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1. PURPOSE
The purpose of this guideline is to:
Define the objectives of the Peace Corps Epidemiologic Surveillance System (ESS)
Delineate the role and responsibilities of the PCMO in the operation of the ESS
Describe the role and responsibilities of OMS and the Peace Corps Medical Epidemiologist
(PCME) in the overall operation of the ESS
2. BACKGROUND
The Peace Corps ESS was implemented in October 1985 to meet the following objectives:
Estimate the magnitude of health and safety problems among Volunteers in specific countries and
regions
Document the distribution and spread of specific health-related events in specific countries and
regions
The ESS is an active reporting system. Each month the PCMO is asked to report the number of
events (cases) of specific conditions occurring among Volunteers during a one-month period. Only
cases which meet the event/case definitions listed below should be reported. It is not necessary to
report all Volunteer illnesses. The surveillance system and event/case-specific definitions are not
intended to be used as clinical case definitions.
February 2008
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ESS
TG 410
The standard reporting form is included in the Guideline (ATTACHMENT A). Using the event/case
definitions (section 5), a monthly report is sent to the Office of Medical Services (OMS.) The data
from each countrys report is entered into a database maintained by Epi Unit staff. The data are
analyzed periodically and the findings are sent to all PCMOs, CDs, and selected headquarters
managers.
Event/Case Classification
Report only conditions/events involving Volunteers and Trainees. Do not include legal
dependents of Volunteers and Trainees that fall under your care or Peace Corps staff
members. Do not report events that occur after Volunteers or Trainees close service or of
which you become aware after Volunteers or Trainees have closed service. Do report
conditions/events confirmed by laboratory results sent prior to close of service but received
after Volunteers or Trainees have closed service.
Classify all reportable events reported using standardized reporting definitions (see
Section 5). Use of these standardized reporting definitions permits us to make comparisons
within a country from year to year as well as to compare one country with another in the
same or different region.
Consult the PCME/OMS when it is unclear whether or not an event fulfills the criteria
for reporting.
How do I report chronic conditions? These conditions should be reported at the time of the
initial diagnosis only.
Example: A Volunteer has genital warts diagnosed in January and continues to
be followed for this condition over the next 4 months. The event should only be
reported once, under Viral STDs (non-HIV) in January.
February 2008
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How do I report a single event which may encompass more than one reporting category?
Report each condition/event as an individual event.
Example: A Volunteer is seriously injured in a car accident. Initially, the Volunteer
is hospitalized in-country to be stabilized and then is medevaced to the United
States for more definitive care. For this one Volunteer, three events should be
reported on the ESS report: One motor vehicle-related injury, one hospitalization,
and one OMS-Authorized medevac.
3.2
Events that occurred in the past should be reported in the month they are divulged to the PCMO
under the category Corrections.
Example: During an IST in June, a Volunteer reports he experienced an episode
of diarrhea in May that resolved with self-treatment. Report the diarrhea in the
June report under Corrections as Add one 'Other Diarrheal Condition' in May.
Updates in classification to a previously reported event should be reported under the category
Corrections. If event/case definition requires laboratory confirmation to be reported, do not
report the case until after the confirmation is made; then report the case for the month of onset
of symptoms in the Volunteer.
Example: A Volunteer has a suspected case of amebiasis in July which is
confirmed by the laboratory in August. Report under Corrections in the August
report as Add one case of amebiasis in July.
February 2008
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ESS
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3.3
Although crime information is no longer collected through the ESS, PCMOs are required to
assist with the new Crime Incident Reporting Form (CIRF), administered through the
Office of Safety and Security. Please consult the CIRF User Manual for specifics on the
role of PCMOs in crime reporting.
The monthly ESS report is a medically sensitive, not medically confidential, report. There
are no unique identifiers (names or social security numbers) included in the report. Only
the Country Director should see the report prior to sending it to OMS.
In some cases it may be possible for the Country Director to deduce the identity of a
Volunteer from the report (e.g., only one pregnancy and one medical evacuation to the U.S.
for the month.) Information that is deduced from the report should not be confirmed by
the PCMO. In addition, the Country Director, when extended medical confidentiality, is
required not to disclose such information concerning the identity of the Volunteer.
The monthly ESS report should be sent as an e-mail attachment to OMS. The ESS report
does not need to be sent as an encrypted attachment since it does not contain sensitive
patient information.
The ESS report should be sent to OMS by the fifth day of the month following the
completed reporting month. (See ATTACHMENT A)
Formally evaluate the ESS periodically to assess whether each of the events in the system should
continue to be under surveillance, describe how the system has been useful, assess the different
qualitative and quantitative attributes of the system, and recommend changes in the system.
February 2008
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ESS
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Country:
Self explanatory.
Month:
Region:
Self explanatory
Year:
Alcohol-Related Problem
REPORT:
An incident where behavior was altered or physical/mental acuity was impaired due to alcohol
intoxication. Signs of intoxication may include violent behavior, slurred speech, decrease in physical
coordination, or unconsciousness.
INCLUDE: Incidents of intoxication that resulted in a behavioral change in the Volunteer; incidents observed by
medical staff, other in-country staff, Volunteers, or other reliable sources.
February 2008
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ESS
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Asthma
REPORT:
Symptoms suggestive
of asthma
(1) New cases meeting the NIH Expert Panels criteria for asthma (see below), and
(2) Recurrences of previously controlled asthma.
Consider
methacholine
challenge, other
diagnosis
FEV1/FVC
low?
Yes
Use bronchodilator, repeat PFT
FEV1
increased?
Yes
FEV1
increased?
Yes
Asthma likely
Consider COPD
Cardiovascular Problem
REPORT:
A condition related to the heart and blood vessels (e.g., hypertension, phlebitis, arrhythmias,
congestive heart failure, myocardial infarction, and stroke) that was evaluated either by the
PCMO or by another health care professional.
Although one cardiovascular problem may result in several visits/contacts/evaluations, it
should only be reported once.
Colposcopies (In-Country)
REPORT:
A colposcopy performed in the PCVs Country of Service at a clinic, hospital, or facility
authorized by medical staff for the diagnosis and/or treatment of a gynecological condition.
February 2008
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ESS
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Dengue
REPORT:
Dental Problem
REPORT:
A condition involving the teeth and gums that was evaluated by a dentist or other health care
professional.
Although a single dental problem may result in several visits to a dentist, it should only be
reported once.
Dermatitis (Infectious)
REPORT:
An infection of the skin due to bacterial, fungal, or parasitic organisms evaluated by a health
care professional.
INCLUDE: Laboratory-confirmed and unconfirmed cases.
Environmental Health Concerns
REPORT:
A one-on-one discussion (in-person or by telephone) with a Volunteer or Trainee regarding
his/her concerns about exposure to environmental threats including air pollution, heavy metal
exposures, pesticides, radiation, water pollution/poor water quality, food sanitation, and
disasters such as earthquakes, hurricanes.
screening or prophylaxis.
February 2008
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ESS
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Filariasis
REPORT:
Any infection of the blood or other tissues with a filaria species (e.g., Wucheria bancrofti,
Brugia malayi, Onchocerca volvulus, Loa loa, Acanthocheilonema perstans, Dipetalonema
streptocerca, and Mansonella ozzardi confirmed by:
(1) demonstration of the parasite in blood or tissues, or
(2) specific antibody against the parasite, or
(3) circulating serum antigen.
Gastrointestinal Infection
Cases of chronic diarrhea should only be reported once, during the month when it was
REPORT:
diagnosed. Distinct episodes of gastrointestinal infections in the same Volunteer should be
reported each time.
Amebiasis
REPORT:
Giardiasis
REPORT:
February 2008
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Helminths
REPORT:
Salmonellosis
REPORT:
An infection of the gastrointestinal tract with Salmonella species confirmed by
demonstration of the bacterium in stool culture.
NOTE:
Extraintestinal infections (e.g., septicemia, typhoid and paratyphoid fever) should be
reported under Febrile Illness with details under Notes and Other Major Conditions.
Shigellosis
REPORT:
February 2008
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Hepatitis
Hepatitis A
REPORT:
Hepatitis B
REPORT:
Hepatitis C
REPORT:
February 2008
IMPORTANT: In-Country
Hospitalizations are to be reported in
both the monthly report and as a
separate incident report as described
in Technical Guideline 430.
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ESS
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Injury (Unintentional)
In categorizing injuries (formerly called accidents), first consider whether the injury was intentional or
unintentional. Intentional injuries, even when they occur in a motor vehicle, should be reported using the
Crime Incident Reporting Form (CIRF). The categorization of unintentional injuries may depend on
whether a vehicle was involved. A vehicle is defined as a conveyance or a means of transport (e.g., bicycle,
motorcycle, motor vehicle, train, streetcar, animal-drawn vehicle).
REPORT:
Injuries that require medical evaluation or treatment by a health care professional
Injuries that involve vehicles are categorized depending on what the Volunteer was doing at the time of
injury and the type of vehicle involved.
treated.
For example, do not report incidents
where the Volunteer skins a knee after
falling off a bicycle if the Volunteer
was not evaluated by a health care
professional.
Pedestrian Injury
REPORT:
An injury associated with a vehicle while the Volunteer was not riding in or on the vehicle.
Includes injuries while standing, walking, running, roller-skating or skate-boarding, as long
as the injury is associated with a vehicle.
Bicycle Riding Injury
REPORT:
An injury that is associated with operating or being a passenger on a bicycle (or unicycle or
tricycle). Includes injuries from falls or being hit by a vehicle while riding a bicycle.
PCMOs should note whether the injured Volunteer wore a helmet during the injury
under "Notes and Other Major Conditions."
Motorcycle Riding Injury
REPORT:
An injury that is associated with operating or being a passenger on a motorcycle (or
moped). Include injuries from falls or burns while riding on a motorcycle.
Motor Vehicle (non-motorcycle) Injury
REPORT:
An injury that is associated with operating or being a passenger in or on a motor vehicle
other than a motorcycle. Include any injury associated with cars, buses, trolleys, streetcars,
and trains.
February 2008
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ESS
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Water-Related Injury/Event
REPORT:
An injury or event associated with swimming, diving, water skiing, boating, or other waterbased activity. Includes but is not limited to near-drowning, decompression sickness,
drowning, spinal-cord injury associated with water sports/events, ciguatera poisoning.
Provide further information about the event under Notes and Other Major
Conditions.
Sports-Related Injury (Note Sport In Notes)
REPORT:
An injury or event associated with engaging in a sporting activity. Includes but is not
limited to soccer, football, baseball, basketball, tennis, jogging, rock climbing, horse back
riding, marathon running, etc. Provide further information about the specific sport
under Notes and Other Major Conditions.
Injuries, Alcohol-Related
REPORT:
Any injury that requires evaluation and/or treatment by a health care professional and is
associated with any alcohol use by a Volunteer or Trainee.
INCLUDE: All injuries associated with alcohol use, even if already reported in one of the categories
above, should be included. For example, if a Volunteer falls while bicycling home from a bar
after drinking, this should be reported as both a Bicycle-Riding Injury and an AlcoholRelated Injury.
February 2008
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TG 410
Leishmaniasis
REPORT:
An infection with Leishmania species, confirmed by demonstration of:
(1) the parasite in smears, biopsy material, or blood, by microscopy or other specific
techniques, or
(2) specific antibody against the parasite.
Medevacs
Medevac to United States Home of Record or Washington, D.C. (OMS-Sponsored Medevac)
REPORT:
A medical evacuation to the United States (either to Washington, D.C. or to the Volunteer's
Home of Record) which requires authorization by the Office of Medical Services.
NOTE:
If a Volunteer's home of record is within the Washington, D.C. metropolitan area, the
category in which to count the medevac depends on where they will reside during the
medevac; if they reside at home or with a relative, it should be considered a medevac to
home of record; if they reside at a hotel arranged through Peace Corps Headquarters, it
should be considered a medevac to Washington, D.C.
Medevac to Other Country (Country Sponsored [Regional] Medevac)
REPORT:
An evacuation to an approved third-country intermediate medevac point (i.e., South Africa,
Senegal, Kenya, Panama, Thailand, Australia) that does not need prior authorization from
the Office of Medical Services.
REPORT:
If a Volunteer/Trainee is evacuated to a country other than South Africa, Senegal, Kenya,
Panama, or Thailand, indicate which country in the "Other" category. The "Other"
category also includes U.S. locations that are not the Volunteer's Home of Record (e.g.,
Hawaii, Miami, and Guam).
REPORT:
Only Volunteers who are evacuated to other countries should be reported as medevacs (e.g.,
South Africa should NOT report any medevacs to South Africa).
February 2008
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ESS
TG 410
A one-to-one discussion (i.e., in person or by telephone) with a Volunteer regarding any nonenvironmental related problem dealing with a previously diagnosed AND accommodated
mental health issue.
INCLUDE: Only previously diagnosed AND accommodated conditions should be reported under this
category. These problems may or may not lead to medical evacuation to the United States for
further evaluation.
New adjustment disorder to Peace Corps
REPORT:
A one-to-one discussion (i.e., in person or by telephone) with a Volunteer regarding any nonenvironmental related problem dealing with adjustment issues related to Peace Corps
service.
INCLUDE: Include ONLY those mental health problems that are newly diagnosed and are a result of
Peace Corps service, e.g., episodes of minor depression, problems with interpersonal
relationships, minor reactions to stress, loneliness. These problems may or may not lead to
medical evacuation to the United States for further evaluation.
Other Mental Health Problem
REPORT:
A one-to-one discussion (i.e., in person or by telephone) with a Volunteer regarding any nonenvironmental related problem dealing with a mental health issue that is NOT a recurrence
of an accommodated condition or an adjustment disorder related to Peace Corps service.
INCLUDE: The problems included in this category are ONLY those that do not fit into the two mental
health categories listed above.
February 2008
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ESS
TG 410
Pregnancy
REPORT:
conception.
February 2008
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ESS
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Malaria Chemoprophylaxis
(Long-Term Only; NOT for Short-Term Travel)
(ALL countries must now report malaria chemoprophylaxis usage.)
REPORT:
The number of Volunteers currently on each of the following antimalarial chemoprophylactic
regimens:
(1) Mefloquine (Lariam)
(2) Chloroquine (Aralen)
(3) Doxycycline (Vibramycin)
(4) Malarone (atovaquone/proguanil)
(5) Other Chemoprophylaxis (specify agent used)
REPORT:
Malaria
The categorization of malaria depends on the prophylaxis prescribed for the Volunteer, the species of
malaria and whether or not it was confirmed. Only laboratory-confirmed cases should be reported under
Falciparum Malaria or Non-falciparum Malaria.
Falciparum Malaria (confirmed)
REPORT:
An infection with Plasmodium falciparum confirmed by demonstration of the parasite in
blood or blood smears by microscopy or other specific techniques.
REPORT:
Confirmed cases only, categorized by the prophylaxis prescribed for the Volunteer.
Non-falciparum Malaria (confirmed)
REPORT:
An infection with Plasmodium vivax, ovale, or malariae confirmed by demonstration of the
parasite in blood or blood smears by microscopy or other specific techniques.
REPORT:
Confirmed cases only, categorized by the prophylaxis prescribed for the Volunteer.
February 2008
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TG 410
Presumptive Malaria
REPORT:
An illness consistent with malaria (e.g., unexplained fever >38 degrees C in a malarious
area) in which treatment for malaria was administered, but was not confirmed by blood
smears or other specific techniques.
INCLUDE: Cases that were self-treated but blood slides were never collected or the slides were not
interpretable.
NOTE:
Cases in which treatment was first administered on clinical grounds, and later confirmed by
laboratory tests, should be reported under one of the above categories.
Schistosomiasis
Clinical Symptoms/Visualized Ova & Parasite
REPORT:
February 2008
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ESS
TG 410
February 2008
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ESS
TG 410
February 2008
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INCLUDE:
Active Tuberculosis
REPORT:
An infection with Mycobacterium tuberculosis confirmed by culture of the organism from a
collected clinical specimen or a clinical presentation consistent with active tuberculosis that
is culture negative but responds to treatment with appropriate anti-tuberculosis therapy.
February 2008
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ESS
TG 410
Vaccine-Preventable Diseases
REPORT:
Any disease that occurs in a Volunteer or Trainee for which there exists a vaccine that can
prevent the disease. Respective diseases should be confirmed by demonstration of specific
diagnostic laboratory tests.
INCLUDE: Measles, mumps, rubella, diphtheria, pertussis, tetanus, chicken pox, meningococcal
disease, haemophilus influenza type B disease, typhoid, yellow fever, Japanese B
encephalitis, tick-borne encephalitis, rabies, or any other vaccine-preventable disease.
Hepatitis A and hepatitis B virus infections are to be reported under Hepatitis above.
Corrections
REPORT:
February 2008
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TG 410 ATTACHMENT A
Africa
ALCOHOL-RELATED PROBLEMS:
ASTHMA (NEW & EXACERBATIONS):
CARDIOVASCULAR PROBLEMS:
COLPOSCOPIES (IN-COUNTRY):
DENGUE:
DENTAL PROBLEMS:
DERMATITIS (INFECTIOUS):
ENVIRONMENTAL HEALTH CONCERNS:
OTHER FEBRILE ILLNESS:
FILARIASIS:
GASTROINTESTINAL CONDITIONS
Amebiasis:
Giardiasis:
Helminths:
Salmonellosis:
Shigellosis:
Bacterial Diarrhea, Other or Presumed:
Viral Diarrhea, Other or Presumed:
Other Diarrheal Condition:
HEPATITIS
Hepatitis A:
Hepatitis B:
Hepatitis C:
Hepatitis, Other or Presumed:
IN-COUNTRY HOSPITALIZATIONS:
INJURIES (UNINTENTIONAL)
Pedestrian:
Bicycle Riding (NOTE HELMET USE IN NOTES):
Motorcycle Riding:
Motor Vehicle (non-Motorcycle):
Water-Related Injury/Event:
Sports-Related (NOTE SPORT IN NOTES):
Other Unintentional Injuries:
(SPECIFY TYPE & NUMBER FOR EACH):
INJURIES, ALCOHOL-RELATED:
LEISHMANIASIS:
MEDEVACS
Medevac to US Home of Record:
Medevac to US Washington, DC.:
Medevac to South Africa:
Medevac to Senegal:
Medevac to Kenya:
Medevac to Thailand:
Medevac to Panama:
Medevac to Australia:
Medevac to Other Location:
(SPECIFY LOCATION):
MENTAL HEALTH PROBLEMS
Recurrence of Accommodated Condition:
New adjustment disorder to Peace Corps:
Other Mental Health Problem:
Revised: JANUARY 2013
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
Month:
January
Year:
2014
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
Bacterial STI:
Presumptive Bacterial STI:
Viral STI (non-HIV):
Other Gynecologic Infections:
HIV (Western Blot Positive):
TUBERCULOSIS
PPD Skin Test Conversion:
Active Tuberculosis:
VACCINE-PREVENTABLE DISEASES :
(SPECIFY TYPE AND NUMBER FOR EACH):
OCULAR CONDITIONS:
(SPECIFY NUMBER WITH CONTACT USE):
REFERRALS TO SPECIALISTS (SPECIFY NUMBER):
CORRECTIONS:
(SPECIFY NUMBER OF CASES, CATEGORY, AND MONTH)
ADD:
DELETE:
NOTES AND OTHER MAJOR CONDITIONS:
0
0
0
0
0
0
0
0
0
0
0
0
0
Peace Corps
Technical Guideline 430
CASE NOTIFICATION
1. PURPOSE
To describe the requirement for case notification in the Volunteer Health System.
To describe the procedures for reporting country-sponosored (regional) medevacs and incountry hospitalizations.
2. BACKGROUND
For the purposes of both medical management and surveillance, Peace Corps Medical
Officers (PCMOs) are required to report significant Volunteer health conditions and events to
the Office of Medical Services (OMS). These events include country-sponsored (regional)
medevacs and in-country hospitalizations. Events may be reported concurrently or
retrospectively
Medical Management
Technical Guideline (TG) 370 Field Consultation identifies specific situations where field
consultation is appropriate or required.
TG 380 Medical Evacuation outlines the procedures for country-sponsored (regional)
medical evacuations (medevacs).
Surveillance
Reporting and analysis of country-sponsored (regional) medical evacuations and
hospitalizations provides specific case data about significant events in the Volunteer Health
System and permits OMS to track the severity of illness among Volunteers that is not
captured in the monthly epidemiologic reporting system.
Regional evacuations require OMS or APCMO consultation and concurrence but do not
require OMS authorization (see TG 380 section 6 Medical Decisions).
September 2008
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TG 430
Case Notification
Regional evacuations are managed by the PCMO and the staff at the evacuation site (see
TG 380 section 12.2 Management of Medevacs at a Regional or Other Non-U.S. site).
Funding for international medical travel and accompaniment (U.S., regional, and other
non-U.S medical travel) is allocated to post budgets from the Office of Volunteer Support
Centrally-Managed Accounts at the beginning of each fiscal year (see TG 380 section 11
Funding).
3.1
Name of PCV;
2.
SSN;
3.
Country of service;
4.
Age;
5.
6.
7.
8.
9.
Accompaniment, if any;
4. REPORTING OF HOSPITALIZATIONS
A hospitalization is defined as an overnight stay at a clinic, hospital, or other facility
authorized by medical staff for the monitoring and/or treatment of a health condition that
requires prolonged attendance by a medical professional.
Office of Medical Services
September 2008
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TG 430
Case Notification
Overnight stays at a non-health care facility, such as the PCMOs residence, are to be
reported only if the Volunteer had a condition that required hospitalization, but an
appropriate hospital was not available.
4.1
Name of PCV:
2.
SSN:
3.
Country of service:
4.
5.
Date of admission
6.
7.
Date of discharge:
8.
9.
September 2008
Page 3
TG 430 ATTACHMENT A
TG 430 ATTACHMENT B
FROM:
TO: OMS/DIRECTOR
1.
Name of PCV:
2.
SSN:
3.
Country of service:
4.
5.
Date of admission
6.
7.
Date of discharge:
8.
9.