter how small, can greatly improve the quality of laboratory medicine, and in turn, improve patient care and outcomes is very rewarding. Continued on page4 Page 3 of 15
Continued from page 3 Duties: My duties consist of providing scientific and technical advice/assistance to the branch and division in support of CMS regulatory activities related to CLIA and laboratory management. These activities include development, revision and evaluation of CLIA regulatory standards, guidelines, and voluntary quality systems standards for the nation s clinical and public health laboratories. Additionally, I have participated in CDC s Emergency Operations Center response during public health emergencies and provide assistance to the HHS Clinical Laboratory Improvement Advisory Committee. Previous Assignments: Previous to CDC, I was assigned to the Food and Drug Administration as a Consumer Safety Officer in Bridgeport, CT, and the Bureau of Prisons as a Medical Technologist in Butner, NC. Prior to the PHS, I worked with Abbott Laboratories in Irving, TX as a telephone technical support specialist for the AxSYM and Architect analyzers. In the Phoenix area, I worked in a blood donor center (where my wife and I met), laboratory supply sales, and at a drug screening facility. My first job out of college was at a trauma center in Fayetteville, NC. When did you first become interested in the laboratory profession? In college, I was interested in majoring in a healthcare related field, but didn t know what direction to go in. A friend of mine was majoring in Medical Technology and encouraged me to look into it. After doing some investigation, the curriculum captured my interest, and I applied. The profession has served me well, providing me with experience in a variety of health related arenas and a rewarding career. How did you hear about the PHS? John, a co-worker of mine from Arizona, had relocated to the same area in Texas at the same time my wife and I had. His next door neighbor s cousin was a PHS officer. About a week after meeting the cousin, John told me about PHS. Two months later I applied and eight years later, here I am. What are your goals with the PHS? My goal with PHS is to have a 30 year career with assignments that are rewarding both personally and professionally. 2010 VOTING MEMBERS OF THE MLSPAG LCDR Michael Clay, Chair (USCG) CDR Clyde Darrah, Chair-Elect (IHS) LCDR Jeri Coats, Secretary (IHS) CDR Todd Alspach (CDC) CDR Jane Preston (IHS) CDR Gina Woodlief (BOP) LCDR Jeff Christopher (IHS) LCDR Cindy Flacks (CMS) LCDR Robin Goodwin (IHS) LCDR Julie Morris (CDC) LCDR Cara Nichols (IHS) LCDR Chauha Pham (NIH) 2010 Page 4 of 15 LCDR Khan Shah (BOP) LCDR Clarence Smiley (IHS) LCDR John Welch (DOD) LT Camille Mitchell (BOP) LCDR (sel) Andrea Peay (BOP) LT Alfred Lugo (IHS) LTJG Lane Vause (CMS) LTJG David Young (HRSA)
My Experience as an Aide-de-Camp Submitted by: LTJG David Young, MBA, MLS (ASCP) CM During this year s COF Symposium in San Diego (2010), I had the privilege of being the Aide-de-Camp (ADC) to RADM Kerry Nesseler, the ninth Chief Nurse Officer for the United States Public Health Service. French for camp assistant, an ADC is a personal assistant to a person of high rank, usually a senior military officer or a head of state. This was my first time as an ADC, and to be chosen as the Aide de Camp for RADM Nesseler was an honor. After all, there are only 48 flag officers in the Commissioned Corps (as of 6/2/2010); this may have been a once in a lifetime experience. Some of you may be curious about what it is like being an ADC. The truth is I was very nervous for the first two days. Serving as an ADC may seem to be an easy task, but it is quite challenging. One must pay strict attention to detail, have great organizational skills, and manage their time wisely in order to effectively assist the flag grade officer in their daily schedules. It requires much forethought, planning, and attentiveness to and anticipation of the needs of your principal. For example, the ADC is responsible for coordinating meeting dates and times. Thus, it was vital for me to identify the location, mode of travel, and any required passes or permits that must be obtained before the appointment. In addition, knowledge of military customs and courtesies is essential. I had to ensure that I was always on her left side, as the place of honor is on the right. I also ensured that I carried my bag in my left hand, should a salute exchange be required. I made the point of carrying a note pad and a pen, just in case I needed to write important information down, that was pertinent to my principal. After the first two days, I was able to find my groove and things got easier. Let me put it this way. How did you feel the first time you performed phlebotomy? Now compare that feeling to how you felt after performing phlebotomy for the third time-- same concept. Flag grade officers are excellent mentors and great resource pools. I learned a lot about the nursing category. Being a Health Service Officer doesn t mean that I can t learn about, or be in serve to, the other USPHS categories. Branching out and learning about other categories is important as when we do get deployed we ll have to work together and coordinate with other categories. I thoroughly enjoyed myself being the ADC for RADM Nesseler. These flag grade officers have been in the Corps for a long time and they provide an abundance of knowledge and experiences, not to mention great stories to share. If you d like to participate in a time honored military tradition, I d advise any junior officer to partake in this great program. For me, it was humbling and glorifying at the same time. To be in complete service to someone who is in complete service to the Corps was indeed one of the greatest honors I ve had in uniform to date. Page 5 of 15
In the Wake of the Disaster in Haiti Submitted by: LCDR Janet Cliatt, MT (ASCP), Ex-officio I had heard the stories on the news and had interviewed several survivors during the Haitian Repatriation Mission support in Atlanta, but it wasn t until we lost two minors that death became a reality to me. As the survivors told us about that day and their rescue, an array of emotions flooded into our eyes. Some people were cooking on the street or at work when suddenly the walls around them began to close in. Hopelessly, they lay under massive concrete walls for days without food or water. Some were found earlier than others as help came and began to get them pulled out from the debris. Some of the victims were taken to the USNS Comfort with its hospital capabilities that included fully equipped operating rooms, radiological services, medical laboratory, a pharmacy, CAT-Scan and other services for surgery. Many patients came in with broken limbs while others were in worsened conditions including premature labor. They were transported to many areas around the United States. Some were alone, some with a sister, brother, or with a neighbor. They experienced recovery and further treatments while receiving our kindness and support. The Service Access Team # 1 (SAT), the Mental Health Team #1 (MHT), Assistant Secretary of Preparedness and Response (ASPR), Refugee Resettlement and Immigration Services of Atlanta (RRISA) and other relief organizations offered help with this mission. How rewarding it is to work with a variety of experts that enhance our nation s public health! SAT # 1, took this event as its first assignment since the team s inception in 2009. The team was responsible for tracking patients, assessing their medical needs and assisting with returning individuals back to Haiti if they so desired. Specifically, the team tracked 79 National Disaster Medical System (NDMS) patients brought to hospitals in the United States from Haiti for medical intervention from February 2 through March 2, 2010. One thing stood out to me no matter what condition they were left to endure, their spirits were never down. They received the care, and the visits, with open hearts and that was priceless! From embracing this opportunity, I learned that people do not care how much you know until they know how much you care. Knowledge of internal culture is vitally important because it provides us a framework for comprehending, analyzing and interpreting the behavior both of others and of ourselves. We reached out to do whatever was needed to be done at the moment. That is what I believe our mission is about. While our focus is helping people all year around, let s work together, going above and beyond what we ve done before, impacting more lives than we can ever imagine possible. Continued on page 7 Page 6 of 15
Continued from page 6 The lives that have been changed since we took the lead back then are: 2 deaths - (1) premature female infant and (1) 16-year-old male 3 moved in with family out-of-state 1 U.S. citizen refused treatment and moved prior to being interviewed by the team 2 requested to return to Haiti 2 uncertain if to remain in the U.S. or return to Haiti 39 requested to remain in the United States Thanks to the ATL Team! Officer-in-Charge (OIC), Health Care Administrator: CDR Tobey Manns-Royal, MHT1 Deputy OIC, Speech Language Pathologist: LCDR Michelle Baker, SAT1 Medical Technologist: LCDR Janet Cliatt, SAT1 Mental Health Nurse: LCDR Jennifer A. McLellan, MHT1 Nurse: LCDR John Schwake, MHT1 Psychologist: LT Arlin Hatch, MHT1 Statistical data was provided by LCDR Michelle Baker Medical Technology Scholarships Submitted by: LCDR (sel) Andrea Peay, MPH, CPH, MT (ASCP) Good news for medical technology students. On July 1, the U.S. Department of Health and Human Services announced that $96 million dollars will be awarded to colleges and universities to help train health professionals. These scholarships will go to disadvantaged students who have a financial need. The award includes nineteen Medical Technology schools in various states and possessions including Alabama, North Carolina, California, Texas, Puerto Rico and many others. Medical technology programs will receive over $600,000 in grants to provide scholarships to qualified students. These scholarships are a great step in recruiting and retaining the much needed medical technology students. Page 7 of 15
COF in San Diego; Work or Play? Submitted by: LCDR Jeri Coats, MT (ASCP) LCDR Cara Nichols, CDR Clyde Darrah, LT Angela Battese and LCDR Jeri Coats touring the USS Midway For those of you who have never attended the USPHS Scientific and Training Symposium, you don t know what you are missing. This year it was held in sunny San Diego, California. It was a week of networking, good food, good speeches, and an overall camaraderie amongst peers. There were also chances to tour San Diego and see some of the sights on your own, or with a group. This was a great opportunity to meet with people from all agencies and all professions and get a peek at what is out there and available to us as officers. For many officers who work in the field, it is a rare chance we get to network outside of our own agency. If you have never had a chance to meet an admiral or the Surgeon General of the United States, this was just the place to do it! Many volunteer opportunities were available during this event as well, whether it was manning your category booth for an hour, participating in Category Day or serving as Aide de Camp. These were all great ways to promote the Medical Technology/ Laboratory Science profession. There were many lectures to attend and you even received continuing education credit for these. You could walk away from this week with a lot of useful information to apply to your career. It wasn t all work and no play though!! A group of MT s/mls went out one night to partake in great seafood--after all we were in San Diego!! In fact, we were the group to hang with as some nurses chose to go with us versus their own category!! It was a chance to let our hair down (literally for some of us) and enjoy each other s company. This week gave us a chance to put faces with names and get to know each other not only as fellow officers, but as friends. We talk on the phone monthly so it was nice to see what some of you actually look like! Next year s conference will be held in New Orleans, Louisiana. If you have an opportunity to attend, I encourage you to do so. There are so many new as well as old friends to meet up with and network. It is a great source of information for officers looking to move in, up, out or around!! Continued on page 9 Page 8 of 15
Continued from page 8 Medical Laboratory Science Officers at the 2010 COF Symposium LCDR Cara Nichols and CDR Todd Alspach manning the HSO booth CDR Cylde Darrah speaking to the HSO category on behalf of the MLSPAG LCDR Cara Nichols donating blood for our troops CDR Todd Alspach and LCDR Welch deciding what to eat at one of the MLS gatherings Page 9 of 15
The Importance of Participating in the Billet Collection Process Submitted by: LT Camille Mitchell, MLS (ASCP) CM and LCDR (sel) Andrea Peay, MT(ASCP) As we know, the billet collection process, part of billet transformation, is in full swing. This October is the month for Health Service Officers to check their email for notifications. Medical Technologists /Medical Laboratory Scientists (MT/MLS) work in various fields and specialities that may be viewed as non-traditional to those outside of the field. These positions may include an Area Consultant for the United States Coast Guard or Tricare management in a regulatory manner. Many MTs/MLSs hold multidisciplinary positions. Therefore, it is vital for all of us in traditional, specialty, and multidisciplinary roles to show our diversity and capabilities during this process. It is important that our category has maximum participation during the collection process in order to maintain the viability of our billets. There are several things to remember: Officers will utilize the Billet Collection System Spreadsheet to select job specific information. Some selections such as years of experience will be pre-filled, and unable to be changed. The overall information the officer provides will be used to describe the billet and calculate a billet grade. This calculation will not be accessible to the officer during the process. If your billet is considered multidisciplinary, indicate so when you first begin the process. This way the billet transformation staff will send you an email for the multidisciplinary positions. Your multidisciplinary job may be vastly different than someone else s. Let's keep these billets available! Also remember, the process starts with the officer, but dialogue between the officer and supervisor is encouraged. The supervisor has input and it is critical that the officer ensures the position is being correctly represented during this beginning phase of the process. Reviewing officials, the agency liaison, and the Professional Advisory Chair (PAC) will all review the collected information. Finally, the officer has 30 days to complete the billet collection process from initiation. It should only take 30 minutes to complete the spreadsheet. If you have not done so, take a look at the billet tutorials for additional help: http://dcp.psc.gov/billets_tutorial.aspx. You may also want to check the frequently asked questions page Billets and Billet Systems: http://www.usphs.gov/transformation/billet.aspx#10 for more information. The billet collection process is integral to billet transformation. By participating we can make a significant contribution to our category s billets. So don t forget, participate! Page 10 of 15
MLSPAG Members and the SAFMLS Submitted by: LCDR John Welch, MT (ASCP) and LCDR Michael Clay, MT (ASCP) As members of the Society for the Armed Forces Medical Laboratory Scientists, Lieutenant Commanders Michael Clay and John Welch have the opportunity to participate in a variety of joint endeavors which give visibility to the Public Health Service and its mission to the United States. The Society of Armed Forces Medical Laboratory Scientists (SAFMLS) continues to be the military lead society in all areas of laboratory medicine including field deployments, licensure, training and updates in blood, microbiology, hematology, chemistry, and histology. SAFMLS was formed in 1958 by a group of dedicated military laboratory officers to aid fellow laboratory directors in planning, emerging electronic healthcare, personnel management, budgeting and educational challenges. SAFMLS growth has continued to climb over the years and is sustained by annual dues and continued membership participation. The primary objective of SAFMLS is that of maintaining and enhancing high professional standards through improved laboratory policies and technology in support of the health care delivery systems of the Armed Forces, Public Health Services and Veterans Administration. As USPHS MLS officers, you may join SAFMLS by completing the application and forwarding the completed copy to either LCDR Clay or LCDR Welch. The application may be downloaded from the following link: http://www.safmls.org/documents/safmls%20membership%20application.pdf After endorsement, you will receive SAFMLS mailing updates and be welcomed to participate in future conference planning and organizational activities. The next annual SAFMLS meeting will be held in New Orleans from 28-31 March 2011. Cost for the conference participation is free however travel, hotel and per diem will be at the cost of the member s individual agencies. For a comprehensive listing of last year s exhibits and workshops, explore this link: http://www.safmls.org/2010/2010_annual_meeting_presentations.html Page 11 of 15
Job opportunities with the Indian Health Service and 638 Tribalowned Health Facilities This first link is to the Navajo Area Indian Health Service website and it describes the minimum qualifications for a generalist Medical Technologist (Click open BASIC REQUIREMENTS at the bottom of the page): http://home.navajo.ihs.gov/lab.htm This website is the National Indian Health Service. It does list vacancies for both IHS and 638 Tribal facilities. When you open the area that you are interested in, it will list the contact information of the human resource office: http://www.ihs.gov/jobscareerdevelop/careercenter/vacancy/ This website provides further information on how to proceed with submitting an application: http://www.ihs.gov/jobscareerdevelop/jobsatihs/ Both Indian Health Service and 638 Tribal Corporation facilities participate in the Loan Forgiveness Program. http://studentaid.ed.gov/students/attachments/siteresources/loanforgivenessv4.pdf This information provided by: Arlinda Bilagody, BS, MT (ASCP), MAHSM Supervisory Medical Technologist Indian Health Service Professional Contact Fort Defiance Indian Hospital Page 12 of 15
HOW TO STAY CONNECTED TO YOUR MLSPAG ATTEND THE MLSPAG MEETINGS 1400 EST (1300 CST) by teleconference on the following dates: The second Thursday of each month Call-in Number: 210-516-9477 or 877-953-2747 Pass code: 4246127 2010 MEETINGS April 8, 2010 May 13, 2010 June 10, 2010 July 8, 2010 August 12, 2010 September 9, 2010 October 14, 2010 November 11, 2010 December 9, 2010 JOIN THE MLSPAG LISTSERVE Just go to http://usphs-hso.org/pags/mlspag/mlspag_listserv.shtml and sign up! VISIT THE MLSPAG WEBSITE http://usphs-hso.org/pags/mlspag/mlspag_main.shtml Page 13 of 15
INVITATION FOR NEWSLETTER SUBMISSIONS: MLS PAG Newsletter Guidelines for Article Submission The MLSPAG Newsletter is a publication of the MLSPAG Communications Sub-Committee. Our goal is to deliver a quarterly newsletter that is informative and relevant to the needs and interests of the Medical Laboratory Scientists of the USPHS. We are always in need of articles and welcome your participation and ideas. We have provided the guidelines below to assist you with submitting your articles to the MLSPAG Newsletter. I. DEADLINES: Deadlines are important to keep so that the newsletter can be turned out in a timely fashion. An email soliciting ideas for the next newsletter will be sent out at least four weeks before the first deadline. A) Deadline #1 Initial ideas(at least 3 weeks from the date solicitation email is sent): Send the editors your article idea and briefly describe what the article will be about. You will hear back from the editors regarding approval of your article within 1 week. B) Deadline #2 article draft (at least 4 weeks from deadline #1): Send a draft of the article in Word format to the editors, once received the editors will respond back with comments within 1 week. C) Deadline #3 Final draft (at least 2 weeks from deadline #2): Final draft due: proofread, grammar and spelling checked. Note: We encourage photos; they help bring the article to life. But, please remember to get permission from all in the picture to use their photo. II. ARTICLE SPECIFICATIONS: Word format: Articles must be in Word format Font: 11point, Times New Roman Word limitations: 500 words or less, however some exceptions may be made depending on the article. Photos: Please submit photos in a separate file; highest quality in.jpg format preferred. Include the following information: Title, Submitted by: (name, rank and credentials), body of article, references. Proofread: Use spell check, check grammar, have someone read over your article to check for errors you may have missed. (http://www.newsroom101.com is a helpful link). References: Be sure to include appropriate references for your article. Ideas for topics: 1) Write about your accomplishments or those of a fellow officer. 2) Describe work that is done in your laboratory and how that work impacts your agency. 3) Highlight any information you feel would be beneficial to the careers and lives of your fellow MLS officers. 4) Tell us about your deployment experiences. 5) Write a commentary on a topic that is of interest to the USPHS MLS community. 6) Send ideas and articles to newsletter editors: LCDR Cara Nichols, Cara.Nichols@ihs.gov and LCDR Julie Morris, jmorris@cdc.gov Page 14 of 15
Medical Laboratory Scientist Professional Advisory Group Coin Order Form Name: Address: Email: Number of Coins: x $10.00 = Send check or money order payable to COF Please write MLSPAG coin in memo section Mail to: LCDR Jeri Coats 107 W Husband Ct Stillwater, Ok 74075 If you have questions email: jeri.coats@ihs.gov or cara.nichols@ihs.gov Page 15 of 15 Return to Table of Contents